8 ms·

From this side of the Altantic, it looks like the US economy is organized so that the lower working class only earns just enough to live. No wonder they are hom

From this side of the Altantic, it looks like the US economy is organized so that the lower working class only earns just enough to live. No wonder they are homeless when illness, disability or bad luck strikes. I am not implying this applies to OP.

PragmaticPulp 6y ago
I worked at an international company where we frequently had employees from other countries visit the US for a while. Some even chose to relocate to the US. These were almost all technical people, raised on the Internet, social media, and discussions in comment sections. It was fascinating to see how bad they expected America to be according to Internet comments and news articles. Many of them were shocked to realize that we do have social safety nets, disability programs, heavily subsidized or government healthcare for lower incomes, and so on. I’ll be the first to admit that our systems require improvement and are far from perfect, but at the same time it’s not the dystopian society as portrayed on Reddit’s front page or in certain media outlets day in and day out. I can’t speak to the OP’s situation because obviously we don’t know the particular details, but given the mention of nearly $10 million of medical treatment it’s possible they were referring to a new or experimental treatment that wasn’t yet covered by traditional healthcare options. We have a lot of cutting-edge and experimental treatments in the United States, but insurance usually refuses to cover expensive experimental treatments until the evidence is sufficient to support their use. For rare disorders, it can take an extremely long time to collect enough evidence to reach that tipping point. It should be noted that many nationalized healthcare programs won’t cover or offer these treatments for the same evidentiary reasons, so I wouldn’t assume this was a uniquely American problem without further details.
- ido 6y ago
  I don't buy it, due to first-hand & second-hand experiences of friends and relatives I have in the US. Let me give you one example: my friend(and at the time business partner)'s wife got cancer in the US. It was fairly "mundane"/common cancer that got treated and everything was alright at the end. He was working as a software developer (normal employee, not self-employed - our venture was a side project) with the aforementioned "good health insurance" well paid professional middle-class Americans get. At the end of the ordeal he was stuck with a $65k bill (presumably that's just the tip of iceberg and insurance paid more). Years later I had a malignant tumor here in Germany. Again everything is fine at the end, but it was in many ways a worse case than my friend's wife (due to where the tumor was) & I spent several weeks in a (very nice) hospital in Berlin. I also get an MRI every 6 months to keep track of the situation. I paid a grand total of ~€500 despite being self-employed at the time (so I only had standard public insurance everyone in Germany gets). My twice-yearly MRIs are free. When I was diagnosed with the tumor they offered me an appointment for surgery for 3 days later (I ended up taking it a week later than that as I wanted to get a 2nd opinion). Neither mine nor my friend's experiences are exceptions.
  - metalliqaz 6y ago
    Yep. That's because in Germany, "healthcare" is about caring for your health. In the US "healthcare" is about keeping laborers productive. Anyone who can generate value for capital will get the care they need to remain productive. When the cost of that care exceeds the value they generate, they are not covered. Public assistance programs are really just the bare minimum that is necessary to keep the following QOL issues from popping up in view of the upper class: homeless overrunning the streets, shantytowns and slums, rioting, black markets.
    - lester_jango 6y ago
      While I don't wish for this level of utilitarianism and inequality, I do wish our system here in the US had this level of organized clarity that you are describing. I think instead much more of the problem needs to be attributed to sheer incompetence and bureaucratic inefficiency. Recently I went to the local medical center and had got some basic checkups and diagnostics. The healthcare was fine, but the billing and medical record interactions were terrible. The negotiation about the amount I owed, which was always in the $50-150 range, was dragged out over six months and involved five different corporations (the medical center, their independent billing agency, the collections agency, my insurer, and my insurer's third party negotiation firm). It went to collections even though all parties had agreed it should be on hold pending the "investigation", which never seemed to bring any new details to light. Then finally they lowered it significantly at the end and never provided a reason why it was different.
  - lettergram 6y ago
    If I had cancer in the US a $65k bill really isn’t bad. Consider in the US taxes are typically <20%. So if you make $100k a year, you pay $20k in taxes. So you have $80k, minus insurance (let’s eat $500/month) you have $74k In Germany (if I recall) it’s closer to 50% taxes so $50k a year. Presumably you can expect cancer once or less, but effectively you only need ~4 years of income to make up for that $65k bill in the US. Not bad at all. Obviously that differs based on income, but you can a see how (for many people in the US) the system works great
- Kye 6y ago
  Visiting is not the same as living it. You can't see how bad it is until you see people around you struggle or fall all the way down because they were short $20 on bills one week and no one around them had money to lend.
  - convolvatron 6y ago
    and living it as a well-paid white collar employee is _alot_ different than living it as everyone else
- TLightful 6y ago
  Wouldn't touch the USA with my worst enemies barge pole.
- hestipod 6y ago
  The only place I have ever gotten quality care and felt it wasn't broken and about profits was a European social system. I've never been able to permanently move back there and it's going to result in my death. It infuriates me when nationalism and propaganda overtake reality and costs people their lives. I recently attempted suicide after 15+ years of severe chronic pain and the resultant disability that was caused by medical mistakes and unneeded surgery in the USA. That system stole my life. I was then denied social assistance. I was then told by a dozen lawyers "You have a legit malpractice case but the costs are too high, award caps are too low, and we cannot afford to take it and it's not like people believe from pop culture". I was then dependent on the same system that harmed me to "help" me survive that harm, but couldn't afford it nor get adequate care. When so much goes wrong, against what people believe SHOULD happen, they nearly always blame YOU to preserve their world view. I struggled for so long piecing things together and reducing my life and trying to find a way out but I could never get off of Maslow's bottom