> We estimate that these laws [mandating safety seats] prevented fatalities of 57 children in car crashes in 2017 but reduced total births by 8,000 that year and have decreased the total by 145,000 since 1980.
Car seats as contraception is just a specific enumeration of the general. "busybodies as contraception" problem wherein the "has so few real problems they stop minding their business and mind other's business" classes try to force priorities on the rest of society that the rest of society can't yet afford to have. And it's not just contraception or kids. Pretty much everything in our economy gets shot in the foot by this to some extent.
Contraception is a bargain deal for any class, assuming you were not intending to have a kid.
I also question the idea that safety regulations (let's call them that) are the result of a class of people who have "so few real problems they stop minding their business and mind other's business." I get the idea, but couldn't the high cost of obstetrics and child car seat requirements be due to the wishes and decisions of people outside of this supposed class?
Car depend infrastructure is amazing to families. A mom can take her children to the grocery store in a car in relative safety without worrying about mentally ill homeless people on the subway.
Why would you need to get on the subway to go to the grocery store? When I lived in Paris I was within a five minute walk to at least three general grocery stores plus various speciality shops. Always plenty of parents all around. This is not uncommon in properly designed non-car dependent cities. Not to mention deliveries are just that much easier and all without a car.
It's pure facts. I used to live in a city where me and my wife were terrorized by homeless people on the light rail. Now we live far away from public transportation and no longer have to worry about the safety of ourselves or our children and our neighbors are fantastic people.
Car dependency and castle doctrine is essential in a low trust society with a legal system that puts violent offenders right back on the street.
Moving in a private vehicle is statistically the most dangerous activity an otherwise healthy young person routinely participates in. Your family is almost certainly at higher risk of death and serious injury now because you based this decision on your perception of safety rather than evaluating the reality of it. Speaking of "pure facts."
Surely the priority should be to help those with mental issues and those without homes? It's bizarre to want to live in a society that prioritises car use so that people don't have to see those discarded by the same society.
I actually thought about including this in the piece (and how car sizes become a problem once you hit 4+ kids) but decided to keep it more focused on just the healthcare costs
Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading. Presumably, you'd be paying those even if you didn't have the child. That said, the cost of health insurance for a family is pretty outrageous. My premiums are along the same lines as the ones here (although less noticeable since they're paid by my employer).
Had the same reaction when I saw how the 40K was calculated (BTW I strongly believe in Medicare for all to control costs and to pay for civilization. To be paid out of progressive taxes on all income).
If Aaronontheweb had the misfortune of getting seriously sick, required surgery .. he would pay $7,150 for something that could easily cost $100K+++. Saying he's paying premiums just for having a baby really feels like weaselly logic .. so he thinks he or the rest of his family will absolutely never fall sick? What if a cancer diagnosis hits one of you out of the blue (I hope it doesn't, but that's what insurance is for).
The charges you mention are likely all from hospitals. How about Pluvicto for advanced prostate cancer at $42,500 per monthly dose? All the players are in on it.
The sound way to manage costs and avoid these games is via Medicare for all, with premiums paid by progressive rate taxation of income. Maybe even wealth beyond a very large amount.
Based on what? Why even leave this comment if you’re just going to say “would likely be worse off” without giving literally any evidence or even suggestion of why.
Insurance is a pool. The bigger your pool the more you spread the risk/load. It’s brain dead simple. Medical care is a human right, beyond that.
Nothing about our system makes any sense and it is built to pad so many pockets in entirely opaque ways between you and the care you actually receive. Cut out several layers of middlemen and the costs go down. God forbid you have an accident and you end up at the wrong hospital when the one down the road is in-network but the one they took you to is out-of-network and you wake up owing thousands of dollars.
I had pretty good marketplace insurance this year but the plan I’m on now isn’t even offered anymore and if I got the next closest offered plan I’d be paying 6X as much for the premiums with higher copays on top. I’ll be switching to my union offered plan instead which is much better than the new marketplace plan but still worse than the marketplace insurance I had before.
> Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading.
I see your point, but do you not think that if you're a family of 4, having to pay $40K before insurance kicks in is ridiculously expensive, and out of reach for most Americans?
I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums). The deductibles can be so high that you're pretty much always paying out of pocket.
> I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums).
Self-employed here. My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible with typically a $20 co-pay. It covers 3 prescriptions, therapy sessions for each of us, various older age diagnostic checks, and almost all office visits. In addition, if either of us develops cancer or is hit by a truck, we will not be rendered bankrupt.
> My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible
That's really nice - are there state/government subsidies involved?
I work for a top tier company and my premiums are not that much lower than yours.
When I checked the public market's insurance options, getting a $3000 or so deductible was a lot more expensive than yours if one is not low income (i.e. not subsidized).
(a) for 2025, federal premium subsidies in effect ($19k/year of subsidy) !
(b) for 2026, NM temporary subsidies
A reminder that until the end of this year almost everyone gets subsidies. Nobody in the US, no matter their income level, should be paying more than 8.3% of their AGI for health insurance. That all changes come Jan 1st 2026, thanks to the current Congress. Our premiums would be $2531/month had NM not stepped in to use some of those sweet, sweet fossil fuel extraction taxes to help us out.
Oh yeah, deductible in 2025 was actually $2800. At our age (early 60s) and general health (good), gold plans make much more sense (if you can afford them).
i'm 36, self-employed. silver plans in my state are ~800/month next year, with 8k deductible, no out of network coverage at all, with no in-network providers out of my state, so god forbid I get injured while traveling to visit my in-laws. the marketplace is a joke and health insurance in this country is pointless.
> In a controversial decision, health insurance giant Anthem Blue Cross Blue Shield is warning policy holders—in Georgia, Kentucky and Missouri—that they may have to pay for their trips to the ER. The company has developed a secret list of diagnoses that they will not pay for, such as "chest pain on breathing" and blood in the urine, even if the patient thought it was a medical emergency.
The problem is the healthcare cost is insane. You will go through $40k after a good injury that may need a major surgery or few smaller surgeries. Average cost for hip replacement is $40k.
I've had a sports hernia and the bill was about $30k.
That's crazy, I looked it up and the average cost for a hip replacement here in the private system in Australia is about $24k (US$16k).
You can get it for basically nothing in the public system but you might have to wait a year or so if it's considered elective (emergency surgery is immediate of course), but most people with private health insurance can get the procedure done within in a few weeks and would only have to pay about $1000 (US$650) out of pocket with a $500 excess (which is pretty common), because the anaesthetist and surgery are usually invoiced separately. Some plans do have lower excesses (like $350) though if you pay higher premiums.
> And what the OP is pointing out is that if your injury is $30K, insurance covers nothing, because the premium + deductible is $40K.
The point of insurance is to mitigate risk. If you think you have enough money to cover your risk, there's no reason to buy insurance.
The sleight of hand here is first complaining that you did not incur enough hazards to offset the risk premium and then citing this as a reason the risk premiums should not exist. Where is the story of the family being weighed down by bills? Or of not getting physical therapy after an injury and having permanent, income-reducing disabilities?
Risk is not the only factor. Premium cost is probably the more important one for most. If someone can afford the $40k deductible option, but not the $5k option, you’ll just have to accept the risk. Increasing earnings significantly right now is harder than hoping medical bankruptcy won’t matter in the long run.
30% of US households make less than $50k. That’s more than 100,000,000 people in homes with less than $3.6k/mo for all living expenses. The stories you ask for are simply inevitable
What's under debate is "how much risk." For most people in the US, they'll need help before they hit $40K. They can't afford paying $40K every year for medical and medical related expenses.
Imagine 2 people get injured in a year, you are now at $60k. Plus, $150 a visit for primary and $300+ for specialist.
My 5 year old has been to the hospital 3 times, stitches once. US healthcare will ruin you if you don't have insurance. A cancer treatment can bankrupt a millionaire.
I skimmed your 2400-word article a second time just now, and I still don't understand why your math is allocating 100% of your family's health insurance premiums to childbirth. And now I additionally don't understand your abrasive tone in answering this fairly straightforward question.
Multiple commenters are raising this point, so perhaps you should consider that you aren't conveying this information well?
1. I mentioned, in multiple places, that this is the cheapest PPO offered to me through a limited selection of potential brokers / marketplaces - and that's important because it covers our current health care providers AND child birth as a benefit.
2. If we weren't trying to have kids, our options for purchasing health insurance expand drastically. Individual marketplace plans become a viable, for instance, since the "not covering childbirth" issue goes away. I mention the short-comings of the individual health insurance marketplace at least twice in this regard, including a big pull quote explaining the ACA work-around with child birth coverage.
> If we weren't trying to have kids, our options for purchasing health insurance expand drastically.
Yes, but crucially none of those expanded options cost $0, so I still don't understand your math at all. I feel like we're talking in circles here.
You should be deducting a substantially non-zero number from the amount in the headline to account for your "normal" non-childbirth-year best-case medical insurance premiums (or out-of-pocket cash costs if foregoing insurance altogether).
What exactly does covering childbirth mean? We've had two children now and it's not something I've considered when choosing insurance (my company's vs my wife's), so maybe we just got lucky. Is there anything different about child birth vs simply in-network hospital coverage? I assumed we'd just hit our out-of-pocket max.
I think OP here is just keeping a completely dominated plan (and his health insurance company knows it). He has less than 50 employees, he is not required to offer health insurance to his employees and he should go on the ACA market.
Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies (which, by the way, in 2021-2026, were available to everyone) by tweaking his income (easy to do when you have a company).
He also says uninformed things like:
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those.
The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
> HMOs or EPOs that have some issues with them: coinsurance
What matters at the end of the day when you have a child is your maximum out of pocket (which you will 100% hit the year you have a child!). Whether you have copays or coinsurance after a deductible does not matter here. The ACA caps your maximum out of pocket at $18,400 no matter what (which, yes, is too high), so what you need to optimize for is premium + OOP for the providers that you care about.
Like, I get it, it's America, for healthcare like many other things (student loans, credit card debt, ...) it's easy to end up in a bad situation, but at some point you have to spend time understanding the game.
> Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies
I am absolutely not eligible. I earn more than $150k. And "manipulating your income" is not really feasible with a pass-through entity.
> The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
As I mention in the piece, I check every year. I have no idea what subsidized plans include, but the other marketplace plans definitely do not include child birth.
I explicitly address this point:
> The Affordable Care Act (Obamacare) barred insurers from turning down applicants based on existing pre-conditions; the way insurers get around this for pregnancy and child-birth is not by rejecting pregnant applicants (illegal), but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
and
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those. All of the ones I’ve found through eHealth Insurance or Healthcare.gov never cover it - and I check every year.
Love the over-confidence though. The best outcome for me in even writing this article would be to get some internet commenter pissed off enough to find me a cheaper version of my plan. That would solve my problem immediately!
Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max, so the childbirth should top out at the 7150. Other expenses might put you at the same 40K cost for the year, but not the childbirth alone.
You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time.
Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years.
I'm not defending it. I'm correcting your misinformation. You are claiming that ACA plans do not cover childbirth. They do. You are claiming that this event alone costs 40K, which is not accurate. It hits your out of pocket max, exactly as designed.
It sounds like you have never looked at an ACA silver plan, which is the lower deductible/out of pocket max option. I also have a family of 5, and have a $1800 per year out of pocket max from an ACA plan. You would still have the same level of premiums as you do now for silver plans, but you would save 13K a year. You are picking bad plans, dude.
Our system has problems, but when you make enough to not be subsidized, yet still pick a crappy 40K per year plan, that is beyond the systemic problems. It is a bad choice. There are insurance consultants who work with people, especially high income people, to find good plans for their family. You should be calling them.
Dude, you don't even have your own facts straight and you are embarrassing yourself. It's clear you have no experience, don't understand your own sources you provided, or any clue how child birth actually works from a medical billing standpoint.
Edit: what do I have to gain from spreading "misinformation?" I just want better / more options?
That's not what the link the OP included said and not what I said either, but I concede your point - that's my fault for checking individual health care marketplaces (like eHealthInsurance and Aetna direct) or not looking closely enough on healthcare.gov.
Looking through some plans now, but TBH these are genuinely not much of an improvement in the cost department and a massive downgrade in the provider selection department. Hence my whole section on trade-offs.
The logic you're using about out-of-pocket costs versus your deductible appear also not to be valid, and are causing you to misstate your out-of-pocket liability by a factor of roughly 4x.
I can assure you they are, if anything, understated - as I am not including the expenses my health insurance will not cover. So no, you are fully in the wrong there. What do I have to do to prove it? Show you itemized receipts?
Moreover, what are you even trying to accomplish by asking for this? Please provide me with a forthright defense of the modern U.S. health insurance markets and why it makes sense for me to have to pay this much to keep our population above replacement level.
Do you have non-ACA insurance? One explanation for why your costs are so much higher than the national average is that you're on a non-complying plan (you can also still buy plans that will exclude preexisting conditions --- they just can't be sold on the ACA marketplace). I'm pretty confident KFF isn't making these numbers up.
As for your second question, one easy response is that prospective parents in other health care systems aren't paying less (with everything factored in) but rather differently: that people making your $119k "true" poverty rate in Europe tend to be taxed at their top marginal rate, which is substantially higher than ours (in fact, in a lot of places in Europe, a Chicago Public School teacher would also be paying the top marginal rate).
A thing worth pointing out is that while the system we have is especially punishing on the uninsured, it's actually not that bad a deal for the insured, demographically/actuarially speaking. That's because being insured definitionally puts you in the cohort that excludes Medicaid-eligible poor/working class people and fixed-income seniors. If you move the typical household from that cohort to the UK, they're likely to be worse off. In surveys, insured families tend to be satisfied with their insurance, which is why taking existing health insurance off the table is such a third rail in American health policy.
Anyways, unless you personally are responsible for keeping our population above replacement level (which sounds exhausting), your numbers just aren't probative for the cost of bringing new citizens online. Other numbers might be!
> Do you have non-ACA insurance? One explanation for why your costs are so much higher than the national average is that you're on a non-complying plan (you can also still buy plans that will exclude preexisting conditions --- they just can't be sold on the ACA marketplace). I'm pretty confident KFF isn't making these numbers up.
Asked and answered in the piece dude - I wish I had the confidence of a Hacker News commenter who didn't read the article.
I read the article. It's extremely unclear to me whether you have ACA-compliant health insurance or not. I've been a startup principal since 2005 and have had PEO coverage at various points since the ACA passed, and it was always ACA-compliant. Could you just answer the question? It shouldn't be a riddle!
(Note that "non-ACA insurance" doesn't mean "insurance you didn't buy on the ACA public marketplace". I've got Anthem Blue Cross through our benefits provider. It is very definitely ACA-compliant.)
While I might not have been happier income-wise when I was on Medicaid vs now, I was much happier with my medicaid insurance than I have ever been with any private insurance. I could see basically any provider and didn’t have to deal with any of the typical insurance bullshit.
Also when you’re beyond the Medicaid threshold but not that much beyond it absolutely sucks. One year I was paying for dramatically worse insurance with a deductible that would have just made it better for me to just not make more money because if I hit that deductible I would be net negative on my income vs the threshold for Medicaid.
Also I think this is such a false premise. You can still have private plans if you want in the UK or elsewhere with a public health system. Nobody is forcing you to use the public system if you don’t want to. To wit, I don’t have children but I still pay for schools with my taxes. You might not want to use the public health system and instead go private, but yes, you should still be paying for a freely accessible healthcare system.
Here’s the rub on that too: The prices we pay here are so much higher than in Europe even if you go private in those countries. Our system is terrible. Point blank.
I would agree that the NHS in the UK has gotten pretty bad. A large part of that is the result of the Tory government actively working against it though for a very long time. The waitlists for a lot of things are quite long and my fiancé who is from the UK and still lives there has to do some things there are crazy to me. On the other hand she still is able to get care freely. She’s paid private for some dental work but that also cost her pennies on the dollar compared to what I’d be paying if I did the same thing here.
If you’re happy with your insurance I am truly thrilled for you because I don’t think of that as being a common experience.
> Most people with private health insurance like it.
Most people don't use it all that much, and in the common case of employer-paid premiums, the actual cost is significantly masked. As your link notes, the more care you need, the less likely you are to enjoy the experience. They dig their heels in more; sometimes egregiously so. https://www.propublica.org/article/unitedhealth-healthcare-i...
that link doesn't even say what you says it does - it said you can apply for coverage, not that there are plans that cover child birth. Have you never done this before?
This same price gets you a platinum plan with Sharp or Kaiser in San Diego and wouldn't have those gigantic deductibles.
He moved his business from California to Texas and is now complaining about pricing problems in markets caused specifically by the lack of regulatory environment in Texas.
In America, you basically need insurance to act as a larger stronger party in the negotiation of prices with the hospital on your behalf. Without the bargaining power of the insurance company the prices you'd pay can be significantly inflated. So paying for the insurance is the slightly lesser of two evils. Supposedly. From your question it seems perhaps you live somewhere with a saner system in place. I'm envious.
I’ve been told that too. But I’ve done self pay for the last year, and every time I go to the hospital they instantly give me a 30% discount.
That makes me think they are artificially inflating prices so that when the insurance company negotiats their discount, well, it might be the same as what I pay
Birth injuries are insured by the ob/gyn, which is part of the very high cost of delivering a baby in the US (because such injuries often lead to a lot of care).
Claiming $200/month for a phone makes one wonder which numbers are valid. I'm not saying everyone needs to make a $100 phone last 5 years and use a $15/month plan, but I'm not even sure how I would get to $200/month in phone bill, even including financing an iPhone 17 Pro Max.
$200 seems valid - it comes from the linked article [0] and it includes home internet (I pay $110 / month Comcast just for home internet in Bellevue. In Seattle I paid $130 / month). Maybe Aaron could have phrased it better. (I also recommend to read the linked article as it is a phenomenally well done financial analysis.)
With $85/month service (AT&T unlimited premium with only a single line) and financing a $2,000 phone (The smaller storage version of the Galaxy Z Fold 7 at MSRP) over 18 months, you’d hit almost exactly that; you could so the same with a cheaper service and/or phone with some add-ons (e.g., while Apple Care is billed directly by Apple and so wouldn't be on a phone bill, insurance for non-Apple phones is often billed by carriers on phone bills.)
$200 doesn't seem that crazy if they are buying several phone lines. I assume he pays at the least his wife as well, so that's two. If they have home internet bundled in as well, that would easily explain that figure. All to say, AT&T. He may also have a home phone line for a fax machine. It is perhaps a bit disingenuous to bundle it all together, but it also isn't the main point of the article.
> I pay that at least much for my family, hence why I used it
and your article says
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
It sounds like you're trying to communicate that you pay at least $200/month per smartphone for your family? Or you don't value precision in communication.
I know you've got a lot going on with a small business, and a new kid... but if money is important to you, maybe spend the time to switch to prepaid phone plans. There's lots of options [1], whatever network you need, you can do direct operator plans, MVNO owned by the operator, or like actual MVNO. If you're short on time and T-Mobile's network works for you, MintMobile has a promo going right now where $180 pays for 12 months of "unlimited" which is $15/month if you divide it out.
> I also pay $1250 per month to TriNet for the privilege of being able to buy their health insurance in the first place - sure, I get some other benefits too, but I’m the only US-based employee currently so this overhead is really 100% me.
Do you live in a state with a reasonable healthcare exchange? You might want to shop and see if an off the shelf plan from the exchange is better than paying TriNet to get access to their insurance; it may well be, but you should check. If you only have one US employee, and it's you, there's a lot of expense for not a lot of value IMHO. It's not really Apples to Apples though --- I think a lot of the TriNet plans have out of state coverage where a lot of exchange plans don't.
> It sounds like you're trying to communicate that you pay at least $200/month per smartphone for your family? Or you don't value precision in communication.
You're moving the goal posts here. You have to have service, realistically, in order to use it like a real person.
I'm trying to figure out what you're getting for $200/month.
Is it for "a smartphone" with service, and presumably financing the phone as well? Or is it the total for all of your family's smartphones, which is how many phones/lines?
Do they come with free mid-tier phones? What if you need 4-5 lines? What if, as a CEO, he needs a better plan than "basic prepaid, lowest-priority-subject-to-throttling"?
And what if the CEO needs international numbers across all continents?
What if the CEO needs to supply an entire 1,332 person company with business phones?
What about an assistant to answer them! What if we're sleeping!
Oh god!
But just to put my comment in context, here is what he said:
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
Okay, so on the non-budget side, I pay ~$64/mo for T-mobile's "unlimited[1]" plan and a Google Pixel phone. ($57/mo for the service, and I've amortized the phone price to ~$7/mo based on my lifetime average phone lifetime. Even if you amortize the phone over only its ridiculously short warranted lifetime, that's $42/mo for the phone, or $99/mo, but that implies purchasing a new phone yearly, which most people do not do (the average phone lifespan is just under 3y).)
In over a decade, the only time I hit that cap was because I let my kid watch too many videos on it.
5 GB is pretty reasonable for the bulk of the country. The only common things that can make it go over are games and streaming - both of which really are luxuries if you simply can't wait till you have Wifi access. So yeah - of course you should pay a lot more if you insist on doing those things.
This is akin to him saying that average American needs X money for the car to participate in society, and you suggest that his numbers don't math because one could:
1. Walk around everywhere (Idaho, Iowa)
2. move to New York (with ok public transportation)
Mobile phone and unlimited high-speed internet are requirements for participation in society.
> unlimited high-speed internet are requirements for participation in society
I pay $7/mo (not a typo) for 1GB mobile data via US Mobile, and I have never hit that cap in many years. I just don't stream video or audio unless on WiFi, which is not a hardship. Respectfully, what on earth are you talking about?
