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Finally. Germany combines some of the worst aspects of the US (credit ranking, complicated abortion process, private healthcare if you want decent treatments) w

Finally. Germany combines some of the worst aspects of the US (credit ranking, complicated abortion process, private healthcare if you want decent treatments) with the worst aspects of Europe (low digitalization, high taxation, recursive federalism: within the country and within the EU). A country like the Netherlands has its own issues (mainly housing) but doesn't have the myriad of pain points you can find in Germany like Schufa, anti-customer contract rules, or public healthcare inaccessible despite paying more than 400€/month for it as a single individual.

tietjens 3y ago
Hello from Germany. No lies detected. Don’t forget about a working culture where process always ranks above results, and leaders commonly lack confidence to make pragmatic decisions.
- odiroot 3y ago
  > Don’t forget about a working culture where process always ranks above results, And where tenure ranks above skills or experience. Especially if unions are involved.
- anovikov 3y ago
  Well, this working culture makes result slow and expensive, and as a result, in many cases uncompetitive, but it does a good job of avoiding fuckups and while slow and expensive, things usually get done predictably, on time and on budget. Which probably makes it better than American reckless "fake it till you make it" approach in most of the complex projects.
  - freshbob 3y ago
    No, it absolutely does not. It might have in the past, when industry was booming in Germany and setup costs were huge and mistakes were very, very expensive. However, they've pretty much lost the race when it comes to software and digitalization, where setup cost is pretty much non-existent, mistakes are inexpensive (fail early, fail fast), and ROI are generally multiples of 100%.
    - anovikov 3y ago
      I had an experience with a German client in a software project. It freaked the hell out of me with slowness of decisionmaking, long contract every point of which as it turned out, was material, in a nutshell it was a 50/50 coding vs lawyer job and took 5x the time same thing would take with an American client. It also made me next to no profit. But, unlike a lot of things we write for Americans, that one turned out to be actually workable, usable in their (rather large) product, and runs happily to this day almost 5 years later. I count it as a success and attribute it mainly to this boring, overly conservative and procedure-ridden work process. But yes, i agree, that for software projects, virtues of this approach are more limited than in "hard" engineering, and probably do not outweigh downsides in many cases.
  - tietjens 3y ago
    I am familiar with this response but I can’t take it seriously. The country is looking at something like -0.4% growth this year. “On time and on budget” really? Like the Berlin airport? Like the digitalization budget that hasn’t been spent? There is no spirit of pragmatism here. Only a fear of not following the rules.
  - chrisandchris 3y ago
    I think scope, budget and time is a triangle. You have to choose 2 of it, and 1 is always lost. There's almost never a on-budget, on-time and on-scope project.
robert_foss 3y ago
This is entirely correct. Having lived both in North America and Sweden this is a very accurate description.
ffsm8 3y ago
> public healthcare inaccessible despite paying more than 400€/month for it as a single individual. That's a pretty new thing though (been getting worse for the last 10 yrs). And the person responsible for the legislature that caused this change is the current health minister. Also... 400€? It's a percentage of your salary. And you're omitting that the employer pays the same amount, so you're effectively paying 800€ at the very least.
- generic92034 3y ago
  > And the person responsible for the legislature that caused this change is the current health minister. Could you please explain that a bit more?
  - ffsm8 3y ago
    He revamped pretty much evey monetary incentive a few years ago, which directly caused the "gold rush" privatization of hospitals etc, making a lot of treatments uneconomical. There has been a lot of coverage about it over the years - both by official channels and independent YouTubers and journalists, I'm not going to do it justice by summarizing it in a comment here. A somewhat recent German video (2yrs old) is "Pflege katastrophe - exposed". But ARTE , DW and ZDF all have reported on it at this point The controversy about diabetis patients getting amputations over simple treatments is a pretty well known symptom of this revamp, as operations get a very high payout
- carlosjobim 3y ago
  > you're effectively paying 800€ at the very least. That makes it worse! Not better.
  - jonp888 3y ago
    It's a collective payment system whereby everyone receives the same treatment, but high earners subsidize low earners, students and pensioners. Whether that is a good idea or not is of course a matter of debate, but it doesn't make sense to compare the benefits with the cost because they are not linked. If you are a really high earner you can opt out and pay a private risk-based premium instead.
jonp888 3y ago
I'm a bit surprised you would consider the credit system the same as the US. It doesn't have the bonkers bit of the US system where you have to take great care to be in a small amount of debt even if you don't need to be, in order to "prove" your creditworthiness so that you can be in a lot of debt later.
- bombcar 3y ago
  Being in debt to build credit is mostly a fairy tale told by the companies - just having an open line of credit is all you need to provide account age. You don’t need to use it or carry a balance (you may need to use it periodically to keep it open but that can be charge/pay off immediately).
- kevin_thibedeau 3y ago
  It's starting to creep into public services. You couldn't even get easy access to Covid stimulus funds without a credit card. Debit cards were rejected despite providing the same level of ID verification.