rungs in this country. Family and people turned away because victim blaming is common and my family are not generally caring and decent people. I live with an emotionally, and now physically abusive parent, as a middle aged man. Isolated. No access to things I need without begging and fighting. It's better than being homeless, but even that is held over my head if I don't "act right". The expected results of such a life like depression, anxiety etc are then retconned and blamed as the root cause and people treat you badly. I now have more, and more serious medical issues as a result of being "saved" against my documented wishes and the people and systems are treating me even worse now, with some even saying it's my own fault because of the attempt. I have doctors giving me opposite opinions on things and escalating the issue to more and more difficult to access and expensive specialties. I have no reliable transportation and live rurally. I have ever factor that caused me to try and kill myself to stop the suffering and now new and worse ones, yet there is still no "help". The system and society in this country are broken...selfish...greedy. I spent a night in the ER recently as things were so bad, and that's what my useless primary care doctor inssited I do, and while kind and professional, they were limited in what they could do beyond that night, and sent me right back out into that broken system and "home" to the broken rural hellhole with the cruel narcissists threatening me at the worst time. Can't get the help needed to live...not allowed to die...Now I am living my worst fear...that things are so bad I cannot even make a leap of faith or run away to start again even WITH help...I want it all to be over but even that is prevented and fought in some sick circlejerk of irony. Healthcare should never be a business...it should be a service. People love to argue about economics when it's not their life on the line, or when it's conceptual. I have seen people in my situation saved by humane social systems. America's has killed me and even watching it happen to me has not budged the people around me and their extreme, nationalistic beliefs. They have decided it's my failure, fault, and this is the "greatest place on earth" and I should be grateful. I guess its probably some filter picking out inflammatory words but even this post isn't showing and makes me feel like my voice doesn't matter...as my life doesn't matter. I have met some very good people in my life so I know it's not ALWAYS bad...but I can forgive myself for thinking it usually is because people usually show it's all about them, ego, and profits. Other people are tools to that end and they don't seem to accept things until they are the victims...and then it's too late.
- im3w1l 6y ago
  I had some visitors over to the SF who were crying in despair over the poverty and suffering seen on some of the streets there. But had a good time in other parts. Your impression really depends on where you go.
lr4444lr 6y ago
Look at their consumption habits as compared to your country too, though.
- kenforthewin 6y ago
  This seems disingenuous. Are you implying that the consumption habits of America's poor are a leading cause of their poverty? To me this smells of victim-blaming, especially given that their consumption habits tend to be a result of their poverty, not a cause.
rayiner 6y ago
That’s true everywhere though. In 2014, the bottom 50% in France warned just 15,000 euros per year on average: https://voxeu.org/sites/default/files/image/FromMay2014/garbintifig1.png https://voxeu.org/sites/default/files/image/FromMay2014/garb.... That’s only a little bit higher than the average income of the bottom 20% in the US: https://www.advisorperspectives.com/images/content_image/data/07/07ff29d2e2e637e5c74515d2282051bc.png https://www.advisorperspectives.com/images/content_image/dat.... In terms of income, the people somewhat below the median in France are doing similarly to the very bottom in the US. But none are making enough to weather illness or disability. In most countries, most people are reliant on the safety net in the case of illness or disability. The French safety net is much more comprehensive, but the US has safety net programs. But they’re unevenly distributed across the country. When one of my family members on the west coast was unemployed, his treatment for his heart attack was covered by Medicaid. Most of the populous states extend Medicaid to everyone below a certain income level. Indeed, about 3/4 of the uninsured in the US are eligible for some sort of insurance, and many of them are eligible for Medicaid but simply don’t sign up. Some states like Texas don’t extend Medicaid to working age adults, but they’re in the minority of states. The gulf between the US and “the other side of the Atlantic” is much smaller than it is made to seem. Federal, state, and local governments spend almost $7 trillion a year on services. We spend 35% of GDP, compared to say 38% for the UK or 41% for Spain: https://www.economicshelp.org/wp-content/uploads/2020/01/top-government-spending-share-of-gdp.png https://www.economicshelp.org/wp-content/uploads/2020/01/top.... There is a bigger gap between Sweden and Spain than Spain and the US. Moreover, people understate the structural challenges in the US that can’t be solved by money. If we just enacted universal healthcare (Medicare for All) our total government spending would jump to 50% of GDP, higher than Sweden or Norway. (And that’s not even adding in free college, etc.)
- jatone 6y ago
  and our private spending on insurance would drop by a similar amount. its basically zero sum. bernie's plan in worst case scenario was a few hundred billion a year more total but the coverage was superior to almost every private plan out there.
  - 6y ago
darksaints 6y ago
I agree with this, but the problem is always framed as a problem of income inequality. We have an income inequality problem for sure, but at the low end of that spectrum, the problem is cost of living. For the past 50 years, the following things have outpaced generally used inflation indicators: housing, education, health care. Basically, the inflation experienced by poor people has drastically exceeded the inflation experienced by rich people. Incomes for our lower quantiles is often higher than countries with comparable gdp/capita. But those incomes don't translate to a comparable standard of living.
TrackerFF 6y ago
The thing you need to know about US economics (and politics), is that it's always driven by some narrow special interest group. Just follow the money, and you'll find some billionaire with special interest, and their millionaire enablers. I'm not saying that it's not like that in other countries, but the big difference between the US and many other western countries, is that core services (health, education, freedom, etc.) are unfortunately so heavily influenced by private interest, that the majority of Americans end up paying more for less - while some few end up filthy rich. And it is quite interesting - if you ever find yourself reading about some policies getting put on the table, just follow the money.

