Ask HN: Is USA that bad when it comes to health insurance, etc?

I used to be self-employed in the US and left in part because of the expense of health insurance. At the time, I had a family of three. When you declare yourself self-employed in the US, you are immediately projected into the highest tax bracket of (if memory serves correctly) 37.5%. Decent health insurance for three cost worked out to be around 40% of that at the time. So, to be self-employed with healthcare cost me around 52% of my then gross salary. And that is just for the plan - there is still a huge excess as well as a plethora of things that the insurance companies won't cover. If memory serves correctly, something like 40% of those in the US are without healthcare. At costs like that, little wonder why.

As for poverty in the US, 1 in 8 are in poverty if you use the CIA-polished statistics. I say CIA-polished because the CIA also says the US spends 12.5% of its GDP on healthcare. According to the OECD, it is more like 15.3%. By comparison, France (top healthcare in the world according to the WHO) spends around 9.5% or so. Canada, number 6 in the world, spends something similar, around 9.7%. The UK, which is somewhere around 20th on the WHO rankings, spends 6.25%. For its 12.5%/15.3%, the US ranks 33rd - just above Cuba.

As for saving up for children's college, university educations are an increasingly well-known bubble in the US. It is not uncommon to have 70 or even many more students packed into a single auditorium for lectures. Even in advanced degrees, there is not as much small group or singular education as there is in Europe. But the costs are nevertheless huge. If I recall correctly, American University in DC currently tops the charts with tuition at $50k per year. That is tuition ONLY. It does not include, books, dorm, clothes, etc. A four-year degree thus has a base cost of $200k. It is nothing anymore for universities to charge $25-30k per year just for tuition. Given that this is the case at a time when many people are losing their houses because they can't make the payments and others can't get on the property ladder because they can't afford the down payment, I would say it is damn hard in the US to pay for things that people in Sweden take for granted.

Just my 2¢. YMMV.

Yeah, this is the biggest issue for me too (as an American who hasn't lived anywhere else). In particular, the tying to your employment status makes everything complicated and coverage uncertain for everyone except career employees who stay with one firm. For example, I switched from a full-time student to part-time for one semester in grad school. Oops, this means I don't get the student health insurance anymore and have to buy gap coverage. So I had to research gap insurance, fill out a bunch of paperwork, wait to be approved, and then still hope that I don't really have to use it, because now the recent change in insurance gives them excuses to claim things were preexisting and thus excluded.

And I don't even have any major chronic conditions! People with major chronic health issues are pretty much required to stay in their current job forever, because if they lose their health insurance they're screwed. The whole employment-tying thing puts a huge drain on entrepreneurship, imo, because lots of people who would start companies are scared of losing their health insurance, and even if you can figure it out, it's a huge bureaucratic hassle. One area where the private sector has managed to gallantly out-bureaucratize any government.

In short, I really, really wish that health-insurance was completely decoupled from employment. It would reduce a lot of friction in the economy, imo.

> As for poverty in the US, 1 in 8 are in poverty if you use the CIA-polished statistics. I say CIA-polished because the CIA also says the US spends 12.5% of its GDP on healthcare. According to the OECD, it is more like 15.3%. By comparison, France (top healthcare in the world according to the WHO) spends around 9.5% or so.

Note that US GDP is also significantly higher.

Also, healthcare costs are affected by things that healthcare can't actually affect. Consider obesity.

Also, the existence of working govt programs in other countries does not imply that the US govt could do as well with comparable programs. For example, the US govt spends about as much per person as France does. Since the US govt services appear to be significantly worse ....

No, military spending doesn't account for the difference.

I'm not American, so I can't really say anything on the subject, but one thing that always shocks me is that while American's health care is strictly bounded to their jobs, yet lots and lots of them seems to have no or little savings, and some even use credit for relatively small purchases.

If I were to live without enough money in the bank to sustain myself for at least a couple of years without a job, i'd be truly scared, even here in Italy where the health care is all paid. I assume it's mostly just a different social behaviour/mindset, nobody can really tell if it's better or not.

Many private health insurance policies feature annual out-of-pocket maximums (for deductibles, co-payments, etc.) so that you do not have a potential limitless liability for out-of-pocket cost-sharing during a given plan year - unless, of course, you happen to hit a lifetime limit on benefit coverage under the policy (another common feature - one that I believe the health insurance reform will phase out). Under the terms of such out-of-pocket maximums, once you hit the annual limit, you may have no further liability for deductibles, co-payments, etc.) during the balance of the plan year. Double check the terms of your policy.