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What does the ranking look like if you compare percentiles? Naively I would assume as a non-American that if you're in the top 20% by income in the US you end

What does the ranking look like if you compare percentiles? Naively I would assume as a non-American that if you're in the top 20% by income in the US you end up much better off than the top 20% income Brit, for example. Or is it just actually worse for everyone? It feels intuitively obvious that the average will be worse because, well, the average person is skint and the US is less socialist.

trimethylpurine 2y ago
The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills. In all cases treatment is required by law, regardless of payment.
- shiroiushi 2y ago
  >In all cases treatment is required by law, regardless of payment. No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for free.
  - trimethylpurine 2y ago
    I'm not sure where this is happening, and I'm not saying you're wrong, but where I live, doctors are paid salary and they care for patients, so from my perspective what you're referring to sounds like a myth. My friends, who are doctors, operate all the time on people who have no identification and they do their absolute best. And there is no monetary incentive to do otherwise and they would quit and find a different hospital if there were. Anecdotal? Maybe. I'm open to hear from a doctor that says otherwise. As best I can tell, the medical community and education system would reject a doctor in the US from licensure for any other attitude towards health care.
    - shiroiushi 2y ago
      Doctors have absolutely nothing to do with who gets care and who doesn't: that's controlled by hospital administration and other hospital staff. The doctors are just employees. When was the last time you saw a doctor in the ER reception room talking to new arrivals and deciding if they need to see a doctor or not?
      - trimethylpurine 2y ago
        I'd love to go to a hospital where the administration determines if my health condition is emergency or not. That's a cash in hand settlement case.
        shiroiushi 2y ago
        Please show me a hospital where actual doctors are manning the ER intake desks and triaging patients instead of actually working with patients in exam rooms.
        trimethylpurine 2y ago
        I didn't say that. But at the very least a nurse or PA will take your vitals while you wait for the doctor. And the doctor will determine when you are low risk enough to be discharged. They aren't taking your vitals in the lobby anywhere I've seen, unless that's where you collapse.
        shiroiushi 2y ago
        The whole conversation here is about Americans not getting life-saving healthcare, and you haven't refuted my claim. If you need chemotherapy for cancer, for instance, you're not going to get that in an ER. If you need bone reconstruction, you're not going to get that in an ER either. These are things that are done by appointment after consultation with specialists. They're not immediate life-threatening emergencies (you're not going to die in an hour without chemo), so the hospital has no responsibility to provide these treatments to you without regard for payment. Their only obligation is to stabilize you so you can see a specialist later.
  - trimethylpurine 2y ago
    Just wanted to post back to share that I researched such incidences and except for a few cases where the hospital was sued and lost and doctors fired, I didn't find any examples of this as an accepted or legally viable practice. If you have some examples to share, I'll be interested.
- daemonologist 2y ago