It’s also what critical thinkers do when evaluating “what percentage full of shit do I think this author is?”
If a glaring innumeracy or terrible estimate is in the article, why did the author include that? What was their angle? Does that make me trust the rest of the article more or less?
Because it indicates dishonesty and/or innumeracy which calls the accuracy of the rest of the piece into question. "Checking if the author can actually count" is basic media literary stuff, not some sinister agenda.
I think he's quoting that from the other article, not necessarily computing it himself. I think that article was about the cost of broadband + smartphones.
We pay ~$100/month for 1G broadband (I realize this could be lowered somewhat), and ~$100-120 for 5 phone lines for the family (AT&T prepaid). I'd like to see you make a household with multiple lines + broadband work for less than $100-125.
And that's not even that hard - I know some people spend $300+ JUST on their phone plans, in addition to broadband. And then if you factor in amortized cost of phone replacement? It's closer to $200 than to $50 for example, IMHO.
$200 seems to include home internet (which I think everyone needs these days to function). The $200 quote comes from the linked article [0] (speaking as a former financial analyst, this is an amazingly well done financial analysis). Maybe Aaron could have phrased this better.
A lot of this is an issue of insurance no longer being "insurance" in the classical sense. Insurance covers all sorts of things, my HSA pays for all sorts of things that I never would have even considered, and while that sounds great, it helps to drive up costs. It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that. But the situatuon is a lot like student loans, colleges know they can charge more because the government will lend 5-6 figures to just about anybody, so the colleges do so. And once that person is educated, you can't just "take back" the education if they don't pay. Same deal with healthcare, government subsidizes it for most of the population in lots of ways, healthcare providers know this, they increase prices to match. And you can't just take back the surgery to fix that broken arm or undeliver the baby. There's not a single silver bullet that will fix everything, but there are definitely concrete changes that can be made to improve the situation. One of them would be to make people healthier. I know, easier said than done. But by God it would make health insurance cheaper. Same way in that if everyone was a safe driver, we'd all be paying less in car insurance. Another way would be to remove that regulation or rule or something that makes it so like a hospital can't open too close to another hospital. Another would be to just, train more doctors! What I'm trying to say is, just as the problem is multi-faceted, the solution must necessarily be as well.
> but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper.
I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.
The best thing we could do is ditch the private healthcare industry to the extent that the rest of the first world has and cover everyone with government plans. Those plans can then negotiate for much better prices and refuse the kinds of insane charges we're seeing. The cost of plans would also drop because prices would be spread out over every taxpayer. Having primarily a single provider for insurance would make everything easier and less expensive for hospitals and doctors offices too.
The billions in profits private healthcare companies rake in all comes at the expense of everyone else one way or another and they have every incentive to make as much money in profit as they can. Without that excess fortune in profits being skimmed off and stuffed into pockets a government funded insurance plan which covered everyone could get the job done taking in closer to what it actually costs to deliver the services we want and no more.
You don't need the insurance industry sticking their dick in most of the business they do. Insurance is for the foreseeable but unforecastable, not for routine things.
The additional overhead is substantial and adds huge marginal cost for routine things and say nothing of the principal-agent problem
You could zero out every dollar American insurers make and not materially alter consumer health care economics; their share of the health care pie is almost literally a rounding error.
The magic of the system is that it's structured so that people like you can say things like that and not even be lying in any provable way.
Sure, it's not the actual insuring that's costing that much but the massive breakdown of incentives from increasingly vertically integrated healthcare companies (some of whom are insurers, some of whom own insurers) owning increasingly large shares of everything is clearly causing cost to spiral. The industry is making work for itself at out expense. Whether that work happens in the insurer's office or the billing office of the clinic that's owned by the insurer isn't really material. And of course everyone in the process gets a cut so they fight for their bit of it. Doctors used to drive the same crappy cars and live in the same modest houses as the rest of us. Nurse didn't used to be the "made it in life" job for people who come from poor backgrounds.
Dial it back a bit. I just made an extremely banal and citable claim about US health care. I agree with you (trivially verifiable from the search bar at the bottom of this page) about the practitioner compensation racket.
> Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it
It’s more they know insurance won’t pay for it, and negotiate discounts based off the “retail” price. Although at this point it’s gotten so ridiculously convoluted and cross-subsidized that I doubt even the insurance company or hospital knows what the actual paid amount for a Tylenol will end up being until months after the fact.
My point being that healthcare costs for pets are immediately calculable, where it’s a big damn mystery for months on end about how much equivalent human healthcare will end up costing. Clearly, if the former is possible, the latter should be too.
> I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.
Did we discover a new kind of monopoly perhaps? It’s not quite full blown corruption as there still (for now) exists a somewhat adversarial relationship between insurance and hospitals. However, at the same time, they seem to be pulling each other into the abyss, and our society is the victim.
> It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that.
But there are other things we could do that we don't.
For example, right now we have the expectation that insurers are going to "negotiate" with providers to determine the price, and then you have to use the providers your insurance has negotiated with, but who actually wants this? When you as a retail customer want to buy a pair of shoes or a piece of exercise equipment, do you call up all the manufacturers and try to haggle with them? No, they list their prices on their websites or sell them through retailers that do the same and then you choose based on who has what you want for the best price.
So make non-emergency healthcare work like that. Require them to publish their prices. Then the insurance company doesn't tell you where to go or negotiate with anybody, they only tell you how much they pay, which might be e.g. 90% of the second-lowest market price in your area, equivalent to a 10% deductible. Then you go to a website that lists every provider and their price, pick where to go and pay the difference yourself.
Suddenly they all have the incentive to publish the best price, because that's what most people are going to pick, and then you have an actual market instead of the existing opaque bureaucracy of corruption.
The majority of spend is in the last few years of life. A man dying of a stroke during the night at age 50 is much cheaper to the system than the same man living to 90 having fought cancer for 10 years.
I'm not advocating against health nor preventive care, however they don't decrease costs nearly as much as you'd expect.
Christian healthcare sharers do precisely this. By restricting services and the population addressed (your pastor or priest must sign off on your application), everything's extremely affordable. In particular, as we don't drink, do drugs, use contraceptives etc. we don't pay for coverage of them or their side effects. Obesity's also less of an issue.
There's also the trick of telling the hospital you'll pay "in cash" and getting a 10x lower bill from the hospital, then getting that reimbursed/covered by your private or alternative insurance.
Christians don't drink or use contraceptives? I think you have to have a pretty extreme "no true Scotsman" attitude to make such a claim. Even the drugs claim is pretty specious.
> Beyond restricting maternity coverage, many groups’ policies state that they won’t reimburse for prescriptions, routine doctor’s visits, contraceptives or mental health or substance use services. Coverage for medical conditions that predate someone’s membership is often excluded, as well. And health care sharing ministries aren’t required by law to limit out-of-pocket costs or maintain large cash reserves to cover members’ bills the way insurance companies are.
So are you still allowed real wine at communion then? A bottle of beer after working on your car all day? I know some christians who preach "100% dry", others are more relaxed. Some are fine with contraceptives (including many Pentecostals, which is how I was raised), quite a few overweight people, etc. And they're just as christian as you are.
It sounds like you're going for the "unlikely to need it" plans, which go broke when you actually get sick..
"The elements of the Eucharist, sacramental bread—either leavened or unleavened—and sacramental wine (among Catholics, Anglicans, Lutherans, Eastern Orthodox and Oriental Orthodox) or non-alcoholic grape juice (among Methodists, Baptists and Plymouth Brethren), are consecrated on an altar or a communion table and consumed thereafter."
> that regulation or rule or something that makes it so like a hospital can't open too close to another hospital
You're referring to certificate of need laws, but it's worth pointing out that they're not universal. More than a dozen states have repealed them (or don't have them) and everywhere I've looked, there's strong evidence that their removal has increased healthcare access, which has put downward pressure on cost of service
> Another would be to just, train more doctors!
Bill Clinton placed a cap on GME funding in the 97 Balanced Budget Act, freezing the number of residency slots that the federal government would provide funding for, so this effectively froze the number of residents there could be, which effectively limits the number of doctors possible
"If insurance covered brake pads they'd cost more" is an old mechanics quip. The principal agent problem just fucks the cost and incentive structure of anything insurance covers.
This is why it's unwise to send "routine" things through the insurance model.
"There's not a single silver bullet that will fix everything" idk, it seems like eliminating the profit motive from healthcare would resolve all kinds of problems.
Suppose you want to remove the profit motive from healthcare.
If doctors would still get paid above-median wages, you would still have a profit motive. Their lobbyists would want to limit the supply of doctors or simply lobby to have the government pay them high wages, to require that things be done by a doctor instead of a nurse, etc. Likewise the drug companies would lobby for the government to pay them more for their drugs, and when the government is captured then that's what happens. The same problems we have now; you haven't solved anything.
If doctors would get paid a lower wage but still have to attend 8 years of medical school, there wouldn't be a profit motive, but then there would be a shortage of people willing to become doctors, patients would have to wait a long time to get an appointment as they do in places like France, etc.
The profit motive isn't the problem, that's the thing that causes anyone to want to (and be able to) provide healthcare. The problem is the corruption. You have to stop limiting the number of medical residency slots and allowing drug companies to patent trivial changes to preexisting things etc.
I have the opposite viewpoint, and I lean heavily progressive in most of my views.
Healthcare in the United States isn't a market, and that is why it is so terrible. For instance, there is no reasonable ability to compare prices of services. Prices are entirely hidden. Then there is the "with insurance" price vs cash prices.
Healthcare doesn't function as a market, to our detriment.
Healthcare doesn't function as a market because the nature of it is largely at odds with the principals of an efficient marketplace and perfect competition. Not to mention the tens of billions of dollars being pocketed by middlemen every year.
In some places, free market healthcare is great. Dermatologists, dentists, chiropractors, things like that. And part of the reason it's great is because you get to shop around and people fight for your business.
In other areas, like heart attacks and strokes, you do not get to shop around. And you pay whatever they say you will pay. When those are the circumstances, there is simply no free market. And since no one is competing for your business with lower prices in that case, you do not get to see lower prices. They charge whatever they can maximally wring out of you.
In those places, free market healthcare is great because they don't have healthcare practitioner cartels and can pay their doctors middle-middle-class salaries instead of investment banker salaries
That has at least one fairly simple explanation: those centers only take lower acuity patients. If you're complex with a history of complications, it'll be "we'll do this one at an actual hospital".
If you're talking emergency medicine and old age care, yes, it's not able to function as a market.
Hence why the US already has government healthcare that covers almost half the population (Medicaid and Medicare cover the old, young, disabled, veterans, and poor people).
However, the place you give birth is, in the vast majority of cases, something people do like to have agency over, especially given the 9 months of heads up given by nature.
If healthcare weren't so perversely incentivized by the twisted triangle of regulated public/employer/private systems and their interactions, I would argue this is something that could be a functioning market.
Like Universities with their endless ability to raise prices due to the US government guaranteeing student loans of any size to anyone, a big problem in healthcare is there being no anchor to reality due to the principle-agent nightmares of the current regulated system.
In Europe, when you give birth it is not a luxury experience with a doctor of your choosing in a 4-5 star level private room where you're sent home with a big basket of freebies. If all Americans had to pay directly out-of-pocket (as Europeans de-facto do via taxation), you can bet reality would set in quick.
Sorry, I'm not going to Google "cheap MRIs near me" when I'm bleeding out on the floor having an emergency. Healthcare is not expensive because you can't see how much a doctor visit costs, it's expensive because that's how a lot of people make a lot of money, and they get very upset when that is threatened.
Most medical care is not an immediate emergency. If I could compare MRI prices and it would impact how much I pay (either as an insurance copay or out of pocket) I would absolutely do that. But I have no opportunity to do that so there is not price feedback like there is in a market.
Even if it's not an emergency, many medical events come with a lot of unknowns. Like having a baby. No way to say how long labor might be, if there will be complications, how long you'll need to stay afterwards. MRIs are actually pretty easy to shop around for and MRIs don't make up a huge part of healthcare.
Sorry, this is simply not true. Every 1-3 years, I get a simple diagnostic procedure to make sure I don't get cancer. Without it, I'm at a very real risk of developing cancer that would quickly kill me.
There is no universe in which it doesn't cost around $10,000. None. It is simply impossible for me to get out of paying that. My options are:
1. Use insurance, and hopefully it's covered.
2. Pay out of pocket.
3. Skip it and hope I don't die.
That's it, those are my options. I can't "shop around" for this, and I shouldn't have to. This is basic medical care available to everyone in a developed nation. Ours is the only one for whom this is apparently an intractable problem, and I am, frankly, tired of being gaslit about it.
Many of those “simple diagnostic procedures” are a tenth of the cost if done outside of insurance out of pocket. MRIs are one of them.
My routine blood work done via my doctor bills something like $1600 to my insurance every other year or so - but it do it on my own outside of the medical system for about $180 every six months.
No one should have to do this for necessary care - but once you get into things not typically covered by insurance like plastic surgery or LASIK the true costs are generally rather reasonable.
A whole shadow ecosystem for “health hackers” or whatever you might want to call it exists where standard medical stuff is 10% of the cost if paid out of pocket and through alternative prescribers. It’s a small subset of all available medical items, but the difference in true cost is illuminating.
That's what the parent is saying. This is totally insane and should be just handled for us with a system that is something like what almost every other country has put in place.
Many have mixed systems. You have the public system which is fine if you have acute appendix for example. And then you have private providers, which do tell the prices and you can check which you can pick for less urgent, even a hip replacement.
It really is two separate questions how much basic procedures should cost. But I see no reason why non-urgent even important care shouldn't operate like real market. Open prices where competition is either on those prices or quality of care.
Recent legal changes have made pricing more transparent. In 2020, the federal government issued the "transparency in coverage" final rule under the Federal No Surprises Act. This limited the expenses for emergency care when out-of-network and a few other things, but even more exciting is that hospitals and insurers are now required to publish a comprehensive machine-readable file with ALL items and services. They have to provide all negotiated rates and cash prices for the services and include a display of "shoppable" services in a consumer-friendly format. The machine-readable files are impractical to process yourself for comparison shopping (picture: different formats, horribly de-normalized DB dumps), but many sites and APIs have emerged to scrape them and expose interfaces to do so.
Nor should it strive to be a market. Healthy markets can only exist where demand is elastic. If the choice is between dying to kidney failure or enduring life-crushing medical debt, you bet I'm going to do anything it takes to get that transplant. And therein lies the problem: You *cannot* have healthy markets in healthcare. Period. Demand for healthcare is fully inelastic. Anyone arguing the opposite is either profiting off the status quo or woefully ignorant of economics.
I think this is actually an opposite problem. For kidney failure in particular, you can check the insane amount USG spends on end stage care. The demand for healthcare at the limit exceeds any reasonable supply. Healthcare spending across counties goes up pretty much with disposable income. There are massively expensive interventions that could give someone close to death few extra months.
Healthcare has to be rationed. Rationing by market is the least bad kind of we learn anything from history... Too bad healthcare in the US is not a market in any way or form, and in fact the most expensive least DALY efficient interventions (Medicare) are subsidized at the expense of everything else.
Sounds like you are looking at it from a consumer's point of view.
The US "market" is between the drug companies, hospitals, practitioners' groups, insurance companies, and government.
They are the ones that have market participation, the patient's not involved with that, their primary duty is to provide justification for the transaction.
>Healthcare doesn't function as a market, to our detriment.
So true, but even worse than that, the market that is there is predatory to a cumulative detriment worse than when simply dropping the ball makes things go wrong :\
"Healthcare shouldn't be a market. That's why you're paying $40k."
I see your drill down to fundamental issues and I raise you:
Pregnancy is not a sickness. Hospitals are for sick people.
If we reserved hospital birth for women and children with actual medical problems we would allocate resources much more judiciously.
An added benefit: not exposing otherwise healthy (and capable) women to an almost universally disempowering and disenfranchising birth-industrial-complex that seems designed to engender fear, self-doubt and pathological outcomes.
Pregnancy can turn bad (10% of first-time pregnancy, might be higher in country with high obesity rates). In that case, the faster you are with the anaesthetic and the C-section, the better. Also, hygiene. Also, ombilical cords around the newborn necks. Also, the maternities in my country are great (the one we have left at least).
Yes but hospitals are an essential part of Enumeration At Birth.
Government loves anything that assists its people-tracking machinery. It will never ever ever discourage pregnant women from doing something that would make reliable Enumeration At Birth more difficult.
In economics 101 one of the first things they teach you is supply and demand, and inelastic goods. Food and healthcare are the two main examples of inelastic goods, where demand is heavily disconnected from supply. There are of course nuances (you can eat just beans and rice, or do the bare minimum of healthcare/medicine to survive), but both are not things you have a lot of choice to consume or not.
My scheduled C-section (which my insurer likely didn't question me about because I was 40 and have other health issues) plus three-night hospital stay was about 5,000 EUR, all paid by my health insurance (private, so I know that 5,000 was the "retail" price), in a fairly prosperous part of Germany.
Not that the German health system isn't facing down some of the same demographic issues the rest of the well-off world is, but comparing wait times for specialists now that I'm on public (more like, very strictly regulated) insurance with my dad back in Texas on a combination of Medicare and supposedly good supplemental plan, I'm still in a better situation.
A strong public/heavily regulated independent insurers system gives the private insurers enough competition to keep prices in check.
Plus, I don't know of an insurer here, public or private, who also owns clinics or employs physicians, and they don't own pharmacies.
So to summarize: a. you're paying that for health insurance, not for the birth of the child. If you, your wife, your children had any other diseases then those would be covered as well. This is a significant benefit. b. all the systems that subsidize health care for those less well off don't apply because you're wealthy. So you are bearing the full cost of extremely high quality health insurance in a western country.
How come other countries have better healthcare at lower real costs? Basically every developed nation has better healthcare outcomes than the US. All other nations have cheaper healthcare.
America is not special, we've just brainwashed our less-observant citizens into believing that solutions the entire rest of the world uses will never and can never work here. There's nothing special about our population or economy that would prevent accessible healthcare. The only thing standing in our way is healthcare companies who want their 6000% cut of every procedure and politicians who will do literally anything to give billionaires another dollar.
As someone who has lived in several countries, I do not believe every developed nation achieves better healthcare outcomes than the United States. Many European countries, as well as Canada, offer some form of universal coverage with free general treatment but waiting times for appointments and procedures can vary widely. That said, I still think universal healthcare is preferable, as these systems tend to prioritize urgent cases effectively and ensure that emergency treatment is fully covered for free.
I think, it's only the Asian countries who have got cheap, easy, and effective healthcare where you can not only get appointments quickly but you can get treatment for cheap too but their emergency services are not always as streamlined as those in more developed systems. There is no clear overall winner. Some places excel in certain aspects. Others perform better in different areas.
> waiting times for appointments and procedures can vary widely
Waiting times for appointments and procedures can very widely in the US. Approvals to get needed treatments can also be denied for seemingly flimsy reasons in the US as well.
When I went to Canada, I talked to someone who said the Canadian government will subsidize trips to the US for certain treatments because it's not available at all in Canada or has insane waiting times. It's one data point, I know, but generally I think it's true that quality and availability of care in the US is much better.
This is only done for very specialized treatments where the province (they run the health care delivery) doesn’t have the treatment and/or the American resource is closer than a Canadian treatment location.
For example Nova Scotia will send some complex paediatric cases to Boston. They could send them to Toronto, but Boston is closer. Same with Manitoba but they use Minneapolis.
Canada is only 40m people and almost half that is in one province. The smaller provinces simply don’t have the population to justify having every possibly medical bell and whistle.
Point is when province sends Canadians for US treatment is isn’t actually about better quality as not all provinces have the same in house capacity and often the next largest city with such capacity is an American city.
Also, outside of the supremely wealthy Canadians, very few go to the US for private care. There is a medical tourism market to Mexico and other parts of Latin America for elective surgeries and uncovered treatments for some chronic conditions, though.
> So you are bearing the full cost of extremely high quality health insurance in a western country.
Overinflated imaginary cost*
There is no way that a medical consultation of 15 minutes actually cost $32k. Examples like this are aplenty, but only from the US. My favourite one was an itemised bill for birth that included a $1k for skin contact with the newborn.
> extremely high quality health insurance in a western country
(Sigh...) Let's put some facts.
Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...
Health care could be more evenly distributed, of course, but the health care that OP is receiving is definitely very high quality. General statistics about the entire population cannot speak to that.
No. The original claim was "all the systems that subsidize health care for those less well off don't apply because you're wealthy. So you are bearing the full cost of extremely high quality health insurance in a western country.":
1. The quality is high.
2. The OP pays the full price.
1 is incorrect. The OP is paying a lot, but is getting the same subpar quality healthcare as everyone else. He differs with people without money in only one thing: the latter don't get the full access to the subpar health system. The system itself is the same and its general quality is well indicated by the core metric of the infant mortality.
The health system is subpar and there is absolutely no reason why such a system should cost that much.
The corruption is so entrenched and so out of control, the only way out of this mess is for regular people to just stop using the health care system. Yes, there's no alternative, and yes, it means living a riskier life. It sucks, and it's not what we want to hear, but they can only charge us if we show up and purchase the product, and that's the last lever of power we can wield.
I'm a single contractor and can't really justify it. It saves me about 8k per year and this would be a bronze plan through MediCali if I got it. People would say "well what if you get a cancer or something" and yea that may be true but in that instance not only would I be out that premium but also the deductible and it won't even cover everything so maybe I'm actually better off stacking cash until the inevitable.
