this post was submitted on 18 Jun 2026
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Germany also does insurance companies. Turns out that can actually be fine if you sweat the details and not just do something random like how the US ended up with employer-sponsored health insurance.
Mind you, the German system is one of the most expensive in the world. It's also only of middling quality in terms of outcomes compared with other wealthy nations.
But it's still less than half as expensive as whatever it is the States are doing, still has effectively universal coverage, and is actually competitive with other wealthy nations.
All because we regulated the everliving shit out of the whole process. You can't as much as fart incorrectly in the German healthcare system without having an army of bureaucrats breathing down your neck in one of three prescribed breathing rhythms, one of which only applies if you farted in a hospital. Reports will be written, filed, and sent to recipients who can only change their mailing address on one of four specific days a year and only if they announced the move four weeks in advance by sending special crafted EDIFACT files to the right people.
As much as it sucks, that bureaucracy also shuts down a lot of nonsense. Insurance networks, deductibles, most copays, and ruinous hospital bills straight up don't exist because everyone in healthcare has zero leeway to do anything in a non-prescribed manner and the prescribed manner was designed to keep as many people as possible reasonably healthy.
It's a very German approach: Massively bureaucratic, regulated to an almost comical degree, and reasonably effective.
Meanwhile in America we have similar levels of bureaucracy but it's corporate bureaucracy that's dead set on forcing you to file mountains of paperwork to get them to pay for anything.
Sorry, recently read a book that among other things lamented the fact that we as a society have stopped acknowledging corporate bureaucracy as bureaucracy
It helps that much of this bureaucracy is invisible to the patient. You just go to the doctor and they scan your insurance card. That's it for billing as far as you're concerned.
What happens behind the scenes is a horrible mess that has been in the process of being digitalized for the last decade. But they did put up a nice facade that hides most of this.
By the way, that part about quarterly EDIFACT files to change addresses is actually how it works for health insurances. Of course they regularly screw this up and then everyone else has to deal with the mess... But that's just everyone who tries to bill them. Patients didn't even know it's a thing.
I live for book recommendations! Please share the title and what you thought of the book!
A Utopia of Rules by David Graeber
It's a collection of 3 essays by him on the topic of bureaucracy and I enjoyed it a lot, but I enjoyed everything by him that I've read
I wondered if it was at all related to Bullshit Jobs
It’s not random, it is another way to make you dependent on corporations.
Or more specifically dependent on your job.
Jobs give health insurance. If you lose your job then you lose your health insurance. It’s how America keeps the work force more docile and willing to put up with working conditions.
Some jobs.
Yeah. The ACA was a way to stop that and a way to work with independent insurance. When it was cheap.
The last 2 years, at least, have been terrible. $500 for single person standard coverage in 24. $650 for standard coverage, single person, in 25. Then, there was also a bit where the only good plans (lower deductible and such) were subsidized. There were people who would work into those and then pay back the difference at tax time, because even that was cheaper than the crappier plans available to those paying 100%.
ACA was meant to be tweaked and improved from the day of inception. It was never “finished”. Instead, it was embattled, left to rot, and eventually de-subsidized.
The problem is Americans view UHC as single payer.