

Ask HN: Is USA that bad when it comes to health insurance, etc? - dotslash

In Sweden we annoyingly socialist and have completely ridiculous taxes.
Any discussions on this subject with swedes usually results in the other person saying something like "What do you want, a society like the USA where people can't afford healthcare and you have homeless people everywhere?"
Now, how accurate is that? Is it actually a problem to pay for premium insurance and save up to your childrens college degree, etc?
======
aquila
Recomendation: Come check out Vienna Austria first.

I am a "U.S. Citizen", "born in the USA", whose parents were also "born in the
USA". I moved my family to Vienna, Austria 8 years ago. I have for 4 years,
owned and operated my own business, a GmbH here.

Vienna. The #1 city in the world 2 years in a row.

<http://www.mercer.com/qualityoflivingpr#City_Ranking_Tables>

First U.S. City, HONOLULU is at #31 with San Francisco at #32.

Insurance: US versus Austria

Three years ago, my daughter, at the age of 14, was diagnosed with morbid
Juvenile Rheumatoid Arthritis, a life threatening condition. She spent 4 weeks
in a hospital, with the total out of pocket cost of 280 euro for her meals.
100 % of the hospital costs and medical procedures was covered by insurance
which costs my family 2400 euros per year.

In the U.S., in 2003, we paid $15,000 per year for insurance, with a $5500 per
person deductible. My wife had her Gaul Bladder removed, and it cost us
$11,000 deductible + all of the customary procedures which the insurance
companies routinely refuse to pay until you take them to court.

My daughters hospital stay, and continuing medical treatments in the U.S.
would certainly have led to a filing for bankruptcy (70 percent of all
bankruptcy filings are due to medical bills). Instead, the annual costs of
treatments in Austria is 240 euros per year, continuing hospital visits, and
Methotrexate Injections.

FYI: Higher education is 100% taxpayer funded in Austria.

As long as a large majority of the U.S. voting public continue to believe that
taxes are "theft" rather than paying their "fair share" of the "high financial
costs of personal freedom and safety", and continue to refuse to admit that
affordable healthcare is a basic human right, staying in Europe is a much
better option in my opinion.

~~~
aquila
I fully expect the Republicans to come into the majority in the November
elections, and for McCain and Mitch McConnell to keep their shrill promise to
gut the Obama healthcare law of its protections. And oh yes, I am a
conservative republican.

~~~
akl
I find your comment confusing. Do you believe they should be trying to gut the
Obama healthcare laws?

~~~
nl
I think that anyone who uses the word "shrill promise" to describe something
usually doesn't agree with what they are saying.

------
all
I used to be self-employed in the US and left in part because of the expense
of health insurance. At the time, I had a family of three. When you declare
yourself self-employed in the US, you are immediately projected into the
highest tax bracket of (if memory serves correctly) 37.5%. Decent health
insurance for three cost worked out to be around 40% of that at the time. So,
to be self-employed with healthcare cost me around 52% of my then gross
salary. And that is just for the plan - there is still a huge excess as well
as a plethora of things that the insurance companies won't cover. If memory
serves correctly, something like 40% of those in the US are without
healthcare. At costs like that, little wonder why.

As for poverty in the US, 1 in 8 are in poverty if you use the CIA-polished
statistics. I say CIA-polished because the CIA also says the US spends 12.5%
of its GDP on healthcare. According to the OECD, it is more like 15.3%. By
comparison, France (top healthcare in the world according to the WHO) spends
around 9.5% or so. Canada, number 6 in the world, spends something similar,
around 9.7%. The UK, which is somewhere around 20th on the WHO rankings,
spends 6.25%. For its 12.5%/15.3%, the US ranks 33rd - just above Cuba.

As for saving up for children's college, university educations are an
increasingly well-known bubble in the US. It is not uncommon to have 70 or
even many more students packed into a single auditorium for lectures. Even in
advanced degrees, there is not as much small group or singular education as
there is in Europe. But the costs are nevertheless huge. If I recall
correctly, American University in DC currently tops the charts with tuition at
$50k per year. That is tuition ONLY. It does not include, books, dorm,
clothes, etc. A four-year degree thus has a base cost of $200k. It is nothing
anymore for universities to charge $25-30k per year just for tuition. Given
that this is the case at a time when many people are losing their houses
because they can't make the payments and others can't get on the property
ladder because they can't afford the down payment, I would say it is damn hard
in the US to pay for things that people in Sweden take for granted.

Just my 2¢. YMMV.

~~~
anamax
> As for poverty in the US, 1 in 8 are in poverty if you use the CIA-polished
> statistics. I say CIA-polished because the CIA also says the US spends 12.5%
> of its GDP on healthcare. According to the OECD, it is more like 15.3%. By
> comparison, France (top healthcare in the world according to the WHO) spends
> around 9.5% or so.

