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US Workers Are Highly Taxed If You Count Premiums
- mikeash 8y agoThe difference is that your taxes go up as you earn more, but your health insurance premiums don’t. Lower middle class workers are getting screwed, but the top earners are doing great! It’s a feature, not a bug.
- lordnacho 8y agoI actually spoke to someone today who is hiring a guy from a FANG in SV to go and work in Denmark. He told me taxes are high enough over there it isn't all that different. Plus like many Americans he was curious about living in Denmark. Cycling everywhere, laid back lifestyle, that sort of thing.
- adamnemecek 8y agoNot just that, they are also getting nothing in return. The US voters need to realize just how much are they getting fucked over by the military-industrial complex. I’m not against taxes, I’m against taxes that go to pay for wars as opposed to medical insurance, infrastructure and education.
- viburnum 8y agoYeah, it’s totally insane, working Americans pay for a Nordic-level welfare state but don’t get it (fun times for rich Americans though).
- z2 8y agoThat budget seems to be always nonnegotiable, despite the occasional media outrage. Realistically, how can US voters change this? As an aside, the US is the only country I've seen give military personnel priority boarding for civilian flights. With all due respect to veterans, it seems so strange to do this sort of worshiping in what is effectively peacetime.
- decebalus1 8y ago> this sort of worshiping in what is effectively peacetime https://en.wikipedia.org/wiki/List_of_wars_involving_the_United_States https://en.wikipedia.org/wiki/List_of_wars_involving_the_Uni... The US has been 'at war' with something continuously. There is no or never was peacetime.
- mikeash 8y agoI think we could stand to do significantly less worshipping of our soldiers, but a lot of the ones boarding commercial flights are on their way to places like Afghanistan where groups of unfriendly armed crazy people will attempt to kill them.
- kelnos 8y agoI agree with you in principle, but calling people you've never met from another country and culture "unfriendly armed crazy people" is a big, sad reason why we even need militaries in the first place. I imagine many of those "crazy people" in Afghanistan consider the US military to be invaders who won't leave them alone. It's of course all not that simple, but... why the need for unnecessary name-calling? It just perpetuates the "us vs. them" mentality that seems to be at the root of many of society's ills.
- mikeash 8y agoI would agree with you in the case of a generic enemy, but I see no problem with calling religious extremists “crazy.”
- rootusrootus 8y agoIt's a small thing, and I consider it a bit of payback for what society did to veterans back in the days of Vietnam.
- adamnemecek 8y agoIt’s bullshit because the govt makes these meaningless gestures but when it’s time to open the wallet, all of sudden they are out of respect.
- pxeboot 8y agoUnfortunately all that waste creates millions of jobs. If military and healthcare costs were brought under control too quickly, it would literally destroy the economy.
- adamnemecek 8y agoThat’s like saying let’s not put out the wildfire, the firemen need a job.
- seppin 8y agoMilitary yes, that's millions of jobs for people that would struggle to be employed otherwise. The health insurance industry, however, needs to die. The sooner the better. The resulting boom in people actually receiving healthcare in the US will cover the job losses over time.
- biesnecker 8y agoI once considered relocating with the same company to a similar role in London. The base pay in London is lower, and the marginal tax rates are high, but overall cost of living isn't too terribly far off (compared to the SF Bay Area), and doing calculations like these it seemed that while it would be something of a step down total compensation-wise, it wasn't nearly as large of one as it at first seemed. I didn't make the jump, but actually doing the math made it seem a lot more reasonable than it did at the outset.
- yomly 8y agoWhat fraction of SF salary did they ask you to take out of interest? I knew a googler who said London was 0.7*Mountain View total comp as an engineer
- biesnecker 8y agoYeah, it was about 75%.
