10 ms·

> I make more than enough to afford proper health insurance on the open market. Everyone at Gumroad is paid very well and should be able to afford the same. Th

> I make more than enough to afford proper health insurance on the open market. Everyone at Gumroad is paid very well and should be able to afford the same. This might be true for everyone at Gumroad, but I wouldn't be so sure. You also seem dismissive (probably unintentionally) of one of the biggest problems we have in the US right now: health care and insurance is ridiculously expensive–especially for people with families who want to be self-employed or contractors. A family of 4 who doesn't qualify for ACA subsidies is going to pay $1,400/month or more out-of-pocket for health insurance. And it goes up every year. Imagine paying 10%+ of your salary just for health insurance.

mkingston 6y ago
In the USA ~17% of GDP appears to be spent on health care. I guess that skews fairly heavily toward elderly people, but 10% on health insurance for a family of four doesn't seem out of the realms of sanity. https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...
- deathgrips 6y ago
  Maybe that's because the US needs more healthcare?
  - barry-cotter 6y ago
    A consequence of the US being richer. They spend more on education too. Baumol’s cost disease means as a country gets richer more money will go to labor costs and medicine is really labor intensive. I’m not sure I’d say the US needs more healthcare so much as they can afford it and that’s how they choose to spend the money. Healthcare and education will soak up a practically unlimited amount of money, and if you’re the richest country in the world you have more money. The US has higher household consumption than anywhere else bar Hong Kong. Rich countries spend more on healthcare and the US is the richest.
- callmeed 6y ago
  By itself maybe not. The problem is I live in California, which means I pay about 40% income tax (state and federal combined). Yet I still don’t get health care/coverage. Also notice how the gap in that graph is getting wider. It gets worse every year.
petsormeat 6y ago
Same racket for anybody over 40, much less 50. I pay $750/month in premiums just for bronze-level coverage on my middle-aged self.
rablackburn 6y ago
> Imaging paying 10%+ of your salary just for health insurance I decided to actually look at my budget from the last year and see how this compares to my costs. In Australia I pay about ~28% of my salary in tax. 2% is for medicare, and I have private health insurance on top of that for roughly the same cost again (for dental, which isn't covered in our system because of dentists lobbying an exception back in the 80s). You still have to pay part of most costs in Australia, looking at my budget that's come out to about another ~1% of my income in the past year. So I pay 5% of my salary for health services. It's pretty much inline with other costs like food and utilities. Doubling it to 10% would be doable, but it would suck. It seems that the US system doubles the cost and the extra money serves as the very healthy profit margin of their private health industry. Keep in mind Australia manages to sustain a private health sector off that 5%, this isn't abolishing private health by any means. A proper government health system could probably be even cheaper than the 5% I pay because the US has much better economies of scale. Not to mention the benefit of untying it from employment. I'm not really making a point here, your comment just inspired me to compare the numbers and it sure is grim...
- peter303 6y ago
  In the US a good chuck of federal & state taxes go to government employee health care, active soldier & veteran health care. This added to medicare tax and health care premiums and medical expenditures gets me fairly close to the 18% of US GDP spent in the medical sector.
- wolco5 6y ago
  Australia spends 10.5% on health. US 17.5 Is the increased level of care worth 7% In Canada it's 11.5 so 6%,extra. In Canada the waiting lists for mri and other advanced testing can be long where the same tests/operations can be done as a walkin option that day in the US.
  - deathgrips 6y ago
    Do Canadians and Australians need as much healthcare as aging and obese Americans do?
DVassallo 6y ago
When I lived in Ireland I paid 51% of my income in taxes. Imagine that!
- pugz 6y ago
  Was that the marginal rate that you paid or the effective rate?
  - DVassallo 6y ago
    It was marginal, but it kicked in after around EUR 25K IIRC. There were only 2 rates. This was 2010.
- philsnow 6y ago
  I don't have to imagine it, I live in California. Top federal income tax: 37% Top California income tax: 13.3% Federal Medicare tax: 1.45% Additional federal medicare tax*: 0.9% The "additional" Medicare tax is only on whatever income is over $200k/$250k for single/joint filers. Call it "0.55% effective". Adds up to 52.3%. There's also a sizeable additional capital gains tax for three lucky ones who live in California.