  - devmor 3y ago
    At what point did you need to use a credit card to receive your economic stimulus payment? I simply confirmed my most recent tax year information when I claimed mine.
- deleted 3y ago
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albert180 3y ago
That's utter bullshit. Your quality of care in the hospital is exactly the same as with public health insurance. Also sometimes private insurance is even worse when it comes to addiction and psychological treatments
- hocuspocus 3y ago
  You're treated the same in big hospitals but when I was in Berlin, private vs public meant I could get an appointment at a dermatologist tomorrow instead of in two months.
- ArmandGrillet 3y ago
  Just open Doctolib and tell me it's the same when looking for any kind of doctor. The difference in waiting time is 3 months, bare minimum.
  - Ringz 3y ago
    I just opened Doctolib and did a test with a dermatologist. The difference between private insurance was 23.5.2024 and public insurance 5.6.2024. That makes 13 days and not "3 months bare minimum". https://0x0.st/HnBZ.png https://0x0.st/HnBZ.png https://0x0.st/HnBN.png https://0x0.st/HnBN.png
    - albert180 3y ago
      Also if your primary doctor determines that you need an urgent appointment, they can give you a priority code, which gives you a quick appointment, since those visits are paid on top of the regular budget for the specialist
- tietjens 3y ago
  This is not true. Private insurance means better care in hospitals in Germany. Better access to appointments, choice of head/experienced doctors, even can mean better rooms.
  - 3y ago
fabian2k 3y ago
That's an overly negative and hyperbolic view. Nothing is entirely wrong here, but you're painting every single point in the most negative way possible. You can certainly argue about how good the healthcare system is in the end, but it isn't categorically inaccessible. And if you pay 400 EUR/month you're earning enough money and can choose the private health system if you prefer that. The credit ranking also works in very different ways than in the US, so I wouldn't compare them directly. I'm not sure what you mean by anti-consumer contract rules.
- panki27 3y ago
  While choosing to be in the private system is an option, it only "makes sense" if you make at least 70k€ a year, so definitly not for everyone. The issue is not getting in - but getting back out before you retire and don't have enough available income to pay the rates anymore.
  - fabian2k 3y ago
    If you pay ~400 EUR for the public healthcare you make 70k or more. The cost for public healthcare is scaled by income, and is limited around 400 EUR. It's a bit higher now, but I would suspect that the OP is not necessarily talking about the most current values here and is hitting the older limit and therefore earning more than the "Beitragsbemessungsgrenze".
    - miroljub 3y ago
      The limit is ~900 € per month, not ~400 €. People frequently forget the employer matching, which at the end comes from your pocket, since it's mandatory. Also Freelancers and self-employed need to pay full contribution of 900 €, not "just" a half.
      - cycomanic 3y ago
        No the employers contribution doesn't come out of your pocket. The employers contribution comes out of the employers pocket and is the cost of doing business. That's like arguing the rent for the office space or even the warehouse or servers come out of your salary. Your salary is essentially a function of supply and demand and not a function of cost. I mean, if external costs would influence salary we'd see remote workers earn more than on site ones, because employers save on office rent. In reality it's more likely to be that remote workers have a lower salary.
deleted 3y ago
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oytis 3y ago
Is Netherlands healthcare better? From what I've heard from people having lived in both countries, German healthcare is more accessible. E.g. in Netherlands you can't see a specialist doctor unless you convinced your GP you absolutely have to - which can be hard at times.
- jacquesm 3y ago
  I'm 58 and not exactly in the best of health. I've had to rely on healthcare in NL quite a few times over the last 20 years or so and all of those were serious cases. I have nothing to complain about, but that's n=1. To increment that n a bit: I know lots of people here and almost all of them have had some health issues over the years and the vast majority of those have been dealt with in a serious and reasonably effective manner. Where NL is utterly ineffective is when it comes to vague symptoms. Until it is perfectly clear what is wrong you're going to be seriously frustrated because the diagnostic machinery isn't really all that effective, when in other countries they'd spend a fortune to find out what's wrong with you in NL unless it's 100% clear you're going to have a hard time getting the care that you need. I blame Calvijn, NL seems to have a misplaced sense of reduced expression of emotion resulting in an expectation to tough things out rather than to deal with them and for some reason doctors seem to see complaints without a direct relatable cause as an attack of hysterics rather than as something to investigate. If you come from a different background you're going to find this a very difficult thing to deal with.
  - formerly_proven 3y ago
    > the diagnostic machinery isn't really all that effective, when in other countries they'd spend a fortune to find out what's wrong with you in NL unless it's 100% clear you're going to have a hard time getting the care that you need. What other countries are those?
    - maeil 3y ago
      Ironically the US seems to be best, or at least the "least bad" at this (if you can afford it); it's the only positive thing I can see about US healthcare.
sofixa 3y ago
