> We estimate that these laws [mandating safety seats] prevented fatalities of 57 children in car crashes in 2017 but reduced total births by 8,000 that year and have decreased the total by 145,000 since 1980.
I also question the idea that safety regulations (let's call them that) are the result of a class of people who have "so few real problems they stop minding their business and mind other's business." I get the idea, but couldn't the high cost of obstetrics and child car seat requirements be due to the wishes and decisions of people outside of this supposed class?
I doubt it. Hospitals charge $15 for a single pill of Tylenol because they know insurance will pay for it, and that includes private insurance.
The best thing we could do is ditch the private healthcare industry to the extent that the rest of the first world has and cover everyone with government plans. Those plans can then negotiate for much better prices and refuse the kinds of insane charges we're seeing. The cost of plans would also drop because prices would be spread out over every taxpayer. Having primarily a single provider for insurance would make everything easier and less expensive for hospitals and doctors offices too.
The billions in profits private healthcare companies rake in all comes at the expense of everyone else one way or another and they have every incentive to make as much money in profit as they can. Without that excess fortune in profits being skimmed off and stuffed into pockets a government funded insurance plan which covered everyone could get the job done taking in closer to what it actually costs to deliver the services we want and no more.
The additional overhead is substantial and adds huge marginal cost for routine things and say nothing of the principal-agent problem
Sure, it's not the actual insuring that's costing that much but the massive breakdown of incentives from increasingly vertically integrated healthcare companies (some of whom are insurers, some of whom own insurers) owning increasingly large shares of everything is clearly causing cost to spiral. The industry is making work for itself at out expense. Whether that work happens in the insurer's office or the billing office of the clinic that's owned by the insurer isn't really material. And of course everyone in the process gets a cut so they fight for their bit of it. Doctors used to drive the same crappy cars and live in the same modest houses as the rest of us. Nurse didn't used to be the "made it in life" job for people who come from poor backgrounds.
It’s more they know insurance won’t pay for it, and negotiate discounts based off the “retail” price. Although at this point it’s gotten so ridiculously convoluted and cross-subsidized that I doubt even the insurance company or hospital knows what the actual paid amount for a Tylenol will end up being until months after the fact.
But there are other things we could do that we don't.
For example, right now we have the expectation that insurers are going to "negotiate" with providers to determine the price, and then you have to use the providers your insurance has negotiated with, but who actually wants this? When you as a retail customer want to buy a pair of shoes or a piece of exercise equipment, do you call up all the manufacturers and try to haggle with them? No, they list their prices on their websites or sell them through retailers that do the same and then you choose based on who has what you want for the best price.
So make non-emergency healthcare work like that. Require them to publish their prices. Then the insurance company doesn't tell you where to go or negotiate with anybody, they only tell you how much they pay, which might be e.g. 90% of the second-lowest market price in your area, equivalent to a 10% deductible. Then you go to a website that lists every provider and their price, pick where to go and pay the difference yourself.
Suddenly they all have the incentive to publish the best price, because that's what most people are going to pick, and then you have an actual market instead of the existing opaque bureaucracy of corruption.
I'm not advocating against health nor preventive care, however they don't decrease costs nearly as much as you'd expect.
There's also the trick of telling the hospital you'll pay "in cash" and getting a 10x lower bill from the hospital, then getting that reimbursed/covered by your private or alternative insurance.
It sounds like you're going for the "unlikely to need it" plans, which go broke when you actually get sick..
You're referring to certificate of need laws, but it's worth pointing out that they're not universal. More than a dozen states have repealed them (or don't have them) and everywhere I've looked, there's strong evidence that their removal has increased healthcare access, which has put downward pressure on cost of service
> Another would be to just, train more doctors!
Bill Clinton placed a cap on GME funding in the 97 Balanced Budget Act, freezing the number of residency slots that the federal government would provide funding for, so this effectively froze the number of residents there could be, which effectively limits the number of doctors possible
This is why it's unwise to send "routine" things through the insurance model.
If doctors would still get paid above-median wages, you would still have a profit motive. Their lobbyists would want to limit the supply of doctors or simply lobby to have the government pay them high wages, to require that things be done by a doctor instead of a nurse, etc. Likewise the drug companies would lobby for the government to pay them more for their drugs, and when the government is captured then that's what happens. The same problems we have now; you haven't solved anything.
If doctors would get paid a lower wage but still have to attend 8 years of medical school, there wouldn't be a profit motive, but then there would be a shortage of people willing to become doctors, patients would have to wait a long time to get an appointment as they do in places like France, etc.
The profit motive isn't the problem, that's the thing that causes anyone to want to (and be able to) provide healthcare. The problem is the corruption. You have to stop limiting the number of medical residency slots and allowing drug companies to patent trivial changes to preexisting things etc.
I see your point, but do you not think that if you're a family of 4, having to pay $40K before insurance kicks in is ridiculously expensive, and out of reach for most Americans?
I'd wager that most self employed folks in the US almost never benefit from insurance (except for things covered by Obamacare which come nowhere near justifying the premiums). The deductibles can be so high that you're pretty much always paying out of pocket.
Self-employed here. My wife and I paid $470/month last year, $618/month next year, for a gold insurance plan than has a $3400 deductible with typically a $20 co-pay. It covers 3 prescriptions, therapy sessions for each of us, various older age diagnostic checks, and almost all office visits. In addition, if either of us develops cancer or is hit by a truck, we will not be rendered bankrupt.
So I'd say ... nah.
That's really nice - are there state/government subsidies involved?
I work for a top tier company and my premiums are not that much lower than yours.
When I checked the public market's insurance options, getting a $3000 or so deductible was a lot more expensive than yours if one is not low income (i.e. not subsidized).