- penagwin 8y agoI never understood why people are against some form of universal healthcare. The idea of "socialism" or "communism" scare many conservatives, but it just doesn't make sense here. How universal healthcare sorta works - we all put money in a pot, and use it to pay for healthcare. How health insurance works - we put money into a company, who uses it to pay for healthcare, while taking a significant cut as it's a private entity. With the correct organization (which the government is notoriously terrible at) it would seem to me that it could only be cheaper to have taxpaid healthcare?
- justaman 8y agoTrusting in a private company that must react to market changes is different than trusting in a government that doesn't listen to you anyway.
- the_gastropod 8y agoWhat is the market, here? What good or service do you get from insurance? For their real value prop (covering the unlikely need for catastrophic healthcare), you 1. most likely won't ever use it. 2. have no idea how good their service is until you have no other option but to exercise your coverage. Market-based capitalism works best when consumers can shop around, and take their money elsewhere when the good or service is not a good value. This is absolutely not the case with health insurance. Meanwhile, medicare is pretty beloved in this country. And the public options in other industrialized nations outperforms US healthcare in most respects for significantly less money.
- pjc50 8y agoIf it's employer-chosen, you're not the customer and they're not listening to you either.
- dsabanin 8y agoWhy do you stop there? The chain goes on. Employer will have to listen to the employees or they will be on a lookout for better place to work. It's not uncommon at all for employers to tout benefits as a way to attract new hires.
- viburnum 8y agoIt’s worse if you include 401k payments to offset a more generous public pension.
- munk-a 8y agoOr really any public pension. I feel like if you're <40 then you should be planning for Social Security to not exist when you get old, anything else seems overly optimistic.
- akhilcacharya 8y agoAs someone that started paying into SS a few years ago this sounds more like a cynical self-fulfilling prophecy more than anything else.
- munk-a 8y agoI definitely place myself on the liberal side of politics and will support social security for people before and after myself, but the current generation of older folks definitely appear to be trying to pull that ladder up behind them.
- paulkon 8y agoYou're paying into SS but that money is not being set aside for you, it's being used for current retirees. The next generation will have to pay into SS for you and betting that SS will not change it's payout conditions till then, in the midst of mounting debt liabilities and potentially shrinking contributions, is quite optimistic.
- munk-a 8y agoJust to clarify, your payments aren't being specifically earmarked for you (this isn't a government run retirement plan) they are being pooled and that pool is being used to pay for current and future SS beneficiaries, but the pool isn't going to run out anytime soon. It's more likely that it will be diverted for political reasons and defunded - to speak precisely the "entitlements" you paid for will be taken away without recompense.
- paulkon 8y agoMisappropriation of funds due to lobbying and regulatory capture. The film 'Vice' on Dick Cheney outlines just how permeable American government is to such non-public interests. It's no wonder tax avoidance is such an interesting topic for those who stand to pay the most if they do nothing.
- arosier 8y ago>It’s just that they pay it into a private insurance system that wastes large portions of it on rents and administrative redundancy. Would love to see a breakdown of real estate and admin costs for private insurance systems throughout the States to understand how much could be saved by eliminating redundancy. Not seeing this broken out in Anthem's Financials: https://ir.antheminc.com/static-files/73562e56-886c-4ff5-a365-d4324728524f https://ir.antheminc.com/static-files/73562e56-886c-4ff5-a36...
- vonmoltke 8y ago> Would love to see a breakdown of real estate and admin costs for private insurance systems throughout the States to understand how much could be saved by eliminating redundancy. I would love to see the same breakdown for the Netherlands, Germany, and Switzerland to see how they avoid it.
- abalone 8y agoAccording to a comprehensive study published in the New England Journal of Medicine, U.S. admin costs are double that of Canada.[1] More context in this NYT column, which features this quote: "'The extraordinary costs we see are not because of administrative slack or because health care leaders don’t try to economize,' said Kevin Schulman, a co-author of [another] study and a professor of medicine at Duke. 'The high administrative costs are functions of the system’s complexity.'"[2] Also, these studies don't take into account the time/opportunity cost to consumers of navigating this complicated system, which can be quite substantial. [1] https://www.nejm.org/doi/full/10.1056/nejmsa022033 https://www.nejm.org/doi/full/10.1056/nejmsa022033 [2] https://www.nytimes.com/2018/07/16/upshot/costs-health-care-us.html?module=inline https://www.nytimes.com/2018/07/16/upshot/costs-health-care-...
