And your reply neatly encapsulates why, for better or worse, the American economy is more efficient/dynamic. Those immigrating into the country know they'll have to hustle and work to survive and thrive.

No, threatening people with death isn't a good way to get dynamism. The American middle class healthcare system, employer plans, is specifically designed to reduce dynamism by making it harder to quit your job. There's other advantages but not that one.

> The American middle class healthcare system, employer plans, is specifically designed to reduce dynamism by making it harder to quit your job.

I’m confused, my understanding was that changing jobs is much much more frequent within the US middle class than elsewhere. How does that make sense if as you say quitting is so risky.

What specifically is risky about the US setup? Of course it encourages not being unemployed as healthcare when unemployed is a problem but most people just line up a new job before quitting.

By "dynamism" I meant it makes it harder to be unemployed, as you might be if you want to start a new business/become a contractor etc. Switching jobs is OK if you already have one lined up.

Also, being married makes it safer (but you might be relying on two incomes) and Obamacare is good in some states.

There is COBRA for 24 months and co-ops for contractors/sole-proprietors. It takes much more capital to start a business than people realize and a good part of that is cost of healthcare. the paystubs and W2s from employers hide how significant a part of employee compensation the benefits are.

Those w/o means have Medicaid and those with minimal means have Obamacare- you're a little out of date with that specific complaint.

That's why I said "middle class". I made the same point as you one reply over.

It seems to be a common belief with Europeans that the US has no safety net or public healthcare at all, but of course this isn't true. It's just mainly targeted at poor or old people.

I don't think most Europeans believe we have no social safety net or public health care, just that it's woefully inadequate.

You are buying into a distorted image of the typical US population experience. Access to healthcare is pretty much instant and high quality for all but the very bottom of the society. 85%+ of the population can get an appointment within a day or two and if it’s urgent can access numerous urgent care clinics with almost no wait.

Best I can tell for many European countries the situation is significantly worse in terms of access.

There is a lot of strange misconceptions about US quality of life from people in other countries.

Very bottom of society has free healthcare. For example for WA.

https://www.hca.wa.gov/free-or-low-cost-health-care

In some states such as Florida and Texas, having low income is not enough for an adult to qualify for Medicaid.

We should define what healthcare means. For example: if you have a cavity, do they simply pull the tooth or do you get a filling? It's just an example, but health care ranges from "preventing you from dying only" up to cosmetic stuff.

> 85%+ of the population can get an appointment within a day or two

I'd love to see where you got that statistic. IME, I have to wait months for any kind of specialist. And when I finally get to see one, my insurance underpays and then I spend endless hours fighting with both the provider and the insurer. This crap happens every single time I need to see a doctor. I can't wait to retire and move to a second world country that has US trained doctors who give you their personal cell number.

Heathcare in the US has become a terrible joke.

> IME, I have to wait months for any kind of specialist.

Ok sure so just realize when you retire in that 2nd world country the wait is for GPs! forget specialist.

> https://www.england.nhs.uk/gp/case-studies/routine-gp-appoin...

The average has dropped to 10 days! The US wait for equivalent of GP is like next 1-2 days, or even same day if you get triaged by the group.

Also they are seeing 30+ patients a day which even in busier US locations is at least 1/2 that rate.

It’s a myth that US healthcare is worse than other countries.

>The US wait for equivalent of GP is like next 1-2 days

Again, I'd like to see the stats on that. I wanted to see my Dr for an annual checkup and was told it was a 2+ month wait and if I didn't want to wait I could see some random nurse practitioner.

There are 2nd world countries where it is incredibly cheap to call your doctor's cell phone and have them come to you in a day or two.

I can confirm that in multiple European countries you just walk to your GP's office and wait an hour or two (worst case) if you do not have an appointment.

I waited 20 min last time I went without appointment.

Specialists is a different story, the worst being psychologists/therapists (wait time counted in years where I live).

The equivalent is urgent care clinics in the US. They are everywhere and you can be seen in 15-20 mins, covered by employer medical plan. Testing, imaging, common medicines and treatments on site.

Wait for specialists and surgeries are significantly less in the US than all other G20 countries.

In France, they are trying to cut back on exactly this because emergency services are completely overwhelmed with non-emergency patients.

People are mixing up numbers because of different naming and conventions.

