Insurance for a family is now > $20K a year. Look at how many counties this would be half or more of the median pay. The whole situation seems like a melt-down ready to happen.
I live in France, which is known for its good health coverage. However, I know a few people who worked both in France and in the US, and they made more there in terms of purchasing power, even after paying all the insurance required to get at least the same level of protection we get "for free" in France.
I suppose that the situation can be different depending on your occupation. But what I am saying is that it is just a different system. Healthcare is expensive by nature: highly trained personnel, state of the art research, unforgiving safety requirements, etc... and has to be paid for in some way, be it by taxes or by private insurance companies.
"While the U.S. has similar public spending, its private sector spending is triple that of comparable countries".
Another example: someone who has trouble concentrating at work in the US might spend (out of pocket, or through insurance) $1000 a year on an Adderall prescription Where in Germany it’s quite unusual to get an adult ADHD diagnosis, and even harder to get medication. People are more likely to just live with their genetics on this issue, or make non-medical accommodations, and their problems holding down a job or a relationship never become a medical cost on any spreadsheet. Again, I’m not saying one is better than the other, but culturally speaking, a larger number of personal problems faced by Americans are medicalized than in other countries.
This also really shows how #medicareforall wouldn’t automatically solve every problem.
Healthcare in the US is corporate welfare for insurance companies.
Healthcare is expensive. The US government started providing healthcare to old people, rather than letting them die on the street outside the hospital.
But rather than the government paying the full cost of this program (ala food subsidies), the government dictated that providers give them special lower prices. The hospitals want to make up for that money some how, and so attempt to pass on extra costs to others. The next target (private health "insurance") doesn't want to subsidize that cost either, so they negotiate lower rates. The hospitals are still optimistic that they can still fool someone, and so attempt to take it out of helpless patients.
The entire system is essentially musical chairs. This is why after you receive medical services, the hospital will send you a fraudulent bill with a fictitious inflated price list rather than waiting for your "insurance" to cover their part first - they're hoping to luck into a sucker who will mindlessly pay the sticker price rather than the back room reduced rates.
I can foresee a trend of people setting up trust funds for themselves, to reduce the chance of losing their assets to the healthcare reverse lottery. That's really the point we're at - the last attempt at healthcare reform was basically jiujitsued by the health "insurance" industry into making patronizing their cartel mandatory!
When you tally up both government and personal expenditure the US is far more expensive for no valid reason.
Even government spending alone the US system is a bizarre outlier against OECD countries who all have universal healthcare as a core part of their system. When you include personal spending it's plain and clear that vested interests have corrupted your healthcare system.
A no brainer step to reforming the health care market is to force all providers to publish a price schedule, uniform across any payer. We wouldn't accept grocery stores forgoing price tags and instead trying to gouge each person for as much as they can, and any free market rhetoric needs to incorporate that fact.
(Note this is orthogonal to what level of care should be guaranteed by the government)
Different in the same way that Windows 3.1 is "just a different system" than MacOS X 10.14. The U.S. pays 2-3 times as much, and does not provide healthcare to vast numbers of people. Many who do receive health care go bankrupt paying for it; many who think they have insurance find that they are denied it by insurance companies.
For a family of 4, if you make under $98K per year, you're eligible for a subsidy so that you will not pay more than 9.5% of your income in premiums.
That can still be a large burden, but it's a far cry from half or more.
I re-read your comment, and yes, in the context of the healthcare debate, where the subsidies could potentially go away, this is quite concerning.
How will it melt down, won't they just become infirm or die?
It's not just their own problem. They won't simply die and get out of the way of the more fortunate.
Potentially causing the next recession.
Or, we modify the system, the whole health insurance industry and hospital industry causes a recession.
The people who can't afford insurance aren't the people that have substantial generational wealth to lose, generally.
1900s... so, the X-Ray machine had just been invented. Antibiotics, Radiation, Chemotherapy, laparoscopy, endoscopy, the mri, titanium, stainless steel. Medicine was in a relative infancy and outcomes were much, much worse.
To your point, the meltdown is more on the insurance side. The normal, every day providers will just charge patients directly.
