7 ms·

I don't understand how the effective tax rate in NY can be the same as Ontario, Canada - but here in Canada we have at least healthcare for all citizens that ge

I don't understand how the effective tax rate in NY can be the same as Ontario, Canada - but here in Canada we have at least healthcare for all citizens that gets paid for out of that. It's not A+ care but it's good, and it covers everyone. And it's like 1/3 of the budget, it's a huge line item. What the heyzeus are you Americans spending all that tax money on? More on topic: the same issue exists between US and Canada, and it needs to be sorted. Some ports of entry on the US/Mexico border are not properly set up to process TN visas etc..

justinator 8y ago
> What the heyzeus are you Americans spending all that tax money on? The Military.
- danielvf 8y ago
  Out of the 4 trillion dollars the US Federal government spent in 2016 (the last year we had a full budget), 0.631 trillion of that was for the military. An almost infinitesimal part of the New York state budget is for the state national guard.
  - justinator 8y ago
    In 2016, the US Military Spending was roughly HALF of the Discretionary Spending of the budget, which you are correct, in that it totaled ~1.15 Trillion
  - pascalxus 8y ago
    for Federal it's a lot higher than that. there are many defense expenditures hidden in other departments/categories.
  - monetus 8y ago
    Plus the mystery budget: https://en.m.wikipedia.org/wiki/Black_budget https://en.m.wikipedia.org/wiki/Black_budget WaPo estimated it was $52.8 billion in 2012.
klipt 8y ago
Cities like New York also unofficially provide free healthcare via the emergency room to people who are too poor to pay the ridiculous sticker price.
- harimau777 8y ago
  Wouldn't that only apply to emergency medicine? I don't think you can go to the emergency room for something like cancer treatment or physical therapy. However, I could be mistaken.
  - svachalek 8y ago
    If you leave anything untreated long enough, it becomes an emergency. Perfectly functional system here.
  - monetus 8y ago
    Personal anecdote: Was rushed to the ER after a seizure. They did give me a craniotomy, but only after a misdiagnosis... Which made things worse. A dye-injected MRI wasn't an option, being uninsured.
- syshum 8y ago
  No the city government does not.... The cost for the "free" care people get that can not pay for Emergency room Care is paid for by the people that can pay This is why a Halls Cough Drop is $15 ea and other common things are 100x more expensive in a Hospital when billed to a insurance company. the City, the government, does not pay for this care nor is it paid for by the tax payers
kolbe 8y ago
I don't know what Canada's approach to efficiency is, but most levels of public service in the US are quite indifferent to the idea of maximizing the good that can be done with tax revenue. Example in NYC: https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-construction-costs.html https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-...
gravy 8y ago
America as a whole? Social Security, Medicare, Medicaid are 3 mandatory spending programs that make up ~45% of gov't spending. Defense makes up ~15% and is discretionary (albeit also globally projected, though most of which goes to paying soldiers and maintenance/operational costs). [0] New York? Mostly on healthcare (~22%) and education (~31%). [1] [0] https://upload.wikimedia.org/wikipedia/commons/thumb/e/e1/CBO_Infographic_2016.png/1280px-CBO_Infographic_2016.png https://upload.wikimedia.org/wikipedia/commons/thumb/e/e1/CB... [1] https://openbudget.ny.gov/overview.html https://openbudget.ny.gov/overview.html
- refurb 8y ago
  One interesting thing I didn't know is that the US social security payments (old age pension) is much more generous than in Canada. Even with fully contributions, the maximum you can receive in Canada is $1,100 per month. In the US, it's $2,800 per month. The US program is much larger than in Canada.
  - stevenwoo 8y ago
    Correct me if I'm wrong but I thought the amount you get in the USA is related to a.) how much you put in b.) how old you are when you elect to start receiving benefits. I am not familiar with the Canadian system - does it differ in this respect?
    - sonnyblarney 8y ago
      Canadian system is somewhat similar but with smaller cap.
- sonnyblarney 8y ago
  The US spends more on public healthcare on a per capita basis than we do in Canada, and for that we get full coverage for everyone - the US only gets Medicare/Medicaid and some vet stuff. Technically speaking the US could wipe out all private healthcare spending, reduce public spending on healthcare and still have enough over to cover everyone with 'adequate' care. Granted, it wouldn't be up to par for what many Americans expect. Americans pay about 2x for services rendered, though often they are better, they are not 2x better. That said, someone who only has to wait 6 weeks for a hip replacement may consider wanting to pay 2x as opposed to waiting 15 months, as they might have to here in Canada.
njarboe 8y ago
In the US about 50% of healthcare is paid by various levels of government. The US spends about twice the percent of GDP on healthcare as most other western countries. So if the US could just figure out how to get similar costs to what Europe has, the US could have a European style government healthcare system without high taxes.
- syshum 8y ago
  Price Control and lower Quality. For example in the EU Ward style rooms are common with 5+ beds per room many have 10+, in the US 4 people in the room is bottom level of care where most get 2 people per room They also have heavy price controls on Drugs, if the US one of the few remaining countries with out them goes down that path Research will suffer as the US funds a huge amount of Drug Related research that the rest of the world gets for far far less investment There are 100's of other differences in how te US system works different in the US, and US Consumers have come to expect those things. This is with out getting into the all the problem associated with 3rd party payer systems like the US has where we have "insurance" that is not really insurance but prepaid healthcare.
  - sonnyblarney 8y ago
    "Price Control and lower Quality" You forgot: massively more economically efficient. Despite that I agree quality is a little lower - it's not that much lower. Health outcomes are similar. In hospital in Montreal, the halls were lined with patients, not enough room, but ... they were doing a big round of a specific surgery (for some common things they line people up and do it factory style one after the next). This might seem uncomfortable, but you get similar outcome at fraction of the cost. Also - it covers everyone - which is a huge advantage. One of the most misunderstood issues of how socialized care works is the 'risk' element is removed. If you are messed up - you just go to the hospital. You're not going to go home with a $20K bill for a broken arm. It's an 'existentially' powerful aspect of daily life that is different. But yes, fully socialized as in Canada is unfair, there needs to be a private outlet.
    - 8y ago

