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Are you accounting for things like free healthcare when comparing wages? (I wish I did't have to say this, but it's a genuine question, not snark). I always won

Are you accounting for things like free healthcare when comparing wages? (I wish I did't have to say this, but it's a genuine question, not snark). I always wonder when people compare other countries to the US. Edit: I agree that Brexit was the most incredible piece of self-harm that I've seen a country do to itself. I certainly don't have rose-tinted spectacles about the state of the UK.

wbl 2y ago
My US job comes with NHS level never seeing a bill. This is really easy to do in CA.
- don_neufeld 2y ago
  Saying “fuck you, I’m rich” is not a good look. A health plan like that costs your company 25K/yr on the backend. They pay that as part of your compensation, you just don’t see it. Even the most basic HDHP Bronze Kaiser plan currently costs over 1K/mo, and that increases about 10% per year. If you’ve ever had a coworker (or yourself) decline COBRA coverage because it was “so expensive”, you need to understand that the price under COBRA was the price the whole time, you just didn’t see it.
  - nsxwolf 2y ago
    $25k doesn't sound like a lot. Doesn't sound like it accounts for the difference in salary.
    - don_neufeld 2y ago
      I’m not sure what your point is? 25K/yr IS a LOT. Per the US Census, the median income in the US is a bit over 37,500, so it’s literally an entire paycheck. Remember - the NHS is available to everyone, not just the rich. Source: https://datacommons.org/place/country/USA?utm_medium=explore&mprop=income&popt=Person&cpv=age,Years15Onwards&hl=en https://datacommons.org/place/country/USA?utm_medium=explore...
      - wbl 2y ago
        You're misunderstanding how the ACA subsidies work.
        sympil 2y ago
        According to article linked to below there are 48 million uninsured Americans. Fifteen percent of the UK population isn’t without coverage. The subsidies don’t work well.
    - hello_moto 2y ago
      $25K is a lot. Respectfully, You're out of touch until you lost your 6 digits job.
  - epistasis 2y ago
    > Saying “fuck you, I’m rich” is not a good look. This is a pitch-perfect example of the Brexit-like self-destructive politics that come with the "win" of appearing strong. Here is a person who has the typical experience, who could easily be convinced by their positive experience to say "everybody should have this." But instead of going that route you impute negative motivations and put very ugly distasteful words into their mouth. Which, even if they are highly supportive of your position, will likely turn them against you. Instead of using this opportunity to advocate for a really good thing, you use it as an opportunity to hit somebody you view as the enemy with a rhetorical hammer. End result: no more people in favor of better means of distributing health care, and perhaps a net negative. Especially in the context of how to account for free-at-point-of-care healthcare, which started this. If the employer is paying the prices that are revealed to employees only via COBRA, should that be accounted for in part of the wages or not? The US chooses to put about twice the fraction of GDP into healthcare that the UK does, and that per-capita GDP is also higher, how do we account for that in terms of wages and individuals? The $1T that employers pay for healthcare should be accounted for how, exactly? It's a tough question, and most likely in any comparison of nations there's a couple different ways to see how it impacts the average person. And when the "average" person in the US has such varying experiences, that has to enter into any comparison too. In California there is great healthcare coverage for those with extremely low to no income, due to subsidy. Those with healthy salaries and savings can weather the times of unemployment and pay the COBRA prices. Those who struggle the most are the ones in between, and improving that involves getting those on the high and low end to advocate for the in-between incomes. It does not involve making enemies of them.
    - alienthrowaway 2y ago
      > Here is a person who has the typical experience This is bullshit: not seeing a bill is atypical in California. Parent is also bullshitting by saying it's easy to get a job with no-bills health insurance in CA, unless they are ignoring 98% of Californians.
      - epistasis 2y ago
        Check out how Californians get their healthcare here: https://www.chcf.org/wp-content/uploads/2024/10/HealthInsurersAlmanac2024.pdf https://www.chcf.org/wp-content/uploads/2024/10/HealthInsure... Medicare and Medical are not going to see a bill ever (if the people I know on them are anything to go by), and that's almost 40% of the population. A huge majority of people on employer plans are in the same situation, so thats some fraction of the 47%. For example, nearly a quarter of Californians are covered by Kaiser. It's not some super rare privilege reserved for those making >$500k.