PragmaticPulp 6y ago

I worked at an international company where we frequently had employees from other countries visit the US for a while. Some even chose to relocate to the US. These were almost all technical people, raised on the Internet, social media, and discussions in comment sections. It was fascinating to see how bad they expected America to be according to Internet comments and news articles. Many of them were shocked to realize that we do have social safety nets, disability programs, heavily subsidized or government healthcare for lower incomes, and so on. I’ll be the first to admit that our systems require improvement and are far from perfect, but at the same time it’s not the dystopian society as portrayed on Reddit’s front page or in certain media outlets day in and day out. I can’t speak to the OP’s situation because obviously we don’t know the particular details, but given the mention of nearly $10 million of medical treatment it’s possible they were referring to a new or experimental treatment that wasn’t yet covered by traditional healthcare options. We have a lot of cutting-edge and experimental treatments in the United States, but insurance usually refuses to cover expensive experimental treatments until the evidence is sufficient to support their use. For rare disorders, it can take an extremely long time to collect enough evidence to reach that tipping point. It should be noted that many nationalized healthcare programs won’t cover or offer these treatments for the same evidentiary reasons, so I wouldn’t assume this was a uniquely American problem without further details.

ido 6y ago
I don't buy it, due to first-hand & second-hand experiences of friends and relatives I have in the US. Let me give you one example: my friend(and at the time business partner)'s wife got cancer in the US. It was fairly "mundane"/common cancer that got treated and everything was alright at the end. He was working as a software developer (normal employee, not self-employed - our venture was a side project) with the aforementioned "good health insurance" well paid professional middle-class Americans get. At the end of the ordeal he was stuck with a $65k bill (presumably that's just the tip of iceberg and insurance paid more). Years later I had a malignant tumor here in Germany. Again everything is fine at the end, but it was in many ways a worse case than my friend's wife (due to where the tumor was) & I spent several weeks in a (very nice) hospital in Berlin. I also get an MRI every 6 months to keep track of the situation. I paid a grand total of ~€500 despite being self-employed at the time (so I only had standard public insurance everyone in Germany gets). My twice-yearly MRIs are free. When I was diagnosed with the tumor they offered me an appointment for surgery for 3 days later (I ended up taking it a week later than that as I wanted to get a 2nd opinion). Neither mine nor my friend's experiences are exceptions.
- metalliqaz 6y ago
  Yep. That's because in Germany, "healthcare" is about caring for your health. In the US "healthcare" is about keeping laborers productive. Anyone who can generate value for capital will get the care they need to remain productive. When the cost of that care exceeds the value they generate, they are not covered. Public assistance programs are really just the bare minimum that is necessary to keep the following QOL issues from popping up in view of the upper class: homeless overrunning the streets, shantytowns and slums, rioting, black markets.
  - lester_jango 6y ago
    While I don't wish for this level of utilitarianism and inequality, I do wish our system here in the US had this level of organized clarity that you are describing. I think instead much more of the problem needs to be attributed to sheer incompetence and bureaucratic inefficiency. Recently I went to the local medical center and had got some basic checkups and diagnostics. The healthcare was fine, but the billing and medical record interactions were terrible. The negotiation about the amount I owed, which was always in the $50-150 range, was dragged out over six months and involved five different corporations (the medical center, their independent billing agency, the collections agency, my insurer, and my insurer's third party negotiation firm). It went to collections even though all parties had agreed it should be on hold pending the "investigation", which never seemed to bring any new details to light. Then finally they lowered it significantly at the end and never provided a reason why it was different.
- lettergram 6y ago