I'm right there with you - this is a case study in "perverse incentives." There is zero benefit to "paying into the system" to be had under the current model. Better to chance it and then sign up for a plan at the last minute since insurers can't deny you based on pre-conditions.
That's indeed the play for non-corporate-insured consumers. Short-term insurance was $1,000 a year for a healthy person last time I checked. Just keep renewing until you need ACA-compliant insurance for some reason.
But back to my point: that does nothing to solve the root cause, which is the price inflation. And Washington is so deeply compromised that they will never fix it. The only solution lies with us just walking away. We hate to bargain a price on getting exposed to the ugly side of life, like disease, discomfort, and death, but indeed, everything has a price. And we will continue to be tested on our willingness to pay it with until we start playing hardball.
This strategy is why there are open-enrollment periods for ACA-compliant plans. I had a startup back in 2014 where I had us on HC.gov/ACA market insurance. A billing SNAFU on Blue Cross's part (that year was really rough for HC.gov!) ended up getting that insurance cancelled for nonpayment about a month in, which is when I discovered that our only coverage options were all non-compliant short-term policies, all of of which excluded preexisting conditions and wouldn't underwrite one of my children at all due to an unexplained seizure several years earlier.
(We resolved the situation by finding a bank-shot qualifying event that allowed us to re-enroll --- it was extremely situational and had to do with my wife and I simultaneously leaving our jobs within a short window of time.)
"Healthcare too expensive? Have you considered dying?"
Sorry, what are you going to do when you get into a car accident and they rush you to the hospital? Assuming you're even conscious. "No, I'm voting with my wallet!" flatlines Come on.
What if we used our collective power to fix the system? (Up to and including replacing it with something that works for the majority, and not the minority.)
How can you be so naive? Like I said. It’s not what we want to hear or think about. But it is the only route left. Either we stop buying the product or they keep raising prices on us.
Regular people are already not using the healthcare system to a large degree. But it's not a realistic ask in perpetuity. If someone gets ill enough, they will get healthcare or they will die.
Many countries have financial incentives provided to its citizens to have children. Requiring half of a citizens median salary to be given to a faceless middleman to provide this service seems untenable. I cannot imagine a society that does this would be able to survive.
When your country is led by a person who seems to find children and marriage inconvenient, you're bound to see that mentality propagate throughout everyday life
I know it's not for everyone but you can give birth in Mexico or Latin American country with good doctors who speak English and pay less. Or you can negotiate with hospitals before giving birth
Nearly 2 in 5 Americans are covered by Medicare or Medicaid. TANSTAAFL. The other 3 bear the burden. At some point Atlas shrugs and decides welfare is a better deal.
The amount of money the US Government pays just for that 40% should be enough to cover all 100%. We know this is possible because it happens in other countries, which have shorter waits and more coverage since that talking point keeps being brought up despite collapsing in the face of reality.
> The amount of money the US Government pays just for that 40% should be enough to cover all 100%
This is true as long as the following changes are made: 1) wages for healthcare workers are scalled back ~50%, 2) many drugs and medical procedures are not longer covered (a good example is CAR-T for cancer or drugs for rare diseases).
The quality of health care in the US is significantly higher than anywhere else in the world.
Whether that quality is necessarily (or good) is debatable, but we are getting something for the money.
You also are just completely wrong in your main point. We cannot provide the same efficacy of healthcare as we are now for 60% less. We are the richest country in the world, labor costs more here than other places.
I tried an American PPO with $10 co-pay and no deductibles. It was awesome :)
Nobody could tell me what anything would cost, or if the insurance would cover it. But I always ended up paying $10, whether it was a few pills or an expensive MRI I didn't need.
Oh, yeah the downside is you can accidentally convince your doctor to get procedures you don't need.
Health care in Denmark is decent. But I've been told, no when I wanted to run some tests. That would never happen on an American PPO :)
I have had go wait, while unpleasant, it's fairly harmless (otherwise they don't let you wait).
So if you're on an great PPO plan in the US, healthcare is great.
Whether the outcome is better for the average Joe, is probably a different question.
My sister used to cook on private Yachts in the Mediterranean, and mingle with that part of the population that pay 3-5k/month for private insurance, helicopter evacuation and all that. I'm pretty sure they can ask their clinics any unnecessary tests they want, too.
I've had PPO insurance for a few decades. I've been denied tests and procedures many times, even when I had radiologist exams that supported the surgery according to their own rules. I've been forced to wait for procedures on many occasions.
> 15 out of the top 50 and 4/6 top hospitals in the world are in the US
Outliers do not say much about the overall quality of healthcare in a country. Rather obvious lesson in statistics.
Reminds me of the Russian mathematician who moved to the US after the fall of the Soviet Union. Most of his essays were criticizing American students, but in one essay he was quite frank:
Russians who graduate with math degrees are better than Americans who do so, by a wide margin. However, the average American is better at math because they still get access to some math education in university and do not need to be a top student for admission. Whereas in Russia, if you didn't meet a rather high bar, you simply couldn't get admitted as an engineering/physics/math program, and thus couldn't further your math education (I believe he said the cutoff was even before university).
Country with the top mathematicians, but country with worse math outcomes.
My argument is that specifically the best care in the US is the best in the world. We have the best doctors and the best technology and the best treatments. This is not completely universal but it is also generally accurate.
Whether or not this care is accessible or the median quality is care is good, that is different.
I’m just saying we do get something for the money, it’s not like it all gets thrown down the drain. The best and brightest come to the US to get some of the huge spigots of money in the US healthcare system and it does drive innovation.
Can't you just look at life expectancy, and life expectancy in good health? Because the data I found doesn't put the US in the top anything. Even if you're in the top decile of earners.
Your mistake is separating those items from healthcare, when it's part of it.
Even in the US, many (most?) insurances and healthcare systems have programs to address all those. My HMO certainly does - I can engage with them and craft a healthy nutrition plan, and my doctor can be involved in that as well. Ditto for exercise.
So you're saying the US optimizes entirely for the best of the best care, without regard for what happens to the 2nd tier? (that the majority of the population actually use)
If care is not affordable and makes average people just one accident away from bankruptcy, then it might well not exist in calculations. This is akin to saying the USA is the richest country because it has more billionaires than any other country.
This is a highly recycled talking point that only applies to people lucky enough to live in the vicinity of Standford, UCLA, Mass Gen, Cleveland Clinic, or Johns Hopkins AND afford a visit and is extremely dismissive of the millions of other Americans who can't. Rural hospitals have been shuttered and some people have even been turned away at emergency rooms now. This claim simply does not match up to reality, no matter how many graphs you put together.
> the best care in the US is the best in the world
For a few Americans. Not for all Americans, and probably not even for most Americans. There's far more to the United States than New England and Southern California.
Don't get me wrong, if I had some rare cancer or other strange disease, chances are I'll want to try and get in to one of these few rare ultra premium hospitals. But if I break my leg or get some normal infection or have a child or any of the other normal kinds of issues people have? Will that still be the best tier of care?
> if I break my leg or get some normal infection or have a child or any of the other normal kinds of issues people have? Will that still be the best tier of care?
Does it need to be? I imagine it's far easier to treat a broken bone, in most cases, vs a rare complex disease
I'd have different standards when researching where to have teeth cleaning vs oral surgery
On an anecdotal basis, I relied on the Taiwanese National Health (NHI) for years and found it vastly superior in terms of quality and cost to the United States.
Perhaps a more accurate claim might be: The quality of the health care system in the U.S. is unparalleled provided that you are in the 1% that can afford it.
If you define quality as range of treatment options available, sure. If you define quality as range of treatment options that are accessible, absolutely not.
> The quality of health care in the US is significantly higher than anywhere else in the world.
Simply not true.
Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...
Expenses are definitely higher, and doctors and hospital CEOs and med school CEOs do drive nicer cars and have bigger summer dachas, but I can't say the same about quality. Six month waits for a specialist, every PCP and shrink you'd want to visit not taking on new patients, ER wait times comparable with other developed nations, worse overall outcomes...
Maybe the top 0.5% is getting better care, but I really wouldn't shed a lot of crocodile tears for them.
> See what the wait times are for the specialists in other countries, if they even exist!
I assure you, they exist, I have been to them, and the wait times were about as long.
> It’s very hard to solve these things are such a massive scale.
That's goalpost-shifting nonsense that doesn't justify the outrageous cost of healthcare. And most of these problems become easier to solve with a higher population and density and larger economy, because you have way more slack in the system, and you have way more economies of scale that you can put to work.
I'm also not complaining about healthcare in the middle of Alaska, 50 miles from a highway (or deep in the poverty belt). I'm talking about overpriced, underachieving care in wealthy metro areas.
Ive been to doctors in different countries including the USA. Theres nothing special with general practitioners with the USA.
Or if you end up in China, you can get blood panels for like 10RMB, MRI for 30RMB, and damn near automated to boot.
Go to Mexico for dental work. What costs you here $30k costs you $2k, and they take your insurance.
The US citizens are being gouged, because our government has been bought out by corporate interests who bribe, err, campaign donate to both parties. And thats across every economic activity. Medical is just an egregious one, alongside academics.
In Australia 5 out of 5 people are covered by Medicare, and 5 of them bear the burden. (at some point in their life. assuming they become a tax payer, which seems likely for most.)
On top of that many things that are 'not urgent' you have to pay for yourself.
I have recently paid over 20K for back surgery. Prior to the back surgery I could barely walk. This was deemed 'not urgent' and had I would have had to have waited at least 18 months for surgery via Medicare.
I also have private health cover.
So, it's important for non-Australians to understand, our health system is far from a panacea where taxes pay for everything.
Currently 778 K Australians are waiting for 'elective surgery' .
If everyone costs the system $10, and the five people pay $8, $9, $10, $11, and $12, respectively, I think it’s a mistake to say only the last two net-positive taxpayers are paying for the system.
The burden of this isn't a big one to bear. I just compared tax rates for a $65k USD income in Australia vs the US. You'd be taxed ~$800 less in Australia.
Superannuation is not a tax. It’s a compulsory retirement saving/investment scheme.
However to calculate total income taxes you do need to include the 15% tax on superannuation contributions.
If your pre-tax take home salary is $100k AUD, then your total salary package is 111.5k including the 11.5% compulsory employer superannuation contribution.
You’ll pay regular income taxes + 2% Medicare levy on $100k and your $11.5k super contribution will be taxed at 15%.
So your total income tax including the Medicare levy (but assuming you don’t pay the Medicare surcharge or claim any deductions) will be $24,513. Giving an effective tax rate of 20.2%
There are no state or local income taxes in Australia so that’s it for personal income taxes. However states do charge payroll tax on most companies payroll (e.g. 4.85% on annual payroll over $1M in the state of Victoria for companies in the Melbourne metro area).
Health spending in 2023–24
In 2023–24, Australia spent an estimated $270.5 billion on health goods and services– an average of approximately $10,037 per person. In real terms (adjusted for inflation), health spending increased by 1.1%, or $2.8 billion more than spending from 2022–23.
In 2023–24, health spending accounted for 10.1% of the gross domestic product (GDP) in Australia, approximately 0.2 percentage points higher than in 2022–23.
In Australia, 15% of all expenditure on health care comes directly from individuals in the form of out‐of‐pocket fees — this is almost double the amount contributed by private health insurers.
There is concern that vulnerable groups — socio‐economically disadvantaged people and older Australians in particular, who also have higher health care needs — are spending larger proportions of their incomes on out‐of‐pocket fees for health care.
A 2019 study identified that one in three low income households are spending more than 10% of their income on health care.
There's little to no public advertising of prescription drugs, cheap generics are widely available from federal scale bulk negotiation deals.
Health outcomes are greater life expectancy than the US, national scale cancer survuival rates are better by a few percentage points (IIRC - they are close but higher).
Australia has long had an innate "we're all in this together" society built on individualism. It's not great, it's not perfect, but the first instinct is generally to look after our own - across the board.
When I was in the USA just paying for things like a GP and a single specialist didn't seem outrageous coming from Australia.
If I worked in the US, I would have health insurance and would be paying lower out of pocket costs than I would in Australia. Combined with the higher salary and cheaper housing that's a pretty good deal.
Edit:
We allegedly have universal healthcare but that doesn't cover any actually competent specialist (need private healthcare for this) so paying $400 for 25 minutes of a psychiatrist every 2 months and $95 for 7 minutes of a GP is common.
Fortunately, a good number of people in the 3 of 5 population have the imagination to see that they or people they love will someday be in the 2 of 5 population.
Weird, I've seen a lot more people bitch about welfare and how easy people on the dole have it, than actually give up their nice jobs and lifestyles to go try living it.
I don't think the critique is that "welfare is objectively preferable" to a high paying career, but rather that the effort:reward ratio isn't scalable to society at large (without some level of social cohesion, I guess).
It was likewise striking how few of America's slave owners thought that slavery was such a sweet deal that they should be enslaved. It's not always true, but it should always give you pause if you find yourself insisting that other people have it too good and yet you've been careful to ensure that you'd never have to trade places...
Theres alot of forces tugging at American "healthcare" - lawsuits, uninsured non-payment, subsidiation of 3rd world drugs, heterogeneous population, over eating, under exercise... usa practices reactive medicine. and maybe part of that is due to hectic modern life, but it certainly adds to the cost, time and money, that could potentially be avoided or at least reduced in a more preventive, educated system.
that being said, one can certainly find cheaper insurance (a policy to limit liability) if one knew where to look.
for instance a self employed single male, 27, queens new york, healthy non smoker, can have a national network $300 deductible, aca qualified policy, $329 a month.
This is a question of priorities. Identify a problem, decide to fix it, then execute. It isn't about the particular solutions. Australia's gun control would not translate to a country like the USA and perhaps neither would its health care. First decide to put a person on the moon. Then execute. Only one country did that. It isn't that they can't solve problems like school shootings or affordable healthcare. There is no real will to do so. Not sure why exactly. It is a very strange place that defies expectations of how a developed country would behave.
Perhaps if non-poor people start speaking out on a regular basis to elected and appointed officials, the media, and policy wonks, we might make some progress getting a better healthcare system.
I've spent 30 years as a policy and budget analyst and advocate on health and human services issues. If electeds and appointeds were going to make decisions based on the lives of poor people it would have happened already.
I have a discussion with my mother often. I tell her to keep a reasonable buffer of money in her bank account and then spend every single $ beyond that. Why? Because when she hits end of life, or even before then when she hits any number of inevitable age related issues, medical bills will take every penny she has and then go for more after that. My family pays even more a month than OP.
Healthcare is reaching for the point of neutrality where the value it provides exactly equals the cost they are charging. This is what happens when the only signal they get is a money related one. Nation after nation has shown that healthcare elsewhere can be better and far cheaper. Not perfect, but better and also not out of control. The real question isn't 'how do we fix healthcare' but instead, 'how do we remove the cancer in our system that is blocking the obvious fixes we see actually working all over the world'.
"The essential theme of Green’s piece is that “participation costs” - the price of admission you pay to simply be in the market, let alone win, have grown out of control. Food and shelter are participation costs for living. Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work/school."
No shit. He mentions food, shelter and a smartphone — might as well add higher education and a functioning car if you're in the U.S.
I struggled being tossed out on my own at 18 with no support from parents. Working at a pizza restaurant, riding a bicycle to a community college for an education, renting a room from a woman (she may well have been renting as well—renting a room to me to take the edge off).
Winter came and riding the 10-speed to college (in Kansas) became a challenge…
Thank god no smartphone or internet plan was required then.
(When I eventually split an apartment with two other roommates we lost power for stretches from time to time because we were unable to come up with the money to pay the electric bill — oh well.)
They were hard times (that I somehow enjoyed—perhaps because I was young and was finally beginning to have a fulfilling social life). These days it has to be even harder.
I doubt it's much harder because of phones or internet. A smartphone can be very cheap. WiFi is pretty much everywhere and even in America there are very cheap esim plans.
Please note that this is the natural birth of an otherwise healthy child.
In Canada, provincial healthcare and private insurers have not kept pace with the needs and advancements in the areas of alternative methods of conception (IUI, IVF...). Yes, a naturally born baby wouldn't cost the parent(s) much medically. But, if you cannot have a child naturally, medication and procedures (lab testing, blood testing, artificial insemination...) are only partially covered and the amount corporate or union-backed insurers will pay varies widly by doctor and by patient. A couple struggling to conceive will easily pay 15-40K per child after the first procedure.
Funnily enough, friends who have jobs in the USA, but live in Canada often have better insurance that fully covers all of the costs after the deductible. It ends up costing much less to have IUI or IVF procedures with Canadian doctors using American insurers (of course they will take the money).
So actually if we compare this with a European country, it would be an almost similar amount in the end: there is no deductible, but health insurance/social security taxes can absolutely reach around 2k-3k per month if you earn enough.
But those social security taxes (theoretically) cover your future pension, and at least in Germany, health insurance also covers your sick days, which is why only true workaholics show up to infect the office.
My wife had to have an emergency C-section the first time around when they lost the heartbeat on our first baby, so we've stuck with planned C-sections - so yes, we are somewhat constrained in terms of our choices there.
Maybe we're living in a failed society if we cannot provide the basic, bare minimum of pregnancy care for women. Like I assume you're the same kind of person that would be equally baffled as to why the fertility rate has been going down and can't connect the two dots. As well as the child mortality rate in the US skyrocketing.
Father of 3 here, first two were home births, the third had complications and ended up being a hospital birth. I was initially skeptical for the same reasons but the first meeting with the midwife convinced me that they were taking every precaution and had the training to deal with whatever might come up.
The majority of births are simple if you let them be and the midwives go to great lengths to make sure the conditions are right for a successful event. In the case of our third we hit some conditions leading up to the delivery date that disqualified us for a home birth so we seamlessly transitioned into the hospital system (where the midwife still delivered the baby)
Home birth is absolutely a rational choice in many cases. The author had a very strong reason to require hospital birth but in scenarios with lower risk it is safer in some respects to avoid the hospital.
It will still cost you 5 - 10k for a good midwife and you'll still want to be insured in case you need to transfer. So it only knocks off 5-10k from the total.
Would it? When I have been uninsured I paid less for bills because the group gave me the cash price. When they are billing an insurance company they bill much more.
Interestingly enough, adoption can cost just as much as the figures quoted in the article ($40,000 - $55,000).
If you're planning to adopt, broadcast it via your social network as much as possible. If you can avoid going through an adoption agency, you'll only have to pay for the legal work ($7,000 - $10,000).
Our first two children were born at the hospital. Both were induced. Everyone was healthy, but looking back each was a miserable, expensive, condescending experience.
After those experiences, my wife then went on a journey to learn everything she could about childbirth and healthcare. The more she learned, the more she became convinced that the entire system is flawed. The pressure to get an epidural, induce (conveniently between 8-5 on a weekday), or to use a C-section is immense. While each intervension is tremendously important in high-risk and edge cases, they are utterly unnecessary in the vast majority of births. But they are used for the majority of births, anyway. Some argue they may even have some damaging effects to the mother and child, but I concede that's not the medical mainstream opinion.
When my wife became pregnant with our third child, the delivery was during the Covid lockdown. Hospitals refused visitors, demanded masks, and were even more impersonal than normal. Although I was initially skeptical, she convinced me that we should use a birth center and a midwife. The birth center was practically next door to a hospital and we talked through how to mitigate risks if something went wrong.
It was a fantastic experience in nearly every way. Our son was born at 7:45 AM and we were home by 11:00 AM. It was substantially more affordable than a hospital birth.
My wife just had our fourth child earlier this year. Once again we used a midwife but this time we had a home birth. You couldn't have paid me to accept a home birth when we were new parents. I wish I knew then what I know now.
I know it's not for everybody (and especially those dealing with high-risk scenarios), but a midwife and home birth is an option if you want to avoid the hospital racket. It's significantly less expensive, more convenient, and every bit as safe for the vast majority of births.
"My wife just had our fourth child earlier this year. Once again we used a midwife but this time we had a home birth. You couldn't have paid me to accept a home birth when we were new parents. I wish I knew then what I know now."
Good for you and the very best wishes.
We had all four of our children at home - two of them breech[1] - and avoided a big basket of unnecessary interventions and complications.
One of the biggest benefits was opting out of the tremendously disempowering culture of medicalized birth fostered by both male and female care providers.
An outsider would not be faulted for thinking that birth care was purpose-designed to disempower, discourage and disenfranchise women giving birth.
[1] Relax. A "frank breech" is considered a normal birth in most of the global north and is not medicalized as it is in the United States - nor does it need to be. (Not to be confused with dangerous conditions like a footling or kneeling presentation).
I pay almost 40% in the US (including state and payroll).
Federal tax rate is 22-24% for most people. State can be anywhere from 0 to over 10%, depending on the state and income level. City taxes may exist. And then social security + Medicare.
> The flip side is that I lose ~30% of my pay to taxes.
That's not a flip side, that's what you'd be paying in the US, too, once you account for all your payroll taxes. Maintaining 11 carrier strike groups and a global empire don't come for free.
If you're in the 24% bracket, you probably have an average rate around 18%. 7% personal FICA witholding, another 7% employer match, and state income tax. Then, if you're in the mood, add your health insurance premium and any college savings for you or your kids (or the difference between what we pay and what you'd pay in [insert some other country here]).
Our military spending is enormous, but it's dwarfed by what we spend on healthcare. The problem with our healthcare system isn't that we have a military, it's the gross and intentional profit-seeking behavior of insurers and many others in the system. They see the government as a bottomless pit of money that they can tap with lobbying, and the result is that we pay stupid prices for absolutely everything, on the assumption that it will be negotiated down somewhat by private or public insurance.