> Europe (low digitalization, high taxation, recursive federalism: within the country and within the EU). A decent chunk of those are exclusive to Germany, or at least far from the norm in the EU or Europe in general. For instance digitalisation varies wildly between countries, but Germany is definitely one of the most embarrassingly behind countries. Taxation also varies (e.g. Bulgaria and Estonia have flat income taxes). Federalism isn't a thing in most European countries too.
WarOnPrivacy 3y ago
> or public healthcare inaccessible despite paying more than 400€/month for it as a single individual. This is super close to my early 2010's ACA experiences. Even when a poor earner could scrape up enough to buy a plan, the deductible made it unusable. Policy pricing was exorbitant for $12k/yr earners but dropped enough for 22k/yr that a few plans were buyable. The challenge was coming up with another $somethingthousand to cover the deductible. There was a sharp drop-off in plan pricing at 32k/yr and some mid-grade plans were in reach. IIRC deductibles were lower on those plans and they may have been usable (or nearly so). What struck then. Of the news orgs cheering/damning the ACA, zero of them ever covered how pricing dropped as income rose. I assume that's because pricing was only ever disclosed to folks who completed the lengthy signup process - and news folks found it too daunting to experiment with.
- fabian2k 3y ago
  There are no real deductibles in German public healthcare, though some areas are excluded almost entirely like glasses and certain dental work. The cost is also scaled to income, the 400 EUR (which is only 50% of the cost, the other 50% pays the employer) here are what you pay when you earn ~70k EUR per year and are essentially the maximum for public health care. So it is much cheaper if you earn less money. One of the main current criticisms of the system is that it can be very difficult to get appointments with specialists compared to people with private health insurance.
  - dkekenflxlf 3y ago
    Bro, du solltest mal deine Gehaltsabrechnung prüfen - mit dem Gehalt bist du bei knapp 1000€
    - fabian2k 3y ago
      I used the values from the original post, which is only the employee part and not the employer part. I also assumed that they're not using current but slightly older values here. I also didn't include the PPV, if you include that and count the employer part you end up at 1000 EUR.
interactivecode 3y ago
Healthcare is kinda shit in The Netherlands. Long waiting lists even for simple things. Never actually prescribing medication but instead over prescribing paracetamol. Only being able to get a set amount for appointments regardless of actual need. Sure if you’re in a car crash and urgently need care they will help you without going bankrupt but anything less urgent good luck getting an appointment this week / month / year
- karpour 3y ago
  This, not nearly as bad in the US, but a mess of private insurances.
  - njarboe 3y ago
    A mess of private insurances, partial payment by the government of private insurance based on income, and then full (or almost full) government payment based on veteran status, income, and age. It's more complicated than this of course.
- notaustinpowers 3y ago
  Does The Netherlands not have Urgent Care facilities like the US? I feel like those for of facilities could handle the issues of a lack of access for simple or menial things. I had to get a cyst lanced a few weeks ago and I just walked into an Urgent Care by my house and was in and out in about an hour with no appointment. I think it was about $180 since I didn't have insurance.
- anonzzzies 3y ago
  I am dutch and have lived in quite a few countries in the eu and se asia: I would prefer to never have to deal with NL healthcare services again compared to other countries. And I have been (unfortunately) been in hospitals, a lot. Since the 90s NL is striving to become little USA policy wise and this is still getting worse. It’s a shit show.
ciclotrone 3y ago
I find it quite disturbing that high taxation is seen as a negative aspect of Europe. I lived in Italy, France and Germany, and I enjoyed public healthcare and education of very high standard at very affordable prices, and free in the limit that one cannot afford to pay for them. As a relative of a person with a chronic disease I can tell you that on the one hand if we are not bankrupt it is because of public healthcare, and on the other I'm proud of contributing through my taxes so that anybody in need can have the same treatment irrespective of their economic situation.
- formerly_proven 3y ago
  High taxes with no matching value behind them is undeniably a negative.
  - Nextgrid 3y ago
    Yes, that's my problem with high taxation, as someone who got burnt by it by virtue of living and paying taxes in the UK. I don't mind paying my fair share of tax if it means I get good value out of it, but the state of our healthcare here means that in practice the public healthcare system is no longer fit for purpose, so we are being forced to pay for a system that doesn't work and end up having to go private (and thus pay again) when we do need timely healthcare. I am generally in favor of fair, progressive taxation to ensure everyone has a good social safety net, but the taxation should be fair (it's no longer the case in the UK, since tax brackets haven't been adjusted for inflation) and the services paid for by those taxes should provide good value. The danger with services funded by taxes as opposed to a private enterprise operating in a free market is that private enterprises are bound by competitive pressure - if they are delivering terrible service and stuffing their pockets with the money, you are free not to do business with them and a potential competitor (that stuffs their pockets a little less) can come along and get your business instead. With tax-funded services, this pressure doesn't exist, so there's no incentive for politicians (and everyone else in the value chain) to deliver good service, since people generally can't opt out of taxes. This means that even if a service is currently good, there's no guarantee it will remain so since the pressure for it to remain isn't there. Thus, when you see high taxation, it's reasonable to be worried whether the service provided by those taxes is any good and whether it will remain so in the future.
