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Comment by rcxdude | Hacker News Reader

Roughly speaking, when I've looked into this comparison, for near-median earners, they're better off in the UK, because of things like healthcare. But when you look at the higher-earning roles, especially engineering or software, then the different in pay more than makes up for the increased cost of living (i.e. a higher percentage of your pay may go towards cost of living, but the smaller percentage of money left over is still larger in absolute terms). There's other tradeoffs in terms of work culture and so on, though (e.g. you get much more holiday in the UK).

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Can you share your research?

In the US, the average out-of-pocket healthcare spending was $1,424.6 per capita in 2022

Most people have insurance. They might have some high out of pocket maximum like $10k. So worse case scenario you're out an additional $10k.

But you pay a lot less in taxes

In US, a single filer, the 12% bracket covers income from $11,926 to $48,475. In UK it's 20%

So at 40k you're paying an additional 3k in taxes, not to mention VAT and others (although I am ignoring other US taxes like state, local and payroll). More than covers your out of pocket healthcare costs.

And pretty much any job in the US is significantly higher paying, for instance a typical accountant in US makes 80k while in the uk that 37k pounds. Pretty much every office job is like this. And note the US 80k figures includes benefits like ... you guessed it, healthcare!

Even if make the generous assumptions that taxes are the same, UK has same healthcare quality and everyone is hitting out of pocket max every year, it's still not close. The whole "but we don't have to pay for healthcare" strikes me as just a cope.

https://www.statista.com/statistics/484578/us-per-capita-out...

https://www.allbusinessschools.com/accounting/salary/

https://uk.indeed.com/career/accountant/salaries

I think if the health insurance situation was as rosy in the U.S as you make out there would not have been as much support for the killer of the United Healthcare CEO. The figure for the average out of pocket expenses hides a lot of pain.

People have lots of anger about healthcare for many many reasons. I can't tell you how many people I've met who are angry about "Obamacare" but don't realize how it helped them compared to the prior situation. There's also lots of anger at the prices for healthcare that we sometimes see, and that anger gets directed at insurance too, even if it's a hospital or other provider setting the prices. And then there's the anxiety of "will this be covered."

Even without out of pocket costs there's lots of reasons to be angry at insurers.

Whether you agree with the Affordable Healthcare Act or not, I feel like nobody remembers “lifetime maximums.” I have some relatively minor (but massively impactful) pre-existing conditions, and I would have exceeded my lifetime maximum by age 30 due to testing, procedures, hospital stays, etc. I have family members that would have exceeded theirs before age 1.

How does the concept of health insurance, risk pooling, etc., make sense if there are no lifetime maximums…?

Eventually 100% of the population will need healthcare of some type.

And without maximums to plan and set prices against, wouldn’t it just be a wealth transfer scheme from the relatively young and healthy to the particularly old and sick…? (With those in the middle roughly neutral)

At least I can’t see any credible way to insure against something 100% of all possible customers will need.

Health insurance is already a huge transfer to older generations (not that that's a bad thing). Medicare pays for older folks but it doesn't pay anywhere near the cost of the services that older folks receive. Prices are higher for everyone else to fill the gap at health care providers.

Health insurance is in many ways not even insurance, it's in many ways a price negotiation mechanism.

Anyway the whole system is overly complex, based off a tax credit from the 1950s, but the transition to a new scheme is nearly impossible while one political party is dead set against any improvement, especially if it might be perceived as a positive for the other political party, and also they have become so hyper partisan that they are not allowed to work with the other party in a bipartisan manner.

Huh I didn’t know that. I thought those on Medicare only got the bare minimum service that stayed within cost.

In that case, the upstream sources of why Americans accept this huge charade is going to keep on messing with even the best laid plans.

It isn’t a simple money in, money out system. You’re taking higher value money in one year, and paying out some money that’s worth less later (inflation)… while at the same time, you’re investing the pool of money you collected, and earning returns on that before you pay out claims - claims that you’ve already negotiated down in price. But by the time the healthier customers need to start making large claims, they’ve already both subsidized the claims of other customers, and made the insurance company more money than they’ll draw in claims.

It's a simple money in, money out system. Health insurance isn't like homeowner's insurance where the insurer accumulates and invests a pool of money in anticipation of occasional rare events like natural disasters that cause a spike in claims. Medical expenses across a large patient population are very predictable and there is no significant carry over of premiums from year to year. In fact, under the Affordable Care Act (Obamacare), it is actually illegal for most health insurers to do that. Any excess premiums collected must be returned to customers at the end of the year.

