You'll get ruined in US if you get cancer in your close family despite 'paying for healthcare' all your life.
In my uncharitable opinion US is good for earning money as a young, highly educated person and for nothing else.
So go there when you are around 25, work your ass off at whoever pays the most for your skillset, spend as little as possible and bail before 35. Later you're screwed. You'll still make more and more there but the money is going to be useless.
You'll get ruined in US if you get cancer in your close family despite 'paying for healthcare' all your life.
Not really if you have insurance which as a software engineer you would have. Might hit your $10k out of pocket maximum but you salary will easily cover that.
edit: When my dad got cancer his insurance actually PAID him a cash payout for every treatment on top of paying the medical costs. He works at a non profit.
The person in the Twitter thread notes how her minimum wage mother had cancer. I think it is highly unlikely that someone working at a minimum wage job would be covered for that by their insurance (I may be wrong)
The comment I replied to made broad statements and based on the second sentence was talking about anyone with a cancer risk and not just those making low income. I don't disagree with your statement about costs to those lacking decent insurance, I merely disagree with creating broad generalizations unfounded in reality.
The US is really bad for the lower middle class in terms of social support. The poor can get passable benefits if they know how to apply but the middle class doesn't get that. As a note, there's other social issues with being poor in the US so I wouldn't recommend that either.
That's why we spent a bunch of money creating the ACA. If I was a single person here in Maryland making $24,000 per year, I could get a low-deductible health plan for $115/month (and a high-deductible one for a fraction of that).
That's 5.75% of gross income, which is lower than the health-insurance tax a lower middle class person would pay in most European countries.
The issue is that insurance companies don't always pay out as they have incentive to find ways to avoid paying. Then you're on the hook. If I remember, deductibles for example don't fully cover many hospital stays so you get hit with out of pocket costs. Those have a maximum cap but I'm sure there's some caveats if you end up in a hospital that's not in network for example. This is what people talk about when they say they went bankrupt despite having insurance.
edit: For example checking the Maryland ACA page is showing maximum out of pocket costs of $7k/person for most plans and up to $17k/family for some. When you make $24k/year that will wipe out your savings for years.
To expand on this. The average healthcare cost in the US is $7k/year/person for the working age population. Children are an additional $3k/child/year. Since insurance companies are private businesses they will be paid $7k/year/person on average. No loopholes, no ifs, no buts. As such, no matter what your plan says or what the tradeoffs are (deductible, monthly, etc.), on average you will be paying them $7k/year/person. If you're paying for it yourself then that price will be paid by you. Now, you can avoid medical treatments to lower that price but I hope it's obvious why that's not a good social solution.
That price may come out of monthly premiums, deductibles, out of pockets or copays but it will be paid out on average.
In a universal healthcare system the government can use progressive taxes to subsidize this cost for the less well off. In a private system that isn't the case.
So if you make $24k/year that comes out to 30% of your income. Assuming you get the average standard of medical care in the US. You may get lucky and avoid this but lotteries aren't good ways to live life.
edit: Please note I'm talking about the working age population. I don't think the elderly make sense in this discussion given that there's government health coverage for them.
The average healthcare cost in the US is $7k/year/person for the working age population.... In a universal healthcare system the government can use progressive taxes to subsidize this cost for the less well off.
Except we don't have a fully-private system. We have Medicaid, which covers the working-age poor, and also people with disabilities which is a very high-cost group. Then we have Medicare taking the high-cost elderly population. And then we have ACA potentially subsidizing much of the rest.
So if you make $24k/year that comes out to 30% of your income.
In Maryland, a low-deductible Kaiser ACA Gold plan for a 36-year old making $24,000 per year costs $3,864/year. But the government pays $2,533 of that, leaving you to pay $1,380 + out of pocket costs.
Out of pocket expenditures in the U.S. add up to about $1,100/year on average: https://www.healthsystemtracker.org/indicator/access-afforda.... But note that other countries have out-of-pocket costs too. Even in France, where point-of-use costs are very low, it's still $463/year.
Your typical person making $24,000 per year is going to be young, and not rack up $1,380 in out of pocket costs each year. But adding that in, you're looking at 10.3%.
The person you responded to was talking about direct-to-consumer costs; you switched figures while suggesting that their number was erroneously low. You were wrong.
