Ask HN: Is USA that bad when it comes to health insurance, etc?
In Sweden we annoyingly socialist and have completely ridiculous taxes.
Any discussions on this subject with swedes usually results in the other person saying something like "What do you want, a society like the USA where people can't afford healthcare and you have homeless people everywhere?"
Now, how accurate is that? Is it actually a problem to pay for premium insurance and save up to your childrens college degree, etc?
39 comments
[ 3.1 ms ] story [ 68.5 ms ] threadIf I were still in Ireland I would pay about 1600 Euros a year to give full coverage to me and my family (wife + 2 kids).
In The US I pay just under $400 on every paycheck (my employer also pays a hefty amount), so thats aprox $4900 a year. That does not include dental, or vision.
I would also add that while my plan isn't bad, its not as good as the Irish equivalent - hard to compare though.
Side Note: You should prefix the title of this with "Ask HN:"
The homeless people thing is much harder to quantify. What do you mean by homeless people everywhere? I was 30 before I ever ran across anyone actually sleeping on the street. There are however homeless shelters were anyone can walk in off the street for a place to stay temporarily.
If you are self employed or work at a small company, then insurance is a big deal. I'm going to pay $6K a year for crappy insurance and I'm still going to pay $7k out of pocket expensive this year because my son had to have surgery and our deductible is 7500. So I think the insurance situation sucks. And I got a notice yesterday that they are raising my rates again. For small business that want to cover the health insurance for their employees it is also a big expense and one that keeps rising. It amazes me that insurance companies can raise rates 15-40% a year and get away with it.
As far as saving up for college education, that is not as difficult because it is a matter of living within your means. Make it a priority and save. That said I have different views on fully paying for 4 years of college vs. having my kids pay part of their way. My parents put me through my first year of school and then I was on my own. I tended to work hard at school (to get it finished) than those I know who's parents were footing the bill.
It's the kind of thing that won't affect everyone, but if it affects you then it's truly life-changing in the bad sense.
I'm not actually in the US so can anyone there comment on this scenario?
Disqualification due to pre-existing conditions are regulated out of existence by 2014 under the recent health care law; some classes (e.g., children) are protected earlier (as early as this fall, if memory serves). One of the major drawbacks of the bill is that it is so complicated, almost no one understands it.
Basically, if you work for a large company and are in a large insurance pool, life's probably pretty good. If you're a small business owner, fresh out of college, unemployed, or have a preexisting condition that can't get covered for whatever reason, you're potentially quite screwed.
On the other comment, yes there are some parts in the U.S. that are very poor off, especially in parts of the older cities and in rural areas. My parents just returned from a visit to a very high per capita income European country and were somewhat surprised with how clean and orderly and relatively well off all of the cities / towns they visited were.
But health insurance is one of the few ways in which the US really discourages entrepreneurship. Individual health insurance, particularly if you're older, have a family, or have some kind of risk factor, costs a fortune.
The conventional wisdom on homeless people in the US is that the vast majority of the homeless got that way because of mental health problems and substance abuse. I believe it's more of a public policy issue than strictly a lack of money.
As for poverty in the US, 1 in 8 are in poverty if you use the CIA-polished statistics. I say CIA-polished because the CIA also says the US spends 12.5% of its GDP on healthcare. According to the OECD, it is more like 15.3%. By comparison, France (top healthcare in the world according to the WHO) spends around 9.5% or so. Canada, number 6 in the world, spends something similar, around 9.7%. The UK, which is somewhere around 20th on the WHO rankings, spends 6.25%. For its 12.5%/15.3%, the US ranks 33rd - just above Cuba.
As for saving up for children's college, university educations are an increasingly well-known bubble in the US. It is not uncommon to have 70 or even many more students packed into a single auditorium for lectures. Even in advanced degrees, there is not as much small group or singular education as there is in Europe. But the costs are nevertheless huge. If I recall correctly, American University in DC currently tops the charts with tuition at $50k per year. That is tuition ONLY. It does not include, books, dorm, clothes, etc. A four-year degree thus has a base cost of $200k. It is nothing anymore for universities to charge $25-30k per year just for tuition. Given that this is the case at a time when many people are losing their houses because they can't make the payments and others can't get on the property ladder because they can't afford the down payment, I would say it is damn hard in the US to pay for things that people in Sweden take for granted.
Just my 2¢. YMMV.
Note that US GDP is also significantly higher.
Also, healthcare costs are affected by things that healthcare can't actually affect. Consider obesity.
Also, the existence of working govt programs in other countries does not imply that the US govt could do as well with comparable programs. For example, the US govt spends about as much per person as France does. Since the US govt services appear to be significantly worse ....
No, military spending doesn't account for the difference.
Maybe I am missing something, but this should mean that the US can afford to do more. No?
>No, military spending doesn't account for the difference.
I didn't say anything about military spending. Where is that coming from?
It implies that spending a larger fraction of GDP on healthcare can be acceptable, but you suggested that spending a larger fraction of gdp on healthcare was a bad thing.
So, what do you have in mind by "do more"? (Of course, being able to afford to do more and actually doing more are very different.)
> >No, military spending doesn't account for the difference.
> I didn't say anything about military spending. Where is that coming from?
"military spending" is the typical reply when someone points out that the US govt spends as much per person as "high tax, high service" countries yet doesn't provide the same level of services.
Spending money may be necessary, but it isn't sufficient.
> you suggested that spending a larger fraction of gdp on healthcare was a bad thing.
