Ok, sounds cool. I'm in. Where do I book the insurance for getting shot?

I definitely didn't expect this in a HN thread

I didn't expect to lose a cousin on a business trip to the US (Michigan) 6 years ago either. Life is full of surprises.

I'm sincerely sorry for your loss, but moving the goalpost doesn't help the discussion. Again, nothing to take away from how dreadful what you lived through is.

Condolences appreciated.

> doesn't help the discussion

That's exactly my point. The discussion started to derail into "Who has more money?" like that's the ultimate metric. This just makes me sad but is pretty representative for the stereotypical US mindset. My point is there is a lot more to life than money.

At no point did I claim it was the ultimate metric and instead clarified that I was talking purely in terms of capital

Life insurance is available- as is emergency healthcare riders.

Americans won’t admit it publicly but a big part of living in America is knowing what parts of America you shouldn’t go. And if you do have to go to or through those areas, you start to understand why so many people drive urban assault vehicles.

And what about sending 2-3 kids to some good universities, how much do you need to save in cash? 1 million?

A bit more, I would say count 100k/year/kid.

And that outside of your own retirement.

I’m currently on a US salary that is very generous. I don’t spend a dime extra because of those. It’s kinda terrifying I don’t know how they do it.

If you think this is good oh boy do I have news for you. You don't need to "afford" fantastic insurance, healthcare is essential and needs to be free for everyone, which it is here. I have complete freedom of choice across 27 countries, no strings attached, completely free of cost. So do people poorer than me.

Just ran some arbitrary numbers. Someone earning $190k in mid Ohio would have take home of around $140k, between state/federal. That's before any other retirement savings or anything else. A 'fantastic' insurance plan from blue cross anthem will be around $2400/month for a family of 3. With a 'modest' deductible of $4k. $2400*12=I around $29k. This person is having to spend ~ 21% of 'take home' just on medical insurance. Assuming working independently, some of that is deductible, and one might argue how much left over is "a lot" or not. There's still food, shelter, utilities, transportation, education, etc. they need to account for, as well as saving for the future.

Actually, looking at it, if the person is 'independent', they'd pay another ~$10k or so on FICA, or have some LLC structure set up. Or they might be lucky enough to have an employer who pays for some/most of this 'fantastic' insurance... until they don't.

Perhaps in terms of raw dollars, there's some advantage, but there's an pervasive threat of "what if" scenarios that is hard to shake for a lot of folks.

But if you are earning that you are likely working for a large corporation where your actual out of pocket expenses are much closer to something like $1000/month for that family (varies by situation). Far better scenario then a much lower European salary (probably closer to $80,000) with higher taxes and the same (at best) quality care.

If you are working independently yea it may be more expensive, but (unfortunately) so few people work independently so it’s an edge case not really that valuable here. Though worth noting providing a way to untie healthcare from employers and still make it affordable so that you can more easily start a company is a good idea.

It’s really difficult to do good analysis here. If you were in Ohio making $190,000 your family is automatically in the top 10% or so. If you worked remote you could buy a house outside of a major city for your salary equivalent, or in a city like Columbus for 2x your salary with some fantastic public schools.

Also a nitpick while I think you get much more efficient and cheaper healthcare with the government running it, at the end of the day it’s never free so you have to actually compare taxes to premiums to get a fair assessment of cost.

> untie healthcare from employers

This 1000 times. I don't think we'll see a meaningful change in my lifetime, but it's an existential burden that we, collectively, have had for generations. So much so, really, that hundreds of millions of people seemingly can not envision meaningful change.

The constant "just get a great job with great benefits!" refrain irks me to no end, and demonstrates a privilege that people often deny exists. Even if/when I can get that "great job with great benefits", I still only have it at the pleasure of the employer. I grow old? You're gone. Employer makes bad decisions? They "take responsibility" by letting me go.

The notion of having access to health care, regardless of my employment status, should be such a basic thing to grasp. If I'm unemployed for a year or so (illness, family issues, whatever), having to upend specific doctors/medicines/hospitals/treatments because "insurance change" is life altering for many. Seen it myself in dozens of personal connections over the years. Want to change jobs? Whether abusive working conditions or just need to be with family? "Can't do it... I need my health care... the only doctors that take my health care are in this area...". Or... "I won't have health insurance for 6 months if I take that new job".

There's 1000 different examples I could find why "employer/insurance" connection is bad, and very few I can think of that are good for all parties, yet, we continue in this mess.

> but (unfortunately) so few people work independently so it’s an edge case not really that valuable here.

I know a growing number of folks doing this, and many more who would love to, but ... "health insurance" keeps them tied to "employers".

argh...