- dnautics 8y agoPrivate healthcare insurance has margins well below most profitable companies, in the us. If anything I'd hazard that the poor treatment of consumers by these entities stems from being barely able to hold the line, not because of greed. Rising medical costs, I think, have the blame elsewhere, but insurance companies sure do make a good Boogeyman for politicians, because they are very poorly understood.
- titanomachy 8y agoThe Canadian figures seem insanely low. 11.5% total? When I lived in BC making an approximately average income, my effective tax rate alone was 21% [EDIT: originally put 23%]. I paid pension, health insurance, and unemployment deductions on top of that. And that only counts the employee side of deductions. This example is "married with two kids", so it's possible that there are massive offsets that I didn't have access to as a single person, but 11.5% still seems very low. I would expect Canada to fare favourably in this comparison, though. The taxes are not as bad as most Americans think. Although they do ramp up very quickly for higher earners, which was an incentive for moving to the states as my income increased. Also, pay is higher in the US (by a factor of about 2 or 3) for the same job.
- ylbss 8y agoMaybe federal tax, but that starts at 15%. I mean when they say effective maybe they're talking about the average people pay after deductions? Who knows, 11% still seems incorrect.
- UnFleshedOne 8y agoThere is a base income level not taxed at all (~12k CAD), after that it is up from 15% + province tax.
- MichaelBurjack 8y agoYou might have a skewed sense of what median Canadian income is. And your job might be further above that median than you realize. Median Canadian individual income is ~$35,000 [0]. In B.C., your average 2019 tax rate would be 13.34% not including non-refundable tax credits (and so the effective rate would likely be a point or two lower). [1] A median tax rate of 11.5% against a median Canadian individual income seems entirely reasonable. ---- 0: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1110023901 https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=111002... 1: https://www.ey.com/ca/en/services/tax/tax-calculators-2019-personal-tax https://www.ey.com/ca/en/services/tax/tax-calculators-2019-p...
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- Someone1234 8y agoI moved to the US from a country with socialised medicine. When you include premiums then taxes in both were roughly similar if not a little higher in the US (ignoring cost of living differences). But even that doesn't include the real sting on the tail of US medicine. You pay a fairly high health insurance premium, but if you actually need health services you then pay again through the nose even with insurance "discounts." For example my under one year old needed to go to the emergency room due to a high fever for several hours, we paid over $300 on top of paying over a thousand in combined employer/employee premiums each month. That's with insurance picking up at least that much.
- zrail 8y ago$300 is a steal.
- maxxxxx 8y agoMy family in Germany throws a fit when they have to pay 50 Euro for something. In the US you can happy if your cost for seeing a doctor is less than 4 digits.
- jsight 8y agoIn fairness, the US typically does not cost $1k+ for a simple doctor visit.
- vonmoltke 8y ago> In the US you can happy if your cost for seeing a doctor is less than 4 digits. My wife and I have never paid four figures for a doctor visit, despite having two surgeries (one oral), a calf strain, and a dislocated shoulder (with ER visit) between us. The state of medical care in the US is bad enough as it is; you don't need to make up hyperbolic bullshit to make it seem worse.
- mikeash 8y agoI went to the ER thinking I was having a heart attack, and it turned out there was nothing wrong. The doctor who saw me afterwards thought it might have been intestinal spams. I got to pay $6,000 for that bit of entertainment.
- ars 8y ago"Fools rush in where angels fear to tread" You can't average averages in this way. You'll get easily manipulated data. He's using a single average data for a married, single income worker, and combining that with the average for health insurance. You can't do that. You need to calculate each individual person's income and share of healthcare costs, and only then average the results.
