3 ms·

Yeah it's quite crazy, and worse for people whom are there on a visa as their visa depends on their employment. And even worse again is that healthcare is tied

Yeah it's quite crazy, and worse for people whom are there on a visa as their visa depends on their employment. And even worse again is that healthcare is tied up to your employer..

lotsofpulp 7y ago
Tax free health insurance is tied up with employer, not healthcare (or health insurance). Anyone can purchase health insurance at healthcare.gov. Recently, the ability to purchase health insurance with pre-tax money has been expanded to self employed, but people who work for an employer that does not offer health insurance are still discriminated against.
- Insanity 7y ago
  Okay fair enough, but from what I gather from my relatives over there is that this is quite expensive? At least compared to EU
  - lotsofpulp 7y ago
    Yes, this pdf shows how much health insurance costs per month for a person in the state of New Jersey (a higher cost of living state, but not far off New York/California): https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates_2020.pdf https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra... The metal levels indicate what portion of your expected healthcare costs the insurance is expected to pay. Bronze is 60%, Silver is 70%, Gold is 80%. At the bottom you will see age rating, so you have to multiply that factor with the premium to get the premium at your age. For example, if you purchase bronze coverage (lets say $250) as a 50 year old in NJ, the factor is 1.78 times $250 = $445 per month divided by 0.6 due to it being bronze = $742 per month is your expected healthcare expenses. Obviously this is not per month, but becomes more accurate amortized over ones' lifetime, as you might go with zero healthcare expenses for years and then get hit with $10,000 easily. Bottom line is eat right, exercise, and either be poor enough to get taxpayer paid healthcare or be rich enough to not care about spending ~$20k per year per couple in their 50s on health insurance premiums plus have ~$30k or so ready for out of pocket costs in case of emergency. If something happens to you at the end of December, the out of pocket will reset Jan 1, so you need to have two years worth of out of pocket costs, and at around $13k or so, I ballpark it at $30k. If I'm in the middle 30% to 80% wealth band of the US, I would plan on killing myself if my prognosis was poor to avoid draining the family's wealth.
    - Insanity 7y ago
      that's just depressing to be honest. :/ EDIT: Follow-up question, the table ends at 64+, how do senior citizens pay for this without having a job?
      - lotsofpulp 7y ago
        65+ enter the magical land of Medicare, where the taxpayers start taking care of you and paying for your medical care. But over the years, even that has been chipped down and is extremely confusing, with a combination of means testing and supplementary insurance programs that you need to buy to get "full coverage". But basically, 65+ means if you go to the hospital, and get a $300k bill, it won't ruin your finances as the government picks up the hospital bills. I'm pretty sure. But there's Part A/B/C/D/etc, which cover different things like prescription medicines, non hospital healthcare, etc that are not paid for or partially paid for, and you have to buy supplementary insurance for those. Also, health insurance in the US is not just insurance, it's also buying access to a set of healthcare providers that the insurance has negotiated pricing with, so that you don't get taken advantage of by the healthcare providers who can otherwise charge you whatever they want. As you can see, the US spends a decent portion of its time trying to figure out how to take advantage of the system (i.e. each other) and wring out as much as possible while putting in as little as possible.
        Insanity 7y ago
        Thanks for clarifying, it does sound like a bit of a mess to be honest. Hopefully things change for the better given in light of the current crisis.
- mgkimsal 7y ago
  > Recently, the ability to purchase health insurance with pre-tax money has been expanded to self employed I've been doing it for 12 years. This isn't 'recent'.
  - lotsofpulp 7y ago
    Oops, I got that mixed up with the ability for small business to reimburse employees with tax free money for purchasing health insurance from healthcare.gov
    - mgkimsal 7y ago
      gotcha. that's recent, iirc, like... in the last year? weren't many companies already doing 'HSA funding' as a benefit before that? Was it just taxable (but... contribution to a HSA would be deductible for me even if the income is initially taxable, so would seem a wash?). I understand this is the actual insurance though.
      - lotsofpulp 7y ago
        HSA’s and related tax benefits are a different topic than paying for the monthly health insurance premiums with pre-tax income. People whose employers offered health insurance got to pay their premiums with pre tax money and contribute to HSA with pre tax money. People whose employers don’t offer health insurance have to pay the premiums with post tax money. But they still get to contribute to HSA with pre tax money.
- jorblumesea 7y ago
  > Anyone can purchase health insurance at healthcare.gov. But in practice, it's so prohibitively expensive that many people just...don't. Pre or post tax, it's insanely expensive. Europeans would be shocked.
marcosdumay 7y ago
> as their visa depends on their employment You know, it's probably not that a large problem because those are very few people, but this one is completely insane. I have no idea how nobody still found it completely opposite to fundamental freedoms. It just escapes being outright slavery because those people can run away to their home country.
- HarryHirsch 7y ago
  The visa issue cripples non-citizens' ability to negotiate better salaries. The salary issue affects everyone, citizen and stranger.