If you look at how $1 of public spending on healthcare is used in the US vs countries with better healthcare, it becomes obvious where the problem is, and it isn't in the ocean. An anti-military ideological stance is one thing, but you don't need to inject it into this.
An American PPO with a $10 co-pay is pretty awesome. The only downside is that it's too easy to get a procedure you don't need :)
I've tried tellings doctors in Denmark I wanted X, Y, Z test and getting told, nah, the outcome wouldn't change your treatment so we don't want to order those tests.
Generally, healthcare is decent, but no doubt a good PPO plan does not compare :)
Public health care seems more like HMO, you have to use a provider within network. Sometimes you need a referral from your primary physician, etc.
You can pick your doctor, but not everyone can take on more patients.
That second paragraph is what scares me the most about pure public healthcare options. The following isn’t to compare/contrast systems.. it’s just a viewpoint.
My cardiologist went “tests look fine, heart looks fine, there’s no reason for you to take colchicine. No clue why you have issues, everything is fine. Just take this brand new beta blocker to manage your heart rate.”
Meanwhile, there’s no answer why my heart rate rises 30-40BPM randomly when I stand. Why my heart rate drops to a very difficult detectable rate when I sleep. No answers as to why two sips of wine causes my body to go into shock. - All resulting post-Covid.
That same doctor told me to discontinue colchicine; yet without colchicine most medications, inc. ADHD, are maybe half as effective.
These are items which deserve answers. Not an answer of “just take another pill”. Some of those “unnecessary” tests can provide inclusion/exclusion information. Yet just refusing that knowledge denies answers.
In the US I can just find new doctors. But in other systems it’s either difficult or impossible.
I find it's a really scary idea to go to a third-world country like USA! - Or, it seems like a third-world country when you're from a developed country.
Unfortunately I'm type 1 diabetic which is either a death sentence there, or you are rich. But then I also accidentally broke my collarbone this summer. And I had this weird throat infection.
As a type 1 diabetic I have had to go to the ER numerous times in my life, and as traumatising as that experience can be, I can't imagine the feeling of also being financially ruined for the pleasure of not dying.
It's weird, I know plenty of people who avoid going to the doctor because it's annoying to wait for over an hour.. but I could see that for an American you might just NEVER go. I guess it's like, ok someone in the family is sick, and we're not rich, so we will sacrifice them to the sun gods. Or I guess you go into indentured servitude? There are people for whom $100k is made very very slowly.
I just do not get it! I guess these things add up properly if you are very wealthy, but people here think that it's the function of the society to make sure you can have basic things like medical treatment. Of course it's not perfect here... try going to the dentist for example. Then you're almost in the USA. Somehow it's not considered medical. A long session could run you over $500 or more.
I have compassion for all the USAians out there! If I was USAian and planning to have a child.. I guess I would consider just going to a civilized country for a while, like... I don't know, Rwanda or Ghana or somewhere that can afford people to be alive(?). In seriousness though (as those countries are very far) you could just go North or South. It's closer. If you go to Canada, a lot of times you wouldn't even need to present ID.. you could just.. get treated right there by walking into a hospital, being triaged, and then waiting (admittedly for maybe almost a day).
Always bring fun things to the hospital if you aren't literally bleeding out all over the place, because you'll be in the waiting room for 12 hours if you're in a big city.
But when it's over you're alive and about as rich as you were before. Seems like a good societal deal to me. I'm scared of being trapped somewhere like the US honestly. It's a nightmare scenario. Although I'm sure it's pretty great if you're a billionaire with slaves and so on... but someone has to incur that cost (the slaves from the lower castes).
IMO, the “thin edge of the wedge” for socialized healthcare in the US is full, high quality and free services for maternity, birth and the 1st year of the kid.
For profit hospitals subsidized and enforced by the leviathan, what could go wrong?
How much does something cost? Whatever the seller can get people to pay for it. Hospital B charges 6 figures for the delivery of a child? Wow, that's expensive, they must be really good to be able to charge that much.
All the dark patterns, negative dynamics, perverse incentives of bad government, stupid healthcare policy, and humans being shitty combine to form for profit hospitals. Those determine how other institutions have to run in order to operate at all, and they're not being managed by well meaning, good faith citizens looking out for the patients and the public.
There's a reason mangione became a cult phenomenon, and $40k babies, multimillion dollar ambulance trips, and other bullshit are exactly why.
Good luck fixing that mess. I don't even know how to conceptualize where you'd even begin to try to fix American healthcare. It's so tangled up and beholden to all the other problematic elements in modern life that it looks nigh on impossible to repair, so my goal in life is to minimize contact with any element of the system as much as humanly possible.
Could you explain how this would help? I'm struggling to understand where you're coming from here, besides perhaps a reflexive libertarian reaction to government.
Massive government subsidies for health care consumption not only eliminate, but disincentivize price discovery. If your biggest consumers of health care (seniors) have access to the best health insurance plan in the world (Medicare), that's going to drive costs up
Your whole argument is that the health care system should be optimized for the most productive members of society (like you, right now).
You are perfectly fine to have that belief, but the majority of people disagree with you, which is one of the primary reasons the system is designed as it is.
I think the market can do a better job of optimizing than central planning ever can - the problem is we have both the costs of capitalism and socialism concurrently with the model we have now. A worst of both worlds scenario.
When somebody is sick we generally save them even if the cost/benefit is poor. No market is going to solve this if you want to save sick people who don’t have a lot of money.
There is no place in the world where health care is solved, it’s one trade off vs another.
The US system is also far far from perfect but your solution is quite shallow and unlikely to fix things in a way society wants.
You know what actually drives costs up? The fact that healthcare doesn't work as a market. I can't shop for medical care. I don't have the knowledge and it's usually extremely time sensitive. This is a ridiculous statement that's only parroted by the most market-pilled right-wing economists.
Have you ever looked into the way the market works for medical devices? And what happens if the implant or device you need to live is from a company that went bankrupt?
If you've ever spent even five minutes reading up on that stuff you would understand that health and medical cannot be a free market. It can never be a free market.
As someone from exUSSR, I'm shocked with the figures. We've given birth in Russia and in Kazakhstan, in both cases I paid nothing at all. Just taxi to the birth house (that's how the birth clinics are called), and my wife disliked the food, so I brought her some fruits and maybe corn flakes every day of 3 days she stayed there. The equipment I could see was modern, everything was clean, there was some confusion where to put her, otherwise everything was fine. If you're suspicious, you can go to private clinic at $1,5K..2K, they even send you a taxi (or who knows, maybe a private ambulance).
My libertarian friends criticise this from the point that "everything state-run is inefficient". Even if this is true, they fail to notice that state-run healthcare keeps prices of the private sector down. You don't have to sell a car if you're seriously sick.
In 1992-96 on Russian state TV, there was a translated program called something like "Rescue number 911", with nobody else but William Shattner. (We already knew him at the time.) I got an impression that the US healthcare was impeccable.
American "healthcare" is pushing many things outside the achievable range.
I have garden-variety hemorrhoids. All I need is one or two 30-minute in-office procedures to treat these things. I'm a senior software engineer working for a FAANG company with "top-tier" employer-sponsored health insurance. I've been trying to get this stuff treated for eight months. I've gone to at least seven or eight appointments with several different offices and I've already spent $3000 out of pocket, and I might actually start treatment in January. That's fucking insane.
The next time I need a minor in-office procedure, I'm seriously going to consider flying to Mexico instead of wasting almost a year of my life fucking around with the ass-wipe US healthcare system.
I just want to point out that the referenced article about the federal poverty level (guidelines, etc, various words being used in the regs) makes it seem like the value is calculated each year based on taking the food budget and multiplying by 3. In reality, it did that in 1965, and has been adjusted by the CPI since then. In doing so, it changes the relative weight of everything as that changes in the CPI basket.
The value the article comes up with (he says like $130,000) is more like the living wage, which might be a good target. The living wage for Bergen County, NJ, is calculated to be $145k for a family of 4 with 2 working parents, and about $100k for the same family without childcare expenses (1 working parent).
I am not sure what counts as poor in reality. Obviously the federal poverty guideline is pretty low. It can't really make sense as a contiguous-48-states guideline for the purpose of feeling "not poor". The calculated living wage is above the median household income for most areas. I have not heard a serious proposal for increasing the median (or, preferably, the 30th %ile) income up to the living wage. I reckon that most proposals that involve the government sound too much like communism for the average American voter.
But we could bring the living wage down to the median. We could make housing cheap, reduce our health care costs, and reduce the childcare component.
While not an answer to the general problem, one pragmatic avenue OP missed is to not have gotten married. Then he can have assets including a business, while his wife-in-spirit is on-paper poor and gets a subsidized plan (which then also covers the child's initial birth as an extension of her). AFAIK this wouldn't help after the children are born though (unless maybe you're willing to leave your name off of their birth certificates, which seems like a much higher level of norm rejection and outright misrepresentation).
In general corpos spend a good chunk of resources making new legal entities to escape liability and legibility - something that is simply not available to most individuals. Getting married takes your two naturally-existing legal entities and basically collapses them into a single one - throwing away much flexibility. So it seems like a poor idea in the current legal environment which has been thoroughly corrupted to extract wealth and channel it upwards.
I wonder what the author means by the repeated assertion that marketplace plans don't cover childbirth? My understanding is that's absolutely false.
In 2015 I had my first child while self-employed, and I paid for the most expensive Aetna plan I could find, about $2k per month if I recall correctly. We had an excellent experience at Mt Sinai, private recovery room for two nights, etc. I don't think we paid hardly anything out of pocket.
Granted, I agree that our health insurance system is a complete mess, but judging by this post and the angry responses of the author here, it sounds to me like they're making it worse on themselves by misunderstanding what's available and needlessly paying for a more expensive option than needed.
We desperately need to increase the number of doctors to decrease the cost of medical care. We also desperately need to cut down on regulations so we can reduce the number of healthcare administrators.
There is tons of fear-mongering around a natural process-- I had a 24 yo friend deliver his first child off grid by himself. There are also a ton of independent midwives out there where you can deliver either at home or a midwife center for a fraction of the cost.
You are absolutely right meatbag producer! Your brand new bundle of joy is expensive, but who can put a price on love? The system is designed to keep you in debt and near poverty as long as possible. But do not fret! If the meatbag is properly trained up to a point, and no further. It will be a hard working productive member of DisneyAICORP. And after working very hard and following instructions it may someday be able to afford its own meatbag production schedule, affording one more production unit each full year of employment!
Cant pay your child birth bill? Easy solution! You can just name your child after one of our pre-approved corpo sponsors and we'll take care of the rest.
There are two ways to look at this. Either children are in fact useful for society, and should be subsidized (I weakly hold this view given mass immigration is politically unworkable, and long term that too would run out). That is well and good but cross country data makes the central argument in the title fall apart - US birth rates are/were recently higher than most public healthcare OECD countries. Why blame X if removing X doesn't appear to do much?
The alternative view, that I would hold if it wasn't for the above considerations, is that first world child rearing is currently an expensive hobby, and why should we subsidize it at all? If it wasn't a personal project most would be parents could easily adopt.
> If your answer to “I can’t afford to have children and run a business” is “then don’t,” you are building the political conditions for extremism. This is how every revolution starts: a critical mass of people who conclude the system offers them nothing worth preserving. They don’t just want change - they want revenge.
Its "not afford to have children", but instead "not afford to live".
And we're already seeing these strong signifiers of extremism everywhere. Shooting CEO's is halfway acceptable, if they are sufficiently horrible (and yes UHC was horrible).
Violence is more and more routinely considered the only answer that works.
Corruption isn't something hidden, but instead openly done. And this is at all levels, from petty theft, up to 'let's rearrange government to screw the other party'.
Look at how much tax dollars you pay in, and what you get for that. Its more and more a socialist country amount of tax, with low/no benefits to the citizenry. And no, shoveling billions to Israel or Ukraine, or project of the week does NOTHING to help me, my friends, and people around me.
It is pretty bleak. Has been for quite some time. I can understand why some might want to vote for Trump- he did and is still making good on his promises. Terrible promises, sure. But he's doing them.
Far as I can tell, none of the candidates are for the public, and willing to do and help the public. Just feels like a corrupt-o-cracy where if you're not in the In group, you're screwed.
And yeah, extremism, revolution, and revenge is spot on.
All part of the plan. Gotta get that world population down to 500 million somehow. You've had three children? That's above replacement! Shame on you for contributing to the overpopulation problem. /s
My hope is that GenX doesn't fall for the socialist panic tactic like Boomers do. Until then we are going to be stuck with this situation for at least another decade.
B. You don't have a child and decide to never have a child. To make up for the decline in population that year the government issues a working visa to an immigrant. The immigrant relocates to your country and sets up their life there.
There are but who is producing them? Adults drive consumption and production. Children just drive consumption.
From an economic perspective increased immigration is better than births. Why have non productive people around when you can just import productive people that pay the government income taxes?
<sarcasm>If there are no children around then we don't have to worry about the children anymore and can worry about important things like the economy!</sarcasm>
My guess is B because that person can produce goods for export while consuming local goods. Children (at least for the first few years of their life or so) do not contribute to production. They only contribute towards consumption. You could argue that they motivate the parents to produce more but increasing skilled migration in the parents industry can do the same.
Related: Car Seats as Contraception https://www.journals.uchicago.edu/doi/10.1086/731812
> We estimate that these laws [mandating safety seats] prevented fatalities of 57 children in car crashes in 2017 but reduced total births by 8,000 that year and have decreased the total by 145,000 since 1980.
Car seats as contraception is just a specific enumeration of the general. "busybodies as contraception" problem wherein the "has so few real problems they stop minding their business and mind other's business" classes try to force priorities on the rest of society that the rest of society can't yet afford to have. And it's not just contraception or kids. Pretty much everything in our economy gets shot in the foot by this to some extent.
Contraception is a bargain deal for any class, assuming you were not intending to have a kid.
I also question the idea that safety regulations (let's call them that) are the result of a class of people who have "so few real problems they stop minding their business and mind other's business." I get the idea, but couldn't the high cost of obstetrics and child car seat requirements be due to the wishes and decisions of people outside of this supposed class?
> be due to the wishes and decisions of people outside of this supposed class?
Of course, but life is just so easier when you can attribute every problem to an imaginary enemy.
It’s not the car seats that are the contraception, it is the cars themselves.
How so?
What does that mean? Plenty of people have been conceived in the backseat, and some in the front. But seriously, what are you talking about?
car-dependent infrastructure and urban design is hostile to human life.
Car depend infrastructure is amazing to families. A mom can take her children to the grocery store in a car in relative safety without worrying about mentally ill homeless people on the subway.
Why would you need to get on the subway to go to the grocery store? When I lived in Paris I was within a five minute walk to at least three general grocery stores plus various speciality shops. Always plenty of parents all around. This is not uncommon in properly designed non-car dependent cities. Not to mention deliveries are just that much easier and all without a car.
A mom can also take her car in a non-car-dependent infrastructure.
wow. this thread is microcosm of how wild and polarised the internet can be.
It's pure facts. I used to live in a city where me and my wife were terrorized by homeless people on the light rail. Now we live far away from public transportation and no longer have to worry about the safety of ourselves or our children and our neighbors are fantastic people.
Car dependency and castle doctrine is essential in a low trust society with a legal system that puts violent offenders right back on the street.
Moving in a private vehicle is statistically the most dangerous activity an otherwise healthy young person routinely participates in. Your family is almost certainly at higher risk of death and serious injury now because you based this decision on your perception of safety rather than evaluating the reality of it. Speaking of "pure facts."
[flagged]
Please avoid personal swipes like this on HN.
https://news.ycombinator.com/newsguidelines.html
In more than a decade living in Stockholm never had a mentally ill homeless person bothering anyone in the subway.
Perhaps the subway itself isn't the problem...
Surely the priority should be to help those with mental issues and those without homes? It's bizarre to want to live in a society that prioritises car use so that people don't have to see those discarded by the same society.
Men would rather build a continent-sized car-dependent infrastructure that deal with mentally ill homeless people on the subway...
It is called the American way.
Correct. Lack of accessibility is a feature when you live around bad people and the legal system doesn't function to eliminate the threat
probably some anti-suburb argument
I actually thought about including this in the piece (and how car sizes become a problem once you hit 4+ kids) but decided to keep it more focused on just the healthcare costs
Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading. Presumably, you'd be paying those even if you didn't have the child. That said, the cost of health insurance for a family is pretty outrageous. My premiums are along the same lines as the ones here (although less noticeable since they're paid by my employer).
Had the same reaction when I saw how the 40K was calculated (BTW I strongly believe in Medicare for all to control costs and to pay for civilization. To be paid out of progressive taxes on all income).
If Aaronontheweb had the misfortune of getting seriously sick, required surgery .. he would pay $7,150 for something that could easily cost $100K+++. Saying he's paying premiums just for having a baby really feels like weaselly logic .. so he thinks he or the rest of his family will absolutely never fall sick? What if a cancer diagnosis hits one of you out of the blue (I hope it doesn't, but that's what insurance is for).
Which bits cost 100k? The $75 ibproufen? The $47 towel? The $19,563 bed charge? Oh, the $32,925 imaging that NFL players get instantly?
Insurance in America is a fucking joke.
The charges you mention are likely all from hospitals. How about Pluvicto for advanced prostate cancer at $42,500 per monthly dose? All the players are in on it.
The sound way to manage costs and avoid these games is via Medicare for all, with premiums paid by progressive rate taxation of income. Maybe even wealth beyond a very large amount.
Currently insured Americans would likely be worse off under any plausible M4A plan.
Based on what? Why even leave this comment if you’re just going to say “would likely be worse off” without giving literally any evidence or even suggestion of why.
Insurance is a pool. The bigger your pool the more you spread the risk/load. It’s brain dead simple. Medical care is a human right, beyond that.
Nothing about our system makes any sense and it is built to pad so many pockets in entirely opaque ways between you and the care you actually receive. Cut out several layers of middlemen and the costs go down. God forbid you have an accident and you end up at the wrong hospital when the one down the road is in-network but the one they took you to is out-of-network and you wake up owing thousands of dollars.
I had pretty good marketplace insurance this year but the plan I’m on now isn’t even offered anymore and if I got the next closest offered plan I’d be paying 6X as much for the premiums with higher copays on top. I’ll be switching to my union offered plan instead which is much better than the new marketplace plan but still worse than the marketplace insurance I had before.
>Why even leave this comment
karma farming, OP has 414049 karma.
He's treating HN as a game and looking for a high score.
Show your work, please
> Hmm, counting the insurance premiums 100% towards the birth of the child is a bit misleading.
I see your point, but do you not think that if you're a family of 4, having to pay $40K before insurance kicks in is ridiculously expensive, and out of reach for most Americans?
I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums). The deductibles can be so high that you're pretty much always paying out of pocket.
> I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums).
Self-employed here. My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible with typically a $20 co-pay. It covers 3 prescriptions, therapy sessions for each of us, various older age diagnostic checks, and almost all office visits. In addition, if either of us develops cancer or is hit by a truck, we will not be rendered bankrupt.
So I'd say ... nah.
> My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible
That's really nice - are there state/government subsidies involved?
I work for a top tier company and my premiums are not that much lower than yours.
When I checked the public market's insurance options, getting a $3000 or so deductible was a lot more expensive than yours if one is not low income (i.e. not subsidized).
Yes, those are numbers with
(a) for 2025, federal premium subsidies in effect ($19k/year of subsidy) ! (b) for 2026, NM temporary subsidies
A reminder that until the end of this year almost everyone gets subsidies. Nobody in the US, no matter their income level, should be paying more than 8.3% of their AGI for health insurance. That all changes come Jan 1st 2026, thanks to the current Congress. Our premiums would be $2531/month had NM not stepped in to use some of those sweet, sweet fossil fuel extraction taxes to help us out.
Oh yeah, deductible in 2025 was actually $2800. At our age (early 60s) and general health (good), gold plans make much more sense (if you can afford them).
i'm 36, self-employed. silver plans in my state are ~800/month next year, with 8k deductible, no out of network coverage at all, with no in-network providers out of my state, so god forbid I get injured while traveling to visit my in-laws. the marketplace is a joke and health insurance in this country is pointless.
> no out of network coverage at all
I thought they'll all cover ER visits out of network. Is that not required by law?
As usual, they find ways to limit that.
https://www.emergencyphysicians.org/press-releases/2017/10-1...
> In a controversial decision, health insurance giant Anthem Blue Cross Blue Shield is warning policy holders—in Georgia, Kentucky and Missouri—that they may have to pay for their trips to the ER. The company has developed a secret list of diagnoses that they will not pay for, such as "chest pain on breathing" and blood in the urine, even if the patient thought it was a medical emergency.
Too expensive? check
Deductibles too high? check
Stupid coverage limitations? check
Pointless? nope
The problem is the healthcare cost is insane. You will go through $40k after a good injury that may need a major surgery or few smaller surgeries. Average cost for hip replacement is $40k.
I've had a sports hernia and the bill was about $30k.
That's crazy, I looked it up and the average cost for a hip replacement here in the private system in Australia is about $24k (US$16k).
You can get it for basically nothing in the public system but you might have to wait a year or so if it's considered elective (emergency surgery is immediate of course), but most people with private health insurance can get the procedure done within in a few weeks and would only have to pay about $1000 (US$650) out of pocket with a $500 excess (which is pretty common), because the anaesthetist and surgery are usually invoiced separately. Some plans do have lower excesses (like $350) though if you pay higher premiums.
