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Comment by tempsy | Hacker News Reader

What is your definition of prohibitively expensive?

I've bought a gold plan off the exchange in California for Kaiser and it's $530/mo with no deductible. That's lower than I expected.

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$530/month sounds insanely expensive to me as someone outside of the US. My private health insurance costs me approx $100/month. 530 is over half my rent (outside of a major city though, in the major cities rent is much higher)

how much do you pay in taxes though?

I've recently moved to the US from Australia. The amount my employer and I pay for my healthcare is significantly more than I paid in Australian taxes for healthcare. And that's before including my deductible, things my insurance doesn't cover and the amount I pay in US taxes for healthcare.

In Australia, the government spends over $70B on healthcare, but collects only around $10B through Medicare levy surcharge. The only reason your healthcare spending in Australia seemed so low is because an overwhelming majority of the cost of healthcare in Australia is covered through general taxes, and not through the Medicare tax. Even if you focus on Medicare benefits only, the Medicare levy surcharge only covers less than half of the Medicare benefits.

That said, healthcare in Australia in fact is cheaper than in the US, but not as much cheaper as you think it is.

The US actually spends more per capita on health care than Australia both public and private https://www.healthsystemtracker.org/chart-collection/health-...

Yes. And US doctors make more "per capita" than Australian doctors. About twice as much. If they continue making more, I don't see how paying their billing rates from the taxes addresses the "affordability" problem. If you were to fix billing rates at a lower level (through single payer and such), you wouldn't really have any doctors to begin with, at least not for a while.

Doctors' wages aren't the biggest cause of higher spending. Admin costs and pharmaceutical spending are the largest (unnecessary) cost centers.

Citation needed. Most of _my_ medical bills go to the doctors.

I live in Australia and that doesn't seem out of the ballpark. I pay the equivalent of USD$1.3k a year in levies and USD$100 a month for health insurance. Australia doesn't have access to the same level of care either (for example, bleeding edge cancer treatments or experimental medicine).

I also pay substantially more in other general taxes (compared to the US), which ends up funding healthcare as well.

For healthcare? In my case much less because the system feels a bit like very regulated competing non profits with a public option available and defined minimum service.

I've heard we've been paying more and more for certain types of medicine as far as subsidies go and although i haven't looked into it enough i can't help but look with distrust at recent governments over it.

https://translate.google.com/translate?sl=nl&tl=en&u=https%3...

Approx 35% in income tax (which includes social security etc).

Note that private health insurance isn’t a necessity, public healthcare is generally ok here, but I choose to go private for comfort and additional peace of mind.

Your insurance is probably heavily subsidized by government from income tax.

Yeah, and? It's not that the US has one of the lowest income tax rates in the world (in fact, it's one of the highest, especially to their citizens that work abroad).

It's prob important to know level of coverage and % of income it costs vs absolute numbers which is fairly meaningless.

I was looking last year in Washington. Cheapest option for my family was ~$1800 / month, and that had a 14k deductible and ~20k max out of pocket. It also couldn't be used outside of Washington state (which sucks).

Went with the health ministry route because we align with their principals already, plus we can visit family out of the country and be "covered".

Can confirm similar prices for a family of 3, no prior health issues.

Since 2010 and ACA, health insurance companies are not allowed to factor in pre existing conditions for premium costs.

When you search for health insurance, you’re only asked for age and location and smoking. Basically, nowadays in the US, your health insurance premium is simply a function of age, and the premium for oldest person at 65 is limited to be a multiple of youngest (healthiest).

Careful with the health ministry: https://www.nytimes.com/2020/01/02/health/christian-health-c...

That’s because health ministry isn’t ACA conforming health insurance. It’s ridiculous the law had to allow those stupid plans to exist to be passed.

$530 a month is like 85% of rent where I live in the midwest. I mean if I could only get healthcare through the marketplace, I would be better off working part time or not at all collecting unemployment and food from pantries than I would be essentially putting all my extra income toward health insurance.

Mine is 275/mo for Kaiser at a high deductible but still gives me the amount of coverage I basically used when I was employed (Physical + maybe one additional visit per year). Single person, 26, no kids.

yeah...for me one expensive drug a month (truvada, which is ~$1500 out of pocket) means it makes no sense to buy a high deductible plan.

> $530/mo

Wow. Just wow. As an Australian, I cannot fathom having to include $530 into my monthly budget just to ensure I don't end up homeless (or heavily in debt) if I get really sick. I'm not a socialist (I'm quite a centrist when it comes to economic policies), but something about the US system absolutely must change.

That’s actually on the cheap side. If you have say a wife and 2 kids, you pay around $1500 a month on the health exchange.

1500/4 = 375, which is significantly cheaper than 530.

The person that said $530 said no deductible, and they’re probably a young person. $1,500 family of 4 insurance will have at least a $5k deductible and $13k oop max I would estimate.

my wife and i are in our mid-50's. Here in NM, we have $1095/month with a $6600 deductible each. I'm happy paying 10 of our income for health insurance, but only if we actually get health coverage without that kind of deductible.