justinator 8y ago

> What the heyzeus are you Americans spending all that tax money on? The Military.

danielvf 8y ago
Out of the 4 trillion dollars the US Federal government spent in 2016 (the last year we had a full budget), 0.631 trillion of that was for the military. An almost infinitesimal part of the New York state budget is for the state national guard.
- justinator 8y ago
  In 2016, the US Military Spending was roughly HALF of the Discretionary Spending of the budget, which you are correct, in that it totaled ~1.15 Trillion
- pascalxus 8y ago
  for Federal it's a lot higher than that. there are many defense expenditures hidden in other departments/categories.
- monetus 8y ago
  Plus the mystery budget: https://en.m.wikipedia.org/wiki/Black_budget https://en.m.wikipedia.org/wiki/Black_budget WaPo estimated it was $52.8 billion in 2012.

klipt 8y ago

Cities like New York also unofficially provide free healthcare via the emergency room to people who are too poor to pay the ridiculous sticker price.

harimau777 8y ago
Wouldn't that only apply to emergency medicine? I don't think you can go to the emergency room for something like cancer treatment or physical therapy. However, I could be mistaken.
- svachalek 8y ago
  If you leave anything untreated long enough, it becomes an emergency. Perfectly functional system here.
- monetus 8y ago
  Personal anecdote: Was rushed to the ER after a seizure. They did give me a craniotomy, but only after a misdiagnosis... Which made things worse. A dye-injected MRI wasn't an option, being uninsured.
syshum 8y ago
No the city government does not.... The cost for the "free" care people get that can not pay for Emergency room Care is paid for by the people that can pay This is why a Halls Cough Drop is $15 ea and other common things are 100x more expensive in a Hospital when billed to a insurance company. the City, the government, does not pay for this care nor is it paid for by the tax payers

kolbe 8y ago

I don't know what Canada's approach to efficiency is, but most levels of public service in the US are quite indifferent to the idea of maximizing the good that can be done with tax revenue. Example in NYC: https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-construction-costs.html https://www.nytimes.com/2017/12/28/nyregion/new-york-subway-...