> I've had a sports hernia and the bill was about $30k.
And what the OP is pointing out is that if your injury is $30K, insurance covers nothing, because the premium + deductible is $40K.
> And what the OP is pointing out is that if your injury is $30K, insurance covers nothing, because the premium + deductible is $40K.
The point of insurance is to mitigate risk. If you think you have enough money to cover your risk, there's no reason to buy insurance.
The sleight of hand here is first complaining that you did not incur enough hazards to offset the risk premium and then citing this as a reason the risk premiums should not exist. Where is the story of the family being weighed down by bills? Or of not getting physical therapy after an injury and having permanent, income-reducing disabilities?
Risk is not the only factor. Premium cost is probably the more important one for most. If someone can afford the $40k deductible option, but not the $5k option, you’ll just have to accept the risk. Increasing earnings significantly right now is harder than hoping medical bankruptcy won’t matter in the long run.
30% of US households make less than $50k. That’s more than 100,000,000 people in homes with less than $3.6k/mo for all living expenses. The stories you ask for are simply inevitable
In my country people are already complaining about a 300 euro deductible (my mom has a chronic illness so she hits that every year)...
I surmise that either Americans are all rich and have 40k in savings that they can lose with no sweat or
America is hell for anyone not rich
> The point of insurance is to mitigate risk.
Agreed - both to you and to society.
What's under debate is "how much risk." For most people in the US, they'll need help before they hit $40K. They can't afford paying $40K every year for medical and medical related expenses.
OP was talking about a family for $30k.
Imagine 2 people get injured in a year, you are now at $60k. Plus, $150 a visit for primary and $300+ for specialist.
My 5 year old has been to the hospital 3 times, stitches once. US healthcare will ruin you if you don't have insurance. A cancer treatment can bankrupt a millionaire.
I am a male breast cancer survivor. I had a mammogram the other week. $620.
No, nobody benefits from insurance in America. Well, nobody ill.
You had health insurance but it did not cover that?
Oh, the bill was 12.3k
So this was sarcasm? Or a remark on the co-pay/deductible being too high?
I only keep this plan because we're planning on having children, so yes, it's included in the pricing decision.
That doesn't make sense to me. Are you saying your health insurance premiums would be $0 if you weren't planning on having children?
Did you try reading the lengthy section of the article where I answered your question?
I skimmed your 2400-word article a second time just now, and I still don't understand why your math is allocating 100% of your family's health insurance premiums to childbirth. And now I additionally don't understand your abrasive tone in answering this fairly straightforward question.
Multiple commenters are raising this point, so perhaps you should consider that you aren't conveying this information well?
1. I mentioned, in multiple places, that this is the cheapest PPO offered to me through a limited selection of potential brokers / marketplaces - and that's important because it covers our current health care providers AND child birth as a benefit.
2. If we weren't trying to have kids, our options for purchasing health insurance expand drastically. Individual marketplace plans become a viable, for instance, since the "not covering childbirth" issue goes away. I mention the short-comings of the individual health insurance marketplace at least twice in this regard, including a big pull quote explaining the ACA work-around with child birth coverage.
> If we weren't trying to have kids, our options for purchasing health insurance expand drastically.
Yes, but crucially none of those expanded options cost $0, so I still don't understand your math at all. I feel like we're talking in circles here.
You should be deducting a substantially non-zero number from the amount in the headline to account for your "normal" non-childbirth-year best-case medical insurance premiums (or out-of-pocket cash costs if foregoing insurance altogether).
What exactly does covering childbirth mean? We've had two children now and it's not something I've considered when choosing insurance (my company's vs my wife's), so maybe we just got lucky. Is there anything different about child birth vs simply in-network hospital coverage? I assumed we'd just hit our out-of-pocket max.
Above comment is discussing choosing via marketplace, which indicates it might not be an employer funded plan. (Which are gonna be better)
You are spreading misinformation when you say ACA doesn't cover childbirth.
If this was true it would be plastered in every newspaper for the last 15 years.
I think OP here is just keeping a completely dominated plan (and his health insurance company knows it). He has less than 50 employees, he is not required to offer health insurance to his employees and he should go on the ACA market.
Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies (which, by the way, in 2021-2026, were available to everyone) by tweaking his income (easy to do when you have a company).
He also says uninformed things like:
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those.
The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
> HMOs or EPOs that have some issues with them: coinsurance
What matters at the end of the day when you have a child is your maximum out of pocket (which you will 100% hit the year you have a child!). Whether you have copays or coinsurance after a deductible does not matter here. The ACA caps your maximum out of pocket at $18,400 no matter what (which, yes, is too high), so what you need to optimize for is premium + OOP for the providers that you care about.
Like, I get it, it's America, for healthcare like many other things (student loans, credit card debt, ...) it's easy to end up in a bad situation, but at some point you have to spend time understanding the game.
> Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies
I am absolutely not eligible. I earn more than $150k. And "manipulating your income" is not really feasible with a pass-through entity.
> The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
As I mention in the piece, I check every year. I have no idea what subsidized plans include, but the other marketplace plans definitely do not include child birth.
I explicitly address this point:
> The Affordable Care Act (Obamacare) barred insurers from turning down applicants based on existing pre-conditions; the way insurers get around this for pregnancy and child-birth is not by rejecting pregnant applicants (illegal), but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
and
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those. All of the ones I’ve found through eHealth Insurance or Healthcare.gov never cover it - and I check every year.
Love the over-confidence though. The best outcome for me in even writing this article would be to get some internet commenter pissed off enough to find me a cheaper version of my plan. That would solve my problem immediately!
ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...). But it might not matter because you aren't on a marketplace plan according to the screenshots in your post.
You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf
Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max, so the childbirth should top out at the 7150. Other expenses might put you at the same 40K cost for the year, but not the childbirth alone.
> the $14300 is the family out of pocket max
You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time.
Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years.
I have to ask - why are you defending this?
I'm not defending it. I'm correcting your misinformation. You are claiming that ACA plans do not cover childbirth. They do. You are claiming that this event alone costs 40K, which is not accurate. It hits your out of pocket max, exactly as designed.
It sounds like you have never looked at an ACA silver plan, which is the lower deductible/out of pocket max option. I also have a family of 5, and have a $1800 per year out of pocket max from an ACA plan. You would still have the same level of premiums as you do now for silver plans, but you would save 13K a year. You are picking bad plans, dude.
Our system has problems, but when you make enough to not be subsidized, yet still pick a crappy 40K per year plan, that is beyond the systemic problems. It is a bad choice. There are insurance consultants who work with people, especially high income people, to find good plans for their family. You should be calling them.
Dude, you don't even have your own facts straight and you are embarrassing yourself. It's clear you have no experience, don't understand your own sources you provided, or any clue how child birth actually works from a medical billing standpoint.
Edit: what do I have to gain from spreading "misinformation?" I just want better / more options?
I don't know what you have to gain from it, but you're wrong. 42 U.S. Code § 18022, (b)(1)(D). ACA plans are required to cover childbirth.
That's not what the link the OP included said and not what I said either, but I concede your point - that's my fault for checking individual health care marketplaces (like eHealthInsurance and Aetna direct) or not looking closely enough on healthcare.gov.
Looking through some plans now, but TBH these are genuinely not much of an improvement in the cost department and a massive downgrade in the provider selection department. Hence my whole section on trade-offs.
The logic you're using about out-of-pocket costs versus your deductible appear also not to be valid, and are causing you to misstate your out-of-pocket liability by a factor of roughly 4x.
I can assure you they are, if anything, understated - as I am not including the expenses my health insurance will not cover. So no, you are fully in the wrong there. What do I have to do to prove it? Show you itemized receipts?
Moreover, what are you even trying to accomplish by asking for this? Please provide me with a forthright defense of the modern U.S. health insurance markets and why it makes sense for me to have to pay this much to keep our population above replacement level.
Do you have non-ACA insurance? One explanation for why your costs are so much higher than the national average is that you're on a non-complying plan (you can also still buy plans that will exclude preexisting conditions --- they just can't be sold on the ACA marketplace). I'm pretty confident KFF isn't making these numbers up.
As for your second question, one easy response is that prospective parents in other health care systems aren't paying less (with everything factored in) but rather differently: that people making your $119k "true" poverty rate in Europe tend to be taxed at their top marginal rate, which is substantially higher than ours (in fact, in a lot of places in Europe, a Chicago Public School teacher would also be paying the top marginal rate).
A thing worth pointing out is that while the system we have is especially punishing on the uninsured, it's actually not that bad a deal for the insured, demographically/actuarially speaking. That's because being insured definitionally puts you in the cohort that excludes Medicaid-eligible poor/working class people and fixed-income seniors. If you move the typical household from that cohort to the UK, they're likely to be worse off. In surveys, insured families tend to be satisfied with their insurance, which is why taking existing health insurance off the table is such a third rail in American health policy.
Anyways, unless you personally are responsible for keeping our population above replacement level (which sounds exhausting), your numbers just aren't probative for the cost of bringing new citizens online. Other numbers might be!
> Do you have non-ACA insurance? One explanation for why your costs are so much higher than the national average is that you're on a non-complying plan (you can also still buy plans that will exclude preexisting conditions --- they just can't be sold on the ACA marketplace). I'm pretty confident KFF isn't making these numbers up.
Asked and answered in the piece dude - I wish I had the confidence of a Hacker News commenter who didn't read the article.
I read the article. It's extremely unclear to me whether you have ACA-compliant health insurance or not. I've been a startup principal since 2005 and have had PEO coverage at various points since the ACA passed, and it was always ACA-compliant. Could you just answer the question? It shouldn't be a riddle!
(Note that "non-ACA insurance" doesn't mean "insurance you didn't buy on the ACA public marketplace". I've got Anthem Blue Cross through our benefits provider. It is very definitely ACA-compliant.)
While I might not have been happier income-wise when I was on Medicaid vs now, I was much happier with my medicaid insurance than I have ever been with any private insurance. I could see basically any provider and didn’t have to deal with any of the typical insurance bullshit.
Also when you’re beyond the Medicaid threshold but not that much beyond it absolutely sucks. One year I was paying for dramatically worse insurance with a deductible that would have just made it better for me to just not make more money because if I hit that deductible I would be net negative on my income vs the threshold for Medicaid.
Also I think this is such a false premise. You can still have private plans if you want in the UK or elsewhere with a public health system. Nobody is forcing you to use the public system if you don’t want to. To wit, I don’t have children but I still pay for schools with my taxes. You might not want to use the public health system and instead go private, but yes, you should still be paying for a freely accessible healthcare system.
Here’s the rub on that too: The prices we pay here are so much higher than in Europe even if you go private in those countries. Our system is terrible. Point blank.
I would agree that the NHS in the UK has gotten pretty bad. A large part of that is the result of the Tory government actively working against it though for a very long time. The waitlists for a lot of things are quite long and my fiancé who is from the UK and still lives there has to do some things there are crazy to me. On the other hand she still is able to get care freely. She’s paid private for some dental work but that also cost her pennies on the dollar compared to what I’d be paying if I did the same thing here.
If you’re happy with your insurance I am truly thrilled for you because I don’t think of that as being a common experience.
I too am nearly universally irritated with my health insurance (due to reasons I’ve had 4 employer sponsored plans in the last year).
But I recognize I’m in the minority. And it’s not close. Most people with private health insurance like it.
tps://www.kff.org/affordable-care-act/kff-survey-of-consumer-experiences-with-health-insurance/
> Most people with private health insurance like it.
Most people don't use it all that much, and in the common case of employer-paid premiums, the actual cost is significantly masked. As your link notes, the more care you need, the less likely you are to enjoy the experience. They dig their heels in more; sometimes egregiously so. https://www.propublica.org/article/unitedhealth-healthcare-i...
> ACA plans absolutely cover childbirth (https://www.healthcare.gov/what-if-im-pregnant-or-plan-to-ge...)
that link doesn't even say what you says it does - it said you can apply for coverage, not that there are plans that cover child birth. Have you never done this before?
> And "manipulating your income" is not really feasible with a pass-through entity.
I don't know if you have a CPA, but this is a sentence my CPA has never uttered.
> but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
Including...? I have never heard of this, and actually have delivered babies and worked with post-partum mothers.
The explanation of benefits simply doesn't cover child birth - this is extremely common for individual marketplace plans.
If by "individual marketplace" you mean the Healthcare.gov-style ACA individual marketplace, you now know this to be totally false.
Welcome to healthcare plans in Texas.
This same price gets you a platinum plan with Sharp or Kaiser in San Diego and wouldn't have those gigantic deductibles.
He moved his business from California to Texas and is now complaining about pricing problems in markets caused specifically by the lack of regulatory environment in Texas.
Why do you need to get insurance for your child to be born anyway? Isn't the hospital already insured? Isn't that kind of janky?
In America, you basically need insurance to act as a larger stronger party in the negotiation of prices with the hospital on your behalf. Without the bargaining power of the insurance company the prices you'd pay can be significantly inflated. So paying for the insurance is the slightly lesser of two evils. Supposedly. From your question it seems perhaps you live somewhere with a saner system in place. I'm envious.
I’ve been told that too. But I’ve done self pay for the last year, and every time I go to the hospital they instantly give me a 30% discount.
That makes me think they are artificially inflating prices so that when the insurance company negotiats their discount, well, it might be the same as what I pay
Birth injuries are insured by the ob/gyn, which is part of the very high cost of delivering a baby in the US (because such injuries often lead to a lot of care).
Also not a big impact on the message, but $200/mo for a phone is a bit disingenuous.
Claiming $200/month for a phone makes one wonder which numbers are valid. I'm not saying everyone needs to make a $100 phone last 5 years and use a $15/month plan, but I'm not even sure how I would get to $200/month in phone bill, even including financing an iPhone 17 Pro Max.
$200 seems valid - it comes from the linked article [0] and it includes home internet (I pay $110 / month Comcast just for home internet in Bellevue. In Seattle I paid $130 / month). Maybe Aaron could have phrased it better. (I also recommend to read the linked article as it is a phenomenally well done financial analysis.)
[0] https://www.yesigiveafig.com/p/part-1-my-life-is-a-lie
With $85/month service (AT&T unlimited premium with only a single line) and financing a $2,000 phone (The smaller storage version of the Galaxy Z Fold 7 at MSRP) over 18 months, you’d hit almost exactly that; you could so the same with a cheaper service and/or phone with some add-ons (e.g., while Apple Care is billed directly by Apple and so wouldn't be on a phone bill, insurance for non-Apple phones is often billed by carriers on phone bills.)
$200 doesn't seem that crazy if they are buying several phone lines. I assume he pays at the least his wife as well, so that's two. If they have home internet bundled in as well, that would easily explain that figure. All to say, AT&T. He may also have a home phone line for a fax machine. It is perhaps a bit disingenuous to bundle it all together, but it also isn't the main point of the article.
I pay that at least much for my family, hence why I used it
When you say
> I pay that at least much for my family, hence why I used it
and your article says
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
It sounds like you're trying to communicate that you pay at least $200/month per smartphone for your family? Or you don't value precision in communication.
I know you've got a lot going on with a small business, and a new kid... but if money is important to you, maybe spend the time to switch to prepaid phone plans. There's lots of options [1], whatever network you need, you can do direct operator plans, MVNO owned by the operator, or like actual MVNO. If you're short on time and T-Mobile's network works for you, MintMobile has a promo going right now where $180 pays for 12 months of "unlimited" which is $15/month if you divide it out.
> I also pay $1250 per month to TriNet for the privilege of being able to buy their health insurance in the first place - sure, I get some other benefits too, but I’m the only US-based employee currently so this overhead is really 100% me.
Do you live in a state with a reasonable healthcare exchange? You might want to shop and see if an off the shelf plan from the exchange is better than paying TriNet to get access to their insurance; it may well be, but you should check. If you only have one US employee, and it's you, there's a lot of expense for not a lot of value IMHO. It's not really Apples to Apples though --- I think a lot of the TriNet plans have out of state coverage where a lot of exchange plans don't.
[1] https://prepaidcompare.net/
> It sounds like you're trying to communicate that you pay at least $200/month per smartphone for your family? Or you don't value precision in communication.
You're moving the goal posts here. You have to have service, realistically, in order to use it like a real person.
I'm trying to figure out what you're getting for $200/month.
Is it for "a smartphone" with service, and presumably financing the phone as well? Or is it the total for all of your family's smartphones, which is how many phones/lines?
Mint or US Mobile are ~$15-20 a month. You're massively overpaying
Do they come with free mid-tier phones? What if you need 4-5 lines? What if, as a CEO, he needs a better plan than "basic prepaid, lowest-priority-subject-to-throttling"?
And what if the CEO needs international numbers across all continents?
What if the CEO needs to supply an entire 1,332 person company with business phones?
What about an assistant to answer them! What if we're sleeping!
Oh god!
But just to put my comment in context, here is what he said:
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
Okay, so on the non-budget side, I pay ~$64/mo for T-mobile's "unlimited[1]" plan and a Google Pixel phone. ($57/mo for the service, and I've amortized the phone price to ~$7/mo based on my lifetime average phone lifetime. Even if you amortize the phone over only its ridiculously short warranted lifetime, that's $42/mo for the phone, or $99/mo, but that implies purchasing a new phone yearly, which most people do not do (the average phone lifespan is just under 3y).)
[1]: (n.b., the plan is not truly unlimited.)
How many phones do you get for that?
My family has two phone lines for $50/mo, plus we buy two ~2 year old iPhones every 3-4 years, which adds maybe another $20/mo average to the cost.
Consider changing your plan?
I pay $70/mo for 2 phone lines. Unlimited everything (well, OK, 5 GB data cap before slowing down).
So that's not unlimited.. I could imagine a CEO could burn through 5GB pretty quick.
Yes, but does the CEO's wife have to be on the same plan?
I suspect needing to make a lot of international calls may be the culprit.
5GB data cap is ridiculously low. Might as well only count the slow speed.
In over a decade, the only time I hit that cap was because I let my kid watch too many videos on it.
5 GB is pretty reasonable for the bulk of the country. The only common things that can make it go over are games and streaming - both of which really are luxuries if you simply can't wait till you have Wifi access. So yeah - of course you should pay a lot more if you insist on doing those things.
This is akin to him saying that average American needs X money for the car to participate in society, and you suggest that his numbers don't math because one could:
1. Walk around everywhere (Idaho, Iowa) 2. move to New York (with ok public transportation)
Mobile phone and unlimited high-speed internet are requirements for participation in society.
Not at all. Most people don't use 5 GB in data each month. Most people do drive.
> Mobile phone and unlimited high-speed internet are requirements for participation in society.
Sadly, I have to agree with you about mobile phones, due to 2FA. But unlimited high speed just for when you don't have Wifi a requirement? Nonsense.
> unlimited high-speed internet are requirements for participation in society
I pay $7/mo (not a typo) for 1GB mobile data via US Mobile, and I have never hit that cap in many years. I just don't stream video or audio unless on WiFi, which is not a hardship. Respectfully, what on earth are you talking about?
It's like $45-$50 for an 'unlimited' plan that is only capped if you are on a busy tower.
A decent percentage more, not a lot of dollars more.
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It’s also what critical thinkers do when evaluating “what percentage full of shit do I think this author is?”
If a glaring innumeracy or terrible estimate is in the article, why did the author include that? What was their angle? Does that make me trust the rest of the article more or less?
I included screenshots of my actual health insurance premium terms, including the plan number, which is what is at issue in the article.
Because it indicates dishonesty and/or innumeracy which calls the accuracy of the rest of the piece into question. "Checking if the author can actually count" is basic media literary stuff, not some sinister agenda.
I think he's quoting that from the other article, not necessarily computing it himself. I think that article was about the cost of broadband + smartphones.
We pay ~$100/month for 1G broadband (I realize this could be lowered somewhat), and ~$100-120 for 5 phone lines for the family (AT&T prepaid). I'd like to see you make a household with multiple lines + broadband work for less than $100-125.
And that's not even that hard - I know some people spend $300+ JUST on their phone plans, in addition to broadband. And then if you factor in amortized cost of phone replacement? It's closer to $200 than to $50 for example, IMHO.
$200 seems to include home internet (which I think everyone needs these days to function). The $200 quote comes from the linked article [0] (speaking as a former financial analyst, this is an amazingly well done financial analysis). Maybe Aaron could have phrased this better.
[0] https://www.yesigiveafig.com/p/part-1-my-life-is-a-lie
I pay about that much for a family of 2.
I pay $127/mo for a family of 4. $800 for 4 refurb iphones amortized over ~5 years so add another $15/mo.
How?
Verizon unlimited plans will be about that after taxes and fees for two lines.
Add in phones being financed and you’re easily over $200/mo direct with a carrier.
A lot of this is an issue of insurance no longer being "insurance" in the classical sense. Insurance covers all sorts of things, my HSA pays for all sorts of things that I never would have even considered, and while that sounds great, it helps to drive up costs. It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that. But the situatuon is a lot like student loans, colleges know they can charge more because the government will lend 5-6 figures to just about anybody, so the colleges do so. And once that person is educated, you can't just "take back" the education if they don't pay. Same deal with healthcare, government subsidizes it for most of the population in lots of ways, healthcare providers know this, they increase prices to match. And you can't just take back the surgery to fix that broken arm or undeliver the baby. There's not a single silver bullet that will fix everything, but there are definitely concrete changes that can be made to improve the situation. One of them would be to make people healthier. I know, easier said than done. But by God it would make health insurance cheaper. Same way in that if everyone was a safe driver, we'd all be paying less in car insurance. Another way would be to remove that regulation or rule or something that makes it so like a hospital can't open too close to another hospital. Another would be to just, train more doctors! What I'm trying to say is, just as the problem is multi-faceted, the solution must necessarily be as well.