(a) for 2025, federal premium subsidies in effect ($19k/year of subsidy) ! (b) for 2026, NM temporary subsidies
A reminder that until the end of this year almost everyone gets subsidies. Nobody in the US, no matter their income level, should be paying more than 8.3% of their AGI for health insurance. That all changes come Jan 1st 2026, thanks to the current Congress. Our premiums would be $2531/month had NM not stepped in to use some of those sweet, sweet fossil fuel extraction taxes to help us out.
Oh yeah, deductible in 2025 was actually $2800. At our age (early 60s) and general health (good), gold plans make much more sense (if you can afford them).
I thought they'll all cover ER visits out of network. Is that not required by law?
Deductibles too high? check
Stupid coverage limitations? check
Pointless? nope
I've had a sports hernia and the bill was about $30k.
And what the OP is pointing out is that if your injury is $30K, insurance covers nothing, because the premium + deductible is $40K.
The point of insurance is to mitigate risk. If you think you have enough money to cover your risk, there's no reason to buy insurance.
The sleight of hand here is first complaining that you did not incur enough hazards to offset the risk premium and then citing this as a reason the risk premiums should not exist. Where is the story of the family being weighed down by bills? Or of not getting physical therapy after an injury and having permanent, income-reducing disabilities?
Agreed - both to you and to society.
What's under debate is "how much risk." For most people in the US, they'll need help before they hit $40K. They can't afford paying $40K every year for medical and medical related expenses.
Imagine 2 people get injured in a year, you are now at $60k. Plus, $150 a visit for primary and $300+ for specialist.
My 5 year old has been to the hospital 3 times, stitches once. US healthcare will ruin you if you don't have insurance. A cancer treatment can bankrupt a millionaire.
You can get it for basically nothing in the public system but you might have to wait a year or so if it's considered elective (emergency surgery is immediate of course), but most people with private health insurance can get the procedure done within in a few weeks and would only have to pay about $1000 (US$650) out of pocket with a $500 excess (which is pretty common), because the anaesthetist and surgery are usually invoiced separately. Some plans do have lower excesses (like $350) though if you pay higher premiums.
No, nobody benefits from insurance in America. Well, nobody ill.
Multiple commenters are raising this point, so perhaps you should consider that you aren't conveying this information well?
2. If we weren't trying to have kids, our options for purchasing health insurance expand drastically. Individual marketplace plans become a viable, for instance, since the "not covering childbirth" issue goes away. I mention the short-comings of the individual health insurance marketplace at least twice in this regard, including a big pull quote explaining the ACA work-around with child birth coverage.
Yes, but crucially none of those expanded options cost $0, so I still don't understand your math at all. I feel like we're talking in circles here.
You should be deducting a substantially non-zero number from the amount in the headline to account for your "normal" non-childbirth-year best-case medical insurance premiums (or out-of-pocket cash costs if foregoing insurance altogether).
If Aaronontheweb had the misfortune of getting seriously sick, required surgery .. he would pay $7,150 for something that could easily cost $100K+++. Saying he's paying premiums just for having a baby really feels like weaselly logic .. so he thinks he or the rest of his family will absolutely never fall sick? What if a cancer diagnosis hits one of you out of the blue (I hope it doesn't, but that's what insurance is for).
Insurance in America is a fucking joke.
The sound way to manage costs and avoid these games is via Medicare for all, with premiums paid by progressive rate taxation of income. Maybe even wealth beyond a very large amount.
Given he has 3 children, 400% of FPL in 2026 is $150,600 so he's easily eligible for ACA subsidies (which, by the way, in 2021-2026, were available to everyone) by tweaking his income (easy to do when you have a company).
He also says uninformed things like:
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those.
The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
> HMOs or EPOs that have some issues with them: coinsurance
What matters at the end of the day when you have a child is your maximum out of pocket (which you will 100% hit the year you have a child!). Whether you have copays or coinsurance after a deductible does not matter here. The ACA caps your maximum out of pocket at $18,400 no matter what (which, yes, is too high), so what you need to optimize for is premium + OOP for the providers that you care about.
Like, I get it, it's America, for healthcare like many other things (student loans, credit card debt, ...) it's easy to end up in a bad situation, but at some point you have to spend time understanding the game.
I am absolutely not eligible. I earn more than $150k. And "manipulating your income" is not really feasible with a pass-through entity.
> The premiums have nothing to do with the plans. Every single plan on the marketplace has to cover child-birth, that's sort of the point of the ACA.
As I mention in the piece, I check every year. I have no idea what subsidized plans include, but the other marketplace plans definitely do not include child birth.
I explicitly address this point:
> The Affordable Care Act (Obamacare) barred insurers from turning down applicants based on existing pre-conditions; the way insurers get around this for pregnancy and child-birth is not by rejecting pregnant applicants (illegal), but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
and
> My wife and I are healthy, but we’re building our family and I have yet to see a marketplace plan that supports child-birth. Maybe the subsidized ones do, but I earn too much money to see those. All of the ones I’ve found through eHealth Insurance or Healthcare.gov never cover it - and I check every year.
Love the over-confidence though. The best outcome for me in even writing this article would be to get some internet commenter pissed off enough to find me a cheaper version of my plan. That would solve my problem immediately!
You are on this plan: https://www.trinetaetna.com/pdfs/Aetna_PPO_7150.pdf
Which does cover childbirth according to page 3. And has a 7150 deductible per person - the $14300 is the family out of pocket max, so the childbirth should top out at the 7150. Other expenses might put you at the same 40K cost for the year, but not the childbirth alone.
You know they charge you, separately, for both the mother's care AND the infant's during a delivery right? Those count as two people. I am, with 100% certainty, going to hit the out of pocket max - I have every time.