The issue is the people who get "left behind"--ones who have large numbers of issues. All our insurance money right now goes to provide for them. If insurance collapses, what happens to them?
You must be joking. In the US, that $20k would barely cover a pregnancy. I’m about to blow $10k on a few dental bridges. It’s insanity.
I know, I know, other conditions apply. But even with young kids (and related pregnancies), my family has not consumed anywhere near what I've paid in premiums the last decade. I'd be shocked if we "got back" 10% of what I've paid in.
I've never heard of it being over $5000. I can imagine that an at-home birth in San Francisco might be that bad or worse, since the midwife needs to deal with the cost of living.
The problem here is "depending on which hospital they visited". There is no need to involve a hospital (full of exotic infections) for a normal bodily function. That is why your cost is so high.
It isn't even desirable that hospital births should be the norm. Besides the financial cost, directly to the consumer or spread out via higher taxes, there are reasons to prefer non-hospital births. Disease is one. Being able to calmly rest with the comforts of home is another.
The real question is why is it so expensive?
When I was growing up in my town with about 1000 kids we had 1 kid who was diabetic, 1 attempted suicide, and 2 serious car accidents.
We had plenty of minor problems like broken bones but you didn’t need insurance to cover these.
So it was maybe 800-1000 working adults covering a handful of serious cases over a 14-16 year time period.
The model you describe, a town subsidizing a few, is why the optimal state of healthcare affairs is the whole of a nation (through taxes) providing healthcare to everyone. It maximizes your healthy pool to offset the costs of the sick.
Theres a completely different mindset in the first world compared to how people in the US behave - if there is anything unusual "its better safe than sorry" in any European country. You still go to the doctor even with a "routine" illness because there is often no expense to you to do so.
But that is the right behavior. You want that at the societal level. Because for every false alarm there is someone developing a crippling or lethal ailment that will dramatically reduce their productivity and cost you substantially more than 15 minutes of consultation and 30 pills would have had they seen a doctor right away.
The US is killing its own citizens to line the pockets of the money hungry just by having its healthcare system be insurance based at all, regardless of if people are insured or not.
> Look at how many counties this would be half or more of the median pay.
Even if your $20K is a correct national average figure for family insurance costs, you can't do that and get meaningful results; insurance costs vary widely between states and localities (e.g., of ACA exchange plans, the statewide as average second lowest cost silver plan costs for states using the federal marketplace range from $459 in ND to $1,185 in WY—and the range of local rates, and/or including the states that don't use the federal exchanges, is even wider.) So you'd need to map local income against local costs to get anything meaningful.
Your link shows $20k / Family too :-) Look at the chart with the caption "Recent from HHS/CMS"
(The costs are you quoting are the monthly costs for a single individual)
The costs do vary, but they do not drop off the way median income does in rural areas.
No, it shows < $20K, not > $20K as you claimed. But, the accuracy of the national average figure is mostly a side issue.
> The costs do vary, but they do not drop off the way median income does in rural areas.
The costs vary enough locally that you can't make anything like a reasonable point by comparing the national cost to local incomes (and, also, you need to consider the effect of subsidies, which are based on income in relation to FPL.) I suspect the reality, before subsidies, may be even worse than what your naive comparison would suggest, but I don't have a lot of confidence in that because I haven't seen, or had time to analyze, national locality data. The bits and pieces I've seen, though, seem to suggest that, while there isn't a simple relationship, local health insurance costs may overall be weakly inversely correlated with local income. But, then you still have to consider subsidy availability—and Medicaid eligibility—to get the real picture.
Note: We don't have the 5-year 2017 ACS data yet (it takes about 2 weeks for us to ingest the data once it comes out).
Disclosure: I'm a developer at IPUMS.
Are these counties where lobbyists live?
Also, it's not $425k for a single family home. It's $425k for a 60-70 year old brick or cinderblock townhome/duplex between 800-1000 sqft that was constructed as WW2-boom housing.
Yes, this is basically an extreme outlier for the U.S. I was surprised to find that it's actually pretty reasonable compared to many urban areas in the world, though - cities like Sydney, Vancouver, Hong Kong and Shanghai are rapidly climbing past Silicon Valley in housing unaffordability.
