In the US, the average out-of-pocket healthcare spending was $1,424.6 per capita in 2022
Most people have insurance. They might have some high out of pocket maximum like $10k. So worse case scenario you're out an additional $10k.
But you pay a lot less in taxes
In US, a single filer, the 12% bracket covers income from $11,926 to $48,475. In UK it's 20%
So at 40k you're paying an additional 3k in taxes, not to mention VAT and others (although I am ignoring other US taxes like state, local and payroll). More than covers your out of pocket healthcare costs.
And pretty much any job in the US is significantly higher paying, for instance a typical accountant in US makes 80k while in the uk that 37k pounds. Pretty much every office job is like this. And note the US 80k figures includes benefits like ... you guessed it, healthcare!
Even if make the generous assumptions that taxes are the same, UK has same healthcare quality and everyone is hitting out of pocket max every year, it's still not close. The whole "but we don't have to pay for healthcare" strikes me as just a cope.
https://www.statista.com/statistics/484578/us-per-capita-out...
Your calculations don't take into account personal allowance, which is £12750($15680) in the UK.
At $40k the difference is much closer to $1.5k.
Also there's the question of costs of living. That same 40k buys you 30% more in the UK if you're including rent.
Even without out of pocket costs there's lots of reasons to be angry at insurers.
Eventually 100% of the population will need healthcare of some type.
And without maximums to plan and set prices against, wouldn’t it just be a wealth transfer scheme from the relatively young and healthy to the particularly old and sick…? (With those in the middle roughly neutral)
At least I can’t see any credible way to insure against something 100% of all possible customers will need.
You're right, it doesn't make literal sense. Though we use the term, health insurance, everybody is really talking about medical coverage, period, except for those trying to play semantic games (not pointing to you). Concepts like risk pooling can still be useful, but at the end of the day we're not really talking about insurance, but how to equitably spread the costs and benefits of rapidly advancing medicine.
Social Security is closer to an insurance scheme. Social Security is a deferred life annuity (a type of insurance instrument) that everybody is required to buy, except there's no middleman. Unfortunately, the last time we extended the deferral period to properly account for risk and cost was 1983. When Social Security originally passed it was assumed Congress would regularly change retirement ages; people in the 1930s knew how insurance worked, and knew full well that lifespans would continue increasing, but they failed to account for political friction in having to explicitly update the terms of the program. Other than military pensions, we didn't have much political experience with large entitlement programs (though it's possible the reason they didn't build in an inflation mechanism then is the same we can't do it today).
Medicare was patterned after Social Security, however like SS we don't properly adjust the age nor pay-in as lifespans have increased and medical costs soared; and advances in medicine and expectations of care evolve so quickly these days that I'm not sure its even possible as a practical matter, not while pretending it's truly any kind of insurance.
Health insurance is in many ways not even insurance, it's in many ways a price negotiation mechanism.
Anyway the whole system is overly complex, based off a tax credit from the 1950s, but the transition to a new scheme is nearly impossible while one political party is dead set against any improvement, especially if it might be perceived as a positive for the other political party, and also they have become so hyper partisan that they are not allowed to work with the other party in a bipartisan manner.
In that case, the upstream sources of why Americans accept this huge charade is going to keep on messing with even the best laid plans.
For Americans overall, 71% rate the quality of healthcare they personally receive as excellent or good. Similarly, 72% give excellent or good marks to the quality of care they receive personally.
Regarding health insurance coverage, 65% of Americans rate their own coverage as excellent or good. Another poll found 63% rated their own health care coverage as excellent or good.
You have to get offline
https://www.ahip.org/news/articles/new-poll-strong-majority-...
https://news.gallup.com/poll/654044/view-healthcare-quality-...
https://news.gallup.com/poll/468176/americans-sour-healthcar...
Perhaps. But if I weren’t online I wouldn’t know how widespread the support of Luigi is.
Only 75% of people on employer healthcare plans are satisfied? A great many people aren’t on employer plans.
From the third link you provided:
For the first time in Gallup’s two-decade trend, less than half of Americans are complimentary about the quality of U.S. healthcare, with 48% rating it “excellent” or “good.” The slight majority now rate healthcare quality as subpar, including 31% saying it is “only fair” and 21% -- a new high -- calling it “poor.”
> A smaller but significant share of adults, 12%, said they were supportive of the decision to murder Brian Thompson, 50, who was shot in New York on Dec. 4.
12% is basically zero in this country. To give you a frame of reference, 14% of people think Obama is antichrist
https://www.msn.com/en-us/news/us/1-in-4-americans-sympathiz...
https://www.yahoo.com/news/12-million-americans-believe-liza...
12% is not basically zero.
https://www.thewrap.com/luigi-mangione-discourse-alarms-home...
I think there's great dissatisfaction with healthcare in general, but social media is not a good way of judging social attitudes across the US. It's great for finding a small niche, however.
Just a whole swathe of anxiety and stress that doesn't exist anymore. I'm not sure I can put a price on how valuable that is for our family. I clearly priced it higher than the higher income and lower tax I'd be paying if I'd stayed in the Bay Area though.
[0] https://www.kff.org/report-section/ehbs-2024-section-1-cost-...
A health plan like that costs your company 25K/yr on the backend. They pay that as part of your compensation, you just don’t see it.
Even the most basic HDHP Bronze Kaiser plan currently costs over 1K/mo, and that increases about 10% per year.
If you’ve ever had a coworker (or yourself) decline COBRA coverage because it was “so expensive”, you need to understand that the price under COBRA was the price the whole time, you just didn’t see it.