  If I had cancer in the US a $65k bill really isn’t bad. Consider in the US taxes are typically <20%. So if you make $100k a year, you pay $20k in taxes. So you have $80k, minus insurance (let’s eat $500/month) you have $74k In Germany (if I recall) it’s closer to 50% taxes so $50k a year. Presumably you can expect cancer once or less, but effectively you only need ~4 years of income to make up for that $65k bill in the US. Not bad at all. Obviously that differs based on income, but you can a see how (for many people in the US) the system works great
Kye 6y ago
Visiting is not the same as living it. You can't see how bad it is until you see people around you struggle or fall all the way down because they were short $20 on bills one week and no one around them had money to lend.
- convolvatron 6y ago
  and living it as a well-paid white collar employee is _alot_ different than living it as everyone else
TLightful 6y ago
Wouldn't touch the USA with my worst enemies barge pole.
hestipod 6y ago
The only place I have ever gotten quality care and felt it wasn't broken and about profits was a European social system. I've never been able to permanently move back there and it's going to result in my death. It infuriates me when nationalism and propaganda overtake reality and costs people their lives. I recently attempted suicide after 15+ years of severe chronic pain and the resultant disability that was caused by medical mistakes and unneeded surgery in the USA. That system stole my life. I was then denied social assistance. I was then told by a dozen lawyers "You have a legit malpractice case but the costs are too high, award caps are too low, and we cannot afford to take it and it's not like people believe from pop culture". I was then dependent on the same system that harmed me to "help" me survive that harm, but couldn't afford it nor get adequate care. When so much goes wrong, against what people believe SHOULD happen, they nearly always blame YOU to preserve their world view. I struggled for so long piecing things together and reducing my life and trying to find a way out but I could never get off of Maslow's bottom rungs in this country. Family and people turned away because victim blaming is common and my family are not generally caring and decent people. I live with an emotionally, and now physically abusive parent, as a middle aged man. Isolated. No access to things I need without begging and fighting. It's better than being homeless, but even that is held over my head if I don't "act right". The expected results of such a life like depression, anxiety etc are then retconned and blamed as the root cause and people treat you badly. I now have more, and more serious medical issues as a result of being "saved" against my documented wishes and the people and systems are treating me even worse now, with some even saying it's my own fault because of the attempt. I have doctors giving me opposite opinions on things and escalating the issue to more and more difficult to access and expensive specialties. I have no reliable transportation and live rurally. I have ever factor that caused me to try and kill myself to stop the suffering and now new and worse ones, yet there is still no "help". The system and society in this country are broken...selfish...greedy. I spent a night in the ER recently as things were so bad, and that's what my useless primary care doctor inssited I do, and while kind and professional, they were limited in what they could do beyond that night, and sent me right back out into that broken system and "home" to the broken rural hellhole with the cruel narcissists threatening me at the worst time. Can't get the help needed to live...not allowed to die...Now I am living my worst fear...that things are so bad I cannot even make a leap of faith or run away to start again even WITH help...I want it all to be over but even that is prevented and fought in some sick circlejerk of irony. Healthcare should never be a business...it should be a service. People love to argue about economics when it's not their life on the line, or when it's conceptual. I have seen people in my situation saved by humane social systems. America's has killed me and even watching it happen to me has not budged the people around me and their extreme, nationalistic beliefs. They have decided it's my failure, fault, and this is the "greatest place on earth" and I should be grateful. I guess its probably some filter picking out inflammatory words but even this post isn't showing and makes me feel like my voice doesn't matter...as my life doesn't matter. I have met some very good people in my life so I know it's not ALWAYS bad...but I can forgive myself for thinking it usually is because people usually show it's all about them, ego, and profits. Other people are tools to that end and they don't seem to accept things until they are the victims...and then it's too late.
im3w1l 6y ago
I had some visitors over to the SF who were crying in despair over the poverty and suffering seen on some of the streets there. But had a good time in other parts. Your impression really depends on where you go.

