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> That’s a financial product, not a medical one. It often goes unsaid, but America, on a cultural and political level, is really ideologically fixated on a dis

> That’s a financial product, not a medical one. It often goes unsaid, but America, on a cultural and political level, is really ideologically fixated on a distinction between working and non-working individuals, and, in a far deeper sense, whether an individual "deserves" healthcare or not. This makes access to healthcare intricately connected to class, wealth, and income, in America. That's why access to healthcare is seen as a product in and of itself. You can either afford it ("you've earned it"), or you go into debt for it ("you have to earn it"), or you simply have no expectation of ever paying for it ("you cheated the system"). The entire conversation is often dominated by these ideas in a way that often makes talking about healthcare with Americans baffling to people that come from many single-payer or universal systems.

xdfgh1112 2y ago
I get this feeling a lot. For example the UK typically has unlimited paid sick days for salaried jobs, while I have heard of US employees pooling together and "donating" sick days to someone. The UK has a ton of benefits for the sick, unemployed, single mothers, carers etc. in the US I am sure those exist but I get the sense that charity is supposed to play more of a role.
- _DeadFred_ 2y ago
  [flagged]
  - brigandish 2y ago
    They don't exist in the UK either, what company would offer unlimited sick days? Getting a job at those companies would represent a lottery win.
    - the_mar 2y ago
      I mean your employment can't technically be terminated because you are taking sick days, unless it's whatever qualifies as long term illness (18 or 28 weeks I forget). Technically they are not obligated to continue to pay you and the govt sick pay is like 100 quid per week. in the us they can fire you the day you don't show up
    - immibis 2y ago
      The catch is that you have to actually be sick.
      - brigandish 2y ago
        The data would suggest that isn't the case. > Record numbers not working due to ill health https://www.bbc.com/news/business-65596283 https://www.bbc.com/news/business-65596283 From the summary of the data[1] being relied upon in that report: > The number of people economically inactive because of long-term sickness has risen to over 2.5 million people, an increase of over 400,000 since the start of the coronavirus (COVID-19) pandemic. > Over 1.35 million (53%) of those inactive because of long-term sickness reported that they had depression, bad nerves or anxiety in Quarter 1 2023, with the majority (over 1 million) reporting it as a secondary health condition rather than their main one. Bad nerves and anxiety could be a reason for a tiny number of people, but those numbers are huge, and if you think I'm lacking compassion for this, hearing what whistleblowers say regarding the way assessments are done[2] may be relevant: > Sickness benefit assessments via telephone (rather than in-person visit) are now routine and it's not always necessary to provide proof of a sick note. In the film, Michael Houston, a former assessor, is asked how well it's possible to discern, over the phone, if someone should qualify for full sickness benefit. "Not very," he replied, "which is one of the things that ethically and morally I didn't really feel comfortable with." That's not even the half of it, and that website has stories of people trapped in the system. [1] https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/economicinactivity/articles/risingillhealthandeconomicinactivitybecauseoflongtermsicknessuk/2019to2023 https://www.ons.gov.uk/employmentandlabourmarket/peoplenotin... [2] https://www.benefitstrap.com/sarah https://www.benefitstrap.com/sarah
- xp84 2y ago
  FYI it’s not common to allow sick days to be transferable. TBH I think in the US it’s more than anything about how much more competitive industries here are vs in the UK. If X company feels it’s worth the extra cost by allowing unlimited PTO and 2 years of parental leave, etc. the worry is that X will be trounced by Y Company, who is ruthless enough to not offer those things and as such has much cheaper labor costs. If you take an industry like retail, those companies have a point - Walmart and Amazon offer low benefits compared to what companies once offered. Their lower prices are part of how they killed off most of the department stores and put the rest on life support. And if you think about a highly paid job, even though our fringe benefits suck compared to Europe style, my impression is that US salaries are higher for equivalent jobs, enough that it makes up for it. So we value the money more than we would the benefits, apparently. Only problem is you can’t use all that money to buy more time with your family (except for by taking breaks between jobs, if you’re good at saving!)
somerandomqaguy 2y ago
To a degree. You have to keep in mind that a hospital emergency room isn't legally permitted to turn you away even if you can't pay under the Emergency Medical Treatment and Active Labor Act. So the wealthy and insured are covered. The lowest rungs and those that don't care and will just run away are covered. It's mostly lower / middle lower class that this really hurts, ironically.
- FireBeyond 2y ago
  > The lowest rungs and those that don't care and will just run away are covered. They're really not. They are only entitled to "stabilizing care". I work as a paramedic. We have had situations with "frequent fliers" where when we've called the hospital to give a report as we are transporting, the hospital will say "let us know when you're here", and when we've done so, there's literally been a physician come out to the ambulance. "Hey, X, what's happening?" "I got a lot of fluid in my gut (he had ascites)." "Okay, well, that's not new, and it looks like you have an appointment for having that fluid drawn in two days." "Oh, okay." "Anything else bothering you?" "Nope." "Alright, we're good then." Gives us a nod. "We're going in then?" "Uh, no. You have been by a physician, you're stable, you're good to go, you can jump off their gurney and head home now." Which is harsh - but also this person at this point was being transported 4+ times _per day_. But EMTALA only requires acute stabilizing care, not definitive management.
miki123211 2y ago
Be aware that in many single-payer systems, insurance is also tied to working (or unemployment / retirement / pensions). In my opinion, this is actually the reason for why we have so little innovation in Europe. Mandatory, single-payer insurance very significantly raises the cost to be self-employed / have a sole proprietorship, which you practically need to run any side project that you want to eventually make money from. This means that if you launch a startup, you either need it to be profitable on day one, or you're vasting significant amounts of your money, not just your time.
- tsimionescu 2y ago
  > Be aware that in many single-payer systems, insurance is also tied to working (or unemployment / retirement / pensions). This is true. > This means that if you launch a startup, you either need it to be profitable on day one, or you're vasting significant amounts of your money, not just your time. This is a false dichotomy. First of all, even ignoring health-care, you're still spending money on housing, food, electricity etc. If you're not employed and your startup is not profitable, you're paying money out of pocket to live. Second of all, even in the USA, you are still going to pay for health insurance even if you are currently founding a startup. You could argue you are allowed to gamble that our health is good enough that you don't need health insurance for a few years, but that's just tossing coins. You could just as well not pay your taxes in the EU for a year or two, and gamble that the authorities will not catch on right away.
- xp84 2y ago
  I don’t get it, why is a self-employed person paying so much more than others for single payer healthcare where you are? That sounds exactly like the USA where those not employed as a normal full-time employee pay the most for equivalent insurance, so people here definitely do stay at their regular jobs instead of quitting to found a startup. Insurance outside of those group plans is even more expensive than the already shocking normal cost, and of course normal full time employment (what we call W-2 jobs) usually provides a generous healthcare subsidy.
  - miki123211 2y ago
coffeecat 2y ago
I think your premise is flawed. In America, the access-to-healthcare versus income curve is U-shaped. If you have literally no income (or your income is entirely "off the books"), then you qualify for medicaid; everything is covered with no premiums, copays, or deductibles. At a middle-class level of income, you're probably looking at either a comparatively shitty ACA marketplace plan, or a comparatively shitty employer-provided HDHP plan. At an upper-class level of income, you can afford top-of-the-line healthcare.
thayne 2y ago
Living in America, I have never met anyone who doesn't think our health care system is a complete mess. That includes doctors, nurses, people who work in HR, and people on both sides of the political spectrum. There is however disagreement about how it should be fixed. But from what I've seen that disagreement isn't about whether people who don't get insurance from their employer "cheated the system", it's about whether the system should be controlled by the state or private companies.
LtWorf 2y ago
You can praise/blame the puritans for this weird idea.

