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You get decent healthcare that won't bankrupt you even if you're comfortable. And you're a few orders of magnitude less likely to get shot by some rando. Also

You get decent healthcare that won't bankrupt you even if you're comfortable. And you're a few orders of magnitude less likely to get shot by some rando. Also longer vacations and a more relaxed working environment. I know of far more people heading to the EU from the US than the other direction.

kube-system 4y ago
Brain drain and crippling healthcare debt affect two entirely different demographics. If you have a top tech job in the US you good have insurance.
- jjav 4y ago
  > If you have a top tech job in the US you good have insurance. Relative to health care in the EU, not that good. Top-tier platinum PPO from top silicon valley employers is still going to cost a lot out of pocket (way above the so-called max out of pocket) if you have health expenses and that's on top of the $25K-$30K we're paying for the coverage itself.
  - lotsofpulp 4y ago
    Why would it cost more than the “so called max out of pocket”? A top tier platinum plan will, per the legal definition of platinum, pay for 90% of expected health expenses. Max out of pocket should be less than $5k for a family of 4 on a platinum plan, and the employer will be paying 70%+ of the premiums, if not more. Assuming you are seeing in network providers, which for a top tier platinum PPO should be almost all doctors, and a BCBS plan would be nationwide, then your premiums would be say $500 per month for a family of four, and out of pocket max will be $5k per year at most. Total expenses of $11k per year for the most expensive locale in the US. And that is assuming you max out health spending every year, which probably will not happen. And that is off the family has only one working adult. And you get an HSA to invest $7.3k per year and withdraw it tax free at any point in the future. You can have a few hundreds of thousands saved up for healthcare expenses by the time you retire, all tax free.
    - zerocrates 4y ago
      You can't have a top-tier plan and an HSA, can you? I was pretty sure HSAs were only available to those on high-deductible plans. People on traditional plans can have FSAs but those typically don't let you really accrue from year to year.
      - frumper 4y ago
        My employer provides a high deductible plan and deposits most of our deductible into an HSA. Once deductible is met it is a top tier plan.
      - lotsofpulp 4y ago
        I have seen gold metal level plans high deductible health plans that qualify for HSA. I do not know about platinum, but the difference in gold and platinum is gold covers 80% of expected expenses and platinum covers 90%. My gold level high deductible health plan has a ~$3k deductible I think (for family coverage). I imagine even a platinum plan can be high deductible if the deductible is set to equal the out of pocket maximum. Either way, the numbers will not be too different for gold and platinum plans.
    - jjav 4y ago
      > Assuming you are seeing in network providers, which for a top tier platinum PPO should be almost all doctors, and a BCBS plan would be nationwide, then your premiums would be say $500 per month for a family of four, and out of pocket max will be $5k per year at most. You're wrong. I'm not speculating here, I'm talking about the real numbers. My monthly premiums for a Platinum PPO plan through my employer (in Silicon Valley) is slightly over $2K/month (for a family of 3). Same plan at my previous employer, same price (a bit cheaper but that's because it goes up every year). This is also very similar to what an ACA plan would cost. Your guess of $500/mo is way off. So out of pocket is ~$25K on premiums alone (pre-tax though). > Why would it cost more than the “so called max out of pocket”? You can easily go above what the insurance company calls "max out of pocket". Again, I'm not speculating here but telling real experiences. That's because if you get a bill for, say, $10K, the insurance company can decide they will only pay $8K so you're stuck with $2K. But not all of that $2K is counted against the out-of-pocket max. The insurance company will say only some smaller amount, say $500, will count as credit towards the out of pocket. So I get to write a check for $2K but in the eyes of the insurance company I've only paid $500 this year. Repeat a handful of times and I can easily go over the so-called max out of pocket in real money.
  - orange_joe 4y ago
    What are you talking about? I’ve worked in two top tier companies and the most I’ve ever paid for the coverage is $120/month (1 firm I paid nothing). How are you paying $2,000/month at a “top SV employer”. I’ve never had to pay more than the maximums (how does that even happen), and my out of pocket costs have always been under $50/visit for a specialist visit. I really don’t understand how you get these numbers.
    - jjav 4y ago
      > the most I’ve ever paid for the coverage is $120/month (1 firm I paid nothing) I'm going to guess that you're young and probably single (or your partner gets insurance separately).
    - briHass 4y ago
      To be fair, the OP with that high cost was using a 'Platinum' PPO plan as the comparison, i.e. zero out-of-pocket (besides modest copays). Almost nobody offers these plans anymore, because they're ludicrously overpriced. Most plans are premium PPOs with a deductible of $500-1000 or HDHPs. Besides bragging rights, I can't see why anyone would want the Platinum PPO. My 'HDHP' PPO costs me ~$200/month for a family and has a family OOP max of $6K. Even not including the HSA tax breaks and the $2K contribution to that HSA from the employer, that extra $1800/month for the 'no cost' PPO would easily be hit by the OOP max in only a few months. That's assuming you actually hit the OOP every year.
- Moldoteck 4y ago
  just out of curiosity. What happens(to citizen/employee) if due to some health issues they are not able to perform their job as a tech worker for 6-12 months?
  - kube-system 4y ago
    At a top tech job? You take advantage of your company’s leave policy, draw from disability insurance, and/or your bank account is already big enough. For other Americans, yeah, this is how many get into medical debt.
frumper 4y ago
People have good care in the US too, just not everyone. If you’re highly desired to be considered part of the brain drain of Europe then you’d likely be able to get good healthcare.

