Living in the US
- Thread starter philiphifi
- Start date
cubastreet
Espresso Fiend
AFAIK the problem was that people didn't want to pay for the healthcare of others, because socialism is bad.
mjw
pfm Member
I’ve encountered that too. Speaking with (otherwise quite reasonable) friends in Florida, they view any form of welfare state as being ‘others getting something they’re paying for’ but without them having a say. They weren’t that angry or even grudging about it, they just don’t get it as a system.
sean99
pfm Member
It's more complex than that. Before the ACA passed the protests were all about bogus socialism scares and having to pay for others insurance.
These days the protests are about the high cost of ACA plans. Obamacare made illegal skimpy health insurance plans that did not protect people from bankruptcy and did not pay for child delivery among other things - i.e. trash insurance. Thus folks claim that their insurance that used to only cost $250 a month now costs $1000 a month, but they are not comparing like with like (though they would not realize this unless they got sick).
In short after the ACA a whole lot more folks were exposed to the true (ripoff) cost of US healthcare and they're mad about it (as they should be). Unfortunately they blame the ACA instead of the medical providers and insurers who profit so handsomely from the ripoff prices.
These days the protests are about the high cost of ACA plans. Obamacare made illegal skimpy health insurance plans that did not protect people from bankruptcy and did not pay for child delivery among other things - i.e. trash insurance. Thus folks claim that their insurance that used to only cost $250 a month now costs $1000 a month, but they are not comparing like with like (though they would not realize this unless they got sick).
In short after the ACA a whole lot more folks were exposed to the true (ripoff) cost of US healthcare and they're mad about it (as they should be). Unfortunately they blame the ACA instead of the medical providers and insurers who profit so handsomely from the ripoff prices.
Minio
Kind of Sort of Not really...
That’s a good explanation Sean and solved my puzzle.
In the U.K. we pay a flat tax of just over 26% of income in NI contributions for health and pension, they say. There is a ceiling on them though.
That’s a sort of socialistic system but I don’t hear many complain very loudly. This is employer and employee contributions so it cunningly diffuses the impact of such a tax.
It’s a shame that a better insurance system could not be implemented in the US. It seems as if a chance has been missed.
In the U.K. we pay a flat tax of just over 26% of income in NI contributions for health and pension, they say. There is a ceiling on them though.
That’s a sort of socialistic system but I don’t hear many complain very loudly. This is employer and employee contributions so it cunningly diffuses the impact of such a tax.
It’s a shame that a better insurance system could not be implemented in the US. It seems as if a chance has been missed.
Marky-Mark
pfm Member
ACA joy really depends on income bracket. If you were uninsured before the ACA because your job didn't provide it and you couldn't dream of affording insurance, the lower plans were certainly better than nothing, and you'd pay about $25 a month for a $15 copay on meds and deductibles in the $600 range. After that you were covered for most major medical at roughly 80/20. If you were coming from an employee plan or a private plan you liked for whatever reason, and you have a decent income, happiness can definitely wane. Also, plan prices went north with some insurers because -they claim- the uncertainties of whether the ACA would survive Trump's meddling made for 'difficult' plan pricing. Some of those companies, thanks to an ACA regulation on how much an ins. company spends from ACA income, are having to pay back millions of $$ directly to plan holders regardless of the policy holder's share vs. what taxpayers actually paid. So if the guy paying $25 a month on a plan that actually cost $2000 a month, the refund % is based on $24,000 and not $300.
jtrade
pfm Member
I spent '96-97 living in Northern California & did not find it expensive at all, having come from London. However, I was living a very alternative lifestyle with a large household of others for whom meditation was a regular daily activity & was relying on long-trip travel insurance in case of health emergency. The household had all sorts, from a successful software engineer pulling in mid-6 figures, to a window cleaner (being California he almost made 6 figures by working very hard), so not the sort of situation the OP envisages. For a conventional lifestyle, health insurance is indeed the one extraordinarily expensive challenge.
