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Comment by iancmceachern | Hacker News Reader

We also have to pay a lot more out of pocket for basic services like healthcare,, transportation, childcare, etc.

You’re paying for healthcare at a tech company? Usually your company provides this as a benefit. Same for commuter subsidies.

I think they’re referring to the time after they leave to go work at a start up.

Even with best-in-class health insurance in the US, one "gotcha" leaves you with an unpayable bill. Usually, your company provides health insurance. Health insurance != health care. Larger companies (I assume this translates to tech) will also usually have a clinic on-site for smaller things and it's heavily subsidized or free.

None of this prevents you from 6-figure debt for something like a difficult, but largely by-the-book, birthing experience or a car accident.

You can also have the best-in-class health insurance and flat out be denied coverage for whatever reason the insurance provider says.

Most insurance plans have an out of pocket maximum, no?

Yes, but it can be tens of thousands in many cases, and it does not cover many things that it should, insurance companies put deliberate effort into screwing people put of their claims.

The legal maximum is $9.1k for an individual and $18.2k for a family. At any half decent employer, it will be $5k/$10k at most.

Generally it's out of pocket maximum to a point, like $250k. Then it's normally split, something like 80-20, where you have to cover 20% of the bill. That seems like a lot until you have something like cancer, where you need surgery plus chemo in the same year, which adds up quite fast.

> Generally it's out of pocket maximum to a point, like $250k. Then it's normally split, something like 80-20, where you have to cover 20% of the bill.

Not since the Affordable Care Act of 2010. It got rid of benefit maximums and implemented out of pocket maximum. An out of pocket maximum up to a limit is a contradiction. The situation works exactly opposite, you first pay 100% up to deductible, then you pay a proportion according to your copay, then you pay 0% after the out of pocket maximum.

Annual out of pocket maximums are typically $5k to $10k for individual/family at any half decent employer.

Legally, the maximums are $9.1k/$18.2k.

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

>one "gotcha" leaves you with an unpayable bill

It is next to unheard of to have an extremely large bill if you have good health insurance. Even if you do, at tech levels of salary, if you were to effectively save the extra money, you should have no problems covering it.

Depending on the plan, you may still be on the hook for part of your premium. And if you have any dependents (kids, spouse, etc.) the cost of their premiums is fully your responsibility.

Outside of FAANG experience.

Dental plans rarely cover anything more than basic maintenance costs. One procedure and you can end up pretty deep into pocket.

If you require regular medication, that can run pretty deep over a year too, since pharmacare plans have copays.

Dental coverage is not available in many places with nationalized healthcare, such as Canada, Italy, Norway, the Netherlands, and de facto uncovered in the UK. You must pay with a private plan or out of pocket. Only a portion of costs is covered in France, Denmark, and Belgium while the patient must pay the entire amount upfront.

Germany has a situation similar to the US where basic care is fully covered, but more complicated care is not fully covered.

Yeah, dental plans are honestly kind of stupid. They typically have a MAXIMUM amount they will cover, after which you have to pay out of pocket. Which.. is not what I purchase insurance for. I purchase insurance to cover me for the huge bills I can't afford that would destroy me.

That said, if my employer is going to subsidize it, I'm going to take the free money.

I'm not paying the premium for health insurance, no. But I am paying 200 a month to upgrade to "platinum", I'm paying 400 a month because Blue Shield lists a lifesaving medicine I've been on for 2 decades as a tier 3 drug, so I had to battle with them for 3 weeks to get them to "cover" it at 400 a month out of my pocket. I then have a 4k per family deductible we need to reach on top of the drug co-pays. So when my wife thought she broke her toe it cost is 1500 out of pocket. This is the absolute best, top tier platinum" insurance afforded me administered by a "non profit" that was stripped of much of its non profit status for making billions in profit.

All that adds up to 7204 out of our pocket per year before any sort of catastrophic or even regular event like childbirth.

And we're the lucky ones

The difference between $200k and $80k soothes the ache of that $7204 quite nicely, I suppose.

This is the big thing. The bigger salary more than covers the difference. And it's not just tech. Nurses in the UK make 25,000 pounds per year, nurses in the US make $85k or more.

I would rather have the higher salary with student loans, my own health insurance, and no subsidized childcare than make 25K GBP (at a higher tax rate!)