miken123 3y ago
> A country like the Netherlands has its own issues (mainly housing) but doesn't have the myriad of pain points you can find in Germany like Schufa In the Netherlands we have BKR, which is less all-encompassing than SCHUFA, but also needed to be fined before giving proper right to access under the GDPR: https://edpb.europa.eu/news/national-news/2020/national-credit-register-bkr-fined-personal-data-access-charges_en https://edpb.europa.eu/news/national-news/2020/national-cred...
javajosh 3y ago
>low digitalization Given that everyone uses IBAN, and it works great, I strongly disagree. >private healthcare if you want decent treatments Your mileage may vary, but I was very impressed with the speed and ease of acquiring healthcare under a public plan. The lack of paperwork for seeing a new doctor is astonishing. The lack of copays, SOBs, and all that is like a breath of fresh air, and is worth copying in the US. Heck I once saw a doctor for something and simply gave my card, and saw the doctor in the next hour, and she decided I needed an ultrasound...and did the ultrasound in 5 minutes herself. In the US, this would have been a multi-week ordeal with multiple rounds of paperwork and visits to different offices. My wife also had a C-section at a Berlin hospital and the care was competent and 100% covered by our public insurance. In the US couples requiring a C-section can expect $20k+ of debt.
- jamesmunns 3y ago
  Low digitalization isn't just payment - it's also needing to fill in paper forms, or making in-person visits to government and business offices. I've been living in Germany for about a decade, and it is still behind in many of these items from when I left the US, and having a friend that recently moved from Germany to NL, he was blown away at how convenient and just not-hostile so many day to day interactions with governments and businesses were. Like - big picture, I'm very happy in Germany, but certain things are still very archaic and sometimes needlessly so.
  - shellfishgene 3y ago
    I agree, just look at the recent (well, decade-long?) attempt to digitalize the car registration process, which can only be called a total desaster.
- Bayart 3y ago
  My impression coming from France, which I never thought of as particularly progressive on the technological front, is that Germany is full of odd, idiosyncratic archaisms.
Unfrozen0688 3y ago
low digitalization, high taxation Sweden is highly digitalized, we pay on our phones, pay taxes on our phones, do government stuff on phone or webbrowser. No stores do cash anymore (also a negative) High taxes is a positive if used right
- miroljub 3y ago
  Sweden is a low tax land compared to Germany. In the past, it was known for high taxes, but one could argue that this progress came together with the tax reduction in the last decades.
usr1106 3y ago
German "public" healthcare is much more accessible and has much better coverage than its Finnish counterpart. Despite Finland reapeatedly making headlines (including on HN) about being a Nordic welfare state. Germans are typically complaining from a high level. Source: Members of the wider family living in both countries. Some over 80 and needing a lot of healthcare services. (I hear general practioners can be a problem in poorer areas in the East. My experiences are from a prosperous area in the West.)
- oarfish 3y ago
  A finnish colleague once told me that the Finns just don't go to the doctor unless something falls off. Any accuracy to that?
  - usr1106 3y ago
    Yes, especially for Finnish men in the countryside that's a sterotype with quite some truth behind it. Edit: And that results in a dangerous combination: First waiting too long and then getting the answser "no free appointments". And if you insist the next one is in 3 or 6 months. Many Finns do not insist.
- graemep 3y ago
  > Germans are typically complaining from a high level. Do Germans share the British tendency to think everything is better in the rest of the world? As an immigrant (as a child, admittedly) and someone who has lived and worked elsewhere and, more importantly, does not completely share this aspect of the culture, I find British pessimism and self-flagellation really, really annoying.
  - carstenhag 3y ago
    Germans unfortunately like to complain a lot. Many things are better elsewhere, is claimed. Except for many other countries nearby. And the weirdos from UK leaving EU. And the weirdos from US with Trump. And we have it so bad, so bad. Sometimes I hate my fellow Germans.
moi2388 3y ago
True, but in the Netherlands it’s the government itself which sells all of your data, literally everything from your house, it’s price, location, blueprints, satellite images, what you paid for it, previous owners, your car, and even your government ID number if you are registered as a company, just to many a couple. And yes, you obviously have to pay to get your own data.
meroes 3y ago
400€ for medical, dental, and optical combined you mean. And less for students. And you conveniently leave out their 4 week minimum vacation time/year. (my sis and her BIL just moved from there, and help people move there). Digitalization is really behind yes, and homeownership is even more expensive than the US. But rent is almost half the US and groceries are cheaper. And instead of subsidizing full sized pickup trucks and EVs, you get Audis, VWs, etc for cheaper.
- discopicante 3y ago
  Now compare median income of Germany vs US. Economic opportunity is fading away in Germany. Also, pretty much all cars - especially Audis, VWs, etc are (20-30%) more expensive in Germany vs US.
mk89 3y ago
> private healthcare if you want decent treatments > public healthcare inaccessible What do you mean? I am not sure what you mean by decent treatments. > Schufa There is some change happening there, especially now that the EU Justice Court ruled against credit scoring institutions (they break GDPR, etc.). Very slowly, as usual, but it might happen. (Also the current governement is planning changes.)