Like I've paid for three kids all on the same plan, including one born in January so my deductible got spread over two different billing years.
I have to ask - why are you defending this?
It sounds like you have never looked at an ACA silver plan, which is the lower deductible/out of pocket max option. I also have a family of 5, and have a $1800 per year out of pocket max from an ACA plan. You would still have the same level of premiums as you do now for silver plans, but you would save 13K a year. You are picking bad plans, dude.
Our system has problems, but when you make enough to not be subsidized, yet still pick a crappy 40K per year plan, that is beyond the systemic problems. It is a bad choice. There are insurance consultants who work with people, especially high income people, to find good plans for their family. You should be calling them.
Edit: what do I have to gain from spreading "misinformation?" I just want better / more options?
Looking through some plans now, but TBH these are genuinely not much of an improvement in the cost department and a massive downgrade in the provider selection department. Hence my whole section on trade-offs.
Moreover, what are you even trying to accomplish by asking for this? Please provide me with a forthright defense of the modern U.S. health insurance markets and why it makes sense for me to have to pay this much to keep our population above replacement level.
As for your second question, one easy response is that prospective parents in other health care systems aren't paying less (with everything factored in) but rather differently: that people making your $119k "true" poverty rate in Europe tend to be taxed at their top marginal rate, which is substantially higher than ours (in fact, in a lot of places in Europe, a Chicago Public School teacher would also be paying the top marginal rate).
A thing worth pointing out is that while the system we have is especially punishing on the uninsured, it's actually not that bad a deal for the insured, demographically/actuarially speaking. That's because being insured definitionally puts you in the cohort that excludes Medicaid-eligible poor/working class people and fixed-income seniors. If you move the typical household from that cohort to the UK, they're likely to be worse off. In surveys, insured families tend to be satisfied with their insurance, which is why taking existing health insurance off the table is such a third rail in American health policy.
Anyways, unless you personally are responsible for keeping our population above replacement level (which sounds exhausting), your numbers just aren't probative for the cost of bringing new citizens online. Other numbers might be!
Asked and answered in the piece dude - I wish I had the confidence of a Hacker News commenter who didn't read the article.
(Note that "non-ACA insurance" doesn't mean "insurance you didn't buy on the ACA public marketplace". I've got Anthem Blue Cross through our benefits provider. It is very definitely ACA-compliant.)
that link doesn't even say what you says it does - it said you can apply for coverage, not that there are plans that cover child birth. Have you never done this before?
I don't know if you have a CPA, but this is a sentence my CPA has never uttered.
> but by simply refusing to cover the care those applicants need to survive pregnancy (legal and common.)
Including...? I have never heard of this, and actually have delivered babies and worked with post-partum mothers.
This same price gets you a platinum plan with Sharp or Kaiser in San Diego and wouldn't have those gigantic deductibles.
He moved his business from California to Texas and is now complaining about pricing problems in markets caused specifically by the lack of regulatory environment in Texas.
> I pay that at least much for my family, hence why I used it
and your article says
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
It sounds like you're trying to communicate that you pay at least $200/month per smartphone for your family? Or you don't value precision in communication.
I know you've got a lot going on with a small business, and a new kid... but if money is important to you, maybe spend the time to switch to prepaid phone plans. There's lots of options [1], whatever network you need, you can do direct operator plans, MVNO owned by the operator, or like actual MVNO. If you're short on time and T-Mobile's network works for you, MintMobile has a promo going right now where $180 pays for 12 months of "unlimited" which is $15/month if you divide it out.
> I also pay $1250 per month to TriNet for the privilege of being able to buy their health insurance in the first place - sure, I get some other benefits too, but I’m the only US-based employee currently so this overhead is really 100% me.
Do you live in a state with a reasonable healthcare exchange? You might want to shop and see if an off the shelf plan from the exchange is better than paying TriNet to get access to their insurance; it may well be, but you should check. If you only have one US employee, and it's you, there's a lot of expense for not a lot of value IMHO. It's not really Apples to Apples though --- I think a lot of the TriNet plans have out of state coverage where a lot of exchange plans don't.
You're moving the goal posts here. You have to have service, realistically, in order to use it like a real person.
Is it for "a smartphone" with service, and presumably financing the phone as well? Or is it the total for all of your family's smartphones, which is how many phones/lines?
What if the CEO needs to supply an entire 1,332 person company with business phones?
What about an assistant to answer them! What if we're sleeping!
Oh god!
But just to put my comment in context, here is what he said:
> Having a $200/mo smartphone is now a participation cost for many things such as getting access to your banking information remotely, medical records, and work / school.
[1]: (n.b., the plan is not truly unlimited.)
My family has two phone lines for $50/mo, plus we buy two ~2 year old iPhones every 3-4 years, which adds maybe another $20/mo average to the cost.
I pay $70/mo for 2 phone lines. Unlimited everything (well, OK, 5 GB data cap before slowing down).
5 GB is pretty reasonable for the bulk of the country. The only common things that can make it go over are games and streaming - both of which really are luxuries if you simply can't wait till you have Wifi access. So yeah - of course you should pay a lot more if you insist on doing those things.
A decent percentage more, not a lot of dollars more.
If a glaring innumeracy or terrible estimate is in the article, why did the author include that? What was their angle? Does that make me trust the rest of the article more or less?
We pay ~$100/month for 1G broadband (I realize this could be lowered somewhat), and ~$100-120 for 5 phone lines for the family (AT&T prepaid). I'd like to see you make a household with multiple lines + broadband work for less than $100-125.
And that's not even that hard - I know some people spend $300+ JUST on their phone plans, in addition to broadband. And then if you factor in amortized cost of phone replacement? It's closer to $200 than to $50 for example, IMHO.