It's 1.25% in Poland. Technically 9% but you can deduct 7.75 of those 9 diectly out of the tax you owe.
It doesn't depend on income and gives you access to whatever hospitals can provide for everybody. My SO had six brain surgeries, two radiation treatments (one with cyber-knife) and Temodar chemo twice, and months of rehabilitation and hospital stay for that. She still died in the end but she got few years of healthy life more (and a year of some life) for the 1.25% of patchy mostly freelancing income. All she had to spend on top of that was maybe 100$ on minor medicaments.
It's 1.25% in Poland. Technically 9% but you can deduct 7.75 of those 9 diectly out of the tax you owe.
It’s 9%. That’s the money that goes into the health insurance system. You can’t run a universal health insurance system with a 1.25% tax.
If you can take a deduction on your personal income tax for what you pay in health tax, then you have to compare those personal income tax rates as well. The proper way to do this is to look at the tax wedge: http://www.oecd.org/tax/tax-policy/taxing-wages-poland.pdf
The tax wedge for an average single worker Poland is 36%, right at the OECD average. For the US it’s 29.8%. The Poland number includes health insurance, and the US number doesn’t. For workers who have to purchase an ACA plan, the effective tax rate probably works out to the same number.
But 70% of US workers get health insurance from their employer, which is a benefit on top of their income (so it’s not factored into the OECD tax wedge data).
In a case study, a patient with lymphoma paid out-of-pocket healthcare costs from $6,446 in a large employer-sponsored health plan to $12,931 in a health plan on the individual health insurance market. These were all Affordable Care Act (ACA)-compliant plans.
Total out of pocket costs for cancer were $5.6 billion in 2018, with 1.8 million cases. That's about $3,100 out of pocket per diagnosis on average.
Over a career, you'll pay way more in additional taxes in Europe than whatever you'll save in out of pocket costs in the U.S. if you get cancer.
There is no need for a short-term limited duration plan under the ACA, because losing your job is a qualifying event that allows you to enroll in the ACA exchange or Medicaid (depending on our financial situation) and that can't be denied due to pre-existing conditions.
We've had the ACA for a decade now, you can't just pretend it never happened.
You have an incredibly inaccurate take on the US healthcare system. I live here and I'm in my late 30s with a family. My wife is a cancer survivor. My oldest son was born 3 months premature. and yet I'm not penniless and broke because my health insurance paid for everything.
I'm not saying it's an ideal system and doesn't have major flaws but if you are a software engineer the scenario you are describing just isn't a thing. I'm sure it feels a lot better to tell yourself that when you realize you're being paid a quarter what you could be on the other side of the Atlantic.
I'm not saying it's an ideal system and doesn't have major flaws but if you are a software engineer the scenario you are describing just isn't a thing. I'm sure it feels a lot better to tell yourself that when you realize you're being paid a quarter what you could be on the other side of the Atlantic.
Most people saying this stuff have never had to actually use the U.S. safety net. There's a lot of stuff we could fix: making medicaid enrollment automatic, extending unemployment benefits, etc. But pretending all these programs don't exist is crazy.
but if you are a software engineer the scenario you are describing just isn't a thing
Note that the author of the original tweet was not afraid of her own financial situation but doesn’t want live in a system where _anyone_ has to fear going broke over medical expenses.
Per the author's twit, without the higher taxes etc. they would not have been able to afford becoming a software engineer without this welfare setup.
Also, yes you save much more, but when your mother has cancer and dad is disabled(As the author explains), realistically much more than what you save ends up being spent to take care of them and paying their medical bills.
I have to say, she might be wrong about that. The US is different, sometimes worse, but people have adapted.
In the US, she would've been able to buy a laptop for dirt cheap or get it from some charity or just someone looking to get rid of it for free. I myself got my first laptops and smartphones from the US, it was cheaper than buying locally, believe it or not.
Most, if not all MOOCs are from the US. Tons of blogs, content, documentation in English, written by Americans. Free for all, just learn and show your skills.
But yes, if there's an unforeseen medical emergency, you could go bankrupt in the US, while you'd be taken care of for free (or nearly free) in Europe.