  - masonic 6y ago
    Top California income tax: 13.3% That's the marginal rate applicable to each additional dollar over the threshold, not an overall rate.
    - philsnow 6y ago
      I honestly don't know, is that (progressive taxation) not the case in e.g. Ireland?
  - callmeed 6y ago
    Don’t forget almost 10% sales tax on most things you buy, the most expensive gas in the country, and property taxes that–while low compared to other states–are still applied to much more expensive properties. At least our public schools are ranked 38th.
bcrosby95 6y ago
My company pays $3,000/month for health insurance for my family of 5. I assume it's pretty good insurance at that price, but we still have to fight the insurance company tooth and nail whenever we have medical bills.
- ricardobeat 6y ago
  That is insane. Here in the Netherlands we pay ~€100 per person, and healthcare is mostly free for everyone under 18. Isn't $36000/year above the US average income? How is that even possible?
  - devonkim 6y ago
    The total cost of healthcare is high and allocated all over the place in the US depending almost solely upon the mercy of one's employer. From a total systemic cost the US has the highest cost in the world per person on every metric possible. What typically happens is many will simply drop from insurance pools and because they tend to be poor make the statistics for the insured look better, which makes our conservatives believe the system produces better health outcomes similar to the statistics for charter schools. I'm quite sure that the actual cost per person for the Netherlands is not actually what the system pays in total because there's taxes whether levied upon income or at the side of an employer or other non-government entity will make up the difference. In the US, unless you're desperately poor or retired (Medicaid or Medicare, respectively), your insurance plan is essentially whatever pricing the market will bear, which means "whatever insurers and health providers charge each other."
rconti 6y ago
That $1400 sounds super low. Last time I saw what my employer paid for my health insurance, it was $1500/mo, for just me. And if you're buying insurance on the open market, it's more expensive than it is for an employer.
- callmeed 6y ago
  A quick search gave me that as an average for a family of 4 in California. I agree with you and was trying to give a conservative number.
geerlingguy 6y ago
Family of five, $2000/month on ACA for a high deductible plan with a lot worse coverage than I used to get at my previous four employers. No vision insurance, and pretty weak dental too. ACA is not a great alternative and I lament the fact that I pay more for health care (even if I don't use it at all) than I do for my mortgage, utilities, internet, and phone bill every month. (Midwest, LCOL).
war1025 6y ago
> insurance is ridiculously expensive–especially for people with families who want to be self-employed or contractors. That cost doesn't go away for people who are regular employees, it just gets absorbed by the employer. That's a big part of the reason you need to make more as a contractor than as an employee. Lots of costs get covered for you pre-paycheck as an employee that you have to pay post-paycheck as an independent contractor.
tharkun__ 6y ago
Replying to this directly because I'd otherwise have to reply to so many other sibling replies individually with overlapping versions of this :) Just for comparison. Disclosure: I no longer live in Germany _but_: In Germany, 90% of people are insured via the mandatory public health insurance system (do a Google translate on https://www.bundesgesundheitsministerium.de/gkv.html https://www.bundesgesundheitsministerium.de/gkv.html, which is the official federal health ministry website). That's 70 million people out of ~83 million in an estimate of 2019 according to Wikipedia. There's still a bunch of different companies that provide coverage under this public system. I remember ~15%+ depending on which company you went with for health insurance. And that's the _public_ system. You can play around here if you want: https://www.brutto-netto-rechner.info/ https://www.brutto-netto-rechner.info/. I plugged in 70.000EUR per year (which is reasonable for a senior dev depending on city (i.e. this is way more than I was paid in Frankfurt 10 years ago but we're talking different level and 10 years ago ...) but you'll get less even as a senior today probably if you're in some "flyover state" equivalent of Germany. Where it says "Rentenversicherung" that's your pension. Where it says "Arbeitslosenversicherung" that's your EI. Where it says "Krankenversicherung" that's your health insurance. Remember, this is the public system, which has been going way down hill since I was working in Germany. Nowadays you gotta have a separate insurance for certain things in dental care for example, that were just covered for me, when I was there. So for my EUR 70.000 / year example health insurance is ~4.5000EUR or about 6%. You gotta remember in that that the employee and the employer share this 50/50, meaning the ~4.500EUR is for the employee only. The employer pays another ~4.500EUR (officially the public health insurance system rate is like 15% and there's all sorts of rules about what extra percentage a public health insurance can charge and different companies charge different extra rate to try and 'compete' with each other. So with all this in mind and percentages already given (and please do look up the German "progressive tax system" as opposed to the tax bracket system in the US and Canada), 70.000 EUR is about 86.000 USD or 4.500 EUR being about 5.500 USD.