- ngngngng 8y agoThe US healthcare system is making many people extremely rich. Someone has to pay for that.
- deleted 8y ago[deleted]
- awakeasleep 8y agoThink of what it'd do to the insurance worker economy if we switched to a medicare for all system! It's pretty fucked up that such a large chunk of our country is now essentially parasitic. (I say this while recognizing that runaway medical costs aren't solely the result of insurers)
- riku_iki 8y agoCurious if there can be Amazon for healthcare..
- SantalBlush 8y agoConsidering the reported working conditions of some Amazon employees, let's not. The most sustainable choice will be neither monopolistic pricing, nor cutthroat pricing at the expense of medical staff, but somewhere in the middle.
- toomuchequate 8y agoPhysicians and Pharmacists? Physicians make 300k/yr, Pharmacists are a expensive dangerous rubber stamp. I'm serious
- raphaelj 8y agoThis does not take into account the fact that in most countries with an universal health care system, you will only contribute to it during your +/- 40 years career while you'll benefit from it during your whole life.
- refurb 8y agoYou don’t pay taxes once you’re retired? That’s certainly not true in places like Canada.
- mrep 8y agoEffectively the same in the states. When you are a kid, you're on your parents health plan which brings up their cost and your future cost as a parent, and when you are old you do get universal healthcare through Medicare.
- tathougies 8y agoIndividual US tax payers pay for most of the world's security. This is one tax of being the global super power, so it's not particularly surprising that when you include all things the US tax payer pays for privately that is taxed in other countries, you arrive at a number higher than other similar countries. In reality, there is no country with which we can fairly compare US tax rates.
- perfmode 8y agoI wouldn’t say the United States provides security when our actions and interventions tend to not be just. We are just a Mafia.
- tathougies 8y agoThe Mafia also provides security. Since I've written the same thing to like three different comments. I'll say it again: Arguments that attack the morality of US action do not counter my claim that US action benefits many foreign countries, corporations, and individuals, who do not contribute anything to the funds that allow such action to take place. Depending on your point of view, this makes the rest of the world either calves sucking from the teats of a benevolent, but ignorant cow, or bats sucking blood from an undead vampire. But regardless of how you slice it, the non-American countries are basically sucking from someone.
- munk-a 8y agoPerfect! So as a counter to that, and dialing my language back to patton-y style, America is going around stirring up shit that the rest of the world needs to shovel. Why is it that after Syria and ISIS have emerged and created a refugee crisis the US is miraculously missing (on a per-GDP basis) in the aide efforts. While America is fueling economic growth beyond the ability for the earth to sustain it why has it refused to help people fleeing desertification in Africa. Oh, the situation in El Salvador, yea... America never did anything to turn central and south america into a dumpster fire... America is the vampire, trying to suck all the resources and productivity into a machine that feeds itself - with little regard for the rest of the world. Oh wait, that was too reductionist... maybe the US does a lot of good by sending food aide around the world but also causes problems... maybe the rest of the world is the same, being good sometimes and bad others, and no one nation is some beacon of light and purity that all others are constantly sucking[1] the productivity out of. [1] The analogies used above were pretty weird and awkward,
- refurb 8y agoThis analysis ignores VAT taxes entirely, which can add significantly to an employee’s tax burden.
- munk-a 8y agoVAT taxes (or sales tax in the US) will tend to more heavily effect lower income workers, which will not be the majority of people on HN. VAT taxes are heavily regressive and, outside of the luxury class of such would be nice to see phased out.
- refurb 8y agoMost sales taxes in the US aren’t applied to staple good like food, blunting the impact on lower income workers. I would disagree it doesn’t impact higher income works because you’re still paying sales tax on luxury items and because of the high prices, the tax is very high. In Canada it’s not uncommon for the HST to be 15%.
