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If healthcare doubles in price do people start working longer to afford healthcare in their old age? Or do they just consume less of it and accept sacrifices to the quality of it?
I think the latter, which is why I put healthcare with luxury goods as an item where a decline in quality won't kill retirement.
Healthcare in particular is also not a great example of hitting limits on what is possible. I'm informed that in many western countries a large part of the scarcity is from strict limitations on how many people can head into the profession rather than from a lack of people who could do the work (after necessary training).
If this is the case then the issue is not that a large retirement population is unsustainable, but that a gross mismanagement of resources is occurring in healthcare.
This is Germany we're talking about. People will do what they're told. If they're told to work longer, they'll work longer unless they get a medical exemption, which at present most who want do manage to get. If quality goes down then they will indeed just accept that. What else would they do? Few people switch from public to private insurance, and the quality difference between the two isn't very pronounced to begin with.
So, you're right. A decline in health care quality will not kill retirement. In my opinion it's the increase in health care expenses that will sooner or later encourage a government to raise the retirement age in order to slow the decline in pension-provided purchasing power. Of course there's not much left to earn here; the nominal retirement age in Germany is at 67, compared to 62 in France. How much productivity can you squeeze out of septuagenarians? It's mostly a question of cutting expenses and leaving more for those who do draw a pension. So I say retirement will become more exclusive in Germany so it doesn't devolve into a joke pension that's insufficient to live off.
Germany also has an immensely expensive healthcare system.
IIRC correctly, people visited doctors on average more than any other OECD country. I'm also shocked by how common, e.g. MRI devices are in Munich. In BC in Canada there are a few mobile ones that services the entire interior, and there are often month long waits for elective scans (too long, IMO, by the way). Near Munich I was able to get an MRI for my knee the next day.
So, there's at least some fat to be cut.
(In a further out there way, I think there's an unserviced niche of 'low-level' medical care -- basically advanced first aid clinics, where I wish we could have 'associate doctors' trained in 1/3 the time (basically advanced nurses) in clinics, as I think they could handle many 'standard' issues that GPs do (including taking blood for tests and administering vaccines. But that's a whole 'nother area)
Where I am GPs would write a script for a blood test and you would go off to the clinic nurse or a pathology centre to get your blood taken. How many countries in the world have GPs that use consultation time for phlebotomy?
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