US Workers Are Highly Taxed If You Count Premiums
peoplespolicyproject.org
peoplespolicyproject.org
But even that doesn't include the real sting on the tail of US medicine. You pay a fairly high health insurance premium, but if you actually need health services you then pay again through the nose even with insurance "discounts."
For example my under one year old needed to go to the emergency room due to a high fever for several hours, we paid over $300 on top of paying over a thousand in combined employer/employee premiums each month. That's with insurance picking up at least that much.
My wife and I have never paid four figures for a doctor visit, despite having two surgeries (one oral), a calf strain, and a dislocated shoulder (with ER visit) between us. The state of medical care in the US is bad enough as it is; you don't need to make up hyperbolic bullshit to make it seem worse.
When I did ask, their response was basically a more nicely worded version of that.
Your mileage will vary depending on the bill collector, hospital system, staff etc., but keep in mind someone has to be paying the bills. American, work in tech, post on Hackernews? It’s probably going to be you.
Always worth a shot though. Worst case they’ll usually let you go on a 0% APR payment plan for years and years.
Just because there wasn't anything wrong doesn't mean you don't have to pay a person for their services.
How much does an ER visit like that cost in a sane country? I mean the actual cost, not the “free” that the patient might see from a socialized system. It’s nowhere near that high.
On the top of that, he didn't charge you for what it was, but for what it wasn't and confirming it.
Take for instance if that muscle spasm actually lead to something darn serious, the doctor ruled that out, that's why he sent you back after 10 mins. For some weird reason (or counter-intuitive economic reasoning which everyone has got), if you had a serious problem, and the doctor had identified it in that 10 mins, then you'd be ok with that billing.
See it this way, if you're tech security contractor and the CEO calls you urgently to come take a look at suspicious behavior on his computer which he thinks might be a hacker hacking his computer, but it turns out to be a quite known windows bug, that doesn't mean you shouldn't charge him your regular fee if it was an actual hacking attempt. You're getting paid for being on call.
It's also about what we paid for my wife's shoulder. Which, like I said, is bad enough on its own.
My son had a laceration glued together (dermabond in lieu of one or two stitches) and that was either close to or slightly over four digits after totaling the hospital bill and doctor bill, both in network.
I'm fine with paying a premium for trained professionals, I'm fine with paying doctors a high wage. $120 is crazy for a doctor who already has an opening in their schedule taking less than 10 minutes to glance at a wound and slap some steri-strips on it.
> Maybe consider that your experience is the exceptional, not the people you call hyperbolic.
I'm not saying I'm typical. I'm saying that four-figure Mexican bills aren't. If they were, then I'm an extreme outlier, which I don't accept.
We have a friend whose hospital tried to charge them $15k for a delivery room they never used - never used because the doctors forgot about them and she delivered her own baby in the hallway. Talk about two major fuckups in a row.
With insurance we paid $800 for her to lay in the Er for 3 hours.
I guess I shouldn’t have gotten injured on a federal holiday.
When I had back surgery I was with a public employer PPO. Total out of pocket was like $300 for about $500k of procedures. Half the people in my recovery PT were selling cars and emptying 401ks to make the mortgage.
I never said it doesn't happen, which seems to be the strawman most people are responding to. However, there is a huge gap between "it happens" and
> happy if your cost for seeing a doctor is less than 4 digits
which I indicates this is common and typical.
Socialized insurance rates in Germany are 15% of income. Unless your family doesn't earn any money, they have been paying far more than 50 Euros.
> In the US you can happy if your cost for seeing a doctor is less than 4 digits.
That isn't generally true. Every insurance plan is different. Cheap plans have a high deductible. It's similar to private insurance in Germany.
It's basically like this: If you're gonna be poor, go to Germany. Everyone else will pay for you. If you're going to earn well, leave Germany, otherwise you're going to be paying for everyone else.
You should add this to your algorithm for location choice: If you get a serious health problem and want to become poor, come to the US.
However, if I were to get seriously and chronically sick I would back to my home country. Not that i couldn’t get very good care in the US, but the system here is just a massive burden compared to countries with universal coverage.
If you already have a serious health problem, you'll be hard pressed to find any country to take you and just take care of it pro-bono, if you're uninsured.
German public insurance only covers the bare minimum. I know enough people who are poor because of serious health issues. Sure, their medical costs were covered, but they're now welfare cases. They can't afford many treatments that would make their lives better. They would've had to buy extra insurance, but they chose not to, or couldn't afford it.
Relating that to the US: Don't skimp on insurance. Don't get an insurance that is capped at a low number, otherwise you will go bankrupt if shit hits the fan.
But shit will not hit the fan for the overwhelming majority of people. There's no good reason for someone in their 20s (or 30s) with, no dependents, no history of medical problems and doesn't partake in a dangerous lifestyle to load up on coverage. Loading up on coverage in that situation might make you feel warm and fuzzy. It might win you internet points. It is not financially sound.
Comments like this always miss the larger point, which is that healthcare overall is cheaper in socialized systems because the government as a large entity negotiates on behalf of citizens and puts strong downward pressure on prices.
What happens in socialized systems is that the government does price fixing, which makes healthcare worse and it limits supply. Try getting a specialist appointment with socialized healthcare in Germany, it can take several months. Get private insurance (or pay out of pocket) and suddenly appointments become available. Doctors are leaving the country in droves.
Some of the hospitals in Germany are in an abysmal state, MRSA rates are extremely high:
https://correctiv.org/en/latest-stories/super-bugs/2017/01/1...
They negotiate prices based on the size of the pool. This is why if you are a small business the rates you will get will be worse than if you were a large enterprise.
With socialized healthcare, the pool is the entire citizenry, which is what gives the government substantial leverage when negotiating.
That's not to say the American system is good, but I can't stand all this talk about how socialized healthcare is so great. It isn't. A lot of what people are calling "socialized" systems are actually private systems with a compulsion to purchase insurance, for example Switzerland, Netherlands, Australia. Even Germany technically has a dual system (public and private) but only the top earners are allowed to go private.
As a Canadian, I will say there are a lot of people dissatisfied with the Canadian system. Likely to a lesser degree than in the US, but the system is far from perfect.
Incorrect. In the public system, the fees are negotiated between the GKV Spitzenverband (federal association of public health insurers) and the KBV (federal association of public doctors).
Germany still is in the top group regarding quality of care indicators.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
Salaries for doctors are the highest in the US. If we want to move to a single payer system they will have to take significant pay cuts.
And that's kinda the point of the parents' post, I think. If I were paying 15% of my income for socialized health care, I would be pissed if I ever had to pay anything out of pocket for my own medical needs.
1. The 15% of income has a cap. It's something like after 60k EUR in wages you don't pay anymore. Also, only 7.5% comes out of your paycheck, the employer pays the other half. When I was there a few years ago I was self employed so I had to pay "both sides". It would've worked out to roughly 750EUR/month for health insurance which had _0 deductible_ and _0 coinsurance_ for doctors visits or ER care and would've covered my entire family no matter on my children I had. Compare that with a typical HDHP family plan offered in the US and you're looking at $400/mo in premiums, with a $3k deductible and max OOP of $6k. The final cost is comparable.
2. The 15% is only if you participate in the public system - the private is not tied to your income.
You might delude yourself that this "other half" is paid by the employer, but in reality your employer takes that cost into account when employing you, so they offer you lower gross salary because of that. In other words: it's still paid by you, just indirectly.
EDIT: more clear wording.
That distinction is imaginary. It all comes out of your total cost for employer, which either goes to you or to (possibly earmarked) taxes.
This doesn't mean the amount is not fair (it very well might be). But it's important to realize it all comes from your paycheck.
This just means that paychecks are 7.5% lower then they would otherwise be. It is a mistake to think that the employer paid benefits are "free". The market adjusts. You find that out right quick of you are self-employed (at least in the US).
But still, if you count everything together, for a 2keur net paycheck you have to charge your customers 4.8k in my country (slovenia), and the government takes 2.8k (social benefits, pension, health, income tax and VAT). Say what you want, but 4.8k->2k is a huge amount of taxes.