Here is an example item, wait time for knee replacement surgery, or any standard surgery. I’m fairly confident the US is lowest among all G20, by significant amounts.

Your annual checkup wait isn’t an appropriate measure, they do that as they are prioritizing care much better than in bureaucratic socialized medical care. That doctor you are calling on cell likely has much less resources than the nurse practitioner you can be seen in 15-20 mins wait almost 24/7 in every major population center in the US at urgent cares, rapid cares, and worst case ERs. Instant testing, imaging, medications on site.

I don’t think you are comparing apples to apples when people claim they would prefer medical care elsewhere, they have some incorrect assumptions about greener grass, or we are discussing the experience of very lowest income segment of the population.

I do agree that bottom 10% might be slightly better off medically in other countries than the US. That is definitely possible. But for 90% I don’t think it is even remotely competitive.

I live in the Bay Area with good insurance. Next appointment with Stanford for a regular check up with a GP as a new patient is 2-3 months, unless I want to drive an hour away.

> > https://www.england.nhs.uk/gp/case-studies/routine-gp-appoin...

> The average has dropped to 10 days! The US wait for equivalent of GP is like next 1-2 days, or even same day if you get triaged by the group.

Unfortunately NHS is in terrible shape and ks performing at the level of a 2nd world country.

Czechia has canver survival 30% higher than UK does.

I lived in Czechia, we had a proton therapy center for Twenty Years. England got one just recently.

There is a story where larents in Britain had to steal their child from a hospital, to take her to czechia for Proton beam therapy. The UK doctors have declared her terminally ill, refused to let parents take her for other treatment and after parents kidnapped tbeir own child, theyl parents were declared wanted in Interpol, launching internstional manhunt.

They foung in court to get thei4 chance to treat a child, took child to czechia, went through therapy and now child is in scholl and free of cancer

If theu had trusted the NHS their child would be dead.

https://www.bbc.co.uk/news/uk-england-32013634

I also know a bloke who was struggling with backpain for 4 years and could not get it sorted in UK, he through he would become handicapped and retuned to Romania to live it out in peace. Turns out it wss really bad Vitamin D deficciency, which makes your bones soft and allows nerved to be pinched. He is living a full life now.

Bear in mind that a bunch of Americans have been sold on public single-payer healthcare as the solution to the problems with their healthcare system based on the amount the UK spends on the NHS after all those cuts (which are more like spending not increasing at the same rate as demand). Also, one of the big cost savings is that medical staff are paid an awful lot less in the UK than the US.

Czechia and Romania do not, however, have US-style insurance market.

There is state provided insurance and none of the US horror stories ever happen here.

that doesnt reflect my experience in US at all. I come from India. Despite our hospitals being flooded with patients, healthcare is not inaccessible. As it is over here, its a insane system with the priorities a* backwards. Focus on patient, not on your profits.

I think this may be an issue with certain provider networks (have heard horror stories about Kaiser and such).

I'm with Anthem and I've gone directly to various specialties with appointments within 1-5 days.

Be sure to check that urgent care clinic is in network first! Having a well paid job in a big US metro gives you access to excellent healthcare but the bureaucracy here is a huge pain compared to countries with universal systems.

Coming from the UK I would have picked the NHS as it was when I left 10 years ago over what I have access to here, but the Tories have really run that service into the ground in the interim.

I'm on FAANG provided PPO and it's a two week wait to see my physician. Specialists are 3-4 months out. Not a rural area.

Worse than my experiences in nz, Australia and UK.

It's not the access really. More the worry about paying for it. In the US it can cost a lot, and while your employer covers it usually, this means you're really tied to your job. Here in Spain I never have to worry about paying for it.

I'm sure the healthcare in the US is world-class considering how much it costs. But that cost is the biggest problem for me.

But really, I'm a socialist and considering that this is a swearword in the US for many people, I just don't want to ever live there. My world view is just too different. I've never even visited.

Having moved from a dense hcol area of the US to a dense hcol area of France, my experience has been that 1) I have access to specialists with less than a week wait in both places, but 2) costs in France are much lower than US.

> Access to healthcare is pretty much instant and high quality for all but the very bottom of the society.

The US simultaneously under-treats poor people while over-treating rich people. This is why health outcomes in the US are so bad across a range of indicators.