gravy 8y ago

America as a whole? Social Security, Medicare, Medicaid are 3 mandatory spending programs that make up ~45% of gov't spending. Defense makes up ~15% and is discretionary (albeit also globally projected, though most of which goes to paying soldiers and maintenance/operational costs). [0] New York? Mostly on healthcare (~22%) and education (~31%). [1] [0] https://upload.wikimedia.org/wikipedia/commons/thumb/e/e1/CBO_Infographic_2016.png/1280px-CBO_Infographic_2016.png https://upload.wikimedia.org/wikipedia/commons/thumb/e/e1/CB... [1] https://openbudget.ny.gov/overview.html https://openbudget.ny.gov/overview.html

refurb 8y ago
One interesting thing I didn't know is that the US social security payments (old age pension) is much more generous than in Canada. Even with fully contributions, the maximum you can receive in Canada is $1,100 per month. In the US, it's $2,800 per month. The US program is much larger than in Canada.
- stevenwoo 8y ago
  Correct me if I'm wrong but I thought the amount you get in the USA is related to a.) how much you put in b.) how old you are when you elect to start receiving benefits. I am not familiar with the Canadian system - does it differ in this respect?
  - sonnyblarney 8y ago
    Canadian system is somewhat similar but with smaller cap.
sonnyblarney 8y ago
The US spends more on public healthcare on a per capita basis than we do in Canada, and for that we get full coverage for everyone - the US only gets Medicare/Medicaid and some vet stuff. Technically speaking the US could wipe out all private healthcare spending, reduce public spending on healthcare and still have enough over to cover everyone with 'adequate' care. Granted, it wouldn't be up to par for what many Americans expect. Americans pay about 2x for services rendered, though often they are better, they are not 2x better. That said, someone who only has to wait 6 weeks for a hip replacement may consider wanting to pay 2x as opposed to waiting 15 months, as they might have to here in Canada.

njarboe 8y ago

In the US about 50% of healthcare is paid by various levels of government. The US spends about twice the percent of GDP on healthcare as most other western countries. So if the US could just figure out how to get similar costs to what Europe has, the US could have a European style government healthcare system without high taxes.

syshum 8y ago
Price Control and lower Quality. For example in the EU Ward style rooms are common with 5+ beds per room many have 10+, in the US 4 people in the room is bottom level of care where most get 2 people per room They also have heavy price controls on Drugs, if the US one of the few remaining countries with out them goes down that path Research will suffer as the US funds a huge amount of Drug Related research that the rest of the world gets for far far less investment There are 100's of other differences in how te US system works different in the US, and US Consumers have come to expect those things. This is with out getting into the all the problem associated with 3rd party payer systems like the US has where we have "insurance" that is not really insurance but prepaid healthcare.
- sonnyblarney 8y ago
  "Price Control and lower Quality" You forgot: massively more economically efficient. Despite that I agree quality is a little lower - it's not that much lower. Health outcomes are similar. In hospital in Montreal, the halls were lined with patients, not enough room, but ... they were doing a big round of a specific surgery (for some common things they line people up and do it factory style one after the next). This might seem uncomfortable, but you get similar outcome at fraction of the cost. Also - it covers everyone - which is a huge advantage. One of the most misunderstood issues of how socialized care works is the 'risk' element is removed. If you are messed up - you just go to the hospital. You're not going to go home with a $20K bill for a broken arm. It's an 'existentially' powerful aspect of daily life that is different. But yes, fully socialized as in Canada is unfair, there needs to be a private outlet.
  - 8y ago