  - wbl 2y ago
    It's Kaiser in northern California. This is an extremely common healthcare option. Yeah, we're rich. That's the whole point: even out of pocket prices for that plan are dwarfed by the gap in salary to the UK professionals.
    - vkou 2y ago
      Most people aren't professionals, though. Nobody's arguing that the US isn't set up for the comfort of people making $500,000+/year.
      - wbl 2y ago
        Kaiser was an option when I was making 130k a year.
        alienthrowaway 2y ago
        You said it was "easy" to get a job with Kaiser upthread - what percentage if CA residents are on it?
        fragmede 2y ago
        roughly a quarter of California (9.4 in CA vs 38 for CA total)
        scarface_74 2y ago
        $130K a year still puts you at the 87th percentile of income in the US. https://dqydj.com/income-percentile-calculator/ https://dqydj.com/income-percentile-calculator/
  - karaterobot 2y ago
    > A health plan like that costs your company 25K/yr on the backend. They pay that as part of your compensation, you just don’t see it. That's very true, but of course the NHS costs some amount of money on the backend, it's just abstracted away in taxes. The real difference is how much care you get for your money, not* which way of not directly paying for health care is better. * You get more in the UK.
    - acdha 2y ago
      It’s also about predictability: medical bankruptcy is an American phenomenon. The average cost isn’t what worries people, it’s the possibility of having coverage denied, being hit with “out of network” charges like an ambulance taking you to the closest hospital or a specialist showing up at an in-network one, or having your health decline rapidly while you need to get a lawyer to convince your health insurer to pay for treatment your doctor considers necessary. It’s especially about what happens if your health declines to where you cannot work and lose all of the treatment that you’ve setup so far.
    - eloisant 2y ago
      Not really, the US health system is so broken is just costs more. The system of who pays what is very different, but at the end of the day the cost of healthcare is much higher in US than any other country.
      - don_neufeld 2y ago
        Yup, I feel that until someone has seen and understood the first graphic in this article, they really don't grok the situation: https://ourworldindata.org/us-life-expectancy-low https://ourworldindata.org/us-life-expectancy-low
      - karaterobot 2y ago
        I'm curious, did you see that little asterisk at the end of my comment?
    - jacobr1 2y ago
      That isn't the question in this thread though. The question is if you are on net better in the UK vs the US inclusive of taxes, healthcare expenses and salary differences. You get more for your money in the UK, but if you more than that difference for the same job (net of taxes), you could still come out ahead, as an individual. Society as a whole might be worse on some measures (due to the gaps in coverage for many in the US, or the hassle of the whole thing, the behavioral influences and impact of avoiding preventative care, the risk of falling into a scenario where you aren't covered and the anxiety of that risk). There are many downsides. But if you make enough then at some point that covers those risks. The salary gap has gotten sufficiently high that the break-even appoint seems to be somewhere at middle-level salaries now, not jut the high end.
- CharlieDigital 2y ago
  That's not how it works for millions upon millions of Americans that are not fortunate enough to work at a job that provides tens of thousands of dollars in healthcare insurance as a benefit. This line of thinking is exactly why the "American Dream" is falling apart; we increasingly place a handicap on some Americans and then wonder why some slice of America is not advancing generationally.
  - wbl 2y ago
    Americans who have jobs with health benefits that include Kaiser in CA is a whole lot of them in CA! It's a massive hospital system that covers 9 million people, a full quarter of the state.
    - hello_moto 2y ago
      You're tied to your job though. Not so in say, UK, Canada.
    - alsetmusic 2y ago
      I was unfortunate enough to have a job that gave me Kaiser healthcare. My job was not my only source of income. Everything about the experience of Kaiser sucked so much that I often paid out of pocket to go to other orgs. Example: I transferred my prescriptions to Kaiser, walked in and saw the dozens of people standing in line, and immediately transferred them back to CVS (where Kaiser doesn’t apply). They called me before I got home with my scripts ready for pickup. I walked in and it was one of the rare moments when no one was in line. But even when they’re busy, I’ve not seen more than ~10 people and mostly more like 1-3. Kaiser sucks. It’s the worst healthcare system I’ve had to deal with in terms of my effort vs my satisfaction. I’m very happy to work a job that lets me choose again so that I can go where I please.
