> in the US and less civilized countries
Going to have a hard time finding some goodwill when you refer to other countries as "less civilized". A tad hypocritical.
Going to have a hard time finding some goodwill when you refer to other countries as "less civilized". A tad hypocritical.
I suppose I should admit as an European that confidence in your own superiority is not solely and American trait.
It's significantly better to be a high earner in the US than almost anywhere else in Europe (in terms of capital)
And that outside of your own retirement.
I’m currently on a US salary that is very generous. I don’t spend a dime extra because of those. It’s kinda terrifying I don’t know how they do it.
Assuming working independently, some of that is deductible, and one might argue how much left over is "a lot" or not. There's still food, shelter, utilities, transportation, education, etc. they need to account for, as well as saving for the future.
Actually, looking at it, if the person is 'independent', they'd pay another ~$10k or so on FICA, or have some LLC structure set up. Or they might be lucky enough to have an employer who pays for some/most of this 'fantastic' insurance... until they don't.
Perhaps in terms of raw dollars, there's some advantage, but there's a pervasive threat of "what if" scenarios that is hard to shake for a lot of folks.
If you are working independently yea it may be more expensive, but (unfortunately) so few people work independently so it’s an edge case not really that valuable here. Though worth noting providing a way to untie healthcare from employers and still make it affordable so that you can more easily start a company is a good idea.
It’s really difficult to do good analysis here. If you were in Ohio making $190,000 your family is automatically in the top 10% or so. If you worked remote you could buy a house outside of a major city for your salary equivalent, or in a city like Columbus for 2x your salary with some fantastic public schools.
Also a nitpick while I think you get much more efficient and cheaper healthcare with the government running it, at the end of the day it’s never free so you have to actually compare taxes to premiums to get a fair assessment of cost.
This 1000 times. I don't think we'll see a meaningful change in my lifetime, but it's an existential burden that we, collectively, have had for generations. So much so, really, that hundreds of millions of people seemingly can not envision meaningful change.
The constant "just get a great job with great benefits!" refrain irks me to no end, and demonstrates a privilege that people often deny exists. Even if/when I can get that "great job with great benefits", I still only have it at the pleasure of the employer. I grow old? You're gone. Employer makes bad decisions? They "take responsibility" by letting me go.
The notion of having access to health care, regardless of my employment status, should be such a basic thing to grasp. If I'm unemployed for a year or so (illness, family issues, whatever), having to upend specific doctors/medicines/hospitals/treatments because "insurance change" is life altering for many. Seen it myself in dozens of personal connections over the years. Want to change jobs? Whether abusive working conditions or just need to be with family? "Can't do it... I need my health care... the only doctors that take my health care are in this area...". Or... "I won't have health insurance for 6 months if I take that new job".
There's 1000 different examples I could find why "employer/insurance" connection is bad, and very few I can think of that are good for all parties, yet, we continue in this mess.
> but (unfortunately) so few people work independently so it’s an edge case not really that valuable here.
I know a growing number of folks doing this, and many more who would love to, but ... "health insurance" keeps them tied to "employers".
argh...
Maybe an idea there to start an independent business owners healthcare association or something that redistributes profits via lower premiums or something? How the hell do you start something like that?
You've generally always been able to buy health insurance independently. I started... 14(?) years ago. The ACA, well-intentioned, was hobbled from day one, and my $220/month high deductible plan has morphed in to a $1300/month plan which is still high deductible ($14k/year), has fewer options, and ... well... some pregnancy services will be covered (cis male here). You want a 'low' deductible? You're looking at probably $2k or more for 2 adults. And yes, I know health insurance has an age component - I'm years older than I was then too. $3k/year in exchange for taking on some risk (higher deductible) makes some sense. But base price of $15k/year in health insurance, plus another $14k/year in deductibles means this is essentially catastrophic only, but not really priced as such).
It's all region-based, and even where I'm at, I get measurably fewer options because I live 2 miles over a county line, and 'no one' insures out here. It got worse for several years - I know in NC, there are ~100 counties, and I believe there were more than 30 at one point who had only one insurer even selling health insurance in those counties.
Also.. FWIW, I didn't take it as you didn't care, but yes, freelance workers are generally overlooked, even as the ranks grow. They just tend to be growing on the lower-end of the spectrum - rideshare drivers, door dash delivery, etc. Much easier to just ignore growing segments of society while we pride ourselves on our ability to "get a better job with great benefits!". I'm not in a position of having to choose food over medication, but having to decide between medication or surgery today over funding retirement savings? I've been there, as have some friends of mine. Yes, it comes across as a bit privileged, but privileges are all relative.