> but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper.
I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.
The best thing we could do is ditch the private healthcare industry to the extent that the rest of the first world has and cover everyone with government plans. Those plans can then negotiate for much better prices and refuse the kinds of insane charges we're seeing. The cost of plans would also drop because prices would be spread out over every taxpayer. Having primarily a single provider for insurance would make everything easier and less expensive for hospitals and doctors offices too.
The billions in profits private healthcare companies rake in all comes at the expense of everyone else one way or another and they have every incentive to make as much money in profit as they can. Without that excess fortune in profits being skimmed off and stuffed into pockets a government funded insurance plan which covered everyone could get the job done taking in closer to what it actually costs to deliver the services we want and no more.
You don't need the insurance industry sticking their dick in most of the business they do. Insurance is for the foreseeable but unforecastable, not for routine things.
The additional overhead is substantial and adds huge marginal cost for routine things and say nothing of the principal-agent problem
You could zero out every dollar American insurers make and not materially alter consumer health care economics; their share of the health care pie is almost literally a rounding error.
The magic of the system is that it's structured so that people like you can say things like that and not even be lying in any provable way.
Sure, it's not the actual insuring that's costing that much but the massive breakdown of incentives from increasingly vertically integrated healthcare companies (some of whom are insurers, some of whom own insurers) owning increasingly large shares of everything is clearly causing cost to spiral. The industry is making work for itself at out expense. Whether that work happens in the insurer's office or the billing office of the clinic that's owned by the insurer isn't really material. And of course everyone in the process gets a cut so they fight for their bit of it. Doctors used to drive the same crappy cars and live in the same modest houses as the rest of us. Nurse didn't used to be the "made it in life" job for people who come from poor backgrounds.
Dial it back a bit. I just made an extremely banal and citable claim about US health care. I agree with you (trivially verifiable from the search bar at the bottom of this page) about the practitioner compensation racket.
https://nationalhealthspending.org/
They add costs in the form of hospital administration which wouldn't be their books.
> Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it
It’s more they know insurance won’t pay for it, and negotiate discounts based off the “retail” price. Although at this point it’s gotten so ridiculously convoluted and cross-subsidized that I doubt even the insurance company or hospital knows what the actual paid amount for a Tylenol will end up being until months after the fact.
Meanwhile, I hand my credit card to the vet for a bottle of Gabapentin and I’m out the door.
That will be uhm, <checks register> $15. Have a fantastic holiday!
My point being that healthcare costs for pets are immediately calculable, where it’s a big damn mystery for months on end about how much equivalent human healthcare will end up costing. Clearly, if the former is possible, the latter should be too.
> I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.
Did we discover a new kind of monopoly perhaps? It’s not quite full blown corruption as there still (for now) exists a somewhat adversarial relationship between insurance and hospitals. However, at the same time, they seem to be pulling each other into the abyss, and our society is the victim.
> It's somewhat counter-intuitive, but if you dropped all government funding of healthcare tomorrow, healthcare plans would get cheaper. It'd also be total chaos, so I get why we don't do that.
But there are other things we could do that we don't.
For example, right now we have the expectation that insurers are going to "negotiate" with providers to determine the price, and then you have to use the providers your insurance has negotiated with, but who actually wants this? When you as a retail customer want to buy a pair of shoes or a piece of exercise equipment, do you call up all the manufacturers and try to haggle with them? No, they list their prices on their websites or sell them through retailers that do the same and then you choose based on who has what you want for the best price.
So make non-emergency healthcare work like that. Require them to publish their prices. Then the insurance company doesn't tell you where to go or negotiate with anybody, they only tell you how much they pay, which might be e.g. 90% of the second-lowest market price in your area, equivalent to a 10% deductible. Then you go to a website that lists every provider and their price, pick where to go and pay the difference yourself.
Suddenly they all have the incentive to publish the best price, because that's what most people are going to pick, and then you have an actual market instead of the existing opaque bureaucracy of corruption.
The majority of spend is in the last few years of life. A man dying of a stroke during the night at age 50 is much cheaper to the system than the same man living to 90 having fought cancer for 10 years.
I'm not advocating against health nor preventive care, however they don't decrease costs nearly as much as you'd expect.
Christian healthcare sharers do precisely this. By restricting services and the population addressed (your pastor or priest must sign off on your application), everything's extremely affordable. In particular, as we don't drink, do drugs, use contraceptives etc. we don't pay for coverage of them or their side effects. Obesity's also less of an issue.
There's also the trick of telling the hospital you'll pay "in cash" and getting a 10x lower bill from the hospital, then getting that reimbursed/covered by your private or alternative insurance.
Christians don't drink or use contraceptives? I think you have to have a pretty extreme "no true Scotsman" attitude to make such a claim. Even the drugs claim is pretty specious.
> Christians don't drink or use contraceptives?
They're talking about a very particular sort of pseudo-insurance plan.
https://en.wikipedia.org/wiki/Health_care_sharing_ministry
They can and do exclude whole swaths of what normal health insurers have to cover. They don't even have a legal requirement to pay out at all.
https://www.nbcnews.com/health/health-care/health-care-cost-...
> Beyond restricting maternity coverage, many groups’ policies state that they won’t reimburse for prescriptions, routine doctor’s visits, contraceptives or mental health or substance use services. Coverage for medical conditions that predate someone’s membership is often excluded, as well. And health care sharing ministries aren’t required by law to limit out-of-pocket costs or maintain large cash reserves to cover members’ bills the way insurance companies are.
Pastor won't sign off (unless you come to an agreement).
So your pastor or priest conveniently rejects you if you have a chronic illness.
It’s not a death panel when it’s divinely inspired I suppose.
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So are you still allowed real wine at communion then? A bottle of beer after working on your car all day? I know some christians who preach "100% dry", others are more relaxed. Some are fine with contraceptives (including many Pentecostals, which is how I was raised), quite a few overweight people, etc. And they're just as christian as you are.
It sounds like you're going for the "unlikely to need it" plans, which go broke when you actually get sick..
> So are you still allowed real wine at communion then?
I've run into folks who claim "wine" was a mistranslation of "grape juice", and some denominations don't use wine.
https://en.wikipedia.org/wiki/Eucharist
"The elements of the Eucharist, sacramental bread—either leavened or unleavened—and sacramental wine (among Catholics, Anglicans, Lutherans, Eastern Orthodox and Oriental Orthodox) or non-alcoholic grape juice (among Methodists, Baptists and Plymouth Brethren), are consecrated on an altar or a communion table and consumed thereafter."
I would think using contraceptives is not in the same category as drugs or liquor, though.
> that regulation or rule or something that makes it so like a hospital can't open too close to another hospital
You're referring to certificate of need laws, but it's worth pointing out that they're not universal. More than a dozen states have repealed them (or don't have them) and everywhere I've looked, there's strong evidence that their removal has increased healthcare access, which has put downward pressure on cost of service
> Another would be to just, train more doctors!
Bill Clinton placed a cap on GME funding in the 97 Balanced Budget Act, freezing the number of residency slots that the federal government would provide funding for, so this effectively froze the number of residents there could be, which effectively limits the number of doctors possible
"If insurance covered brake pads they'd cost more" is an old mechanics quip. The principal agent problem just fucks the cost and incentive structure of anything insurance covers.
This is why it's unwise to send "routine" things through the insurance model.
Unfortunately, most of what you suggest would get in the way of many people making a lot of money.
"There's not a single silver bullet that will fix everything" idk, it seems like eliminating the profit motive from healthcare would resolve all kinds of problems.
Suppose you want to remove the profit motive from healthcare.
If doctors would still get paid above-median wages, you would still have a profit motive. Their lobbyists would want to limit the supply of doctors or simply lobby to have the government pay them high wages, to require that things be done by a doctor instead of a nurse, etc. Likewise the drug companies would lobby for the government to pay them more for their drugs, and when the government is captured then that's what happens. The same problems we have now; you haven't solved anything.
If doctors would get paid a lower wage but still have to attend 8 years of medical school, there wouldn't be a profit motive, but then there would be a shortage of people willing to become doctors, patients would have to wait a long time to get an appointment as they do in places like France, etc.
The profit motive isn't the problem, that's the thing that causes anyone to want to (and be able to) provide healthcare. The problem is the corruption. You have to stop limiting the number of medical residency slots and allowing drug companies to patent trivial changes to preexisting things etc.
Whose profit motive?
Insurance? Hospitals? Doctors? Pharmacists?
Even public system that are fee for service have problems with profit motive - doctor “does more” and they make more.
The first sentence is your answer. The third word even.
The healthcare market. MARKET
Healthcare shouldn't be a market. That's why you're paying $40k.
I have the opposite viewpoint, and I lean heavily progressive in most of my views.
Healthcare in the United States isn't a market, and that is why it is so terrible. For instance, there is no reasonable ability to compare prices of services. Prices are entirely hidden. Then there is the "with insurance" price vs cash prices.
Healthcare doesn't function as a market, to our detriment.
Healthcare doesn't function as a market because the nature of it is largely at odds with the principals of an efficient marketplace and perfect competition. Not to mention the tens of billions of dollars being pocketed by middlemen every year.
In some places, free market healthcare is great. Dermatologists, dentists, chiropractors, things like that. And part of the reason it's great is because you get to shop around and people fight for your business.
In other areas, like heart attacks and strokes, you do not get to shop around. And you pay whatever they say you will pay. When those are the circumstances, there is simply no free market. And since no one is competing for your business with lower prices in that case, you do not get to see lower prices. They charge whatever they can maximally wring out of you.
In those places, free market healthcare is great because they don't have healthcare practitioner cartels and can pay their doctors middle-middle-class salaries instead of investment banker salaries
If that's true, explain surgical center pricing, which often beats health chain prices by over 50%.
That has at least one fairly simple explanation: those centers only take lower acuity patients. If you're complex with a history of complications, it'll be "we'll do this one at an actual hospital".
(This is frequently the case for my wife.)
They may also not take Medicaid patients; my state publishes lists of ones that actually do because of this. https://www.health.ny.gov/health_care/medicaid/quality/surge...
If you're talking emergency medicine and old age care, yes, it's not able to function as a market.
Hence why the US already has government healthcare that covers almost half the population (Medicaid and Medicare cover the old, young, disabled, veterans, and poor people).
However, the place you give birth is, in the vast majority of cases, something people do like to have agency over, especially given the 9 months of heads up given by nature.
If healthcare weren't so perversely incentivized by the twisted triangle of regulated public/employer/private systems and their interactions, I would argue this is something that could be a functioning market.
Like Universities with their endless ability to raise prices due to the US government guaranteeing student loans of any size to anyone, a big problem in healthcare is there being no anchor to reality due to the principle-agent nightmares of the current regulated system.
In Europe, when you give birth it is not a luxury experience with a doctor of your choosing in a 4-5 star level private room where you're sent home with a big basket of freebies. If all Americans had to pay directly out-of-pocket (as Europeans de-facto do via taxation), you can bet reality would set in quick.
"billions"
lol..
Dr Evil in the time you've been in cryostasis...
Sorry, I'm not going to Google "cheap MRIs near me" when I'm bleeding out on the floor having an emergency. Healthcare is not expensive because you can't see how much a doctor visit costs, it's expensive because that's how a lot of people make a lot of money, and they get very upset when that is threatened.
Most medical care is not an immediate emergency. If I could compare MRI prices and it would impact how much I pay (either as an insurance copay or out of pocket) I would absolutely do that. But I have no opportunity to do that so there is not price feedback like there is in a market.
Even if it's not an emergency, many medical events come with a lot of unknowns. Like having a baby. No way to say how long labor might be, if there will be complications, how long you'll need to stay afterwards. MRIs are actually pretty easy to shop around for and MRIs don't make up a huge part of healthcare.
Sorry, this is simply not true. Every 1-3 years, I get a simple diagnostic procedure to make sure I don't get cancer. Without it, I'm at a very real risk of developing cancer that would quickly kill me.
There is no universe in which it doesn't cost around $10,000. None. It is simply impossible for me to get out of paying that. My options are:
1. Use insurance, and hopefully it's covered.
2. Pay out of pocket.
3. Skip it and hope I don't die.
That's it, those are my options. I can't "shop around" for this, and I shouldn't have to. This is basic medical care available to everyone in a developed nation. Ours is the only one for whom this is apparently an intractable problem, and I am, frankly, tired of being gaslit about it.
Many of those “simple diagnostic procedures” are a tenth of the cost if done outside of insurance out of pocket. MRIs are one of them.
My routine blood work done via my doctor bills something like $1600 to my insurance every other year or so - but it do it on my own outside of the medical system for about $180 every six months.
No one should have to do this for necessary care - but once you get into things not typically covered by insurance like plastic surgery or LASIK the true costs are generally rather reasonable.
A whole shadow ecosystem for “health hackers” or whatever you might want to call it exists where standard medical stuff is 10% of the cost if paid out of pocket and through alternative prescribers. It’s a small subset of all available medical items, but the difference in true cost is illuminating.
That's what the parent is saying. This is totally insane and should be just handled for us with a system that is something like what almost every other country has put in place.
Many have mixed systems. You have the public system which is fine if you have acute appendix for example. And then you have private providers, which do tell the prices and you can check which you can pick for less urgent, even a hip replacement.
It really is two separate questions how much basic procedures should cost. But I see no reason why non-urgent even important care shouldn't operate like real market. Open prices where competition is either on those prices or quality of care.
I wonder if you could pay a few air fairs and have the procedure done overseas and still come out ahead?
> Prices are entirely hidden
Recent legal changes have made pricing more transparent. In 2020, the federal government issued the "transparency in coverage" final rule under the Federal No Surprises Act. This limited the expenses for emergency care when out-of-network and a few other things, but even more exciting is that hospitals and insurers are now required to publish a comprehensive machine-readable file with ALL items and services. They have to provide all negotiated rates and cash prices for the services and include a display of "shoppable" services in a consumer-friendly format. The machine-readable files are impractical to process yourself for comparison shopping (picture: different formats, horribly de-normalized DB dumps), but many sites and APIs have emerged to scrape them and expose interfaces to do so.
When you're having a medical emergency, you can't exactly go online and start price shopping.
Nor should it strive to be a market. Healthy markets can only exist where demand is elastic. If the choice is between dying to kidney failure or enduring life-crushing medical debt, you bet I'm going to do anything it takes to get that transplant. And therein lies the problem: You *cannot* have healthy markets in healthcare. Period. Demand for healthcare is fully inelastic. Anyone arguing the opposite is either profiting off the status quo or woefully ignorant of economics.
I think this is actually an opposite problem. For kidney failure in particular, you can check the insane amount USG spends on end stage care. The demand for healthcare at the limit exceeds any reasonable supply. Healthcare spending across counties goes up pretty much with disposable income. There are massively expensive interventions that could give someone close to death few extra months.
Healthcare has to be rationed. Rationing by market is the least bad kind of we learn anything from history... Too bad healthcare in the US is not a market in any way or form, and in fact the most expensive least DALY efficient interventions (Medicare) are subsidized at the expense of everything else.
Sounds like you are looking at it from a consumer's point of view.
The US "market" is between the drug companies, hospitals, practitioners' groups, insurance companies, and government.
They are the ones that have market participation, the patient's not involved with that, their primary duty is to provide justification for the transaction.
>Healthcare doesn't function as a market, to our detriment.
So true, but even worse than that, the market that is there is predatory to a cumulative detriment worse than when simply dropping the ball makes things go wrong :\
"Healthcare shouldn't be a market. That's why you're paying $40k."
I see your drill down to fundamental issues and I raise you:
Pregnancy is not a sickness. Hospitals are for sick people.
If we reserved hospital birth for women and children with actual medical problems we would allocate resources much more judiciously.
An added benefit: not exposing otherwise healthy (and capable) women to an almost universally disempowering and disenfranchising birth-industrial-complex that seems designed to engender fear, self-doubt and pathological outcomes.
Pregnancy can turn bad (10% of first-time pregnancy, might be higher in country with high obesity rates). In that case, the faster you are with the anaesthetic and the C-section, the better. Also, hygiene. Also, ombilical cords around the newborn necks. Also, the maternities in my country are great (the one we have left at least).
Yes but hospitals are an essential part of Enumeration At Birth.
Government loves anything that assists its people-tracking machinery. It will never ever ever discourage pregnant women from doing something that would make reliable Enumeration At Birth more difficult.
In economics 101 one of the first things they teach you is supply and demand, and inelastic goods. Food and healthcare are the two main examples of inelastic goods, where demand is heavily disconnected from supply. There are of course nuances (you can eat just beans and rice, or do the bare minimum of healthcare/medicine to survive), but both are not things you have a lot of choice to consume or not.
My scheduled C-section (which my insurer likely didn't question me about because I was 40 and have other health issues) plus three-night hospital stay was about 5,000 EUR, all paid by my health insurance (private, so I know that 5,000 was the "retail" price), in a fairly prosperous part of Germany.
Not that the German health system isn't facing down some of the same demographic issues the rest of the well-off world is, but comparing wait times for specialists now that I'm on public (more like, very strictly regulated) insurance with my dad back in Texas on a combination of Medicare and supposedly good supplemental plan, I'm still in a better situation.
A strong public/heavily regulated independent insurers system gives the private insurers enough competition to keep prices in check.
Plus, I don't know of an insurer here, public or private, who also owns clinics or employs physicians, and they don't own pharmacies.
So to summarize: a. you're paying that for health insurance, not for the birth of the child. If you, your wife, your children had any other diseases then those would be covered as well. This is a significant benefit. b. all the systems that subsidize health care for those less well off don't apply because you're wealthy. So you are bearing the full cost of extremely high quality health insurance in a western country.
How come other countries have better healthcare at lower real costs? Basically every developed nation has better healthcare outcomes than the US. All other nations have cheaper healthcare.
America is not special, we've just brainwashed our less-observant citizens into believing that solutions the entire rest of the world uses will never and can never work here. There's nothing special about our population or economy that would prevent accessible healthcare. The only thing standing in our way is healthcare companies who want their 6000% cut of every procedure and politicians who will do literally anything to give billionaires another dollar.
As someone who has lived in several countries, I do not believe every developed nation achieves better healthcare outcomes than the United States. Many European countries, as well as Canada, offer some form of universal coverage with free general treatment but waiting times for appointments and procedures can vary widely. That said, I still think universal healthcare is preferable, as these systems tend to prioritize urgent cases effectively and ensure that emergency treatment is fully covered for free.
I think, it's only the Asian countries who have got cheap, easy, and effective healthcare where you can not only get appointments quickly but you can get treatment for cheap too but their emergency services are not always as streamlined as those in more developed systems. There is no clear overall winner. Some places excel in certain aspects. Others perform better in different areas.
> As someone who has lived in several countries, I do not believe every developed nation achieves better healthcare outcomes than the United States.
Is that true for a median-wage earning person?
> There is no clear overall winner.
A lot of countries are likely clear overall losers though.
> waiting times for appointments and procedures can vary widely
Waiting times for appointments and procedures can very widely in the US. Approvals to get needed treatments can also be denied for seemingly flimsy reasons in the US as well.
When I went to Canada, I talked to someone who said the Canadian government will subsidize trips to the US for certain treatments because it's not available at all in Canada or has insane waiting times. It's one data point, I know, but generally I think it's true that quality and availability of care in the US is much better.
I’m a Canadian and I’ve worked in health care.
This is only done for very specialized treatments where the province (they run the health care delivery) doesn’t have the treatment and/or the American resource is closer than a Canadian treatment location.
For example Nova Scotia will send some complex paediatric cases to Boston. They could send them to Toronto, but Boston is closer. Same with Manitoba but they use Minneapolis.
Canada is only 40m people and almost half that is in one province. The smaller provinces simply don’t have the population to justify having every possibly medical bell and whistle.
Point is when province sends Canadians for US treatment is isn’t actually about better quality as not all provinces have the same in house capacity and often the next largest city with such capacity is an American city.
Also, outside of the supremely wealthy Canadians, very few go to the US for private care. There is a medical tourism market to Mexico and other parts of Latin America for elective surgeries and uncovered treatments for some chronic conditions, though.
Canada should just join the US. (Joke <- have to be explicit these days. )
> So you are bearing the full cost of extremely high quality health insurance in a western country.
Overinflated imaginary cost*
There is no way that a medical consultation of 15 minutes actually cost $32k. Examples like this are aplenty, but only from the US. My favourite one was an itemised bill for birth that included a $1k for skin contact with the newborn.
> extremely high quality health insurance in a western country
(Sigh...) Let's put some facts.
Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...
Health care could be more evenly distributed, of course, but the health care that OP is receiving is definitely very high quality. General statistics about the entire population cannot speak to that.
No. The original claim was "all the systems that subsidize health care for those less well off don't apply because you're wealthy. So you are bearing the full cost of extremely high quality health insurance in a western country.":
1. The quality is high.
2. The OP pays the full price.
1 is incorrect. The OP is paying a lot, but is getting the same subpar quality healthcare as everyone else. He differs with people without money in only one thing: the latter don't get the full access to the subpar health system. The system itself is the same and its general quality is well indicated by the core metric of the infant mortality.
The health system is subpar and there is absolutely no reason why such a system should cost that much.
> high quality health insurance in a western country
This is less true than it used to be.