That said, the USA is an amazingly beautiful country with so many wonderful places to live & lots of very welcoming people. I used to be amazed at how anti-US so many Europeans are, based largely on US foreign policy and political leadership (which I'd agree often beggars belief) - now I've got used to it. For those who have the opportunity to spend a period of their lives living there, I would say give it serious consideration : I know quite a few who have done so, not all of them high earners, and all have enjoyed it (some stayed).
I will not go back, but only because Italy is calling me to return (my favourite country overall).
That said, the USA is an amazingly beautiful country with so many wonderful places to live & lots of very welcoming people. I used to be amazed at how anti-US so many Europeans are, based largely on US foreign policy and political leadership (which I'd agree often beggars belief) - now I've got used to it. For those who have the opportunity to spend a period of their lives living there, I would say give it serious consideration : I know quite a few who have done so, not all of them high earners, and all have enjoyed it (some stayed).
I will not go back, but only because Italy is calling me to return (my favourite country overall).
sean99
pfm Member
Healthcare costs have tripled since the late 1990s.
https://www.healthsystemtracker.org...-health-spending-has-grown-substantially_2017
In the late 1990s if you were employed your employer would cover almost all costs - a visit to the doctor was maybe $10 and similar for pharmacy, perhaps $50 to go to the ER. Now almost all plans involve very large out of pocket spending (up to $12k) before insurance kicks in. Thus your kid's trip to the ER for stitches that would have been $50 is now $2500 out of your pocket. A 15 minute talk with your doctor is $250.
It's unfortunate, because it is an interesting experience to live in the US, but I think for the average European citizen they can surely come for work, but be prepared to leave immediately that your employment comes to an end.
Plus if you want to visit US national parks it's often easier to do that with 4 weeks of vacation and a fly-drive than trying to squeeze it into 2 weeks of US vacation time.
https://www.healthsystemtracker.org...-health-spending-has-grown-substantially_2017
In the late 1990s if you were employed your employer would cover almost all costs - a visit to the doctor was maybe $10 and similar for pharmacy, perhaps $50 to go to the ER. Now almost all plans involve very large out of pocket spending (up to $12k) before insurance kicks in. Thus your kid's trip to the ER for stitches that would have been $50 is now $2500 out of your pocket. A 15 minute talk with your doctor is $250.
It's unfortunate, because it is an interesting experience to live in the US, but I think for the average European citizen they can surely come for work, but be prepared to leave immediately that your employment comes to an end.
Plus if you want to visit US national parks it's often easier to do that with 4 weeks of vacation and a fly-drive than trying to squeeze it into 2 weeks of US vacation time.
sean99
pfm Member
I can believe that - it's usually my first thought when there's a mass shooting - those that are not killed are likely to have large out of pocket costs, and hours on the phone fighting their health insurer to pay. A Las Vegas hospital group waived costs for the Vegas mass shooting:
https://www.reviewjournal.com/local...ives-medical-costs-for-mass-shooting-victims/
which I thought was a good gesture, but you're right that no civilized society should a) allow the sale of guns in the way the US does and b) bankrupt people due to medical costs.
https://www.reviewjournal.com/local...ives-medical-costs-for-mass-shooting-victims/
which I thought was a good gesture, but you're right that no civilized society should a) allow the sale of guns in the way the US does and b) bankrupt people due to medical costs.
Minio
Kind of Sort of Not really...
At least Americans don’t waste the doctors time. This is due to the cost.
I know people that go to the doctor in Britain with all sorts of silly things like colds and acne.
I even know someone that booked a doctors appointment weeks ahead just in case they might need it.
Spoilt brats aggravating an already overloaded system!
I know people that go to the doctor in Britain with all sorts of silly things like colds and acne.
I even know someone that booked a doctors appointment weeks ahead just in case they might need it.
