The happiness a "bundle of joy" should bring to the family is often replaced by additional stress of having to work a "better paying" (but often soul-destroying) job to be able to afford the bigger house, school/education, extra curricular activities like sports/music/ballet and eventually college tuition.
Conrad Bastable's well-researched post could easily have concluded that having kids "too early" will bankrupt a family.
The solution/answer is affordable housing. Housing is the single biggest "expense" for all people/families. Which is why it's the problem I want to tackle personally: https://github.com/dwyl/home
The fact that merely giving birth to a child in SF is $15k is mind-boggling. The "Government" needs to fix that or risk population decline catastrophe which will have many knock-on effects!
SF should follow the model from Finland where young parents/mothers are given cash incentives and all FREE healthcare: https://www.kela.fi/web/en/families
I just tend to write the way I talk and using punctuation, speech marks and italics/bold is the only way I can think of to convey intonation/meaning. I will try harder to avoid the excessive use of emphasis, as you say it detracts from the writing/reading.
PG almost never uses any sort of emphasis in his essays: http://paulgraham.com/articles.html so I'm going to wean myself off it.
I am genuinely grateful for the feedback. =)
The fertility and associated problems of local population can be completely ignored by the government of country like US - country with low population density, predictable steady population growth, and always a large group of people around the world willing to immigrate into the country. If not you, it's going to be someone else.
Half (or more of) the battle in these public policy discussions is coming to an agreement on terms.
Thus, insurance actually acts like insurance, like car insurance or fire insurance, there to catch you in a bad situation, not to give you discounts on your day-to-day expenses.
In Switzerland there is a deductible for adults but everything connected to pregnancy and child-birth is deductible-free. Also, kids below 18 yrs old have mandatory insurance that is has no deductible, thus treatments for them are free.
That's an average. The problem is the huge variance. Also just because you have heath insurance doesn't necessarily mean your insurance will pick up the tab.
I’ve been charged out of network at an in-network hospital because the physician didn’t identify themselves or their network. If they’re not your primary doc it might be worth asking for someone who is covered to save you hundreds or thousands of dollars.
Do most people just decide to do it at home and take the risk?
Deductibles can vary wildly depending on someone's insurance plan. However, there are a myriad of financing options, charities, etc if for some reason you can't afford that.
https://www.bloomberg.com/news/features/2018-06-26/sky-high-...
I would estimate the vast majority of people in the US need to budget at least $5k for a baby, if everything goes right. It would be better to have $10k cash though depending on prenatal visits, c section possibility, and multitude of other costs that can arise.
Spain sometimes subcontract public healthcare to private hospital. However from a patient point of view, you are still treated as a public healthcare patient (i.e. you pay through your tax and the government has a specific financial agreement with the company running the hospital).
Otherwise I'm confused by France model. What's the business model of a Private Hospital is they receive no money neither from the Government nor insurances nor their patient ?
For everyday care the public health insurance reimburses 70% and the private health insurance the remainder.
For more serious procedures (such as a baby delivery) the public health insurance reimburses 100% of the fees. The prices are fixed by law, the practitioner can charge more (if it's a private hospital) but then the private health insurance will have to pay the difference.
The public health insurance is paid through taxes (I think something like 5 to 10% of the salary?) and the private health insurance is between 50 to 100e depending on your family and coverage (glasses, teeth, etc.)
I think we'd have been given a shared room for free, but at the time it seemed like a good choice to make.
Both the UK and Spain have also a public health sector, with Clinics, GP, ... that is accessible for free.
In the UK and Spain, very few private health insurances covers Birth or Emergency Care: for those you are supposed to go to the public service or pay cash in a private clinic.
Other countries like Belgium have health insurances that give you the kind of extra comfort you mention. But they cost something like 5 EUR a month vs the 100 EUR in Spain and the UK.
Letting all the healthy white collar office people stick with their employer chosen health insurance means the leftovers are the poor and unhealthy which many insurance companies can’t handle the losses from since there is no health population to balance it out, so you have places that have no health insurance competition.
Even then, the people that make the most money in healthcare are the providers (doctors) and by a significant multiple, so increasing their supply would be necessary to bringing costs down.
> ...unless of course we needed a C-section, in which case it’ll be a casual $30,000.
In India, we got c-section done in a luxurious hospital in a suite ward for slightly over $1K. About 80% of that was covered by insurance. Even if it wasn't that kind of money is a typical middle class family in India can easily afford. Note that I'm talking about top of the line hospital so the median cost for a c-section is somewhere around $500.
I guess what I'm trying to say is that I'm really blown away by that kind of cost difference. In a developed country shouldn't health be more affordable? No wonder medical tourism is on the rise in India.
This cost disparity is not one of developed world vs undeveloped, it is one of an insane health care system vs a rational one.
[1]https://www.rcn.org.uk/employment-and-pay/nhs-pay-scales-201...
Unless you're really rich. It's now more of a status symbol amongst the rich. "Oh you have 5 kids? Two nannies, a cook too. That's the life!".