You obviusly dont insure a family of 5 and I suspect dont actually use the healthcare system.
The corruption is so entrenched and so out of control, the only way out of this mess is for regular people to just stop using the health care system. Yes, there's no alternative, and yes, it means living a riskier life. It sucks, and it's not what we want to hear, but they can only charge us if we show up and purchase the product, and that's the last lever of power we can wield.
I've discussed just opting out of health insurance altogether and doing CrowdHealth with my wife, thinking along these same lines.
I'm a single contractor and can't really justify it. It saves me about 8k per year and this would be a bronze plan through MediCali if I got it. People would say "well what if you get a cancer or something" and yea that may be true but in that instance not only would I be out that premium but also the deductible and it won't even cover everything so maybe I'm actually better off stacking cash until the inevitable.
I'm right there with you - this is a case study in "perverse incentives." There is zero benefit to "paying into the system" to be had under the current model. Better to chance it and then sign up for a plan at the last minute since insurers can't deny you based on pre-conditions.
That's indeed the play for non-corporate-insured consumers. Short-term insurance was $1,000 a year for a healthy person last time I checked. Just keep renewing until you need ACA-compliant insurance for some reason.
But back to my point: that does nothing to solve the root cause, which is the price inflation. And Washington is so deeply compromised that they will never fix it. The only solution lies with us just walking away. We hate to bargain a price on getting exposed to the ugly side of life, like disease, discomfort, and death, but indeed, everything has a price. And we will continue to be tested on our willingness to pay it with until we start playing hardball.
This strategy is why there are open-enrollment periods for ACA-compliant plans. I had a startup back in 2014 where I had us on HC.gov/ACA market insurance. A billing SNAFU on Blue Cross's part (that year was really rough for HC.gov!) ended up getting that insurance cancelled for nonpayment about a month in, which is when I discovered that our only coverage options were all non-compliant short-term policies, all of of which excluded preexisting conditions and wouldn't underwrite one of my children at all due to an unexplained seizure several years earlier.
(We resolved the situation by finding a bank-shot qualifying event that allowed us to re-enroll --- it was extremely situational and had to do with my wife and I simultaneously leaving our jobs within a short window of time.)
"Healthcare too expensive? Have you considered dying?"
Sorry, what are you going to do when you get into a car accident and they rush you to the hospital? Assuming you're even conscious. "No, I'm voting with my wallet!" flatlines Come on.
What if we used our collective power to fix the system? (Up to and including replacing it with something that works for the majority, and not the minority.)
How can you be so naive? Like I said. It’s not what we want to hear or think about. But it is the only route left. Either we stop buying the product or they keep raising prices on us.
If you were rushed to the hospital you'd be treated: https://www.cms.gov/priorities/your-patient-rights/emergency...
And then you would be bankrupt, because if you have any money they are going to come after you.
yeah, pretty much
Regular people are already not using the healthcare system to a large degree. But it's not a realistic ask in perpetuity. If someone gets ill enough, they will get healthcare or they will die.
> they will get healthcare and they will die
FTFY
Many countries have financial incentives provided to its citizens to have children. Requiring half of a citizens median salary to be given to a faceless middleman to provide this service seems untenable. I cannot imagine a society that does this would be able to survive.
When your country is led by a person who seems to find children and marriage inconvenient, you're bound to see that mentality propagate throughout everyday life
I had a kid before trump and the costs were insane back then too
I know it's not for everyone but you can give birth in Mexico or Latin American country with good doctors who speak English and pay less. Or you can negotiate with hospitals before giving birth
Nearly 2 in 5 Americans are covered by Medicare or Medicaid. TANSTAAFL. The other 3 bear the burden. At some point Atlas shrugs and decides welfare is a better deal.
The amount of money the US Government pays just for that 40% should be enough to cover all 100%. We know this is possible because it happens in other countries, which have shorter waits and more coverage since that talking point keeps being brought up despite collapsing in the face of reality.
> The amount of money the US Government pays just for that 40% should be enough to cover all 100%
This is true as long as the following changes are made: 1) wages for healthcare workers are scalled back ~50%, 2) many drugs and medical procedures are not longer covered (a good example is CAR-T for cancer or drugs for rare diseases).
The quality of health care in the US is significantly higher than anywhere else in the world.
Whether that quality is necessarily (or good) is debatable, but we are getting something for the money.
You also are just completely wrong in your main point. We cannot provide the same efficacy of healthcare as we are now for 60% less. We are the richest country in the world, labor costs more here than other places.
>The quality of health care in the US is significantly higher than anywhere else in the world.
Yeah, I'm gonna need a citation for that. Because it sounds like a health insurance propoganda rather than the actual truth.
I tried an American PPO with $10 co-pay and no deductibles. It was awesome :)
Nobody could tell me what anything would cost, or if the insurance would cover it. But I always ended up paying $10, whether it was a few pills or an expensive MRI I didn't need. Oh, yeah the downside is you can accidentally convince your doctor to get procedures you don't need.
Health care in Denmark is decent. But I've been told, no when I wanted to run some tests. That would never happen on an American PPO :)
I have had go wait, while unpleasant, it's fairly harmless (otherwise they don't let you wait).
So if you're on an great PPO plan in the US, healthcare is great.
Whether the outcome is better for the average Joe, is probably a different question.
My sister used to cook on private Yachts in the Mediterranean, and mingle with that part of the population that pay 3-5k/month for private insurance, helicopter evacuation and all that. I'm pretty sure they can ask their clinics any unnecessary tests they want, too.
I've had PPO insurance for a few decades. I've been denied tests and procedures many times, even when I had radiologist exams that supported the surgery according to their own rules. I've been forced to wait for procedures on many occasions.
> The quality of health care in the US is significantly higher than anywhere else in the world.
Do you have any evidence of that?
15 out of the top 50 and 4/6 top hospitals in the world are in the US: https://rankings.newsweek.com/worlds-best-hospitals-2025
Again, I’m not saying the health care outcomes are better, or the value is better. I’m saying the hospitals are nicer, the doctors are the best, etc.
Perhaps this is the wrong thing to optimize for! But we are getting something.
> 15 out of the top 50 and 4/6 top hospitals in the world are in the US
Outliers do not say much about the overall quality of healthcare in a country. Rather obvious lesson in statistics.
Reminds me of the Russian mathematician who moved to the US after the fall of the Soviet Union. Most of his essays were criticizing American students, but in one essay he was quite frank:
Russians who graduate with math degrees are better than Americans who do so, by a wide margin. However, the average American is better at math because they still get access to some math education in university and do not need to be a top student for admission. Whereas in Russia, if you didn't meet a rather high bar, you simply couldn't get admitted as an engineering/physics/math program, and thus couldn't further your math education (I believe he said the cutoff was even before university).
Country with the top mathematicians, but country with worse math outcomes.
Perhaps my language was too imprecise.
My argument is that specifically the best care in the US is the best in the world. We have the best doctors and the best technology and the best treatments. This is not completely universal but it is also generally accurate.
Whether or not this care is accessible or the median quality is care is good, that is different.
I’m just saying we do get something for the money, it’s not like it all gets thrown down the drain. The best and brightest come to the US to get some of the huge spigots of money in the US healthcare system and it does drive innovation.
Can't you just look at life expectancy, and life expectancy in good health? Because the data I found doesn't put the US in the top anything. Even if you're in the top decile of earners.
How does that account for a population who..
..74% are overweight or obese
..less than 10% meet the fruit and vegetable recommendations
..25% get the recommended amount of exercise
..eat more than 70g added sugar a day
Healthcare really has the deck stacked against it however you look at it
Your mistake is separating those items from healthcare, when it's part of it.
Even in the US, many (most?) insurances and healthcare systems have programs to address all those. My HMO certainly does - I can engage with them and craft a healthy nutrition plan, and my doctor can be involved in that as well. Ditto for exercise.
So you're saying the US optimizes entirely for the best of the best care, without regard for what happens to the 2nd tier? (that the majority of the population actually use)
I think at least the median citizen in the US has very good access to the best possible care. It may or may not be affordable but you can get it.
And yes, that is what I think we optimize for.
If care is not affordable and makes average people just one accident away from bankruptcy, then it might well not exist in calculations. This is akin to saying the USA is the richest country because it has more billionaires than any other country.
This is a highly recycled talking point that only applies to people lucky enough to live in the vicinity of Standford, UCLA, Mass Gen, Cleveland Clinic, or Johns Hopkins AND afford a visit and is extremely dismissive of the millions of other Americans who can't. Rural hospitals have been shuttered and some people have even been turned away at emergency rooms now. This claim simply does not match up to reality, no matter how many graphs you put together.
> 15 out of the top 50 and 4/6 top hospitals
> I’m just saying we do get something for the money
Who is this "we" that gets to be treated at the 15-out-of-50 and 4-out-of-6 top hospitals in the world?
> the best care in the US is the best in the world
For a few Americans. Not for all Americans, and probably not even for most Americans. There's far more to the United States than New England and Southern California.
Don't get me wrong, if I had some rare cancer or other strange disease, chances are I'll want to try and get in to one of these few rare ultra premium hospitals. But if I break my leg or get some normal infection or have a child or any of the other normal kinds of issues people have? Will that still be the best tier of care?
> if I break my leg or get some normal infection or have a child or any of the other normal kinds of issues people have? Will that still be the best tier of care?
Does it need to be? I imagine it's far easier to treat a broken bone, in most cases, vs a rare complex disease
I'd have different standards when researching where to have teeth cleaning vs oral surgery
> Does it need to be?
If we're spending the most for it, shouldn't it be? Why would I want to pay more for worse outcomes?
Quoting you:
> "The quality of health care in the US is significantly higher than anywhere else in the world."
Common Wealth Study of 10 Western Countries (U.S. lags far behind the other countries)
https://www.commonwealthfund.org/publications/fund-reports/2...
Peterson-KFF Research
https://www.healthsystemtracker.org/chart-collection/quality...
Numbeo Health Care Inex
https://www.numbeo.com/health-care/rankings_by_country.jsp?t...
On an anecdotal basis, I relied on the Taiwanese National Health (NHI) for years and found it vastly superior in terms of quality and cost to the United States.
Perhaps a more accurate claim might be: The quality of the health care system in the U.S. is unparalleled provided that you are in the 1% that can afford it.
"My healthcare outcomes are great, which means American healthcare is good."
If you define quality as range of treatment options available, sure. If you define quality as range of treatment options that are accessible, absolutely not.
> The quality of health care in the US is significantly higher than anywhere else in the world.
Simply not true.
Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...
It is also significantly more expensive: https://ourworldindata.org/grapher/life-expectancy-vs-health...
> The quality of health care in the US is significantly higher than anywhere else in the world.
Source, backup your claims.
Health outcomes are WORSE than most other developed countries and that's the only statistic that matters here
Expenses are definitely higher, and doctors and hospital CEOs and med school CEOs do drive nicer cars and have bigger summer dachas, but I can't say the same about quality. Six month waits for a specialist, every PCP and shrink you'd want to visit not taking on new patients, ER wait times comparable with other developed nations, worse overall outcomes...
Maybe the top 0.5% is getting better care, but I really wouldn't shed a lot of crocodile tears for them.
See what the wait times are for the specialists in other countries, if they even exist!
The US is also the 3rd biggest country in the world. It’s very hard to solve these things are such a massive scale.
> See what the wait times are for the specialists in other countries, if they even exist!
I assure you, they exist, I have been to them, and the wait times were about as long.
> It’s very hard to solve these things are such a massive scale.
That's goalpost-shifting nonsense that doesn't justify the outrageous cost of healthcare. And most of these problems become easier to solve with a higher population and density and larger economy, because you have way more slack in the system, and you have way more economies of scale that you can put to work.
I'm also not complaining about healthcare in the middle of Alaska, 50 miles from a highway (or deep in the poverty belt). I'm talking about overpriced, underachieving care in wealthy metro areas.
Citation definitely needed.
Ive been to doctors in different countries including the USA. Theres nothing special with general practitioners with the USA.
Or if you end up in China, you can get blood panels for like 10RMB, MRI for 30RMB, and damn near automated to boot.
Go to Mexico for dental work. What costs you here $30k costs you $2k, and they take your insurance.
The US citizens are being gouged, because our government has been bought out by corporate interests who bribe, err, campaign donate to both parties. And thats across every economic activity. Medical is just an egregious one, alongside academics.
US average lifespan are shorter than most of western Europe's.
> The quality of health care in the US is significantly higher than anywhere else in the world.
Health outcomes do not support that statement.
In Australia 5 out of 5 people are covered by Medicare, and 5 of them bear the burden. (at some point in their life. assuming they become a tax payer, which seems likely for most.)
On top of that, 53% pay for Private Health Care as well.
https://www.health.gov.au/topics/private-health-insurance/re...
On top of that many things that are 'not urgent' you have to pay for yourself.
I have recently paid over 20K for back surgery. Prior to the back surgery I could barely walk. This was deemed 'not urgent' and had I would have had to have waited at least 18 months for surgery via Medicare.
I also have private health cover.
So, it's important for non-Australians to understand, our health system is far from a panacea where taxes pay for everything.
Currently 778 K Australians are waiting for 'elective surgery' .
https://www.aihw.gov.au/hospitals/topics/elective-surgery
What percentage of Australian society is net-positive tax payer? That’s your real number, not this pretend 5 out of 5 as you claim.
If everyone costs the system $10, and the five people pay $8, $9, $10, $11, and $12, respectively, I think it’s a mistake to say only the last two net-positive taxpayers are paying for the system.
Agreed. It is a small proportion of people who do not contribute to their own healthcare in this way.
More info on Australia from a quick search.
Private health insurance is nowhere near $40k here. Can be down around US$100/mo for a single or US$300ish/mo for a family, depending on inclusions.The burden of this isn't a big one to bear. I just compared tax rates for a $65k USD income in Australia vs the US. You'd be taxed ~$800 less in Australia.
There's no way that's true - include the employer side payroll taxes. Whether PPP or nominal my napkin math gives me 40% more tax payable in Australia
Edit: I'm too dumb to know whether to include superannuation as a tax or not so I'm not sure if I'm right or not.
Superannuation is not a tax. It’s a compulsory retirement saving/investment scheme.
However to calculate total income taxes you do need to include the 15% tax on superannuation contributions.
If your pre-tax take home salary is $100k AUD, then your total salary package is 111.5k including the 11.5% compulsory employer superannuation contribution.
You’ll pay regular income taxes + 2% Medicare levy on $100k and your $11.5k super contribution will be taxed at 15%.
So your total income tax including the Medicare levy (but assuming you don’t pay the Medicare surcharge or claim any deductions) will be $24,513. Giving an effective tax rate of 20.2%
There are no state or local income taxes in Australia so that’s it for personal income taxes. However states do charge payroll tax on most companies payroll (e.g. 4.85% on annual payroll over $1M in the state of Victoria for companies in the Melbourne metro area).
Pointing out the myth of "socialism just means higher taxes and less freedom" will only draw the pitchforks to your door.
I guess your health industry is not raping you with outrageous costs?
From the top:
~ https://www.aihw.gov.au/reports/health-welfare-expenditure/h...From the bottom:
~ https://pmc.ncbi.nlm.nih.gov/articles/PMC10953298/There's little to no public advertising of prescription drugs, cheap generics are widely available from federal scale bulk negotiation deals.
Health outcomes are greater life expectancy than the US, national scale cancer survuival rates are better by a few percentage points (IIRC - they are close but higher).
Australia has long had an innate "we're all in this together" society built on individualism. It's not great, it's not perfect, but the first instinct is generally to look after our own - across the board.
When I was in the USA just paying for things like a GP and a single specialist didn't seem outrageous coming from Australia.
If I worked in the US, I would have health insurance and would be paying lower out of pocket costs than I would in Australia. Combined with the higher salary and cheaper housing that's a pretty good deal.
Edit:
We allegedly have universal healthcare but that doesn't cover any actually competent specialist (need private healthcare for this) so paying $400 for 25 minutes of a psychiatrist every 2 months and $95 for 7 minutes of a GP is common.
Fortunately, a good number of people in the 3 of 5 population have the imagination to see that they or people they love will someday be in the 2 of 5 population.
Weird, I've seen a lot more people bitch about welfare and how easy people on the dole have it, than actually give up their nice jobs and lifestyles to go try living it.
I don't think the critique is that "welfare is objectively preferable" to a high paying career, but rather that the effort:reward ratio isn't scalable to society at large (without some level of social cohesion, I guess).
It was likewise striking how few of America's slave owners thought that slavery was such a sweet deal that they should be enslaved. It's not always true, but it should always give you pause if you find yourself insisting that other people have it too good and yet you've been careful to ensure that you'd never have to trade places...
Theres alot of forces tugging at American "healthcare" - lawsuits, uninsured non-payment, subsidiation of 3rd world drugs, heterogeneous population, over eating, under exercise... usa practices reactive medicine. and maybe part of that is due to hectic modern life, but it certainly adds to the cost, time and money, that could potentially be avoided or at least reduced in a more preventive, educated system.
that being said, one can certainly find cheaper insurance (a policy to limit liability) if one knew where to look.
for instance a self employed single male, 27, queens new york, healthy non smoker, can have a national network $300 deductible, aca qualified policy, $329 a month.
This is a question of priorities. Identify a problem, decide to fix it, then execute. It isn't about the particular solutions. Australia's gun control would not translate to a country like the USA and perhaps neither would its health care. First decide to put a person on the moon. Then execute. Only one country did that. It isn't that they can't solve problems like school shootings or affordable healthcare. There is no real will to do so. Not sure why exactly. It is a very strange place that defies expectations of how a developed country would behave.
Perhaps if non-poor people start speaking out on a regular basis to elected and appointed officials, the media, and policy wonks, we might make some progress getting a better healthcare system.
I've spent 30 years as a policy and budget analyst and advocate on health and human services issues. If electeds and appointeds were going to make decisions based on the lives of poor people it would have happened already.
Folks need to make some noise.
The premiums aren't particularly out of line with typical costs.
https://www.kff.org/affordable-care-act/annual-family-premiu...
I have a discussion with my mother often. I tell her to keep a reasonable buffer of money in her bank account and then spend every single $ beyond that. Why? Because when she hits end of life, or even before then when she hits any number of inevitable age related issues, medical bills will take every penny she has and then go for more after that. My family pays even more a month than OP.
Healthcare is reaching for the point of neutrality where the value it provides exactly equals the cost they are charging. This is what happens when the only signal they get is a money related one. Nation after nation has shown that healthcare elsewhere can be better and far cheaper. Not perfect, but better and also not out of control. The real question isn't 'how do we fix healthcare' but instead, 'how do we remove the cancer in our system that is blocking the obvious fixes we see actually working all over the world'.
"The essential theme of Green’s piece is that “participation costs” - the price of admission you pay to simply be in the market, let alone win, have grown out of control. Food and shelter are participation costs for living. Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work/school."
No shit. He mentions food, shelter and a smartphone — might as well add higher education and a functioning car if you're in the U.S.
I struggled being tossed out on my own at 18 with no support from parents. Working at a pizza restaurant, riding a bicycle to a community college for an education, renting a room from a woman (she may well have been renting as well—renting a room to me to take the edge off).
Winter came and riding the 10-speed to college (in Kansas) became a challenge…
Thank god no smartphone or internet plan was required then.
(When I eventually split an apartment with two other roommates we lost power for stretches from time to time because we were unable to come up with the money to pay the electric bill — oh well.)
They were hard times (that I somehow enjoyed—perhaps because I was young and was finally beginning to have a fulfilling social life). These days it has to be even harder.
I doubt it's much harder because of phones or internet. A smartphone can be very cheap. WiFi is pretty much everywhere and even in America there are very cheap esim plans.
Please note that this is the natural birth of an otherwise healthy child.
In Canada, provincial healthcare and private insurers have not kept pace with the needs and advancements in the areas of alternative methods of conception (IUI, IVF...). Yes, a naturally born baby wouldn't cost the parent(s) much medically. But, if you cannot have a child naturally, medication and procedures (lab testing, blood testing, artificial insemination...) are only partially covered and the amount corporate or union-backed insurers will pay varies widly by doctor and by patient. A couple struggling to conceive will easily pay 15-40K per child after the first procedure.
Funnily enough, friends who have jobs in the USA, but live in Canada often have better insurance that fully covers all of the costs after the deductible. It ends up costing much less to have IUI or IVF procedures with Canadian doctors using American insurers (of course they will take the money).
Clickbait. I too think insurance costs are too high, but the author included their annual insurance premiums in the calculation.
yea, 40k is not the "real cost" of the birth, if he includes his + the wife's health insurance premiums in the calculation.
$25,680 premium + $14,300 deductible = $39,980 annual cost
So actually if we compare this with a European country, it would be an almost similar amount in the end: there is no deductible, but health insurance/social security taxes can absolutely reach around 2k-3k per month if you earn enough.
But those social security taxes (theoretically) cover your future pension, and at least in Germany, health insurance also covers your sick days, which is why only true workaholics show up to infect the office.
Fair, he's lucky enough to have not been in a major car accident that year, so he can attribute it all to the cost of giving birth.
What would have been the out-of-pocket cost of a normal birth without health insurance? It's still your choice to go without.
No one is forcing you to give birth in a hospital. Rational people do it at home all the time to this day.
My wife had to have an emergency C-section the first time around when they lost the heartbeat on our first baby, so we've stuck with planned C-sections - so yes, we are somewhat constrained in terms of our choices there.
