Europe has a lot of braindrain as well. If you are truly talented, why would you stay (many don't)? Either you're not that good, or something else is tethering you here (many valid reasons).
Also longer vacations and a more relaxed working environment.
I know of far more people heading to the EU from the US than the other direction.
Relative to health care in the EU, not that good. Top-tier platinum PPO from top silicon valley employers is still going to cost a lot out of pocket (way above the so-called max out of pocket) if you have health expenses and that's on top of the $25K-$30K we're paying for the coverage itself.
A top tier platinum plan will, per the legal definition of platinum, pay for 90% of expected health expenses.
Max out of pocket should be less than $5k for a family of 4 on a platinum plan, and the employer will be paying 70%+ of the premiums, if not more.
Assuming you are seeing in network providers, which for a top tier platinum PPO should be almost all doctors, and a BCBS plan would be nationwide, then your premiums would be say $500 per month for a family of four, and out of pocket max will be $5k per year at most.
Total expenses of $11k per year for the most expensive locale in the US. And that is assuming you max out health spending every year, which probably will not happen. And that is off the family has only one working adult.
And you get an HSA to invest $7.3k per year and withdraw it tax free at any point in the future. You can have a few hundreds of thousands saved up for healthcare expenses by the time you retire, all tax free.
You're wrong. I'm not speculating here, I'm talking about the real numbers.
My monthly premiums for a Platinum PPO plan through my employer (in Silicon Valley) is slightly over $2K/month (for a family of 3). Same plan at my previous employer, same price (a bit cheaper but that's because it goes up every year). This is also very similar to what an ACA plan would cost. Your guess of $500/mo is way off.
So out of pocket is ~$25K on premiums alone (pre-tax though).
> Why would it cost more than the “so called max out of pocket”?
You can easily go above what the insurance company calls "max out of pocket". Again, I'm not speculating here but telling real experiences.
That's because if you get a bill for, say, $10K, the insurance company can decide they will only pay $8K so you're stuck with $2K. But not all of that $2K is counted against the out-of-pocket max. The insurance company will say only some smaller amount, say $500, will count as credit towards the out of pocket. So I get to write a check for $2K but in the eyes of the insurance company I've only paid $500 this year. Repeat a handful of times and I can easily go over the so-called max out of pocket in real money.
My calculations are for the portion the employee pays directly, meaning the ~25% to ~30% the employer does not pay.
Since all employers of this caliber part the 75% portion as a benefit without option to receive it as cash compensation, it is not appropriate to consider the employer subsidized portion in the amount the employees pay.
> That's because if you get a bill for, say, $10K, the insurance company can decide they will only pay $8K so you're stuck with $2K. But not all of that $2K is counted against the out-of-pocket max. The insurance company will say only some smaller amount, say $500, will count as credit towards the out of pocket. So I get to write a check for $2K but in the eyes of the insurance company I've only paid $500 this year. Repeat a handful of times and I can easily go over the so-called max out of pocket in real money.
If you have an ACA compliant plan, which the platinum designation indicates it is, this should not be happening for in network services that have prior authorizations. Either the insurance company thinks you are being given superfluous treatment not supported by evidence, or the insurance company is ripping you off in which case you need to file an appeal.
https://www.healthcare.gov/marketplace-appeals/ways-to-appea...
I have had 2 childbirths since ACA was passed and both years we hit out of pocket maximum and did not have to pay a dime afterwards.
I'm talking about the employee-paid portion deducted from paychecks.
People who are surprised by this tend to be single. Most companies usually pay close to 100% of the employee premium. But they are far less generous on the family member premiums.
> this should not be happening for in network services that have prior authorizations
There's a lot of insurance company weasel wording in that phrase. Plenty has been written on how when you go to an in-network hospital, turns out that every doctor who shows up while you're unconscious (some of whom you'll never even knew saw you until the bills arrive a few months later) is actually an out-of-network contractor.
Lots of things shouldn't be happening, but happen every day in the US health care industry.