Note that US GDP is also significantly higher.

Also, healthcare costs are affected by things that healthcare can't actually
affect. Consider obesity.

Also, the existence of working govt programs in other countries does not imply
that the US govt could do as well with comparable programs. For example, the
US govt spends about as much per person as France does. Since the US govt
services appear to be significantly worse ....

No, military spending doesn't account for the difference.

~~~
all
>Note that US GDP is also significantly higher.

Maybe I am missing something, but this should mean that the US can afford to
do more. No?

>No, military spending doesn't account for the difference.

I didn't say anything about military spending. Where is that coming from?

~~~
anamax
> Maybe I am missing something, but this should mean that the US can afford to
> do more. No?

It implies that spending a larger fraction of GDP on healthcare can be
acceptable, but you suggested that spending a larger fraction of gdp on
healthcare was a bad thing.

So, what do you have in mind by "do more"? (Of course, being able to afford to
do more and actually doing more are very different.)

> >No, military spending doesn't account for the difference.

> I didn't say anything about military spending. Where is that coming from?

"military spending" is the typical reply when someone points out that the US
govt spends as much per person as "high tax, high service" countries yet
doesn't provide the same level of services.

Spending money may be necessary, but it isn't sufficient.

~~~
all
Okay, I think I see where you are coming from. Let me clarify what I said.

> you suggested that spending a larger fraction of gdp on healthcare was a bad
> thing.

I was probably in a rush when I wrote 'do more' and so apologise for any
confusion. My meaning was not communicated well. If the data say anything, it
is that the way the money is spent counts more than how much money is spent.
That being said, getting the medical establishment and Big Pharma to take a
pay cut is a Herculean task.

> "military spending" is the typical reply

I suppose for some it is, and the US does spend plenty on war. But I would
agree with what I understand as your underlying point: The money needs to be
spent better before more money is spent on anything.

~~~
anamax
> That being said, getting the medical establishment and Big Pharma to take a
> pay cut is a Herculean task.

Apart from the obvious cases of fraud (which seem to be concentrated on govt
programs) and reducing some of the monopolies (including things that should be
OTC), it's not clear that they're significantly overpaid. (Yes, I know about
the "marketing" argument, but that includes free drugs to poor people and it's
how folks find out that what they have is treatable. I see both as good. And
allowing old people to have sex is a good thing.)

We want people buying Cadillacs (and Mercedes) because that's how we get good
things in Toyotas.

A lot of US health spending is triggered by things that are outside the
healthcare system. The only thing that the healthcare system can do is refuse
coverage, and no one will admit to that.

~~~
all
>A lot of US health spending is triggered by things that are >outside the
healthcare system.

Can you give examples of this?

------
Lewisham
Even after all other factors that are mentioned already, the one significant
difference I feel (having come to the US from the UK) is one of constant fear.
Can I afford to go to the doctor with my co-pay? If something bad happens to
me, will my insurance company look after me, or do whatever they can to ensure
they don't pay out? If I get a terminal disease, will the co-pay for the
medication I need to live as long as I can bankrupt my family?

With the NHS, while the Brits like to complain about it, the fear isn't there.
You will always be looked after if you need to be. Here... I'm not so
confident.

~~~
_delirium
Yeah, this is the biggest issue for me too (as an American who hasn't lived
anywhere else). In particular, the tying to your employment status makes
everything complicated and coverage uncertain for everyone except career
employees who stay with one firm. For example, I switched from a full-time
student to part-time for one semester in grad school. Oops, this means I don't
get the student health insurance anymore and have to buy gap coverage. So I
had to research gap insurance, fill out a bunch of paperwork, wait to be
approved, and then still hope that I don't really have to use it, because now
the recent change in insurance gives them excuses to claim things were
preexisting and thus excluded.

And I don't even have any major chronic conditions! People with major chronic
health issues are pretty much required to stay in their current job forever,
because if they lose their health insurance they're screwed. The whole
employment-tying thing puts a huge drain on entrepreneurship, imo, because
lots of people who would start companies are scared of losing their health
insurance, and even if you can figure it out, it's a huge bureaucratic hassle.
One area where the private sector has managed to gallantly out-bureaucratize
any government.

