Americans Are Going Bankrupt from Getting Sick

As a German software engineer that used to work in the USA, do I pay more taxes in Germany, yes. But, I don't have to worry about going bankrupt from medical issues. In Seattle where I used to live daycare is 30,000$ a year per kid. In Germany it's at most like 200-300 euros a month. Plus you get kindergeld too(200 euros per kid). We don't go into 10s of thousands to hundreds of thousands of dollars in debt for school. Even with my "good" benefits I had at my job in the US, I would never move back.

It's true, but it also includes benefits and not only taxes. An American-level software engineering salary in Sweden is also probably twice that of the average software engineer, so you are going to pay a lot more in taxes than the average software engineer. That is because wealth transfers and income equality is Sweden's way to create a nice society. The problem is however that today an average salary, even as a software engineer, doesn't go very far in Sweden. And especially not in the housing market. You need wealth, which isn't taxed much by comparison. So in that sense your outrage is correct.

True, but those taxes pay for things that money can't buy; for example job security, open spaces, parks, social services such as cheap child-care, paternity/maternity leave, etc, etc.

You can't just compare salary. The lifestyle is different. You'll get 4-5 weeks of (paid) holiday, you'll live in a modern country where the taxes are high, but the streets are clean, people are looked after, and you'll have effective health-care.

(Disclaimer: I'm in Finland, not Sweden, but things are similar here.)

I would gladly give up 70% of my salary to live in a comfortable and equitable society.

All of this is a side-effect of the uniquely American philosophy that says that if someone is making money they must be making a net positive contribution to society, because otherwise why would anyone buy their product? This approach overlooks externalities and rent-seeking. The net result is that we have a lot of people making money selling things to people that they want but makes them sick (soda, cigarettes, corn chips) and a lot of other people making money professing to make them less sick, and yet another group of people making money by professing to control the costs of the second group, and lot of other people making money lobbying politicians to keep the laws in place that maintains the status quo. So everyone's making money (except for the slackers who dare to get sick), so everything must be hunky dory. The American health care system is the broken-window theory writ large.

The spending is due to research and development, not because more people are sick.

A “true free market” doesn’t have no patents any more than it has no rights in land. Patents prevent what would othwrwise be a market failure (free riding) just as property rights in land prevent tragedy of the commons. Put differently, you can’t have markets where you can just take things instead of entering into transactions. Because you can do that in the state of nature, markets are inherently artificial constructs.

America's healthcare system is what furthers the world's healthcare through research and development. Because it is for profit, the quality and advances are superior. Other countries that reap the benefits of drugs that America create while only paying generic prices when Americans have to pay for the inflated prices that pay for those expensive drug trials.

but of course that doesn't mean Sweden pays more from those taxes on Healthcare than the US.

Looking at the "Government and compulsory" figures here https://data.oecd.org/healthres/health-spending.htm the US appears to be at $8407 per person for gov. + compulsory spending and Swedent is at $4606.

Healthcare gets funded in each country by a combination of taxes and people paying out of pocket. In the U.S. employer subsidized health care insurance should be viewed as part of an employee’s compensation. What matters in such discussions is not the tax rate but the overall spending per capita and how much it costs at point of contact. The relevant facts are that the U.S. spends far more per capita and costs far more at point of contact than every other OECD country.

I think the person you responded to was attempting to point out that Sweden’s healthcare costs come mostly from taxes and is cheap at point of contact. I don’t believe they meant to give the impression that taxes in the U.S. are higher than in Sweden.

Ironically, I support single payer healthcare (or at least a dramatic restructuring that decouples pricing from employment) specifically because of individualism.

Right now, you need to work at a corporation to get collective bargaining for healthcare prices. This presents a huge disadvantage to people wanting to be contractors, self-employed artists, people wanting to start small businesses, people who only want to work every other year for whatever reason, etc.

Your options are limited because you need to be part of a corporate collective to get reasonable healthcare options.

It's interesting you say that, I've heard that line of argument before but it is quite puzzling.

Are you suggesting that a person on Low income in the US doesn't object to paying more than they have for their own healthcare (i.e. that they wouldn't like that healthcare to be cheaper)

That seems a bit counter-intuitive, as usually people don't like being bankrupt.

And you do have a system where you pay more than anyone else for the pleasure of poor people dying. Harshly worded but that is already solved, and somehow I don't see people being happy with it.

I think it's pretty clear that taxes per capita to healthcare being third highest in the world isn't common knowledge.

> America is a deeply individualistic society

Polls say otherwise: http://nymag.com/intelligencer/2018/08/new-poll-majority-of-...

Who benefits from convincing Americans they're individualistic and should remain isolated when negotiating with giant corporations?

All this leads to is less people going in for annual checkups and preventative health care which leads to people becoming catastrophically sick ($40k medical bills) vs. preventing that situation from happening at all if it can be prevented; or catching it early on so it can be mitigated.

It's been a long time since I've worked in retail where I had no employee provided healthcare but back then I'd only go to the doctor if my arm was falling off. Everything else was "this feels weird, I'll wait it out, hopefully it goes away because I don't have $150-200 for a checkup if it turns out to be nothing."