      - wbl 2y ago
        I am happy that the doctor calls me to schedule things instead of the other way around. My prescriptions come by mail order, and the few times I've had to get to the pharmacy it's been a very straightforward process.
rcxdude 2y ago
Roughly speaking, when I've looked into this comparison, for near-median earners, they're better off in the UK, because of things like healthcare. But when you look at the higher-earning roles, especially engineering or software, then the different in pay more than makes up for the increased cost of living (i.e. a higher percentage of your pay may go towards cost of living, but the smaller percentage of money left over is still larger in absolute terms). There's other tradeoffs in terms of work culture and so on, though (e.g. you get much more holiday in the UK).
- bko 2y ago
  Can you share your research? In the US, the average out-of-pocket healthcare spending was $1,424.6 per capita in 2022 Most people have insurance. They might have some high out of pocket maximum like $10k. So worse case scenario you're out an additional $10k. But you pay a lot less in taxes In US, a single filer, the 12% bracket covers income from $11,926 to $48,475. In UK it's 20% So at 40k you're paying an additional 3k in taxes, not to mention VAT and others (although I am ignoring other US taxes like state, local and payroll). More than covers your out of pocket healthcare costs. And pretty much any job in the US is significantly higher paying, for instance a typical accountant in US makes 80k while in the uk that 37k pounds. Pretty much every office job is like this. And note the US 80k figures includes benefits like ... you guessed it, healthcare! Even if make the generous assumptions that taxes are the same, UK has same healthcare quality and everyone is hitting out of pocket max every year, it's still not close. The whole "but we don't have to pay for healthcare" strikes me as just a cope. https://www.statista.com/statistics/484578/us-per-capita-out-of-pocket-health-care-payments-since-1960/ https://www.statista.com/statistics/484578/us-per-capita-out... https://www.allbusinessschools.com/accounting/salary/ https://www.allbusinessschools.com/accounting/salary/ https://uk.indeed.com/career/accountant/salaries https://uk.indeed.com/career/accountant/salaries
  - g8oz 2y ago
    I think if the health insurance situation was as rosy in the U.S as you make out there would not have been as much support for the killer of the United Healthcare CEO. The figure for the average out of pocket expenses hides a lot of pain.
vineyardmike 2y ago
I think most Americans over-index on the cost of healthcare and the availability of insurance because it’s constant in our news and our system absolutely sucks. Most people don’t need regular medical care because most people are healthy (until they start getting older). It’s expensive, sure, but most people in the middle-class have employer sponsored healthcare, and retirees have government sponsored healthcare, and many low-income people have government sponsored healthcare. The difference in out-of-pocket costs is easily accounted for within significantly higher salaries. Of course, the issue is not the actual availability of insurance, it is that there is a patchwork of laws and protections and it’s not universal to be covered at any point in your life. But many states have well above a 90% insurance rate. California, the most populous state, has 93%. Massachusetts is sitting at 98%. Even Texas, the worst state for health insurance, is at 85% of the population covered.
- fastasucan 2y ago
  >The difference in out-of-pocket costs is easily accounted for within significantly higher salaries. Any sources for this?
  - vineyardmike 2y ago
    Salary Info (25k USD salary difference, before tax) https://en.wikipedia.org/wiki/List_of_countries_by_average_wage https://en.wikipedia.org/wiki/List_of_countries_by_average_w... Cost of healthcare: There are a bunch of numbers that are trivially accessible via Google, including government sources, but I couldn’t find any that match perfectly with the time range of the wage data. Here is one quote, from a few years earlier… > Median annual out-of-pocket spending on medical care ranged from $360 (Hawaii) to $1,500 (Nebraska). In four states, households in the top 10 percent of out-of-pocket expenses spent $7,000 or more on these items. https://www.commonwealthfund.org/publications/issue-briefs/2019/may/how-much-us-households-employer-insurance-spend-premiums-out-of-pocket https://www.commonwealthfund.org/publications/issue-briefs/2... See also: https://meps.ahrq.gov/data_files/publications/st441/stat441.shtml https://meps.ahrq.gov/data_files/publications/st441/stat441....
- SnorkelTan 2y ago
lttlrck 2y ago
It's not free.