25K/yr IS a LOT.
Per the US Census, the median income in the US is a bit over 37,500, so it’s literally an entire paycheck.
Remember - the NHS is available to everyone, not just the rich.
Source: https://datacommons.org/place/country/USA?utm_medium=explore...
Respectfully, You're out of touch until you lost your 6 digits job.
This is a pitch-perfect example of the Brexit-like self-destructive politics that come with the "win" of appearing strong.
Here is a person who has the typical experience, who could easily be convinced by their positive experience to say "everybody should have this." But instead of going that route you impute negative motivations and put very ugly distasteful words into their mouth. Which, even if they are highly supportive of your position, will likely turn them against you. Instead of using this opportunity to advocate for a really good thing, you use it as an opportunity to hit somebody you view as the enemy with a rhetorical hammer. End result: no more people in favor of better means of distributing health care, and perhaps a net negative.
Especially in the context of how to account for free-at-point-of-care healthcare, which started this. If the employer is paying the prices that are revealed to employees only via COBRA, should that be accounted for in part of the wages or not? The US chooses to put about twice the fraction of GDP into healthcare that the UK does, and that per-capita GDP is also higher, how do we account for that in terms of wages and individuals? The $1T that employers pay for healthcare should be accounted for how, exactly? It's a tough question, and most likely in any comparison of nations there's a couple different ways to see how it impacts the average person. And when the "average" person in the US has such varying experiences, that has to enter into any comparison too.
In California there is great healthcare coverage for those with extremely low to no income, due to subsidy. Those with healthy salaries and savings can weather the times of unemployment and pay the COBRA prices. Those who struggle the most are the ones in between, and improving that involves getting those on the high and low end to advocate for the in-between incomes. It does not involve making enemies of them.
This is bullshit: not seeing a bill is atypical in California. Parent is also bullshitting by saying it's easy to get a job with no-bills health insurance in CA, unless they are ignoring 98% of Californians.
https://www.chcf.org/wp-content/uploads/2024/10/HealthInsure...
Medicare and Medical are not going to see a bill ever (if the people I know on them are anything to go by), and that's almost 40% of the population. A huge majority of people on employer plans are in the same situation, so thats some fraction of the 47%. For example, nearly a quarter of Californians are covered by Kaiser. It's not some super rare privilege reserved for those making >$500k.
My relatives on Medical never see bills.
It's not just Kaiser.
That's very true, but of course the NHS costs some amount of money on the backend, it's just abstracted away in taxes. The real difference is how much care you get for your money, not* which way of not directly paying for health care is better.
* You get more in the UK.
This line of thinking is exactly why the "American Dream" is falling apart; we increasingly place a handicap on some Americans and then wonder why some slice of America is not advancing generationally.
Example: I transferred my prescriptions to Kaiser, walked in and saw the dozens of people standing in line, and immediately transferred them back to CVS (where Kaiser doesn’t apply). They called me before I got home with my scripts ready for pickup. I walked in and it was one of the rare moments when no one was in line. But even when they’re busy, I’ve not seen more than ~10 people and mostly more like 1-3.
Kaiser sucks. It’s the worst healthcare system I’ve had to deal with in terms of my effort vs my satisfaction. I’m very happy to work a job that lets me choose again so that I can go where I please.
Wal-Mart provides pretty decent health insurance and they hire anyone. If you don’t have health insurance, it’s a choice.
Of course, the issue is not the actual availability of insurance, it is that there is a patchwork of laws and protections and it’s not universal to be covered at any point in your life. But many states have well above a 90% insurance rate. California, the most populous state, has 93%. Massachusetts is sitting at 98%. Even Texas, the worst state for health insurance, is at 85% of the population covered.
Any sources for this?
https://en.wikipedia.org/wiki/List_of_countries_by_average_w...
Cost of healthcare:
There are a bunch of numbers that are trivially accessible via Google, including government sources, but I couldn’t find any that match perfectly with the time range of the wage data.
Here is one quote, from a few years earlier…
> Median annual out-of-pocket spending on medical care ranged from $360 (Hawaii) to $1,500 (Nebraska). In four states, households in the top 10 percent of out-of-pocket expenses spent $7,000 or more on these items.
https://www.commonwealthfund.org/publications/issue-briefs/2...
See also: https://meps.ahrq.gov/data_files/publications/st441/stat441....
COBRA isn’t meant to be a full healthcare insurance, it’s meant to be a “bridge” care for people in between jobs (that’s why it’s tied to your prior employers plans). You also don’t even need to pay the COBRA premiums unless you actually use it, so you can save that $1K/mo while being implicitly insured (helpful in case you only really want to be insured against catastrophic accidents).
If you were not working because you were caring for a dependent (like a sick adult), or if you’re a minimum wage worker, you wouldn’t use an employer sponsored plan through COBRA, you’d use Medi-Cal (California’s expanded Medicaid) or the ACA marketplace, and could be “free” or ultra low (premiums). Medi-Cal is free, and the ACA plan for a 45yo male in SF making Cali minimum wage (34k/yr) would pay $18/mo.
Healthcare is absolutely a “pretty big deal” and absolutely the system is terrible. But if you actually made 34k/yr, it probably makes sense to spend 1hr googling for the actual programs that exist so you’d discover that you can get it for much cheaper.
Edit: I agree that Brexit was the most incredible piece of self-harm that I've seen a country do to itself. I certainly don't have rose-tinted spectacles about the state of the UK.