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That's not how insurance works, expensive insurance has a lower max out of pocket.

What you are talking about is that rich people don't need insurance at all. They just pay out of pocket.


That is how health insurance works in New Zealand.

If you want private health insurance for say $50 a month[1], then insurance gives access to procedures more quickly and the rooms are much nicer than the public health care system. It may give access to rare but expensive procedures.

If you don’t want insurance, then the default is the public healthcare system, which is paid for by taxes. You will usually be in a ward with other patients. You pay small amounts on use (to prevent abuse, and even those amounts are reduced to nearly free if you are poor). The level of care is reasonable, but can be slow for non-urgent elective surgery, and extremely expensive procedures are not available. The public healthcare system handles ongoing chronic conditions much better than a private system could.

[1] You can see a quote from https://www.southerncross.co.nz/ if you give your age, gender and tick whether you smoke. Note that Southern Cross is a nonprofit co-op, most premiums get returned to members (on average, less an approx 10% administrative overhead).


They still pay taxes, though.

Germany allows people to opt out entirely, although there are a bunch of conditions and limitations. Most people don't, so the public system can still pay for itself.


Sadly in germany it's rather difficult to switch between public and private or no insurance. Or rather, it's very difficult to get back on a public insurance once you're private or self-insured. The best you can hope for is pulling it off once, maybe twice.


That doesn't seem unreasonable.

If you're avoiding paying into a system because you don't want to claim from it then letting you hop back on whenever you need it would destroy the system very quickly.


It's not that easy, luckily, if you're self-insured and have to take the service of a doctor, you can't switch just like that. It takes about a year of paper exchange with everyone involved to switch cleanly. Even then, any costs you started paying for from before will still have to be paid unless you're below a certain income bracket (or declare bankruptcy).

So if you were self-insured and broke a leg, then decided to switch back to insurance, you'd still be on the hook for the costs of the ongoing physiotherapy until it is healed back up. The insurance doesn't have to actually pay anything that happened before a switch (switching from public to public insurance or private to private doesn't have this limit, private to public and the other way round but you don't pay, your old insurance pays).


I'd wager that is by design, and one of the ways they keep people from avoiding insurance when young and healthy, and then getting it when old


It's possibly one intention, though there are already laws that prevent you from going back to public insurance if you're over 55 years old as well as if you're over a certain income limit.

The only universal way to switch is to marry someone in public insurance.


The most expensive plan for my family (2 parents and a young child) is $367 a month. Equivalent coverage in the US would be thousands of dollars.


I do not know the New Zealand system, but I suspect the base level of care is still covered by public funding and the insurance is only covering optional extras (like private rooms).


That system looks terrible for handling cancer and pre-existing conditions.


All NZers get treated for cancer or pre-existing conditions, within the funding limits of the health system.

Severe health problems don’t bankrupt NZers, and you are not locked into a job just to (a) keep your insurance, or (b) keep your insurance benefits.

How many recently unemployed in the US have lost cover for their pre-existing conditions?

I expect you can find the benefits list document for Southern Cross, if you wished to check out the details of cover for cancer or pre-existing conditions.


Cancer is not an elective surgery and gets treated with urgency. Across the Tasman Sea with a very similar system my father had bowel cancer removed the day after diagnosis in the public system and spent most of the recovery in no state to miss a private room.


As opposed to one where everyone avoids medical care at all costs to avoid extortionate bills?


I don't think there is any system like that in first world countries. The US isn't like that if that's what you're insinuating


Please look around you a little more. My buddy separated his shoulder snowboarding in Tahoe. He had a full time (40 hours a week) job at the time, but it didn't provide healthcare.

He couldn't afford to go to hospital, so never did. I was visiting from Australia at the time and was utterly horrified, having no idea the US worked like that. Now years later his shoulder is still screwed.

Of course people in the US avoid going if at all possible, it's horrendously expensive, and medical bills are the number one cause for bankruptcy in the US [1]

In a stack of OECD countries (all the other ones?) nobody has ever gone bankrupt from medical bills, because that's impossible.

[1] https://www.thebalance.com/medical-bankruptcy-statistics-415...


Sorry, but is this a good example?