My parents at a few years older than you get bronze HSA PPO at ~$2k per month for both with a $13k oop max and a $5k or something deductible.

The thing about health coverage is that you either pay via your premium or via deductible/oop max, but there is no escape. The health insurance is there to protect you from losing your assets from costs over the out of pocket maximum.

Since you’re in mid 50s, even the astronomical amount you pay is actually being subsidized by younger people, since your premium is capped as a multiple of someone in their young 20s.

Otherwise, you’re real health insurance premium would be even higher. That’s just how expensive healthcare is in the US, and how guaranteed you are to needing it as you get older.

I don’t know how you guys do it. With the exchange rate that’s probably close the my rent each month!

Medicare and Medicaid provide free healthcare to many Americans. Obamacare subsidizes health insurance for many additional Americans. For the most part, you only pay full cost for insurance if you can afford it.

You don't qualify for medicaid if you have any assets. You'll have to spend down to you last $2k in assets before you qualify for medicaid. So... someone in the middle, who perhaps has some savings, can still be ruined if they have one moderate incident which would force them to spend down all their assets to poverty level before receiving any assistance.

For the record, if you live in CA, I don’t believe this applies to Medi-Cal. Unless you’re a “Medi-Cal individual who receives long-term supportive services or who enrolls in Medi-Cal through certain disabilities”, I believe only income is tested.

(Not that this is enough! I am absolutely on the side of everyone having access to good public health care.)

https://ca.db101.org/ca/programs/health_coverage/medi_cal/pr...

well... certainly in NC, it's 'assets' (although house/car don't count, but any savings/investments do)

the difference is probably negligible when you sum up taxes

and like others said you would qualify for either free or subsidized insurance if you were low income

I don't think that's the case. $530 is nearly 10% the median household income. And that's just healthcare. Keep in mind countries with higher tax rates aren't just getting socialized medicine but vacation days, parental leave, cheaper education, and usable public transit.

Germany's system is generally liked, and "the public option" is ~15% of income (but we "split" it between employer and employee so it doesn't look as grim, which means you get half of that less in salary, but only pay half yourself). 10% seems reasonable, and is something you'd only achieve in Germany if you have a high income (because the total amount paid is limited) or go for private plans (which you can if you're self-employed or in some special cases, or if you have a high income; caveats apply). The public insurances also provide a much lower level of service than the private entities (e.g. you're paying for glasses yourself unless you're basically unable to function without them). That's on top of having income tax on the higher side and a high VAT, and high rents. From that perspective, 10% seems great.

Not at all! Using some simple online calculators, assuming you earn $125k in San Fran, your take home pay after tax is $85k. In Australia, your take-home pay after tax is $88k (and that includes the medicare levy deduction if you don't have private health cover).

So not only are you being taxed more in the US, you also have to pay for healthcare on top of it. Insane.

if you're working a regular job then that's not true because employers heavily subsidize your premium or pay for it in full if you're working full time.

if you're self employed then your health care premium is 100% tax deductible

Half of Americans don’t have employer sponsored health insurance:

https://www.kff.org/health-reform/press-release/coverage-at-...

$530 a month would be amazing. I have a wife and 3 kids and we are looking at closer to $1200-$1500 a month for decent health insurance.

I'm confused. You're currently paying $300 pp pm. That is much better than $530 pm.

the per person amount hardly matters for a family's budget...the fact is you're paying far more than a single person

Of course per person health insurance costs matter when discussing health insurance costs. Why would one compare the cost of one apple to the cost of a bag of apples?

"I'm not sure why I can't afford to feed my children, I only have 12 of them."

Children are getting covered just like adults are. Just because they aren't/can't earn an income to cover it doesn't mean it doesn't cost just as much to the insurance provider. In fact, children tend to go to the doctor more, so...

Not sure how it works in Australia, but if i break down my salary by taxes in Eastern Europe, I'm paying 33% "social tax" which comes out to around 1900€/month. This breaks down further to 2 groups. One for pension and the other for healthcare.

Pension is 20% from the total. (used to pay the current pensions)

Healthchare is 13% from the total.

This comes out at around 990€/month for "health insurance". There are advantages and disadvantages to both systems, but I'm pretty sure you're paying something as a tax for you health insurance and it's probably similar to what they're paying.

To be fair, i'm well paid and a person with an average salary would pay around 250€ monthly. It's just the way our system is setup with a fixed % which automatically creates tax brackets.

Wow, you earn a lot for Eastern Europe. What do you do if I may ask?

Probably a software engineer. If you're a little above average, salaries are very high. Most software engineers I know in Romania make at least 5 times the national average. Good ones make up to 10 times the national average.

Still, according to his numbers he makes about about €70k/year. That's more than me and my friends make in Germany and Austria. Either Eastern European salaries took off like a rocket or Germany heavily underpais.