So with 3 kids, I'm likely $750K down on my wealth. As a tech worker, that is not bankrupt. But if I were living closer to poverty? Then the problem is less about my personal wealth and more about where I choose to cut corners when raising the kids.
But I recall reading a vivid passage about ten years ago, talking about the difference between rich and poor maternity wards: the wailing.
Anesthesia is an elective expense in childbirth, not always covered by Medicaid.
I had a friend who got an appendectomy at Stanford that was paid for by Google (she was on business travel, works in the London office) and the price was obscene, far above what should ever be charged, literally 10x what other hospitals charge. That place is crazy.
Maybe you could move in and set up a maternity ward and advertise it as “only $10,000!” And then people will ask what the competition charges and you won’t be able to answer. They won’t be able to answer.
Also, I would expect any service to cost 50% more in the Bay Area.
How well things go during an emergency depends on how much effort you put into preparing ahead of time. Nothing new or strange about that.
[0] http://www.chhs.ca.gov/Press%20Releases/Smart_Care_Californi...
If you have insurance that covers this, it’s simple. You don’t even need to call anyone. You’ll pay your deductible.
If you want to compete on price, you’ll either need to charge substantially less than people’s dedictibles in order to make a noticeable difference, aim your price competition at insurance companies (who pay vastly lower prices already), or target the not-exactly-lucrative uninsured population.
That is an incredible misunderstanding of supply-and-demand. Just, wow.
It's commonly said that having a baby will result in costs that exceed your out of pocket max, so you can think of the out of pocket max as the real cost to a family on one of these for the medical services from prenatal care through the birth. Caveat: Your accumulation towards this maximum will typically reset to 0 at the beginning of the calendar year, so try to finish your pregnancy before 12/31.
When people talk about 'good' health care plans in the US they tend to think of traditional low deductible PPO. Those tend to have family deductibles in the $500-1k range.
Though the employee premium differences might add up to more than 10K in the face of a 'good' health care plan so its largely not relevant to the argument about health care costs in a nation vs nation way (though you'd want to include tax burden for health insurance in that case).
Many employers offer high deductible plans but also contribute into the employee's HSA which can be used to pay deductibles. In theory that incentivizes the employee to shop around and get the best possible deal on care.
To the people downvoting: please read properly. If you move your place of residence outside your country, you're no longer insured, and that's what I'm talking about - I specifically said "if you don't have insurance".
The only case that would maybe trigger a payment would be if you were a visitor to EU and had a baby - but most likely no hospital would bill you as hospitals are just not equipped for billing, they don't have the staff or the equipment to do such weird things as issue bills for treatment to people. I know at least several non-EU people who had treatment in EU and no one ever asked them for any insurance info to bill them, unless it's something major and very very expensive there's just no point, it would most likely cost the hospital more to figure out how much and how to bill you in the first place.
In Sweden every visit to a doctor or hospital is billed, as is every night spend at the hospital, so they are definitely equipped to handle it.
Slightly different, but also extreme, case - Germany. There, one always is insured, only for the months one doesn't pay a debt is accumulating (you thought healthcare can incur debt only in US?). It's quite difficult to get out of German healthcare insurance actually, even while being EU citizen and moving out of Germany.
In fact, for a EU citizen who takes advantage of free movement of workers and relocates often between EU countries, one can fall pretty badly on its face healthcare insurance-wise.
In Germany free-lancers face issue, they need to get their insurance somewhere. But thay have to get, there is no such thing as uninsured German resident.
It's true that you'd be covered even if you never paid but you have to be entitled to be a part of the system - and thus you're insured. Also the money for treatment will be later demanded from you, on top of insurance payments and interest (personal experience); of course there are options for the socially less able (the government pays insurance for them, that's why it might seem free) but as a software engineer, no it's not true.
If you read my comment properly you'd know that I'm talking about uninsured people.
In the Nordic countries that's extended quite a bit for citizens of other Nordic countries (even if the other country isn't in the EU), and I wouldn't be surprised if there are other groups of countries in the EU with their own similar agreements.
None of the above says anything about the level of welfare the individual EU countries have, however. If an EU member has a below-average welfare system then you might end up with nothing simply because you don't meet the requirements for receiving benefits.
It sounds like there's a hole for people to fall in: if you're a Czech national, but not resident nor employed in Czech Republic, but in the country anyway, and you don't have private insurance, then you have a problem.
(It looks like if you're a resident proper in another EU country with resident-based healthcare, such as the UK, then that would work for EHIC purposes if you visited Czech Republic.)
My comment was talking about uninsured people, so mostly non-EU residents and people that didn't pay and weren't entitled for coverage by their government - the way it works is that your governments pays the insurance for you if you can't, but will not if you can; there is an exception - Germany, where everyone is covered through taxes.
In Germany everybody who is employed in way that pays social insurance is also health insured, you cannot opt out of it. In that system, in addition to taxes, social security and unemployment insurance, you pay a certain percentage of your gross salary to get health insurance. This percentage varies by your choosen provider. Your employer is paying the same amount (more or less, not sure if the employer amount is fixed). You can opt out of the public system above a certain salary and pick private insurance, prices vary greatly.