Lobbyists, senior executive officials, senior Congressional staffers, executives and highly-paid employees of government contractors,...
Not saying they don't deserve it, far from it, just saying there are plenty of high paying jobs (tech or otherwise) in the DC area.
: Page 19: https://www.apsva.us/wp-content/uploads/2018/10/Pay-Plan-18-...
>By metropolitan statistical area:
>Barnstable Town, Mass
As someone unfortunately familiar with the local economy in that cesspool (will global warming hurry up and wash that glorified sandbar away already?) this is a great illustration of how stats like this can be limited.
There is no shortage of money in Barnstable county. It is chock full of old retired people and rich people (with a significant overlap). They mostly happen to have primary residences elsewhere. Lots of people have their primary residence in Florida. The only industry is tourism. For three months of the year there is a firehouse of money directed at Barnstable county. The economic incentives that come with that mean that everyone tries to rip everyone else off and extract maximum value from everyone else (I could go on a pretty good rant about this). The blue collar tradesmen get very good at keeping their income off the books (I don't blame them, not doing so would be a competitive disadvantage). Everyone has an under the table side gig. Many "businesses" pay employees in cash. Jobs are often paid in cash.
Cape Cod is the Long Island of New England. While it's no SF suburb there is a ton of money in Barnstable county. It's just that most of it gets reported elsewhere or never gets reported at all so the county looks poor on paper. The absurdly high cost of living doesn't help (doesn't help the people actually struggling to get by that is). Housing is not as insane as Silly Valley but every other thing is priced outrageously (what the market will bear thanks to tourism) and you can't avoid those costs because you're basically on an island.
So yeah, take those stats with a grain of salt. I suspect the national stats are quite accurate but the county by county numbers are probably not that great.
My guess is that it's by county because this is 2018. The full census is done every ten years. More granular information will come after the next full census.
1) Western and northeastern Wyoming
2) Western North Dakota
3) Northern Alaska
Does anyone know why that might be the case, and where the money could be coming from? (National parks? Military bases? Oil fields?)
Western Wyoming has some crazy huge oil fields and refineries. I would assume similar cases for North Dakota and Alaska as well, but I don't know for sure.
I haven't been in the oil business for a very long time but that was a very common pattern for offshore drilling rigs and the like. The interval of weeks varied from 1 to 4 as I recall generally based on how remote the location was.
Caveats: I'm still using an older dataset (the 2011-2015 one, IIRC), but I'm hoping I can migrate to the new one soon. And because of some boneheaded design decisions I made, the income and housing data is only available at the county level and below, not at the state and statistical area levels.
I also had to wrangle the data in certain ways to get the data in the format i want (median income, median housing cost, and median housing cost as a percentage of income; the source data is segregated by renters, homeowners with mortgages, and homeowners with no mortgages). I've written about this before, and you can find my calculations at https://news.ycombinator.com/item?id=14196287 (and yes I'm comfortable linking it now because I've since set up a robots.txt so Google doesn't crawl every endpoint that algorithmically generates graphics)
And, yes, at some point I'm going to get off my lazy ass and implement Let's Encrypt.
But all of them are representated in Mississippi, which (not “rural areas”) is what was being discussed.
> And "slow broadband" feels hilariously out of place in that list.
Both slow broadband as mentioned upthread, and even moreso low broadband subscription rates as actually covered in the source article, are opportunity-limiting.
I can work remotely with a very basic internet connection. So can others. And you can be a successful developer (in your country, let alone your county) without working remotely.
But on a less anecdotal note, legitimate companies are doing “rural sourcing” of call centers where everyone works remotely and they give you a special boot disk that only runs thier software. They pay better than minimum wage and the requirement is a decent - above DSL internet connection.
Even in a major metro area, in a millennial demographic, I know very few non computer scientists that require much more than a cell phone.
I don't have a video game console...
I've had multiple significant others (sub 30s) who only had a tv and smart phone at home.
Does this mean that ~75% of counties had excatly zero change in median income? Like down to the cent? With or without inflation? This is difficult to believe. Even with stagnant wages you would expect some up and down across the whole country.