The tax rate for my income bracket in the UK is 45%, and while federal income tax is 39.6% I still have to pay state and city taxes on top of that which works out to be about the same.
However I get free medical care in the UK, affordable college tuition (10x less than the US at least), maternity leave, great public transit, I could go on. What does the same amount of taxes paid get me in the US? I’m not complaining about having to pay taxes, but sure would be nice to get something back that isn’t military.
This statement is meaningless without specifying the brackets or providing an effective tax rate for a certain amount of income.
https://www.nerdwallet.com/article/taxes/federal-income-tax-...
https://www.gov.uk/income-tax-rates
The 45% UK income tax rate is for 150k GBP, which is $167k. The top bracket for US federal income tax starts at $578k/$693k at a 37% tax rate.
It does not seem to pencil out to being remotely close, and that is ignoring UK National insurance and pension tax rates, but I am not sure how UK pension works to equivocate to US FICA taxes.
People here are talking like the difference between US taxes and EU taxes is 20% or more, when in reality it’s maybe 5%
UPD: looked at the tax wedge, the US vs UK looks pretty similar to me- which supports my point. Germany looks a lot higher, but they have 100% free tuition and I am not familiar with the rest of the benefits germans get.
Also, lol at UK public transit. Horrifically expensive - probably more than a single digit % of total income if you actually have to commute anywhere on a regular basis.
In the US, that sounds like a need to either ruin your finances/life/pension/etc. In most places of Europe, not so much.
An American doesn't have that privilege.
The delta in wages from my home country to the US, after taxes, could pay for private insurance for 5 families.
It's unfair, as all short takes are, and it saddens me to see my friends who live there, who are at no fault for the mess they are in, suffer. I fear the coming mid-terms will only make things worse.
US wealth is a joke.
Developers are already very well off no matter what country they live in, and I'd wager that "normal" people in the US are not far wealthier than people in Nordic countries for instance.
Trust me, the unemployed life in third world countries, and even in second world countries, is far more brutal than the unemployed life in the US, especially for unemployed big-tech workers who can find a new job anytime.
> unemployed life in third world countries, and even in second world countries, is far more brutal than the unemployed life in the US
We should work out a deal where we continue to provide their security, and they provide our healthcare. Even Stevens.
Having said that, the US healthcare system is very efficient at extracting profit.
https://randomcriticalanalysis.com/why-conventional-wisdom-o...
That said: tying insurance to employment is evil. I’m a New Zealander and our healthcare system certainly has its problems too.
Coz like… it’s not hard to spend trillions of dollars when you charge $5000 for a tablet you can buy in Australia for like… $20.
A lot of people hold the belief Healthcare in the US is bad because it callously refuses to spend money on people. This is not the case.
When you remember that those funds were largely deducted from someone's paycheck, it has a real impact on those workers and it's important not to dismiss all the hard work that did go into supplying those funds.
That's not to say that there are major structural issues with how Healthcare is regulated in the US, primarily related to how those funds are spent
I don't know if it is better, but it is certainly a different problem, which matters if anyone is interested in understanding or fixing it.
I think it is important to understand the problem specifically there are a lot of patients dying of treatable cancer who would benefit from a health care system that functions better.
As for labor laws, the US does far better than it seems. Easy to fire also means easy to hire too, as the risk taken by the employer is also far lower. And the stronger the protections, the higher the slack, showing in unemployment. Very few European countries have the unemployment rates of the US, and the ones that do get there via a lot of temporary work, which has about as many protections as US work. And even with those protections, you still see Spain and Greece at well over 10% unemployment, while the US is under 4.
The easiest is basing Medicare spending on patient benefit in terms off quality adjusted life years.
I think it is a common misunderstanding that European countries maintain lower costs via price caps. In actuality, most don't limit the sale price, but control how much they are willing to pay for a drug, device, or procedure. This means that a product has to be substantially better to command a substantially higher price. More treatment with slightly worse products means much more benefit overall. Similarly, it puts some downward pressure on the price of new products because they have to compete with cheaper but less effective ones.
Also it has been proven many times by many people that if US were to transition to single payer insurance system, it would actually decrease the spending. No one claims it is easy, but there is absolutely no reason for the US insurance system to exist under single payer, that would be just setting piles of cash on fire.
It's also worth noting that many countries with single pair still have a supplemental insurance market for premium coverage not included.
The US should grow up and stop it with these bicameral partisan pissing matches.
Both the US centre right and alt-right parties are equally responsible for putting US citizens taxes directly in the grubby hands of middlemen who fail to deliver outcomes.