Comment by gus_massa | Hacker News Reader

Comment by gus_massa | Hacker News Reader

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> The OECD data is particularly flawed because it is based on “income,” which excludes [...] healthcare provided by Medicaid, free clinics, and the Children’s Health Insurance Program.

Don't many of the other countries offer some kind of "free" medical service for everyone? Should they add this to the average income of those countries?

Anecdote time. Here in Argentina we have:

* Free hospitals and free ambulances for emergencies, and even some standard procedures. The quality and waiting time may vary. It's free for everyone. Should they count this as "income"?

* Also we get a compulsory 5% discount of the salary for additional healthcare that is controlled by the working union, this includes dental care. The quality and waiting time may vary. I'm not sure if they would count this 5% as income.

* Also you can pay a private medical plan or pay to a medic for a consultation. The quality and waiting time may vary, but it's usually faster and you have more options to pick a good medic hopefully.

Poor people in the US, the demographic being discussed here, all have access to free medical care at the same clinics middle class people use. This is partly paid for by the government from taxes and partly subsidized by the non-poor users of medical services.

I grew up very poor in the US. We never paid for anything healthcare related, and still have poor relatives receiving excellent free healthcare today.

False. Medicaid eligibility requirements vary by state. In Mississippi, for example, they cover children and pregnant women at roughly the same income level as other states... but the parents of those children aren't covered if the household makes more than $227/mo (+78/mo for each additional household member).

If you don't have children? No coverage unless you're in a very specific category (disabled, covered by medicare, etc)... no matter how poor and destitute you are.

https://www.healthinsurance.org/mississippi-medicaid/

Missouri: no medicaid if you aren't disabled or have children (and you're below 381/mo for a family of 3): https://www.healthinsurance.org/missouri-medicaid/

Same in TN: https://www.healthinsurance.org/tennessee-medicaid/

Same in TX: https://www.healthinsurance.org/texas-medicaid/

Seriously, go through the states that haven't accepted the ACA expansion: https://www.healthinsurance.org/medicaid/

These poor people are not getting Medicaid.

Who said anything about Medicaid? That is a Federal program that States can opt into to varying degrees, and most States have longstanding separate programs for the purpose. The landscape of how free healthcare is delivered is complicated. Like education, it is the prerogative of the States so any Federal view is only going to tell a small part of the story.

I should add, all of my experience is decades before the ACA Medicaid expansion.

> Who said anything about Medicaid? That is a Federal program that States can opt into to varying degrees, and most States have longstanding separate programs for the purpose.

No, they don't. Many states name their Medicaid-participating program with a local name that does not include “Medicaid”—California’s is “Medi-Cal”, Oregon’s is “Oregon Health Plan”—but none of them have a general, broad coverage health insurance program for the poor that is not the state Medicaid plan (except to the extent that their CHIP program is separate from their Medicaid program, but that is usually not the case, and CHIP is, in any case, a similar federal program to Medicaid, but newer.)

> I should add, all of my experience is decades before the ACA Medicaid expansion.

At a minimum, your generalization of your experience across the country and across times and to the whole body of the poor and not those in specific circumstances, and the understanding of the administrative context which enabled your experience, is incorrect, but it's quite possible that the reported experience itself rather than the generalizations based on it (that is, that you had decent, free healthcare while being poor in the US) is correct, especially as a child.

> Poor people in the US, the demographic being discussed here, all have access to free medical care at the same clinics middle class people use. This is partly paid for by the government from taxes and partly subsidized by the non-poor users of medical services.

This is simply not true. Maybe it was for you growing up where you lived, but I can assure you it isn't today in any part of the country I am familiar with. Our poor friends most certainly do not receive "free medical care at the same clinics middle class people use."

A lot of the these programs don't cover a good chunk of the working poor. If you worked full time at a minimum wage job in california for example, you'd be over the limits and wouldn't have healthcare as a result.

> Poor people in the US, the demographic being discussed here, all have access to free medical care at the same clinics middle class people use.

No, they don't. Poor people in the US have access to emergency care from the same hospital ERs other people use. They do not, as a rule, have access to general healthcare from the same clinics middle class people use; some of them may have Medicaid managed care plans that cover clinics otherwise used by the middle class, and some clinics that also have a middle class clientele may take fee-for-service Medicaid, but neither of those is generally the case. And some of the poor being discussed will not have access to Medicaid, anyway (not all states participate in expansion, and not all the poor are covered, especially in non-expansion states.)