...at which point progressive income tax starts kicking in badly.
> Also, only 7.5% comes out of your paycheck, the employer pays the other half.
Guess what, the employer pays 100% of your paycheck, including your vacation, pension, healthcare and taxes. It doesn't really matter to the employer how the cost is labeled. That's why you get to charge more when self-employed.
> The final cost is comparable.
Comparable? It's almost double if you don't take any care. Also, what if you don't have children? It's apples and oranges.
> The 15% is only if you participate in the public system - the private is not tied to your income.
Caveat: You are forced to take part in the public system unless you earn well or you are self-employed.
But many places don't have any kind of Urgent Care centers, much less one that is open 24 hours a day.
* Potentially life-threatening emergency: ER
* Something like a broken bone or fever that needs to be fixed asap, but not life-threatening: Urgent Care
* Everything else that can wait a bit: regular doctor appt
In two years we were there with our baby two times. Not charged a penny. During this time, I went once, my wife went once. In all instances we were reassured that it was appropriate to visit the hospital instead of visiting the GP the next day.
My wife firmly believes the US healthcare system is a giant scam where insurance companies leech off people without actually providing any value.
Health insurance in the US is built around providing value to employers. Most employers are concerned about which network is going to upset the fewest key employees and cost the least amount of money for the employer, while fulfilling all legal obligations, without making the employees spend too much time dealing with the insurance company when they could be working. Nicer employers may want to cover more of the cost, or want to upset fewer employees, or have specific things they want covered that aren't legally obligated.
There's also the problem that different groups of people want totally different things from the system. I like integrated care, because it provides me with a single place to go, that handles everything, even though it may not always be the best care. Other people are more focused on getting the best care, and are ok with (or prefer) to pick the individuals who provide each service, even though it means visiting multiple locations. Nicer employers offer you a choice of providers, but it would probably be less expensive for them if everyone was on one plan, at the cost of upsetting more employees.
The fact that you would go without thought of the cost but in a similiar situation would avoid because of the direct costs shows why the Ontario system is a poor model. The costs are hidden so more services are used. If costs were direct paid for out of your Ontario fund (a yearly budget that if not used would be carried forwarded or removed from your taxes) than a better balance could be found.
> The fact that you would go without thought of the cost but in a similar situation would avoid because of the direct costs shows why the Ontario system is a poor model
The pricing is hidden from me regardless, except that in one case people get the care they need and go on with their lives, and in the other I hear stories of people getting a surprise 4-digit bill in the mail three weeks later, after already paying through the nose for insurance.
When you look at international rankings of standard of living, the Ontario system is considered a good model (along with other similar healthcare systems such as those in nordic countries). The US model is poorer on several fronts, from pricing opaqueness to availability for low income people, and let's not even go into medical bankruptcies...
Lol. I wish. For me it was 5 digits. Closer to 6 than 4. And I had a $1,800/month premium for a family of 4. Spent multiple hours per week for months on end playing phone tag for the hospital and insurance company until it got resolved. Hospital billing also told me to not worry because nothing ever gets paid until both sides start suing eachother.
Yeah, this is peak efficiency. I just love taking up "resolving medical bills" as an unpaid part time job for the better part of a year.
I'm 40, and my Mom was telling me about how my brother cut his head as a child, and the local small town doctor came in after hours to stitch it up. Different era.
ER is open 24/7 and doesn't turn people away even if they don't accept their insurance plan.
They don't want anyone to risk staying home with their child if there's a chance that they are in danger
This is in Australia and there is no cost for this
We have late-night general practitioner services here (at least in the city), which I have used for less-urgent stuff.
[1] “after premiums” is roughly the same as “after taxes”, right?
In the US, I've already payed thousands in after-premium medical expenses for my very healthy young children, just in copays and ER visit fees for normal accidents that kids get into, and that after having what in the US is considered amazing health insurance, so I'm a very lucky person.
I had to go to the ER in the UK as a tourist recently. They refused to take payment since I wasn't admitted to the hospital.
> [1] “after premiums” is roughly the same as “after taxes”, right?
For the purposes of comparison between the US and other OECD countries, yes.
They didn't have urgent care back then, but I understand there were "clinics" that could give those shots.
- taking a kid to the ER costs nothing
- taking a kid to a GP or a pediatrician costs nothing
- staying a night at the hospital costs around 15€
- getting a prescription from the pharmacy costs 5€
Personally, I avoid the very high deductible plans, mostly because I have the option, but also because I don't want to deal with hospital billing. I've got an HMO (kaiser) and they charge me almost nothing at point of service, and I get to consume all the medical care my doctor thinks I need.
Unfortunately, my employer has a really juicy high deductible plan that a lot of my co-workers use. Like they actually give you money to put in your HSA that covers most of your high deductible. It's a good plan. But I don't like it because it means my co-workers get to keep extra money for not going to the doctor when they are sick, and instead they come into the open plan office and cough all over the place.
I mean, I do okay, and I'd be happy to kick in a little extra money if it meant my co-workers were more likely to go to the doctor when they are sick rather than sharing the love with the office.
When you are sick, don't go to work. If there is any question of if the doctor can help, talk to the doctor. (Via phone or video chat, if necessary)
The US is much cheaper for all health insurances, except if your poor. Obama tried to fix that, but made it worse and more expensive for everyone (socialism).
If you're "poor", insurance is actually cheap, because that's when you get public insurance. However, if you're just middle income, health care is a non-trivial portion of your income. One major health incident will bankrupt you and you're likely to become poor. But once you're poor, hey, you can get cheap health insurance.
The critical problem is that obtaining reasonable health insurance requires you to be employed full time at a large company. This must stop. Obamacare was a first step toward cutting the employer out of the picture.
As far as cost controls/etc, set by something like a dutch auction within a given metro area, and then some bean counter will get to figure out if it's cost effective to ship people that are outside of metro areas in to them to provide non-urgent care.
When I became a salaried employee in the Bay area I went to an urgent care recommended by Cigna and my allergy problems were resolved inside of 15 minutes with a $20 copay.
Obamacare is anything but cheap when you are poor.
Why should I trust your figures over the article? Are you including the "employer contribution" toward your taxes and health care premiums?
I imagine you can still pay $1000+ out of pocket to have a baby in a US hospital, even if you have great insurance.
Also, the article talks "average", while I imagine US health costs are highly variable depending on whether you are young, old, smoker, non-smoker, fat, skinny, pre-existing conditions, etc...
Some people pay $1500 per month in health care. And some, $400.
I just got that bill, in fact, and we have about the lowest deductible insurance you can buy, at a cost of about $1500/month. It was still $6500.
Good luck finding a Medicaid provider.
Depends on if the individual's state accepted Medicaid expansion funds from the federal government (states like Texas and Florida haven't) and whether the individual makes less than ~$16.5k/yr.
I wouldn't call either $0k/yr in North Carolina, or $17k/yr in New York, lower middle class. Neither of those incomes in those places would give an individual access to Medicaid.
I would love to pay $400 a month for health care for my entire family all inclusive in the US! Can you please state the name of your insurance company and your specific policy so I can get this too? My rate is over $20,000 a year right now so that would be a tremendous savings. Thank you so much!
My health alone is $2,100/month for a family of four. I suspect your employer is paying a large portion of your premiums as a benefit.
This is quite common in the US, and a significant portion of the problem, as people think they're getting great insurance "cheap". They're not - it's just being paid in a way that's not visible. As a result, any discussion of "it'd be cheap to implement national healthcare, it'd only cost $X" is met with "but I pay peanuts for mine now!"
In my case I do know. My employer pays $930 some a month. My rent used to be $860/month.
The other thing the happens is just because you have insurance doesn't mean that healthcare providers aren't trying to jack more money out of you. Any procedure/service will be up coded to increase your out of pocket share.
https://www.irs.gov/affordable-care-act/form-w-2-reporting-o...
