"simply not having to worry about healthcare and medicine costs as a freelancer makes a huge, obvious differences the length and viability of their careers"

I've been a freelancer for 10 years and have always purchased my own health insurance in the US. When I was single, it was only around $150/month (even only a few years ago). This included Doctor visits, prescriptions, and if I had an emergency..I wouldn't go bankrupt.

If Canada and Europe are great places for startups, why do they lag so far behind the US? The reason is because while it seems great that you get free healthcare, as your company grows, it's many more times difficult survive because of the taxes and regulations imposed on you.

An increase in taxes and regulations only helps large companies because they have the attorneys and employees to handle all of the paperwork and can still survive when a large percentage of their revenue is given to the government.

Rates of entrepreneurship are comparable to (and in some cases higher than) the US in most wealthy European countries. The difference in “startup” culture has more to do with the access to capital and the US government’s historic, unmatched investment in technology infrastructure in the context of the Cold War. It’s the same reason why Russia today still punches above its weight in the IT sector.

Startups are just one small category of business: the sort which must grow at 6% per week or else they will fail.

The U.S. does great with these “bet the farm” business models because most of them can fail, and the few that succeed can pay off the capital class handsomely.

Personally, I would rather live in a world where all of my most talented friends can start lifestyle businesses that allow them to do their best work, and be healthy.

The success of startups has some nice macro effects on GDP, but does not solve the problem of labor exploitation that, for me, is just as important a goal of entrepreneurship as making a windfall for the capital class.

While taxes are high, employees in Europe are still way cheaper than say SF or NYC. You can get a decent web developer for EUR 60-80k in total cost per year in Austria. Spend 100k and you get the top 5% talent.

What Europe lacks is private funding. I don’t find the article now, but years ago read that there’s 5x as much funding in the US market as compared to the EU market. Seed funding is 3-5x less than you would expect in the US.

This has seemed to me to be a key problem for the European tech industry. A few seemingly minor structural differences mean there is very little domestic VC available. Those are:

1. In the U.S., there are many pension funds that put some of their money into venture investment. In general in Europe it is illegal for a pension fund to invest in such risky assets at all.

2. In the U.S. there are many more private foundations and private universities that have large investment funds, and some of this gets put into VC. For a variety of reasons, there aren't many large private foundations and there are few private universities with large endowments.

If I were doing industrial policy in a European country, the first thing I would do is to start to invest a couple percent of the state pension funds into VC like vehicles. Given how underinvested it is, the returns should be great, and the extra economic activity should help the fiscal health of their economies a lot.

> it's many more times difficult survive because of the taxes and regulations imposed on you.

There are several things going on here:

* "Europe" isn't one place.

* It can both be true that there are higher taxes and more regulations, and the health care system is better. You're still paying less for health care as a % of GDP, so it's not like you're paying the same amount, just through taxes.

* There are a lot of other factors such as universities, access to capital, and simply 'culture'.

I work in the visual arts in the US and the triple-whammy of student loan debt (MFA's are basically a prerequisite for almost any job in the field), high real estate/rental prices, and lack of healthcare make it extremely difficult for anyone who lacks outside funding (partner in stable job, family money, etc.) to set up a studio and make a viable living at their art. If we at least had universal healthcare it might just be doable.. As it is now, most artists that I know are without insurance or on Medicaid.

Yeah, it’s a horrible situation. Some illustrators I know live in terror of earning too much that they no longer qualify for Medicaid (which they rely on for various health conditions). It also pushes people in the arts into the gray economy where they’re more likely to get taken advantage of or build a stable, growing career.

Not to worry about healthcare and medicine costs is not really true. I just commented about it. Most people pay extra for private insurance even if they get public healthcare for free.

I’m in regular contact with artist friends in the UK and Canada and absolutely none of them do this. And neither did any of my family in the UK. Not sure where you’re getting this idea from.

The only people who generally have private health insurance in the UK (other than dental care) are those who work for companies where, usually senior, staff get this as a taxable part of their package. I wouldn't have thought that artists would belong to this category.

Here in Canada health insurance is seen as important. Government does not cover dentistry, mental health, eyecare, physiotherapy, ambulance. There are provincial programs to help with prescription drug costs, but the deductible that must be met first is quite high.

That's true for the UK but not for many European countries. See https://www.oecd-ilibrary.org/docserver/health_glance-2015-3...