Great post and I do apologize if I came off as 'not caring' about people working independently it's just if we do broad characterizations we have to compare broadly and so few work independently.

Maybe an idea there to start an independent business owners healthcare association or something that redistributes profits via lower premiums or something? How the hell do you start something like that?

FWIW, there are orgs that do that, but they almost always end up being somewhat regional, and... it ends up being a lot of work. FreelancersUnion, in New York, I believe did/does something like that. Some chambers of commerce and similar groups do too, but... it doesn't really end up changing much of the price at all, especially since ACA. (oh, misread, I initially read that as simply just offering a buyers group to get 'group' rates).

You've generally always been able to buy health insurance independently. I started... 14(?) years ago. The ACA, well-intentioned, was hobbled from day one, and my $220/month high deductible plan has morphed in to a $1300/month plan which is still high deductible ($14k/year), has fewer options, and ... well... some pregnancy services will be covered (cis male here). You want a 'low' deductible? You're looking at probably $2k or more for 2 adults. And yes, I know health insurance has an age component - I'm years older than I was then too. $3k/year in exchange for taking on some risk (higher deductible) makes some sense. But base price of $15k/year in health insurance, plus another $14k/year in deductibles means this is essentially catastrophic only, but not really priced as such).

It's all region-based, and even where I'm at, I get measurably fewer options because I live 2 miles over a county line, and 'no one' insures out here. It got worse for several years - I know in NC, there are ~100 counties, and I believe there were more than 30 at one point who had only one insurer even selling health insurance in those counties.

Also.. FWIW, I didn't take it as you didn't care, but yes, freelance workers are generally overlooked, even as the ranks grow. They just tend to be growing on the lower-end of the spectrum - rideshare drivers, door dash delivery, etc. Much easier to just ignore growing segments of society while we pride ourselves on our ability to "get a better job with great benefits!". I'm not in a position of having to choose food over medication, but having to decide between medication or surgery today over funding retirement savings? I've been there, as have some friends of mine. Yes, it comes across as a bit privileged, but privileges are all relative.

Better how? It is probably better if you do not intend to have children or ever need medical care. People saying that taxes in the US are much lower than Europe, as a person who lived in London, San Francisco and NYC I’d like to disagree.

The tax rate for my income bracket in the UK is 45%, and while federal income tax is 39.6% I still have to pay state and city taxes on top of that which works out to be about the same.

However I get free medical care in the UK, affordable college tuition (10x less than the US at least), maternity leave, great public transit, I could go on. What does the same amount of taxes paid get me in the US? I’m not complaining about having to pay taxes, but sure would be nice to get something back that isn’t military.

> The tax rate for my income bracket in the UK is 45%, and while federal income tax is 39.6% I still have to pay state and city taxes on top of that which works out to be about the same.

This statement is meaningless without specifying the brackets or providing an effective tax rate for a certain amount of income.

Oh, spare me the semantics, the difference is still single digit % of the total income.

How would a reader know that? And how can that be true when the brackets are so different? UK does not even look like it has single vs married distinctions, not to mention the myriad deductions in the US, and the drastically different taxes in various locales (I pay $30k+ less per year by living 10 miles across the state/city border).

https://www.nerdwallet.com/article/taxes/federal-income-tax-...

https://www.gov.uk/income-tax-rates

The 45% income tax rate is for 150k GBP, which is $167k. The top bracket for US federal income tax starts at $578k/$693k at a 37% tax rate.

I was providing my personal anecdotal experience of having the basically the same net income in 3 places. 37% federal tax also does not account for 6.8% state tax and the 3.8% NYC tax which I know does not apply to all of the US, but then we get into the territory where we have to address that I will probably not have same income in bumblefuck alabama anyway.

People here are talking like the difference between US taxes and EU taxes is 20% or more, when in reality it’s maybe 5%

The difference in tax burden is give here: https://data.oecd.org/tax/tax-revenue.htm . It varies quite a bit by country, but the contrast with France/Nordics is particularly large

I’m not sure how income tax % to GDP is relevant here, but perhaps I am looking at a wrong thing, it’s quite painful on mobile

UPD: looked at the tax wedge, the US vs UK looks pretty similar to me- which supports my point. Germany looks a lot higher, but they have 100% free tuition and I am not familiar with the rest of the benefits germans get.

A single digit % of total income may not be a big deal in European salary terms, but when you make US salaries it's significant. That's your first mistake.

Also, lol at UK public transit. Horrifically expensive - probably more than a single digit % of total income if you actually have to commute anywhere on a regular basis.