As someone who spent the first half of their life in poverty, this is not an accurate characterization of that situation in the US. Becoming a software engineer in the US is available to just about anyone, basically the cost of a cheap computer that sometimes literally rounds to "free" and some time. That is how I became a software engineer while working long hours at low-skill jobs. I eventually worked at FAANG and earned (much more than) $250k. This isn't a unique story; one of the under-rated aspects of living in the US is that this is realistically possible and many people do it. Low salaries for engineers don't help anyone except the company owners.
Poor people generally don't pay for healthcare in the US for the most part. I have multiple family members that received (literally) state-of-the-art cancer treatment at top hospitals at no cost to themselves. The hospitals don't even try to collect anything. That's pretty normal in the US. Having to pay expensive medical bills is something that happens to the middle class, not the poor.
Thanks for sharing this. She also mentions not affording university but that is besides the point.
I think there are two issue, Low gross salaries in EU(which I agree with you), and high taxes in the EU(Which the twitt justifies and I agree).
For the first issue, I am all for better and more fair wages in EU, but that is a completely different topic with different dynamics.
Just one question as I am genuinely curious, when poor people get hospitalized or can not work and have to rest at home, do they receive any payment due to their job? Do they get terminated? Do they receive a social payment of sorts? Even if they don't pay the medical bills, can they afford to get by without family/community support?
For more context see my other reply about a friend having stomach issues.
They'd realistically have Medicaid in the US which doesn't have high out of pocket costs. Probably social security payments for disability and various other government programs. Some programs would even pay the mother (or a relative) to stay home and help their disabled spouse. Community college is fairly inexpensive in the US so there's that as well.
I know someone that immigrated to EU from middle east, after ~1 year developed a severe life threatening stomach/liver illness(can not recall the details), went through multiple operations, after 1.5-2 years away from work but getting most of his salary due to welfare got better and got back to work. He is very young and I suspect you could have anything close to this in US. Let alone immigrants, even citizens can not afford to do this.
I have never lived in the US and this all from online media, reading and talking to various ex/current US citizens/residents colleagues, so I might be wrong still.
As someone who has lived in various parts of the US and knows people across the economic spectrum I only know of one person who has had major issues with medical coverage in the US. Various complaining about doctors and treatments and so on but that's the case in all countries.
edit: And my comment was more to point out that anecdotes make poor facts.
I hope that advocates of purchasing power parity comparisons are prepared to factor in implicitly consumed but not easily purchasable goods. Otherwise, they would miss out on many of the things that truly matter in life.
For example, in the EU, my middle class neighbors’ children safely bike and ride the train to and from their excellent publicly funded schools, after school activities, and friends’ houses requiring little to no adult supervision while in transit.* What do private schooling, chauffeurs, and security personnel cost in the US, anyway?
*Of course, COVID does interfere somewhat with this, but this is true worldwide.
Did you read the Twitter thread? The person writing the Twitter thread clearly outlines their feelings about the need to contribute to the social safety net.
I wanna give back, im okay with that
I don't wanna make 250k while most people work three jobs
Nobody is stopping one from voluntarily donating to a non-profit or for-profit organization, or being involved in one for that matter.
In Europe, most people don't work 3 jobs because either it's not legal to do so or those jobs don't exist because of debilitating regulations... or at some point, making more isn't really worth it because of how high the taxes go up.
The financial efficiency of a well managed charitable organisation is atrocious compared to state programs. This is largely due to state programs having the capability to actually solve problems.
Eliminating working three jobs is desirable, it isnt debilitating to prevent exploitation of workers, its enabling. Setting a minimum wage and maximum working hours creates a minimum quality of life.
For most people this is desirable. As far as I can see you'd either have to be a sadist, or incredibly obsessed with how well off you are vs others to not want this.
The occasional donation to a non-profit might help people subsist, but it doesn't build a better society with more opportunities for everyone.
Nobody needs an obscene salary for writing code when others are struggling to afford the basics.
As an aside, I remember being really taken aback when I went on holiday to the US and most of the menial jobs were being carried out by Hispanic and Black people. I guess if you are a white American you get inured to it, but as a white European it was kind of creepy and a bit repulsive.
I guess freedom of movement allowing Eastern Europeans to legally live, work and pay tax in Western Europe without jumping through hoops, and immediately being able to benefit from the social systems there.
Comments
DO compare it and see how much one can end up saving in a given time in the US, even after paying for healthcare, education etc.