- Scoundreller 8y ago> In Canada And if your income is low enough, you get an HST credit to control for its regressive nature.
- rhacker 8y agoLike to bring this up when we talk taxes: I think it's totally crazy that we give the feds 25% or more and our states soo soo sooooo much less. I think it should be the other way around: 5% for the feds, and maybe 20% to the states. The reason is that our cities are filled with bums, and have absolutely no money to either give them jobs or make new programs. The feds don't give a shit and are busy making missiles or creating massive social programs that enrich the wrong people. I think the current strategy is broken. The other nice thing about this, is that we'd pay less in taxes AND the states/cities would be able to handle every damn thing it needs. It would be like 2x to 3x the money they are getting right now.
- kevin_thibedeau 8y agoBut then the tax shelter states wouldn't be able to mooch off of federal programs.
- rhacker 8y agoThere's going to be a lot of buts I get it. I want someone that can figure this out and move it forward.
- throwaway284721 8y agoThe reason for this is that if one state has better social programs then another and higher taxes the poorest are going to move there, and the high earners are going to move away.
- AnthonyMouse 8y agoThis doesn't seem to be a major problem for the EU, which has unrestricted internal migration but social programs are administered by the individual member states. The idea that the poor will mass migrate to California and the rich will mass migrate to South Dakota is pretty unrealistic. The poor can't afford to live in California even with social assistance, and the rich don't want to live in South Dakota no matter how low the taxes are. Because money buys stuff taxpayers want. Middle class people want good schools and functioning transit and to know they're going to have a secure retirement. The premise of having the government do these things is that they can do them at least as well as the market. If they succeed they'll have no trouble attracting people to come there and pay taxes in exchange for receiving those services. If they fail and are then out-competed by other states that do better, whether by leaving things to the market or otherwise, isn't that a good thing? It requires the underperforming states to improve or lose population.
- pochamago 8y ago"If you include things that aren't taxes, people are taxed a lot more"
- kelnos 8y agoIf you don't do something, comparing tax rates between countries is meaningless when you get different things for those tax dollars. I think the developed world (minus us here in the US, of course) has finally realized that access to health care is a basic human right and should be included.
- gwright 8y agoThe primary reason that some people push back against this notion of health care as a "basic human right" is that it is an example of a "right" that can only be provided by force. And by force I mean that the only way it can be "guaranteed" by the government is for the government to forcibly collect taxes to pay for the services. Forceable redistribution is required. Perhaps even forcible job assignments (nurses, doctors, technicians, etc) if you really want to make sure the right is provided equally to everyone (ratio of patients to doctors, etc.). In contrast rights such as freedom of speech, assembly, press, religion and so on can be guaranteed through inaction of the government. Nothing needs to be taken away from anyone to guarantee these rights. Basically this is the difference between positive rights and negative rights. One large problem with bucketing positive and negative rights together as "basic rights" and insisting that the government must guarantee these basic rights is that it becomes difficult to identify a limiting principle. If health care is a "basic right", then why isn't "food" or "shelter" or "clothing"? How would we go about guaranteeing those things? Please don't interpret my comments as suggesting that reasonably priced health insurance and accessible health care services aren't important. They are, but there are ways of structuring those services and socializing some of the costs that don't require that they be considered "basic rights". It is interesting that you qualify your claim that health care is a "basic human right" to the "developed world". Does that mean that it is not a "basic human right" in other parts of the world? Why not? If it is a basic human right, shouldn't it be protected universally? And if you think it should be provided universally who should be responsible for providing that right outside the developed world? And if it there is some complex economic conditions that are pre-requisites then is it really a "basic human right"?
- tptacek 8y agoJust a quick note that health insurance premiums do not in fact get plowed directly into rents and administrative redundancies; we pay more than Europe (and Medicare) does in administrative costs, but far-and-away the largest components of health care expenditures in the US are in inpatient and outpatient procedure billings (outpatient by a factor of almost 2x inpatient, itself something like 3-4x all administrative costs). We certainly do seem to pay far too much for health care! But the explanations aren't as simple as evil health insurers. The system appears to be structurally pretty messed up, and alterations to the payer-side alone, without radical changes to the provider side, are unlikely to solve the problem.