Many would say thats not rational
Maybe we're living in a failed society if we cannot provide the basic, bare minimum of pregnancy care for women. Like I assume you're the same kind of person that would be equally baffled as to why the fertility rate has been going down and can't connect the two dots. As well as the child mortality rate in the US skyrocketing.
> Rational people do it at home all the time to this day.
I had to read again 3 times. Are you serious?
If there is any complication, you're risking 2 lives.
Father of 3 here, first two were home births, the third had complications and ended up being a hospital birth. I was initially skeptical for the same reasons but the first meeting with the midwife convinced me that they were taking every precaution and had the training to deal with whatever might come up.
The majority of births are simple if you let them be and the midwives go to great lengths to make sure the conditions are right for a successful event. In the case of our third we hit some conditions leading up to the delivery date that disqualified us for a home birth so we seamlessly transitioned into the hospital system (where the midwife still delivered the baby)
Is this mindset the cause of US skyrocketing child mortality?
ikr.
They rather try their luck at home than leverage a thousand years of medical research that culminates in hospitals.
Not once but 3 times. I'd be pissed knowing my parents put me through such unnecessary risk.
Home birth is absolutely a rational choice in many cases. The author had a very strong reason to require hospital birth but in scenarios with lower risk it is safer in some respects to avoid the hospital.
It will still cost you 5 - 10k for a good midwife and you'll still want to be insured in case you need to transfer. So it only knocks off 5-10k from the total.
Why are you paying to give birth at home when there's a hospital right there, that has all the equipment in case anything goes sideways?
The two biggest benefits are reduction of iatrogenic harm and comfort for the mother delivering.
Midwives are medical professionals who have the equipment and expertise to intervene in the most common scenarios that require it.
Yes, it's routinely done. The NHS has this to say: https://www.nhs.uk/pregnancy/labour-and-birth/where-to-give-...
Yes, and? Without it, the total paid would be at least the same or more.
Would it? When I have been uninsured I paid less for bills because the group gave me the cash price. When they are billing an insurance company they bill much more.
Interestingly enough, adoption can cost just as much as the figures quoted in the article ($40,000 - $55,000).
If you're planning to adopt, broadcast it via your social network as much as possible. If you can avoid going through an adoption agency, you'll only have to pay for the legal work ($7,000 - $10,000).
Our first two children were born at the hospital. Both were induced. Everyone was healthy, but looking back each was a miserable, expensive, condescending experience.
After those experiences, my wife then went on a journey to learn everything she could about childbirth and healthcare. The more she learned, the more she became convinced that the entire system is flawed. The pressure to get an epidural, induce (conveniently between 8-5 on a weekday), or to use a C-section is immense. While each intervension is tremendously important in high-risk and edge cases, they are utterly unnecessary in the vast majority of births. But they are used for the majority of births, anyway. Some argue they may even have some damaging effects to the mother and child, but I concede that's not the medical mainstream opinion.
When my wife became pregnant with our third child, the delivery was during the Covid lockdown. Hospitals refused visitors, demanded masks, and were even more impersonal than normal. Although I was initially skeptical, she convinced me that we should use a birth center and a midwife. The birth center was practically next door to a hospital and we talked through how to mitigate risks if something went wrong.
It was a fantastic experience in nearly every way. Our son was born at 7:45 AM and we were home by 11:00 AM. It was substantially more affordable than a hospital birth.
My wife just had our fourth child earlier this year. Once again we used a midwife but this time we had a home birth. You couldn't have paid me to accept a home birth when we were new parents. I wish I knew then what I know now.
I know it's not for everybody (and especially those dealing with high-risk scenarios), but a midwife and home birth is an option if you want to avoid the hospital racket. It's significantly less expensive, more convenient, and every bit as safe for the vast majority of births.
"My wife just had our fourth child earlier this year. Once again we used a midwife but this time we had a home birth. You couldn't have paid me to accept a home birth when we were new parents. I wish I knew then what I know now."
Good for you and the very best wishes.
We had all four of our children at home - two of them breech[1] - and avoided a big basket of unnecessary interventions and complications.
One of the biggest benefits was opting out of the tremendously disempowering culture of medicalized birth fostered by both male and female care providers.
An outsider would not be faulted for thinking that birth care was purpose-designed to disempower, discourage and disenfranchise women giving birth.
[1] Relax. A "frank breech" is considered a normal birth in most of the global north and is not medicalized as it is in the United States - nor does it need to be. (Not to be confused with dangerous conditions like a footling or kneeling presentation).
Over here in Australia, the most expensive part of my kid's birth were the AUD$200 antenatal classes.
The prenatal checkups, hospital stay, and postnatal midwife home visits were all covered by Medicare.
The flip side is that I lose ~30% of my pay to taxes. That's fine by me
I pay almost 40% in the US (including state and payroll).
Federal tax rate is 22-24% for most people. State can be anywhere from 0 to over 10%, depending on the state and income level. City taxes may exist. And then social security + Medicare.
NYC effective tax rates exceed 30% (if earning in excess of $100k).
> The flip side is that I lose ~30% of my pay to taxes.
That's not a flip side, that's what you'd be paying in the US, too, once you account for all your payroll taxes. Maintaining 11 carrier strike groups and a global empire don't come for free.
If only we paid only 30% in the US.
If you're in the 24% bracket, you probably have an average rate around 18%. 7% personal FICA witholding, another 7% employer match, and state income tax. Then, if you're in the mood, add your health insurance premium and any college savings for you or your kids (or the difference between what we pay and what you'd pay in [insert some other country here]).
Our military spending is enormous, but it's dwarfed by what we spend on healthcare. The problem with our healthcare system isn't that we have a military, it's the gross and intentional profit-seeking behavior of insurers and many others in the system. They see the government as a bottomless pit of money that they can tap with lobbying, and the result is that we pay stupid prices for absolutely everything, on the assumption that it will be negotiated down somewhat by private or public insurance.
If you look at how $1 of public spending on healthcare is used in the US vs countries with better healthcare, it becomes obvious where the problem is, and it isn't in the ocean. An anti-military ideological stance is one thing, but you don't need to inject it into this.
An American PPO with a $10 co-pay is pretty awesome. The only downside is that it's too easy to get a procedure you don't need :)
I've tried tellings doctors in Denmark I wanted X, Y, Z test and getting told, nah, the outcome wouldn't change your treatment so we don't want to order those tests.
Generally, healthcare is decent, but no doubt a good PPO plan does not compare :)
Public health care seems more like HMO, you have to use a provider within network. Sometimes you need a referral from your primary physician, etc.
You can pick your doctor, but not everyone can take on more patients.
That second paragraph is what scares me the most about pure public healthcare options. The following isn’t to compare/contrast systems.. it’s just a viewpoint.
My cardiologist went “tests look fine, heart looks fine, there’s no reason for you to take colchicine. No clue why you have issues, everything is fine. Just take this brand new beta blocker to manage your heart rate.”
Meanwhile, there’s no answer why my heart rate rises 30-40BPM randomly when I stand. Why my heart rate drops to a very difficult detectable rate when I sleep. No answers as to why two sips of wine causes my body to go into shock. - All resulting post-Covid.
That same doctor told me to discontinue colchicine; yet without colchicine most medications, inc. ADHD, are maybe half as effective.
These are items which deserve answers. Not an answer of “just take another pill”. Some of those “unnecessary” tests can provide inclusion/exclusion information. Yet just refusing that knowledge denies answers.
In the US I can just find new doctors. But in other systems it’s either difficult or impossible.
At least in the systems I’ve experienced (Australia and Japan). You can just go to another doctor.
There’s no “insurance networks” and no visitation limits. You can go to _any_ doctor nationwide.
I’d be curious to know where you had that experience and what the limits are on finding a different doctor ..
> All resulting post-Covid
Find a long Covid specialist, those things aren't normal but are known to be effects of long Covid.
Minus the costly premium and not all employer offer PPO or its so expensive that it’s priced out as an option
I find it's a really scary idea to go to a third-world country like USA! - Or, it seems like a third-world country when you're from a developed country.
Unfortunately I'm type 1 diabetic which is either a death sentence there, or you are rich. But then I also accidentally broke my collarbone this summer. And I had this weird throat infection.
As a type 1 diabetic I have had to go to the ER numerous times in my life, and as traumatising as that experience can be, I can't imagine the feeling of also being financially ruined for the pleasure of not dying.
It's weird, I know plenty of people who avoid going to the doctor because it's annoying to wait for over an hour.. but I could see that for an American you might just NEVER go. I guess it's like, ok someone in the family is sick, and we're not rich, so we will sacrifice them to the sun gods. Or I guess you go into indentured servitude? There are people for whom $100k is made very very slowly.
I just do not get it! I guess these things add up properly if you are very wealthy, but people here think that it's the function of the society to make sure you can have basic things like medical treatment. Of course it's not perfect here... try going to the dentist for example. Then you're almost in the USA. Somehow it's not considered medical. A long session could run you over $500 or more.
I have compassion for all the USAians out there! If I was USAian and planning to have a child.. I guess I would consider just going to a civilized country for a while, like... I don't know, Rwanda or Ghana or somewhere that can afford people to be alive(?). In seriousness though (as those countries are very far) you could just go North or South. It's closer. If you go to Canada, a lot of times you wouldn't even need to present ID.. you could just.. get treated right there by walking into a hospital, being triaged, and then waiting (admittedly for maybe almost a day).
Always bring fun things to the hospital if you aren't literally bleeding out all over the place, because you'll be in the waiting room for 12 hours if you're in a big city.
But when it's over you're alive and about as rich as you were before. Seems like a good societal deal to me. I'm scared of being trapped somewhere like the US honestly. It's a nightmare scenario. Although I'm sure it's pretty great if you're a billionaire with slaves and so on... but someone has to incur that cost (the slaves from the lower castes).
It seems like a huge stretch. The US still has a pretty good fertility rate for a developed country, much better than most of the Europe.
Two thoughts...
1) The insurance premiums are tax deductible for the self employed so probably 30% or $8000 less
2) He should have planned to have two of the children in the same calendar year could have saved $14000 (jk)
IMO, the “thin edge of the wedge” for socialized healthcare in the US is full, high quality and free services for maternity, birth and the 1st year of the kid.
Real poverty is not in fact "closer to $140,000 than to $31,000" and economics people have been dunking on that claim for a week now on Twitter.
Because they can.
For profit hospitals subsidized and enforced by the leviathan, what could go wrong?
How much does something cost? Whatever the seller can get people to pay for it. Hospital B charges 6 figures for the delivery of a child? Wow, that's expensive, they must be really good to be able to charge that much.
All the dark patterns, negative dynamics, perverse incentives of bad government, stupid healthcare policy, and humans being shitty combine to form for profit hospitals. Those determine how other institutions have to run in order to operate at all, and they're not being managed by well meaning, good faith citizens looking out for the patients and the public.
There's a reason mangione became a cult phenomenon, and $40k babies, multimillion dollar ambulance trips, and other bullshit are exactly why.
Good luck fixing that mess. I don't even know how to conceptualize where you'd even begin to try to fix American healthcare. It's so tangled up and beholden to all the other problematic elements in modern life that it looks nigh on impossible to repair, so my goal in life is to minimize contact with any element of the system as much as humanly possible.
Completely removing the U.S. Government from the health care market (Medicare, Medicaid, Obamacare, uncompensated care, etc) would be a great start.
Why not go to the other extreme, as most other developed countries have done (and have lower healthcare per capita)?
Do you know any countries that have no government involvement in healthcare that has good health outcomes?
Could you explain how this would help? I'm struggling to understand where you're coming from here, besides perhaps a reflexive libertarian reaction to government.
Massive government subsidies for health care consumption not only eliminate, but disincentivize price discovery. If your biggest consumers of health care (seniors) have access to the best health insurance plan in the world (Medicare), that's going to drive costs up
Your whole argument is that the health care system should be optimized for the most productive members of society (like you, right now).
You are perfectly fine to have that belief, but the majority of people disagree with you, which is one of the primary reasons the system is designed as it is.
I think the market can do a better job of optimizing than central planning ever can - the problem is we have both the costs of capitalism and socialism concurrently with the model we have now. A worst of both worlds scenario.
A struggling business can go under.
When somebody is sick we generally save them even if the cost/benefit is poor. No market is going to solve this if you want to save sick people who don’t have a lot of money.
There is no place in the world where health care is solved, it’s one trade off vs another.
The US system is also far far from perfect but your solution is quite shallow and unlikely to fix things in a way society wants.
You know what actually drives costs up? The fact that healthcare doesn't work as a market. I can't shop for medical care. I don't have the knowledge and it's usually extremely time sensitive. This is a ridiculous statement that's only parroted by the most market-pilled right-wing economists.
Have you ever looked into the way the market works for medical devices? And what happens if the implant or device you need to live is from a company that went bankrupt?
If you've ever spent even five minutes reading up on that stuff you would understand that health and medical cannot be a free market. It can never be a free market.
Healthcare was a far smaller percentage of US GDP prior to heavy government regulations and especially limits on the number of new doctors a year.
As someone from exUSSR, I'm shocked with the figures. We've given birth in Russia and in Kazakhstan, in both cases I paid nothing at all. Just taxi to the birth house (that's how the birth clinics are called), and my wife disliked the food, so I brought her some fruits and maybe corn flakes every day of 3 days she stayed there. The equipment I could see was modern, everything was clean, there was some confusion where to put her, otherwise everything was fine. If you're suspicious, you can go to private clinic at $1,5K..2K, they even send you a taxi (or who knows, maybe a private ambulance).
My libertarian friends criticise this from the point that "everything state-run is inefficient". Even if this is true, they fail to notice that state-run healthcare keeps prices of the private sector down. You don't have to sell a car if you're seriously sick.
In 1992-96 on Russian state TV, there was a translated program called something like "Rescue number 911", with nobody else but William Shattner. (We already knew him at the time.) I got an impression that the US healthcare was impeccable.
American "healthcare" is pushing many things outside the achievable range.
I have garden-variety hemorrhoids. All I need is one or two 30-minute in-office procedures to treat these things. I'm a senior software engineer working for a FAANG company with "top-tier" employer-sponsored health insurance. I've been trying to get this stuff treated for eight months. I've gone to at least seven or eight appointments with several different offices and I've already spent $3000 out of pocket, and I might actually start treatment in January. That's fucking insane.
The next time I need a minor in-office procedure, I'm seriously going to consider flying to Mexico instead of wasting almost a year of my life fucking around with the ass-wipe US healthcare system.
I just want to point out that the referenced article about the federal poverty level (guidelines, etc, various words being used in the regs) makes it seem like the value is calculated each year based on taking the food budget and multiplying by 3. In reality, it did that in 1965, and has been adjusted by the CPI since then. In doing so, it changes the relative weight of everything as that changes in the CPI basket.
The value the article comes up with (he says like $130,000) is more like the living wage, which might be a good target. The living wage for Bergen County, NJ, is calculated to be $145k for a family of 4 with 2 working parents, and about $100k for the same family without childcare expenses (1 working parent).
https://livingwage.mit.edu/counties/34003
I am not sure what counts as poor in reality. Obviously the federal poverty guideline is pretty low. It can't really make sense as a contiguous-48-states guideline for the purpose of feeling "not poor". The calculated living wage is above the median household income for most areas. I have not heard a serious proposal for increasing the median (or, preferably, the 30th %ile) income up to the living wage. I reckon that most proposals that involve the government sound too much like communism for the average American voter.
But we could bring the living wage down to the median. We could make housing cheap, reduce our health care costs, and reduce the childcare component.
Misleading title, it's only the US healtcare market
at certain times - you can't fight the system but vote with your feet.
keep running US business, but live in a different country n get private healthcare.
While not an answer to the general problem, one pragmatic avenue OP missed is to not have gotten married. Then he can have assets including a business, while his wife-in-spirit is on-paper poor and gets a subsidized plan (which then also covers the child's initial birth as an extension of her). AFAIK this wouldn't help after the children are born though (unless maybe you're willing to leave your name off of their birth certificates, which seems like a much higher level of norm rejection and outright misrepresentation).
In general corpos spend a good chunk of resources making new legal entities to escape liability and legibility - something that is simply not available to most individuals. Getting married takes your two naturally-existing legal entities and basically collapses them into a single one - throwing away much flexibility. So it seems like a poor idea in the current legal environment which has been thoroughly corrupted to extract wealth and channel it upwards.
I wonder what the author means by the repeated assertion that marketplace plans don't cover childbirth? My understanding is that's absolutely false.
In 2015 I had my first child while self-employed, and I paid for the most expensive Aetna plan I could find, about $2k per month if I recall correctly. We had an excellent experience at Mt Sinai, private recovery room for two nights, etc. I don't think we paid hardly anything out of pocket.
Granted, I agree that our health insurance system is a complete mess, but judging by this post and the angry responses of the author here, it sounds to me like they're making it worse on themselves by misunderstanding what's available and needlessly paying for a more expensive option than needed.
We desperately need to increase the number of doctors to decrease the cost of medical care. We also desperately need to cut down on regulations so we can reduce the number of healthcare administrators.
Nope. Only in your s-hole country. We don't have this problem here in Europe.
There is tons of fear-mongering around a natural process-- I had a 24 yo friend deliver his first child off grid by himself. There are also a ton of independent midwives out there where you can deliver either at home or a midwife center for a fraction of the cost.
I'm relatively confident that reproduction occurred both long before, and will continue long after, the existence of the market in question.
You are absolutely right meatbag producer! Your brand new bundle of joy is expensive, but who can put a price on love? The system is designed to keep you in debt and near poverty as long as possible. But do not fret! If the meatbag is properly trained up to a point, and no further. It will be a hard working productive member of DisneyAICORP. And after working very hard and following instructions it may someday be able to afford its own meatbag production schedule, affording one more production unit each full year of employment!
Cant pay your child birth bill? Easy solution! You can just name your child after one of our pre-approved corpo sponsors and we'll take care of the rest.
- Cinderella
- Moana
- Mulan
- Cruella
- Mark (property of Meta™)
- Ariel
Meta World Peace Jr.
There are two ways to look at this. Either children are in fact useful for society, and should be subsidized (I weakly hold this view given mass immigration is politically unworkable, and long term that too would run out). That is well and good but cross country data makes the central argument in the title fall apart - US birth rates are/were recently higher than most public healthcare OECD countries. Why blame X if removing X doesn't appear to do much?
The alternative view, that I would hold if it wasn't for the above considerations, is that first world child rearing is currently an expensive hobby, and why should we subsidize it at all? If it wasn't a personal project most would be parents could easily adopt.
> If your answer to “I can’t afford to have children and run a business” is “then don’t,” you are building the political conditions for extremism. This is how every revolution starts: a critical mass of people who conclude the system offers them nothing worth preserving. They don’t just want change - they want revenge.
Its "not afford to have children", but instead "not afford to live".
And we're already seeing these strong signifiers of extremism everywhere. Shooting CEO's is halfway acceptable, if they are sufficiently horrible (and yes UHC was horrible).
Violence is more and more routinely considered the only answer that works.
Corruption isn't something hidden, but instead openly done. And this is at all levels, from petty theft, up to 'let's rearrange government to screw the other party'.
Look at how much tax dollars you pay in, and what you get for that. Its more and more a socialist country amount of tax, with low/no benefits to the citizenry. And no, shoveling billions to Israel or Ukraine, or project of the week does NOTHING to help me, my friends, and people around me.
It is pretty bleak. Has been for quite some time. I can understand why some might want to vote for Trump- he did and is still making good on his promises. Terrible promises, sure. But he's doing them.
Far as I can tell, none of the candidates are for the public, and willing to do and help the public. Just feels like a corrupt-o-cracy where if you're not in the In group, you're screwed.
And yeah, extremism, revolution, and revenge is spot on.
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>Why Am I Paying $40k for the Birth of My Child?
All part of the plan. Gotta get that world population down to 500 million somehow. You've had three children? That's above replacement! Shame on you for contributing to the overpopulation problem. /s
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My hope is that GenX doesn't fall for the socialist panic tactic like Boomers do. Until then we are going to be stuck with this situation for at least another decade.
I mean if revolution isn't in the cards this term I don't know what would get you there.
Maybe a tax on tea or something.
;-)
Seriously, though, I suspect it has to get a lot worse. 23% unemployment might be something.
Because you live in the wrong country.
Because children don’t contribute to GDP.
Having a child definitely more than doubled my contributions to the GDP.
Consider two scenarios:
A. You have a child.
B. You don't have a child and decide to never have a child. To make up for the decline in population that year the government issues a working visa to an immigrant. The immigrant relocates to your country and sets up their life there.
Do you think that A or B raises GDP more?
Breaking news! There are no products or services in existence for anyone under the age of 18! lol
There are but who is producing them? Adults drive consumption and production. Children just drive consumption.
From an economic perspective increased immigration is better than births. Why have non productive people around when you can just import productive people that pay the government income taxes?
<sarcasm>If there are no children around then we don't have to worry about the children anymore and can worry about important things like the economy!</sarcasm>
> Because children don’t contribute to GDP
The simplest model of GDP is productivity per capital times population. And the simplest model in finance is moving cash flows around in time.
So who adds more to GDP:
A. A child of any age.
OR
B. A migrant worker.
My guess is B because that person can produce goods for export while consuming local goods. Children (at least for the first few years of their life or so) do not contribute to production. They only contribute towards consumption. You could argue that they motivate the parents to produce more but increasing skilled migration in the parents industry can do the same.
Not yet. This is why countries that are not shitholes take care of their children.
Apart from being 100% a product of people which are almost often a former child.
Of course they do. Everything a parent buys for a child increases GDP.
GDP is not measuring what is bought, but what is produced.