Did my taxes and my family of four was well past the $30k mark for insurance, copays, dental, and optical this year.
Not only do employers pay for a portion of employee healthcare costs, they also get better coverage for less.
> In Denmark, only health is covered, so for eye and dental many go out-of-country to get it cheap.
That kinda sucks for Denmark. In Austria, everything is included in the 7.5% that health insurance costs.
Health insurance typically only covers the minimum at the dentist, and almost nothing of what is considered "cosmetic" or would be good in the long-run (e.g. oral hygiene, braces). It gets expensive quite fast.
Or that socialism is a bad thing?
Yes, it's not Ivy League, but it does the job.
EDIT:
Doh! Just checked the cost of undergrad in some of those nations.
Umm, Yeah.
I guess if I were a German or French guy, I'd likely find tuition levels in the US a bit outrageous.
https://www.moneysavingexpert.com/students/student-loans-tui...
I'm not sure if they account for inflation or have any fixed interest on the loans. 30 years without any would be pretty crazy.
It's basically inflation + 3% if you're earning more than £45k/yr+.
For example, tuition fees at Scottish universities are "free" (i.e. paid for by the Scottish Government) for Scottish residents and people from other EU countries (but not the rest of the UK).
If you miss it the first round then there is a massive incentive to transfer or find an easier program, otherwise you face the prospect of being forced to go abroad to complete a degree.
This is very much aligned with the direct cost and services provided. Attending German universities is virtually free, and under certain conditions, the country will give you very cheap loans to pay for your living expenses. My spouse had a single digit number of thousands of Euros to pay back after graduating.
PhD students are often underpaid employees and are treated that way (for better or worse) instead of being considered as and treated like students. This doesn't imply one is preferable to another, just that it is a continuation of treating them with and expecting a higher degree of maturity and independence.
An upshot for me was that when I applied to my first industry job, the time as a PhD student was treated as work experience.
So yeah, I think you're spot on in that many folks from continental Europe would find the amenities bewildering. :)
EDIT: There is also the case where you may live in a state with insufficient opportunities for higher education. For example, neither of North Dakota's two public research universities (U of ND, ND State) rank inside the US News top 200, and both of those schools will still charge you around $20,000 per year. Germans or Brits will be able to receive subsidized educations at any university in their countries.
You'd probably have access to a better education at U of M in Minneapolis. But it's going to be quite a bit more expensive and I'm not sure it would have that large effect on your career.
I didn’t have the grades, legacy or extracurricular activities to get into the Ivy League. I could get into good engineering schools, but couldn’t imagine the debt or bankrupting my parents. So I went to a SUNY school, and everything worked out fine.
correction - wow! the first ever audit has finally happened https://www.defensenews.com/pentagon/2018/11/15/heres-what-t... :
"But department officials were quick to note that was no expectation that the audit would be clean, given the size and scope of the project."
Next up: Venezuela.
And if you get seriously ill and lose your job you are pretty much ... done! oO
If you do you can disregard this message. I hate to see legitimate new users being turned away because they feel like they’re shouting into an anti-spam void.
If you need emergency care then sure, there isn't time. The vast majority of interactions with the medical system aren't that type of emergency though. People have time to choose the better of two options. They can't decide on better if they don't know the price.
For those insured, it depended on the insurance you had but they would give you a rough estimate based on the plan you had (mostly because they can’t be 100% certain what the insurance will cover down to the exact dollar amount.
In my experience the estimate is often off but close enough that I am not worried I’d owe an insane amount afterwards.
I have no illusions, a person without a degree in accounting probably won't be able to decipher these prices, but that could be a step in a proper direction.
IMHO, it is because folks are overly deferential to medical doctors.
While a lot of the problems are actually caused by the insurance industry (a constantly changing billing code system) rather than the doctors themselves, I think folks are growing tired of being yanked around by the system.
This deference is decreasing based on my limited experience (i.e., just talking to people about their medical experiences), and it may drop precipitously soon. My guess is that most/all of the good doctors going to "concierge" will be the breaking point.
Because the American medical system is perhaps the finest example in the world of regulatory capture, ironically masquerading as an example of pure capitalism, while decrying the "socialism" in other countries.
In many developing nations insurance is the exception, rather than the rule. This changes two big things. The first is that you're expected to pay for things that would have more than a negligible cost before these procedures are done. If you don't like the cost - you go somewhere else. Emergency care, like the US, is an exception - and nobody can be turned away, so you are billed afterwards.
But the really big thing this changes is that costs are such that people can actually pay them. For instance in one procedure I had a consultation, x-ray, and medicine. Total cost was about $20, and that's not government subsidized in any way - the hospital is making profit on that cost. And this is not a "hospital" with "doctors". Most of the medical staff are educated in the west and then come back home to work afterwards. As an aside, it also means they generally have great English. It's why developing nations are increasingly a destination for medical care - 'medical tourism'.
But the mere fact that you can go get a surgery, and not only will you not know what it will cost, you don't even know who you're doing business with: you're going to get bills from the doctor, from the hospitals, from the nurses, from the anesthetist, and god know what else from, for the next 6 months. You don't even know if you're done paying all your bills or not!
Its completely absurd.
Just like when you buy food! Or heating! Or water!
This is not a probleam of health-care as much as it is of insurnace. If you paid doctors cash you will get straight up pricing.
Thing is the market is like 95% insurance.
I believe this will change in the near future. High-deductible plans and DPC's will bring back some sane price sensitivty into the system. But while patients with great PPO plans pay 20 bucks for a 300 dollar visit, its not going to get fixed itself by "posting prices somewhere"
The dental industry works the same as the medical, I have a half-useless insurance that covers too little, and out-of-pocket expenses are always higher than you expect. But if they can do estimates before a procedure, why the hell can't the medical industry do the same?
I recently learned that there are 2 different codes involved and that it's the combination that matters.
1. The diagnostic code - the reason why you need that test
2. The procedure code - what the test is
My insurance tells me that their coverage (as in whether they cover a service or do not) is different for the same procedure code with a different diagnostic code. I'm not sure if that implies that their coverage price for the same procedure code also varies by the diagnostic code.
Your doctor can give you both codes for the test they're prescribing. In theory, your insurance company can tell you what they'll pay for the combination, and then you can contact each lab / hospital / service provider to get an estimate for what they'd bill. It's unclear how much recourse you have if the bill turns out to be significantly different than the estimate… that is once the bill actually arrives, sometimes 30–60 days later. I'm not sure if the service provider's bill varies for the same procedure code with a different diagnostic code.
Admittedly this is all a huge pain and with my insurance company at least, cannot be done online, you must call and wait. It's all such a time sink that I usually just get the service done upfront and hope. Sometimes the end consumer cost is practically free, sometimes it's hundreds of dollars or more.
It should be more feasible for us to know a rough estimate for a procedure across providers upfront.
When the process is voodoo for the people who actually deal with insurance payments, normal people stand zero chance because it's unlikely you'll ever find a person to talk to who can find this information out.
That's mostly not true if you have an HMO plan, but your employer may not offer HMO plans if it offers insurance, the HMO may not be a good one if it is available, or it may not cover good providers in your area.
I think you meant that tongue in cheek, but essentially that means it's true for a significant number of people whose circumstances meet any of those criteria.
I forgot the fees on top of our insurance in the US (it being >16 years ago) but it was pretty steep.
After moving to the US I have earned more money in 10 years then I could have earned in my entire life in Canada. My medical is outstanding and my taxes in TX are a pittance.
It seems where you live in the US might make a difference.
https://www.thenation.com/article/thanks-koch-brothers-proof...
The problem, as always, is what do you do with all the redundant bullshit jobs that are eliminated in the process.
The idea that the poor will mass migrate to California and the rich will mass migrate to South Dakota is pretty unrealistic. The poor can't afford to live in California even with social assistance, and the rich don't want to live in South Dakota no matter how low the taxes are.