- mercutio2 8y agoAgreed! The way countries with cheaper healthcare manage to spend less is by paying healthcare workers much less. Doctors and nurses in the US are high status. When they lobby against something, it’s hard to win. When I read people discussing cheaper healthcare, I always go looking for the part where they explain that healthcare professionals will make a significantly lower dollar per hour. I rarely find this discussed.
- elliekelly 8y agoI wonder how the earnings of American doctors compare to European doctors once you've removed the high cost of an American education/all those student loans they're paying off.
- cpach 8y agoWork hours could also be a factor. I’m quite sure US doctors work more than European doctors.
- programmertote 8y agoNot everyone. My host family parents are both doctors (psychiatrist and anesthesiologist) in the US, and my girlfriend is currently in a residency program in Long Island, so I can tell from my limited observations. My host family father (anesthesiologist) works from 7am to about 3pm (works for Einstein medical center in Philly). He pulls weekend extra time (on-call) to make ~$1000/call on Saturdays (to support his hobbies like expensive bikes and lens for photography). Gets paid well above $400K/year until he retired in 2015. My host mom works as at a quasi-private psychiatry treatment center where she manages about 20 in-house patients (almost always the same patients who she has been treating for many years). She goes to work just like any other 8-5 job. Very relaxed atmosphere. Gets paid very well (to the tune of more than $320K/year until she retired in 2016). My gf and her fellow residents at the hospital do not have a lot of stuff going on during most part of the days. She is a bit luckier than average resident in that regard though because her hospital is in a suburban setting. Her friends who got into residency programs like in Brooklyn, Bronx or Queens (e.g., Elmhurst hospital in Queens) have to work harder in their first and second years (especially only the first year). But not as bad as like 80 hrs/week like what you read in exaggerated news articles. Sure they work more than 40 hours because of on-calls and night duties. But definitely around 60 hrs/week (never approaching more than 70). All this is to say that the work hours of US doctors and medical residents (doctors in training) that we see in the news, I suspect, are a bit exaggerated (of course, they have to be bad/outliers in order to be in the news). I'd like to add that my host parents practiced in the UK for almost 7 years, and decided to move to the US (practiced here for almost two decades) because in the UK, they made like a quarter of what they were able to make in the US. Last but not least, all of them (my host parents and my gf) studied medicine in Burma (a third world country) for 5 years only (+2 years of residency). Certainly, the education one can get at Myanmar government-funded medical Universities isn't top-notch or state-of-the-art, but most med students learned on their own by supplementing with private classes, self-learning and practice (e.g., shadowing doctors). They (international medical graduates) score very well (usually better than their US peers--see chart #6, #7 in [1]). The point I'm trying to make is that we do NOT need 4 years of undergraduate education for wanna-be doctors (pre-med students) because that is not necessary and adds more debt burden to future doctors. This artificial barrier to entry is adding to the inflated healthcare price by making it very difficult for anyone to become a doctor in the US. We don't need 8 years of college and medical school education for most specialties; in the end, the garden-variety illnesses can be diagnosed by reading up references like [2], and it doesn't take 8 years of training to do that. [1] http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-IMGs.pdf http://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outc... [2] https://www.uptodate.com/login https://www.uptodate.com/login P.S. This rant is partly contributed by my experience when I got an ear infection (acute otitis media) last week and saw a doctor in New York, who charged me $200 for looking into my ears with otoscope for 10 seconds, and wrote up a prescription (the entire encounter lasted no more than 5 minutes). Since my deductible is high ($3K/yr), I had to pay $133 out of pocket. The oral pills (amoxicillin-variant and an antihistamine) for three days costs $30 (which I paid). The worst part is seeing the $283 price quote for ear drop (CIPRODEX). When I decided to not buy that and asked my doc for a more generic version, that costs $35. I asked my mom to buy the same generic version of ear drop from Myanmar as she is visiting me this week. The ear drop costs $15 a piece there; doctor consultation $40; oral pills $7 (for two weeks supply just in case I get the ear infection again in the near future).
