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Comment by mseidl | Hacker News Reader

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.

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Most Americans have good healthcare through their employer. The premiums are reasonable, and the quality is great. Only if you're self employed or part time do you pay out of pocket, something you need to factor in when you make life decisions.

I think maybe you mean to qualify that as “most American software engineers?” Or maybe even “most Americans in white collar jobs”, although that’s not a universal, and the premiums and quality of care in many of those plans is absolute crap. Heck, even as a software engineer, my medical insurance is mediocre and a high-deductible plan costs more in premiums ON TOP OF what my employer pays than I’d spend out of pocket in a year without a major medical emergency.

In 2017, 91.2% of people have coverage, 67.2% through their employer. 71% of Americans answered they are satisfied with their employer-provided coverage.

Anecdotally, I'm satisfied with my coverage.

https://www.ahip.org/majority-of-americans-satisfied-with-th...

https://www.census.gov/library/publications/2018/demo/p60-26...

I have “excellent” coverage in the US and am now pregnant with my second baby. My first pregnancy and birth ended up costing thousands of dollars. During pregnancy, I received an endless stream of unpredictable lab test bills (why does this test cost $13 and this one costs $273?). After the birth itself, every provider who saw me in the hospital sent me a separate bill, on top of which I was billed for the room itself and for the individual drugs.

Almost any other system would be better than this. If it were out of pocket there would at least be downward pressure on prices and clearer pricing in the first place. Or we could provide it as a public service like every other developed country.

What did you really end up paying though?

On average Americans pay $3,000 for childbirth.

If our system was like every other developed country, we wouldn't have the medical developments we have today.

> 91.2% of people have coverage, 67.2% through their employer. 71% of Americans answered they are satisfied with their employer-provided coverage.

So, almost 4 percentage points more Americans are satisfied with their employer-provided healthcare than actually have it?

Or do you mean 71% of the 67.2% not 71% of Americans?

That survey was for employee provided coverage, so it would be 71% of the 67.2% Americans who get their coverage via employers. I couldn't find satisfaction rates for government provided coverage.

Which means less than half of Americans are satisfied with their coverage. Not “most”.

No that means the majority of people with employee provided insurance are happy.

There aren't stats on satisfaction of government provided healthcare, but if they are unsatisfied it furthers my point that the government should stay out of healthcare. And if they are satisfied then there is no problem :)

Uh..no..I'm not sure where you're getting your facts but no this is completely false. Most Americans have either Medicare/Medicaid, or various levels of employer sponsored healthcare, most of which are really poor or push large burdens on their employees. I have fully paid for healthcare through my employer and I STILL have a $5000 max out of pocket that I have to cover before insurance fully covers me. To put that in perspective that's an entire month's income in a country where most people live paycheck to paycheck.

Oh and the cherry on top of that is that in the US you can literally be fired for getting a prolonged medical illness, such as, oh say, cancer, which impacts nearly every single American. It's totally legal, which then takes your wonderful healthcare and removes it right when you need it most and can least afford to lose it. Another fun fact is that it's really hard for most people to work when getting prolonged medical care, which means, again you can't really pay for the bills you are getting.

If you think quality is great, then you're lucky. US hospitals can flat out refuse to treat you properly if you're "lucky" enough to go to a Christian based hospital, which will deny care unless life threatening, in some states this nears the majority of hospitals.

So no, most people who go bankrupt from medical bills in America HAVE health insurance. You're living in a fantasy bubble I suggest you step out of before you get a huge shock. I sincerely hope you never have to experience this first hand because it's absolutely hell for those who have to go through it.

Sources: Average US Income: https://en.wikipedia.org/wiki/Household_income_in_the_United...

Catholic Healthcare: https://www.forbes.com/sites/judystone/2016/05/07/health-car...

Healthcare bankruptcies: https://www.cnbc.com/id/100840148 Rebuttal: https://www.snopes.com/fact-check/643000-bankruptcies-in-the... https://www.studyfinds.org/two-thirds-of-all-american-bankru...

Edit: I don't mean to suggest US healthcare providers are poor, it's generally the best in the world if you live in the east coast, Texas, or west coast the south and midwest generally have poorer coverage with the exception of cities. We basically have the best healthcare that you can afford, the problem is that most people can't afford it.

Over 71% of people are happy with their employer coverage, as am I. I also chose a high deductible of $5000, but I have a $0 monthly premium. If I chose a $50 premium, I would pay $500 deductible. And that's only for major expenses. Drugs and checkups don't need the deductible. Yes, there's reforms needed, but it's not the apocalyptic picture people paint.

> Over 71% of people are happy with their employer coverage

That statistic is not terribly revealing, as I suspect that the vast majority of those 71% are relatively healthy/young people. I'd like to know the percentage of people who have had significant health events in the past 12 months that are happy with their coverage.

It usually takes a few months for employer coverage to kick in. And most people stay at their jobs for well over a couple of years. I'm sure most of those people have had to use their insurance in their period of time of working at their job. I find it harder to believe the opposite.

> I'm sure most of those people have had to use their insurance in their period of time of working at their job. I find it harder to believe the opposite.

Using your insurance for regular doctor appointments or the occasional flu or bronchitis is quite different from realizing you have a serious chronic condition, or require a major surgery. You don't buy insurance for regular needs, you buy it for the unforeseen serious ones. These are rare, but it's here where the quality of insurance really matters.

Judging the quality of insurance from the standpoint of the "average person" is not the correct perspective. You need to judge it by the person who needs to file serious claims. From this perspective, 70% of "average people" being happy with their insurance seems remarkably low.

Funny you talk about quality insurance, but its employer provided insurance that's higher quality than the government or self paid ones. Because the employer gets a very good bulk deal and pays a high premium, much more than the average person can self-pay. That is why satisfaction is so high for employer provided insurance.

> Funny you talk about quality insurance, but its employer provided insurance that's higher quality than the government or self paid ones.

Government insurance, at least for federal employees, is actually very good, and for the same reasons you stated. There are few with as much bargaining power as governments.

But I don't quite get your point. You said that 70% of people are happy with their insurance. And my point was that doesn't seem very high at all as most people aren't that sick. You can't use a majority's viewpoint to judge the quality of a service that they don't use.

For how many years did you work in the USA?

I highly doubt daycare is 30k / year.

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