In short, I really, _really_ wish that health-insurance was completely
decoupled from employment. It would reduce a lot of friction in the economy,
imo.

~~~
phaedrus
Can't upvote this enough.

On NPR an economist said that one thing that makes the US economy different
(in a good way) from the EU economy is the extreme mobility of our workforce -
that when times are tough, a reasonable portion of US people can and will pack
up and move to a state where they can find jobs. If that is true, conversely
isn't the effect of having health insurance so tightly coupled to employment
equally _detrimental_? I mean it just blows my mind that we tie employment and
healthcare together.

------
beagle3
College degree is probably not too bad if you settle for local community
college -- about $5,000/year or so. Private universities and colleges can
easily get to $30,000/year.

As for healthcare, it IS that bad. Most working people have reasonable
coverage (some of then even at reasonable price, as a percentage of income).
However, it ties the worker to the employer. If you get fired, you lose your
health insurance. If you quit, to move to another job, you lose your health
insurance and have to get a new one (and at least until the recent healthcare
laws, they didn't have to accept you -- sucks if something happens during your
first job, because it's a "pre-existing condition" for the new one).

The end result is that employees are often held captive by their job because
of the (essentially unrelated) health benefits. A friend of mine married 6
months earlier than planned to get coverage because she lost her own job.

Job mobility is much harmed.

There's COBRA -- an insurer must let you keep paying for one more year.
However, the employer subsidy is gone, so people who pay $200/month all of a
sudden find themselves having to pay $1200/month after quitting their job (or
being fired).

------
JereCoh
My family nearly went bankrupt from my mom's cancer treatment even though we
had health insurance. Until the recent healthcare reform, yearly and lifetime
limits and the ability to deny coverage due to pre-existing conditions after
enrollment were allowed. My cousin who is healthy but has severe asthma has
been unable to attain health insurance on his own since graduating college. He
works two part time jobs, but does not have employer sponsored health
insurance. The American system is broken and the people who'd benefit the most
from fixing it are more concerned about "death panels" that don't exist than
looking out for one another.

------
exline
If you work for a typical company, health insurance isn't a huge deal, mostly
because the company picks up most of the tab. Its part of the benefits
package. You will still typically pay $100-400 a month out of pocket depending
on if you have family and kids. That also may include dental and vision.
Dental is common, vision is not.

If you are self employed or work at a small company, then insurance is a big
deal. I'm going to pay $6K a year for crappy insurance and I'm still going to
pay $7k out of pocket expensive this year because my son had to have surgery
and our deductible is 7500. So I think the insurance situation sucks. And I
got a notice yesterday that they are raising my rates again. For small
business that want to cover the health insurance for their employees it is
also a big expense and one that keeps rising. It amazes me that insurance
companies can raise rates 15-40% a year and get away with it.

As far as saving up for college education, that is not as difficult because it
is a matter of living within your means. Make it a priority and save. That
said I have different views on fully paying for 4 years of college vs. having
my kids pay part of their way. My parents put me through my first year of
school and then I was on my own. I tended to work hard at school (to get it
finished) than those I know who's parents were footing the bill.

------
donohoe
I've been in the US for almost 10 years, and its been only the last 6 years
that I have had health insurance.

If I were still in Ireland I would pay about 1600 Euros a year to give full
coverage to me and my family (wife + 2 kids).

In The US I pay just under $400 on every paycheck (my employer also pays a
hefty amount), so thats aprox $4900 a year. That does not include dental, or
vision.

I would also add that while my plan isn't bad, its not as good as the Irish
equivalent - hard to compare though.

 _Side Note:_ You should prefix the title of this with "Ask HN:"

------
frankus
Like pretty much everyone has said, the health care situation is Not That Bad
if your employer covers it, and if you don't get seriously ill or have an
expensive chronic condition.

But health insurance is one of the few ways in which the US really discourages
entrepreneurship. Individual health insurance, particularly if you're older,
have a family, or have some kind of risk factor, costs a fortune.

The conventional wisdom on homeless people in the US is that the vast majority
of the homeless got that way because of mental health problems and substance
abuse. I believe it's more of a public policy issue than strictly a lack of
money.

------
rikthevik
I've heard too many horror stories (and from people with supposedly good
insurance) to consider moving from Canada to the States. Illness in the family
is hard enough without a serious likelihood of bankruptcy. The Canadian system
certainly has issues, but for the most part I think it works okay.

Can any other Canadians comment on their experiences? Are there any who would
prefer American-style healthcare?