  It's a patchwork, with a lot of holes for people to fall through: * Hospitals must treat or stabilize regardless of payment, but only for emergencies - they just have to try to keep you from dying on the spot * The ACA (or Medicaid) subsidizes insurance for the unemployed, if your household income for the calendar year is low enough * Employers are required to offer coverage to their employees, provided they work more than 30 hours a week at that company and it has at least 50 full time employees (this extends to dependent children but not spouses or other dependents) This is better than nothing, don't get me wrong, but it could be a lot better still. We have the technology.
- dragonwriter 2y ago
  > In all cases treatment is required by law, regardless of payment. Screening for and stabilization of emergency medical conditions is required at all emergency departments by law, regardless of ability to pay, but that's much more limited than "in all cases, treatment is required by law, regardless of payment", and even then, hospitals skirt the rules.
  - trimethylpurine 2y ago
    And how does this differ from care elsewhere? To contrast, my sister lives in Europe and needs shoulder surgery and unless she pays for a private treatment (by the same doctor) she will not be treated for 12 months. Guess what I paid for. Is that any better?
- gregjor 2y ago
  Not true except for immediate emergency care. Many employers do not provide coverage. They skirt the law by employing people part-time (Walmart, Amazon) or as gig workers. Even if the law reads as you claim that doesn’t mean you can get care in the US.
  - trimethylpurine 2y ago
    And that's different from other countries how? I can walk into a hospital in any country in Europe as a non-citizen and request non emergency care and receive it? >Many employers do not provide coverage For under 50 employees, making less than 50k, Healthcare.gov covers those cases. You can visit there now to confirm my claim. And yes, it means you can get care in the US. I brought my Euro girlfriend here and she got care under a bullshit name. And they treated her, the same as any other patient. And she never paid anything. It was non emergency and we went to an emergency room anyway. Do you have a counter example? If so please share.
    - gregjor 2y ago
      Counter examples that don’t involve fraud, as you describe? Yes, many, but I don’t see any reason to try to refute the nonsense you posted.
      - trimethylpurine 2y ago
        The point is that hospitals in the US indeed treat anyone with or without ID. Emergency or not. I'm not sure what point you were making, or refuting, but I didn't catch it.
        gregjor 2y ago
        You got lucky. US hospitals routinely turn people away for non-emergency conditions. That probably happens everywhere but I was only responding about US medical care. https://journalofethics.ama-assn.org/article/obligation-provide-services-physician-public-defender-comparison/2006-05 https://journalofethics.ama-assn.org/article/obligation-prov...
shiroiushi 2y ago
If you're a billionaire or close to it, the US healthcare system is fantastic, unless of course you're traveling in one of the "medical deserts" and have an acute emergency.
- brtkdotse 2y ago
  If you’re a billionaire EVERYTHING is fantastic.
  - shiroiushi 2y ago
    Not necessarily: if you're famous, you might have a hard time going out in public.
    - highwaylights 2y ago
      Hire your own public and make them act normal when you’re around.
    - ben_w 2y ago
      I think that's more a problem with being famous: the top of the Wikipedia list* as I write this is "Bernard Arnault & family", who I've never heard of and therefore couldn't spot in a lineup much less a crowd. But I did double-take when walking past Russell T Davis (or a lookalike) in Sheffield a decade and a half ago, and Richard Osman in Cambridge train station some other time. * https://en.wikipedia.org/wiki/The_World's_Billionaires https://en.wikipedia.org/wiki/The_World's_Billionaires
      - shiroiushi 2y ago
        That's why I said "if". Some billionaires are not well-known publicly, and then there's Elon Musk or Bill Gates.
        ben_w 2y ago