Spoilt brats aggravating an already overloaded system!
Americans vote for politicians that treat the poor like animals. Its quite shocking to see the vast inequality over there. A sign of things to come in after the Tory Brexit.
For child birth most of the colleagues I spoke to considered it completely normal to expect a bill of $20-30k. That is for a routine birth with only a couple of days in hospital. If there are any complications with the birth such as premature birth requiring time in the ICU, the bill can rapidly go up to hundreds of thousands. The policy we had when covered all costs, but the policy cost my employer $50k!
misterdog
Not the canine kind
Good post, though many see the higher incomes available and go whoopee.
Did you mention pensions ?
By the time you factor in the healthcare and pensions, life looks less rosy.
The biggest cause of bankruptcy in the US is healthcare costs.
We take the NHS for granted here, but get shot or in a car accident over there without GOOD medical cover and you are f**ked.
House prices are much cheaper as they are built from cardboard.
misterdog
Not the canine kind
Most medical facilities are lumbered with vast insurance costs.
The insurers are suffering from vast awards after any court case.
We had one $200k claim that was awarded £5m punitive damages; overturned on appeal but costs were rather a lot.
I feel the US market is learning a lesson but slowly.
The insurers are suffering from vast awards after any court case.
We had one $200k claim that was awarded £5m punitive damages; overturned on appeal but costs were rather a lot.
I feel the US market is learning a lesson but slowly.
Derek Wright
pfm Member
For several years we visited Az, NM, Co and Ut for 3 to 4 weeks each year in the Fall. This was during the times of the great Obamacare planning and rollout.
Once the locals discovered we were from the UK we were often asked how we were treated in a regime of socialist medicine. We would reply OK, I would describe my back surgery and how much it cost me and how I was treated (£0 and good). Sometimes the grilling could be quite aggressive, we had quite a grilling one breakfast in a hotel by a sales rep for one of the medical insurance companies. She did not want to listen to our experience of the NHS as she knew the answers.
One very notable discussion in southern Colorado town was with a young woman who was soo aggressively against Obamacare as it was an infringement of ones civil liberties. She cited a local business that had closed down because it was now required to contribute to the medical insurance payments for its employees. The company owners fervently disagreed with abortion and that as the medical insurance premiums could be used to pay for abortions (ignoring heart transplants and ingrowing toenails) and as it was not possible to fence the premiums so that they could only be spent on morally approved procedures.
As an employer they were not able to opt out of paying the medical insurance premiums they closed the company down, sacking quite a few people.
Once the locals discovered we were from the UK we were often asked how we were treated in a regime of socialist medicine. We would reply OK, I would describe my back surgery and how much it cost me and how I was treated (£0 and good). Sometimes the grilling could be quite aggressive, we had quite a grilling one breakfast in a hotel by a sales rep for one of the medical insurance companies. She did not want to listen to our experience of the NHS as she knew the answers.
One very notable discussion in southern Colorado town was with a young woman who was soo aggressively against Obamacare as it was an infringement of ones civil liberties. She cited a local business that had closed down because it was now required to contribute to the medical insurance payments for its employees. The company owners fervently disagreed with abortion and that as the medical insurance premiums could be used to pay for abortions (ignoring heart transplants and ingrowing toenails) and as it was not possible to fence the premiums so that they could only be spent on morally approved procedures.