There are people that cannot afford insulin. THAT is a problem. But the fact that he took a risk, for fun, and suffered the consequences, rather than having everyone paying for it? That sounds a bit reasonable...

Note: important that the risk is voluntary, optional and recreational rather than professional. Why would the collective bear the costs, in those circumstances? Why is that fair?


Person doesn't have insurance and injured themselves doing a risky activity, and can't afford treatment. If it's really bad, why not use bankruptcy, I can't imagine this person has anything valuable given the history you described.

Or use physical therapy, it's cheap.


What is insurance for? To cover risk of something bad happening. The bigger the pool paying for it, the less impact to any one person to cover all the risk.

Now imagine that was scaled up to a whole country. That's New Zealand. Check out the Accident Compensation Corporation. All medical costs related to accidents are automatically covered!

But who pays the costs! Everyone, via levies. How much? $2000 on a $150K IT income.

But how do you control costs? Who is entitled? Who is at fault? Surprise! It's a no-fault accident insurance system that covers all accidents.

In exchange for that, we gave up our right to sue in accidents for medical damages. Why pay a lawyer when they're not required?


I guarantee the average US worker that makes 150k (not an avg salary) pays more then 2k in SSI taxes that cover Medicaid. They pay all over again for private healthcare, probably in the 6k range if they don't have kids.


So you think it's fair for someone to spend 2.5% of their income on a flu test when they have good reason to believe they may have COVID-19?


Do you mean monthly or annual?

If monthly, the answer is still no, but only because testing for covid is a significant public good.

Otherwise, yes, sure?

It is an unpredictable, low probability event, with not so big an impact (the payment, I mean, not covid)


It absofuckinglutely is. If you don’t see that you may want to check whether your perspective is informed entirely by a (quite rich) bubble.


Serious question, has anyone installed Android on their iPhone?

I love the idea of budget iPhone, but I hated iOS.

Does it work as smooth as Pixel?


The great software and drivers (IOS) is why Iphones are so smooth. Not the hardware.


I'm confused by your comment. Which is it? Do they run great software or iOS?


What’s wrong with iOS?


Browsers are limited to using the built-in webkit engine, many default applications are fixed to Apple applications and can not be replaced as the default by a 3rd party app, apps can only be installed from the Apple App Store, support for PWAs is poor, and the UI/UX doesn't provide good discoverability of functionality (This seems to affect most Apple products but for some reason people here seem to think Apple has great user interfaces. For the worse example of this see tvOS.).

Also when switching providers iOS has a habit of sometimes getting into a state where it will refuse to send SMS or MMS messages. This has plagued it over many versions with the only resolution being to wipe the device and not restoring any backups because restoring will then break the functionality again. I know several people who have been hit by this and the support forums are filled with this happening to people.

The latest news is that since version 6 receiving certain email can lead to your phone being compromised even if you don't open the email. Which reminds me of another point. Despite Apple's best efforts there still exists software and/or devices available to governments which can subvert the security protections on iPhones. Also don't forget that time when receiving certain text messages could lock up iPhones.

That is just a short list of a few of the ways iOS is not great. You can argue it is better than some other systems but that still doesn't make it great.


These seem like minor/non issues


iOS is great software.


There's a project that pulls it off, but as you would expect, device drivers are missing for almost everything like WiFi, etc..


The money ran out before our company could get 1k.

Another example how the 10% is taxed to pay for the 0.1%.


I don't really understand pateron when I have a donate button..but I imagine people who use pateron are doing better..

Gamification?


Single place, consistent UI, my credit card details are already there. I can change my card / address for everything in one go. It removes a lot of friction.


I've got my Patreon set up to pay some folks I like monthly, and I can't even tell you who they are off the top of my head, but I decided that I wanted to budget $x towards supporting cool people and it's been charging me in the background ever since. Meanwhile, I can barely remember to pay my voice teacher every week and I go there in person (well, not anymore) and sing for an hour.


For 10 years I’ve had an automatic $2 monthly PayPal payment sent to a podcast I enjoy.


In addition to what lmm mentioned, giving to patreon usually comes with some sort of perk or special content, and it's also a subscription by default which I imagine isn't the case with a donate button.


It's the same thing that PayPal brings to the table when any website could just have a credit card form.


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