Really curious what his job and location is, maybe I move there :)

That's before taxes I believe. So after income tax and social contributions, you'll have paid 40-50% of that. Doesn't sound off to me. At least, that's the case here in Romania.

Another interesting fact is that in Romania the tax system is simple enough to always negotiate in net salary. Your employer takes care of paying taxes and social contributions etc.

So €70k/year before taxes is a normal dev salary in Romania? Are you sure, since that's basically German level of salaries but with much lower COL. Do you have any sources for this?

Because if that's the case I'm coming over to join you. :)

we compete on the same market, so we have the same salaries.

But the rest of the country doesn't, so we have the lower COL.

Give me a private contact and I can give you some concrete answers and tips regarding the area.

Cool. Drop me a line at the email in my profile please. Thanks

software engineer/manager with (bigger) international projects. This is on the high end for such positions.

I can't complain :)

The healthcare costs for insurance in the US don't include the costs of actually visiting the doctor or getting medicine. You still have to pay for those, amount dependent on the terms of your plan.

For example, a routine doctor's office visit can cost hundreds in addition to the monthly fee you pay.

Last year I paid $300/month for my medicine, in addition to other costs.

Wait until you hear what we pay for child care on top of the cost of insuring a family (I suspect that $530 is just for a single individual, or maybe a couple at most). Let's hope your student debts don't put you in the poor house too. Oh btw, that $530/mo for health insurance really only matters if you have a serious illness. Needed to go to the emergency room for some minor injury, or perhaps want preventative care? Be prepared to spend thousands every year.

Let's do the math.

Someone making 100,000

On average you pay 2% of annual salary to health levy which gives you medicare 2000.00

If you are over 90k you pay 1.5 unless you have private insurance On average $2000. Plus on average $800 in extra like someone driving you to the hospital

$4800 aus to usd = $3312.41

It looks like you are paying half.

But the government is spending 7800 a year per person. So the additional cost comes from general tax revenue which you pay.

On average you are paying an extra 10000-15000 in taxes on that 100,000

Given the context of this conversation... How does the math change if you strike out on your own, earning nothing for a year?

I think it suggests that the healthcare barrier to entrepreneurship is much higher in the US than in Australia.

I pay $15K/yr for a family of 3 for health insurance. Where I live it costs $95K/yr post-tax for a family of 3 to maintain middle class lifestyle (verified by not working for a year), including about $3K/mo mortgage, $1k/mo real estate tax, $1K/mo groceries, and a modest vacation in the tropics in December. So while $15K is clearly expensive, it's not dominant in the grand scheme of things. Of these numbers, BTW, it's the real estate tax that pisses me off the most: I have to pay the government to live in my own goddamn house, WTF.

Try changing your viewpoint on real estate taxes. I assume you live in a city (or else you wouldn't be paying much). By allotting your parcel of land for private use, everyone else's destination will be just a little bit farther away on average when a trip from A to B takes them past your land.

(Ref: why were medieval cities so dense despite their low populations and plentiful surrounding acreage? Everything had to be walking distance, so a big manor in the middle of the city would place a major burden on everyone's commute whose destination was not that manor).

So the tax is what you pay for the burden that your exclusive hold on the land imposes on others.

Or, you could think of it as what you pay to maintain the right for it not to be paved over as a superhighway, plus what you pay for the government to agree to keep other people from trespassing.

Not the fee for living there -- the fee for not letting others live there.

Medieval cities are dense because they had walls outside for protection. It's not like the US has insufficient acreage. I kind of got why the real estate tax was so high when my state wasn't charging sales tax on internet purchases out of state, but now it does, and yet the tax just keeps going up every year, and they also pile on the levies to boot.

I think you are missing the point of the system: you pay the difference in general income tax now so when you are unable to pay such levels the state (and those still paying income tax) take care of you. If you are always able to pay for private health insurance or are always being taxed highly on income you are very lucky and should have no problem kicking in for public health.

There is no minimum tax payable before accessing healthcare services: if you have no income, or are unlucky, you won’t die or be debt ridden for the rest of your life.

And in the US the Affordable Care Act means that if you don't have much income the government will pay for some (maybe all?) of your health insurance premium.

Keep in mind Australia has ~40% more doctors per capita than the US [0]. And the supply/demand curve is not linear, so physician shortage alone can account for a significant part of the price difference (note that Singapore and Japan are noteworthy exceptions to the doctor/quality ratio). As for why there are fewer doctors in the US than most developed countries, there are a number of potential reasons, and there is no reason to believe that any of them would be solved by the government subsidizing healthcare. You might just get long wait times like Canada and the UK (with comparable, but still higher physician counts than the US), which are sort of the jokes of socialized medicine countries.

[0] https://data.worldbank.org/indicator/SH.MED.PHYS.ZS

I think most people don't know that. I didn't know that.

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