That makes me think they are artificially inflating prices so that when the insurance company negotiats their discount, well, it might be the same as what I pay
The healthcare market. MARKET
Healthcare shouldn't be a market. That's why you're paying $40k.
Healthcare in the United States isn't a market, and that is why it is so terrible. For instance, there is no reasonable ability to compare prices of services. Prices are entirely hidden. Then there is the "with insurance" price vs cash prices.
Healthcare doesn't function as a market, to our detriment.
In other areas, like heart attacks and strokes, you do not get to shop around. And you pay whatever they say you will pay. When those are the circumstances, there is simply no free market. And since no one is competing for your business with lower prices in that case, you do not get to see lower prices. They charge whatever they can maximally wring out of you.
Hence why the US already has government healthcare that covers almost half the population (Medicaid and Medicare cover the old, young, disabled, veterans, and poor people).
However, the place you give birth is, in the vast majority of cases, something people do like to have agency over, especially given the 9 months of heads up given by nature.
If healthcare weren't so perversely incentivized by the twisted triangle of regulated public/employer/private systems and their interactions, I would argue this is something that could be a functioning market.
Like Universities with their endless ability to raise prices due to the US government guaranteeing student loans of any size to anyone, a big problem in healthcare is there being no anchor to reality due to the principle-agent nightmares of the current regulated system.
In Europe, when you give birth it is not a luxury experience with a doctor of your choosing in a 4-5 star level private room where you're sent home with a big basket of freebies. If all Americans had to pay directly out-of-pocket (as Europeans de-facto do via taxation), you can bet reality would set in quick.
Recent legal changes have made pricing more transparent. In 2020, the federal government issued the "transparency in coverage" final rule under the Federal No Surprises Act. This limited the expenses for emergency care when out-of-network and a few other things, but even more exciting is that hospitals and insurers are now required to publish a comprehensive machine-readable file with ALL items and services. They have to provide all negotiated rates and cash prices for the services and include a display of "shoppable" services in a consumer-friendly format. The machine-readable files are impractical to process yourself for comparison shopping (picture: different formats, horribly de-normalized DB dumps), but many sites and APIs have emerged to scrape them and expose interfaces to do so.
There is no universe in which it doesn't cost around $10,000. None. It is simply impossible for me to get out of paying that. My options are:
1. Use insurance, and hopefully it's covered.
2. Pay out of pocket.
3. Skip it and hope I don't die.
That's it, those are my options. I can't "shop around" for this, and I shouldn't have to. This is basic medical care available to everyone in a developed nation. Ours is the only one for whom this is apparently an intractable problem, and I am, frankly, tired of being gaslit about it.
My routine blood work done via my doctor bills something like $1600 to my insurance every other year or so - but it do it on my own outside of the medical system for about $180 every six months.
No one should have to do this for necessary care - but once you get into things not typically covered by insurance like plastic surgery or LASIK the true costs are generally rather reasonable.
A whole shadow ecosystem for “health hackers” or whatever you might want to call it exists where standard medical stuff is 10% of the cost if paid out of pocket and through alternative prescribers. It’s a small subset of all available medical items, but the difference in true cost is illuminating.
The US "market" is between the drug companies, hospitals, practitioners' groups, insurance companies, and government.
They are the ones that have market participation, the patient's not involved with that, their primary duty is to provide justification for the transaction.
>Healthcare doesn't function as a market, to our detriment.
So true, but even worse than that, the market that is there is predatory to a cumulative detriment worse than when simply dropping the ball makes things go wrong :\
Healthcare has to be rationed. Rationing by market is the least bad kind of we learn anything from history... Too bad healthcare in the US is not a market in any way or form, and in fact the most expensive least DALY efficient interventions (Medicare) are subsidized at the expense of everything else.
I see your drill down to fundamental issues and I raise you:
Pregnancy is not a sickness. Hospitals are for sick people.
If we reserved hospital birth for women and children with actual medical problems we would allocate resources much more judiciously.
An added benefit: not exposing otherwise healthy (and capable) women to an almost universally disempowering and disenfranchising birth-industrial-complex that seems designed to engender fear, self-doubt and pathological outcomes.
Government loves anything that assists its people-tracking machinery. It will never ever ever discourage pregnant women from doing something that would make reliable Enumeration At Birth more difficult.
Not that the German health system isn't facing down some of the same demographic issues the rest of the well-off world is, but comparing wait times for specialists now that I'm on public (more like, very strictly regulated) insurance with my dad back in Texas on a combination of Medicare and supposedly good supplemental plan, I'm still in a better situation.
A strong public/heavily regulated independent insurers system gives the private insurers enough competition to keep prices in check.
Plus, I don't know of an insurer here, public or private, who also owns clinics or employs physicians, and they don't own pharmacies.
My libertarian friends criticise this from the point that "everything state-run is inefficient". Even if this is true, they fail to notice that state-run healthcare keeps prices of the private sector down. You don't have to sell a car if you're seriously sick.
In 1992-96 on Russian state TV, there was a translated program called something like "Rescue number 911", with nobody else but William Shattner. (We already knew him at the time.) I got an impression that the US healthcare was impeccable.
(We resolved the situation by finding a bank-shot qualifying event that allowed us to re-enroll --- it was extremely situational and had to do with my wife and I simultaneously leaving our jobs within a short window of time.)
Sorry, what are you going to do when you get into a car accident and they rush you to the hospital? Assuming you're even conscious. "No, I'm voting with my wallet!" flatlines Come on.
What if we used our collective power to fix the system? (Up to and including replacing it with something that works for the majority, and not the minority.)
America is not special, we've just brainwashed our less-observant citizens into believing that solutions the entire rest of the world uses will never and can never work here. There's nothing special about our population or economy that would prevent accessible healthcare. The only thing standing in our way is healthcare companies who want their 6000% cut of every procedure and politicians who will do literally anything to give billionaires another dollar.
