4 ms·

I don't understand how you have a discussion about this without discussing the total benefits an employee receives. i.e. if may salary remains constant at $30k

I don't understand how you have a discussion about this without discussing the total benefits an employee receives. i.e. if may salary remains constant at $30k a year but the employer portion of my health care coverage is $6k/year and growing at 15% - I do not have stagnant wages (i just didn't have a say in how they were spent)

davidgerard 12y ago
So the salary is constant but you're projecting health insurance costs rising 15% annually for the foreseeable future ... I may not understand the US, but is this actually something that is expected to happen?
- WildUtah 12y ago
  It happened pretty consistently from 1980 to 2010, except the late 1990s. It's relaxed a little since 2010.
  - davidgerard 12y ago
    Given the US pays twice per citizen what other first-world countries do, I'd expect that cost to go down with increasing socialisation of health care - there's still a lot of inefficiency there.
    - WildUtah 12y ago
      Health care could hardly be any more socialized in the USA; it's been the most controlled industry in the country for decades. Changes from subsidized finance to tax finance under Obamacare are superficial and accomplish little. The hope has to be that we can transition from bad, counterproductive state control to good state control. Bureaucrats have finally forced the medical colleges to allow new schools and expansions to train new doctors after decades of drastic undersupply so there is hope.
      - davidgerard 12y ago
        You appear to be using "socialised" as a synonym for "regulated". It's highly regulated, but evidently for the benefit of private insurance companies, which is where that ridiculous cost disparity from other first world countries come from, which are more to the benefit of the actual citizens.
        WildUtah 12y ago
        Socialism is the centralized control of the means of production. How much rich elites hoard surplus value by means of that centralized control is immaterial. Wealth redistribution is orthogonal to socialism or freedom. In fact, welfare policies supporting egalitarian consumption are more compatible with capitalism plus an income tax than any kind of socialism. And socialism is a synonym for tightly, centrally regulated. Which is what the US health care system is; it's one of the most socialist systems in the world. The benefit of private insurance companies is a small part of what makes US medicine expensive. The relative lack of trained doctors and denying qualified nurses permission to treat common conditions without direct supervision of an MD and multiple layers of review for simple prescriptions are much more important. The cost disparity is mostly a result of badly run regulation rather than anyone's profits. Changing to a different funding system -- whether Obamacare or single player or NHS style public hospitals -- won't make US medicine much cheaper. The problems run deep and will take decades of dedicated bureaucrats rewriting rules, reorganizing institutions, and instituting new standards of practice with the support of wise, patient politicians to get it right.
        jholman 12y ago
        I agree with you about the (original and most important) meaning of "socialism", and I agree with the majority of the declarative sentences in your comment. However, that's not what the "socialized" in "socialized healthcare" means. Nobody uses it that way, that's not what it means. "Socialized healthcare" means that the cost burden of providing (some aspects of) healthcare is borne by the society. "Socialized healthcare" is fundamentally about wealth redistribution. That's how people use that phrase; that's what that phrase means when people say it. I also am highly skeptical that the U.S. system of healthcare is "one of the most socialist systems" in the first world. More socialist than healthcare in Uganda, sure, perhaps. The means of production of healthcare are primarily owned and operated by private companies. Yes, they are regulated, but that's very nearly orthogonal to capitalism or socialism. And yes, there are socialist aspects to the American system, but my understanding is that they tend to be corner cases (admittedly large corner cases). I think you would be hard-pressed to find a first-world system of healthcare that has as much private ownership of the means of production of healthcare. As for the fix for the established fact that Americans pay around twice as much for slightly-inferior care (relative to other first-world countries).... Your claim that it's over-regulation is wildly citation-needed, although you might be right, and I think it's clear that there's room for SOME savings in things like nurse-practitioners. Nonetheless, the first and most dramatic thing that everyone notices when they compare the U.S. system to the systems that work better (e.g. every other member of the G8) is that the U.S. system is full of adversarial friction, where many private corporations each strive to take a piece of the pie. Good for private profits, bad for everyone else. Not a value judgement, just a difference from other first-world systems.
  - madcaptenor 12y ago
    This can't continue forever, though. Health care spending is 15% of GDP; if this trend continued for another thirty years it would be (15%)*(1.15)^30 or about 1000%.
dingaling 12y ago
> I don't understand how you have a discussion about this without discussing the total benefits an employee receives. In the UK, most employer-provided 'benefits' are taxable in that their value is deducted from the individual's personal allowance, i.e. the amount they earn before paying income tax. So it's even worse; not only does the employer 'spend' your salary on benefits you may not want, but it also hits your wallet by increasing the amount of income tax you pay. One of the first things I do at a new employer is opt-out of as many benefits as possible. They do not compensate with additional cash, but it reduces my tax burden.
- spacecowboy_lon 12y ago
  err? do you actualy work in the Uk? the only benefit that it can make sense to opt out of is company car - The major benefit in USA terms is health is all ready provided by the NHS. Do you realy opt out of the pension? when I worked for a big company that was worth 6% tax free - let alone the share save schemes
  - dingaling 12y ago
    > the only benefit that it can make sense to opt out of is company car And private health insurance, gym membership and dental insurance, which knocked £900 out of my personal allowance until I cancelled them at my last work place.
    - spacecowboy_lon 12y ago
      Did you not ask if you coudl have the equivelent benefits added to your pension ?

davidgerard 12y ago

So the salary is constant but you're projecting health insurance costs rising 15% annually for the foreseeable future ... I may not understand the US, but is this actually something that is expected to happen?

