> In Holland it's around 100 i think and here in Spain it's free.

You personally pay around that amount in "insurance", but a big part of your healthcare costs are being taken out of your general taxation. The Netherlands spends around 13-14% of its GDP. That's pretty far from 100/EUR/month per person.

I live in The Netherlands and I'd take Western European healthcare over the US's any day, but let's not sugar coat it by hiding the ball about how it's being paid for[1].

Before I moved to The Netherlands I paid 0 EUR/month in "health insurance" (a country with a true single payer system). Does that mean I wasn't actually paying anything for healthcare? No.

1. https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Well yes but if you're unemployed you don't pay a lot. This is what makes it much less of a pressure.

If you're employed by a top company in the US, your health insurance is generally much better quality than most public option in Europe

It's an important point for software developers.

US healthcare for the top 1/4 is far better than what public healthcare is like in most of Western Europe.

In the US if you have good healtchare you have exceptionally fast access to among the world's best healthcare services. You also have a freedom of (ab)use when it comes to utilizing healthcare services; it's a luxury you do not get in most of Europe, where service rationing and very long wait times are normal in the public healthcare sphere (also true in Canada). There are trade-offs in all of these systems.

It sucks if you're in the middle ~40% in the US. It's spectacular if you're in the top 1/4 and your health insurance is covered by your employer.

> Of the Dutch adults surveyed, 59 percent said that they were very confident of receiving high quality and safe health care, compared to only 35 percent of the American adults surveyed.

-- https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

Since you were replying to a comment about Holland this seemed relevant. Don't know about a general study covering all of Europe or something.

But I guess that's where the "if you're employed by a bigcorp" part comes in. You can get better service if you pay a lot, yeah that much seems a bit obvious.

> You can get better service if you pay a lot, yeah that much seems a bit obvious.

Not exactly - larger organizations in the US are able to negotiate better rates with insurance companies. So it's more so that your buck goes further than it is you paying more bucks ;)

the issue i have with this argument, is that it makes healthcare for those who are not in a privileged non existant. (with the boatload of social issues that come with it).

Sure, you might get proper and very good healthcare, but what about those around you in your community?

It's not an argument. It's just the reality of health insurance in the US at this time.

As an argument in favour of privatised healthcare, this is valid, but in the context of Europeans moving to the US, it doesn't seem relevant. The US is not going to reform its healthcare just because a few Germans don't immigrate.

That's not true in the US.

The very non-privileged get moderately ok, free healthcare via Medicaid (along with numerous other programs for poorer people, including coverage for children, SS disability and so on). That covers the poorest/worst off quarter of the US population approximately.

It's the working poor and middle class that really get screwed with the US system. The well-off pay taxes to cover the free healthcare system that the US has. The working poor and middle class often can't afford the healthcare system, are more frequently at risk while unemployed, and their employers are less likely to provide good coverage as a benefit.

I'd like to understand this better. If I was a software engineer for 20 years and had cover and savings etc then was between jobs for a few months for whatever reason and got into a car crash how would that work.

Would I get medicare/aid?

Are all people students / unemployed expected to be paying monthly premiums to get any kind of cover?

I have had healthcare in the US for a serious accident, but I had travel insurance (UK based) which likely saved me 100,000s of dollars. Fortunately they paid up without question. I'm not sure how that would have worked if I was just some regular student from the US travelling around, would I be bankrupted for life or hoping for crowdfunding? Sounds like if you have an accident in the US you need to be rich or popular (or maybe really poor).

Even if we argue the very disagreeable notion that European healthcare is:

1) heterogeneous

2) subpar

3) public only

Then we’re still left with the fact that most big companies do offer private health coverage in Europe. Mostly this is for less than life threatening illnesses, psychological help and physiotherapy.

Well that notion is wrong anyway because every European country has their own system. Some are mainly public with a purely optional private option, like Spain. Some are kinda forced private because otherwise you have to wait for years, like Ireland. Some are absolutely mandatory private like the Netherlands.

And yes in most countries some classes are purely private. I think Britain is a big exception though I've heard the NHS is also not what it used to be.

> If you're employed by a top company in the US, your health insurance is generally much better quality than most public option in Europe

Assuming you are high up enough in the organization. Unless junior developers get the same plan and coverage as the CFO.

The bigger assumption would be that a person with a good employer plan today, had no health conditions that went under-treated as a child and are more acute in adulthood.

Someone in a UHC country may not have top-quality access to care, but it is the simple act of access to primary care itself that can have conditions diagnosed and treated early. That in turn will have a compound effect on QOL, even if you do earn the Tim Cook-level coverage plan when you're 50.

> Assuming you are high up enough in the organization. Unless junior developers get the same plan and coverage as the CFO.

Companies are required to offer the same benefits to all employees, so yes you do get the same health insurance as the CFO.

This is one reason that companies keep pushing low-level labor jobs to contractors or falsely separate contracting companies. They want to attract software engineers with good health insurance, but avoid offering it to their janitors.

not sure why you get downvoted, but yes - it is

The US out of pocket expense for healthcare is a lot lower than you probably think:

https://i.imgur.com/kZlS6pC.png

The overall US healthcare cost per capita is around double the median of affluent Europe typically; higher than double vs Britain, and lower than double vs eg Switzerland or Norway.

A lot of US healthcare is covered entirely or partially by employers. If you're a software developer making near or over six figures, it's very common that your healthcare costs are covered by your employer.