tietjens 3y ago

Hello from Germany. No lies detected. Don’t forget about a working culture where process always ranks above results, and leaders commonly lack confidence to make pragmatic decisions.

odiroot 3y ago
> Don’t forget about a working culture where process always ranks above results, And where tenure ranks above skills or experience. Especially if unions are involved.
anovikov 3y ago
Well, this working culture makes result slow and expensive, and as a result, in many cases uncompetitive, but it does a good job of avoiding fuckups and while slow and expensive, things usually get done predictably, on time and on budget. Which probably makes it better than American reckless "fake it till you make it" approach in most of the complex projects.
- freshbob 3y ago
  No, it absolutely does not. It might have in the past, when industry was booming in Germany and setup costs were huge and mistakes were very, very expensive. However, they've pretty much lost the race when it comes to software and digitalization, where setup cost is pretty much non-existent, mistakes are inexpensive (fail early, fail fast), and ROI are generally multiples of 100%.
  - anovikov 3y ago
    I had an experience with a German client in a software project. It freaked the hell out of me with slowness of decisionmaking, long contract every point of which as it turned out, was material, in a nutshell it was a 50/50 coding vs lawyer job and took 5x the time same thing would take with an American client. It also made me next to no profit. But, unlike a lot of things we write for Americans, that one turned out to be actually workable, usable in their (rather large) product, and runs happily to this day almost 5 years later. I count it as a success and attribute it mainly to this boring, overly conservative and procedure-ridden work process. But yes, i agree, that for software projects, virtues of this approach are more limited than in "hard" engineering, and probably do not outweigh downsides in many cases.
- tietjens 3y ago
  I am familiar with this response but I can’t take it seriously. The country is looking at something like -0.4% growth this year. “On time and on budget” really? Like the Berlin airport? Like the digitalization budget that hasn’t been spent? There is no spirit of pragmatism here. Only a fear of not following the rules.
- chrisandchris 3y ago
  I think scope, budget and time is a triangle. You have to choose 2 of it, and 1 is always lost. There's almost never a on-budget, on-time and on-scope project.

robert_foss 3y ago

This is entirely correct. Having lived both in North America and Sweden this is a very accurate description.

ffsm8 3y ago

> public healthcare inaccessible despite paying more than 400€/month for it as a single individual. That's a pretty new thing though (been getting worse for the last 10 yrs). And the person responsible for the legislature that caused this change is the current health minister. Also... 400€? It's a percentage of your salary. And you're omitting that the employer pays the same amount, so you're effectively paying 800€ at the very least.

generic92034 3y ago
> And the person responsible for the legislature that caused this change is the current health minister. Could you please explain that a bit more?
- ffsm8 3y ago
  He revamped pretty much evey monetary incentive a few years ago, which directly caused the "gold rush" privatization of hospitals etc, making a lot of treatments uneconomical. There has been a lot of coverage about it over the years - both by official channels and independent YouTubers and journalists, I'm not going to do it justice by summarizing it in a comment here. A somewhat recent German video (2yrs old) is "Pflege katastrophe - exposed". But ARTE , DW and ZDF all have reported on it at this point The controversy about diabetis patients getting amputations over simple treatments is a pretty well known symptom of this revamp, as operations get a very high payout
carlosjobim 3y ago
> you're effectively paying 800€ at the very least. That makes it worse! Not better.
- jonp888 3y ago
  It's a collective payment system whereby everyone receives the same treatment, but high earners subsidize low earners, students and pensioners. Whether that is a good idea or not is of course a matter of debate, but it doesn't make sense to compare the benefits with the cost because they are not linked. If you are a really high earner you can opt out and pay a private risk-based premium instead.

jonp888 3y ago

I'm a bit surprised you would consider the credit system the same as the US. It doesn't have the bonkers bit of the US system where you have to take great care to be in a small amount of debt even if you don't need to be, in order to "prove" your creditworthiness so that you can be in a lot of debt later.

bombcar 3y ago
Being in debt to build credit is mostly a fairy tale told by the companies - just having an open line of credit is all you need to provide account age. You don’t need to use it or carry a balance (you may need to use it periodically to keep it open but that can be charge/pay off immediately).
kevin_thibedeau 3y ago
It's starting to creep into public services. You couldn't even get easy access to Covid stimulus funds without a credit card. Debit cards were rejected despite providing the same level of ID verification.
- devmor 3y ago
  At what point did you need to use a credit card to receive your economic stimulus payment? I simply confirmed my most recent tax year information when I claimed mine.
deleted 3y ago
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albert180 3y ago