- rattray 6y ago
  Sorry, didn't quite follow - is the summary here that German healthcare is generally affordable?
rattray 6y ago
As another data point, I pay ~$350/mo for a low-deductible, high-quality HMO ACA plan as a single male in Maryland. (It would have been $550 in California). I'm incensed at the idea we leave families out in the cold like that - IMO healthcare should be free - but I don't find my care to entirely unaffordable.
- masonic 6y ago
  I pay ~$350/mo for a low-deductible, high-quality HMO ACA plan That's the total amount the provider gets, or just your out of pocket before ACA subsidy?
  - rattray 6y ago
    The latter, why?
baby 6y ago
> This might be true for everyone at Gumroad, but I wouldn't be so sure. You also seem dismissive (probably unintentionally) of one of the biggest problems we have in the US right now: health care and insurance is ridiculously expensive–especially for people with families who want to be self-employed or contractors. I don't want to be dismissive, but with a full remote job why not go live in a country where healthcare is a thing? Especially if you have a family. Now that I'm writing that, I realize that it might be hard to get a Visa.
- deleted 6y ago
  [deleted]
- batty_alex 6y ago
  I hear Barbados offers a 1 year remote-work visa
uberswe 6y ago
In Sweden, about 9% of my salary goes towards healthcare and I pay almost nothing extra for any of my healthcare needs. This 9% also covers things like elderly care and I don't lose this benefit if I lose my job.
- uberswe 6y ago
  We have a max amount of $140 per year for healthcare, if I go above this any further treatment is free.
- cycomanic 6y ago
  How do you get to 9%, I'm also in Sweden but I've never seen a specific breakdown. Genuinely curious.
  - Jommi 6y ago
    There is some research done via approximation. I cant find the figures anymore but I remember reading something similar.
bartvk 6y ago
I live in The Netherlands as a freelancer, and thus there's no employer in between that obscures taxes somehow. It's all visible to me, and I pay roughly 8% of my income on health insurance. The Netherlands is just this tiny little kingdom in Europe that basically has all their ducks in a row. Nothing is super great, but nothing is bad either. It's my gut feeling that anything around 8% is really just the cost of health insurance that covers mostly everyone.
nikolay 6y ago
$1,400/month for a family of 4?! Lucky you! The cost greatly depends on the oldest person in the family, not on the health status. I'm 46 and the premiums are nearly $3,000/mo for my family, but, glory to God, we almost never have major issues, but I'm sure there are young people who drain the insurance more with risky lifestyles and unhealthy behaviors. How is this fair? Also, isn't age a protected class to penalize based on it in pricing? Meanwhile, I can't recall seeing a senior citizen discount in many years. I know long ago they removed "free entry" and other benefits for which only women were eligible for. I was finally offered a high deductible plan with HSA so I don't lose all the money when I don't use it.
wreath 6y ago
> Imagine paying 10%+ of your salary just for health insurance. In Germany it's 14% that is split between you and your employer, so I guess you'd have to all of that on your own if you are self-employed. Granted, you can also choose to have a private health insurance which will seem cheaper but gets outrageously expensive with ages and it is very very difficult to get back to statutory insurance.
- geggo98 6y ago
  To my understanding this plan should include the spouse and any number of kids up to the age of of 23 (age limit for the kids, not for the spouse of course). Dental care and eye care might be a bit limited in these kinds of plans. This means that you have to pay extra if you want more then the medical necessary minimum.
  - wreath 6y ago
    That's exactly right. It seems that your experience with health care will also depend on where you live in Germany.
hobby-coder-guy 6y ago
Why the hell do Americans rely on their employer for health care? It’s so fucking dumb.
Abimelex 6y ago
10% is really low. In Germany it's min 14% and you don't have a choice to opt out. Everybody needs to pay this.