Because money buys stuff taxpayers want. Middle class people want good schools and functioning transit and to know they're going to have a secure retirement. The premise of having the government do these things is that they can do them at least as well as the market. If they succeed they'll have no trouble attracting people to come there and pay taxes in exchange for receiving those services. If they fail and are then out-competed by other states that do better, whether by leaving things to the market or otherwise, isn't that a good thing? It requires the underperforming states to improve or lose population.
I might be off the mark here, but from my understanding wasn't unrestricted migration one of the big drivers behind Brexit? Or at least the idea that the "poor countries" were "taking advantage" of the "rich countries"?
It’s true for blue collar workers as well: try hiring a contractor to remodel your house and then watch them leave the job unfinished because they got a better paying gig in UK (that actually happened to a friend of mine)
The thing about rich people moving to places with lower taxes and poor people moving to places with more services is that it's the sort of thing that seems intuitively obvious until you actually think about it, and you realize it's like arguing that lakes are impossible because water evaporates.
It's not that water doesn't evaporate. It's not that poor people don't prefer more services and rich people don't prefer lower taxes. It's that everything is not one dimensional and there are other factors that outweigh that one by enough that the lake is still full of water.
Leaving the EU will mean more migrants from outside of the EU - so will actually cause the situation a lot of Leavers were worrying about to get a lot worse.
See Robert Peston's WTF? for details.
Are you serious?
Expand your timeline.
Those high earners will screw up the economy of their destination state accidentally gutting the lower middle class, institute social programs to deal with the all the problems this creates, realized they just created the same dystopia they fled and move again.
It's like a perverse form of rolling upgrades.
You can see this process in action in places like CO and the PNW states which are starting to flip from "rich people move here" to "poor people move here". TX will probably start flipping soon.
Major urban areas with lots of job opportunity seem vacuum up the wealthy regardless of the state wide trend (no matter how bad NY state gets upper middle class people in search of a lucrative career will be moving to NYC). I'm not sure how that plays into things.
New York City spends about $30k per homeless and you still cannot walk a block without seeing one.
It's not about the money...
Not really. States like California are net payers, but only just, because they have large diverse populations and end up getting back almost all of what they pay in.
It's true that a lot of the middle states are net recipients, but most of them are still below $4000 per capita.
And the bigger problem is that so much of the money is wasted. Each Congressman goes to Washington to bring back pork, and they do, but pork is inefficient. So they bring back $10,000 per capita in funding after paying in $6000, but only $5000 of the $10,000 is put to productive use. Does that really help the states compared to just keeping their original $6000 and using all of it productively because you don't have to negotiate with 49 other states for how to spend your own money?
Moreover, the military budget is where a sizable chunk of the pork lives.
And the problem isn't just pork, it's the general inefficiency of hoovering up your state's money and then sending it back with strings attached. Federal programs can require hot garbage like designated "affordable housing" (i.e. cordoning off a slum to concentrate poverty in) as a condition for housing grants, or "teach to the test" education programs like NCLB. It's not a stretch to claim that the states could be better off with less money but without the strings attached.
If you have to spend five hours a month to prove that you qualify for a program that pays $80/month when your labor is worth $10/hour, you're not receiving net $80/month, you're receiving net $30/month and then getting paid to labor for five hours, the second of which you could have done for any other employer using the same five hours, so the value of the program is $30/month even though it costs $80/month to the taxpayer. Plus whatever administrative costs exist on the government's side. And then whatever value the alternative employer would have derived from having a worker available to work those extra hours.
It's even possible for programs to have negative value. They can cost money and then destroy more value than that. A lot of housing and other subsides can do this, e.g. you give some people $500/month for housing, but that only causes local rents to increase by $150/month -- on everyone, including the people not eligible for the subsidy. So on paper you have a thousand people receiving $500/month and you think you've gained $500,000, but then you account for the five thousand people who now pay $150/month more, cost of $750,000, and you're net -$250,000. Meanwhile the taxpayer still had to pay $500,000 to make that happen.
But realistically how could Montana get an 80% increase in efficiency while providing similar services to the federal government?
And according to normal economics textbooks increasing market rent isn't destroying value. If more people move to a city which drives up demand and rent. Economists don't think of that as value destruction. In classic economics textbooks the value destruction caused by subsidized rent is that some people will spend $1000 on rent that they would never rent without the subsidy because they only get $800 of value from it + the dead weight loss of the taxes that funded that subsidy.
By removing all the strings. The problem with the existing federal programs is that they're numerous, complex and individually small, which is the recipe for inefficiency. That results in high administrative costs -- not only for the government but also for the recipients, and only the first cost is actually accounted for in the government budget, even though the second is much larger. Because government agencies do their tasks as a full time job but the recipients are novices who have to amortize the cost of learning and using the system over only their individual use of it. Again, suppose someone has to spend five hours a month to navigate a program that pays $80/month. Then if their labor is worth $10/hour, just their side of the transaction contains $50/month worth of inefficiency.
Even the fact that housing grants have to be spent on housing is inefficient, because it distorts the market for the thing being subsidized:
> And according to normal economics textbooks increasing market rent isn't destroying value. If more people move to a city which drives up demand and rent. Economists don't think of that as value destruction. In classic economics textbooks the value destruction caused by subsidized rent is that some people will spend $1000 on rent that they would never rent without the subsidy because they only get $800 of value from it + the dead weight loss of the taxes that funded that subsidy.
But this isn't caused by more people moving to the city, it's caused by the people who already live there getting a bunch of money they're only allowed to spend on rent. Then some of them would prefer to have fewer roommates or a bigger apartment, so they try to use the money for that, which requires the people who would otherwise live in those other apartments to have to outbid them, causing everyone to have to pay higher rents on the same apartments.
Meanwhile the rent increase goes to landlords who typically remove it from the local economy, either because the building isn't owned by a local to begin with, or because the owner is a wealthy person who then invests the money in index funds etc. which transfers ~98% of it out of the state. So the value isn't "destroyed" but it immediately leaves the state, which from the state's perspective is basically equivalent.
I'm not encouraging underage binge drinking, but if you want to have a quick pint with your high school senior, that's absolutely legal.
I live in Indiana. Lets shut down the interstates for non-Indiana citizens. Yes, that means the I69, I65, I70, I90 corridors.
The feds would have came to a 'deal', in new speak.
Well, there's also Defense, and then service payments on the debt. Those are the big 3 without question. So "the wrong people" must be in there somewhere?
But the real reason we give more to the feds is because if we didn't it would be AWESOME for places like New York, Minnesota, Texas, Delaware, California etc, and TERRIBLE for places like Wisconsin, Alabama, South Carolina, and Florida.
Now, consider how the above is impacted in the wake of Citizens United where $1 == 1 vote, and Corporations are People Too.
If you ask people if they support the abstract idea of having a military so we're not invaded by foreign forces, or having a program to prevent the elderly from dying in the streets, they say yes.
But then you ask them whether social security should send a larger check to a retired Jeff Bezos than a retired firefighter on a fixed income, or the government should spend billions of dollars on equipment the military itself says it doesn't need but the Congressman from the district which is getting the contract to build it says that it does, and the public support for that falls off pretty fast.
And those "features" cause those programs to cost hundreds of billions of dollars more than they need to, which money could otherwise go to infrastructure and schools and tax cuts for the middle class, all of which are also immensely popular with voters of all kinds. But won't happen when the programs absorbing more than three quarters of the total budget are administered in a federal system where the Congressmen are rewarded for bringing home the pork and Florida is an important swing state full of retirees.
And the DoD and the VA are also considered separately, but let's not pretend they're unrelated. If you have twice as many soldiers today then you need twice the VA budget tomorrow.
Of course that deduction is gone now, which just further solidifies government power.
It's a tough issue. From the Federal perspective is makes a lot of sense to get rid of the SALT deductions, and I suspect the next time the Dems are in charge they will "be unable" to restore the deduction for "reasons", since both parties want the extra revenue.
As an example, if your federal marginal rate were 25%, paying $4k in state taxes would only get you $1k off your federal taxes, not $4k.