That's utter bullshit. Your quality of care in the hospital is exactly the same as with public health insurance. Also sometimes private insurance is even worse when it comes to addiction and psychological treatments

hocuspocus 3y ago
You're treated the same in big hospitals but when I was in Berlin, private vs public meant I could get an appointment at a dermatologist tomorrow instead of in two months.
ArmandGrillet 3y ago
Just open Doctolib and tell me it's the same when looking for any kind of doctor. The difference in waiting time is 3 months, bare minimum.
- Ringz 3y ago
  I just opened Doctolib and did a test with a dermatologist. The difference between private insurance was 23.5.2024 and public insurance 5.6.2024. That makes 13 days and not "3 months bare minimum". https://0x0.st/HnBZ.png https://0x0.st/HnBZ.png https://0x0.st/HnBN.png https://0x0.st/HnBN.png
  - albert180 3y ago
    Also if your primary doctor determines that you need an urgent appointment, they can give you a priority code, which gives you a quick appointment, since those visits are paid on top of the regular budget for the specialist
tietjens 3y ago
This is not true. Private insurance means better care in hospitals in Germany. Better access to appointments, choice of head/experienced doctors, even can mean better rooms.
- 3y ago

fabian2k 3y ago

That's an overly negative and hyperbolic view. Nothing is entirely wrong here, but you're painting every single point in the most negative way possible. You can certainly argue about how good the healthcare system is in the end, but it isn't categorically inaccessible. And if you pay 400 EUR/month you're earning enough money and can choose the private health system if you prefer that. The credit ranking also works in very different ways than in the US, so I wouldn't compare them directly. I'm not sure what you mean by anti-consumer contract rules.

panki27 3y ago
While choosing to be in the private system is an option, it only "makes sense" if you make at least 70k€ a year, so definitly not for everyone. The issue is not getting in - but getting back out before you retire and don't have enough available income to pay the rates anymore.
- fabian2k 3y ago
  If you pay ~400 EUR for the public healthcare you make 70k or more. The cost for public healthcare is scaled by income, and is limited around 400 EUR. It's a bit higher now, but I would suspect that the OP is not necessarily talking about the most current values here and is hitting the older limit and therefore earning more than the "Beitragsbemessungsgrenze".
  - miroljub 3y ago
    The limit is ~900 € per month, not ~400 €. People frequently forget the employer matching, which at the end comes from your pocket, since it's mandatory. Also Freelancers and self-employed need to pay full contribution of 900 €, not "just" a half.
    - cycomanic 3y ago
      No the employers contribution doesn't come out of your pocket. The employers contribution comes out of the employers pocket and is the cost of doing business. That's like arguing the rent for the office space or even the warehouse or servers come out of your salary. Your salary is essentially a function of supply and demand and not a function of cost. I mean, if external costs would influence salary we'd see remote workers earn more than on site ones, because employers save on office rent. In reality it's more likely to be that remote workers have a lower salary.

deleted 3y ago

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oytis 3y ago

Is Netherlands healthcare better? From what I've heard from people having lived in both countries, German healthcare is more accessible. E.g. in Netherlands you can't see a specialist doctor unless you convinced your GP you absolutely have to - which can be hard at times.

jacquesm 3y ago
I'm 58 and not exactly in the best of health. I've had to rely on healthcare in NL quite a few times over the last 20 years or so and all of those were serious cases. I have nothing to complain about, but that's n=1. To increment that n a bit: I know lots of people here and almost all of them have had some health issues over the years and the vast majority of those have been dealt with in a serious and reasonably effective manner. Where NL is utterly ineffective is when it comes to vague symptoms. Until it is perfectly clear what is wrong you're going to be seriously frustrated because the diagnostic machinery isn't really all that effective, when in other countries they'd spend a fortune to find out what's wrong with you in NL unless it's 100% clear you're going to have a hard time getting the care that you need. I blame Calvijn, NL seems to have a misplaced sense of reduced expression of emotion resulting in an expectation to tough things out rather than to deal with them and for some reason doctors seem to see complaints without a direct relatable cause as an attack of hysterics rather than as something to investigate. If you come from a different background you're going to find this a very difficult thing to deal with.
- formerly_proven 3y ago
  > the diagnostic machinery isn't really all that effective, when in other countries they'd spend a fortune to find out what's wrong with you in NL unless it's 100% clear you're going to have a hard time getting the care that you need. What other countries are those?
  - maeil 3y ago
    Ironically the US seems to be best, or at least the "least bad" at this (if you can afford it); it's the only positive thing I can see about US healthcare.

sofixa 3y ago

> Europe (low digitalization, high taxation, recursive federalism: within the country and within the EU). A decent chunk of those are exclusive to Germany, or at least far from the norm in the EU or Europe in general. For instance digitalisation varies wildly between countries, but Germany is definitely one of the most embarrassingly behind countries. Taxation also varies (e.g. Bulgaria and Estonia have flat income taxes). Federalism isn't a thing in most European countries too.

