US Workers Are Highly Taxed If You Count Premiums • Hacker News Board

Re: US Workers Are Highly Taxed If You Count Premiums

#491

Post by exodus_de » Tue, Apr 09, 2019, 6:23 PM UTC

germanier wrote: post #418

exodus_de wrote: post #294

Earlier quoted context omitted.

The German government doesn't negotiate anything. They set prices, period. Set them too low and you create shortages. Guess what the German healthcare system has, it's a shortage of doctors , especially specialists. German doctors are leaving for greener pastures, like Switzerland. They are replaced by doctors from Eastern Europe. Quality suffers. Waiting times are high. Most Germans are too uninformed or arrogant to…

> The German government doesn't negotiate anything. They set prices, period Incorrect. In the public system, the fees are negotiated between the GKV Spitzenverband (federal association of public health insurers) and the KBV (federal association of public doctors). Germany still is in the top group regarding quality of care indicators.

Yes, in the public system, insurers negotiate fees with "public doctors" (Kassenarzt), but the government has the right to override (which admittedly it hasn't used).

However, the prices that doctors are allowed to charge patients (private or out of pocket) are set by the government through legislation (GOÄ). There is no negotiation. You simply can not charge what you see fit, as a doctor, in Germany. Otherwise, why leave for Switzerland? You could just become a private doctor, the demand is definitely there.

Re: US Workers Are Highly Taxed If You Count Premiums

#492

Post by biesnecker » Tue, Apr 09, 2019, 6:28 PM UTC

yomly wrote: post #386

biesnecker wrote: post #3

I once considered relocating with the same company to a similar role in London. The base pay in London is lower, and the marginal tax rates are high, but overall cost of living isn't too terribly far off (compared to the SF Bay Area), and doing calculations like these it seemed that while it would be something of a step down total compensation-wise, it wasn't nearly as large of one as it at first seemed. I didn't mak…

What fraction of SF salary did they ask you to take out of interest? I knew a googler who said London was 0.7*Mountain View total comp as an engineer

Yeah, it was about 75%.

Re: US Workers Are Highly Taxed If You Count Premiums

#493

Post by pnutjam » Tue, Apr 09, 2019, 6:43 PM UTC

lsc wrote: post #389

billions wrote: post #127

Earlier quoted context omitted.

Based on US household income, 7.65% of 56,516 = $4,323/yr

Yup, and that's about what you pay for a single person health insurance in the US that isn't very high deductible. I think my employer pays about $6K/yr for me and another $6K/yr for my partner, (I know this 'cause I've gotta pay taxes on hers, as we're not married) but it's a reasonably good plan. Same provider, but more expensive/better coverage when I was buying through my own company. When I see the doctor, they…

Just because they don't go to the doctor doesn't mean the have to come into the office, unless you have a terrible employer... I hate policies that require a doctors note. Yeah, I have the flu, going to the doctor is just going to spread it, unless I have some sort of complication.

Re: US Workers Are Highly Taxed If You Count Premiums

#494

Post by exodus_de » Tue, Apr 09, 2019, 6:44 PM UTC

Thlom wrote: post #384

refurb wrote: post #353

Earlier quoted context omitted.

You have a point. There are a lot of people comparing the worst parts of the US system with the best parts of the single payer systems. As a Canadian, I will say there are a lot of people dissatisfied with the Canadian system. Likely to a lesser degree than in the US, but the system is far from perfect.

Health care can never be perfect unless you (personally or government) are willing to pay an indefinite amount of money towards it. The positive with an imperfect socialized system is that it's under democratic control. In other words society decides what to prioritize.

> The positive with an imperfect socialized system is that it's under democratic control. In other words society decides what to prioritize.

You understand that democracy means "majority rule", right? Who are the majority? The sick? The doctors? The healthcare workers earning terrible wages? The people who are actually affected by the decisions made by the majority?

No, it's the average citizens who are fairly healthy. And they want to pay as little as possible or have everyone else to pay for them. So they get what they asked for, which is worse healthcare. The difference is, they force that healthcare on everyone (except the high-earners and the self-employed).

Re: US Workers Are Highly Taxed If You Count Premiums

#495

Post by ddxxdd » Tue, Apr 09, 2019, 6:49 PM UTC

bilbo0s wrote: post #191

jedberg wrote: post #185

Earlier quoted context omitted.

The whole point of allowing people to deduct their state tax payments was to solve exactly this problem. Let the states that want to tax more and provide more social services do so without harm to their citizens. Of course that deduction is gone now, which just further solidifies government power.

My own suspicion is that we got rid of that because government wants to harm the citizens of certain states. That's likely one of the benefits of having federal power, the ability structure the system to perpetuate your hold on it. In the US, our politicians do this all the time.

