5 ms·

You obviously know this, but for those who are not familiar with America, regarding #2 above, the experience in the US is vastly different from other rich count

by runako 8y ago

You obviously know this, but for those who are not familiar with America, regarding #2 above, the experience in the US is vastly different from other rich countries. > The lower threshold for the U.S. is $23,416 PPP-adjusted 2010 dollars per year. A person that makes this in the US usually will not receive health insurance at work. Depending on the specifics of the person's demographics/state/income, a worker at the boundary between "middle income" and "lower income" may not be eligible for ACA subsidies and may not make enough to pay premiums. The middle/lower part of the income range is where a lot of the uninsured live. Jobs that pay near this boundary also tend not to come with real health insurance. So the frequent debate about repealing the ACA means that even if they are insured today, these folks do not have any healthcare security as the nation actively debates repealing their lifeline. (IIRC the Supreme Court will decide this summer whether millions of people lose their insurance this year. It's not a sure thing either way.) My personal take is that not until you're fairly rich (upper middle class) can you attain roughly the level of healthcare security that comes with residency in other rich countries. And even that requires you to stay employed, so it's still a lesser quality of security. Similar factors apply to the rest of the safety net. The US might be the worst rich country to live in if you're low-income/modest income.

rayiner 8y ago
That is true, but that's also only one side of the story. Statistically, most people won't need to use the safety net. And while Americans have less security, they also enjoy a substantially higher level of material comfort. Americans have more/newer cars, live in bigger houses, etc. https://www.businessinsider.com/ons-english-homes-are-a-third-of-the-size-of-american-homes-2017-10 https://www.businessinsider.com/ons-english-homes-are-a-thir... Now, I think it would be better to have more of a safety net and less in the way of material comforts. But it's not fair to ignore the fact that higher incomes come with tangible benefits for Americans. It's not all downside with no upside.
- thatfrenchguy 8y ago
  > Statistically, most people won't need to use the safety net As a person, you'll around 100% likely to the doctor. In any Western Europe country, you don't have to think about it. In the US, you either think about it because of your copay or your don't go because you don't have money.
  - rayiner 8y ago
    Most Americans have insurance through their employer, or under Medicare/Medicaid. (And that was true before ACA.) Copays are small ($20-30 typically) and similar to what they are in say Sweden or Finland: https://megaphoneoz.com/why-sweden-gets-away-with-health-co-payments https://megaphoneoz.com/why-sweden-gets-away-with-health-co-....
    - thatfrenchguy 8y ago
      I make a good six figures. I have a $20 copay. The copay in France is usually €1. I have delayed going to the doctor in the US because "do I really want to spend 20 bucks on this ?" and ended up going a week after while in a worse state. Most people I know here are like this. Also, 12.4% of all Americans are uninsured and 28% are underinsured: http://fortune.com/2019/02/07/americans-health-care-underinsured-rate/ http://fortune.com/2019/02/07/americans-health-care-underins... . Don't pretend the current situation in the US is anywhere near healthy.
      - rayiner 8y ago
        The whole point of copays is to dissuade you from using services unnecessarily, which is why many countries, even ones with socialized medicine, have copays or similar out-of-pocket charges (Sweden, Norway, Netherlands, Finland, etc.). In the typical case where you're not sick, it works out. As to your point about the uninsured--I'm not debating the merits of various healthcare systems, I'm trying to contextualize the experience of the typical American. The typical American has health insurance (and is not underinsured), pays $25 or so for their annual checkup, and lives in a house two and a half times bigger than their counterpart in the U.K. (That American is also a job loss + health scare away from significant financial problems. Both things are true.)
- runako 8y ago
  Hard agree with most of this. There's something to the notion that the US (and possibly Canada) should be in a wealth tier beyond other rich countries. But the security thing is a real thing that affects even people who make good money. American cars/bigger houses/etc. can be transitory because our healthcare system sucks and our education system is too expensive. I wouldn't dismiss these things because there's two generations now that are experiencing all of the insecurity in healthcare & education costs without experiencing the benefits that accrued to prior generations. Our current model may not be sustainable. (Also & this isn't 100% germane to your argument, but most of the US population is eligible for some part of the safety net at some point. Notably, most infants are eligible for WIC because they are not born to well-off families. Obviously ditto the Social Security & Medicare. It's probably fair to say that most Americans will lean on the safety net at some point in their lives.)
hackeraccount 8y ago
Wait. Hold on. You're acting like Medicaid doesn't exist. Firstly I bet that in most states if you're making $23,000 a year don't make enough for the ACA not too much so that you end up on Medicaid.
- rayiner 8y ago
  ACA subsidizes coverage from the Medicaid line up to well above the median income. For example, for an individual making $23,000, premiums are capped at 4-6% of income. (Which is, incidentally, lower than the health insurance tax in Germany, which is 15.5%, with the employer covering half.)
- runako 8y ago
  I specifically didn't go to this level of analysis because I was responding to a post that uses 2010 PPP-adjusted numbers. I have no idea how to quickly compare that to today's benefits & costs. But there are millions of families that fall on that border between "low-income" and "middle class" who are not eligible for subsidies, get crappy insurance, and have trouble paying for even that (which they lose if the employee gets sick).