In Sweden, until you hit ~$65,000 in yearly income, all of the taxes you pay on income (which is a relatively high rate) goes to your local government. Only after that point, your extra income goes to the federal government. [1]
This model cuts out the immensely large federal government which serves as a middle-man for distributing the income you contribute to your local community, while simultaneously sucking out so much of it— either siphoning it to federal causes, or people's salaries chipping away at it as it's sloshed around.
It's much more efficient when the majority of your income taxes support your local community directly. In the U.S. right now, these localities rely on property taxes, which is _much_ smaller of an income stream. People supporting the Scandinavian model should understand that this is necessary, and that's even more true when your country is larger.
[1] https://www.nordisketax.net/main.asp?url=files/sve/eng/i07.a... Heard this point from Swedish family and having trouble finding it online, but the typical municipality income tax is 29-34% and corresponds to equivalent tax deductions from federal taxation, which seems to effectively have the same (or near same) result.
There isn’t explicitly, and I know that’s part of what the federal top-down model tries to prevent, but is it really working? The United States’ affluent areas are night-and-day to the poor ones.
If we think about the per-capita income in poorer areas of the States, and what can be taxed off of that, it seems like it’s still enough for that community to function.
The current U.S. model seems to result in everyone getting a much smaller pie, even if the government manages to change the portions of who gets what.
That is a perspective from somebody living in a place with state income tax. Life is so much better when you are not paying state income taxes. Texas, Florida, and a few other places have no state income taxes.
0: https://taxfoundation.org/state-and-local-sales-tax-rates-20...
1: https://www.thebalance.com/best-and-worst-states-for-propert...
2: https://en.wikipedia.org/wiki/List_of_toll_roads_in_Texas#Op...
We certainly do seem to pay far too much for health care! But the explanations aren't as simple as evil health insurers. The system appears to be structurally pretty messed up, and alterations to the payer-side alone, without radical changes to the provider side, are unlikely to solve the problem.
Doctors and nurses in the US are high status. When they lobby against something, it’s hard to win.
When I read people discussing cheaper healthcare, I always go looking for the part where they explain that healthcare professionals will make a significantly lower dollar per hour. I rarely find this discussed.
My host family father (anesthesiologist) works from 7am to about 3pm (works for Einstein medical center in Philly). He pulls weekend extra time (on-call) to make ~$1000/call on Saturdays (to support his hobbies like expensive bikes and lens for photography). Gets paid well above $400K/year until he retired in 2015.
My host mom works as at a quasi-private psychiatry treatment center where she manages about 20 in-house patients (almost always the same patients who she has been treating for many years). She goes to work just like any other 8-5 job. Very relaxed atmosphere. Gets paid very well (to the tune of more than $320K/year until she retired in 2016).
My gf and her fellow residents at the hospital do not have a lot of stuff going on during most part of the days. She is a bit luckier than average resident in that regard though because her hospital is in a suburban setting. Her friends who got into residency programs like in Brooklyn, Bronx or Queens (e.g., Elmhurst hospital in Queens) have to work harder in their first and second years (especially only the first year). But not as bad as like 80 hrs/week like what you read in exaggerated news articles. Sure they work more than 40 hours because of on-calls and night duties. But definitely around 60 hrs/week (never approaching more than 70).
All this is to say that the work hours of US doctors and medical residents (doctors in training) that we see in the news, I suspect, are a bit exaggerated (of course, they have to be bad/outliers in order to be in the news).
I'd like to add that my host parents practiced in the UK for almost 7 years, and decided to move to the US (practiced here for almost two decades) because in the UK, they made like a quarter of what they were able to make in the US.
Last but not least, all of them (my host parents and my gf) studied medicine in Burma (a third world country) for 5 years only (+2 years of residency). Certainly, the education one can get at Myanmar government-funded medical Universities isn't top-notch or state-of-the-art, but most med students learned on their own by supplementing with private classes, self-learning and practice (e.g., shadowing doctors). They (international medical graduates) score very well (usually better than their US peers--see chart #6, #7 in [1]). The point I'm trying to make is that we do NOT need 4 years of undergraduate education for wanna-be doctors (pre-med students) because that is not necessary and adds more debt burden to future doctors. This artificial barrier to entry is adding to the inflated healthcare price by making it very difficult for anyone to become a doctor in the US. We don't need 8 years of college and medical school education for most specialties; in the end, the garden-variety illnesses can be diagnosed by reading up references like [2], and it doesn't take 8 years of training to do that.
[1] http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outc... [2] https://www.uptodate.com/login
P.S. This rant is partly contributed by my experience when I got an ear infection (acute otitis media) last week and saw a doctor in New York, who charged me $200 for looking into my ears with otoscope for 10 seconds, and wrote up a prescription (the entire encounter lasted no more than 5 minutes). Since my deductible is high ($3K/yr), I had to pay $133 out of pocket. The oral pills (amoxicillin-variant and an antihistamine) for three days costs $30 (which I paid). The worst part is seeing the $283 price quote for ear drop (CIPRODEX). When I decided to not buy that and asked my doc for a more generic version, that costs $35. I asked my mom to buy the same generic version of ear drop from Myanmar as she is visiting me this week. The ear drop costs $15 a piece there; doctor consultation $40; oral pills $7 (for two weeks supply just in case I get the ear infection again in the near future).
I think you would need to compare median nurse/doctor salaries against median salaries for that country...
In the UK in the NHS, there is none of the layers of beurocracy and paperwork related to call-centers and payment handling and claims inspectors (as far as I know anyway) that I assume is commonplace in the US hospitals and insurance companies. You go in, see the doctor, then leave. Usually the only "paperwork" required is booking another appointment if you need to come back - no forms, no invoices, no payment etc.
I guess it is the same argument made about universal income benefits - if we just gave everyone (rich or poor) in the country a set amount of money each year we'd save billions in not having to means-test every claimant individually and actually save money by giving it away to everyone.
For example, I think all buses in London should be free. Look around the bus and you'll see that most people aren't directly paying (under 16, over 60, on benefits) and by taking away the need to check for payment we could get people on and off the buses much faster and completely remove the need for card readers.
And I guess the relevance is that discerning and switching between the two when a better diagnosis is made causes large administrative overhead?
This example is "married with two kids", so it's possible that there are massive offsets that I didn't have access to as a single person, but 11.5% still seems very low.
I would expect Canada to fare favourably in this comparison, though. The taxes are not as bad as most Americans think. Although they do ramp up very quickly for higher earners, which was an incentive for moving to the states as my income increased. Also, pay is higher in the US (by a factor of about 2 or 3) for the same job.
Who knows, 11% still seems incorrect.
Median Canadian individual income is ~$35,000 [0].
In B.C., your average 2019 tax rate would be 13.34% not including non-refundable tax credits (and so the effective rate would likely be a point or two lower). [1]
A median tax rate of 11.5% against a median Canadian individual income seems entirely reasonable.
----
0: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=111002...
1: https://www.ey.com/ca/en/services/tax/tax-calculators-2019-p...
Lessons: 1) I have no concept of the median experience in my country, 2) a single number can't answer the question "does this country have high taxes".
I spent my 20s far below median (which I knew), and my 30s far above median (which I didn't realize, at least not at first). Very different lived experiences :)
And I know many folks around me (friends, family, colleagues) look around (confirmation bias & availability heuristic, amongst others) and believe that $60k-$80k (or more) represents a "typical" lived Canadian experience. They are, to a person, universally surprised to see the actual median income (as was I when first tracking it down).
It certainly is viewpoint-shifting. Cheers!
The median income for 45-54 year olds from that site seems to be $49,100. Median for 35-44 is 48,000. It's not $60-80k as you say below, but not $35k either.
One other interesting note is that there is a pretty big difference by gender. Median income for _males_ 35-44 is $56,300 while females are at $41,400. For 45-54 year olds those numbers are $58,000 and $42,400 respectively.