I can see this happening. However, in my ~3 different employer experiences, the employee and children are very well subsidized, and the spouse is the only one the employer usually does not cover to incentivize the spouse to use their own employer’s subsidies.
> There's a lot of insurance company weasel wording in that phrase. Plenty has been written on how when you go to an in-network hospital, turns out that every doctor who shows up while you're unconscious (some of whom you'll never even knew saw you until the bills arrive a few months later) is actually an out-of-network contractor.
This is true, and I had not experienced it. Good news is that is illegal now:
https://www.cms.gov/newsroom/fact-sheets/requirements-relate...
The last couple years have had quite a few good rules come into place, including another one that obligated your doctor/hospital to give you a good faith estimate for which you are only responsible for the estimate + $400.
It is still extremely risky and costly in the US, even if you have nice employer subsidies because the second you lose the ability to work, you are on the hook for many, many thousands of dollars of expenses at the same time you no longer have income. And then if you want government help before age 65, you basically have to liquidate all your assets and become poor forever. Dual income families are almost a requirement just for that reason.
Age 50 to 65 is extremely risky in the US. A few wrong steps and you are deciding between sacrificing your kids’ future to save yours.
People on traditional plans can have FSAs but those typically don't let you really accrue from year to year.
My gold level high deductible health plan has a ~$3k deductible I think (for family coverage).
I imagine even a platinum plan can be high deductible if the deductible is set to equal the out of pocket maximum.
Either way, the numbers will not be too different for gold and platinum plans.
Besides bragging rights, I can't see why anyone would want the Platinum PPO. My 'HDHP' PPO costs me ~$200/month for a family and has a family OOP max of $6K. Even not including the HSA tax breaks and the $2K contribution to that HSA from the employer, that extra $1800/month for the 'no cost' PPO would easily be hit by the OOP max in only a few months. That's assuming you actually hit the OOP every year.
I'm going to guess that you're young and probably single (or your partner gets insurance separately).
For other Americans, yeah, this is how many get into medical debt.
Maybe because, IME, 90% of US offers are: Remote (US based)?
Less? By what metric? The tax burden is lower in the US than in Europe by a good amount. Does paying a lot more in taxes not count toward paying for social services?
The problem with money savings is that they might not keep their value. Last thing I want is to be old, ill, broke and living in a country with no free social services. That said, it all depends on the risks one wants to take... Life is dangerous. :)
The counterpoint to that will often be "But, why not just work extra hard in the US for 10-20 years, and then retire? I'd much rather work hard now, and then live my life at [30/35/40]" which is probably also a valid point, but Americans will soon notice that Europeans are in a much less hurry to "retire".
It all comes down to labor laws, and work/life balance.
There are TONS of talented workers in Europe, that live just fine as it is. And many just truly enjoy a relaxed, easy, and predictable lifestyle.
I also doubt the amount of braindrain, i see a lot of brain-gain where I live (in the south of germany and I don't include europeans).
I doubt Germany, France, Austria etc. would see much significant drain. Poorer countries (eg Poland) have been already hit quite hard and might be impacted a lot more by this though.
By all accounts of everyone I know in Canada and also those in Canadian Healthcare, the system is on the verge of collapsing
Sure enough, if you take the small percentage of extreme tech talent or very entrepreneurial employees, many in that group might consider taking their business to the US.
But how much is that really? 1%? 5%? Can't be much more. So, 95-99% don't...hardly a brain drain.
The other thing Americans can't seem to comprehend is that not everybody is a dollar-chaser. For the typical European, if they have a decent quality of life and some reasonable disposable income, they are satisfied.
Bread and games as they say.
* Top 1% pay 48% of all income taxes * Top 5% pay 59% of all income taxes * Top 50% pay 96% of all income taxes * Bottom 50% pay 3% of all income taxes
https://www.ntu.org/foundation/tax-page/who-pays-income-taxe...
The point I made is that I don't expect a "lot of braindrain" from Europe and that this concerns a tiny percentage willing to move to the US. What is the relation with the tax revenue you shared?