4 ms·

Well it's definitely not cost of housing, which is very expensive here. For the most part you can expect to pay a lot more for a much smaller house in the UK co

by ladon86 16y ago

Well it's definitely not cost of housing, which is very expensive here. For the most part you can expect to pay a lot more for a much smaller house in the UK compared to the US. I'm not sure where it is that we make up the difference in costs, or if indeed we do.

Mz 16y ago
As a guess: Healthcare. My understanding is that it is largely covered by the government in the UK but consumes somewhere in the neighborhood of 20% of US incomes (figure remembered off the top of my head -- I really want to say about 22% but that implies more accuracy than I feel confident implying). So that one item alone should make a quite large impact on actual outcomes.
- hga 16y ago
  But, assuming we've been talking about before tax incomes, the mechanism by which you pay for your health care doesn't matter for the purposes of this discussion, does it? I.e. the U.K. has higher individual tax rates in part to cover the NHS's expenses. That said, the U.K. spends a lot less as a percentage of GDP on health care, but then they have a substantially lower per capita GDP. ADDED: off the top of my head, U.K. health care spending is 6-7% of GDP, US is 17%.
  - Mz 16y ago
    That said, the U.K. spends a lot less as a percentage of GDP on health care, but then they have a substantially lower per capita GDP. As someone who has a life-threatening medical condition (and also spends a lot of time talking to others with serious conditions), I will note that being unhealthy has a great many costs involved that go far beyond whatever is spent on doctors and drugs. The very high healthcare costs in the US are not merely a financial cost. They are an indicator of general poor health in the US: High levels of obesity, high blood pressure, heart disease, diabetes and on and on. People who are ill have less energy and mental focus for the tasks of day-to-day living and often spend more money on lower quality products, like eating microwave meals and fast food instead of cooking from scratch. In fact, the degree to which my local grocery store is an utter madhouse right before American holidays that revolve around a big meal where extended family is typically invited suggests to me and others that I have spoken with that most Americans just don't much cook. I was a homemaker for 2 decades and the degree to which I shopped daily for fresh meats and produce and cooked for dinner what I had bought fresh earlier that afternoon drew frequent remarks from people who worked at the grocery store and who wished their wife would cook like I did. I have gotten myself a great deal healthier than doctors think is possible for my condition and dietary changes are a big part of how I accomplished that. It is well known that Europe has a food culture in a way that is unknown here in the US. I strongly suspect that the emphasis on eating well in Europe is linked both to having a high quality of life without a very high salary and to lower overall healthcare costs. /soapbox
  - cstross 16y ago
    Note that UK healthcare costs are lower than US healthcare expenditure in part because there's no parasitic insurance industry. (Or rather, there is, but it's tiny: private healthcare accounts for <10% of UK healthcare expenditure). Instead, there's a single payer that funds everything and doesn't bother with assessing individual eligibility for treatment except in edge cases (foreign visitors, or rare and horrendously expensive cancer cases, mostly).
    - hga 16y ago
      Are you asserting that the US system spends more effort "assessing individual eligibility for treatment" than the U.K.'s? Well, I suppose so, the UK's NICE (http://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence http://en.wikipedia.org/wiki/National_Institute_for_Health_a...), much like our CMS (http://en.wikipedia.org/wiki/Centers_for_Medicare_and_Medicaid_Services http://en.wikipedia.org/wiki/Centers_for_Medicare_and_Medica...), establishes the impersonal guidelines, but in the US only those over 64 or on Medicaid are impersonally bound by them. In practice when our "parasitic insurance industry" addresses this it's about providing coverage beyond the CMS guidelines, since the latter are a floor which our legal system won't let the "parasitic insurance industry" go below. That legal system and most especially its lack of the English "loser pays" Rule is probably a greater influence on costs, especially since the NHS has got to have some level of sovereign immunity.
      - cstross 16y ago
        the NHS has got to have some level of sovereign immunity. Does it? (I don't know of anyone suing NICE, but they've certainly brought lawsuits against GP practices and hospital trusts, and won substantial damages for malpractice and/or judgements requiring the provision of treatment that was at first denied on various grounds.) Meanwhile, the NHS bodies that deliver healthcare -- be they PCTs or fundholding GP practices -- don't have a profit incentive for excluding people with pre-existing medical conditions from receiving treatment. (They may have a cost control incentive to for denying anomalously expensive treatments, but that kicks in at the opposite end of the supply-and-demand chain: and it's defended by reference to metrics like quality-adjusted life-years per unit expenditure rather than the requirement to show a profit.) Finally, the "loser pays" rule has been greatly undermined by the widespread adoption of conditional-fee lawsuits for civil damages in the UK over the past decade.
- tesseract 16y ago
  Does that take into account that in the US a lot of healthcare spending is done by employers and thus wouldn't even be included in incomes?
  - Mz 16y ago
    If you are chronically ill, you are going to have "costs" beyond whatever such studies measure as 'healthcare costs'. I was unemployable for year and years until I finally got a proper diagnosis and began getting my condition under control. The single biggest cost savings I have experienced with getting well is that my food budget has shrunk dramatically. My ex was career military. I had very few out-of-pocket "medical" expenses (co-pays for doctor's visits or for prescription drugs). My health problems did enormous damage to our budget anyway. Anyone spending in the neighborhood of 20% of their income on medical care is not healthy. Please see my other reply if you really want to read more of my rant on the topic. Peace.
tesseract 16y ago
I know in some European countries (I'm thinking specifically of Germany) it's much more common for employees to be issued a company car than it is in the US. Is that true in the UK as well? Or are there other things commonly provided as in-kind employment benefits that would otherwise cost a lot of money?

