2020 Democratic Primaries/General Election Thread

[Edward64]

Originally Posted by RainMaker

We're a giant country. Look at per capita rates.

The World Factbook — Central Intelligence Agency

Its not who immigrated to what country.

It's which country would a person want to immigrate to if given a choice.

The vast, vast majority of wanna-be-migrants would pick the US even with all the bad stuff going on.

[RainMaker]

I'm sure people in the Western Hemisphere would like to stay in that hemisphere near family and people of their ethnicity. Not a surprise that the only 2 highly developed countries are 1 and 2.

Regardless, net immigration per capita is higher in those European countries and they beat us in virtually every statistic related to quality of life. Face it, we aren't really good at much anymore.

[Arles]

Europe is extremely aggressive with their tax rate. If you make 60-70K or more in places like Belgium, Sweden or Denmark, you will pay close to 60% of what you earn in taxes. In the UK and France, you have higher thresholds but a lot people pay over 50% when you factor in everything.

Most people in the US have effective tax rate of less than 15% (if you make less the. 200K). Is it worth paying 4-5X more in taxes to get the European system? I would say no, but maybe I’m in the minority.

[RainMaker]

Originally Posted by Arles

Most people in the US have effective tax rate of less than 15% (if you make less the. 200K). Is it worth paying 4-5X more in taxes to get the European system? I would say no, but maybe I’m in the minority.

A single person making $60k a year, the tax wedge on just income is 32%.

Now throw in property tax (average $2,300 a year)

Now throw in sales tax.

Then we have to factor in things we don't actually get in this country compared to those others.

Throw in health insurance. Premium for an average person is $400/month or $4800 a year. That doesn't include your co-insurance or co-pays.

Now if you went to college, on average you will have close to $40,000 in loans when you leave (not to mention what you spent to go). Average student loan payment is $400/month so another $4,800 a year.

So for the best case scenario where you have absolutely no need for a doctor and live in a state with no sales taxes of any kind while somehow avoiding all government fees, you'd be at 45%. Realistically over 50% since you'll need medical care and pay government taxes/fees.

We actually pay a lot in taxes when you factor in that we have to pay exorbitant amounts for education and health care that are mostly free in those other countries. We just do a better job of making it seem like we don't.

[Edward64]

Its pretty clear the US pays a lot less taxes than Europe. But what benefits/welfare are provided for the taxes is a good question.

I did some googling this morning and was not able to find a comparison. Searched on terms-like "US vs Europe Taxes Benefits/Welfare". If anyone knows of an analysis, I would be interested in reading it.

[JPhillips]

Originally Posted by Arles

Europe is extremely aggressive with their tax rate. If you make 60-70K or more in places like Belgium, Sweden or Denmark, you will pay close to 60% of what you earn in taxes. In the UK and France, you have higher thresholds but a lot people pay over 50% when you factor in everything.

Most people in the US have effective tax rate of less than 15% (if you make less the. 200K). Is it worth paying 4-5X more in taxes to get the European system? I would say no, but maybe I’m in the minority.

You are underestimating what we pay.

In the US, FICA taxes alone are 12.4% if you earn under 100k. Federal income taxes will be single digit, probably, for those same earners. Then there are state and local taxes. For most, a sales tax. If you own property, there's a property tax. And on and on for other fees and taxes. The average person pays more than 15%, even if we pay less than many European countries.

The best way to look at taxation is %of GDP. In 2015 the OECD had us at 27% and the EU average at 40%. There were no EU countries at 50%, although there were three between 45-50%

[ISiddiqui]

Originally Posted by Edward64

Its pretty clear the US pays a lot less taxes than Europe. But what benefits/welfare are provided for the taxes is a good question.

I did some googling this morning and was not able to find a comparison. Searched on terms-like "US vs Europe Taxes Benefits/Welfare". If anyone knows of an analysis, I would be interested in reading it.

Indeed. It's hard to find a like for like due to this. For example: I know that I pay over $200 a month for health insurance (individual - my wife gets insurance through her work, but we should probably look at what would be best for costs there...) and I pay $800 a month for student loan repayments. Perhaps in a society where health care and schooling is mostly paid by the state my taxes would go up significantly.. but would they go up more than $1000 a month? Because if they don't, then I would have been better off financially (and, of course, the health care costs don't cover cost sharing).