xdfgh1112 2y ago

I get this feeling a lot. For example the UK typically has unlimited paid sick days for salaried jobs, while I have heard of US employees pooling together and "donating" sick days to someone. The UK has a ton of benefits for the sick, unemployed, single mothers, carers etc. in the US I am sure those exist but I get the sense that charity is supposed to play more of a role.

_DeadFred_ 2y ago
[flagged]
- brigandish 2y ago
  They don't exist in the UK either, what company would offer unlimited sick days? Getting a job at those companies would represent a lottery win.
  - the_mar 2y ago
    I mean your employment can't technically be terminated because you are taking sick days, unless it's whatever qualifies as long term illness (18 or 28 weeks I forget). Technically they are not obligated to continue to pay you and the govt sick pay is like 100 quid per week. in the us they can fire you the day you don't show up
  - immibis 2y ago
    The catch is that you have to actually be sick.
    - brigandish 2y ago
      The data would suggest that isn't the case. > Record numbers not working due to ill health https://www.bbc.com/news/business-65596283 https://www.bbc.com/news/business-65596283 From the summary of the data[1] being relied upon in that report: > The number of people economically inactive because of long-term sickness has risen to over 2.5 million people, an increase of over 400,000 since the start of the coronavirus (COVID-19) pandemic. > Over 1.35 million (53%) of those inactive because of long-term sickness reported that they had depression, bad nerves or anxiety in Quarter 1 2023, with the majority (over 1 million) reporting it as a secondary health condition rather than their main one. Bad nerves and anxiety could be a reason for a tiny number of people, but those numbers are huge, and if you think I'm lacking compassion for this, hearing what whistleblowers say regarding the way assessments are done[2] may be relevant: > Sickness benefit assessments via telephone (rather than in-person visit) are now routine and it's not always necessary to provide proof of a sick note. In the film, Michael Houston, a former assessor, is asked how well it's possible to discern, over the phone, if someone should qualify for full sickness benefit. "Not very," he replied, "which is one of the things that ethically and morally I didn't really feel comfortable with." That's not even the half of it, and that website has stories of people trapped in the system. [1] https://www.ons.gov.uk/employmentandlabourmarket/peoplenotinwork/economicinactivity/articles/risingillhealthandeconomicinactivitybecauseoflongtermsicknessuk/2019to2023 https://www.ons.gov.uk/employmentandlabourmarket/peoplenotin... [2] https://www.benefitstrap.com/sarah https://www.benefitstrap.com/sarah
xp84 2y ago
FYI it’s not common to allow sick days to be transferable. TBH I think in the US it’s more than anything about how much more competitive industries here are vs in the UK. If X company feels it’s worth the extra cost by allowing unlimited PTO and 2 years of parental leave, etc. the worry is that X will be trounced by Y Company, who is ruthless enough to not offer those things and as such has much cheaper labor costs. If you take an industry like retail, those companies have a point - Walmart and Amazon offer low benefits compared to what companies once offered. Their lower prices are part of how they killed off most of the department stores and put the rest on life support. And if you think about a highly paid job, even though our fringe benefits suck compared to Europe style, my impression is that US salaries are higher for equivalent jobs, enough that it makes up for it. So we value the money more than we would the benefits, apparently. Only problem is you can’t use all that money to buy more time with your family (except for by taking breaks between jobs, if you’re good at saving!)