WarOnPrivacy 3y ago

> or public healthcare inaccessible despite paying more than 400€/month for it as a single individual. This is super close to my early 2010's ACA experiences. Even when a poor earner could scrape up enough to buy a plan, the deductible made it unusable. Policy pricing was exorbitant for $12k/yr earners but dropped enough for 22k/yr that a few plans were buyable. The challenge was coming up with another $somethingthousand to cover the deductible. There was a sharp drop-off in plan pricing at 32k/yr and some mid-grade plans were in reach. IIRC deductibles were lower on those plans and they may have been usable (or nearly so). What struck then. Of the news orgs cheering/damning the ACA, zero of them ever covered how pricing dropped as income rose. I assume that's because pricing was only ever disclosed to folks who completed the lengthy signup process - and news folks found it too daunting to experiment with.

fabian2k 3y ago
There are no real deductibles in German public healthcare, though some areas are excluded almost entirely like glasses and certain dental work. The cost is also scaled to income, the 400 EUR (which is only 50% of the cost, the other 50% pays the employer) here are what you pay when you earn ~70k EUR per year and are essentially the maximum for public health care. So it is much cheaper if you earn less money. One of the main current criticisms of the system is that it can be very difficult to get appointments with specialists compared to people with private health insurance.
- dkekenflxlf 3y ago
  Bro, du solltest mal deine Gehaltsabrechnung prüfen - mit dem Gehalt bist du bei knapp 1000€
  - fabian2k 3y ago
    I used the values from the original post, which is only the employee part and not the employer part. I also assumed that they're not using current but slightly older values here. I also didn't include the PPV, if you include that and count the employer part you end up at 1000 EUR.

interactivecode 3y ago

Healthcare is kinda shit in The Netherlands. Long waiting lists even for simple things. Never actually prescribing medication but instead over prescribing paracetamol. Only being able to get a set amount for appointments regardless of actual need. Sure if you’re in a car crash and urgently need care they will help you without going bankrupt but anything less urgent good luck getting an appointment this week / month / year

karpour 3y ago
This, not nearly as bad in the US, but a mess of private insurances.
- njarboe 3y ago
  A mess of private insurances, partial payment by the government of private insurance based on income, and then full (or almost full) government payment based on veteran status, income, and age. It's more complicated than this of course.
notaustinpowers 3y ago
Does The Netherlands not have Urgent Care facilities like the US? I feel like those for of facilities could handle the issues of a lack of access for simple or menial things. I had to get a cyst lanced a few weeks ago and I just walked into an Urgent Care by my house and was in and out in about an hour with no appointment. I think it was about $180 since I didn't have insurance.
anonzzzies 3y ago
I am dutch and have lived in quite a few countries in the eu and se asia: I would prefer to never have to deal with NL healthcare services again compared to other countries. And I have been (unfortunately) been in hospitals, a lot. Since the 90s NL is striving to become little USA policy wise and this is still getting worse. It’s a shit show.

ciclotrone 3y ago

I find it quite disturbing that high taxation is seen as a negative aspect of Europe. I lived in Italy, France and Germany, and I enjoyed public healthcare and education of very high standard at very affordable prices, and free in the limit that one cannot afford to pay for them. As a relative of a person with a chronic disease I can tell you that on the one hand if we are not bankrupt it is because of public healthcare, and on the other I'm proud of contributing through my taxes so that anybody in need can have the same treatment irrespective of their economic situation.

formerly_proven 3y ago
High taxes with no matching value behind them is undeniably a negative.
- Nextgrid 3y ago
  Yes, that's my problem with high taxation, as someone who got burnt by it by virtue of living and paying taxes in the UK. I don't mind paying my fair share of tax if it means I get good value out of it, but the state of our healthcare here means that in practice the public healthcare system is no longer fit for purpose, so we are being forced to pay for a system that doesn't work and end up having to go private (and thus pay again) when we do need timely healthcare. I am generally in favor of fair, progressive taxation to ensure everyone has a good social safety net, but the taxation should be fair (it's no longer the case in the UK, since tax brackets haven't been adjusted for inflation) and the services paid for by those taxes should provide good value. The danger with services funded by taxes as opposed to a private enterprise operating in a free market is that private enterprises are bound by competitive pressure - if they are delivering terrible service and stuffing their pockets with the money, you are free not to do business with them and a potential competitor (that stuffs their pockets a little less) can come along and get your business instead. With tax-funded services, this pressure doesn't exist, so there's no incentive for politicians (and everyone else in the value chain) to deliver good service, since people generally can't opt out of taxes. This means that even if a service is currently good, there's no guarantee it will remain so since the pressure for it to remain isn't there. Thus, when you see high taxation, it's reasonable to be worried whether the service provided by those taxes is any good and whether it will remain so in the future.