[Edward64]

Originally Posted by JPhillips

You are underestimating what we pay.

In the US, FICA taxes alone are 12.4% if you earn under 100k. Federal income taxes will be single digit, probably, for those same earners. Then there are state and local taxes. For most, a sales tax. If you own property, there's a property tax. And on and on for other fees and taxes. The average person pays more than 15%, even if we pay less than many European countries.

The best way to look at taxation is %of GDP. In 2015 the OECD had us at 27% and the EU average at 40%. There were no EU countries at 50%, although there were three between 45-50%

For a visual

How do US taxes compare internationally? | Tax Policy Center

[molson]

What is the job market like in Europe? (obviously that varies a ton between countries like France and Italy v. wealthier countries like Denmark).

I always got the sense it was stagnant. Their classes of income and wealth are closer because there's fewer super-rich, but, it is truly easier to get from say, entry level to $80k+ than it is in the U.S.? Or is there kind of a glut of people under 50 that basically all have the same lifestyle - fewer poor, fewer rich. Their medium and average income levels seem to be lower than the U.S.

Not saying any of this is better or more desirable, I think free healthcare is maybe the most important thing any country should do. But I wonder if it's better to be an educated professional in IT, law, engineering, etc, in the U.S.

[Arles]

Originally Posted by RainMaker

A single person making $60k a year, the tax wedge on just income is 32%.

Now throw in property tax (average $2,300 a year)

Now throw in sales tax.

Then we have to factor in things we don't actually get in this country compared to those others.

Throw in health insurance. Premium for an average person is $400/month or $4800 a year. That doesn't include your co-insurance or co-pays.

Now if you went to college, on average you will have close to $40,000 in loans when you leave (not to mention what you spent to go). Average student loan payment is $400/month so another $4,800 a year.

So for the best case scenario where you have absolutely no need for a doctor and live in a state with no sales taxes of any kind while somehow avoiding all government fees, you'd be at 45%. Realistically over 50% since you'll need medical care and pay government taxes/fees.

We actually pay a lot in taxes when you factor in that we have to pay exorbitant amounts for education and health care that are mostly free in those other countries. We just do a better job of making it seem like we don't.

No one pays 32% in Federal income tax. If you are single, you pay this:
10% on the first 10K, 12% on 10-39K, 22% on 39-82.5K and 24% on 82-150K
If you are married and file together, you pay:
10% on the first 20K, 12% on 20-77K, 22% on 77-165K and 24% on 165-315K
Then, you take out deductions. Even if you do a standard deduction only, that's 12K off for individuals and 24K off for married. So, let's say you are single and make $75K a year. You can deduct your 410K investments and heath care, but let's keep it simple and just take off the standard deduction (63K taxable). Your fed taxes are $8,500 and your social security/medicare tax is $5,738 (7.65% of 75K). Your state taxes are a % of federal, around $1,800 in this case. So your total fed+SS/Med+state = $16,038 (21%). But that's saying you don't deduct any for health care, 401K or any itemized deductions. For most individuals, it would be closer to 18% after deductions.

Now, let's say you are married and make $140K combined. After the standard, you are at 116K. Your fed taxes are $17,237 and your social security is $8,240 (max) and your medicare is $2,030 (1.45% of gross). Your state taxes are a % of federal and about $3,600. So your total fed+SS/Med+state = $31,107 (22%). But that's saying you don't deduct any for health care, 401K or any itemized deductions. Again, most families would be closer to 18-20% at that range.

I didn't count sales tax because I wasn't counting the VAT tax in Europe. You can also deduct property tax off your return as well. Most families with a 401K, employer provided health care, that pay for day care (deductible) and use the standard (or own a home and itemize) probably pay in the 17-19% rate for fed+state+SS+medicare+property tax. That's a far cry from what Europe pays.

[Arles]

Originally Posted by molson

What is the job market like in Europe? (obviously that varies a ton between countries like France and Italy v. wealthier countries like Denmark).

I always got the sense it was stagnant. Their classes of income and wealth are closer because there's fewer super-rich, but, it is truly easier to get from say, entry level to $80k+ than it is in the U.S.? Or is there kind of a glut of people under 50 that basically all have the same lifestyle - fewer poor, fewer rich. Their medium and average income levels seem to be lower than the U.S.