What you're talking about when you say "100" for Holland is subsidization by way of taxation for covering healthcare costs. When you say it's free in Spain, you're talking about subsidization by taxation. Around 1/4 of the US population also gets "free" healthcare (ie the higher income brackets are paying higher taxes to cover those people).

US healthcare is artificially very expensive, for numerous reasons. The employer provided system can also make unemployment quite risky, definitely. There is no free lunch however, someone is paying for the healthcare in France, Switzerland, Germany, the Netherlands, and so on. Whether it's $7k (Germany), $8k (Switzerland), or $11k (US) per person, it's a lot of money.

> ower than double vs eg Switzerland or Norway.

Norway? Really. Health care costs here in Norway are capped at about 350 USD per year. If you pay more than that you get a card that exempts you from paying for things like GP visits, X-rays, MRIs, prescriptions, etc. Anything you did pay in excess of that you get refunded in the next tax settlement.

> Health care costs here in Norway are capped at about 350 USD per year.

You are confusing "individual out of pocket extra costs" with "total costs".

Norway's annual per capita expenditures on healthcare are about 71883 krone (about $7,000 USD). Only the United States and Switzerland are higher.

Source: https://www.ssb.no/en/nasjonalregnskap-og-konjunkturer/stati...

Sorry, I was misled by the reference to out of pocket costs.

I know it's always paid by someone, but what I mean is that it's a big pressure on an employee to stay employed. In the EU we don't have as much pressure.

My understanding is that the important difference is in the tail of the distribution.

In the US, your employer will buy you health insurance, which covers some but not all of your healthcare costs.

If you don't need much medical care, your costs in the US will be small or nothing, essentially the same as in Europe, probably with much more expensive and luxurious service.

But if you do need extensive care, then even when a good insurance policy, you may be facing substantial costs.

A friend who moved to New York with a big tech company told me (lightly paraphrased to anonymise):

> I’ve had a surgery, a ton of dental work, and a new child. It’s cost me tens of thousands of dollars, but the experience has been consistently better than in the UK.

If that child had been ill and needed special care when it was born, that could have been hundreds of thousands. Whereas in Europe the cost is still zero, or only a little more.

There's also the issue that the insurance is tied to your job, and it's extremely hard to get decent insurance directly from an insurer. I'm not sure if this is still true in the Obamacare era, but I've read of extremely rich people being unable to get decent insurance.

That's weird, if you're extremely rich, couldn't you just set up an LLC and employ yourself? And then you can give yourself health benefits :) I thought most of these guys do this stuff anyway for all the tax breaks.

I know all the self-employed and entrepreneurs in the Netherlands do this, they all have "BV"s and "Holdings" so they pay less income tax.

It depends heavily on your employer. Mine pays the insurance but there is a deductible. That deductible is a bit more than what it is in NL but my monthly costs are zero. It works out to about the same.

Almost all employers will pay your health insurance. Also, the salary often 3-7x greater than EU. Who cares even if you have $1k more expense while making $10k more a month.

True but it's not all about money. It would worry me a lot if I would have recurring costs that high. Especially if it was directly tied to employment (e.g. getting healthcare through the employer).

It makes it much harder to change jobs in case of difficulty and a much bigger blow to getting fired.

That’s still not really true. Your healthcare is approximately free when employed and you pay ~1k/mo when unemployed. But your saving rate is much much larger so that expense isn’t actually high. I think the bigger issue is housing prices (if you live in US hcol) as even modest apartments can be 3k+.

I’m the US if you’re unfortunate enough to be so ill that you cannot work you’re much worse off.

This is one of those questions where knowing the median value won’t do you much good. The true cost is highly individualized, but I’d be remiss if I didn’t acknowledge that, yes, it’s more expensive, and yes, it can be more treacherous, especially if you have existing medical conditions you must maintain or that could cause you to become unemployed. To answer your question directly: roughly on average for families it is, yes. However, even that isn’t so cut and dry. For example, some plans just have a family rate, whereas other providers will offer plans tailored to family sizes. Anyway, for individuals, the average is around $500 from what I can find. It’s going to vary a lot by employer. Regardless, for the kinds of jobs we have, it’s usually better across the board. I, for instance, pay less than half that.

It can be even worse than that if you’re buying your insurance yourself and you have a family.

But if you have insurance through your work, it’s usually not that bad, it’ll probably be under a thousand.

I Germany you pay close to 1000$ monthly too for public health insurance. It covers whole family, that is single advantage. However better treatments cost something, but mostly <500€. That’s ok too.

Sorry, but that's just wrong, the maximum you're paying for public health insurance (as an employee) in Germany is around 7.5% of your pre-taxed income. BUT, there is a limit called "Beitragsbemessungsgrenze" which caps the amount of yearly income when calculating the amounts. The cap is currently at 58050 Euros, which translates to roughly 385 Euros.

Only if you also include the public pension and unemployment insurance deductions (both of which are also percentage based and capped) you'll max out at about 1050 Euros.

Let’s face the truth. It does not matter if it’s paid by me or partially by my employer, the health insurance costs me 779,5€ every month. I don’t get that money to my account. It’s AOK Bayern basic package and not that far from 1000$.

Wow I had no idea it was that expensive in Germany.

How do people cope that are on minimum wage?

It's not, see here: https://news.ycombinator.com/item?id=29373722

Half of it is payed by the employer. You pay around 7.5% of your income before taxes (up to a certain limit aka Beitragsbemessungsgrenze).

Many countries use this trick “payed by employer” trying to hide the real amount of taxes. 385€ does not sound that bad, but in the reality it’s twice that with another half “paid by employer”.