- teslaberry 8y agothis is why when you hear billionairs call for higher taxes on billioniers you should understand they are after 2 things 1) they want to keep their competition down from other lesser wealthy billionairs. 2) they want to distract the public 99% from demanding a complete and total abolishment of payroll taxes. they didn't become billionaires by being nice or honest. don't every trust buffet, dalio or others when they talk about tax policy. buffets entire fortune is contingent upon tax subsidies for the insurance industry, as well as compulsory mandates for his product (insurance) dalio makes his fortune by taking into account taxation of capital (front running buybacks of stock) and other tax surgery. no one making under 50k a year should pay a dime in federal labor (income and payroll) tax. and no one, absolutely no one should pay payroll tax, it is a disguised poverty inducing tax and should be abolished as a form of slavery. when so called socialists and liberals begin talking about abolishing payroll tax, before they all clamor like morons to disucss a federally mandated higher minimum wage, i might just take them seriously.
- rayiner 8y agoThe international comparison is a bit eyebrow raising. It has two countries (Canada and the Netherlands), which are on the lower side in terms of overall taxation, on opposite sides of the scale. The Netherlands is listed as the highest tax jurisdiction, at 48%, despite having one of the lower tax burdens in Europe: https://en.wikipedia.org/wiki/List_of_countries_by_tax_revenue_to_GDP_ratio https://en.wikipedia.org/wiki/List_of_countries_by_tax_reven.... Canada is listed as just 11%.
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- Shivetya 8y agoUS workers are highly taxed if you bother to count every tax they pay from payroll, property, sales, and embedded taxes.
- learnstats2 8y agoThe article decides to include employer-side payroll taxes in its US calculations as though this is an income tax - but this is not (appears not to be) done for other countries, where payroll taxes are often higher, so it's not a fair comparison. The inevitable Wikipedia link: https://en.wikipedia.org/wiki/Payroll_tax#/media/File:Payroll_and_income_tax_by_country.png https://en.wikipedia.org/wiki/Payroll_tax#/media/File:Payrol...
- dingo_bat 8y agoYeah if you count non-tax expenses as tax, everybody is highly taxed. Let's lump in rent and food too.
- novalis78 8y agoThe only problem with the ‘Medicare for all’ system is that it won’t reduce that insanely high ‘stealth’ taxation - it will just add to it... However, at least with efforts like Oklahoma’s Surgery Center etc one stands a chance to escape the compulsory racket through market efficiency. Potentially.
- geggam 8y agoOne thing he missed. Only in the US can you be bankrupted with full coverage, a simple medivac helicopter ride would take care of most Americans.
- dragonwriter 8y agoYou can't be bankrupted with full coverage (except by the cost of premiums), but very few, proportionately, Americans have anything like full coverage.
- geggam 8y agoyou are simply wrong
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- bernardlunn 8y agoAbout time. As a Brit who worked in America for many years this was blindingly obvious. It is only who you pay your tax to.
- philjohn 8y agoSo - in the UK you pay national insurance, which ostensibly pays for the NHS and retirement benefits. If you earn £150k a year (top 2% of salaries in the UK) you pay £6,964.16 a year. That's an astounding deal. There are no deductibles, no co pays for hospital stays, GP visits are free, as are any tests and investigations. You do pay £9 for each item on a prescription, but if you get more than 3 items a month you can pay a flat rate of £104 a year for a prepayment certificate. Private health insurance is still a thing - it just gets you a nicer room in a private hospital and quicker treatment for non life-threatening conditions.
