National Healthcare = Border Wall

@Walter Hinteler,

Walter Hinteler wrote:

livinglava wrote:
Requiring people to pool their money together to make it easier for others to milk revenue from it results in a demand-friendly market that is ripe for greed to abuse.
This might be so, but it's the idea of any insurance here in Germany, especially a mutual insurance, since the first of such companies was founded more than 250 years ago.

What happened after the affordable care act was implemented by the Obama administration was that healthcare costs rose as providers saw an opportunity to make more money from the companies because more people were going to pay in.

It worked like this: it became mandatory for individuals to purchase health insurance so investment markets responded by buying insurance, which they expected to make more money because of the mandate. Then, healthcare providers saw the opportunity to get that money instead of allowing the investors to cash in on it, so they raised their prices.

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@Walter Hinteler,

Walter Hinteler wrote:

livinglava wrote:
What I am saying is that if you build a city in a certain way, driving becomes practically inevitable and that works like a mandate for buying and maintaining a car, fuel, parts, etc
Indeed.
It's even worse here: when you are born, you need nutrition - individuals are basically taxed by having to buy something to drink and eat.

Your sarcasm isn't funny. Food is a necessity. Driving is not. People often act as if driving is a necessity and entitlement, and it is a common expression that "driving is a privilege, not a right."

The fact is that economic opportunities shouldn't be moved further from residences and vice-versa to the point that walking or riding a bicycle becomes an inferior choice, but that is what has happened most everywhere in the US, and global investors and auto (parts) makers are the beneficiaries of it.

There is enough food in the world for everyone to eat if none was wasted. If there are business interests that control food prices to unaffordable levels, it is so they can force poorer people to perform undesirable jobs that are necessary for bigger economic players to make the money they make.

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@livinglava,

You asked a question about "National Heatkcare", said, it was a "Border Wall".

I noticed that you still think so, without knowing at all how it works.
I don't know besides basics about Obamacare. And I don't see how it might be related to our health insurances here.

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@livinglava,

livinglava wrote:

I'm not saying anything specific about any insurance in particular. I'm explaining the basic economic forces involved.

But

you wrote:

You don't get the same quality from any insurance.

And I denied that and gave reasons why it is not so here.

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@livinglava,

livinglava wrote:

Laws and policies can say one thing while subtle human behavior can achieve something else at another level. I'm not in your situation so I can't see what you see from your perspective.

True. But I don't live in a lawless society nor in a country without laws.

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@Walter Hinteler,

Walter Hinteler wrote:

You asked a question about "National Heatkcare", said, it was a "Border Wall".

I noticed that you still think so, without knowing at all how it works.
I don't know besides basics about Obamacare. And I don't see how it might be related to our health insurances here.

The bottom line is that people don't want to share benefits with non-citizens when the benefits are better than what they would get elsewhere.

People can't live in Germany without having insurance, so that creates a border condition for entering Germany.

If you want to have open borders, you can't have people resenting those who respond to the invitation.

The only way people are not going to resent immigrants is if they are not losing money or benefits to them.

Don't you see how it creates a political-economic 'border wall' to have citizen entitlements?

For some reason, I just don't think you're capable of really scrutinizing the causes of xenophobia and the will to keep immigrants out. It goes deeper than citizen entitlements, but they are connected phenomena. They are all part of creating a social-economic network of citizen entitlements that exclude non-citizens. You don't need a physical barrier to achieve that.

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@livinglava,

Again: if some gets some money here - be it wage, (state) benefit of any kind, pension .... - she/he is health insured.
If tourists come here without health insurance, they have to pay medical treatment.

In Germany, the principle of solidarity is the fundamental principle of any social security insurance. I tried already to explain before that the guarantees of solidarity are enshrined in our constitution (Grundgesetz).
To name this as the reason for xenophobia is ... well, you seem to know more about that than I do. In any case, I consider solidarity to be the most important means against xenophobia.

