I know this personally, as I've spent 21yrs of my life in one half, and another 20 in the other half.
I've also lived overseas for several years, and they also have stratas, but much less pronounced than here in the US.
- Something like 2x as much surgery done in the US than in other countries, because it is profitable, not because it is needed. So perfectly health people are cut open, because they got a good insurance which can pay for it.
- Opioid crisis. Again having health insurance is a problem, not a benefit in this case. That turns you into a money bag, they can push opioids on.
- Antibiotic resistance. America is all about getting more of everything. Quantity over quality, which unfortunately also means excessive use of antibiotics making Antibiotic resistance a major problem.
The US system really isn't working for anyone. It means those who cannot pay get too little treatment, and those who can pay get too much. If only there was a way to even it out...
That's a ridiculous statement, it benefits the wealthy massively. We can argue over whether or not these benefits would be even more massive without over-treatment, but there is no doubt about the overall benefits to the wealthy.
>A Harvard analysis of 1.4 billion Internal Revenue Service records on income and life expectancy that showed staggering differences in life expectancy between the richest and poorest also found evidence that low-income residents in wealthy areas, such as New York City and San Francisco, have life expectancies significantly longer than those in poorer regions.
https://news.harvard.edu/gazette/story/2016/04/for-life-expe...
Fatal opioid use is less common with wealthy folks, and great diet + exercise + friends (easier if you're rich) are all good prevention mechanisms against antibiotic resistant bacteria.
When going to a doctor for a simple diagnosis or bloodwork can easily cost $400 to $1000, many put off doctor visits unless it's an emergency. It can easily become a choice between a doctor visit or a car repair. Preventative checkups are gone and insurance is only something one uses with an emergency room visit or major health issue.
A perfect example is vitamin deficiency and the very serious effects such deficiencies can have, and how inexpensive the preventative care is.
Generally necessary pathology/radiology or routine blood tests are covered by medicare which is paid for by a levy of about 1% on income.
Likewise pharmaceuticals are generally fairly low cost (there are exceptions), being subsidised by the government and for low income or people with ongoing requirements can be free.
Private health insurance is available and encouraged by a decrease in your medicare levy, but a lot of people are finding that it doesn't provide any financial benefit and as we have a very good public health system, does not provide any better health outcome.
Health Insurance is not a major concern in Australia. It certainly is not tied to an employer and doesn't rate on the list of things to worry about when getting a job.
So you won't seek medical treatment at a hospital if you get injured or become severely ill? Or do you plan to go to the hospital and pay out of pocket? Or, like some other voluntarily uninsured people, will you ask for medical treatment and then just not pay?
> than work a low waged job and pay for Obamacare.
Why would a "low waged" job be a requirement, unless that's the only job you can get? You can pay for Obamacare with a middle or high wage job too. You can also pay for it if you are self employed (which is a lot of people on Obamacare).
This is where it gets uncomfortable, isn't it? That their lives are so miserable, that they would gladly trade away years and years of expected lifespan for higher quality of life.
https://en.m.wikipedia.org/wiki/Emergency_Medical_Treatment_...
It isn’t the way we should want this to work, but it is certainly something that people actually do.
I'm saying low waged as in I make $14/hr or less. I mean it boggles my mind that you'd even say that because there frankly, is a large portion of the US who don't make Silicon Valley salaries.
It’s factually correct. For example [0]:
Life expectancy increases with age as the individual survives the higher mortality rates associated with childhood. For instance, the table above listed the life expectancy at birth among 13th-century English nobles at 30. Having survived until the age of 21, a male member of the English aristocracy in this period could expect to live:
1200–1300: to age 64
1300–1400: to age 45 (because of the bubonic plague)
1400–1500: to age 69
1500–1550: to age 71
17th-century English life expectancy was only about 35 years, largely because infant and child mortality remained high. Life expectancy was under 25 years in the early Colony of Virginia, and in seventeenth-century New England, about 40 percent died before reaching adulthood.
During the Industrial Revolution, the life expectancy of children increased dramatically. The under-5 mortality rate in London decreased from 74.5% in 1730–1749 to 31.8% in 1810–1829.
[0] https://en.wikipedia.org/wiki/Life_expectancy#Variation_over...
Someone making $15/hr is likely does not have any assets that would be surrendered in chapter 7 bankruptcy. A lot of people would gladly crater their credit score for a few years to delete an $80,000 bill. Plenty of people crater their credit scores over dumber stuff.
This is the life I have in capitalist America. I'm afraid to do basic things like ride a bicycle in fear of it financially crippling me to the point that I'm incapable of paying rent and becoming homeless
Tax incidence doesn’t not depend on who writes the actual check to the government.
When you get your monthly paycheck, your employer had already withheld the income tax and sent it to the government treasury. Does that mean that you pay no income tax, and the employer kindly covers it for you? No, of course not.
When you buy a new phone, 19% VAT tax is paid. Who pays it? The retailer is responsible to send the money to government, does it mean that he pays full tax, and consumers pay no VAT? Of course not, VAT is reflected in price, and if there was no VAT, the prices would fall down. Suppose that government said that half of VAT is paid by buyer, and half by seller. Would that make any difference at all to anyone involved? No, the final price paid by the customer would be the same, the amount of revenue received by the seller after VAT would be the same, and the government would receive the exact same amount of money. Of course, the outcome would be exactly the same for any other government mandated “split” in who pays VAT.