You'll get ruined in US if you get cancer in your close family despite 'paying for healthcare' all your life.
In my uncharitable opinion US is good for earning money as a young, highly educated person and for nothing else.
So go there when you are around 25, work your ass off at whoever pays the most for your skillset, spend as little as possible and bail before 35. Later you're screwed. You'll still make more and more there but the money is going to be useless.
Not really if you have insurance which as a software engineer you would have. Might hit your $10k out of pocket maximum but you salary will easily cover that.
edit: When my dad got cancer his insurance actually PAID him a cash payout for every treatment on top of paying the medical costs. He works at a non profit.
The person in the Twitter thread notes how her minimum wage mother had cancer. I think it is highly unlikely that someone working at a minimum wage job would be covered for that by their insurance (I may be wrong)
This now infamous reddit comment puts it into perspective very well: https://old.reddit.com/r/ABoringDystopia/comments/hj6t3t/not...
The comment I replied to made broad statements and based on the second sentence was talking about anyone with a cancer risk and not just those making low income. I don't disagree with your statement about costs to those lacking decent insurance, I merely disagree with creating broad generalizations unfounded in reality.
Are you really unaware of Medicaid? Here in Maryland, a 3-person household like the author's can make up to $29,000/year and be eligible for Medicaid.
The US is really bad for the lower middle class in terms of social support. The poor can get passable benefits if they know how to apply but the middle class doesn't get that. As a note, there's other social issues with being poor in the US so I wouldn't recommend that either.
That's why we spent a bunch of money creating the ACA. If I was a single person here in Maryland making $24,000 per year, I could get a low-deductible health plan for $115/month (and a high-deductible one for a fraction of that).
That's 5.75% of gross income, which is lower than the health-insurance tax a lower middle class person would pay in most European countries.
The issue is that insurance companies don't always pay out as they have incentive to find ways to avoid paying. Then you're on the hook. If I remember, deductibles for example don't fully cover many hospital stays so you get hit with out of pocket costs. Those have a maximum cap but I'm sure there's some caveats if you end up in a hospital that's not in network for example. This is what people talk about when they say they went bankrupt despite having insurance.
edit: For example checking the Maryland ACA page is showing maximum out of pocket costs of $7k/person for most plans and up to $17k/family for some. When you make $24k/year that will wipe out your savings for years.
To expand on this. The average healthcare cost in the US is $7k/year/person for the working age population. Children are an additional $3k/child/year. Since insurance companies are private businesses they will be paid $7k/year/person on average. No loopholes, no ifs, no buts. As such, no matter what your plan says or what the tradeoffs are (deductible, monthly, etc.), on average you will be paying them $7k/year/person. If you're paying for it yourself then that price will be paid by you. Now, you can avoid medical treatments to lower that price but I hope it's obvious why that's not a good social solution.
That price may come out of monthly premiums, deductibles, out of pockets or copays but it will be paid out on average.
In a universal healthcare system the government can use progressive taxes to subsidize this cost for the less well off. In a private system that isn't the case.
So if you make $24k/year that comes out to 30% of your income. Assuming you get the average standard of medical care in the US. You may get lucky and avoid this but lotteries aren't good ways to live life.
edit: Please note I'm talking about the working age population. I don't think the elderly make sense in this discussion given that there's government health coverage for them.
Except we don't have a fully-private system. We have Medicaid, which covers the working-age poor, and also people with disabilities which is a very high-cost group. Then we have Medicare taking the high-cost elderly population. And then we have ACA potentially subsidizing much of the rest.
In Maryland, a low-deductible Kaiser ACA Gold plan for a 36-year old making $24,000 per year costs $3,864/year. But the government pays $2,533 of that, leaving you to pay $1,380 + out of pocket costs.
Out of pocket expenditures in the U.S. add up to about $1,100/year on average: https://www.healthsystemtracker.org/indicator/access-afforda.... But note that other countries have out-of-pocket costs too. Even in France, where point-of-use costs are very low, it's still $463/year.
Your typical person making $24,000 per year is going to be young, and not rack up $1,380 in out of pocket costs each year. But adding that in, you're looking at 10.3%.
Actual US healthcare spending in 2019 was $11,582/person.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...
That's not the average cost per person; it's simply the total amount of health care spending, in all categories, in the US divided by its population.