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@Walter Hinteler,

Walter Hinteler wrote:

In Germany, the principle of solidarity is the fundamental principle of any social security insurance. I tried already to explain before that the guarantees of solidarity are enshrined in our constitution (Grundgesetz).
To name this as the reason for xenophobia is ... well, you seem to know more about that than I do. In any case, I consider solidarity to be the most important means against xenophobia.

Isn't solidarity among national citizens the essence of xenophobia? Or are you saying that as long as national citizens bond together to prevent foreign competition, they don't feel threatened and thus hostile toward foreigners?

The way I see it is this: individuals must take responsibility for living responsibly wherever they go in the world. It doesn't matter if they are in one country or another; whether they are national/ethnic/political minorities or majority.

Solidarity should be at the universal level, above nation, ethnicity, party, or even species. Individuals should put effort and sacrifice into living in a way that is sustainable for all humans and other species to prosper without harming, threatening, or exploiting each other (i.e. other humans or other species) or the planetary future.

What I see in insurance is people pooling their money together so certain other people and their businesses can make more money than they would in a free market. When prices go up, people with the least ability to pay are excluded. Competitive economies necessarily exclude some people in favor of others. If everyone had access to everything, there would be no need to put prices on anything.

So solidarity among citizens of a nation amounts to exclusion of non-citizens. People are criticizing Trump for wanting to build a wall, just as they criticized the Berlin Wall, but why aren't the same people questioning the social solidarity among national citizens by providing national entitlements that exclude non-citizens then?

Either you're for excluding non-citizens to show solidarity among citizens, or you're for solidarity with a greater good that goes beyond narrow collective identities like nation, party, and species. How can you have both?

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@livinglava,

livinglava wrote:

Isn't solidarity among national citizens the essence of xenophobia? Or are you saying that as long as national citizens bond together to prevent foreign competition, they don't feel threatened and thus hostile toward foreigners?

I din't use the term "national citizen".
Our health insurance isn't exclusive for persons of German nationality but for everyone earning/receiving money here. As are the other types of our soical insurances.

I also didn't introduce foreign competition.
There are some private health insurers, belonging to foreign companies, but they act here as German companies. (I'm sure, you have a lot foreign health insurers as competitive alternatives in the USA.)
However, the British Forces have created for the primary, community and secondary health care (restricted for members of the forces and their families) with the SSAFA GSTT Care LLP a "foreign" German mandatory health insurer. (It's a a partnership between SSAFA Forces Help [SSAFA] and Guy's and St Thomas' Trust [GSTT], because the Royal Forces use German civil doctors and civil hospitals.)

1 Reply

@livinglava,

livinglava wrote:

What I see in insurance is people pooling their money together so certain other people and their businesses can make more money than they would in a free market.

None of the insurance companies in the mandatory system "makes more money", that's all regulated by law and the statutes of the insurances companies. (If my insurer makes a big plus, I get money back.)

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@livinglava,

livinglava wrote:

So solidarity among citizens of a nation amounts to exclusion of non-citizens. People are criticizing Trump for wanting to build a wall, just as they criticized the Berlin Wall, but why aren't the same people questioning the social solidarity among national citizens by providing national entitlements that exclude non-citizens then?

Either you're for excluding non-citizens to show solidarity among citizens, or you're for solidarity with a greater good that goes beyond narrow collective identities like nation, party, and species. How can you have both?

Again: the solidarity principle in the German social insurance system- here: the statutory health insurance - does not apply exclusively to German nationals but to everyone here who makes use of this system.

1 Reply

@Walter Hinteler,

Walter Hinteler wrote:

I din't use the term "national citizen".
Our health insurance isn't exclusive for persons of German nationality but for everyone earning/receiving money here. As are the other types of our soical insurances.

There are various forms of bias against hiring non-citizens everywhere, as far as I know. Sometimes official governmental laws/policies encourage hiring of citizens over non-citizens in various ways, and sometimes it is an informal feeling of solidarity that deters people from hiring foreigners when they feel that the domestic economy isn't providing enough jobs/prosperity for citizens, whose well-being they feel should take priority over non-citizens.