~~~
lotusleaf1987
Pfff...are you kidding me? Let me give you an example I have mid to mid-
premium insurance. I went to a new dentist a while back and he tells me he
needs to take xrays which seems normal, only this time the xrays go on, and
on, and on. He takes 32 x-rays of my teeth (while I am asking if this is
absolutely necessary and he continues to say 'yes, yes it is'). My insurance
company denies the bill, passes it on to me for $10 per xray (they covered
8).... Another time I went to the doctor for an ingrown hair, had them give me
a cortizone shot and got a bill for "surgery" for $200. It's highway robbery
and there's nothing you can do about it. Most Americans just put up with it
because they don't know what else to do. You pay for insurance and then the
insurance doesn't even cover basic stuff like it should, they try to get you
to get so frustrated that you'll give up and just pay it. It's a broken,
horrible, frustrating system.

~~~
tdfx
I recently had something similar happen to me. I've got an individual PPO plan
and my "routine checkup" was over $400. It was less than 15 minutes long...
insurance company notified me that I am responsible for $171 beyond the $30
co-pay that I was required to pay at the checkup. I'm not sure sure whether to
blame the insurance or the doctor, as both are clearly screwing people out of
money.

------
acqq
You have to read:

[http://blogs.msdn.com/b/michkap/archive/2010/03/21/9982732.a...](http://blogs.msdn.com/b/michkap/archive/2010/03/21/9982732.aspx)

Written by the programmer who got multiple sclerosis in U.S. How he suffered
because of the system. A good example of something "only in America" (from the
Europe perspective of course).

------
jon_hendry
Yes. But the more important thing is the non-negligible possibility of losing
coverage completely due to job loss.

------
startupcomment
Note to fellow HN readers in the U.S.: Please ensure that you have at least
some basic health insurance even if you are self-employed or unemployed or you
do not have access to health insurance through your employer. You should be
able to find a relatively cheap policy if you are single and elect a high
deductible. While the likelihood of a major medical illness is relatively low
for healthy, young individuals, you never know when medical catastrophe can
strike. I know couple of young individuals who were tragically diagnosed with
cancer and did not have health insurance. You do not want to find yourself in
such a position. Thank goodness Congress enacted health reform earlier this
year. While the bill is not perfect, I personally am pleased that it includes
a health insurance mandate.

------
startupcomment
Agree with other posters. If you do not work for a sizable private or public
employer, health insurance can be costly. I have a fairly good deal with the
health savings account I have - about 150 / mo and 1200 per annum deductible -
for a PPO plan with very good preventive, major medical, and prescription drug
coverage.

On the other comment, yes there are some parts in the U.S. that are very poor
off, especially in parts of the older cities and in rural areas. My parents
just returned from a visit to a very high per capita income European country
and were somewhat surprised with how clean and orderly and relatively well off
all of the cities / towns they visited were.

------
Spechal
I am trying to move to Canada for health and business reasons. I was recently
apprehended for helping a man with psoriasis obtain medical marijuana for his
condition. Now I face 3 felonies and cannot leave the country for 5 years.

Thank you America

------
fbnt
I'm not American, so I can't really say anything on the subject, but one thing
that always shocks me is that while American's health care is strictly bounded
to their jobs, yet lots and lots of them seems to have no or little savings,
and some even use credit for relatively small purchases.

If I were to live without enough money in the bank to sustain myself for at
least a couple of years without a job, i'd be truly scared, even here in Italy
where the health care is all paid. I assume it's mostly just a different
social behaviour/mindset, nobody can really tell if it's better or not.

------
ZeroGravitas
The part that sounds really bad to me is you (or your wife/child) getting some
kind of long term disease and you losing any health coverage if you're forced
(say by losing a job) to move from one insurance policy to another as it will
then be classed as a pre-existing condition on the new policy.

It's the kind of thing that won't affect everyone, but if it affects you then
it's truly life-changing in the bad sense.

I'm not actually in the US so can anyone there comment on this scenario?

~~~
thyrsus
Currently, if you are continuously covered by health insurance, you can
usually move from one insurer to another without being disqualified for a
"pre-existing" condition. If you let it lapse for any period, you're in deep
trouble.

Disqualification due to pre-existing conditions are regulated out of existence
by 2014 under the recent health care law; some classes (e.g., children) are
protected earlier (as early as this fall, if memory serves). One of the major
drawbacks of the bill is that it is so complicated, almost no one understands
it.

------
illamint
I transitioned recently from my parents' insurance which they pay for
themselves as small business owners to the insurance my employer provides,
which is probably the best insurance situation I could possibly be in. I pay
about $16 a month on my paycheck for no deductible, very high lifetime limit,
essentially unrestricted healthcare coverage, and pretty decent dental and
vision as well. I'm lucky I love my job, basically, because being in my
parents' situation where they paid thousands of thousands of dollars a year
for practically no preventative coverage would be pretty awful if anything
actually happened.

Basically, if you work for a large company and are in a large insurance pool,
life's probably pretty good. If you're a small business owner, fresh out of
college, unemployed, or have a preexisting condition that can't get covered
for whatever reason, you're potentially quite screwed.

------
stonemetal
Health insurance costs me a little over 200 a month(pre income tax) to cover
my family(full health, vision and dental).

The homeless people thing is much harder to quantify. What do you mean by
homeless people everywhere? I was 30 before I ever ran across anyone actually
sleeping on the street. There are however homeless shelters were anyone can
walk in off the street for a place to stay temporarily.

~~~
xlorm
Where were you living before you were 30?

~~~
stonemetal
Texas( various cities including a few big ones like Dallas).