My alternative suspicion is that SALT harms smaller and poorer states, since they can't lower local taxes to attract large businesses without also raising those businesses' federal taxes.

Re: US Workers Are Highly Taxed If You Count Premiums

#496

Post by pnutjam » Tue, Apr 09, 2019, 7:14 PM UTC

petronio wrote: post #489

zrail wrote: post #455

Earlier quoted context omitted.

You can keep it there and withdraw it after 65 penalty free (have to pay taxes like a traditional IRA) or you can pull it out now and pay taxes plus a 10% penalty.

Probably better to withdraw and eat the penalty then, inflation will make it worth peanuts by the time I'm 65.

If it's over a certain amount you can treat it like an IRA, otherwise you should get regular savings account interest, yeah.. I'm laughing too.

Re: US Workers Are Highly Taxed If You Count Premiums

#497

Post by therealdrag0 » Tue, Apr 09, 2019, 7:22 PM UTC

AnthonyMouse wrote: post #271

dkural wrote: post #151

Earlier quoted context omitted.

who are the "wrong people" that massive social programs enrich? Can you give an example? Most of federal spending is medicare, medicaid and social security; which are immensely popular with voters of all kind.

> who are the "wrong people" that massive social programs enrich? Can you give an example? Most of federal spending is medicare, medicaid and social security; which are immensely popular with voters of all kind. If you ask people if they support the abstract idea of having a military so we're not invaded by foreign forces, or having a program to prevent the elderly from dying in the streets, they say yes. But then yo…

Military is like 15% of federal spending, social security and healthcare is 50+% of federal spending. I agree that there is military excess, but I'm skeptical that reducing it would make THAT much difference.

Re: US Workers Are Highly Taxed If You Count Premiums

#498

Post by bodono » Tue, Apr 09, 2019, 7:29 PM UTC

mattlondon wrote: post #484

bodono wrote: post #467

Earlier quoted context omitted.

A good citation can be found in the one you provided: Under Key findings: Its main weakness is health care outcomes. The UK appears to perform less well than similar countries on the overall rate at which people die when successful medical care could have saved their lives. Among its strengths, the NHS does better than health systems in comparable countries at protecting people from heavy financial costs when they ar…

Nowhere in that report does it say it is "garbage", as you suggest it is. Yes it is not as good as some other wealthy countries, but it is by no means "garbage", e.g. on page 35: "The results show that although the UK does well by global standards, it performs poorly compared with the other developed countries in our comparison group". "..does well by global standards.." completely contradicts the idea that it is "ga…

Does well by global standards?! Yes, we should definitely be comparing our healthcare system to those found in places like the Congo. It has bad healthcare outcomes and costs a lot for them, that is bad, don't get hung up on the single word 'garbage', it's called hyperbole.

Re: US Workers Are Highly Taxed If You Count Premiums

#499

Post by pnutjam » Tue, Apr 09, 2019, 7:33 PM UTC

MertsA wrote: post #480

dsfyu404ed wrote: post #448

Earlier quoted context omitted.

You didn't pay $120 for the doctor to slap on a band-aid. You paid $120 for the peace of mind of having a "trained professional" do it and tell you that was an acceptable solution. It's the same reason people call plumbers to snake drains and pay mechanics to change brakes. Those are basic things that the least trained workers in those industries are capable of doing but you pay a premium to not have to think about i…

Nothing about the situation required an expert opinion and the pediatrician made a pretty poor decision to boot. It was abundantly clear that the wound just needed stitches, that's not something I can do myself. In the future I might just get some Vetbond, because if I had that on hand that would have been preferable to the care received from paying an expert $120. No other developed country on the planet is this bac…

The US, in general, is hell bent on forcing consumers to be experts in everything if they don't want to be screwed over on prices.

Re: US Workers Are Highly Taxed If You Count Premiums

#500

Post by pnutjam » Tue, Apr 09, 2019, 7:35 PM UTC

vonmoltke wrote: post #458

jdmichal wrote: post #93

Earlier quoted context omitted.

You walked away from multiple ER visits including surgeries for less than four digits out of pocket? Maybe consider that your experience is the exceptional, not the people you call hyperbolic. My son had a laceration glued together (dermabond in lieu of one or two stitches) and that was either close to or slightly over four digits after totaling the hospital bill and doctor bill, both in network.

One ER visit. The surgeries we're both planned, and I went to an urgent care for triage of my strain, then to a regular orthopedist. > Maybe consider that your experience is the exceptional, not the people you call hyperbolic. I'm not saying I'm typical. I'm saying that four-figure Mexican bills aren't. If they were, then I'm an extreme outlier, which I don't accept.

I'm certain your visits were four figures, you just have good insurance.