I'm Canadian. Almost nobody does this, although health benefits through work will usually cover the cost of drugs and dental. But nobody is paying extra for medical coverage outside of those areas.

According to this 67% of Canadians are paying extra for supplementary insurance. (it's a few years old but probably didn't change much since) https://www.oecd-ilibrary.org/docserver/health_glance-2015-3...

That supplemental insurance is most likely just dental and prescription drugs. It’s not for the more expedited care you cited. Drugs in Canada are still cheaper overall because of government involvement in the market and many Canadians actually wish their national system was expanded to include dental care.

That might be true in some eu states (Mostly the newer and poorer news)

From experience in the UK Private insurance is not worth it as an employer benefit as you get taxed on it.

And even in newer and poorer EU states it is not that bad as in US.

I'm in the UK, I know of no one who pays for private healthcare. You can often get private healthcare from your employer, but I believe you incur a tax cost to do so. Something something benefit in kind?

I'm from belgium and I'm considered as having complementary insurance beside regular free insurance. The complementary insurance is part of the same package as regular insurance and is not even optional. I pay 40€ every 3 month. According to the study you posted, I have a complementary insurance. It has to be taken with a grain of salt...

I an European and I have worked and lived in 4 different EU member states, some rich, some more poor. I know almost nobody who gets private insurance.

Currently I am in Germany, and I had a serious health issue. The sort of thing that makes you go bankrupt in the US. I had surgery and months of treatment for free. I stayed on my own private room in the hospital, and it looked like a hotel room, with a private bathroom. I payed zero euros, this was all on public healthcare. They even offered me a few days in a SPA to recover after surgery. They even funded the metro tickets to go from my house to the place where I received the treatment.

Some other EU member states do not have the resources for such niceties, but you will absolutely get the treatment you need.

I feel sorry for people in the U.S. I read about all sorts of situations that are heartbreaking, and it confuses me that most people there still vote against universal healthcare. This serves nobody except the very rich people exploiting the situation.

I listen to North American podcasts and such, and I am still surprised to hear educated people repeating lies about the situation in Europe, as if we were some almost-communist repressive society about to collapse. The most common assertion is that, after all, the US is the only country with "real freedom". To my European ears, this sounds exactly like the sort of propaganda you get from any authoritarian regime. As if "freedom" is some simple one-dimensional things that can be measured like this.

I think it would be good if U.S. citizens had a more realistic picture of how the rest of the western world lives.

That varies a lot from place to place. Most people in Italy, where I lived for many years, did not get supplemental insurance.

I don't know anybody here in Israel who pays for private insurance.

What?? Read https://www.calcalist.co.il/local/articles/0,7340,L-3755829,...

To quote for the non-Hebrew readers: "83% of the people paid for extra insurance in addition to what they get from the government"

Oh, but that's such a minor expense I don't consider it at all. It's an extra 10$ a month for the absolute majority. Top insurance is about 25$ a month. Practically negligible for the absolute majority of people and nothing like the hundreds of dollars a month most people pay in the US.

Also, it's not "private" insurance in any meaningful sense. It's out of pocket adjustments for exactly the same services. This is what I was alluding to.

I'm assuming 10$/month you're talking about the supplementary insurance like "mashlim" that 90% of the people with reasonable income do. The article also says that 53% of the higher income group also have private insurance, which I'm sure is more expensive than that. (the article is from a few years ago so things might have changed since; I don't know). But I agree that most people probably don't need private insurance.

Also to make things clear, when you say people in the US pay hundreds of dollars a month, that's also true for many Israelis. The public insurance is not free if you have a job. The more you make the more you pay. If you work in tech it's likely you're also paying hundreds of dollars a month. (don't get me wrong, I think this system makes sense, it's the same as income taxes). The situation in the US isn't great but it's been much better in the last decade. For example, I live in Massachusetts and everyone in the state is required to have health insurance. If you're low income then you get your insurance from the state.

Fair enough. I'm glad more states are following suit. Both of us appear to understand the differences between the systems and so I don't think we should be bogged down with semantics. Israel has a single-payer public healthcare system, almost entirely paid for by taxes, which is utilized by a large majority of the population.

Is it basically single-payer healthcare there?

It is, yeah. If you go to the ER and are admitted, you pay literally nothing, even if you needed an ambulance. Subsidized medication is extremely cheap, etc etc..