Not saying any of this is better or more desirable, I think free healthcare is maybe the most important thing any country should do. But I wonder if it's better to be an educated professional in IT, law, engineering, etc, in the U.S.

It's a good question. In places like the UK, Belgium and most Scandinavian countries, it really makes no sense to make more than 100K. You are basically paying 45-60% in taxes over that amount. And most of these countries also have their own form of social security tax in addition to income tax. Take Denmark (often listed as one of the top countries in Europe to live in). If you make the equivalent of 120K US in Denmark, you would pay 55K of that in taxes (take home 65K). If, instead, you made the equivalent of 60K US, you would pay about 20K in taxes (take home 40K). So is it really worth working the stress of a 120K a year job over a 60K job when you really only bring home an extra 25K in real money? In the US, the 120K person would bring home around 95K compared to the 60K person, who would bring home around $47K. That's basically double the take home pay so it is worth working that higher stress job.

[thesloppy]

Originally Posted by Arles

So is it really worth working the stress of a 120K a year job over a 60K job when you really only bring home an extra 25K in real money? In the US, the 120K person would bring home around 95K compared to the 60K person, who would bring home around $47K. That's basically double the take home pay so it is worth working that higher stress job.

This would make sense if there was any correlation between pay and stress/work. If anything I'd argue that most folks in the US making $30K are typically working harder and under more stress than those making $100k plus.

[Arles]

Depends, a lot of those jobs are harder to find. So, if a 60K a year guy loses his job, he can find another fairly easily. If a guy making 120K loses his job, a lot of times he's making that because he's been at his current company for a long time. Going back on the market, he may find it tough to get a new job at that rate. The stress may be more "I can't afford to lose this job" more than the difficulty of the job. Also, most 120K jobs are salaried and involved more hours. Whereas a 60K job is either hourly or not as demanding on weekly hours. If I'm in Denmark and working 50-60 hours a week in a salary job paying 120K and I could drop down to a 40-hour a week hourly job paying 60K and only lose 25K of real money, I would think that would be an attractive option.

[ISiddiqui]

In that case, you are drastically inflating effective European tax rates:

https://www.businessinsider.com/worl...x-rates-2013-1

For people making $100k USD, the highest effective tax rate on income is ~42% (Germany), if you add in income and employee based social security (payroll tax, basically), the highest is Belgium at ~47%.

[Arles]

The effective rates are lower because it is extremely punitive to higher wage earners. Take Denmark, there's 0 tax on the first 8,000 US, 39% from 8,000 to 83,000 US and 56.5% above 83,000 US. There is also an employment tax and local tax rate that applies to many. Finally, there is 12% tax on investment. And, remember, these are flat rates so no deductions apply. You are going to pay 40+% in taxes anywhere in Europe and it could be as high as 50% based on the country and your salary. Again, most people in the US pay under 20% of their Gross income in combined Fed+state+SS+Medicare+property taxes. That's a massive change in tax rates.

[larrymcg421]

I don't quite buy the idea that higher paying jobs are necessarily more stressful than lower paying ones. Almost all of the lower paying jobs I've had were way more stressful than the higher paying ones.

[Arles]

I would say it's more the time investment in your job and the stress of staying at that pay rate. The actual job activities are probably not more stressful.There is a bonus to just working the 40 hours you are paid for and leaving your work at the place. Take our manufacturing plant I work out. We have some hourly guys making $22-25 an hour. With bonuses and occasional paid overtime, they probably gross $55K. We have salaried support staff (QA, engineers, IT) who make $70-75K - but they usually work closer to 50 hours a week and have to be on call over the weekend if things break/have issues. So, the physical effort for the hourly guy is a little more during his 40 hours - but he gets to leave work here and has an extra 10-15 hours a week to spend doing what he wants outside of work. And, if he's asked to work an extra 10 hours, he gets paid for that.

[ISiddiqui]

Originally Posted by Arles

The effective rates are lower because it is extremely punitive to higher wage earners.

So the two charts literally say effective tax rate for those making $100k (USD) and $300k (USD).

[Edward64]

Originally Posted by Arles

Depends, a lot of those jobs are harder to find. So, if a 60K a year guy loses his job, he can find another fairly easily. If a guy making 120K loses his job, a lot of times he's making that because he's been at his current company for a long time. Going back on the market, he may find it tough to get a new job at that rate. The stress may be more "I can't afford to lose this job" more than the difficulty of the job.