75% of Americans with employer-provided health coverage are satisfied with their current plans

For Americans overall, 71% rate the quality of healthcare they personally receive as excellent or good. Similarly, 72% give excellent or good marks to the quality of care they receive personally.

Regarding health insurance coverage, 65% of Americans rate their own coverage as excellent or good. Another poll found 63% rated their own health care coverage as excellent or good.

You have to get offline

https://www.ahip.org/news/articles/new-poll-strong-majority-...

https://news.gallup.com/poll/654044/view-healthcare-quality-...

https://news.gallup.com/poll/468176/americans-sour-healthcar...

You have to get offline

Perhaps. But if I weren’t online I wouldn’t know how widespread the support of Luigi is.

Only 75% of people on employer healthcare plans are satisfied? A great many people aren’t on employer plans.

From the third link you provided:

For the first time in Gallup’s two-decade trend, less than half of Americans are complimentary about the quality of U.S. healthcare, with 48% rating it “excellent” or “good.” The slight majority now rate healthcare quality as subpar, including 31% saying it is “only fair” and 21% -- a new high -- calling it “poor.”

Is the support that widespread, or is it a bubble created by social media?

I think there's great dissatisfaction with healthcare in general, but social media is not a good way of judging social attitudes across the US. It's great for finding a small niche, however.

He’s got a lot more support than any other murderer I know about.

Not to mention, they are satisfied compared to what? The situation they'd be in if they were unemployed and had to pay for the entire overpriced thing themselves?

> The poll by CloudResearch found that 27% of U.S. adults expressed “moderate” or “a lot” of sympathy for Mangione.

> A smaller but significant share of adults, 12%, said they were supportive of the decision to murder Brian Thompson, 50, who was shot in New York on Dec. 4.

12% is basically zero in this country. To give you a frame of reference, 14% of people think Obama is antichrist

https://www.msn.com/en-us/news/us/1-in-4-americans-sympathiz...

https://www.yahoo.com/news/12-million-americans-believe-liza...

The former DHS head seems to think it’s a lot of people. Don’t know any other murderers who have 27% of the population having sympathy for them.

12% is not basically zero.

https://www.thewrap.com/luigi-mangione-discourse-alarms-home...

The thing about insurance is that the reason you purchase it is for managing tail events. And the only way to know if you are satisfied with your insurance company is to experience a tail event and see how your insurance company behaves. If you develop an expensive to manage chronic illness, is your insurance company prompt in paying claims? Does it try to deny all of them and require you to hire an attorney to get them to pay anything at all? Does it turn out that much of the treatments you need for recovery were never covered by insurance at all? And even if it is paying - how many hours a week do they expect you to spend submitting and resubmitting claims and calling various doctors to collect more information and submit more and more paperwork?

I've lived in the UK, the USA, and Australia. I've had excellent employer funded/subsidised health insurance in the latter two. The moment my wife & learned we were having our first child it focussed our priorities in an incredibly clear and sudden way, and healthcare was a huge component of that. It was immediately clear we did not want to have a raise a family with the US healthcare system given the other alternatives we had available to us. We saw out the pregnancy in the USA and moved home to Australia shortly after. Our second child was born in Australia. The out of pocket cost difference between the two countries was negligible. My wife would subjectively say the quality of care we got in the USA was slightly higher, though there was nothing wrong with the care we got in Australia either so it's almost splitting hairs just to declare a winner. The most obvious difference is how little planning or effort needs to be made around healthcare decisions in Australia. No worrying about if we're in network or not. No worrying about if the pathology lab that's doing the testing is in network. Is some out of network surgeon going to be attending/observing on the day? What are the financial impacts if there are complications? Do we need to pre-agree a plan of what's acceptable financially? Is the bill we receive at the end accurate? Are there risks of signification on-going medication or other costs for medications if there's a complication in surgery?

Just a whole swathe of anxiety and stress that doesn't exist anymore. I'm not sure I can put a price on how valuable that is for our family. I clearly priced it higher than the higher income and lower tax I'd be paying if I'd stayed in the Bay Area though.

> So at 40k you're paying an additional 3k in taxes

Your calculations don't take into account personal allowance, which is £12750($15680) in the UK.

At $40k the difference is much closer to $1.5k.

Also there's the question of costs of living. That same 40k buys you 30% more in the UK if you're including rent.

Total healthcare spending per capita includes insurance premiums too though, which is $8,951 for single coverage and $25,572 for family coverage[0], and needs to be added to that ~$1,400 to get the total cost. Some amount of this may be paid by employers, but is still theoretically money that could go to you otherwise.

[0] https://www.kff.org/report-section/ehbs-2024-section-1-cost-...

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