If you make American-level software engineer salary in Sweden, your EFFECTIVE (not marginal, effective) tax rate is a freaking 55% - at least that’s the number given to me by a recruiter whi tried to bring me there. Also, you pay 25% VAT. I’m sorry, but that’s a bit outrageous.

As a German software engineer that used to work in the USA, do I pay more taxes in Germany, yes. But, I don't have to worry about going bankrupt from medical issues. In Seattle where I used to live daycare is 30,000$ a year per kid. In Germany it's at most like 200-300 euros a month. Plus you get kindergeld too(200 euros per kid). We don't go into 10s of thousands to hundreds of thousands of dollars in debt for school. Even with my "good" benefits I had at my job in the US, I would never move back.

Most Americans have good healthcare through their employer. The premiums are reasonable, and the quality is great. Only if you're self employed or part time do you pay out of pocket, something you need to factor in when you make life decisions.

I think maybe you mean to qualify that as “most American software engineers?” Or maybe even “most Americans in white collar jobs”, although that’s not a universal, and the premiums and quality of care in many of those plans is absolute crap. Heck, even as a software engineer, my medical insurance is mediocre and a high-deductible plan costs more in premiums ON TOP OF what my employer pays than I’d spend out of pocket in a year without a major medical emergency.

In 2017, 91.2% of people have coverage, 67.2% through their employer. 71% of Americans answered they are satisfied with their employer-provided coverage.

Anecdotally, I'm satisfied with my coverage.

https://www.ahip.org/majority-of-americans-satisfied-with-th...

https://www.census.gov/library/publications/2018/demo/p60-26...

I have “excellent” coverage in the US and am now pregnant with my second baby. My first pregnancy and birth ended up costing thousands of dollars. During pregnancy, I received an endless stream of unpredictable lab test bills (why does this test cost $13 and this one costs $273?). After the birth itself, every provider who saw me in the hospital sent me a separate bill, on top of which I was billed for the room itself and for the individual drugs.

Almost any other system would be better than this. If it were out of pocket there would at least be downward pressure on prices and clearer pricing in the first place. Or we could provide it as a public service like every other developed country.

What did you really end up paying though?

On average Americans pay $3,000 for childbirth.

If our system was like every other developed country, we wouldn't have the medical developments we have today.

> 91.2% of people have coverage, 67.2% through their employer. 71% of Americans answered they are satisfied with their employer-provided coverage.

So, almost 4 percentage points more Americans are satisfied with their employer-provided healthcare than actually have it?

Or do you mean 71% of the 67.2% not 71% of Americans?

That survey was for employee provided coverage, so it would be 71% of the 67.2% Americans who get their coverage via employers. I couldn't find satisfaction rates for government provided coverage.

Which means less than half of Americans are satisfied with their coverage. Not “most”.

No that means the majority of people with employee provided insurance are happy.

There aren't stats on satisfaction of government provided healthcare, but if they are unsatisfied it furthers my point that the government should stay out of healthcare. And if they are satisfied then there is no problem :)

Uh..no..I'm not sure where you're getting your facts but no this is completely false. Most Americans have either Medicare/Medicaid, or various levels of employer sponsored healthcare, most of which are really poor or push large burdens on their employees. I have fully paid for healthcare through my employer and I STILL have a $5000 max out of pocket that I have to cover before insurance fully covers me. To put that in perspective that's an entire month's income in a country where most people live paycheck to paycheck.

Oh and the cherry on top of that is that in the US you can literally be fired for getting a prolonged medical illness, such as, oh say, cancer, which impacts nearly every single American. It's totally legal, which then takes your wonderful healthcare and removes it right when you need it most and can least afford to lose it. Another fun fact is that it's really hard for most people to work when getting prolonged medical care, which means, again you can't really pay for the bills you are getting.

If you think quality is great, then you're lucky. US hospitals can flat out refuse to treat you properly if you're "lucky" enough to go to a Christian based hospital, which will deny care unless life threatening, in some states this nears the majority of hospitals.

So no, most people who go bankrupt from medical bills in America HAVE health insurance. You're living in a fantasy bubble I suggest you step out of before you get a huge shock. I sincerely hope you never have to experience this first hand because it's absolutely hell for those who have to go through it.

Sources: Average US Income: https://en.wikipedia.org/wiki/Household_income_in_the_United...

Catholic Healthcare: https://www.forbes.com/sites/judystone/2016/05/07/health-car...