Unemployed people are insured by the state, I guess using taxes or social security or unemployement budgets, I have no idea. You have to be registered as unemployed to be covered. If you do not register you have the choice of being insured with a family member (public health care) or voluntarily (private or via the public system). You are obliged to be insured oine way or the other.
Exceptions are soldiers (some kind of in-service system with cost reimbursement, don't ask for the details), public servants (something similar in a lot of cases, again, please don't insist on details), certain professions (doctors, pharmacists, artists,lawyers) with their own insurance solutions. You are screwed as a afreelancer, your only solution is a private insurance that can get quite expensiver.
TL/Dr: You are always insured one way or the other. It is not paid for by taxes.
And sure, health care ia costing money, nobody is argueing that. What Europe figured out is that a solidaric system, one where people with less individual costs are covering for those with higher costs, are the optimal solution from a national perspective. It still pizzles me how that can actually be a issue in any developed democracy.
And again, all legal residents are eligible for health care in EU countries. A good thing if you ask me.
Yes, but that's comparing listed prices and not adjusted for purchasing parity. They will substantially reduce the price if you're not insured and ask them.
> And again, all legal residents are eligible for health care in EU countries. A good thing if you ask me.
I tend to agree, but that's not my point. I'm just saying that a clinic will bill you (indirectly) roughly the same as they'd in the US after you get it adjusted, but of course it's fully covered for most people here.
So if an EU citizen moves to another EU country, there's no problem.
An average hospital in The Netherlands (#1 in quality in Europe [2], but #6 in costs) charges the insurance company between €607 (natural birth) and €4450 (c-section).
[1] https://en.wikipedia.org/wiki/List_of_countries_with_univers...
[2] https://en.wikipedia.org/wiki/Healthcare_in_Europe#European_...
I guess what I'm trying to say as someone who lived a lot of years in the U.S - why the hell they gotta screw you so hard there?
on edit: of course I should also specify that Denmark is pretty capitalistic, so you pay for your kindergarten once you enroll the kids in there and that will cost more per month then you are getting in stipend.
The same reason most things happens: Lots of short term profit, no matter the long term cost.
Now, it likely a) does cost a lot less in Denmark than in the States in real terms and b) paying for it with taxes might absolutely make the most operational sense. But it isn't free.
Also as an aside there are lots of babies born in the US that are paid for via taxes and cost $0 out of pocket for the family. Medicaid, the VA, Tri-care etc. I don't have the numbers in front of me but I'd bet that there were more American babies that were tax paid for than Danish ones in a given year.
But it’s just untrue that you paid $0 to have a kid. You don’t know how much you paid & that’s ok. But it’s a valid criticism of single payer.
Further it is also true that the US system has deep flaws but it’s fundamentally untrue that the many Americans get the full boat costs of a birth. So comparing your $0 cost & a $15k outlier is largely a futile excercise.
I'm pretty sure every other person reading my initial comment understood huh, the government pays for it and he pays his taxes. But you seemed to need to make a gotcha argument about it which again, given how human conversation is structured and the literal impossibility of defining everything down to constituent atoms in every communication it is generally assumed that people in good faith take some things as given which is why in response to your taxes comment I was sarcastic because who among us is so lightheaded that they don't understand taxes exist and are used to pay for things the government provides us?
I don't think the people who upvoted the comment thought I had made a brilliant refutation of your point about taxes, I think they just thought what is this guy with taxes on about - because that's not what the point under discussion is and you would have to be rather obtuse to think it was. That's ok, I certainly have my own issues that I am thickheaded about, but really people do know taxes pay for the births in European hospitals.
As to whether it is fundamentally untrue that many Americans get the full boat costs of a birth, I don't know. I do know the article seemed to think they were getting enough of a boat that they were sinking. Hence all of us Europeans saying, he we're doing swell with the kids and all started up. I don't think that's such a futile exercise.
As far as that goes referring to Danish people as Dutch could also be considered less than civil.
Maybe it takes me a lot of words because I am an especially prolix person, sorry, I hadn't realized how damaging verbosity was to your feelings. I do realize however brevity is the soul of wit so let me cut it down:
Everybody knows that taxes pay for hospital costs in Europe. The context of the conversation was being charged money at the birth of a baby, which people in Europe are not. To say that I paid 0 at the birth of my children was not an untruth but the exact truth. That I have paid taxes in the past and will pay them in the future does not change that.
Given that I was accused of lying, I think I maintained the appropriate level of civility.
Given your hectoring tone here, your insults to my nationality, complaints about my wordcount, and accusations of wiggling I worry I've been too civil.
https://www.babycenter.com/101_what-birth-costs-around-the-w...
Surely this is not true?
Does having kids just bankrupt ordinary people in the US or what?
I'm not asking about exceptional cases, like what is the normal way of dealing with having to pay $15,000 just to have a baby climb out of your body, when I'm assuming most people don't have that much money?