mkingston 6y ago

In the USA ~17% of GDP appears to be spent on health care. I guess that skews fairly heavily toward elderly people, but 10% on health insurance for a family of four doesn't seem out of the realms of sanity. https://en.m.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...

deathgrips 6y ago
Maybe that's because the US needs more healthcare?
- barry-cotter 6y ago
  A consequence of the US being richer. They spend more on education too. Baumol’s cost disease means as a country gets richer more money will go to labor costs and medicine is really labor intensive. I’m not sure I’d say the US needs more healthcare so much as they can afford it and that’s how they choose to spend the money. Healthcare and education will soak up a practically unlimited amount of money, and if you’re the richest country in the world you have more money. The US has higher household consumption than anywhere else bar Hong Kong. Rich countries spend more on healthcare and the US is the richest.
callmeed 6y ago
By itself maybe not. The problem is I live in California, which means I pay about 40% income tax (state and federal combined). Yet I still don’t get health care/coverage. Also notice how the gap in that graph is getting wider. It gets worse every year.

petsormeat 6y ago

Same racket for anybody over 40, much less 50. I pay $750/month in premiums just for bronze-level coverage on my middle-aged self.

rablackburn 6y ago

> Imaging paying 10%+ of your salary just for health insurance I decided to actually look at my budget from the last year and see how this compares to my costs. In Australia I pay about ~28% of my salary in tax. 2% is for medicare, and I have private health insurance on top of that for roughly the same cost again (for dental, which isn't covered in our system because of dentists lobbying an exception back in the 80s). You still have to pay part of most costs in Australia, looking at my budget that's come out to about another ~1% of my income in the past year. So I pay 5% of my salary for health services. It's pretty much inline with other costs like food and utilities. Doubling it to 10% would be doable, but it would suck. It seems that the US system doubles the cost and the extra money serves as the very healthy profit margin of their private health industry. Keep in mind Australia manages to sustain a private health sector off that 5%, this isn't abolishing private health by any means. A proper government health system could probably be even cheaper than the 5% I pay because the US has much better economies of scale. Not to mention the benefit of untying it from employment. I'm not really making a point here, your comment just inspired me to compare the numbers and it sure is grim...

peter303 6y ago
In the US a good chuck of federal & state taxes go to government employee health care, active soldier & veteran health care. This added to medicare tax and health care premiums and medical expenditures gets me fairly close to the 18% of US GDP spent in the medical sector.
wolco5 6y ago
Australia spends 10.5% on health. US 17.5 Is the increased level of care worth 7% In Canada it's 11.5 so 6%,extra. In Canada the waiting lists for mri and other advanced testing can be long where the same tests/operations can be done as a walkin option that day in the US.
- deathgrips 6y ago
  Do Canadians and Australians need as much healthcare as aging and obese Americans do?

DVassallo 6y ago

When I lived in Ireland I paid 51% of my income in taxes. Imagine that!

pugz 6y ago
Was that the marginal rate that you paid or the effective rate?
- DVassallo 6y ago
  It was marginal, but it kicked in after around EUR 25K IIRC. There were only 2 rates. This was 2010.
philsnow 6y ago
I don't have to imagine it, I live in California. Top federal income tax: 37% Top California income tax: 13.3% Federal Medicare tax: 1.45% Additional federal medicare tax*: 0.9% The "additional" Medicare tax is only on whatever income is over $200k/$250k for single/joint filers. Call it "0.55% effective". Adds up to 52.3%. There's also a sizeable additional capital gains tax for three lucky ones who live in California.
- masonic 6y ago
  Top California income tax: 13.3% That's the marginal rate applicable to each additional dollar over the threshold, not an overall rate.
  - philsnow 6y ago
    I honestly don't know, is that (progressive taxation) not the case in e.g. Ireland?
- callmeed 6y ago
  Don’t forget almost 10% sales tax on most things you buy, the most expensive gas in the country, and property taxes that–while low compared to other states–are still applied to much more expensive properties. At least our public schools are ranked 38th.