wbl 2y ago

My US job comes with NHS level never seeing a bill. This is really easy to do in CA.

don_neufeld 2y ago
Saying “fuck you, I’m rich” is not a good look. A health plan like that costs your company 25K/yr on the backend. They pay that as part of your compensation, you just don’t see it. Even the most basic HDHP Bronze Kaiser plan currently costs over 1K/mo, and that increases about 10% per year. If you’ve ever had a coworker (or yourself) decline COBRA coverage because it was “so expensive”, you need to understand that the price under COBRA was the price the whole time, you just didn’t see it.
- nsxwolf 2y ago
  $25k doesn't sound like a lot. Doesn't sound like it accounts for the difference in salary.
  - don_neufeld 2y ago
    I’m not sure what your point is? 25K/yr IS a LOT. Per the US Census, the median income in the US is a bit over 37,500, so it’s literally an entire paycheck. Remember - the NHS is available to everyone, not just the rich. Source: https://datacommons.org/place/country/USA?utm_medium=explore&mprop=income&popt=Person&cpv=age,Years15Onwards&hl=en https://datacommons.org/place/country/USA?utm_medium=explore...
    - wbl 2y ago
      You're misunderstanding how the ACA subsidies work.
      - sympil 2y ago
        According to article linked to below there are 48 million uninsured Americans. Fifteen percent of the UK population isn’t without coverage. The subsidies don’t work well.
  - hello_moto 2y ago
    $25K is a lot. Respectfully, You're out of touch until you lost your 6 digits job.
- epistasis 2y ago
  > Saying “fuck you, I’m rich” is not a good look. This is a pitch-perfect example of the Brexit-like self-destructive politics that come with the "win" of appearing strong. Here is a person who has the typical experience, who could easily be convinced by their positive experience to say "everybody should have this." But instead of going that route you impute negative motivations and put very ugly distasteful words into their mouth. Which, even if they are highly supportive of your position, will likely turn them against you. Instead of using this opportunity to advocate for a really good thing, you use it as an opportunity to hit somebody you view as the enemy with a rhetorical hammer. End result: no more people in favor of better means of distributing health care, and perhaps a net negative. Especially in the context of how to account for free-at-point-of-care healthcare, which started this. If the employer is paying the prices that are revealed to employees only via COBRA, should that be accounted for in part of the wages or not? The US chooses to put about twice the fraction of GDP into healthcare that the UK does, and that per-capita GDP is also higher, how do we account for that in terms of wages and individuals? The $1T that employers pay for healthcare should be accounted for how, exactly? It's a tough question, and most likely in any comparison of nations there's a couple different ways to see how it impacts the average person. And when the "average" person in the US has such varying experiences, that has to enter into any comparison too. In California there is great healthcare coverage for those with extremely low to no income, due to subsidy. Those with healthy salaries and savings can weather the times of unemployment and pay the COBRA prices. Those who struggle the most are the ones in between, and improving that involves getting those on the high and low end to advocate for the in-between incomes. It does not involve making enemies of them.
  - alienthrowaway 2y ago
    > Here is a person who has the typical experience This is bullshit: not seeing a bill is atypical in California. Parent is also bullshitting by saying it's easy to get a job with no-bills health insurance in CA, unless they are ignoring 98% of Californians.
    - epistasis 2y ago
      Check out how Californians get their healthcare here: https://www.chcf.org/wp-content/uploads/2024/10/HealthInsurersAlmanac2024.pdf https://www.chcf.org/wp-content/uploads/2024/10/HealthInsure... Medicare and Medical are not going to see a bill ever (if the people I know on them are anything to go by), and that's almost 40% of the population. A huge majority of people on employer plans are in the same situation, so thats some fraction of the 47%. For example, nearly a quarter of Californians are covered by Kaiser. It's not some super rare privilege reserved for those making >$500k.
- wbl 2y ago
  It's Kaiser in northern California. This is an extremely common healthcare option. Yeah, we're rich. That's the whole point: even out of pocket prices for that plan are dwarfed by the gap in salary to the UK professionals.
  - vkou 2y ago
    Most people aren't professionals, though. Nobody's arguing that the US isn't set up for the comfort of people making $500,000+/year.
