We were just one Senate vote away (Joe Lieberman) from getting a public option during the Obama administration. The law essentially needed a 60% supermajority to pass and it had 59% support of our legislature. Quite tragic - the next generation may get to try again.

Literally. What is called "profit" in a private industry is what would be called "waste" in a public service. It's literally money that runs through the system and accumulates rather than being used. Ironically when politicians want to run a public service more "like a business", they will try to squeeze the budget to cut costs to in turn justify further cuts until the service fails to do what it was originally meant to do and has to be replaced by a for-profit industry that generates an even larger overhead at even more cost to society once you factor in the fees, subsidies and other factors.

> I got bored of software 20 years ago and really am only in it for the insurance and pay.

And you don't see how this is a horrible state of affairs? What of those who are forced to the same, but in careers that are actively harmful to their person?

Not necessarily. For some countries mandatory public health contributions plus good private insurance, can still work out to cheaper than good private insurance alone in the US. This is because when private insurance has to compete with a universal public option, prices go down.

What if someone trying to pay for their kid's chemo hit you over the head with a hammer to take your wallet and left you unable to continue your current line of work?

Portugal: paid out of pocket, no insurance. A trip to the ER to refill a prescription (it's what our landlord told us to do) took about twenty minutes and cost under $30. Filling that prescription cost less than the copay in the U.S.

Thailand: paid out of pocket, no insurance. A trip to the ER for digestive issues took under an hour and the visit plus antibiotics cost under $200. This was at Bumrungrad, one of the best hospitals in Thailand.

I'll double-check, but I'm pretty confident my wife's care in the UK was under the NHS. Nepal was also her, I think it was out of pocket, but I'll check.

I checked with my wife:

Nepal: she had some form of insurance. She doesn't know how much it cost, but presumably not much (she was volunteering for a non-profit) and her out-of-pocket costs were zero for a multi-day stay at a hospital.

UK: she doesn't remember having insurance, but thinks she must have (she was a student at the time). She used the NHS, again with no out-of-pocket expenses.

I am talking about absolute costs not affordability. MRI costs might be mostly salaries, but it's not the same for drugs, labs, etc. Given the much bigger purchasing power in the US, prices should be lower, not higher. Why the economics of consumer electronics don't apply to health care? TVs and laptops are much more expensive in Bulgaria, but drugs are way, way cheaper and not subsidized - and these are commodities. Levothyroxine is a commodity available around the globe. Why it's so expensive in the States?! Why are American pharmacies buying generics from India, which so often have recalls due to contamination, and don't buy European drugs (such as from BERLIN-CHEMIE [0])? Because they want much bigger margins - I have no other explanation.

[0]: https://www.berlin-chemie.de/en-us/about-us/our-history

Yeah, because it's already a business but non-competitive like in the States. Pharmacies can still sell me medications without an Rx - it's not allowed, but they still do it, because why do I need to schedule a doctor's visit get a medication thats for life (like my wife's Levothyroxine).

Yeah, but Walmart generics are made in India by companies known for recalls due to carcinogen contamination. Not that recalls in Europe don't happen, but I'd rather purchase from a pharmaceutical company in business from the 19th century. If US regulators believe that India has more stringent pharmaceutical standards than Germany, then something is fishy! And there's so much corruption in generics [0]!

[0]: https://www.washingtonpost.com/business/2023/04/04/big-pharm...

So correct me if I'm wrong, but:

* Germany has an Obamacare-like system: Insurance is private, but mandatory.

* You can choose and change your insurance provider freely, and they cannot reject you

So if that is true, health insurance companies have the risk of older residents joining, whether or not the previously resided in Germany, and it's not like they benefited from their contributions before.

So how exactly would this exclusion work? Is insurance not mandatory for immigrants after a certain age? Do insurance companies have a right to reject them?

I was not able to find a direct discussion of the question, but this page discussing the health problems of older immigrants (including "access to the health care system") does not mention the possibility that they would be excluded from the health care system altogether: https://heimatkunde.boell.de/de/2013/11/18/ältere-migrantinn...

What if they are EU citizens?

This is about social security and has nothing to with health care.

In fact it says:

"Although the agreement between the United States and Germany allows the Social Security Administration to count your German credits to help you qualify for U.S. retirement, disability or survivor benefits, the agreement doesn’t cover Medicare benefits. As a result, we cannot count your credits in Germany to establish entitlement to free Medicare hospital insurance."

There might be other loopholes though.

First of all, it is not mandatory for everyone. Anyone with an income above an entry level IT job is exempt, but there are other exceptions as well.

Secondly it is not open to anyone. If you opted out of it at a young age you usually cannot come back (it's a bit more complicated). If you were not in the system for a couple of years and are over 55 you are out. So the US retiree will not get in, but the migrant with a low-incone that worked a couple of years in Germany has mandatory health care forever.

Thirdly, it is not a single state-run insurance company. There are many companies that provide mandatory health care and you can choose freely but you have to choose one if health insurance is mandatory for you. The companies differ in premiums and benefits but usually not by much. They also cannot refuse you if (and usually only if) health care is mandatory for you. The biggest ones are AOK, Barmer and maybe Tk. Bigger companies like BMW run their own ones for their employees.

Of course there are many companies that provide private health care. You can have private insurance in addition or, if you are exempt from mandatory health care, instead of the mandatory providers.

Everything is more complicated, but that is the rough idea.