        Indeed, though I think he likes it that way, and that it's a choice.
zjp 2y ago
Also: an unironic 1%-er income in France is like literally the bottom of the barrel Bay Area salary. If you're at or above the median America is great, outside of some very high cost of living cities.
- naming_the_user 2y ago
  Yeah, I've always found the "meme" of the 1% kind of amusing. The 95th percentile US taxpayer earns as much as the 99th percentile Brit. Huge, huge difference.
  - HPsquared 2y ago
    The the UK is quite "unequal pay" as far as Europe goes.
- chgs 2y ago
  Really teachers and baristas and builders get paid more than 99% of people in France Or are you just talking specific tech jobs.
  - deleted 2y ago
    [deleted]
  - MediumOwl 2y ago
    According to this article (https://www.lemonde.fr/en/france/article/2022/06/03/france-has-4-5-million-rich-people_5985520_7.html https://www.lemonde.fr/en/france/article/2022/06/03/france-h...), top 1% earner in France in 2021 was 7180€ monthly, so ~8000$.
    - chgs 2y ago
      And what is 8k/month in terms of US percentile?
      - zjp 2y ago
vidarh 2y ago
As someone in the UK with income in the top 1%, I have never bothered with private insurance because I genuinely don't feel I need it. I occasionally pay for private GP services, and I've paid for some private services for my son, but for the most part the NHS works. It has waiting times for non-essential things, and if you don't want that, you can pay for insurance that gets you seen faster and it costs a pittance. But if you need treatment, you get it. Overall, paying cash for healthcare here is also so much cheaper that for Americans, for elective procedures with short-ish recovery, flying to London can be a cost-effective option compared to US hospitals. I'm sure that if you're rich enough, you have fantastic care available in the US, but from what I've seen of prices for pretty basic stuff, I'm not so convinced most of the top 20% in the US have healthcare I'd consider tolerable.
- mytailorisrich 2y ago
  As soon as you need treatment beyond standard GP/prescriptions, like checks/analyses or specialised consultation/treatment then private insurance comes very handy to get good care quickly. Waiting times are not only for non-essential things. The only thing with no waiting time is A&E if you are in immediate danger of death. The NHS is some "safety net" that does the bare minimum at this point, or no longer anything at all (eg. dentistry). Interestingly, nowadays if you have a good job and private insurance in China you get better routine checks than in Europe/UK. Even Chinese hospitals are extremely thorough and quick compared to British ones (at least the main Chinese cities)
  - vidarh 2y ago
    I have had extensive rounds of tests for various things with the NHS over the last several years, and never had a problem sufficient to feel private insurance, even as cheap as it is in the UK, to be worth it. I don't doubt it's worth it for some, but there's a reason - and while costs will stop some, costs does not explain nearly all of it, given how cheap it is - that only about 10% of the UK population has private insurance, even with the underfunding of the NHS in recent years (e.g. 20%-30% lower healthcare spend for capita PPP adjusted than comparable economies does have an effect). There's an inflection point, sure, where you start spending enough privately that the insurance is worth it, but so many of these things are so cheap here anyway that the gap from between where it starts to pay off until you're ill enough to get reasonably fast treatment with the NHS is quite narrow. Sometimes people think it is wider than it really is because people want and push for treatments that are not medically indicated. E.g. patients pushing for pointless MRIs is common enough that same-day MRIs is a huge industry here even though they only make an impact on outcomes for very specific symptoms.
deleted 2y ago
[deleted]