    - wbl 2y ago
      Kaiser was an option when I was making 130k a year.
      - alienthrowaway 2y ago
        You said it was "easy" to get a job with Kaiser upthread - what percentage if CA residents are on it?
        fragmede 2y ago
        roughly a quarter of California (9.4 in CA vs 38 for CA total)
      - scarface_74 2y ago
        $130K a year still puts you at the 87th percentile of income in the US. https://dqydj.com/income-percentile-calculator/ https://dqydj.com/income-percentile-calculator/
- karaterobot 2y ago
  > A health plan like that costs your company 25K/yr on the backend. They pay that as part of your compensation, you just don’t see it. That's very true, but of course the NHS costs some amount of money on the backend, it's just abstracted away in taxes. The real difference is how much care you get for your money, not* which way of not directly paying for health care is better. * You get more in the UK.
  - acdha 2y ago
    It’s also about predictability: medical bankruptcy is an American phenomenon. The average cost isn’t what worries people, it’s the possibility of having coverage denied, being hit with “out of network” charges like an ambulance taking you to the closest hospital or a specialist showing up at an in-network one, or having your health decline rapidly while you need to get a lawyer to convince your health insurer to pay for treatment your doctor considers necessary. It’s especially about what happens if your health declines to where you cannot work and lose all of the treatment that you’ve setup so far.
  - eloisant 2y ago
    Not really, the US health system is so broken is just costs more. The system of who pays what is very different, but at the end of the day the cost of healthcare is much higher in US than any other country.
    - don_neufeld 2y ago
      Yup, I feel that until someone has seen and understood the first graphic in this article, they really don't grok the situation: https://ourworldindata.org/us-life-expectancy-low https://ourworldindata.org/us-life-expectancy-low
    - karaterobot 2y ago
      I'm curious, did you see that little asterisk at the end of my comment?
  - jacobr1 2y ago
    That isn't the question in this thread though. The question is if you are on net better in the UK vs the US inclusive of taxes, healthcare expenses and salary differences. You get more for your money in the UK, but if you more than that difference for the same job (net of taxes), you could still come out ahead, as an individual. Society as a whole might be worse on some measures (due to the gaps in coverage for many in the US, or the hassle of the whole thing, the behavioral influences and impact of avoiding preventative care, the risk of falling into a scenario where you aren't covered and the anxiety of that risk). There are many downsides. But if you make enough then at some point that covers those risks. The salary gap has gotten sufficiently high that the break-even appoint seems to be somewhere at middle-level salaries now, not jut the high end.
CharlieDigital 2y ago
That's not how it works for millions upon millions of Americans that are not fortunate enough to work at a job that provides tens of thousands of dollars in healthcare insurance as a benefit. This line of thinking is exactly why the "American Dream" is falling apart; we increasingly place a handicap on some Americans and then wonder why some slice of America is not advancing generationally.
- wbl 2y ago
  Americans who have jobs with health benefits that include Kaiser in CA is a whole lot of them in CA! It's a massive hospital system that covers 9 million people, a full quarter of the state.
  - hello_moto 2y ago
    You're tied to your job though. Not so in say, UK, Canada.
  - alsetmusic 2y ago
    I was unfortunate enough to have a job that gave me Kaiser healthcare. My job was not my only source of income. Everything about the experience of Kaiser sucked so much that I often paid out of pocket to go to other orgs. Example: I transferred my prescriptions to Kaiser, walked in and saw the dozens of people standing in line, and immediately transferred them back to CVS (where Kaiser doesn’t apply). They called me before I got home with my scripts ready for pickup. I walked in and it was one of the rare moments when no one was in line. But even when they’re busy, I’ve not seen more than ~10 people and mostly more like 1-3. Kaiser sucks. It’s the worst healthcare system I’ve had to deal with in terms of my effort vs my satisfaction. I’m very happy to work a job that lets me choose again so that I can go where I please.
    - wbl 2y ago
      I am happy that the doctor calls me to schedule things instead of the other way around. My prescriptions come by mail order, and the few times I've had to get to the pharmacy it's been a very straightforward process.