somerandomqaguy 2y ago

To a degree. You have to keep in mind that a hospital emergency room isn't legally permitted to turn you away even if you can't pay under the Emergency Medical Treatment and Active Labor Act. So the wealthy and insured are covered. The lowest rungs and those that don't care and will just run away are covered. It's mostly lower / middle lower class that this really hurts, ironically.

FireBeyond 2y ago
> The lowest rungs and those that don't care and will just run away are covered. They're really not. They are only entitled to "stabilizing care". I work as a paramedic. We have had situations with "frequent fliers" where when we've called the hospital to give a report as we are transporting, the hospital will say "let us know when you're here", and when we've done so, there's literally been a physician come out to the ambulance. "Hey, X, what's happening?" "I got a lot of fluid in my gut (he had ascites)." "Okay, well, that's not new, and it looks like you have an appointment for having that fluid drawn in two days." "Oh, okay." "Anything else bothering you?" "Nope." "Alright, we're good then." Gives us a nod. "We're going in then?" "Uh, no. You have been by a physician, you're stable, you're good to go, you can jump off their gurney and head home now." Which is harsh - but also this person at this point was being transported 4+ times _per day_. But EMTALA only requires acute stabilizing care, not definitive management.

miki123211 2y ago

Be aware that in many single-payer systems, insurance is also tied to working (or unemployment / retirement / pensions). In my opinion, this is actually the reason for why we have so little innovation in Europe. Mandatory, single-payer insurance very significantly raises the cost to be self-employed / have a sole proprietorship, which you practically need to run any side project that you want to eventually make money from. This means that if you launch a startup, you either need it to be profitable on day one, or you're vasting significant amounts of your money, not just your time.

tsimionescu 2y ago
> Be aware that in many single-payer systems, insurance is also tied to working (or unemployment / retirement / pensions). This is true. > This means that if you launch a startup, you either need it to be profitable on day one, or you're vasting significant amounts of your money, not just your time. This is a false dichotomy. First of all, even ignoring health-care, you're still spending money on housing, food, electricity etc. If you're not employed and your startup is not profitable, you're paying money out of pocket to live. Second of all, even in the USA, you are still going to pay for health insurance even if you are currently founding a startup. You could argue you are allowed to gamble that our health is good enough that you don't need health insurance for a few years, but that's just tossing coins. You could just as well not pay your taxes in the EU for a year or two, and gamble that the authorities will not catch on right away.
xp84 2y ago
I don’t get it, why is a self-employed person paying so much more than others for single payer healthcare where you are? That sounds exactly like the USA where those not employed as a normal full-time employee pay the most for equivalent insurance, so people here definitely do stay at their regular jobs instead of quitting to found a startup. Insurance outside of those group plans is even more expensive than the already shocking normal cost, and of course normal full time employment (what we call W-2 jobs) usually provides a generous healthcare subsidy.
- miki123211 2y ago

coffeecat 2y ago

I think your premise is flawed. In America, the access-to-healthcare versus income curve is U-shaped. If you have literally no income (or your income is entirely "off the books"), then you qualify for medicaid; everything is covered with no premiums, copays, or deductibles. At a middle-class level of income, you're probably looking at either a comparatively shitty ACA marketplace plan, or a comparatively shitty employer-provided HDHP plan. At an upper-class level of income, you can afford top-of-the-line healthcare.

thayne 2y ago

Living in America, I have never met anyone who doesn't think our health care system is a complete mess. That includes doctors, nurses, people who work in HR, and people on both sides of the political spectrum. There is however disagreement about how it should be fixed. But from what I've seen that disagreement isn't about whether people who don't get insurance from their employer "cheated the system", it's about whether the system should be controlled by the state or private companies.

LtWorf 2y ago

You can praise/blame the puritans for this weird idea.