The US spends the majority of its budget on social welfare programs.

Gun violence is a tiny fraction of death/injury here. You’re much more likely to die in a car accident.

Firearms are the leading cause of death for American children and teens - higher than motor vehicle deaths.

https://www.nejm.org/doi/full/10.1056/nejmc2201761

Suicide is often included as a cause of death to intentionally distort this statistic:

> From 2019 to 2020, the relative increase in the rate of firearm-related deaths of all types (_suicide_, homicide, unintentional, and undetermined) among children and adolescents was 29.5%

If you control for this, and include rates of homicide using other means of destruction (i.e., explosives or knives), it starts to look a lot more even compared to other OECD countries (albeit still above average).

I wouldn't consider that distortion. Its a significant problem that firearms are highly successful suicide on the first impulse. Children who try another means are much more likely to have a chance to contemplate if they really want to kill themselves.

I'm calling it a distortion, because it's often used as a dishonest portrayal of how prevalent gun violence is in the US. Usually by the media, who wants attention grabbing headlines, and don't really care how the numbers are manipulated to peddle to their readers' selection bias.

It's US government agencies that call death by suicide a form of violence, and that's the reason that death by suicide involving a gun is a form of gun violence.

This is despite all the weird laws in the US against collecting, analysing, and reporting statistics.

Shouldn't that number be concerning 30% of children deaths are from guns?

Suicide or not, doesn't that seem concerning? Hmm... Some people say it's the top way children die now by gun. I remember growing up and having active shooter drills in elementary school but it's nothing like they are now. I think we are one of the few countries where children dieing by firearm has increased 46% in the last twenty years or so.

Where I grew up it wasn't rare to hear about stabbings or shooting but it does put me on edge hearing about a mall I used to go to having an active shooter etc.

https://www.nytimes.com/interactive/2022/12/14/magazine/gun-...

www.kff.org/private-insurance/press-release/firearms-are-the-leading-cause-of-death-for-children-in-the-united-states-but-rank-no-higher-than-fifth-in-other-industrialized-nations/amp/

It is concerning. But not for the reasons the media makes it out to be.

Only 0.18% of all gun homicides were committed during a mass shooting. https://www.maciverinstitute.com/2022/05/debunking-every-maj.... The chances of you being killed in a shooting are less than being struck by lightning. If you don't plan on joining a gang, frequenting a bad part of Baltimore or St. Louis, or committing suicide, it becomes orders of magnitude less likely, to the point where you're no less safe in the USA than any other country.

So, gun violence isn't a problem but only if you ignore several signifcant forms of gun violence?

Glad you pointed this out, because it's a perfect example of the propaganda machine in action.

Gun violence is the leading cause of death between 1 and 19 years of age. Want to know why this study chose such an odd and very specific age range? Cut it off at 18 and it wouldn't work, since it would exclude gang violence. Start it at birth and it also wouldn't work, since the statistic would include infant mortality. The "kids" being killed by guns are disadvantaged black youth in crime-ridden cities (Open the supplement - https://www.nejm.org/doi/suppl/10.1056/NEJMc2201761/suppl_fi...). Unfortunately, that doesn't sell gun control, so the study is custom tailored to be manipulative in the way it frames the issue.

What does it mean to "sell" gun control (I get that you mean "promote")? Can someone profit from it and how?

hilarious ! nobody wants to help anyone else, because you never know if the other party has guns. Its nuts.

Nothing like a bit of hyperbole to ground a discussion.

> You’re much more likely to die in a car accident.

Maybe so, but I believe you are also more likely to die of a car accident in the US. There's no getting around the fact that amongst western nations, the US has certain aspects to its culture that make it a more dangerous place to live in many ways.

You're also much more likely there to die in a car accident than here :) I don't even own a car where I live and I don't need one. In fact I wouldn't even know where to leave it in this city.

Here in Barcelona a flat rate of 20 euros a month takes care of all my travel needs on metro, bus, tram and train <3

> And where people can't just run around carrying guns.

The number of non-cops I've seen openly carrying in public is... One.

Bit of a tangent, but what issues might you mark Spain down on? I’m seriously eyeing their digital nomad visa.

Having stayed there 1-3 months at a time so far, it’s pretty hard to find fault.