rcxdude 2y ago

Roughly speaking, when I've looked into this comparison, for near-median earners, they're better off in the UK, because of things like healthcare. But when you look at the higher-earning roles, especially engineering or software, then the different in pay more than makes up for the increased cost of living (i.e. a higher percentage of your pay may go towards cost of living, but the smaller percentage of money left over is still larger in absolute terms). There's other tradeoffs in terms of work culture and so on, though (e.g. you get much more holiday in the UK).

bko 2y ago
Can you share your research? In the US, the average out-of-pocket healthcare spending was $1,424.6 per capita in 2022 Most people have insurance. They might have some high out of pocket maximum like $10k. So worse case scenario you're out an additional $10k. But you pay a lot less in taxes In US, a single filer, the 12% bracket covers income from $11,926 to $48,475. In UK it's 20% So at 40k you're paying an additional 3k in taxes, not to mention VAT and others (although I am ignoring other US taxes like state, local and payroll). More than covers your out of pocket healthcare costs. And pretty much any job in the US is significantly higher paying, for instance a typical accountant in US makes 80k while in the uk that 37k pounds. Pretty much every office job is like this. And note the US 80k figures includes benefits like ... you guessed it, healthcare! Even if make the generous assumptions that taxes are the same, UK has same healthcare quality and everyone is hitting out of pocket max every year, it's still not close. The whole "but we don't have to pay for healthcare" strikes me as just a cope. https://www.statista.com/statistics/484578/us-per-capita-out-of-pocket-health-care-payments-since-1960/ https://www.statista.com/statistics/484578/us-per-capita-out... https://www.allbusinessschools.com/accounting/salary/ https://www.allbusinessschools.com/accounting/salary/ https://uk.indeed.com/career/accountant/salaries https://uk.indeed.com/career/accountant/salaries
- g8oz 2y ago
  I think if the health insurance situation was as rosy in the U.S as you make out there would not have been as much support for the killer of the United Healthcare CEO. The figure for the average out of pocket expenses hides a lot of pain.

vineyardmike 2y ago

I think most Americans over-index on the cost of healthcare and the availability of insurance because it’s constant in our news and our system absolutely sucks. Most people don’t need regular medical care because most people are healthy (until they start getting older). It’s expensive, sure, but most people in the middle-class have employer sponsored healthcare, and retirees have government sponsored healthcare, and many low-income people have government sponsored healthcare. The difference in out-of-pocket costs is easily accounted for within significantly higher salaries. Of course, the issue is not the actual availability of insurance, it is that there is a patchwork of laws and protections and it’s not universal to be covered at any point in your life. But many states have well above a 90% insurance rate. California, the most populous state, has 93%. Massachusetts is sitting at 98%. Even Texas, the worst state for health insurance, is at 85% of the population covered.

fastasucan 2y ago
>The difference in out-of-pocket costs is easily accounted for within significantly higher salaries. Any sources for this?
- vineyardmike 2y ago
  Salary Info (25k USD salary difference, before tax) https://en.wikipedia.org/wiki/List_of_countries_by_average_wage https://en.wikipedia.org/wiki/List_of_countries_by_average_w... Cost of healthcare: There are a bunch of numbers that are trivially accessible via Google, including government sources, but I couldn’t find any that match perfectly with the time range of the wage data. Here is one quote, from a few years earlier… > Median annual out-of-pocket spending on medical care ranged from $360 (Hawaii) to $1,500 (Nebraska). In four states, households in the top 10 percent of out-of-pocket expenses spent $7,000 or more on these items. https://www.commonwealthfund.org/publications/issue-briefs/2019/may/how-much-us-households-employer-insurance-spend-premiums-out-of-pocket https://www.commonwealthfund.org/publications/issue-briefs/2... See also: https://meps.ahrq.gov/data_files/publications/st441/stat441.shtml https://meps.ahrq.gov/data_files/publications/st441/stat441....
SnorkelTan 2y ago

lttlrck 2y ago

It's not free.