bcrosby95 6y ago

My company pays $3,000/month for health insurance for my family of 5. I assume it's pretty good insurance at that price, but we still have to fight the insurance company tooth and nail whenever we have medical bills.

ricardobeat 6y ago
That is insane. Here in the Netherlands we pay ~€100 per person, and healthcare is mostly free for everyone under 18. Isn't $36000/year above the US average income? How is that even possible?
- devonkim 6y ago
  The total cost of healthcare is high and allocated all over the place in the US depending almost solely upon the mercy of one's employer. From a total systemic cost the US has the highest cost in the world per person on every metric possible. What typically happens is many will simply drop from insurance pools and because they tend to be poor make the statistics for the insured look better, which makes our conservatives believe the system produces better health outcomes similar to the statistics for charter schools. I'm quite sure that the actual cost per person for the Netherlands is not actually what the system pays in total because there's taxes whether levied upon income or at the side of an employer or other non-government entity will make up the difference. In the US, unless you're desperately poor or retired (Medicaid or Medicare, respectively), your insurance plan is essentially whatever pricing the market will bear, which means "whatever insurers and health providers charge each other."

rconti 6y ago

That $1400 sounds super low. Last time I saw what my employer paid for my health insurance, it was $1500/mo, for just me. And if you're buying insurance on the open market, it's more expensive than it is for an employer.

callmeed 6y ago
A quick search gave me that as an average for a family of 4 in California. I agree with you and was trying to give a conservative number.

geerlingguy 6y ago

Family of five, $2000/month on ACA for a high deductible plan with a lot worse coverage than I used to get at my previous four employers. No vision insurance, and pretty weak dental too. ACA is not a great alternative and I lament the fact that I pay more for health care (even if I don't use it at all) than I do for my mortgage, utilities, internet, and phone bill every month. (Midwest, LCOL).

war1025 6y ago

> insurance is ridiculously expensive–especially for people with families who want to be self-employed or contractors. That cost doesn't go away for people who are regular employees, it just gets absorbed by the employer. That's a big part of the reason you need to make more as a contractor than as an employee. Lots of costs get covered for you pre-paycheck as an employee that you have to pay post-paycheck as an independent contractor.

tharkun__ 6y ago

Replying to this directly because I'd otherwise have to reply to so many other sibling replies individually with overlapping versions of this :) Just for comparison. Disclosure: I no longer live in Germany _but_: In Germany, 90% of people are insured via the mandatory public health insurance system (do a Google translate on https://www.bundesgesundheitsministerium.de/gkv.html https://www.bundesgesundheitsministerium.de/gkv.html, which is the official federal health ministry website). That's 70 million people out of ~83 million in an estimate of 2019 according to Wikipedia. There's still a bunch of different companies that provide coverage under this public system. I remember ~15%+ depending on which company you went with for health insurance. And that's the _public_ system. You can play around here if you want: https://www.brutto-netto-rechner.info/ https://www.brutto-netto-rechner.info/. I plugged in 70.000EUR per year (which is reasonable for a senior dev depending on city (i.e. this is way more than I was paid in Frankfurt 10 years ago but we're talking different level and 10 years ago ...) but you'll get less even as a senior today probably if you're in some "flyover state" equivalent of Germany. Where it says "Rentenversicherung" that's your pension. Where it says "Arbeitslosenversicherung" that's your EI. Where it says "Krankenversicherung" that's your health insurance. Remember, this is the public system, which has been going way down hill since I was working in Germany. Nowadays you gotta have a separate insurance for certain things in dental care for example, that were just covered for me, when I was there. So for my EUR 70.000 / year example health insurance is ~4.5000EUR or about 6%. You gotta remember in that that the employee and the employer share this 50/50, meaning the ~4.500EUR is for the employee only. The employer pays another ~4.500EUR (officially the public health insurance system rate is like 15% and there's all sorts of rules about what extra percentage a public health insurance can charge and different companies charge different extra rate to try and 'compete' with each other. So with all this in mind and percentages already given (and please do look up the German "progressive tax system" as opposed to the tax bracket system in the US and Canada), 70.000 EUR is about 86.000 USD or 4.500 EUR being about 5.500 USD.