Healthcare bankruptcies: https://www.cnbc.com/id/100840148 Rebuttal: https://www.snopes.com/fact-check/643000-bankruptcies-in-the... https://www.studyfinds.org/two-thirds-of-all-american-bankru...

Edit: I don't mean to suggest US healthcare providers are poor, it's generally the best in the world if you live in the east coast, Texas, or west coast the south and midwest generally have poorer coverage with the exception of cities. We basically have the best healthcare that you can afford, the problem is that most people can't afford it.

Over 71% of people are happy with their employer coverage, as am I. I also chose a high deductible of $5000, but I have a $0 monthly premium. If I chose a $50 premium, I would pay $500 deductible. And that's only for major expenses. Drugs and checkups don't need the deductible. Yes, there's reforms needed, but it's not the apocalyptic picture people paint.

> Over 71% of people are happy with their employer coverage

That statistic is not terribly revealing, as I suspect that the vast majority of those 71% are relatively healthy/young people. I'd like to know the percentage of people who have had significant health events in the past 12 months that are happy with their coverage.

It usually takes a few months for employer coverage to kick in. And most people stay at their jobs for well over a couple of years. I'm sure most of those people have had to use their insurance in their period of time of working at their job. I find it harder to believe the opposite.

> I'm sure most of those people have had to use their insurance in their period of time of working at their job. I find it harder to believe the opposite.

Using your insurance for regular doctor appointments or the occasional flu or bronchitis is quite different from realizing you have a serious chronic condition, or require a major surgery. You don't buy insurance for regular needs, you buy it for the unforeseen serious ones. These are rare, but it's here where the quality of insurance really matters.

Judging the quality of insurance from the standpoint of the "average person" is not the correct perspective. You need to judge it by the person who needs to file serious claims. From this perspective, 70% of "average people" being happy with their insurance seems remarkably low.

Funny you talk about quality insurance, but its employer provided insurance that's higher quality than the government or self paid ones. Because the employer gets a very good bulk deal and pays a high premium, much more than the average person can self-pay. That is why satisfaction is so high for employer provided insurance.

> Funny you talk about quality insurance, but its employer provided insurance that's higher quality than the government or self paid ones.

Government insurance, at least for federal employees, is actually very good, and for the same reasons you stated. There are few with as much bargaining power as governments.

But I don't quite get your point. You said that 70% of people are happy with their insurance. And my point was that doesn't seem very high at all as most people aren't that sick. You can't use a majority's viewpoint to judge the quality of a service that they don't use.

For how many years did you work in the USA?

I highly doubt daycare is 30k / year.

It's true, but it also includes benefits and not only taxes. An American-level software engineering salary in Sweden is also probably twice that of the average software engineer, so you are going to pay a lot more in taxes than the average software engineer. That is because wealth transfers and income equality is Sweden's way to create a nice society. The problem is however that today an average salary, even as a software engineer, doesn't go very far in Sweden. And especially not in the housing market. You need wealth, which isn't taxed much by comparison. So in that sense your outrage is correct.

True, but those taxes pay for things that money can't buy; for example job security, open spaces, parks, social services such as cheap child-care, paternity/maternity leave, etc, etc.

You can't just compare salary. The lifestyle is different. You'll get 4-5 weeks of (paid) holiday, you'll live in a modern country where the taxes are high, but the streets are clean, people are looked after, and you'll have effective health-care.

(Disclaimer: I'm in Finland, not Sweden, but things are similar here.)

And not to forget: College

There's a reason I was comparing healthcare costs per capita, because then we don't have to argue about things like total tax rate, because it doesn't matter. US taxes wouldn't need to increase.

I would gladly give up 70% of my salary to live in a comfortable and equitable society.

As far equitable goes, Swedish elites are probably as dodgy as any other country's. For example, the IKEA is famously set up as a maze of international companies and non-profits (IIRC) to pay minimal taxes. Also, Nordea (largest bank by far in the Scandinavian region) was recently involved in money laundering and organized crime.

As for comfortable, stress free living, here's a fun fact about Sweden - the average length of a mortgage is over 100 years.

Absolutely, public spending on healthcare in USA is enormous. Higher than military budget. USA is unfortunately country where enormous amounts of people are sick. Mostly side effects of obesityand lack of physical activity.