Those differences are big enough that I wonder whether this is being affected by the relative incidence of part-time vs full-time work. The statistics here seem to be looking at people with any income at all (including investment income), not "salaries"... Depending on the demographics of the people you talk to (full-time jobs, 35-55 years old, maybe toss in "male"), $60k is not an unreasonable thing for them to feel a "typical" experience is.
I agree that people with educations and in "good" jobs tend to over-estimate the median income, but I also think that once you account for lifecycle effects the median income of what people think of as a "typical worker" (which is not a 17-year old nor a 70-year old) is higher than the summary statistics suggest. And of course the thing that can really hurt is if you can't find full-time work at all....
The inevitable Wikipedia link: https://en.wikipedia.org/wiki/Payroll_tax#/media/File:Payrol...
(I say this while recognizing that runaway medical costs aren't solely the result of insurers)
The most sustainable choice will be neither monopolistic pricing, nor cutthroat pricing at the expense of medical staff, but somewhere in the middle.
I would disagree it doesn’t impact higher income works because you’re still paying sales tax on luxury items and because of the high prices, the tax is very high.
In Canada it’s not uncommon for the HST to be 15%.
And if your income is low enough, you get an HST credit to control for its regressive nature.
At the very least it indicates that the company prioritizes the finances of that one department much more than any other.
The other problem I have with this complaint is that it implies that things would be different if it didn’t hold treasuries. If it had $3 trillion in a bank account, would that make it “real”? The US government issues dollars too, and can devalue the currency at will, so it’s not really better.
Ultimately, it’s a commitment mechanism. If SS were paid out of the general fund, it could be cut off to fund other projects at will, as long as Congress were willing to piss off old folks. (Which is already a big obstacle, admittedly.) By funding benefits from a gigantic trust fund holding government debt, cutting off SS to fund something else would require imploding the world economy.
That's like saying "Oh man, your job isn't paying you enough money, you should quit." 'But I make 80k, that's plenty!' "Oh, you uh did, until I stole all but five dollars." 'Oh darn, guess I'll quit then.'
Personally, I agree with your opinion. I think that we're going to get to the point where SS is taking in less than it pays out and, combined with the large amount of individuals who don't like anyone getting government money and so push to get rid of it, the system is going to fall apart.
The worst part is that it's not even the government's money. People pay into the SS and take back out later. It's supposed to work like a savings account, to some extent.
In a few years, given no changes, the cash flow will go negative and we'll begin spending down the trust fund. By 2035 or so (I forget the numbers, and the projections tend to vary widely anyway because of differing models and, yeah, partisan spin) the trust fund will be spent and the social security administration will need to adjust, as it will be taking in something like 80% of obligations.
A 20% shortfall is a big accounting problem. It's hardly "plan for it not to exist".
This is from a 1999 OMB report:
``These [trust fund] balances are available to finance future benefit payments and other trust fund expenditures–but only in a bookkeeping sense. These funds are not set up to be pension funds, like the funds of private pension plans. They do not consist of real economic assets that can be drawn down in the future to fund benefits. Instead, they are claims on the Treasury, that, when redeemed, will have to be financed by raising taxes, borrowing from the public, or reducing benefits or other expenditures.``
that's totally self defeating. There are simple adjustments that can be done to make it viable long term. But there are quite few people in DC who desperately want it to fail to show that government is no good.
And there are quite a few others that want to expand it to cost even more, so they refuse anything beside perfection to achieve meaningful compromise.
Let alone the idea of income over a certain amount having to pay a larger percent...
[1] https://www.nationalpriorities.org/budget-basics/federal-bud... [2] https://www.populationpyramid.net/united-states-of-america/1...
If you earn £150k a year (top 2% of salaries in the UK) you pay £6,964.16 a year. That's an astounding deal. There are no deductibles, no co pays for hospital stays, GP visits are free, as are any tests and investigations.
You do pay £9 for each item on a prescription, but if you get more than 3 items a month you can pay a flat rate of £104 a year for a prepayment certificate.
Private health insurance is still a thing - it just gets you a nicer room in a private hospital and quicker treatment for non life-threatening conditions.
I dont think that the NHS is utter garbage - sure there is room for improvement, but it seems that it is not "garbage" at all according to recent research: https://www.kingsfund.org.uk/sites/default/files/2018-06/NHS...
That report has some very interesting charts. E.g. Figure 9 shows that almost 25% of people in USA skipped going to the doctors due to cost, or almost 20% of people in USA skipped prescription medicine due to cost. For comparison on the NHS it was 5% and 2% respectively. Mind-boggling.
I'd agree though that anyone on 150K plus (and probably anyone in a job from the 40K range upward (if not lower)) would have private medical cover. As others have noted, private cover basically just means you get seen quicker/at a more convienient time and the waiting room is nicer - the care is no better or worse than the NHS IME (although I dont have any data on that - just a personal anecdote)
Under Key findings:
Its main weakness is health care outcomes. The UK appears to perform less well than similar countries on the overall rate at which people die when successful medical care could have saved their lives.
Among its strengths, the NHS does better than health systems in comparable countries at protecting people from heavy financial costs when they are ill. People in the UK are also less likely than in other countries to be put off from seeking medical help due to costs.
So: main strength - cheap, main weakness - health care outcomes!
It's no surprise that fewer people in the UK skip medical care due to costs when it's (close to) free. The problem is that the health care is bad when you get it (according to your own provided document)!
Yes it is not as good as some other wealthy countries, but it is by no means "garbage", e.g. on page 35: "The results show that although the UK does well by global standards, it performs poorly compared with the other developed countries in our comparison group". "..does well by global standards.." completely contradicts the idea that it is "garbage".
There are some interesting comments in the document suggesting that some of the health outcomes might actually be social which was news to me an quite interesting - e.g. the british "stiff upper lip"/"keep calm and carry on" might be causing people to defer medical help, or that the large income disparity could be skewing it. Interesting & worrying stuff.
The NHS is underfunded, sure, but in an emergency situation (you know, the kind that will bankrupt you in the US) you won't get treated privately, it will be done on the NHS. Sure, if you have cancer your Chemo will be given in nicer surroundings, but it's the same drugs administered under the same protocol.
All private insurance in the UK gives you is that - a nicer environment and quicker access to treatment for non life-threatening conditions.
"All private insurance in the UK gives you is that - a nicer environment and quicker access to treatment for non life-threatening conditions."
I don't think you would consider this a small thing if you were one of the 500k people waiting > 6 months for basic treatment on the nhs: https://www.telegraph.co.uk/news/2018/08/11/numbers-going-pr...
Still a good deal though.
It is also not the costs "not covered by health insurance", rather the insurance premium is the cost of the policy itself.
Would love to see a breakdown of real estate and admin costs for private insurance systems throughout the States to understand how much could be saved by eliminating redundancy.
Not seeing this broken out in Anthem's Financials: https://ir.antheminc.com/static-files/73562e56-886c-4ff5-a36...
I would love to see the same breakdown for the Netherlands, Germany, and Switzerland to see how they avoid it.
Also, these studies don't take into account the time/opportunity cost to consumers of navigating this complicated system, which can be quite substantial.
[1] https://www.nejm.org/doi/full/10.1056/nejmsa022033
[2] https://www.nytimes.com/2018/07/16/upshot/costs-health-care-...
Seems to be a huge reluctance for anyone in politics to place the blame on them. But I'm pretty sure they make far more in the US than anywhere else in the world.
Hmm. There's that word "insurance" again.
As mentioned above, a problem is that the system is so opaque, seemingly by design. A potential benefit of a government run system is that there could simply be fewer business entities. For instance, doctors could just work for the government, for a decent salary.
Yea, but the opportunity cost of getting there is huge. At graduation, most doctors are in the ballpark of $1MM behind where they'd be if they went straight into a professional career.
Also, doctor's salaries only account for 8% to 20% of total healthcare costs.
So the two great failures of the American economic system, education and health care, reinforcing each other to make the situation even worse.
"Also, doctor's salaries only account for 8% to 20% of total healthcare costs."
Where does the rest go?