miken123 3y ago

> A country like the Netherlands has its own issues (mainly housing) but doesn't have the myriad of pain points you can find in Germany like Schufa In the Netherlands we have BKR, which is less all-encompassing than SCHUFA, but also needed to be fined before giving proper right to access under the GDPR: https://edpb.europa.eu/news/national-news/2020/national-credit-register-bkr-fined-personal-data-access-charges_en https://edpb.europa.eu/news/national-news/2020/national-cred...

javajosh 3y ago

>low digitalization Given that everyone uses IBAN, and it works great, I strongly disagree. >private healthcare if you want decent treatments Your mileage may vary, but I was very impressed with the speed and ease of acquiring healthcare under a public plan. The lack of paperwork for seeing a new doctor is astonishing. The lack of copays, SOBs, and all that is like a breath of fresh air, and is worth copying in the US. Heck I once saw a doctor for something and simply gave my card, and saw the doctor in the next hour, and she decided I needed an ultrasound...and did the ultrasound in 5 minutes herself. In the US, this would have been a multi-week ordeal with multiple rounds of paperwork and visits to different offices. My wife also had a C-section at a Berlin hospital and the care was competent and 100% covered by our public insurance. In the US couples requiring a C-section can expect $20k+ of debt.

jamesmunns 3y ago
Low digitalization isn't just payment - it's also needing to fill in paper forms, or making in-person visits to government and business offices. I've been living in Germany for about a decade, and it is still behind in many of these items from when I left the US, and having a friend that recently moved from Germany to NL, he was blown away at how convenient and just not-hostile so many day to day interactions with governments and businesses were. Like - big picture, I'm very happy in Germany, but certain things are still very archaic and sometimes needlessly so.
- shellfishgene 3y ago
  I agree, just look at the recent (well, decade-long?) attempt to digitalize the car registration process, which can only be called a total desaster.
Bayart 3y ago
My impression coming from France, which I never thought of as particularly progressive on the technological front, is that Germany is full of odd, idiosyncratic archaisms.

Unfrozen0688 3y ago

low digitalization, high taxation Sweden is highly digitalized, we pay on our phones, pay taxes on our phones, do government stuff on phone or webbrowser. No stores do cash anymore (also a negative) High taxes is a positive if used right

miroljub 3y ago
Sweden is a low tax land compared to Germany. In the past, it was known for high taxes, but one could argue that this progress came together with the tax reduction in the last decades.

usr1106 3y ago

German "public" healthcare is much more accessible and has much better coverage than its Finnish counterpart. Despite Finland reapeatedly making headlines (including on HN) about being a Nordic welfare state. Germans are typically complaining from a high level. Source: Members of the wider family living in both countries. Some over 80 and needing a lot of healthcare services. (I hear general practioners can be a problem in poorer areas in the East. My experiences are from a prosperous area in the West.)

oarfish 3y ago
A finnish colleague once told me that the Finns just don't go to the doctor unless something falls off. Any accuracy to that?
- usr1106 3y ago
  Yes, especially for Finnish men in the countryside that's a sterotype with quite some truth behind it. Edit: And that results in a dangerous combination: First waiting too long and then getting the answser "no free appointments". And if you insist the next one is in 3 or 6 months. Many Finns do not insist.
graemep 3y ago
> Germans are typically complaining from a high level. Do Germans share the British tendency to think everything is better in the rest of the world? As an immigrant (as a child, admittedly) and someone who has lived and worked elsewhere and, more importantly, does not completely share this aspect of the culture, I find British pessimism and self-flagellation really, really annoying.
- carstenhag 3y ago
  Germans unfortunately like to complain a lot. Many things are better elsewhere, is claimed. Except for many other countries nearby. And the weirdos from UK leaving EU. And the weirdos from US with Trump. And we have it so bad, so bad. Sometimes I hate my fellow Germans.

moi2388 3y ago

True, but in the Netherlands it’s the government itself which sells all of your data, literally everything from your house, it’s price, location, blueprints, satellite images, what you paid for it, previous owners, your car, and even your government ID number if you are registered as a company, just to many a couple. And yes, you obviously have to pay to get your own data.

meroes 3y ago

400€ for medical, dental, and optical combined you mean. And less for students. And you conveniently leave out their 4 week minimum vacation time/year. (my sis and her BIL just moved from there, and help people move there). Digitalization is really behind yes, and homeownership is even more expensive than the US. But rent is almost half the US and groceries are cheaper. And instead of subsidizing full sized pickup trucks and EVs, you get Audis, VWs, etc for cheaper.

discopicante 3y ago
Now compare median income of Germany vs US. Economic opportunity is fading away in Germany. Also, pretty much all cars - especially Audis, VWs, etc are (20-30%) more expensive in Germany vs US.

mk89 3y ago

> private healthcare if you want decent treatments > public healthcare inaccessible What do you mean? I am not sure what you mean by decent treatments. > Schufa There is some change happening there, especially now that the EU Justice Court ruled against credit scoring institutions (they break GDPR, etc.). Very slowly, as usual, but it might happen. (Also the current governement is planning changes.)