I agree this is one factor in "stress" (e.g. living paycheck to paycheck). I think other factors include work environment/working conditions, poor managers, low growth potential etc.

If level of stress is limited to just the actual work someone has to do (e.g. flipping burgers, Macy's retail clerk etc.), IMO higher paying jobs have more stress. If you factor in all the other stuff, I'd lean towards lower paying jobs have more stress.

[Arles]

Originally Posted by ISiddiqui

So the two charts literally say effective tax rate for those making $100k (USD) and $300k (USD).

For countries like Belgium and Italy, 100K is already over the max rate. So, it makes sense there isn't a big difference. But compare 50K to 150K and you would see a big difference. But if you look at France or the Netherlands, you go from paying 42% and 40% at 100K to 54% and 48% at the 300K gross. These are extremely high flat rates compared to the US at either level. Someone who makes 100K in the US pays under 20% after deductions. I'm not sure people understand the massive difference between paying 19-20K in taxes and 40K in taxes for a 100K job. If you are paying that much in taxes, you better not have to pay anything for health care, college, day care, etc. The reality is if people want European options, they could pay the extra 20K that would go into taxes to get supplemental health insurance (tax free, but most people wouldn't need it with employer subsidized plans), a college fund for your kids (tax free), a retirement account (tax free) and the best day care out there (also tax free). What's nice is we have the option to make that call. In Europe, that decision is taken from you and you get little future benefits from all that money.

[thesloppy]

I can speak to both working QA on salary and flipping burgers, and let me tell you nothing can touch the immediate stress of a busy dinner rush in a 130 degree kitchen. That said, you don't ever have to carry any of those stresses home with you (other than the crushing poverty that comes from working in a kitchen).

[ISiddiqui]

While you think it to be nice, the rest of us have horror stories with our employer subsidized plans, and the crippling amount of student loan debt. Not to mention those below the $100k line (US median income is much less) who would have even harder time. They don't get a "choice". They just get fucked. And go without decent health care, or college education, or day care (which sometimes precludes job opportunities that can help with other things).

I'd far rather pay an extra $20k in taxes for government subsidized health care and college that would benefit all people, and especially the poor and lower middle class.

[Arles]

I get it. If paying more in taxes guaranteed us to fix health care costs, rising tuition and other US issues - it would be tempting. The problem is it won't. If you want to have more of the European system, the key is price caps. Set limits on what companies can charge for prescription drugs or medical services and set caps on what a public university can charge for tuition. That fixes all the issues and doesn't involve raising taxes a ton. But, I just can't see the US government ever doing that given the lobbies out there for pharmaceuticals and the state boondoggles that Universities offer.

Sticking it to people making 100-200K to pay for a single-payer health care system (that still will have issues with cost, we will just paying with our taxes instead of our out of pocket money) and subsidizing college for people making less (while those who make over 100K still have to pay extremely high tuition costs) doesn't really solve anything. Atleast with the current system, we have a choice on where to spend money, how to plan our kids going to college and which company to work at to get the best health care. If we go to single payer and free tuition for people making under 100K, those making over 100K still have medical expense issues and have to pay for their kids college - they just have less money to do it. Capping what people can charge is really the only guaranteed solution. We do it for other state-involved monopolies like utilities, why should health care and tuition be any different?

[ISiddiqui]

Originally Posted by Arles

Sticking it to people making 100-200K to pay for a single-payer health care system (that still will have issues with cost, we will just paying with our taxes instead of our out of pocket money) and subsidizing college for people making less (while those who make over 100K still have to pay extremely high tuition costs) doesn't really solve anything.

Seems like it would solve quite a bit (especially in health care, where employer sponsored health care is a farce - especially considering the vast levels of cost sharing and insurance negotiation that go on). In addition why wouldn't a Medicare for All system not cap costs? Isn't that something people complain about - Medicare can pay less to providers than private insurance does. And allowing people who make under $100k to see doctors without working about cost or being able to go to college to get an education solves a whole Hell of a lot. It would help equalize opportunities for those on the lower end (as we like to say we are for equality of opportunity, right?) especially those who don't have generational wealth to fall back on.