Insurance companies are regulated on profit margins, which means it's actually in their interest for costs to rise, since their income is limited to a percentage of the costs. Administrative overhead at the insurance company is limited by percentage as well, but I don't think that includes the overhead at medical offices required to deal with insurance billing.
Users may be able to pick between different cost options, but at best they know the direct cost to them, not the overall cost. There's also a sense of wanting to get the most the insurance will cover, because that's why you paid for it.
Doctors' compensation is certain a factor, especially since there are effective rate limits on new doctors based on the number of slots for residencies, that aren't adjusted for population growth.
Employers (who are usually the ones selecting the insurance plans) may be cost aware, but might be selecting based on direct costs to the employer and not on total cost to the employer and employee combined.
Owners, executives and shareholders. Look at who owns the hospitals, practices, labs, insurers, suppliers and associated facilities.
The profit margin is the amount by which revenue exceeds costs.
It's circular reasoning to point out that an industry with enormous redundant costs has low margins.
The value of a sector to its host civilizaiton is the amount by which its externalities exceed its revenues. If the sector were eliminated, those revenues could be directed elsewhere.
In the case of Hollywood, the value of the movies produced is worth at least as much as people are willing to pay to see them. Solvency here is evidence of net positive value.
Even in a vilified industry like big tobacco, the value of the product is worth more to the people paying for it than their money is. Solvency here is evidence of net positive (perceived) value.
But in the case of the private medical insurance sector, the amount of benefit that all customers receive has to be less than the amount that all customers pay. Solvency is evidence of net negative value, unless there are some other externalities. So, what could those be? Fire insurance can prevent disruptions to a city. But can private medical insurance prevent public health hazards? I don't see why it would be better suited to do so than a single-payer alternative.
* This article also ignores the fact that many of the countries listed also still have private insurance supplementals. Those may need to be added for a fair comparison.
In the end I don’t have good solution, but think the traditional arguments in both directions are generally hyperbolic and over simplified. Unless data shows conclusively otherwise, I lean toward free market solutions.
In reality, there is no country with which we can fairly compare US tax rates.
We are just a Mafia.
So as a counter to that, and dialing my language back to patton-y style, America is going around stirring up shit that the rest of the world needs to shovel. Why is it that after Syria and ISIS have emerged and created a refugee crisis the US is miraculously missing (on a per-GDP basis) in the aide efforts. While America is fueling economic growth beyond the ability for the earth to sustain it why has it refused to help people fleeing desertification in Africa. Oh, the situation in El Salvador, yea... America never did anything to turn central and south america into a dumpster fire...
America is the vampire, trying to suck all the resources and productivity into a machine that feeds itself - with little regard for the rest of the world.
Oh wait, that was too reductionist... maybe the US does a lot of good by sending food aide around the world but also causes problems... maybe the rest of the world is the same, being good sometimes and bad others, and no one nation is some beacon of light and purity that all others are constantly sucking[1] the productivity out of.
[1] The analogies used above were pretty weird and awkward,
I never claimed America was a beacon of light. I merely claimed that many non-American countries benefit from American global hegemony. That is an observation (which perhaps you think is wrong, but I don't see any generalized counter claim), not a value judgement.
> [1] The analogies used above were pretty weird and awkward,
Perhaps, but that doesn't take away anything from the main argument.....
Yes, the issue at hand isn't whether the US provides a net benefit to every country, because 'every country' is rarely used as a metric against which to measure the US. Instead, America is typically measured against western European countries and 'developed' countries (so, ex-colonies, essentially). The article in question in this HN thread compares the US to Europe.
Pretty much every 'developed' country benefits from US hegemony. That is one reason why they are considered 'developed'.
How many times do I have to say that I am in no way justifying American military action or even saying it's a good and ethical thing. I am just making a very obvious observation that American tax payers pay for the current Pax Americana (evil or not) that many countries often contrasted with the US benefit greatly from.
>Individual US tax payers pay for most of the world's security.
>Pretty much every 'developed' country benefits from US hegemony.
The former is outright wrong. I'm not convinced the latter is correct either, but at least we're getting closer.
How would the USSR have evolved without the US security presence in Europe since WWII?
How would China have evolved without the US deep-water navel presence in the Pacific? Without the US support for Taiwan?
How do you value the success of South Korea in the presence of US troops?
What would have happened in the Middle East if the the US hadn't supported Israel or pushed back on Saddam Hussein in Iraq?
I'm not trying to justify any or all US actions, just trying to point out that any evaluation of the US military's impact over the last 100 years is going to be more complex than suggested by your comment.
Although the existence of the US military probably helps. As long as they don't do anything.
I'm undecided on this one.
But the US has one of the largest all-volunteer armies in the world, with some of the most advanced technology, so it makes sense that it costs more. My comment is not a justification for America's military power, it is simply an observation that American tax payers pay for something the rest of the world gets to enjoy for free -- the threat that if another country attempts to upset the balance of power from which many countries profit (namely many of those in Western Europe), the United States (and only or mainly the United States) will stage an intervention.
For example, regardless of Norway's foreign policy, they benefit from American warfare (or threat of warfare) in the middle east which ultimately does lower the supply of oil. Same with Saudi Arabia. None of these countries contribute, which is why it makes sense that the american tax payer pays more.
I mean the American ethical stance, as demonstrated numerous times by various popular votes, is also against war. However, that does not change the fact that countries benefit from it. Ultimately, while perhaps making some countries hypocritical, none of what you said changes the argument I put forth: namely that, by virtue of being the only country whose citizens are forced to pay for the status quo (which has the effect of subsidizing the economies of many of the countries to which the article attempts to compare the united states), there is no way to properly compare US tax policy to any other country.
> Partially yea, it may be that using the word "security" in that first post was a wording error that caused a bunch of people to misunderstand you
Indeed. For some reason, many people define security as not just security of the status quo but also some cosmic fight between good and evil.
Both countries do not benefit from it, otherwise they would view these wars as just and support them. The political machines in both countries support these wars and force the populace into them - in part (in the US at least) by being a two party system without any way to politically express a desire to not go to war, one party is more hawkish but both parties are full of hawks.
As an American I am happy to say, "Please, America, stop messing up the world for everyone with your endless economic wars." A bully cannot neutrally justify their own actions, they are biased in approving of the path they have chosen.
So the claim is that it is only possible to benefit monetarily from things that are ethically sound?
Not so long ago it was nice to have a couple of tank divisions located in West Germany doing nothing. Doing nothing. Just looking at their Soviet colleagues stationed across the border.
Security from?
Also, do you know that, in exchange, the rest of the world accepts US dollars as reserve currency?
Euro can eventually become a good alternative, but it has to build some "credit history".
Security from currency instability via the use of the dollar as a reserve currency?
A country's defense expenses are for its own benefit providing easy global market access for its companies, leverage, favorable terms and markets for arms for its own defense industry. All these benefit the US and its citizens.
There is a well documented history of military intervention under pretexts driven by business interests going back centuries with the latest being Venezuela. A country is being openly destabilized, millions will suffer, there will be increased immigration leading to more right wing extremism against immigrants, and more business opportunities for US companies with access to the largest deposits of oil in the world. How does this help global security, this seems to transparently benefit US interests at the cost of everyone else. [1]
"They have pillaged the world: when the land has nothing left for men who ravage everything, they scour the sea. If an enemy is rich, they are greedy, if he is poor, they crave glory. Neither East nor West can sate their appetite. They are the only people on earth to covet wealth and poverty with equal craving. They plunder, they butcher, they ravish, and call it by the lying name of 'empire'. They make a desolation and call it 'peace'."
Because, in general, maintaining the status quo (regardless of whether the status quo is good or bad) is good for perceptions of stability and security. Saying that American military might preserves the status quo of Western European / American global hegemony is not particularly controversial. Neither is pointing out that many many countries benefit from maintaining the status quo while contributing nothing to the force that maintains it.
This is not a justification of American military maneuvering, but simply an observation that many countries, individuals, and businesses benefit from it, while contributing nothing.