WildUtah 12y ago
It happened pretty consistently from 1980 to 2010, except the late 1990s. It's relaxed a little since 2010.
- davidgerard 12y ago
  Given the US pays twice per citizen what other first-world countries do, I'd expect that cost to go down with increasing socialisation of health care - there's still a lot of inefficiency there.
  - WildUtah 12y ago
    Health care could hardly be any more socialized in the USA; it's been the most controlled industry in the country for decades. Changes from subsidized finance to tax finance under Obamacare are superficial and accomplish little. The hope has to be that we can transition from bad, counterproductive state control to good state control. Bureaucrats have finally forced the medical colleges to allow new schools and expansions to train new doctors after decades of drastic undersupply so there is hope.
    - davidgerard 12y ago
      You appear to be using "socialised" as a synonym for "regulated". It's highly regulated, but evidently for the benefit of private insurance companies, which is where that ridiculous cost disparity from other first world countries come from, which are more to the benefit of the actual citizens.
      - WildUtah 12y ago
        Socialism is the centralized control of the means of production. How much rich elites hoard surplus value by means of that centralized control is immaterial. Wealth redistribution is orthogonal to socialism or freedom. In fact, welfare policies supporting egalitarian consumption are more compatible with capitalism plus an income tax than any kind of socialism. And socialism is a synonym for tightly, centrally regulated. Which is what the US health care system is; it's one of the most socialist systems in the world. The benefit of private insurance companies is a small part of what makes US medicine expensive. The relative lack of trained doctors and denying qualified nurses permission to treat common conditions without direct supervision of an MD and multiple layers of review for simple prescriptions are much more important. The cost disparity is mostly a result of badly run regulation rather than anyone's profits. Changing to a different funding system -- whether Obamacare or single player or NHS style public hospitals -- won't make US medicine much cheaper. The problems run deep and will take decades of dedicated bureaucrats rewriting rules, reorganizing institutions, and instituting new standards of practice with the support of wise, patient politicians to get it right.
        jholman 12y ago
        I agree with you about the (original and most important) meaning of "socialism", and I agree with the majority of the declarative sentences in your comment. However, that's not what the "socialized" in "socialized healthcare" means. Nobody uses it that way, that's not what it means. "Socialized healthcare" means that the cost burden of providing (some aspects of) healthcare is borne by the society. "Socialized healthcare" is fundamentally about wealth redistribution. That's how people use that phrase; that's what that phrase means when people say it. I also am highly skeptical that the U.S. system of healthcare is "one of the most socialist systems" in the first world. More socialist than healthcare in Uganda, sure, perhaps. The means of production of healthcare are primarily owned and operated by private companies. Yes, they are regulated, but that's very nearly orthogonal to capitalism or socialism. And yes, there are socialist aspects to the American system, but my understanding is that they tend to be corner cases (admittedly large corner cases). I think you would be hard-pressed to find a first-world system of healthcare that has as much private ownership of the means of production of healthcare. As for the fix for the established fact that Americans pay around twice as much for slightly-inferior care (relative to other first-world countries).... Your claim that it's over-regulation is wildly citation-needed, although you might be right, and I think it's clear that there's room for SOME savings in things like nurse-practitioners. Nonetheless, the first and most dramatic thing that everyone notices when they compare the U.S. system to the systems that work better (e.g. every other member of the G8) is that the U.S. system is full of adversarial friction, where many private corporations each strive to take a piece of the pie. Good for private profits, bad for everyone else. Not a value judgement, just a difference from other first-world systems.
- madcaptenor 12y ago
  This can't continue forever, though. Health care spending is 15% of GDP; if this trend continued for another thirty years it would be (15%)*(1.15)^30 or about 1000%.

dingaling 12y ago

> I don't understand how you have a discussion about this without discussing the total benefits an employee receives. In the UK, most employer-provided 'benefits' are taxable in that their value is deducted from the individual's personal allowance, i.e. the amount they earn before paying income tax. So it's even worse; not only does the employer 'spend' your salary on benefits you may not want, but it also hits your wallet by increasing the amount of income tax you pay. One of the first things I do at a new employer is opt-out of as many benefits as possible. They do not compensate with additional cash, but it reduces my tax burden.

spacecowboy_lon 12y ago
err? do you actualy work in the Uk? the only benefit that it can make sense to opt out of is company car - The major benefit in USA terms is health is all ready provided by the NHS. Do you realy opt out of the pension? when I worked for a big company that was worth 6% tax free - let alone the share save schemes
- dingaling 12y ago
  > the only benefit that it can make sense to opt out of is company car And private health insurance, gym membership and dental insurance, which knocked £900 out of my personal allowance until I cancelled them at my last work place.
  - spacecowboy_lon 12y ago
    Did you not ask if you coudl have the equivelent benefits added to your pension ?