kube-system 4y ago

Brain drain and crippling healthcare debt affect two entirely different demographics. If you have a top tech job in the US you good have insurance.

jjav 4y ago
> If you have a top tech job in the US you good have insurance. Relative to health care in the EU, not that good. Top-tier platinum PPO from top silicon valley employers is still going to cost a lot out of pocket (way above the so-called max out of pocket) if you have health expenses and that's on top of the $25K-$30K we're paying for the coverage itself.
- lotsofpulp 4y ago
  Why would it cost more than the “so called max out of pocket”? A top tier platinum plan will, per the legal definition of platinum, pay for 90% of expected health expenses. Max out of pocket should be less than $5k for a family of 4 on a platinum plan, and the employer will be paying 70%+ of the premiums, if not more. Assuming you are seeing in network providers, which for a top tier platinum PPO should be almost all doctors, and a BCBS plan would be nationwide, then your premiums would be say $500 per month for a family of four, and out of pocket max will be $5k per year at most. Total expenses of $11k per year for the most expensive locale in the US. And that is assuming you max out health spending every year, which probably will not happen. And that is off the family has only one working adult. And you get an HSA to invest $7.3k per year and withdraw it tax free at any point in the future. You can have a few hundreds of thousands saved up for healthcare expenses by the time you retire, all tax free.
  - zerocrates 4y ago
    You can't have a top-tier plan and an HSA, can you? I was pretty sure HSAs were only available to those on high-deductible plans. People on traditional plans can have FSAs but those typically don't let you really accrue from year to year.
    - frumper 4y ago
      My employer provides a high deductible plan and deposits most of our deductible into an HSA. Once deductible is met it is a top tier plan.
    - lotsofpulp 4y ago
      I have seen gold metal level plans high deductible health plans that qualify for HSA. I do not know about platinum, but the difference in gold and platinum is gold covers 80% of expected expenses and platinum covers 90%. My gold level high deductible health plan has a ~$3k deductible I think (for family coverage). I imagine even a platinum plan can be high deductible if the deductible is set to equal the out of pocket maximum. Either way, the numbers will not be too different for gold and platinum plans.
  - jjav 4y ago
    > Assuming you are seeing in network providers, which for a top tier platinum PPO should be almost all doctors, and a BCBS plan would be nationwide, then your premiums would be say $500 per month for a family of four, and out of pocket max will be $5k per year at most. You're wrong. I'm not speculating here, I'm talking about the real numbers. My monthly premiums for a Platinum PPO plan through my employer (in Silicon Valley) is slightly over $2K/month (for a family of 3). Same plan at my previous employer, same price (a bit cheaper but that's because it goes up every year). This is also very similar to what an ACA plan would cost. Your guess of $500/mo is way off. So out of pocket is ~$25K on premiums alone (pre-tax though). > Why would it cost more than the “so called max out of pocket”? You can easily go above what the insurance company calls "max out of pocket". Again, I'm not speculating here but telling real experiences. That's because if you get a bill for, say, $10K, the insurance company can decide they will only pay $8K so you're stuck with $2K. But not all of that $2K is counted against the out-of-pocket max. The insurance company will say only some smaller amount, say $500, will count as credit towards the out of pocket. So I get to write a check for $2K but in the eyes of the insurance company I've only paid $500 this year. Repeat a handful of times and I can easily go over the so-called max out of pocket in real money.
- orange_joe 4y ago
  What are you talking about? I’ve worked in two top tier companies and the most I’ve ever paid for the coverage is $120/month (1 firm I paid nothing). How are you paying $2,000/month at a “top SV employer”. I’ve never had to pay more than the maximums (how does that even happen), and my out of pocket costs have always been under $50/visit for a specialist visit. I really don’t understand how you get these numbers.
  - jjav 4y ago
    > the most I’ve ever paid for the coverage is $120/month (1 firm I paid nothing) I'm going to guess that you're young and probably single (or your partner gets insurance separately).
  - briHass 4y ago
    To be fair, the OP with that high cost was using a 'Platinum' PPO plan as the comparison, i.e. zero out-of-pocket (besides modest copays). Almost nobody offers these plans anymore, because they're ludicrously overpriced. Most plans are premium PPOs with a deductible of $500-1000 or HDHPs. Besides bragging rights, I can't see why anyone would want the Platinum PPO. My 'HDHP' PPO costs me ~$200/month for a family and has a family OOP max of $6K. Even not including the HSA tax breaks and the $2K contribution to that HSA from the employer, that extra $1800/month for the 'no cost' PPO would easily be hit by the OOP max in only a few months. That's assuming you actually hit the OOP every year.
Moldoteck 4y ago
just out of curiosity. What happens(to citizen/employee) if due to some health issues they are not able to perform their job as a tech worker for 6-12 months?
- kube-system 4y ago
  At a top tech job? You take advantage of your company’s leave policy, draw from disability insurance, and/or your bank account is already big enough. For other Americans, yeah, this is how many get into medical debt.

frumper 4y ago

People have good care in the US too, just not everyone. If you’re highly desired to be considered part of the brain drain of Europe then you’d likely be able to get good healthcare.