Your evil specter of big business is ultimately a distraction from the issue, because many non-American companies also got pretty good paychecks from American military involvement, despite them or their employees contributing anything to the United States's actions that gave them that money.
I'm unsure how an argument that attacks the ethics or morality of US action can at all counter an argument that US action maintains a status quo that benefits many people who do not pay for it.
Also, bear in mind that a good chunk of that money just gets cycled into politicians via the DOD -> defense contractors -> lobbying.
You do have half a point, though, because the lobbying leads Congress to fund projects that, if one were trying to efficiently run a military, one would not fund.
And the US is definitely not getting it's money's worth it if the goal is world security.
Correct, further supporting my claim that there is no other country that can be properly compared to the United States, since no other country has corresponding military might and it is unclear how to value such a thing fairly.
How much better off would the world be if the US military had been too poorly funded to invade Iraq?
Only in the US can you be bankrupted with full coverage, a simple medivac helicopter ride would take care of most Americans.
Plus like many Americans he was curious about living in Denmark. Cycling everywhere, laid back lifestyle, that sort of thing.
The film 'Vice' on Dick Cheney outlines just how permeable American government is to such non-public interests.
It's no wonder tax avoidance is such an interesting topic for those who stand to pay the most if they do nothing.
The US voters need to realize just how much are they getting fucked over by the military-industrial complex.
I’m not against taxes, I’m against taxes that go to pay for wars as opposed to medical insurance, infrastructure and education.
As an aside, the US is the only country I've seen give military personnel priority boarding for civilian flights. With all due respect to veterans, it seems so strange to do this sort of worshiping in what is effectively peacetime.
https://en.wikipedia.org/wiki/List_of_wars_involving_the_Uni...
The US has been 'at war' with something continuously. There is no or never was peacetime.
It's of course all not that simple, but... why the need for unnecessary name-calling? It just perpetuates the "us vs. them" mentality that seems to be at the root of many of society's ills.
The health insurance industry, however, needs to die. The sooner the better. The resulting boom in people actually receiving healthcare in the US will cover the job losses over time.
You can't average averages in this way. You'll get easily manipulated data.
He's using a single average data for a married, single income worker, and combining that with the average for health insurance.
You can't do that. You need to calculate each individual person's income and share of healthcare costs, and only then average the results.
How universal healthcare sorta works - we all put money in a pot, and use it to pay for healthcare.
How health insurance works - we put money into a company, who uses it to pay for healthcare, while taking a significant cut as it's a private entity.
With the correct organization (which the government is notoriously terrible at) it would seem to me that it could only be cheaper to have taxpaid healthcare?
For their real value prop (covering the unlikely need for catastrophic healthcare), you 1. most likely won't ever use it. 2. have no idea how good their service is until you have no other option but to exercise your coverage.
Market-based capitalism works best when consumers can shop around, and take their money elsewhere when the good or service is not a good value. This is absolutely not the case with health insurance.
Meanwhile, medicare is pretty beloved in this country. And the public options in other industrialized nations outperforms US healthcare in most respects for significantly less money.
- Whatever my employer wants
- Something on the exchange for quadruple the price (particularly without my employer's share of premiums)
How does the market decide when it isn't a competitive market? Why are employers allowed to pick their employee's health insurance? Why are employed people at large companies paying less than employed people at startups?
Plus I think(/hope) that people in the US have fully embraced their hatred of pre-existing condition exclusion in health care that came through with the ACA. The GOP keeps saying they'll drop it and they keep shying away due to the popularity.
Meanwhile in the US it can be had in 3 days or so in every decent sized suburb or city.
If you have an emergency, you essentially have no wait time for an MRI. If you have a condition that can wait, you go into the line and potentially wait for a long time. When the wait times become too long, it becomes a scandal and then improves. Every scandal then gets reported in the USA as stories about how horrible Canadian healthcare is.
Queues are a good thing in that regard, they indicate efficiency of use, what we mostly argue about in countries with socialised medicine is "how long the queues should be?".
Ideally they are on average just long enough so that they never become empty when the usual various peaks/troughs of demand occur, plus have the capacity to handle all the life threatening cases on an urgent basis
That is, how notoriously terrible the government is at organization is a major reason for why people are against universal healthcare. Whether their concerns are overblown or not I leave to opinion. But that is a major fear for many.
A major propaganda point, not a reason based on data. It’s really hard to find a first-world country which has a medical system which doesn’t compare favorably with American insurance companies on either cost or quality — the baked-in conflicts of interest are too powerful.
I also think people forget that, in any case, the gov't is not a private enterprise and efficiency is actually not their first mandate, it's effectiveness.
It comes from Ronald Coase's theory about the natural size of companies. Companies exist at the tradeoff where the costs of transactions between multiple companies equal the internal inefficiency of a large organization. The larger the organization, the more it tends towards inefficiency. Anything that decreases transaction costs, decreases the size of organizations. And vice versa.
From that you expect large organizations of all kinds to be inefficient. Which fits your observation. Now note that government organizations tend to be are large organizations with a tendency towards complexity and no incentives for efficiency. How do you predict that will work out?
Again, whether or not this is a compelling argument is a matter of opinion. But if you want to understand the views of those who don't like government healthcare, this is a key point to keep in mind.
We've just offloaded all of the terrible organization to large corporations like ISPs or health insurers, which don't actually have the consumers best interests in mind. I've worked for a government contractor in the past and I can tell you that private companies will do everything they can to drag their feet or siphon money while creating bureaucracy on the level of any government agency.
If you're young healthy, have a good job and are a bit short sighted, you're way better off in the US (with little to no insurance or a crappy high deductible plan) in term of take home pay.
Even if you're not healthy, if you have a lot of money, you're also way better off since wait times in affluent cities are way, WAAAAAY, _WAAAAAY_ better.
When I lived up north, getting an apointment with my family doctor was a 3+ month deal, most people didn't even have a family doctor because almost none took new patients, wait times for surgeries were so high my grandma almost died while waiting for hers (and did end up dying because of lack of care in the end). And i think in some places they're talking about no longer covering some services like regular check ups?
I had a bunch of lingering non-critical conditions I never got checked until I moved to the US, because it just wasn't worth the trouble, and was able to get everything squared away in record time since I did.
Something that isn't always brought up too is things like dental, which wasn't covered up there so you needed private insurance anyway, and very few of my employers offered compared to my US employers.
It's completely messed up and only benefit people who don't think far enough or have money up the wazoo, but for those, the socialized system would be worse.
Most employer provided dental plans have a $1,000 or $2,000 cap.
I can see my family doctor within zero to two days, assuming I don't use the practice's walk-in clinic first.
Dental coverage is a valid point, I was surprised at how many things weren't covered under my company plan.
I think the developed world (minus us here in the US, of course) has finally realized that access to health care is a basic human right and should be included.
In contrast rights such as freedom of speech, assembly, press, religion and so on can be guaranteed through inaction of the government. Nothing needs to be taken away from anyone to guarantee these rights. Basically this is the difference between positive rights and negative rights.
One large problem with bucketing positive and negative rights together as "basic rights" and insisting that the government must guarantee these basic rights is that it becomes difficult to identify a limiting principle. If health care is a "basic right", then why isn't "food" or "shelter" or "clothing"? How would we go about guaranteeing those things?
Please don't interpret my comments as suggesting that reasonably priced health insurance and accessible health care services aren't important. They are, but there are ways of structuring those services and socializing some of the costs that don't require that they be considered "basic rights".
It is interesting that you qualify your claim that health care is a "basic human right" to the "developed world". Does that mean that it is not a "basic human right" in other parts of the world? Why not? If it is a basic human right, shouldn't it be protected universally? And if you think it should be provided universally who should be responsible for providing that right outside the developed world? And if it there is some complex economic conditions that are pre-requisites then is it really a "basic human right"?
You misunderstand. I personally believe that everyone has a right to access to healthcare. My point was that the developed world has finally decided (for the most part) to recognize and codify that into law and taxation, whereas much of the less-developed world has not (to be fair, a decent amount of it has, though).