In addition, they may have used a threshold value. But it's not noted anywhere.
I'd also assume indeed there was inflation-adjustment.
Well, no, the ACS uses whole dollars as the indivisible unit for income stats. And it is estimated, not actual, with a reported (non-zero) margin of error for each figure in the source. E.g., here's the national median income table for 2017, by various characteristics:
Did you expect it to be different?
In my (rural) area, DSL internet is the only decent option, and I pay about $72/month for it. It's acceptable, streams netflix okay, but I could never be competitive in a FPS. But people around here are more interested in more traditional activities. I think their rate of watching TV and engaging with their phones and other similar measures would be far, far less than the national average. I simply think internet is not a priority; they'd rather be outside. At least in my small bubble.
Shows the positive side of local loop unbundling.
City people drink their beer in a bar. Country people drink their beer standing around a pile of burning pallets.
Er, no, we mostly don't.
> Country people drink their beer standing around a pile of burning pallets.
I suspect they city and country people both mostly drink their beer outside of business establishments, though, sure, standing around a pile of burning pallets specifically may be more common for country folk.
The outdoor options for recreation are somewhat more sparse in urban areas.
The indoor options for employment are much more sparse in rural areas. White collar jobs are overwhelmingly located in urban and suburban areas. You've got teachers and dentists and stuff like that in rural areas but those scale with population so they don't affect the proportional difference between urban/rural.
I mostly agree that rural areas have a higher proportion of outdoor jobs, but it’s still a super small fraction.
> “The outdoor options for recreation are somewhat more sparse in urban areas.”
Do you have evidence for that? My initial reaction is that it’s very likely false. And if it’s not false, the actual difference is not enough to be meaningful in terms of population statistics of how much indoor time / outdoor time people spend as dense urban dwellers vs rural dwellers.
For example, in the northeast US, I exercise outdoors all year except when the weather literally prevents it. But then, it also prevents it in rural places too, likely more often given the city resources that can clear areas for running / biking that couldn’t be similarly cleared in rural areas.
Having grown up in the rural Midwest, I can only say anecdotally that people in large east coast cities exercise much more, do outdoor activities year round much more, go to public beaches, have large city parks, and generally spend more time doing outdoor activities.
Where I’m from in the Midwest, people exercise less, only use cars to go anywhere (even short distances), and the rural roads are such safety hazards that they can’t be reliably used for jogging or biking and people end up driving to fitness centers to do that stuff indoors.
In fact, I would usually just walk or take a train to these activities, and likely could commute to do them faster than people not in a city. Hunting is probably the main exception, but I don’t think it's meaningful for the point of this thread.
One of my primary hobbies in Boston was taking a bus to the Middlesex Fells nature reserve and hiking all day to find geocaches. Most people I knew also primarly engaged in outdoor, physically vigorous activities like kayaking/rowing, long distance jogging and bicycle riding.
An internet connection isn't regulated as a utility. As far as the law is concerned, the internet is a luxury item so access/quality/cost is set by the market. Telephone companies (or I should say, company: Bell) operated in much the same way 100 years ago until state utility commissions started to regulate them as utilities and cap the price they could charge for local calls. Since the state had no jurisdiction over long-distance charges, those prices skyrocketed to make up the difference. In the 80's the DOJ finally wrapped up the antitrust case against "Ma Bell" that broke the company into several smaller phone service providers. With a lot of competing operators the prices were reasonable. More importantly, while telephone service was regulated as a utility the state utility commissions had largely required Bell to wire rural areas for service the same as they had wired cities.
It can be argued that internet access is more of a utility today than it was in the past, and is likely to become increasingly more crucial for folks to have. Many local, state, and national communications are over the internet, more and more jobs require it to some degree (and having internet helps find new jobs more than not having it). donald's 'official' communication mechanism is twitter, which requires internet access.
> The term utilities can also refer to the set of services provided by these organizations consumed by the public: Coal, electricity, natural gas, water, sewage, telephone, and transportation. Broadband internet services (both fixed-line and mobile) are increasingly being included within the definition
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