trimethylpurine 2y ago

The US health care system is partly socialized. Health care is provided for the unemployed or low income and the employed are covered as employers are required to provide health coverage. The odd ones out are typically small business owners who don't insure themselves and choose to take on the risk of potentially large medical bills. In all cases treatment is required by law, regardless of payment.

shiroiushi 2y ago
>In all cases treatment is required by law, regardless of payment. No, it's not. This is a myth. The only thing that's required is to stabilize the patient. If you need surgery to repair your shattered leg bone so you don't get an infection and need an amputation, you're not going to get that surgery without payment. But once you get a bad infection and need the leg amputated so you don't die, they'll do that for free.
- trimethylpurine 2y ago
  I'm not sure where this is happening, and I'm not saying you're wrong, but where I live, doctors are paid salary and they care for patients, so from my perspective what you're referring to sounds like a myth. My friends, who are doctors, operate all the time on people who have no identification and they do their absolute best. And there is no monetary incentive to do otherwise and they would quit and find a different hospital if there were. Anecdotal? Maybe. I'm open to hear from a doctor that says otherwise. As best I can tell, the medical community and education system would reject a doctor in the US from licensure for any other attitude towards health care.
  - shiroiushi 2y ago
    Doctors have absolutely nothing to do with who gets care and who doesn't: that's controlled by hospital administration and other hospital staff. The doctors are just employees. When was the last time you saw a doctor in the ER reception room talking to new arrivals and deciding if they need to see a doctor or not?
    - trimethylpurine 2y ago
      I'd love to go to a hospital where the administration determines if my health condition is emergency or not. That's a cash in hand settlement case.
      - shiroiushi 2y ago
        Please show me a hospital where actual doctors are manning the ER intake desks and triaging patients instead of actually working with patients in exam rooms.
        trimethylpurine 2y ago
        I didn't say that. But at the very least a nurse or PA will take your vitals while you wait for the doctor. And the doctor will determine when you are low risk enough to be discharged. They aren't taking your vitals in the lobby anywhere I've seen, unless that's where you collapse.
        shiroiushi 2y ago
        The whole conversation here is about Americans not getting life-saving healthcare, and you haven't refuted my claim. If you need chemotherapy for cancer, for instance, you're not going to get that in an ER. If you need bone reconstruction, you're not going to get that in an ER either. These are things that are done by appointment after consultation with specialists. They're not immediate life-threatening emergencies (you're not going to die in an hour without chemo), so the hospital has no responsibility to provide these treatments to you without regard for payment. Their only obligation is to stabilize you so you can see a specialist later.
- trimethylpurine 2y ago
  Just wanted to post back to share that I researched such incidences and except for a few cases where the hospital was sued and lost and doctors fired, I didn't find any examples of this as an accepted or legally viable practice. If you have some examples to share, I'll be interested.
daemonologist 2y ago
It's a patchwork, with a lot of holes for people to fall through: * Hospitals must treat or stabilize regardless of payment, but only for emergencies - they just have to try to keep you from dying on the spot * The ACA (or Medicaid) subsidizes insurance for the unemployed, if your household income for the calendar year is low enough * Employers are required to offer coverage to their employees, provided they work more than 30 hours a week at that company and it has at least 50 full time employees (this extends to dependent children but not spouses or other dependents) This is better than nothing, don't get me wrong, but it could be a lot better still. We have the technology.
dragonwriter 2y ago
> In all cases treatment is required by law, regardless of payment. Screening for and stabilization of emergency medical conditions is required at all emergency departments by law, regardless of ability to pay, but that's much more limited than "in all cases, treatment is required by law, regardless of payment", and even then, hospitals skirt the rules.
- trimethylpurine 2y ago
  And how does this differ from care elsewhere? To contrast, my sister lives in Europe and needs shoulder surgery and unless she pays for a private treatment (by the same doctor) she will not be treated for 12 months. Guess what I paid for. Is that any better?
gregjor 2y ago
Not true except for immediate emergency care. Many employers do not provide coverage. They skirt the law by employing people part-time (Walmart, Amazon) or as gig workers. Even if the law reads as you claim that doesn’t mean you can get care in the US.
- trimethylpurine 2y ago
  And that's different from other countries how? I can walk into a hospital in any country in Europe as a non-citizen and request non emergency care and receive it? >Many employers do not provide coverage For under 50 employees, making less than 50k, Healthcare.gov covers those cases. You can visit there now to confirm my claim. And yes, it means you can get care in the US. I brought my Euro girlfriend here and she got care under a bullshit name. And they treated her, the same as any other patient. And she never paid anything. It was non emergency and we went to an emergency room anyway. Do you have a counter example? If so please share.
  - gregjor 2y ago
    Counter examples that don’t involve fraud, as you describe? Yes, many, but I don’t see any reason to try to refute the nonsense you posted.
    - trimethylpurine 2y ago
      The point is that hospitals in the US indeed treat anyone with or without ID. Emergency or not. I'm not sure what point you were making, or refuting, but I didn't catch it.
      - gregjor 2y ago
        You got lucky. US hospitals routinely turn people away for non-emergency conditions. That probably happens everywhere but I was only responding about US medical care. https://journalofethics.ama-assn.org/article/obligation-provide-services-physician-public-defender-comparison/2006-05 https://journalofethics.ama-assn.org/article/obligation-prov...

shiroiushi 2y ago

If you're a billionaire or close to it, the US healthcare system is fantastic, unless of course you're traveling in one of the "medical deserts" and have an acute emergency.

