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Comment by jacobush | Hacker News Reader

What about health care?

Most Americans have health insurance. Of the ones that don’t:

1/3 are illegal immigrants. Those folks would be excluded from the universal healthcare system of nearly every EU country. France and Spain are the exceptions, but France is under a lot of pressure to scrap that.

1/3 are eligible for Medicaid but haven’t signed up.

1/3 can afford Obamacare premiums but choose not to buy insurance. The Obamacare premiums are capped at 9.5% of income. That’s about the same as the employee-side healthcare tax would be in France or other countries with universal healthcare.

"Have health insurance" is not comparable with "is covered by universal health care" without a lot of clarification.

1. It's dependent on employment.

2. It comes with various forms of limits, out of pocket payments, and other caveats.

3. It comes with a profit motive for the insurance company to decline coverage.

etc

So fundamentally, "Am I under the threat of financial ruin if I were to get ill?" is still very much alive even with health insurance.

All health care systems regardless of payer structure have a financial motive to decline coverage.

Yes, but vastly different. Universal health care certainly won't come with a dozen pages of fine-print. It doesn't have pricing levels either. You won't hear: "Oh, you should've chosen our premium plan for that!".

That's true. The tradeoffs are different. There will be procedures you can't readily get, and more complexity in getting others. Some of those are procedures you shouldn't be getting in the first place. You'll have far less control over your own care, but most people weren't taking advantage of that control in the first place.

"Far less control over your own care" implies a very small, and wealthy, subset of the population.

I don't think that's at all true. Wealthy health care consumers are generally not price conscious.

I guess I misunderstood you? Because that's what I'm saying. That it would require substantial wealth to be able to have significant control over your own care.

> 1/3 are eligible for Medicaid but haven’t signed up

Does that include all of the people who live in states that haven't expanded Medicare?

It seems like it logically couldn't, else why bother expanding Medicare in the first place?

Migrants are not excluded from healthcare in most EU countries. They are on special schemes, A.M.E. in France. In fact, as an Australian resident I came back to a French hospital (after expiry of my SSN / a consultation is cheaper in France), and after seeing the doctor, they said they couldn’t establish the bill without current SSN and would have to... call me back. I’m the kind of guy who really wants to pay (It was just 120€, on an Australian salary), so I did give them my real name, email, phone, but the scene was surreal. “I want to pay you. Here is money to pay France, please take it.” —“No”

That country is going to end up in debt.

As I said, France and Spain are the two exceptions. In the U.K., for example, illegal immigrants can access the NHS only for urgent care, similar to the situation for hospitals in the US.

Workers pay for the medicare in Europe, it's a collective (and compulsory) insurance. You also have to work to qualify in most of the countries (unless you're disabled etc). In America you often talk about the mysterious billionaires that shall pay it (Sanders etc) but in reality is that in these so called model countries its literally a workers tax paid by employees.

I wonder if this isn't a question of who bears the responsibility. For example, in the US you make more money but are expected to save, and make sure you have something to fall on in case of difficult times. In France, you expect the state to take care of you in such a situation. Spoiler alert: depending on the state is not a good situation.

Some people may therefore prefer to be able to spend all they've got without having to think of hard times. Because they may think "it won't happen to me" / "I'll save tomorrow".

As such, I would be very curious to see some actual numbers to be able to do as objective a comparison as possible. Because indeed, if in the US the prices are overall higher relative to the wages, the deal might not be as good in a bad situation. From France, this doesn't seem to be the case, mostly because (outside of SF) pretty much everything looks cheaper. Housing, food, entertainment, cars / gas, electronics, etc. The only issue seems to be related to healthcare. So I'd like to have that actually quantified.

The issue in France is that in addition to the fact that "having a 140k salary is impossible", taxation is very, very high.

If an employer pays 100k in total for an employee, the actual, cash in hand, after income, social security and medical insurance (1) for the employee is around 55-60k. Once said employee has his 60k in hand, practically everything has a 20% VAT [2]. Oh, and since this is France, you also have taxes on taxes. For example, VAT is levied on some taxes related to electricity.

So out of a 100k USD total paid by the company, how much would a US employee have in hand after tax?

I've also noticed that for similar positions in the US (outside of SV) a software engineer can expect twice the salary compared to Paris. And mind, Paris is very expensive for the basics (food and housing).

It would be interesting to see how this compares to professions other than IT. In France, you're mostly barely above minimum wage for blue collar jobs. And minimum wage is nation-wide, the same in Paris and in some village in the middle of nowhere.

[1] Only "basic" health care is actually "free". If you need anything more "advanced", such as dental work or glasses, you better have a "mutuelle", which is basically private insurance. This is usually provided by the employer, but what is actually covered varies.

[2] Food, "necessities" and some other items have a lower VAT, 5.5% I think. There's also a 10% VAT for restaurants in some cases.

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