All of this is a side-effect of the uniquely American philosophy that says that if someone is making money they must be making a net positive contribution to society, because otherwise why would anyone buy their product? This approach overlooks externalities and rent-seeking. The net result is that we have a lot of people making money selling things to people that they want but makes them sick (soda, cigarettes, corn chips) and a lot of other people making money professing to make them less sick, and yet another group of people making money by professing to control the costs of the second group, and lot of other people making money lobbying politicians to keep the laws in place that maintains the status quo. So everyone's making money (except for the slackers who dare to get sick), so everything must be hunky dory. The American health care system is the broken-window theory writ large.

While I do not disagree with you altogether, I have a hard time believing it would be possible to come up with some sort system that is inclusive of these externalities. Look at what a crapshow nutrition science is - do we really want government encouraging/discouraging foods more so than it already is? Look at how bad farm subsidies have affected our health in general.

The spending is due to research and development, not because more people are sick.

Not really, it's Medicaid and Medicare.

https://en.m.wikipedia.org/wiki/Expenditures_in_the_United_S...

That's the government's spending on healthcare insurance. Which furthers my point, those insurance companies are paying the cost of development that gets tacked on to drug prices and other healthcare services.

I think most medical professionals may agree with this: the U.S. healthcare system is built on rewarding volume and doing more things. It's an especially attractive field for clinicians who specialize because they have to do special things - with highly regulated barriers to entry.

And while there has been recognition by experts in recent years to push for quality and efficiency (since doing more procedures, especially those unnecessary, raises the risk of harm), the system has been slow to both incentivize this and lower the overall costs.

With healthcare you either have a true free market, as in no licenses, no patents, etc or you need the State to regulate it and provide it for everybody. The US has the worst possible combination.

A “true free market” doesn’t have no patents any more than it has no rights in land. Patents prevent what would othwrwise be a market failure (free riding) just as property rights in land prevent tragedy of the commons. Put differently, you can’t have markets where you can just take things instead of entering into transactions. Because you can do that in the state of nature, markets are inherently artificial constructs.

America's healthcare system is what furthers the world's healthcare through research and development. Because it is for profit, the quality and advances are superior. Other countries that reap the benefits of drugs that America create while only paying generic prices when Americans have to pay for the inflated prices that pay for those expensive drug trials.

How much R&D did pharma boy do?

That's your counter? One instance of abuse?

I'll take that if it comes with all the breakthroughs the American healthcare system has developed.

> In Sweden we pay less per capita than americans do (from taxes)

Taxes as a percentage of GDP in Sweden is 37%, versus about 27% in the United States.

but of course that doesn't mean Sweden pays more from those taxes on Healthcare than the US.

Looking at the "Government and compulsory" figures here https://data.oecd.org/healthres/health-spending.htm the US appears to be at $8407 per person for gov. + compulsory spending and Swedent is at $4606.

Healthcare gets funded in each country by a combination of taxes and people paying out of pocket. In the U.S. employer subsidized health care insurance should be viewed as part of an employee’s compensation. What matters in such discussions is not the tax rate but the overall spending per capita and how much it costs at point of contact. The relevant facts are that the U.S. spends far more per capita and costs far more at point of contact than every other OECD country.

I think the person you responded to was attempting to point out that Sweden’s healthcare costs come mostly from taxes and is cheap at point of contact. I don’t believe they meant to give the impression that taxes in the U.S. are higher than in Sweden.

>>Don't fall for the 'yes, but countries that have cheap healthcare pay for it with taxes'. The US pays more than most from taxes[0].

Americans don't actually have an objection to paying more for healthcare.

What they do have an objection to is paying for other people's healthcare.

America is a deeply individualistic society, and the idea of one's tax dollars being spent to benefit others lies at the root of most people's objections to single-payer, or anything else that smells like "socialism".

Ironically, I support single payer healthcare (or at least a dramatic restructuring that decouples pricing from employment) specifically because of individualism.

Right now, you need to work at a corporation to get collective bargaining for healthcare prices. This presents a huge disadvantage to people wanting to be contractors, self-employed artists, people wanting to start small businesses, people who only want to work every other year for whatever reason, etc.

Your options are limited because you need to be part of a corporate collective to get reasonable healthcare options.

I support a variant of single payer healthcare too: you pay for your own healthcare out of pocket. All this requires is that wages be high enough and health care costs be controlled. If this sounds impossible, you should consider that it was how our system worked in the USA in living memory.

You then deny that health insurance is a reasonable way to plan for illness?