I think, it's only the Asian countries who have got cheap, easy, and effective healthcare where you can not only get appointments quickly but you can get treatment for cheap too but their emergency services are not always as streamlined as those in more developed systems. There is no clear overall winner. Some places excel in certain aspects. Others perform better in different areas.
Is that true for a median-wage earning person?
Waiting times for appointments and procedures can very widely in the US. Approvals to get needed treatments can also be denied for seemingly flimsy reasons in the US as well.
This is only done for very specialized treatments where the province (they run the health care delivery) doesn’t have the treatment and/or the American resource is closer than a Canadian treatment location.
For example Nova Scotia will send some complex paediatric cases to Boston. They could send them to Toronto, but Boston is closer. Same with Manitoba but they use Minneapolis.
Canada is only 40m people and almost half that is in one province. The smaller provinces simply don’t have the population to justify having every possibly medical bell and whistle.
Point is when province sends Canadians for US treatment is isn’t actually about better quality as not all provinces have the same in house capacity and often the next largest city with such capacity is an American city.
Overinflated imaginary cost*
There is no way that a medical consultation of 15 minutes actually cost $32k. Examples like this are aplenty, but only from the US. My favourite one was an itemised bill for birth that included a $1k for skin contact with the newborn.
(Sigh...) Let's put some facts.
Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...
This is less true than it used to be.
You obviusly dont insure a family of 5 and I suspect dont actually use the healthcare system.
https://www.kff.org/affordable-care-act/annual-family-premiu...
that being said, one can certainly find cheaper insurance (a policy to limit liability) if one knew where to look.
for instance a self employed single male, 27, queens new york, healthy non smoker, can have a national network $300 deductible, aca qualified policy, $329 a month.
This is true as long as the following changes are made: 1) wages for healthcare workers are scalled back ~50%, 2) many drugs and medical procedures are not longer covered (a good example is CAR-T for cancer or drugs for rare diseases).
Whether that quality is necessarily (or good) is debatable, but we are getting something for the money.
You also are just completely wrong in your main point. We cannot provide the same efficacy of healthcare as we are now for 60% less. We are the richest country in the world, labor costs more here than other places.
Yeah, I'm gonna need a citation for that. Because it sounds like a health insurance propoganda rather than the actual truth.
Nobody could tell me what anything would cost, or if the insurance would cover it. But I always ended up paying $10, whether it was a few pills or an expensive MRI I didn't need. Oh, yeah the downside is you can accidentally convince your doctor to get procedures you don't need.
Health care in Denmark is decent. But I've been told, no when I wanted to run some tests. That would never happen on an American PPO :)
I have had go wait, while unpleasant, it's fairly harmless (otherwise they don't let you wait).
So if you're on an great PPO plan in the US, healthcare is great.
Whether the outcome is better for the average Joe, is probably a different question.
Do you have any evidence of that?
Again, I’m not saying the health care outcomes are better, or the value is better. I’m saying the hospitals are nicer, the doctors are the best, etc.
Perhaps this is the wrong thing to optimize for! But we are getting something.
Outliers do not say much about the overall quality of healthcare in a country. Rather obvious lesson in statistics.
Reminds me of the Russian mathematician who moved to the US after the fall of the Soviet Union. Most of his essays were criticizing American students, but in one essay he was quite frank:
Russians who graduate with math degrees are better than Americans who do so, by a wide margin. However, the average American is better at math because they still get access to some math education in university and do not need to be a top student for admission. Whereas in Russia, if you didn't meet a rather high bar, you simply couldn't get admitted as an engineering/physics/math program, and thus couldn't further your math education (I believe he said the cutoff was even before university).
Country with the top mathematicians, but country with worse math outcomes.
My argument is that specifically the best care in the US is the best in the world. We have the best doctors and the best technology and the best treatments. This is not completely universal but it is also generally accurate.
Whether or not this care is accessible or the median quality is care is good, that is different.
I’m just saying we do get something for the money, it’s not like it all gets thrown down the drain. The best and brightest come to the US to get some of the huge spigots of money in the US healthcare system and it does drive innovation.
..74% are overweight or obese
..less than 10% meet the fruit and vegetable recommendations
..25% get the recommended amount of exercise
..eat more than 70g added sugar a day
Healthcare really has the deck stacked against it however you look at it
Even in the US, many (most?) insurances and healthcare systems have programs to address all those. My HMO certainly does - I can engage with them and craft a healthy nutrition plan, and my doctor can be involved in that as well. Ditto for exercise.
And yes, that is what I think we optimize for.
> I’m just saying we do get something for the money
Who is this "we" that gets to be treated at the 15-out-of-50 and 4-out-of-6 top hospitals in the world?
For a few Americans. Not for all Americans, and probably not even for most Americans. There's far more to the United States than New England and Southern California.
Don't get me wrong, if I had some rare cancer or other strange disease, chances are I'll want to try and get in to one of these few rare ultra premium hospitals. But if I break my leg or get some normal infection or have a child or any of the other normal kinds of issues people have? Will that still be the best tier of care?
Does it need to be? I imagine it's far easier to treat a broken bone, in most cases, vs a rare complex disease
I'd have different standards when researching where to have teeth cleaning vs oral surgery
If we're spending the most for it, shouldn't it be? Why would I want to pay more for worse outcomes?
> "The quality of health care in the US is significantly higher than anywhere else in the world."
Common Wealth Study of 10 Western Countries (U.S. lags far behind the other countries)
https://www.commonwealthfund.org/publications/fund-reports/2...
Peterson-KFF Research
https://www.healthsystemtracker.org/chart-collection/quality...