As an employer they were not able to opt out of paying the medical insurance premiums they closed the company down, sacking quite a few people.
palasr
>>>...<<<
Some perspective from a lifelong US resident in upstate NY. I'm a relatively spry 50, and have had the same employer for more than 20 years. I work at a technical university that employs over 3000 people, and we have a choice of three different medical insurance plans, all of which are very good. Being unwed (albeit living in sin for 25 years) without children, my healthcare insurance (Capital District Physicians Health Plan) costs exactly $7145 per year, with my employer covering 75% of the costs leaving the remainder being deducted from my pay. My yearly deductible (the maximum amount I'd have to pay out of pocket regardless of procedure) is $5000. Some procedures require pre-approval from my insurer (for example, I'm about to have a cardiac CT scan with contrast that required pre-approval). I've never come close to having to pay $5K for any medical procedure (and I've injured myself severely a couple of times in the last 25 years) - this unfortunately varies by plan, location, quality of insurance and the size of one's employer - smaller companies are charged more per employee since they have less employees enrolled in any given insurance plan - there is, in other words, strength in numbers as to how much one's healthcare insurance is going to cost out of pocket. Folks I know who are self-employed pay approximately $12000 per year for the equivalent coverage I have. I also consider myself lucky in that we have a large, regional health-care collective whereby most folks get locked into one provider for all services - these collective providers (there are approximately four regional networks) compete with one another, but in the end most folks eventually get settled into one regional health care network. My primary care provider, my cardiologist, my any specialist you can imagine all work under the auspices of this one network. I'm free to use a physician outside this network, but this is where that pesky deductible begins to dig in - this out of network provider may or may not adhere to the set guidelines from my insurance provider - any charges out of range would also be out of pocket. If for example, I'm injured while travelling domestically and have to seek out medical assistance, my insurance would pay only the amount had the service been provided locally, or on a scale averaged for a particular region. Prices for healthcare vary wildly all over the country; even within the same city, the same procedure performed at different hospitals can be bizarrely different in price.
I take two meds - a statin and an ACE inhibitor. 90 days supplies of each cost me approximately $1 to fill (at my current pharmacy - my old pharmacy charged me $10 for one and $5 for the other).
Dental insurance is completely separate from medical insurance. All things optometry (contacts, eyeglasses) are not covered by insurance, although yearly eye exams are covered. Ophthalmology is considered medical and is covered under health insurance. Cosmetic surgery is not covered at all.
I am all for the eradication of private healthcare insurance and demolition of the for-profit medical system we currently have, favoring something along the lines of the UK or Japanese system - all procedures have a fixed price regardless of where they are carried out or by whom; physicians and hospitals are compensated at a sane rate (there's no reason for a surgeon (or anyone for that matter) in the US to make millions of dollars per year). I would rather pay into a system that guarantees healthcare for all citizens, not just those who are employed or who can afford it. Healthcare (like education) is a basic fundamental human right - there are no downsides to having everyone educated and healthy.
If you have any other questions, feel free.
I take two meds - a statin and an ACE inhibitor. 90 days supplies of each cost me approximately $1 to fill (at my current pharmacy - my old pharmacy charged me $10 for one and $5 for the other).
Dental insurance is completely separate from medical insurance. All things optometry (contacts, eyeglasses) are not covered by insurance, although yearly eye exams are covered. Ophthalmology is considered medical and is covered under health insurance. Cosmetic surgery is not covered at all.
I am all for the eradication of private healthcare insurance and demolition of the for-profit medical system we currently have, favoring something along the lines of the UK or Japanese system - all procedures have a fixed price regardless of where they are carried out or by whom; physicians and hospitals are compensated at a sane rate (there's no reason for a surgeon (or anyone for that matter) in the US to make millions of dollars per year). I would rather pay into a system that guarantees healthcare for all citizens, not just those who are employed or who can afford it. Healthcare (like education) is a basic fundamental human right - there are no downsides to having everyone educated and healthy.
If you have any other questions, feel free.
cctaylor
pfm Member
The other side of this I am sure some patients in the US avoid necessary appointments due to cost, affecting their health and life expectancy.
We do need to find a way to take the load off our GPs. Some kind of triage system screening patients using suitably trained staff. Our surgery uses nurse practitioners and para medics. When my mother passed away at home it was a nurse practitioner who came out to confirm that she had died. This saved a half hour of a doctor's time. Can't be done in all cases, but mum's death had been expected so was suitable.