by ladon86 16y ago

Mz 16y ago

As a guess: Healthcare. My understanding is that it is largely covered by the government in the UK but consumes somewhere in the neighborhood of 20% of US incomes (figure remembered off the top of my head -- I really want to say about 22% but that implies more accuracy than I feel confident implying). So that one item alone should make a quite large impact on actual outcomes.

hga 16y ago
But, assuming we've been talking about before tax incomes, the mechanism by which you pay for your health care doesn't matter for the purposes of this discussion, does it? I.e. the U.K. has higher individual tax rates in part to cover the NHS's expenses. That said, the U.K. spends a lot less as a percentage of GDP on health care, but then they have a substantially lower per capita GDP. ADDED: off the top of my head, U.K. health care spending is 6-7% of GDP, US is 17%.
- Mz 16y ago
  That said, the U.K. spends a lot less as a percentage of GDP on health care, but then they have a substantially lower per capita GDP. As someone who has a life-threatening medical condition (and also spends a lot of time talking to others with serious conditions), I will note that being unhealthy has a great many costs involved that go far beyond whatever is spent on doctors and drugs. The very high healthcare costs in the US are not merely a financial cost. They are an indicator of general poor health in the US: High levels of obesity, high blood pressure, heart disease, diabetes and on and on. People who are ill have less energy and mental focus for the tasks of day-to-day living and often spend more money on lower quality products, like eating microwave meals and fast food instead of cooking from scratch. In fact, the degree to which my local grocery store is an utter madhouse right before American holidays that revolve around a big meal where extended family is typically invited suggests to me and others that I have spoken with that most Americans just don't much cook. I was a homemaker for 2 decades and the degree to which I shopped daily for fresh meats and produce and cooked for dinner what I had bought fresh earlier that afternoon drew frequent remarks from people who worked at the grocery store and who wished their wife would cook like I did. I have gotten myself a great deal healthier than doctors think is possible for my condition and dietary changes are a big part of how I accomplished that. It is well known that Europe has a food culture in a way that is unknown here in the US. I strongly suspect that the emphasis on eating well in Europe is linked both to having a high quality of life without a very high salary and to lower overall healthcare costs. /soapbox
- cstross 16y ago
  Note that UK healthcare costs are lower than US healthcare expenditure in part because there's no parasitic insurance industry. (Or rather, there is, but it's tiny: private healthcare accounts for <10% of UK healthcare expenditure). Instead, there's a single payer that funds everything and doesn't bother with assessing individual eligibility for treatment except in edge cases (foreign visitors, or rare and horrendously expensive cancer cases, mostly).
  - hga 16y ago
    Are you asserting that the US system spends more effort "assessing individual eligibility for treatment" than the U.K.'s? Well, I suppose so, the UK's NICE (http://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence http://en.wikipedia.org/wiki/National_Institute_for_Health_a...), much like our CMS (http://en.wikipedia.org/wiki/Centers_for_Medicare_and_Medicaid_Services http://en.wikipedia.org/wiki/Centers_for_Medicare_and_Medica...), establishes the impersonal guidelines, but in the US only those over 64 or on Medicaid are impersonally bound by them. In practice when our "parasitic insurance industry" addresses this it's about providing coverage beyond the CMS guidelines, since the latter are a floor which our legal system won't let the "parasitic insurance industry" go below. That legal system and most especially its lack of the English "loser pays" Rule is probably a greater influence on costs, especially since the NHS has got to have some level of sovereign immunity.
    - cstross 16y ago
      the NHS has got to have some level of sovereign immunity. Does it? (I don't know of anyone suing NICE, but they've certainly brought lawsuits against GP practices and hospital trusts, and won substantial damages for malpractice and/or judgements requiring the provision of treatment that was at first denied on various grounds.) Meanwhile, the NHS bodies that deliver healthcare -- be they PCTs or fundholding GP practices -- don't have a profit incentive for excluding people with pre-existing medical conditions from receiving treatment. (They may have a cost control incentive to for denying anomalously expensive treatments, but that kicks in at the opposite end of the supply-and-demand chain: and it's defended by reference to metrics like quality-adjusted life-years per unit expenditure rather than the requirement to show a profit.) Finally, the "loser pays" rule has been greatly undermined by the widespread adoption of conditional-fee lawsuits for civil damages in the UK over the past decade.
tesseract 16y ago
Does that take into account that in the US a lot of healthcare spending is done by employers and thus wouldn't even be included in incomes?
- Mz 16y ago
  If you are chronically ill, you are going to have "costs" beyond whatever such studies measure as 'healthcare costs'. I was unemployable for year and years until I finally got a proper diagnosis and began getting my condition under control. The single biggest cost savings I have experienced with getting well is that my food budget has shrunk dramatically. My ex was career military. I had very few out-of-pocket "medical" expenses (co-pays for doctor's visits or for prescription drugs). My health problems did enormous damage to our budget anyway. Anyone spending in the neighborhood of 20% of their income on medical care is not healthy. Please see my other reply if you really want to read more of my rant on the topic. Peace.

tesseract 16y ago

I know in some European countries (I'm thinking specifically of Germany) it's much more common for employees to be issued a company car than it is in the US. Is that true in the UK as well? Or are there other things commonly provided as in-kind employment benefits that would otherwise cost a lot of money?