Numbeo Health Care Inex
https://www.numbeo.com/health-care/rankings_by_country.jsp?t...
On an anecdotal basis, I relied on the Taiwanese National Health (NHI) for years and found it vastly superior in terms of quality and cost to the United States.
Perhaps a more accurate claim might be: The quality of the health care system in the U.S. is unparalleled provided that you are in the 1% that can afford it.
Simply not true.
Infant mortality and under-five mortality rate (U5MR) are one of best simple indicators of the quality of healthcare. USA's mortality is x3 (!!!) of the countries on top. This puts USA around place 50 in the world, worse than Russia...
Source, backup your claims.
Health outcomes are WORSE than most other developed countries and that's the only statistic that matters here
Maybe the top 0.5% is getting better care, but I really wouldn't shed a lot of crocodile tears for them.
The US is also the 3rd biggest country in the world. It’s very hard to solve these things are such a massive scale.
I assure you, they exist, I have been to them, and the wait times were about as long.
> It’s very hard to solve these things are such a massive scale.
That's goalpost-shifting nonsense that doesn't justify the outrageous cost of healthcare. And most of these problems become easier to solve with a higher population and density and larger economy, because you have way more slack in the system, and you have way more economies of scale that you can put to work.
I'm also not complaining about healthcare in the middle of Alaska, 50 miles from a highway (or deep in the poverty belt). I'm talking about overpriced, underachieving care in wealthy metro areas.
Health outcomes do not support that statement.
Ive been to doctors in different countries including the USA. Theres nothing special with general practitioners with the USA.
Or if you end up in China, you can get blood panels for like 10RMB, MRI for 30RMB, and damn near automated to boot.
Go to Mexico for dental work. What costs you here $30k costs you $2k, and they take your insurance.
The US citizens are being gouged, because our government has been bought out by corporate interests who bribe, err, campaign donate to both parties. And thats across every economic activity. Medical is just an egregious one, alongside academics.
https://www.health.gov.au/topics/private-health-insurance/re...
On top of that many things that are 'not urgent' you have to pay for yourself.
I have recently paid over 20K for back surgery. Prior to the back surgery I could barely walk. This was deemed 'not urgent' and had I would have had to have waited at least 18 months for surgery via Medicare.
I also have private health cover.
So, it's important for non-Australians to understand, our health system is far from a panacea where taxes pay for everything.
Currently 778 K Australians are waiting for 'elective surgery' .
- Public hospital birth is about $0-1k USD.
- Private hospital with health insurance: $2-3k USD
- Private without insurance: typically up to $13k USD
Edit: I'm too dumb to know whether to include superannuation as a tax or not so I'm not sure if I'm right or not.
However to calculate total income taxes you do need to include the 15% tax on superannuation contributions.
If your pre-tax take home salary is $100k AUD, then your total salary package is 111.5k including the 11.5% compulsory employer superannuation contribution.
You’ll pay regular income taxes + 2% Medicare levy on $100k and your $11.5k super contribution will be taxed at 15%.
So your total income tax including the Medicare levy (but assuming you don’t pay the Medicare surcharge or claim any deductions) will be $24,513. Giving an effective tax rate of 20.2%
There are no state or local income taxes in Australia so that’s it for personal income taxes. However states do charge payroll tax on most companies payroll (e.g. 4.85% on annual payroll over $1M in the state of Victoria for companies in the Melbourne metro area).
Health spending in 2023–24
In 2023–24, Australia spent an estimated $270.5 billion on health goods and services– an average of approximately $10,037 per person. In real terms (adjusted for inflation), health spending increased by 1.1%, or $2.8 billion more than spending from 2022–23.
In 2023–24, health spending accounted for 10.1% of the gross domestic product (GDP) in Australia, approximately 0.2 percentage points higher than in 2022–23.
From the bottom:
In Australia, 15% of all expenditure on health care comes directly from individuals in the form of out‐of‐pocket fees — this is almost double the amount contributed by private health insurers.
There is concern that vulnerable groups — socio‐economically disadvantaged people and older Australians in particular, who also have higher health care needs — are spending larger proportions of their incomes on out‐of‐pocket fees for health care.
A 2019 study identified that one in three low income households are spending more than 10% of their income on health care.
There's little to no public advertising of prescription drugs, cheap generics are widely available from federal scale bulk negotiation deals.
Health outcomes are greater life expectancy than the US, national scale cancer survuival rates are better by a few percentage points (IIRC - they are close but higher).
Australia has long had an innate "we're all in this together" society built on individualism. It's not great, it's not perfect, but the first instinct is generally to look after our own - across the board.
If I worked in the US, I would have health insurance and would be paying lower out of pocket costs than I would in Australia. Combined with the higher salary and cheaper housing that's a pretty good deal.
Edit:
We allegedly have universal healthcare but that doesn't cover any actually competent specialist (need private healthcare for this) so paying $400 for 25 minutes of a psychiatrist every 2 months and $95 for 7 minutes of a GP is common.
I've spent 30 years as a policy and budget analyst and advocate on health and human services issues. If electeds and appointeds were going to make decisions based on the lives of poor people it would have happened already.
Folks need to make some noise.
Healthcare is reaching for the point of neutrality where the value it provides exactly equals the cost they are charging. This is what happens when the only signal they get is a money related one. Nation after nation has shown that healthcare elsewhere can be better and far cheaper. Not perfect, but better and also not out of control. The real question isn't 'how do we fix healthcare' but instead, 'how do we remove the cancer in our system that is blocking the obvious fixes we see actually working all over the world'.