by runako 8y ago

rayiner 8y ago

That is true, but that's also only one side of the story. Statistically, most people won't need to use the safety net. And while Americans have less security, they also enjoy a substantially higher level of material comfort. Americans have more/newer cars, live in bigger houses, etc. https://www.businessinsider.com/ons-english-homes-are-a-third-of-the-size-of-american-homes-2017-10 https://www.businessinsider.com/ons-english-homes-are-a-thir... Now, I think it would be better to have more of a safety net and less in the way of material comforts. But it's not fair to ignore the fact that higher incomes come with tangible benefits for Americans. It's not all downside with no upside.

thatfrenchguy 8y ago
> Statistically, most people won't need to use the safety net As a person, you'll around 100% likely to the doctor. In any Western Europe country, you don't have to think about it. In the US, you either think about it because of your copay or your don't go because you don't have money.
- rayiner 8y ago
  Most Americans have insurance through their employer, or under Medicare/Medicaid. (And that was true before ACA.) Copays are small ($20-30 typically) and similar to what they are in say Sweden or Finland: https://megaphoneoz.com/why-sweden-gets-away-with-health-co-payments https://megaphoneoz.com/why-sweden-gets-away-with-health-co-....
  - thatfrenchguy 8y ago
    I make a good six figures. I have a $20 copay. The copay in France is usually €1. I have delayed going to the doctor in the US because "do I really want to spend 20 bucks on this ?" and ended up going a week after while in a worse state. Most people I know here are like this. Also, 12.4% of all Americans are uninsured and 28% are underinsured: http://fortune.com/2019/02/07/americans-health-care-underinsured-rate/ http://fortune.com/2019/02/07/americans-health-care-underins... . Don't pretend the current situation in the US is anywhere near healthy.
    - rayiner 8y ago
      The whole point of copays is to dissuade you from using services unnecessarily, which is why many countries, even ones with socialized medicine, have copays or similar out-of-pocket charges (Sweden, Norway, Netherlands, Finland, etc.). In the typical case where you're not sick, it works out. As to your point about the uninsured--I'm not debating the merits of various healthcare systems, I'm trying to contextualize the experience of the typical American. The typical American has health insurance (and is not underinsured), pays $25 or so for their annual checkup, and lives in a house two and a half times bigger than their counterpart in the U.K. (That American is also a job loss + health scare away from significant financial problems. Both things are true.)
runako 8y ago
Hard agree with most of this. There's something to the notion that the US (and possibly Canada) should be in a wealth tier beyond other rich countries. But the security thing is a real thing that affects even people who make good money. American cars/bigger houses/etc. can be transitory because our healthcare system sucks and our education system is too expensive. I wouldn't dismiss these things because there's two generations now that are experiencing all of the insecurity in healthcare & education costs without experiencing the benefits that accrued to prior generations. Our current model may not be sustainable. (Also & this isn't 100% germane to your argument, but most of the US population is eligible for some part of the safety net at some point. Notably, most infants are eligible for WIC because they are not born to well-off families. Obviously ditto the Social Security & Medicare. It's probably fair to say that most Americans will lean on the safety net at some point in their lives.)

hackeraccount 8y ago

Wait. Hold on. You're acting like Medicaid doesn't exist. Firstly I bet that in most states if you're making $23,000 a year don't make enough for the ACA not too much so that you end up on Medicaid.

rayiner 8y ago
ACA subsidizes coverage from the Medicaid line up to well above the median income. For example, for an individual making $23,000, premiums are capped at 4-6% of income. (Which is, incidentally, lower than the health insurance tax in Germany, which is 15.5%, with the employer covering half.)
runako 8y ago
I specifically didn't go to this level of analysis because I was responding to a post that uses 2010 PPP-adjusted numbers. I have no idea how to quickly compare that to today's benefits & costs. But there are millions of families that fall on that border between "low-income" and "middle class" who are not eligible for subsidies, get crappy insurance, and have trouble paying for even that (which they lose if the employee gets sick).