Your point seems to be that if preference for citizens is happening, it's not because they can't buy the insurance that's available and required. My question then just becomes what other factors limit the choice to live, work, and thus pay for the mandatory insurance. I can't believe that there are no social-economic effects caused by insurance or any other form of economic solidarity that don't play a roll in limiting and structuring all the various aspects of life-choices, from where people get to live to what they're allowed to do for work, to access to a healthy diet, lifestyle, healthcare, etc.

Quote:

I also didn't introduce foreign competition.
There are some private health insurers, belonging to foreign companies, but they act here as German companies. (I'm sure, you have a lot foreign health insurers as competitive alternatives in the USA.)

Yes, and I think private/corporate healthcare drives up costs and thus stimulates exclusion of uninsured people in the US as it would/must anywhere. It's simply not possible for a corporation to control resources without effectuating exclusion unless the resources in question are somehow unlimited/abundant, which healthcare should be if it was used for what it is and not as a tool for business and economic growth, or as a privilege to control by powerful people, corporations, and governments.

Quote:

However, the British Forces have created for the primary, community and secondary health care (restricted for members of the forces and their families) with the SSAFA GSTT Care LLP a "foreign" German mandatory health insurer. (It's a a partnership between SSAFA Forces Help [SSAFA] and Guy's and St Thomas' Trust [GSTT], because the Royal Forces use German civil doctors and civil hospitals.)

So your point is that it is an example of exclusionary health plan that utilizes 'German civil doctors and civil hospitals?' To me that implies that those civil doctors and hospitals should be liberated from exclusionary control, but then what factors would limit access to them? I am assuming that such health care resources aren't unlimited or abundant there.

I'm glad you introduced this example, because it provides an opportunity to examine potential solutions and their side-effects. E.g. would it be better if the military personnel brought doctors and hospitals into the local economy in proportion to their utilization? Would it also be better if all people had access to those doctors/hospitals, not just military insured? If they did, would de facto exclusion result, e.g. because waits for care would increase due to higher utilization?

Many subtly discriminatory scenarios are imaginable. E.g. if various healthcare businesses grew more lucrative as a result of health insurance mandates of the ACA (Obamacare), then the people making that money could gain the option to move to some other healthcare market where the quality of care was higher. If the same happened in Germany, for example, for whatever reason, you could have people making money on German healthcare but then traveling elsewhere for shorter waits or better quality care. It's very difficult to explore all these possibilities at the general level, but it's not very difficult to understand in general why they are possibilities.

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@livinglava,

From the start onward, you claimed that "national healthcare" acts as a border wall. You continue to say so, can't accept that it isn't so here.

livinglava wrote:

My question then just becomes what other factors limit the choice to live, work, and thus pay for the mandatory insurance. I can't believe that there are no social-economic effects caused by insurance or any other form of economic solidarity that don't play a roll in limiting and structuring all the various aspects of life-choices, from where people get to live to what they're allowed to do for work, to access to a healthy diet, lifestyle, healthcare, etc.

Of course, many if not all would like to keep the gross wage as the net wage.
And 'yes', insurances, taxes, rent, mortgages, other bills etc play a roll in limiting and structuring all the various aspects of life-choices, from where people get to live to what they're allowed to do for work, to access to a healthy diet, lifestyle, healthcare, etc..

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@livinglava,

livinglava wrote:

So your point is that it is an example of exclusionary health plan that utilizes 'German civil doctors and civil hospitals?' To me that implies that those civil doctors and hospitals should be liberated from exclusionary control, but then what factors would limit access to them? I am assuming that such health care resources aren't unlimited or abundant there.

I'm glad you introduced this example, because it provides an opportunity to examine potential solutions and their side-effects. E.g. would it be better if the military personnel brought doctors and hospitals into the local economy in proportion to their utilization? Would it also be better if all people had access to those doctors/hospitals, not just military insured? If they did, would de facto exclusion result, e.g. because waits for care would increase due to higher utilization?