Fine as long as you're able to keep earning said salary. It's the state you end up in when you're not for whatever reason that's arguably the big difference. My own partner's a nurse and has gone through extensive periods where her income has been low or non-existent and while it wasn't really an issue given the presence of my salary to fall back on it's not hard to see how difficult things might become esp. if there were no/limited government subsidized healthcare and high levels of student debt (again, thankfully not such a problem in Australia - even as a foreign student, as she was, there are measures in place to ensure they don't saddle themselves with unreasonable debt. Citizens can often pay off higher education fees within a few years of graduating, and no repayments are required in years your salary is below a certain threshold)

Yes in general I agree. The biggest problem is for those who experience chronic un/underemployment.

I'm not against a social safety net, but I don't think the benefits one gets in Europe equals out to the higher income + lower tax rate in the states

Exactly, it's not unheard of for police officers to make up to 300k a year, including overtime, here in the bay area. Starting pay for many "regular" jobs is well over 6 figures here

QoL in Europe is way better than US.Labor laws and life in general is better even with the lower pay as its all relative.

Agreed, I think all those things amount to less stress, less stress to just exist as a regular human.

It depends. I work at a tech company as an engineer and insurance eats about $1K/month. My employer contributes only about $400 to the plan.The total plan cost is $1.4K. Keep in mind, while I pay this just for insurance, I am waiting to get a $3,000 dollar bill from the hospital (still!) for when my daughter had to go to the ER in December.

I wish. My wife and I both work at different big tech companies as developers and the only thing health insurance does is guarantee we won't go bankrupt in the event of an emergency. Last month on top of spending several hundred on the monthly insurance cost, I spent $300 on rather mundane pediatrician appointments for my two kids who had ear infections. Ironically I had much better healthcare coverage when I worked at a steel mill.

I've never heard of any big tech co fully subsidizing healthcare. I pay ~$160/week between health/vision/dental

Is $160/week just for your coverage? I've worked at small startups and medium sized public companies, and my healthcare coverage costs have been far less than that.

I can believe that for a good family plan. But that's probably more than you'd pay without a subsidy for a pretty good individual plan.

Correct - I should have mentioned that is for 4 people(total) covered

Well, that changes the math entirely.

A marketplace equivalent plan that's not subsidized would probably cost ~$1500+/month or more for a family of 4, with a decent level of coverage.

Many companies pay 100% of premium costs for you and your dependents

Many don't also

Its also like <$200 per month for most companies, pretty good for someone making north of $200k.

I can only speak from experience - I've worked at 3/5 FAANGs and none of them did

yeah this would be more mid stage startup I've found, like 750-1500 employees, pre IPO

If you subtract $8320/year from a big tech salary, I'd wager you'll still find yourself quite handsomely compensated.

Absolutely, but that doesn't mean I pay nothing out of pocket for healthcare.

Yes there is usually a "employee cost" associated with health insurance although the employer usually pays a bigger portion of the total cost

In EU, you also pay for healthcare and transport, just indirectly in the form of taxes, which is why tax rates are much higher.

There is a cross over point for salary in US where below that, it becomes advantageous to live in EU, but tech salaries are well above this point.

My manager moved from the US to Sweden, said he got about 60% in Sweden. His Wife isn't working in Sweden yet and they still have more money on pocket. Very anecdotal and might be inflated one way or the other. But I'm not so sure it's as clear-cut as some might think. Unless you're the top X % raking in the biggest $$

For anyone working in big tech it is very clear cut from a financial perspective. That isn’t the only consideration for sure, but it’s wishful thinking to believe otherwise.

You don't have to be top X%. If you are single and graduating college, you will absolutely net more money in US in the tech sector, way more if you are exceptionally skilled.

After that, it depends on your living situation and family situation. Of course 200k in California with 3 kids and a house is likely going to be less than what you could make in EU.

The wonderful part of this is that you get the choice.

Choose where you live, who you have for healthcare, who you use for childcare/schooling.

We have the opportunity to make that choice instead of having a bureaucracy making those choices for us.

In countries with socialised health insurance systems any political party that threatens to take it away (or defund it) tends not to get chosen at election time, strangely enough.

I wouldn't really call it "having choices". Most services are duopolies at best.

Visas, different languages, and family mean that people often don't really have a choice. Likewise, most employers only provide insurance from a single provider.

Let me fix it for you:

(If you are rich by most definitions) ...you get the choice

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