brtkdotse 2y ago
If you’re a billionaire EVERYTHING is fantastic.
- shiroiushi 2y ago
  Not necessarily: if you're famous, you might have a hard time going out in public.
  - highwaylights 2y ago
    Hire your own public and make them act normal when you’re around.
  - ben_w 2y ago
    I think that's more a problem with being famous: the top of the Wikipedia list* as I write this is "Bernard Arnault & family", who I've never heard of and therefore couldn't spot in a lineup much less a crowd. But I did double-take when walking past Russell T Davis (or a lookalike) in Sheffield a decade and a half ago, and Richard Osman in Cambridge train station some other time. * https://en.wikipedia.org/wiki/The_World's_Billionaires https://en.wikipedia.org/wiki/The_World's_Billionaires
    - shiroiushi 2y ago
      That's why I said "if". Some billionaires are not well-known publicly, and then there's Elon Musk or Bill Gates.
      - ben_w 2y ago
        Indeed, though I think he likes it that way, and that it's a choice.

zjp 2y ago

Also: an unironic 1%-er income in France is like literally the bottom of the barrel Bay Area salary. If you're at or above the median America is great, outside of some very high cost of living cities.

naming_the_user 2y ago
Yeah, I've always found the "meme" of the 1% kind of amusing. The 95th percentile US taxpayer earns as much as the 99th percentile Brit. Huge, huge difference.
- HPsquared 2y ago
  The the UK is quite "unequal pay" as far as Europe goes.
chgs 2y ago
Really teachers and baristas and builders get paid more than 99% of people in France Or are you just talking specific tech jobs.
- deleted 2y ago
  [deleted]
- MediumOwl 2y ago
  According to this article (https://www.lemonde.fr/en/france/article/2022/06/03/france-has-4-5-million-rich-people_5985520_7.html https://www.lemonde.fr/en/france/article/2022/06/03/france-h...), top 1% earner in France in 2021 was 7180€ monthly, so ~8000$.
  - chgs 2y ago
    And what is 8k/month in terms of US percentile?
    - zjp 2y ago

vidarh 2y ago

As someone in the UK with income in the top 1%, I have never bothered with private insurance because I genuinely don't feel I need it. I occasionally pay for private GP services, and I've paid for some private services for my son, but for the most part the NHS works. It has waiting times for non-essential things, and if you don't want that, you can pay for insurance that gets you seen faster and it costs a pittance. But if you need treatment, you get it. Overall, paying cash for healthcare here is also so much cheaper that for Americans, for elective procedures with short-ish recovery, flying to London can be a cost-effective option compared to US hospitals. I'm sure that if you're rich enough, you have fantastic care available in the US, but from what I've seen of prices for pretty basic stuff, I'm not so convinced most of the top 20% in the US have healthcare I'd consider tolerable.

mytailorisrich 2y ago
As soon as you need treatment beyond standard GP/prescriptions, like checks/analyses or specialised consultation/treatment then private insurance comes very handy to get good care quickly. Waiting times are not only for non-essential things. The only thing with no waiting time is A&E if you are in immediate danger of death. The NHS is some "safety net" that does the bare minimum at this point, or no longer anything at all (eg. dentistry). Interestingly, nowadays if you have a good job and private insurance in China you get better routine checks than in Europe/UK. Even Chinese hospitals are extremely thorough and quick compared to British ones (at least the main Chinese cities)
- vidarh 2y ago
  I have had extensive rounds of tests for various things with the NHS over the last several years, and never had a problem sufficient to feel private insurance, even as cheap as it is in the UK, to be worth it. I don't doubt it's worth it for some, but there's a reason - and while costs will stop some, costs does not explain nearly all of it, given how cheap it is - that only about 10% of the UK population has private insurance, even with the underfunding of the NHS in recent years (e.g. 20%-30% lower healthcare spend for capita PPP adjusted than comparable economies does have an effect). There's an inflection point, sure, where you start spending enough privately that the insurance is worth it, but so many of these things are so cheap here anyway that the gap from between where it starts to pay off until you're ill enough to get reasonably fast treatment with the NHS is quite narrow. Sometimes people think it is wider than it really is because people want and push for treatments that are not medically indicated. E.g. patients pushing for pointless MRIs is common enough that same-day MRIs is a huge industry here even though they only make an impact on outcomes for very specific symptoms.

deleted 2y ago

[deleted]