rattray 6y ago
Sorry, didn't quite follow - is the summary here that German healthcare is generally affordable?

rattray 6y ago

As another data point, I pay ~$350/mo for a low-deductible, high-quality HMO ACA plan as a single male in Maryland. (It would have been $550 in California). I'm incensed at the idea we leave families out in the cold like that - IMO healthcare should be free - but I don't find my care to entirely unaffordable.

masonic 6y ago
I pay ~$350/mo for a low-deductible, high-quality HMO ACA plan That's the total amount the provider gets, or just your out of pocket before ACA subsidy?
- rattray 6y ago
  The latter, why?

baby 6y ago

> This might be true for everyone at Gumroad, but I wouldn't be so sure. You also seem dismissive (probably unintentionally) of one of the biggest problems we have in the US right now: health care and insurance is ridiculously expensive–especially for people with families who want to be self-employed or contractors. I don't want to be dismissive, but with a full remote job why not go live in a country where healthcare is a thing? Especially if you have a family. Now that I'm writing that, I realize that it might be hard to get a Visa.

deleted 6y ago
[deleted]
batty_alex 6y ago
I hear Barbados offers a 1 year remote-work visa

uberswe 6y ago

In Sweden, about 9% of my salary goes towards healthcare and I pay almost nothing extra for any of my healthcare needs. This 9% also covers things like elderly care and I don't lose this benefit if I lose my job.

uberswe 6y ago
We have a max amount of $140 per year for healthcare, if I go above this any further treatment is free.
cycomanic 6y ago
How do you get to 9%, I'm also in Sweden but I've never seen a specific breakdown. Genuinely curious.
- Jommi 6y ago
  There is some research done via approximation. I cant find the figures anymore but I remember reading something similar.

bartvk 6y ago

I live in The Netherlands as a freelancer, and thus there's no employer in between that obscures taxes somehow. It's all visible to me, and I pay roughly 8% of my income on health insurance. The Netherlands is just this tiny little kingdom in Europe that basically has all their ducks in a row. Nothing is super great, but nothing is bad either. It's my gut feeling that anything around 8% is really just the cost of health insurance that covers mostly everyone.

nikolay 6y ago

$1,400/month for a family of 4?! Lucky you! The cost greatly depends on the oldest person in the family, not on the health status. I'm 46 and the premiums are nearly $3,000/mo for my family, but, glory to God, we almost never have major issues, but I'm sure there are young people who drain the insurance more with risky lifestyles and unhealthy behaviors. How is this fair? Also, isn't age a protected class to penalize based on it in pricing? Meanwhile, I can't recall seeing a senior citizen discount in many years. I know long ago they removed "free entry" and other benefits for which only women were eligible for. I was finally offered a high deductible plan with HSA so I don't lose all the money when I don't use it.

wreath 6y ago

> Imagine paying 10%+ of your salary just for health insurance. In Germany it's 14% that is split between you and your employer, so I guess you'd have to all of that on your own if you are self-employed. Granted, you can also choose to have a private health insurance which will seem cheaper but gets outrageously expensive with ages and it is very very difficult to get back to statutory insurance.

geggo98 6y ago
To my understanding this plan should include the spouse and any number of kids up to the age of of 23 (age limit for the kids, not for the spouse of course). Dental care and eye care might be a bit limited in these kinds of plans. This means that you have to pay extra if you want more then the medical necessary minimum.
- wreath 6y ago
  That's exactly right. It seems that your experience with health care will also depend on where you live in Germany.

hobby-coder-guy 6y ago

Why the hell do Americans rely on their employer for health care? It’s so fucking dumb.

Abimelex 6y ago

10% is really low. In Germany it's min 14% and you don't have a choice to opt out. Everybody needs to pay this.