Which is also the arithmetic mean cost per person, by definition. Which average did you have in mind?
The median might arguably be a more useful average here, but I doubt the data necessary to even identify the median individual cost are kept.
The person you responded to was talking about direct-to-consumer costs; you switched figures while suggesting that their number was erroneously low. You were wrong.
It's 1.25% in Poland. Technically 9% but you can deduct 7.75 of those 9 diectly out of the tax you owe.
It doesn't depend on income and gives you access to whatever hospitals can provide for everybody. My SO had six brain surgeries, two radiation treatments (one with cyber-knife) and Temodar chemo twice, and months of rehabilitation and hospital stay for that. She still died in the end but she got few years of healthy life more (and a year of some life) for the 1.25% of patchy mostly freelancing income. All she had to spend on top of that was maybe 100$ on minor medicaments.
It’s 9%. That’s the money that goes into the health insurance system. You can’t run a universal health insurance system with a 1.25% tax.
If you can take a deduction on your personal income tax for what you pay in health tax, then you have to compare those personal income tax rates as well. The proper way to do this is to look at the tax wedge: http://www.oecd.org/tax/tax-policy/taxing-wages-poland.pdf
http://www.oecd.org/tax/tax-policy/taxing-wages-united-state...
The tax wedge for an average single worker Poland is 36%, right at the OECD average. For the US it’s 29.8%. The Poland number includes health insurance, and the US number doesn’t. For workers who have to purchase an ACA plan, the effective tax rate probably works out to the same number.
But 70% of US workers get health insurance from their employer, which is a benefit on top of their income (so it’s not factored into the OECD tax wedge data).
https://healthpayerintelligence.com/news/cancer-patients-pai...
Total out of pocket costs for cancer were $5.6 billion in 2018, with 1.8 million cases. That's about $3,100 out of pocket per diagnosis on average.
Over a career, you'll pay way more in additional taxes in Europe than whatever you'll save in out of pocket costs in the U.S. if you get cancer.
So you just need to be lucky to have an employer that won't fire you if you get sick right?
There is no need for a short-term limited duration plan under the ACA, because losing your job is a qualifying event that allows you to enroll in the ACA exchange or Medicaid (depending on our financial situation) and that can't be denied due to pre-existing conditions.
We've had the ACA for a decade now, you can't just pretend it never happened.
You have an incredibly inaccurate take on the US healthcare system. I live here and I'm in my late 30s with a family. My wife is a cancer survivor. My oldest son was born 3 months premature. and yet I'm not penniless and broke because my health insurance paid for everything.
I'm not saying it's an ideal system and doesn't have major flaws but if you are a software engineer the scenario you are describing just isn't a thing. I'm sure it feels a lot better to tell yourself that when you realize you're being paid a quarter what you could be on the other side of the Atlantic.
Most people saying this stuff have never had to actually use the U.S. safety net. There's a lot of stuff we could fix: making medicaid enrollment automatic, extending unemployment benefits, etc. But pretending all these programs don't exist is crazy.
Note that the author of the original tweet was not afraid of her own financial situation but doesn’t want live in a system where _anyone_ has to fear going broke over medical expenses.
Per the author's twit, without the higher taxes etc. they would not have been able to afford becoming a software engineer without this welfare setup.
Also, yes you save much more, but when your mother has cancer and dad is disabled(As the author explains), realistically much more than what you save ends up being spent to take care of them and paying their medical bills.
I have to say, she might be wrong about that. The US is different, sometimes worse, but people have adapted.
In the US, she would've been able to buy a laptop for dirt cheap or get it from some charity or just someone looking to get rid of it for free. I myself got my first laptops and smartphones from the US, it was cheaper than buying locally, believe it or not.
Most, if not all MOOCs are from the US. Tons of blogs, content, documentation in English, written by Americans. Free for all, just learn and show your skills.
But yes, if there's an unforeseen medical emergency, you could go bankrupt in the US, while you'd be taken care of for free (or nearly free) in Europe.
As someone who spent the first half of their life in poverty, this is not an accurate characterization of that situation in the US. Becoming a software engineer in the US is available to just about anyone, basically the cost of a cheap computer that sometimes literally rounds to "free" and some time. That is how I became a software engineer while working long hours at low-skill jobs. I eventually worked at FAANG and earned (much more than) $250k. This isn't a unique story; one of the under-rated aspects of living in the US is that this is realistically possible and many people do it. Low salaries for engineers don't help anyone except the company owners.
