4 ms·

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

by wbl 2y ago

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.

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

by wbl 2y ago

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

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.