A simple example is dental care. Yearly checkups, cleanings, etc and actively working to prevent major issues leads to far less diseases (blood, etc). But when you don't have decent insurance knowing that you might go in and get told you've got a $400 cavity or need a $1500 root canal out of pocket dissuades a lot of people from even going in. Thankfully I have generally healthy teeth but I hadn't gone to a dentist since my teens (parents insurance) until a few years ago. And once you tell someone that you might be shocked by the number of people who come out of the woodwork to tell you they haven't gone either.

I generally thought I was incredibly healthy and invincible until 28 when out of the blue I got appendicitis, which was $35k. I still had my "only go if my arms falling off" mentality back then but eventually the pain was so unbearable that I drove myself to the ER as I knew something serious was going on. Thankfully I had insurance. That really taught me that there's a lot of things in my body that I have no control over regardless of how healthy and active I am and having a fall back plan to help when catastrophe happens is critical.

I agree. Unfortunately, Americans are not all multi millionaires or billionaires and almost all Americans are too stupid to realize that they won't be able to afford their own healthcare without a "socialized" government run system. Such stupidity is a hallmark trait of such an individualistic, selfish society in which people cannot think of others or or collective action. Other traits are high levels of depression, anxiety, and drug abuse due to isolation and the complete lack of community. But hey, at least you can watch your neighbor die slowly of cancer he can't afford to get treatment for from afar. That seems to be something Americans enjoy.

I don't think that "individualistic" is a strong enough word. European society, for instance, is also very individualistic, yet doesn't have anywhere near the levels of indoctrination against "socialism".

It seems Americans (generalizing here) have been let to believe that someones gain can only happen at someone else's loss, thinking there can't be a win-win situation.

You have touched on what i think is the critical underlying difference between Left and Right thinking.

Systemic responsibility vs personal responsibility.

The thing is, they are not mutually exclusive. They are more like two sides of the same coin. And while those two sides may not be exactly equal, most arguments between the sides seem to centre on the disjunct between these two ways of thinking.

If you can acknowledge, but frame the very real issue of personal responsibility within the context of a system, we may find it easier to bridge this divide.

For example, judge the responsibility of three hypothetical people with a sweet tooth.

1. Tries to eat healthy, but goes out to buy a cake every day.

2. Tries to eat healthy, but friend brings around cake every day to tempt.

3. Tries to eat healthy, but friend brings around cake everyday, and empties pantry of all other healthy food.

Most people will waver on 2. or 3. But depending on where you live, 3. may well be the closest to reality.

Yeah yeah the deflationary death spiral that’s never actually happened.

Saving is literally keeping money to use it at a later date. So how will you retire without saving? Are you planning on working until you’re dead?

The bulk of research shows the US spends more on healthcare due to higher prices, not more care. Increasing taxes will not solve anything without some sort of strategy to control prices.

One solution is price controls for common, well understood procedures and medications, like most other countries with single-payer. The UK for example, engages in price controls.

> It can probably be helpful to try and look for differences between countries as opposed to just going for a libertarian end-run. Problems with the US system are an out-of-control pricing structure due to fragmentation of bargaining power, insane patenting laws which allow evergreening strategies, ideological opposition to functional and prove reforms, and good old fashioned cronyism.

It’s funny what “differences” people choose to fixate on. For example, patent systems are very similar between the US and Europe. And I doubt you can quantify any difference in “cronyism.” Supply of medical professionals, and doctor salaries, are quite different. So to are limits on what the state will pay for end-of-life and terminal care. (For example, when you see stories about people reaching their lifetime limit on insurance in the US, go check if the UK NHS’s death panels would have allowed anywhere near those expenses under their QALY calculations.)

I’d also love to hear your theory for how pharmaceuticals are a “natural monopoly.” EU countries lower drug prices through good old monopsony (single buyer), which has similar detrimental effects to a monopoly (single seller). They just get away with it because the US continues to resist such efforts.

3 hour of wait time is bearable but i'm really sorry that you had to spend $2 on that shitty Timmies coffee.

While that's true, that's also true for all other countries where hospitals don't bill you $2,600 for glue and five minutes. So now the question merely shifts to why America needs that much money for stocking supplies and keeping doctors sitting at hospital.

It's more that they paid to cover the costs of all of the other emergency room patients that never paid their bills.

No one actually pays the sticker price anyway, that's an artifact of the strange ways that medical billing works. People that pay in cash (rather than insurance) are given large discounts.

If I go to an Apple store and buy a mouse would it be reasonable for them to add on $300 for keeping iMacs in stock just in case I'd wanted one?

That would make sense if it was a fixed charge regardless of treatment. But if you did need those extra facilities they would charge you even more!

No none of that overhead was needed. He was giving them free money. That's what this system is more akin too.

If that overhead cost was required the insurance company wouldn't have been able to negotiate it down

It needs to be billed and itemized then because that's racketeering language.

Moreso for the indigent patients who don't pay at all for ER use.

You need single payer because you can overcharge anyone who can't negotiate lower rates (i.e. individuals who's personal business with the healthcare system doesn't have much if any effect on it).

Compare that to a state bargaining on behalf of 10+ million customers.

I think the final amount I had to pay was around $1,150.

Any other system is going to be written by lobbyist relying on complexity for cover.

If consumers had as much political strength on capitol hill as the medical industry, another system could be worked out. But they don't. The window was closed on that option with Citizens United.