Poor people generally don't pay for healthcare in the US for the most part. I have multiple family members that received (literally) state-of-the-art cancer treatment at top hospitals at no cost to themselves. The hospitals don't even try to collect anything. That's pretty normal in the US. Having to pay expensive medical bills is something that happens to the middle class, not the poor.
Thanks for sharing this. She also mentions not affording university but that is besides the point.
I think there are two issue, Low gross salaries in EU(which I agree with you), and high taxes in the EU(Which the twitt justifies and I agree).
For the first issue, I am all for better and more fair wages in EU, but that is a completely different topic with different dynamics.
Just one question as I am genuinely curious, when poor people get hospitalized or can not work and have to rest at home, do they receive any payment due to their job? Do they get terminated? Do they receive a social payment of sorts? Even if they don't pay the medical bills, can they afford to get by without family/community support?
For more context see my other reply about a friend having stomach issues.
They'd realistically have Medicaid in the US which doesn't have high out of pocket costs. Probably social security payments for disability and various other government programs. Some programs would even pay the mother (or a relative) to stay home and help their disabled spouse. Community college is fairly inexpensive in the US so there's that as well.
I know someone that immigrated to EU from middle east, after ~1 year developed a severe life threatening stomach/liver illness(can not recall the details), went through multiple operations, after 1.5-2 years away from work but getting most of his salary due to welfare got better and got back to work. He is very young and I suspect you could have anything close to this in US. Let alone immigrants, even citizens can not afford to do this.
I have never lived in the US and this all from online media, reading and talking to various ex/current US citizens/residents colleagues, so I might be wrong still.
Like most things, the people who the system works for fine don't complain about it and those it fails for do complain about it.
Most of them were actually SV tech people who were well off. So I think the system was working fine for them.
As someone who has lived in various parts of the US and knows people across the economic spectrum I only know of one person who has had major issues with medical coverage in the US. Various complaining about doctors and treatments and so on but that's the case in all countries.
edit: And my comment was more to point out that anecdotes make poor facts.
I hope that advocates of purchasing power parity comparisons are prepared to factor in implicitly consumed but not easily purchasable goods. Otherwise, they would miss out on many of the things that truly matter in life.
For example, in the EU, my middle class neighbors’ children safely bike and ride the train to and from their excellent publicly funded schools, after school activities, and friends’ houses requiring little to no adult supervision while in transit.* What do private schooling, chauffeurs, and security personnel cost in the US, anyway?
*Of course, COVID does interfere somewhat with this, but this is true worldwide.
Did you read the Twitter thread? The person writing the Twitter thread clearly outlines their feelings about the need to contribute to the social safety net.
Yes, I did read the whole thread.
Nobody is stopping one from voluntarily donating to a non-profit or for-profit organization, or being involved in one for that matter.
In Europe, most people don't work 3 jobs because either it's not legal to do so or those jobs don't exist because of debilitating regulations... or at some point, making more isn't really worth it because of how high the taxes go up.
The financial efficiency of a well managed charitable organisation is atrocious compared to state programs. This is largely due to state programs having the capability to actually solve problems.
Eliminating working three jobs is desirable, it isnt debilitating to prevent exploitation of workers, its enabling. Setting a minimum wage and maximum working hours creates a minimum quality of life.
For most people this is desirable. As far as I can see you'd either have to be a sadist, or incredibly obsessed with how well off you are vs others to not want this.
The occasional donation to a non-profit might help people subsist, but it doesn't build a better society with more opportunities for everyone.
Nobody needs an obscene salary for writing code when others are struggling to afford the basics.
As an aside, I remember being really taken aback when I went on holiday to the US and most of the menial jobs were being carried out by Hispanic and Black people. I guess if you are a white American you get inured to it, but as a white European it was kind of creepy and a bit repulsive.
Race aside, how is that different than western europe importing eastern europeans to work their menial jobs?
I guess freedom of movement allowing Eastern Europeans to legally live, work and pay tax in Western Europe without jumping through hoops, and immediately being able to benefit from the social systems there.