I second that. I grew up poor in the US as well and received entirely free healthcare. I have a few poor relatives that receive free healthcare now due to their low income status, it's quite decent. They get access to exactly the same system as anybody else until you get into the top ~20% or so that are buying another tier of healthcare (easier access to the best specialists and latest medtech & biotech is the primary gap).

In the U.S. we have Medicaid for low-income earners. So the bottom 20% the article mentions would largely qualify for free health care: https://eligibility.com/medicaid/texas-tx-medicaid-benefits

Have you looked at Medicaid eligibility requirements?

It is a common misunderstanding that if you’re poor you get Medicaid. Eg. In Florida no matter how poor your are you don’t qualify unless you’re disabled, have children, or are pregnant. In other states there are hard income limits which are incredibly low, and earns a dollar more, you don’t qualify. You go from having free Medicaid to needing to pay $1000 per month in premiums which obviously you still can’t afford.

Edit: actually looks like it’s the same thing in Texas, if you’re poor you don’t qualify. You have to have kids or be disabled. These are all the states that refused the federal funding for Medicaid expansion I guess.

This is why we should allow medicaid buy in.

Interesting; I wonder if the kids thing is why I always hear from conservatives that medicaid is all we need in this area. "It's your fault for not wanting to start a family like a normal American."

> Eg. In Florida no matter how poor your are you don’t qualify unless you’re disabled, have children, or are pregnant.

There are 4.4 million people on Medicaid in Florida. That's about 21% of the population, which matches up with the national Medicaid figure of 22% of the US population.

How does that relate? Grass is often green. So are leaves.

> In the U.S. we have Medicaid for low-income earners. So the bottom 20% the article mentions would largely qualify for free health care:

Medicaid isn't necessarily free healthcare:

“States can impose copayments, coinsurance, deductibles, and other similar charges on most Medicaid-covered benefits, both inpatient and outpatient services, and the amounts that can be charged vary with income. All out of pocket charges are based on the individual state’s payment for that service.”

https://www.medicaid.gov/medicaid/cost-sharing/out-of-pocket...

As an American who's seen and experienced "the bottom 20%" in our country, this was my first thought. People in America "consume" more economically because it's our only option. If our cost of living is higher relative to our average income compared to other developed countries then of course more of our money is economically "consumed". Notice there's no mention or comparison to other key economic indicators like savings, quality of life and upward economic mobility. Statistically most of America's "middle class" lives paycheck to paycheck. According to a recent article on CNBC 60% of Americans couldn't afford an unexpected $1000 expense.

"Just 40 percent of Americans are able to cover an unexpected $1,000 expense, such as an emergency room visit or car repair, with their savings, according to a survey from personal finance website Bankrate."

https://www.cnbc.com/2019/01/23/most-americans-dont-have-the...

> Should they count this as "income"?

You certainly could include that in the total government benefits category (including it into income is questionable and probably unnecessary), which is regularly done for example when tabulating individual conditions & resources that segments have access to. That picture gives you a combination of income, entitlements, welfare, etc.

The US jumps off the page in this case however, as the US spends 10x or more per capita on healthcare versus Argentina.

For example it would not make sense in the unusual US system, to ignore that the bottom ~25% get free healthcare (which is an extremely expensive social transfer). You would want to consider their healthcare picture when looking at their total condition. If you don't look at the comprehensive, then you would miss that the US welfare state has vastly expanded and improved over the last 20, 30, 50 years. That is, ignoring these details is only effective if you are dealing with an entirely stagnant system (not likely).

I don't think anybody would argue that eg Russia pensions should be ignored when looking at any comprehensive view of their condition as a people. It's a fundamental part of their system, their social contract, and their well-being nationally.

The funny part is the article at the same time arguing how much benefits people receive and thus them not being poor while at the same time pointing out the US is great despite social programs, heavily implying that it would be even better with even less taxation and less "government assistance programs" that provide "an incentive, and the means, not to work."

I would find it a lot more fair to not counting all those benefits in my analysis, if I'd want to get rid of them.

The website appears to be from some sort of right-libertarian organization, so I'm not surprised by this.

How does the publisher of the article affect how surprised you are by anecdotes?

The agenda is clear enough to make it useless as a source of information. Just peeking at their position on birthright citizenship solidifies this

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