Similarly, any split in who nominally pays healthcare tax does not in fact matter in the slightest with respect to who actually bears the burden of the tax. Government cannot mandate that half of the burden is on employer and half on employee, because it simply has no power to do so: tax incidence depends on relative elasticities of supply and demand, and not at all on what the government claims the incidence to be. In case of taxing labor, almost all of the incidence is on the seller, that is, on the worker. So, government might say that half of tax is paid by the employer, but the only result of it is that some people are tricked in actually believing that.
I think the key thing was getting past the lower rungs of the Maslow hierarchy. It is very difficult to concentrate on schooling (or anything) when you are hungry or sick. I was constantly hungry when we didnt have free public school meals. A close relative had TB, due to poor healthcare where the hospital/system didn't seem to give a darn. The worst thing is how horrible normal people treated you (even teachers at public school.) I was constantly sick, probably due to poor nutrition.
College was great, I will still poor, but the prospects were getting better and all the basics were covered (no longer hungry; decent healthcare). This allowed more happiness because you knew it would be over soon.
With better jobs comes more stress -- the expectations (perhaps justified) that one should have a home, that one should have a school for children w/o crime/gangs -- and bigger mortgages, bigger spending. I live fairly conservatively despite decent career success, but I can see how I could "become unhappy trying to reach happiness" ... all that said, i'd take unhappy-rich to hungry-poor any day.
Personally I've decided to forgo as many personal luxuries as possible (ie don't fly first class, no boat besides a shitty canoe, no peasant steel case rolex, no car worth > $20k in an effort to retire with a few million in liquid assets on top of my house by my early 40s. Having no worries is the ultimate luxury.
Alternatively, if I lived in California where the weather is mild perhaps I would just go full Diogenes.
- 3 months in Japan - 3 Months in Germany - 3 months in the US - 3 months in India
The transition was alarming. I see bits of both Germany and India in the US. Unfortunately (having grown up in America) I see the trend as towards India. I don't mean this as a cultural slight, but as a cultural observation. I've seen high-trust vs low-trust societies brought up many times on HN. Traffic was most pronounced. In Germany, they obeyed the rules to the extent they wouldn't J-walk even if there was no traffic. In America, you'd look both ways then cross. In India might makes right, big cars get the right of way, pedestrians have to be aggressive and just make their way, eyeballing cars down with a death stare of determination.
Anyway all this is to say, it seems like there are two types of wealth:
- In India, you can found a startup, make money, buy a Ferrari, but that would be a terrible move because if you drive it anywhere on public roads you will go max 30kph, and it will get destroyed on the roads - In Germany, you can have a modest Skoda and still hit 200 kph on their impeccable freeways with confidence that the person in the right lane will never, ever change lanes without a signal and mirror check
So, my personal take, and I realize that this is highly reductionist, but I hope, relevant is that there are two types of wealth:
1. a type where society is wealthy, and that translates into well being for the individual and the whole 2. a type where wealth is relative, and the wealthy take joy not in having an absolute sense of wealth (as in compared to a German), but as in "my neighbor lives in a shack and I live in a gated tower high rise"
I fear America is at a cross roads and will make a choice that makes us poor in a global sense.
America made the choice in the 1980s, with the arrival of Reagan, to transition from being a rich society to being a poor society that has a fair number of rich people in it. Income inequality has deteriorated since then, the quality of public services/public infrastructure has severely degraded, and social trust is rapidly eroding. It's almost certainly too late to change course.
> with confidence that the person in the right lane will never, ever change lanes without a signal and mirror check
Always expect someone to sleep at the steering wheel and switch lanes at an instant without so much as using the signal. Especially when you are going 200kph.
If you generally are in the Bay Area or LA you rarely see the level of obesity you see in say Houston despite the fact that both areas despite being rich have their fair share of the poor too.
Similarly for smoking. It's exceedingly rare to see public smoking in the Bay Area.
Similarly for diets. When traveling in the South I was amazed at just how ridiculously unhealthy the average food eaten by the average person there was. Everything deep fried, laden with calories, consumed along with sugary drinks.
County level:
https://www.worldlifeexpectancy.com/usa/life-expectancy-by-c...
State and county level:
https://www.cdc.gov/nchs/data-visualization/life-expectancy/...
Wikipedia's collected some of the recent per-county census data here, although that isn't a perfect metric since states vary a lot in county size: https://en.wikipedia.org/wiki/List_of_highest-income_countie...
In general there's a good/bad outcomes split within (almost?) every major American city between the affluent and the poor neighborhoods. I haven't verified this with the life-expectancy data, but I would bet it differs more between rich vs. poor areas within each state, than it does between coastal and non-coastal states.
Metro-Denver, Metro-Austin/Dallas/Huston, Metro-Atlanta, Metro-Nashville, Metro-Chicago, Metro-Detroit, Metro-Minneapolis, etc. etc. etc.
I’d say it’s more city/suburban vs rural. This doesn’t account for the poor & homeless in all of America’s inner cities, but does a better job explaining.
Maybe “Fortune 500 headquarters adjacent” is the better indicator. The towns with big global companies almost always have affluent suburbs surrounding them. Even Cincinnati has tons of affluent people due to P&G.
Chicago, for example. My old stomping grounds. The inequality within that city is stark. Glaring. The South and West sides are a world apart from the North side.
Food deserts and gang violence - both accelerated by concentrated poverty - are a couple of ways this manifests in some of the "elite" cities.
In SF or LA they'd be middle-class.
It's not just about wealth in dollars, it's about purchasing power.