Obviously you misunderstood my response.
The military (and civil) personal use the German pharmacies, doctors, hospitals via a comapny which acts like any other of more than 200 other insurance companies within our statutory health insurance system. They can go to any pharmacy, doctor, hspital like anybody else. Hwever, they have some pharmacies, doctors, hospitals. However, they have - besides the 'uniformed' medical care in the barracks - some "host" services and "partner" hospitals and clinics = all English speaking persona, signs, formulars etc in English.
The doctor's practises as well as the clinics and hospitals are normal German ones, everyone can go there.

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@livinglava,

livinglava wrote:

If the same happened in Germany, for example, for whatever reason, you could have people making money on German healthcare but then traveling elsewhere for shorter waits or better quality care. It's very difficult to explore all these possibilities at the general level, but it's not very difficult to understand in general why they are possibilities.

That's done here.
For instance many Dutch go to a German doctors across the border.
Many Germans go to Poland or Czechia for the rehabilitation after operations. To those countries plus a couple more for dentists.
(Few statuary insurance companies don't support this, but even then it could be done since our insurance card is automatically an European Health Insurance Card, valid in 32 European countries.)

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@Walter Hinteler,

Walter Hinteler wrote:

None of the insurance companies in the mandatory system "makes more money", that's all regulated by law and the statutes of the insurances companies. (If my insurer makes a big plus, I get money back.)

My analysis is based on the general laws of supply and demand where businesses and individuals attempt to make as much money as possible within the parameters available to them within the market conditions they are dealing.

So, for example, if you are a doctor or a pharmacist or a CT scan machine operator, or a person who sells xray machines, etc. etc. you are going to try to sell your products and/or your labor/time for as much money as you can.

If people all worked for free, it would be communism but they don't. So the question is how people and businesses take advantage of laws to gain more economic power. If the law successfully prevents that there, as you claim, then you should question whether the government is perfect in their decision-making regarding the regulations of pricing and access. I, personally, do not believe that humans ever achieve perfection through political/governmental structures or otherwise, so I always have faith that there are imperfections/flaws to be found and addressed in any system.

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@Walter Hinteler,

Walter Hinteler wrote:

Again: the solidarity principle in the German social insurance system- here: the statutory health insurance - does not apply exclusively to German nationals but to everyone here who makes use of this system.

Well, if it was an ideal system, it would be expandable to include the entire human population. I don't think it is, though. I think if people are truly motivated by solidarity beyond some limited group/category they identify with, such as nations, genders, races/ethnicities, etc. then they would observe the general principle Marx described in the Communist Manifesto, "from each according to his ability and to each according to need." If people truly follow that principle, they never attempt to transcend austerity with indulgence lest they take more than they need. They would also then provide as much help to anyone and everyone else as they can muster.

I find this Marxian ethic of work and austerity valid, but in practice there are reasons not to submit to total solidarity. For one, other people take advantage of generosity. As a dentist, for example, you could offer to take care of everyone's teeth but then would they brush and floss and do everything in their power to prevent dental problems? Or would they just shirk their own responsibility and go to the dentist because it was free? Another thing is that people aren't willing to make the sacrifices they should. Not only is that a problem for solidarity where others are working to provide you with the things you are failing to sacrifice, it is a major problem for environmental/resource conservation and sustainability.

Industrial consumerism encourages people to spend money liberally to stimulate business/economic growth in solidarity with everyone else who needs/wants to make money, have jobs, etc. but by failing to achieve austerity, they/we all use (and thus waste) resources and land that could be devoted to restoration of natural ecology and thus secure the long-term climate/resource stability of the planet.

So if solidarity doesn't work at the level of the planet/species as a more-or-less indefinitely-sustainable system, than how can you claim it works at the national level? Somehow some people have to be ignoring or shirking solidarity with the greater good, or else you would have already succeeded in saving the planet from human exploitation. The simple fact is that every 'national' economy is just part of a larger global economy that is failing to achieve sustainability and solidarity at the broadest level. You can say that it's not your responsibility, but to the extent that you are economically interdependent with global economic activities that are unsustainable, you are contributing to them by your participation. This may be inevitable because of an inability to survive without trade, but we all bear responsibility to solve these global problems; or is there a limit to solidarity?

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National Healthcare = Border Wall

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