After those experiences, my wife then went on a journey to learn everything she could about childbirth and healthcare. The more she learned, the more she became convinced that the entire system is flawed. The pressure to get an epidural, induce (conveniently between 8-5 on a weekday), or to use a C-section is immense. While each intervension is tremendously important in high-risk and edge cases, they are utterly unnecessary in the vast majority of births. But they are used for the majority of births, anyway. Some argue they may even have some damaging effects to the mother and child, but I concede that's not the medical mainstream opinion.
When my wife became pregnant with our third child, the delivery was during the Covid lockdown. Hospitals refused visitors, demanded masks, and were even more impersonal than normal. Although I was initially skeptical, she convinced me that we should use a birth center and a midwife. The birth center was practically next door to a hospital and we talked through how to mitigate risks if something went wrong.
It was a fantastic experience in nearly every way. Our son was born at 7:45 AM and we were home by 11:00 AM. It was substantially more affordable than a hospital birth.
My wife just had our fourth child earlier this year. Once again we used a midwife but this time we had a home birth. You couldn't have paid me to accept a home birth when we were new parents. I wish I knew then what I know now.
I know it's not for everybody (and especially those dealing with high-risk scenarios), but a midwife and home birth is an option if you want to avoid the hospital racket. It's significantly less expensive, more convenient, and every bit as safe for the vast majority of births.
Good for you and the very best wishes.
We had all four of our children at home - two of them breech[1] - and avoided a big basket of unnecessary interventions and complications.
One of the biggest benefits was opting out of the tremendously disempowering culture of medicalized birth fostered by both male and female care providers.
An outsider would not be faulted for thinking that birth care was purpose-designed to disempower, discourage and disenfranchise women giving birth.
[1] Relax. A "frank breech" is considered a normal birth in most of the global north and is not medicalized as it is in the United States - nor does it need to be. (Not to be confused with dangerous conditions like a footling or kneeling presentation).
No shit. He mentions food, shelter and a smartphone — might as well add higher education and a functioning car if you're in the U.S.
I struggled being tossed out on my own at 18 with no support from parents. Working at a pizza restaurant, riding a bicycle to a community college for an education, renting a room from a woman (she may well have been renting as well—renting a room to me to take the edge off).
Winter came and riding the 10-speed to college (in Kansas) became a challenge…
Thank god no smartphone or internet plan was required then.
(When I eventually split an apartment with two other roommates we lost power for stretches from time to time because we were unable to come up with the money to pay the electric bill — oh well.)
They were hard times (that I somehow enjoyed—perhaps because I was young and was finally beginning to have a fulfilling social life). These days it has to be even harder.
In Canada, provincial healthcare and private insurers have not kept pace with the needs and advancements in the areas of alternative methods of conception (IUI, IVF...). Yes, a naturally born baby wouldn't cost the parent(s) much medically. But, if you cannot have a child naturally, medication and procedures (lab testing, blood testing, artificial insemination...) are only partially covered and the amount corporate or union-backed insurers will pay varies widly by doctor and by patient. A couple struggling to conceive will easily pay 15-40K per child after the first procedure.
Funnily enough, friends who have jobs in the USA, but live in Canada often have better insurance that fully covers all of the costs after the deductible. It ends up costing much less to have IUI or IVF procedures with Canadian doctors using American insurers (of course they will take the money).
$25,680 premium + $14,300 deductible = $39,980 annual cost
So actually if we compare this with a European country, it would be an almost similar amount in the end: there is no deductible, but health insurance/social security taxes can absolutely reach around 2k-3k per month if you earn enough.
What would have been the out-of-pocket cost of a normal birth without health insurance? It's still your choice to go without.
I had to read again 3 times. Are you serious?
If there is any complication, you're risking 2 lives.
The majority of births are simple if you let them be and the midwives go to great lengths to make sure the conditions are right for a successful event. In the case of our third we hit some conditions leading up to the delivery date that disqualified us for a home birth so we seamlessly transitioned into the hospital system (where the midwife still delivered the baby)
They rather try their luck at home than leverage a thousand years of medical research that culminates in hospitals.
Not once but 3 times. I'd be pissed knowing my parents put me through such unnecessary risk.
It will still cost you 5 - 10k for a good midwife and you'll still want to be insured in case you need to transfer. So it only knocks off 5-10k from the total.
Midwives are medical professionals who have the equipment and expertise to intervene in the most common scenarios that require it.
I've tried tellings doctors in Denmark I wanted X, Y, Z test and getting told, nah, the outcome wouldn't change your treatment so we don't want to order those tests.
Generally, healthcare is decent, but no doubt a good PPO plan does not compare :)
Public health care seems more like HMO, you have to use a provider within network. Sometimes you need a referral from your primary physician, etc.
You can pick your doctor, but not everyone can take on more patients.
My cardiologist went “tests look fine, heart looks fine, there’s no reason for you to take colchicine. No clue why you have issues, everything is fine. Just take this brand new beta blocker to manage your heart rate.”
Meanwhile, there’s no answer why my heart rate rises 30-40BPM randomly when I stand. Why my heart rate drops to a very difficult detectable rate when I sleep. No answers as to why two sips of wine causes my body to go into shock. - All resulting post-Covid.
That same doctor told me to discontinue colchicine; yet without colchicine most medications, inc. ADHD, are maybe half as effective.
These are items which deserve answers. Not an answer of “just take another pill”. Some of those “unnecessary” tests can provide inclusion/exclusion information. Yet just refusing that knowledge denies answers.
In the US I can just find new doctors. But in other systems it’s either difficult or impossible.
There’s no “insurance networks” and no visitation limits. You can go to _any_ doctor nationwide.
I’d be curious to know where you had that experience and what the limits are on finding a different doctor ..
Find a long Covid specialist, those things aren't normal but are known to be effects of long Covid.
The prenatal checkups, hospital stay, and postnatal midwife home visits were all covered by Medicare.