Yeah it's quite crazy, and worse for people whom are there on a visa as their visa depends on their employment. And even worse again is that healthcare is tied up to your employer..

lotsofpulp 7y ago

Tax free health insurance is tied up with employer, not healthcare (or health insurance). Anyone can purchase health insurance at healthcare.gov. Recently, the ability to purchase health insurance with pre-tax money has been expanded to self employed, but people who work for an employer that does not offer health insurance are still discriminated against.

Insanity 7y ago
Okay fair enough, but from what I gather from my relatives over there is that this is quite expensive? At least compared to EU
- lotsofpulp 7y ago
  Yes, this pdf shows how much health insurance costs per month for a person in the state of New Jersey (a higher cost of living state, but not far off New York/California): https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcrates_2020.pdf https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra... The metal levels indicate what portion of your expected healthcare costs the insurance is expected to pay. Bronze is 60%, Silver is 70%, Gold is 80%. At the bottom you will see age rating, so you have to multiply that factor with the premium to get the premium at your age. For example, if you purchase bronze coverage (lets say $250) as a 50 year old in NJ, the factor is 1.78 times $250 = $445 per month divided by 0.6 due to it being bronze = $742 per month is your expected healthcare expenses. Obviously this is not per month, but becomes more accurate amortized over ones' lifetime, as you might go with zero healthcare expenses for years and then get hit with $10,000 easily. Bottom line is eat right, exercise, and either be poor enough to get taxpayer paid healthcare or be rich enough to not care about spending ~$20k per year per couple in their 50s on health insurance premiums plus have ~$30k or so ready for out of pocket costs in case of emergency. If something happens to you at the end of December, the out of pocket will reset Jan 1, so you need to have two years worth of out of pocket costs, and at around $13k or so, I ballpark it at $30k. If I'm in the middle 30% to 80% wealth band of the US, I would plan on killing myself if my prognosis was poor to avoid draining the family's wealth.
  - Insanity 7y ago
    that's just depressing to be honest. :/ EDIT: Follow-up question, the table ends at 64+, how do senior citizens pay for this without having a job?
    - lotsofpulp 7y ago
      65+ enter the magical land of Medicare, where the taxpayers start taking care of you and paying for your medical care. But over the years, even that has been chipped down and is extremely confusing, with a combination of means testing and supplementary insurance programs that you need to buy to get "full coverage". But basically, 65+ means if you go to the hospital, and get a $300k bill, it won't ruin your finances as the government picks up the hospital bills. I'm pretty sure. But there's Part A/B/C/D/etc, which cover different things like prescription medicines, non hospital healthcare, etc that are not paid for or partially paid for, and you have to buy supplementary insurance for those. Also, health insurance in the US is not just insurance, it's also buying access to a set of healthcare providers that the insurance has negotiated pricing with, so that you don't get taken advantage of by the healthcare providers who can otherwise charge you whatever they want. As you can see, the US spends a decent portion of its time trying to figure out how to take advantage of the system (i.e. each other) and wring out as much as possible while putting in as little as possible.
      - Insanity 7y ago
        Thanks for clarifying, it does sound like a bit of a mess to be honest. Hopefully things change for the better given in light of the current crisis.
mgkimsal 7y ago
> Recently, the ability to purchase health insurance with pre-tax money has been expanded to self employed I've been doing it for 12 years. This isn't 'recent'.
- lotsofpulp 7y ago
  Oops, I got that mixed up with the ability for small business to reimburse employees with tax free money for purchasing health insurance from healthcare.gov
  - mgkimsal 7y ago
    gotcha. that's recent, iirc, like... in the last year? weren't many companies already doing 'HSA funding' as a benefit before that? Was it just taxable (but... contribution to a HSA would be deductible for me even if the income is initially taxable, so would seem a wash?). I understand this is the actual insurance though.
    - lotsofpulp 7y ago
      HSA’s and related tax benefits are a different topic than paying for the monthly health insurance premiums with pre-tax income. People whose employers offered health insurance got to pay their premiums with pre tax money and contribute to HSA with pre tax money. People whose employers don’t offer health insurance have to pay the premiums with post tax money. But they still get to contribute to HSA with pre tax money.
jorblumesea 7y ago
> Anyone can purchase health insurance at healthcare.gov. But in practice, it's so prohibitively expensive that many people just...don't. Pre or post tax, it's insanely expensive. Europeans would be shocked.

marcosdumay 7y ago

> as their visa depends on their employment You know, it's probably not that a large problem because those are very few people, but this one is completely insane. I have no idea how nobody still found it completely opposite to fundamental freedoms. It just escapes being outright slavery because those people can run away to their home country.

HarryHirsch 7y ago
The visa issue cripples non-citizens' ability to negotiate better salaries. The salary issue affects everyone, citizen and stranger.