As currently implemented? Absolutely, it observably isn't. Why do we need middlemen preying on fear, confusion, and preventing any reasonable price discovery from occurring while driving an absolutely absurd inflation rate[1]. Please note those are monthly, not annual numbers, and some months alone hit 5%! Keeping costs down and wages up has plenty of other positive effects too.

[1] https://ycharts.com/indicators/us_health_care_inflation_rate

It's interesting you say that, I've heard that line of argument before but it is quite puzzling.

Are you suggesting that a person on Low income in the US doesn't object to paying more than they have for their own healthcare (i.e. that they wouldn't like that healthcare to be cheaper)

That seems a bit counter-intuitive, as usually people don't like being bankrupt.

Americans believe that only poor people get bankrupt... then they get cancer.

It's hard to swallow an increase on taxes when you're healthy and think you will never get sick.

I can understand (although not agree with) the idea that rich people don't want to subsidise poor people's healthcare, but the argument I was responding to appeared to say that Americans don't mind paying more for their healthcare, which puzzles me.

I'd have thought that lower income Americans would be pretty happy to have a source of cheaper healthcare, even if it wasn't quite as effective as the expensive stuff.

There is a miriad less mortal deseases then cancer, that can broke anyone, especially if its Your kids are suffering...

And you do have a system where you pay more than anyone else for the pleasure of poor people dying. Harshly worded but that is already solved, and somehow I don't see people being happy with it.

I think it's pretty clear that taxes per capita to healthcare being third highest in the world isn't common knowledge.

> America is a deeply individualistic society

Polls say otherwise: http://nymag.com/intelligencer/2018/08/new-poll-majority-of-...

Who benefits from convincing Americans they're individualistic and should remain isolated when negotiating with giant corporations?

All this leads to is less people going in for annual checkups and preventative health care which leads to people becoming catastrophically sick ($40k medical bills) vs. preventing that situation from happening at all if it can be prevented; or catching it early on so it can be mitigated.

It's been a long time since I've worked in retail where I had no employee provided healthcare but back then I'd only go to the doctor if my arm was falling off. Everything else was "this feels weird, I'll wait it out, hopefully it goes away because I don't have $150-200 for a checkup if it turns out to be nothing."

A simple example is dental care. Yearly checkups, cleanings, etc and actively working to prevent major issues leads to far less diseases (blood, etc). But when you don't have decent insurance knowing that you might go in and get told you've got a $400 cavity or need a $1500 root canal out of pocket dissuades a lot of people from even going in. Thankfully I have generally healthy teeth but I hadn't gone to a dentist since my teens (parents insurance) until a few years ago. And once you tell someone that you might be shocked by the number of people who come out of the woodwork to tell you they haven't gone either.

I generally thought I was incredibly healthy and invincible until 28 when out of the blue I got appendicitis, which was $35k. I still had my "only go if my arms falling off" mentality back then but eventually the pain was so unbearable that I drove myself to the ER as I knew something serious was going on. Thankfully I had insurance. That really taught me that there's a lot of things in my body that I have no control over regardless of how healthy and active I am and having a fall back plan to help when catastrophe happens is critical.

A lot of people just don't like doctors. I have good insurance, but I haven't been to a doctor (MD) in probably close to 20 years.

I do get regular dental cleaning and checks though.

Oh believe me, I sat in my car outside for an hour before I even forced myself to go into the ER. I was afraid of doctors, hadn't been in years, and my first foray since then would be taking myself to the ER. I was terrified.

And.. it wasn't bad at all. I'd never had surgery. They knocked me out and I woke up and didn't even know it was over with until I checked my stomach for the scar.

I agree. Unfortunately, Americans are not all multi millionaires or billionaires and almost all Americans are too stupid to realize that they won't be able to afford their own healthcare without a "socialized" government run system. Such stupidity is a hallmark trait of such an individualistic, selfish society in which people cannot think of others or or collective action. Other traits are high levels of depression, anxiety, and drug abuse due to isolation and the complete lack of community. But hey, at least you can watch your neighbor die slowly of cancer he can't afford to get treatment for from afar. That seems to be something Americans enjoy.

I don't think that "individualistic" is a strong enough word. European society, for instance, is also very individualistic, yet doesn't have anywhere near the levels of indoctrination against "socialism".

It seems Americans (generalizing here) have been let to believe that someones gain can only happen at someone else's loss, thinking there can't be a win-win situation.