- fabricexpert 8y agoYou pay around 40% effective tax rate at £150k. It doesn't really matter exactly where the money goes, at the end of the day the budget has to made by the chancellor and they'll funnel money from NI to other areas and vice versa if they need to. Still a good deal though.
- deleted 8y ago[deleted]
- bodono 8y agoExcept for the fact that the NHS is utter garbage and anyone here making 150k is on private health insurance.
- mattlondon 8y agoCitation needed. I dont think that the NHS is utter garbage - sure there is room for improvement, but it seems that it is not "garbage" at all according to recent research: https://www.kingsfund.org.uk/sites/default/files/2018-06/NHS_at_70_how_good_is_the_NHS.pdf https://www.kingsfund.org.uk/sites/default/files/2018-06/NHS... That report has some very interesting charts. E.g. Figure 9 shows that almost 25% of people in USA skipped going to the doctors due to cost, or almost 20% of people in USA skipped prescription medicine due to cost. For comparison on the NHS it was 5% and 2% respectively. Mind-boggling. I'd agree though that anyone on 150K plus (and probably anyone in a job from the 40K range upward (if not lower)) would have private medical cover. As others have noted, private cover basically just means you get seen quicker/at a more convienient time and the waiting room is nicer - the care is no better or worse than the NHS IME (although I dont have any data on that - just a personal anecdote)
- timwaagh 8y agoonly country doing worse: netherlands. no surprise there.
- dandare 8y agoTangential: As a non-native speaker, I find the word PREMIUM highly problematic. You need a lot of contexts to understand that the article is talking about health care costs not covered by health insurance.
- fabricexpert 8y agoIt's not because you are a non-native speaker. It's not a widely used English term without the word Insurance in front of it, however it is a standard American English term. It is also not the costs "not covered by health insurance", rather the insurance premium is the cost of the policy itself.
- dandare 8y agoInteresting, thanks! But from what I know people in US often end up paying extra cash (on top of their health insurance) for procedures, checkups, and drugs. This is rather rare in EU. That should be included in whatever international comparison.
- shireboy 8y agoThis article makes some good points up until the end. It criticizes private sector waste without evaluating waste in the public sector. I see how the taxpayer impact could possibly* be a wash, and do see problems in the private sector for sure. But my experiences with just about any US federal system does not cause me to see them as a bastion of efficiency. Without a profit incentive or really any incentive beyond occasional bad press, and with strict salary and firing controls they do not innovate or improve. Look at the VA for an example. Horror stories do exist for British and Canadian systems as well as others I’m sure. * This article also ignores the fact that many of the countries listed also still have private insurance supplementals. Those may need to be added for a fair comparison. In the end I don’t have good solution, but think the traditional arguments in both directions are generally hyperbolic and over simplified. Unless data shows conclusively otherwise, I lean toward free market solutions.
- harrumph 8y agoMarkets such as the US health care market, characterized by ineslastic demand and secret prices, should never, ever be tolerated under any circumstances. This arrangement is here to benefit the supply side and screw the demand side and it has to be stopped. The only pathway out of this crisis starts with the federal government replacing private insurers, relegating them to selling supplemental coverage. Such companies also should be legally compelled to run as mutual insurance companies, where any profit deriving from good risk management is sent back to policyholders. It is long past time everybody in the US admitted that markets have completely failed in US health care.
- dre85 8y agoMy understanding is that in the US there are even companies which can be hired by hospitals and other care centers to "optimize" the codes before the final submission to the insurance. I take this to mean that they can ensure that you're using the right codes and also probably try to maximize the payout.
- alexiazf 8y agoI think I'm privileged to live in Australia where I do not need to pay for my visits to the hospital and for my operation when I had appendicitis. Whereas in the US I've seen it is 30-70k. It's also interesting that there is a range of prices depending on the hospital. Would this be representative of treatment quality? How much one can pay shouldn't be the determinant of the optimal treatment that one deserves to receive.