I was probably in a rush when I wrote 'do more' and so apologise for any confusion. My meaning was not communicated well. If the data say anything, it is that the way the money is spent counts more than how much money is spent. That being said, getting the medical establishment and Big Pharma to take a pay cut is a Herculean task.
> "military spending" is the typical reply
I suppose for some it is, and the US does spend plenty on war. But I would agree with what I understand as your underlying point: The money needs to be spent better before more money is spent on anything.
Apart from the obvious cases of fraud (which seem to be concentrated on govt programs) and reducing some of the monopolies (including things that should be OTC), it's not clear that they're significantly overpaid. (Yes, I know about the "marketing" argument, but that includes free drugs to poor people and it's how folks find out that what they have is treatable. I see both as good. And allowing old people to have sex is a good thing.)
We want people buying Cadillacs (and Mercedes) because that's how we get good things in Toyotas.
A lot of US health spending is triggered by things that are outside the healthcare system. The only thing that the healthcare system can do is refuse coverage, and no one will admit to that.
Can you give examples of this?
With the NHS, while the Brits like to complain about it, the fear isn't there. You will always be looked after if you need to be. Here... I'm not so confident.
And I don't even have any major chronic conditions! People with major chronic health issues are pretty much required to stay in their current job forever, because if they lose their health insurance they're screwed. The whole employment-tying thing puts a huge drain on entrepreneurship, imo, because lots of people who would start companies are scared of losing their health insurance, and even if you can figure it out, it's a huge bureaucratic hassle. One area where the private sector has managed to gallantly out-bureaucratize any government.
In short, I really, really wish that health-insurance was completely decoupled from employment. It would reduce a lot of friction in the economy, imo.
On NPR an economist said that one thing that makes the US economy different (in a good way) from the EU economy is the extreme mobility of our workforce - that when times are tough, a reasonable portion of US people can and will pack up and move to a state where they can find jobs. If that is true, conversely isn't the effect of having health insurance so tightly coupled to employment equally detrimental? I mean it just blows my mind that we tie employment and healthcare together.
It would have been nice if the health care reform created some sort of common labeling for policies that allows you to quickly scan your coverage. Or even some online "what if" simulator, where you can ask questions about what the policy will and will not cover (startup idea here?)
http://blogs.msdn.com/b/michkap/archive/2010/03/21/9982732.a...
Written by the programmer who got multiple sclerosis in U.S. How he suffered because of the system. A good example of something "only in America" (from the Europe perspective of course).
I am a "U.S. Citizen", "born in the USA", whose parents were also "born in the USA". I moved my family to Vienna, Austria 8 years ago. I have for 4 years, owned and operated my own business, a GmbH here.
Vienna. The #1 city in the world 2 years in a row.
http://www.mercer.com/qualityoflivingpr#City_Ranking_Tables
First U.S. City, HONOLULU is at #31 with San Francisco at #32.
Insurance: US versus Austria
Three years ago, my daughter, at the age of 14, was diagnosed with morbid Juvenile Rheumatoid Arthritis, a life threatening condition. She spent 4 weeks in a hospital, with the total out of pocket cost of 280 euro for her meals. 100 % of the hospital costs and medical procedures was covered by insurance which costs my family 2400 euros per year.
In the U.S., in 2003, we paid $15,000 per year for insurance, with a $5500 per person deductible. My wife had her Gaul Bladder removed, and it cost us $11,000 deductible + all of the customary procedures which the insurance companies routinely refuse to pay until you take them to court.
My daughters hospital stay, and continuing medical treatments in the U.S. would certainly have led to a filing for bankruptcy (70 percent of all bankruptcy filings are due to medical bills). Instead, the annual costs of treatments in Austria is 240 euros per year, continuing hospital visits, and Methotrexate Injections.
FYI: Higher education is 100% taxpayer funded in Austria.
As long as a large majority of the U.S. voting public continue to believe that taxes are "theft" rather than paying their "fair share" of the "high financial costs of personal freedom and safety", and continue to refuse to admit that affordable healthcare is a basic human right, staying in Europe is a much better option in my opinion.
Here in Italy, it's good, but a bit 'drab' - the doctors know what they're doing, but sometimes the settings are not so nice, if that makes sense. Whereas in the US, you might get a room to yourself, or with one other person, you might have to share with more people here, and perhaps have fewer amenities.
However, like others have said, there's a huge peace of mind factor. I don't have to worry about insurance at all here. Job, no job, whatever, you get health care, end of story.
It's one thing that makes me quite nervous about going back to the US.
If I were to live without enough money in the bank to sustain myself for at least a couple of years without a job, i'd be truly scared, even here in Italy where the health care is all paid. I assume it's mostly just a different social behaviour/mindset, nobody can really tell if it's better or not.
As for healthcare, it IS that bad. Most working people have reasonable coverage (some of then even at reasonable price, as a percentage of income). However, it ties the worker to the employer. If you get fired, you lose your health insurance. If you quit, to move to another job, you lose your health insurance and have to get a new one (and at least until the recent healthcare laws, they didn't have to accept you -- sucks if something happens during your first job, because it's a "pre-existing condition" for the new one).
The end result is that employees are often held captive by their job because of the (essentially unrelated) health benefits. A friend of mine married 6 months earlier than planned to get coverage because she lost her own job.
Job mobility is much harmed.
There's COBRA -- an insurer must let you keep paying for one more year. However, the employer subsidy is gone, so people who pay $200/month all of a sudden find themselves having to pay $1200/month after quitting their job (or being fired).
Thank you America
Can any other Canadians comment on their experiences? Are there any who would prefer American-style healthcare?