The flip side is that I lose ~30% of my pay to taxes. That's fine by me
Federal tax rate is 22-24% for most people. State can be anywhere from 0 to over 10%, depending on the state and income level. City taxes may exist. And then social security + Medicare.
That's not a flip side, that's what you'd be paying in the US, too, once you account for all your payroll taxes. Maintaining 11 carrier strike groups and a global empire don't come for free.
If you're in the 24% bracket, you probably have an average rate around 18%. 7% personal FICA witholding, another 7% employer match, and state income tax. Then, if you're in the mood, add your health insurance premium and any college savings for you or your kids (or the difference between what we pay and what you'd pay in [insert some other country here]).
If you look at how $1 of public spending on healthcare is used in the US vs countries with better healthcare, it becomes obvious where the problem is, and it isn't in the ocean. An anti-military ideological stance is one thing, but you don't need to inject it into this.
1) The insurance premiums are tax deductible for the self employed so probably 30% or $8000 less
2) He should have planned to have two of the children in the same calendar year could have saved $14000 (jk)
For profit hospitals subsidized and enforced by the leviathan, what could go wrong?
How much does something cost? Whatever the seller can get people to pay for it. Hospital B charges 6 figures for the delivery of a child? Wow, that's expensive, they must be really good to be able to charge that much.
All the dark patterns, negative dynamics, perverse incentives of bad government, stupid healthcare policy, and humans being shitty combine to form for profit hospitals. Those determine how other institutions have to run in order to operate at all, and they're not being managed by well meaning, good faith citizens looking out for the patients and the public.
There's a reason mangione became a cult phenomenon, and $40k babies, multimillion dollar ambulance trips, and other bullshit are exactly why.
Good luck fixing that mess. I don't even know how to conceptualize where you'd even begin to try to fix American healthcare. It's so tangled up and beholden to all the other problematic elements in modern life that it looks nigh on impossible to repair, so my goal in life is to minimize contact with any element of the system as much as humanly possible.
Do you know any countries that have no government involvement in healthcare that has good health outcomes?
You are perfectly fine to have that belief, but the majority of people disagree with you, which is one of the primary reasons the system is designed as it is.
When somebody is sick we generally save them even if the cost/benefit is poor. No market is going to solve this if you want to save sick people who don’t have a lot of money.
There is no place in the world where health care is solved, it’s one trade off vs another.
The US system is also far far from perfect but your solution is quite shallow and unlikely to fix things in a way society wants.
If you've ever spent even five minutes reading up on that stuff you would understand that health and medical cannot be a free market. It can never be a free market.
I have garden-variety hemorrhoids. All I need is one or two 30-minute in-office procedures to treat these things. I'm a senior software engineer working for a FAANG company with "top-tier" employer-sponsored health insurance. I've been trying to get this stuff treated for eight months. I've gone to at least seven or eight appointments with several different offices and I've already spent $3000 out of pocket, and I might actually start treatment in January. That's fucking insane.
The next time I need a minor in-office procedure, I'm seriously going to consider flying to Mexico instead of wasting almost a year of my life fucking around with the ass-wipe US healthcare system.
The value the article comes up with (he says like $130,000) is more like the living wage, which might be a good target. The living wage for Bergen County, NJ, is calculated to be $145k for a family of 4 with 2 working parents, and about $100k for the same family without childcare expenses (1 working parent).
https://livingwage.mit.edu/counties/34003
I am not sure what counts as poor in reality. Obviously the federal poverty guideline is pretty low. It can't really make sense as a contiguous-48-states guideline for the purpose of feeling "not poor". The calculated living wage is above the median household income for most areas. I have not heard a serious proposal for increasing the median (or, preferably, the 30th %ile) income up to the living wage. I reckon that most proposals that involve the government sound too much like communism for the average American voter.
But we could bring the living wage down to the median. We could make housing cheap, reduce our health care costs, and reduce the childcare component.
keep running US business, but live in a different country n get private healthcare.
In general corpos spend a good chunk of resources making new legal entities to escape liability and legibility - something that is simply not available to most individuals. Getting married takes your two naturally-existing legal entities and basically collapses them into a single one - throwing away much flexibility. So it seems like a poor idea in the current legal environment which has been thoroughly corrupted to extract wealth and channel it upwards.
The alternative view, that I would hold if it wasn't for the above considerations, is that first world child rearing is currently an expensive hobby, and why should we subsidize it at all? If it wasn't a personal project most would be parents could easily adopt.
Its "not afford to have children", but instead "not afford to live".
And we're already seeing these strong signifiers of extremism everywhere. Shooting CEO's is halfway acceptable, if they are sufficiently horrible (and yes UHC was horrible).
Violence is more and more routinely considered the only answer that works.
Corruption isn't something hidden, but instead openly done. And this is at all levels, from petty theft, up to 'let's rearrange government to screw the other party'.
Look at how much tax dollars you pay in, and what you get for that. Its more and more a socialist country amount of tax, with low/no benefits to the citizenry. And no, shoveling billions to Israel or Ukraine, or project of the week does NOTHING to help me, my friends, and people around me.
It is pretty bleak. Has been for quite some time. I can understand why some might want to vote for Trump- he did and is still making good on his promises. Terrible promises, sure. But he's doing them.
Far as I can tell, none of the candidates are for the public, and willing to do and help the public. Just feels like a corrupt-o-cracy where if you're not in the In group, you're screwed.
And yeah, extremism, revolution, and revenge is spot on.
All part of the plan. Gotta get that world population down to 500 million somehow. You've had three children? That's above replacement! Shame on you for contributing to the overpopulation problem. /s
;-)
Seriously, though, I suspect it has to get a lot worse. 23% unemployment might be something.
The simplest model of GDP is productivity per capital times population. And the simplest model in finance is moving cash flows around in time.