lr4444lr 6y ago

Look at their consumption habits as compared to your country too, though.

kenforthewin 6y ago
This seems disingenuous. Are you implying that the consumption habits of America's poor are a leading cause of their poverty? To me this smells of victim-blaming, especially given that their consumption habits tend to be a result of their poverty, not a cause.

rayiner 6y ago

That’s true everywhere though. In 2014, the bottom 50% in France warned just 15,000 euros per year on average: https://voxeu.org/sites/default/files/image/FromMay2014/garbintifig1.png https://voxeu.org/sites/default/files/image/FromMay2014/garb.... That’s only a little bit higher than the average income of the bottom 20% in the US: https://www.advisorperspectives.com/images/content_image/data/07/07ff29d2e2e637e5c74515d2282051bc.png https://www.advisorperspectives.com/images/content_image/dat.... In terms of income, the people somewhat below the median in France are doing similarly to the very bottom in the US. But none are making enough to weather illness or disability. In most countries, most people are reliant on the safety net in the case of illness or disability. The French safety net is much more comprehensive, but the US has safety net programs. But they’re unevenly distributed across the country. When one of my family members on the west coast was unemployed, his treatment for his heart attack was covered by Medicaid. Most of the populous states extend Medicaid to everyone below a certain income level. Indeed, about 3/4 of the uninsured in the US are eligible for some sort of insurance, and many of them are eligible for Medicaid but simply don’t sign up. Some states like Texas don’t extend Medicaid to working age adults, but they’re in the minority of states. The gulf between the US and “the other side of the Atlantic” is much smaller than it is made to seem. Federal, state, and local governments spend almost $7 trillion a year on services. We spend 35% of GDP, compared to say 38% for the UK or 41% for Spain: https://www.economicshelp.org/wp-content/uploads/2020/01/top-government-spending-share-of-gdp.png https://www.economicshelp.org/wp-content/uploads/2020/01/top.... There is a bigger gap between Sweden and Spain than Spain and the US. Moreover, people understate the structural challenges in the US that can’t be solved by money. If we just enacted universal healthcare (Medicare for All) our total government spending would jump to 50% of GDP, higher than Sweden or Norway. (And that’s not even adding in free college, etc.)

jatone 6y ago
and our private spending on insurance would drop by a similar amount. its basically zero sum. bernie's plan in worst case scenario was a few hundred billion a year more total but the coverage was superior to almost every private plan out there.
- 6y ago

darksaints 6y ago

I agree with this, but the problem is always framed as a problem of income inequality. We have an income inequality problem for sure, but at the low end of that spectrum, the problem is cost of living. For the past 50 years, the following things have outpaced generally used inflation indicators: housing, education, health care. Basically, the inflation experienced by poor people has drastically exceeded the inflation experienced by rich people. Incomes for our lower quantiles is often higher than countries with comparable gdp/capita. But those incomes don't translate to a comparable standard of living.

TrackerFF 6y ago

The thing you need to know about US economics (and politics), is that it's always driven by some narrow special interest group. Just follow the money, and you'll find some billionaire with special interest, and their millionaire enablers. I'm not saying that it's not like that in other countries, but the big difference between the US and many other western countries, is that core services (health, education, freedom, etc.) are unfortunately so heavily influenced by private interest, that the majority of Americans end up paying more for less - while some few end up filthy rich. And it is quite interesting - if you ever find yourself reading about some policies getting put on the table, just follow the money.