[Arles]

My point is that if you want the European system, capping costs on prescriptions/medical services seems like the best way to make that happen. That's exactly what Europe does and why a drug that costs $500 here only costs $40 in Europe. Even if we go for medicare for all, that doesn't guarantee capped costs. It just means that instead of one individual paying $500 for a drug, we just share that $500 cost across a bunch of taxpayers who don't use the drug.

[thesloppy]

You are (again) completely ignoring the significant effect of removing the entire insurance industry from the equation, even if nothing else were to change.

[Lathum]

Originally Posted by Arles

I would say it's more the time investment in your job and the stress of staying at that pay rate. The actual job activities are probably not more stressful.There is a bonus to just working the 40 hours you are paid for and leaving your work at the place. Take our manufacturing plant I work out. We have some hourly guys making $22-25 an hour. With bonuses and occasional paid overtime, they probably gross $55K. We have salaried support staff (QA, engineers, IT) who make $70-75K - but they usually work closer to 50 hours a week and have to be on call over the weekend if things break/have issues. So, the physical effort for the hourly guy is a little more during his 40 hours - but he gets to leave work here and has an extra 10-15 hours a week to spend doing what he wants outside of work. And, if he's asked to work an extra 10 hours, he gets paid for that.

I have referenced it here before, but my wife is a VP/GM of sales for a Warren Buffet owned company we have all heard of and use their product daily. She is the 2nd highest ranking woman in the company. Her job can be crazy stressful and disruptive. We have been on vacation the last 2 weeks and just about every day she has had to do some level of work. You can truly never leave the job behind. She has about 50 people working for her and decisions need to be made. She also travels a ton and has to go to work dinners, etc...there is no leaving the job behind. There is also the stress of many other peoples livelihoods at stake. She doesn't deliver her numbers people get less bonuses, etc...

now the trade off is an amazing salary, retirement, benefits, upward mobility, etc...but at times it doesn't feel worth it and she has no desire to climb the ladder any higher now that we have young kids. She was recently offered to head up another Buffet company and she turned it down.

[Arles]

Originally Posted by thesloppy

You are (again) completely ignoring the significant effect of removing the entire insurance industry from the equation, even if nothing else were to change.

There are a ton of health insurance companies in Europe right now. Supplemental insurance is big business. Companies like Allianz, Generali and AXA do massive business and we would have a similar situation here. To get the same level of response most employer-provided care does today under a single payer, you would have to pay for supplemental insurance. If you want to get an ACL tear fixed in 2-3 weeks, you will need better care than the national single payer.

It's not removing the insurance companies that makes the difference, it's setting the price caps. Insurance companies don't want to pay $500 for a prescription drug, they would love to only pay $40. Whether we have private insurance companies or not, the price caps are the only thing that is guaranteed to control costs. If you removed the price caps from Europe tomorrow, their entire system would fall apart (even within the state-provided plans).

[thesloppy]

Complicating the issue of work stress is the fact that high paying work and low paying work tend to deal with different kinds of stress. Low paying work generally seems to come with immediate stressors, both in terms of timing and presence, whereas high-paying stress seems to be more shadowy and omnipresent. I don't imagine either version is all that much 'better' or 'worse' for the human brain.

[JPhillips]

Physical laborers, on average, die younger. Our desk stresses don't compare.

[RainMaker]

Originally Posted by Arles

For countries like Belgium and Italy, 100K is already over the max rate. So, it makes sense there isn't a big difference. But compare 50K to 150K and you would see a big difference. But if you look at France or the Netherlands, you go from paying 42% and 40% at 100K to 54% and 48% at the 300K gross. These are extremely high flat rates compared to the US at either level. Someone who makes 100K in the US pays under 20% after deductions. I'm not sure people understand the massive difference between paying 19-20K in taxes and 40K in taxes for a 100K job. If you are paying that much in taxes, you better not have to pay anything for health care, college, day care, etc. The reality is if people want European options, they could pay the extra 20K that would go into taxes to get supplemental health insurance (tax free, but most people wouldn't need it with employer subsidized plans), a college fund for your kids (tax free), a retirement account (tax free) and the best day care out there (also tax free). What's nice is we have the option to make that call. In Europe, that decision is taken from you and you get little future benefits from all that money.

A person making $100k already pays more than $40k when factoring in health care, property taxes, and sales tax.

To get this stuff, we probably wouldn't even have to raise taxes on the middle class. Just tax wealthy people at the same rate the middle class pays. And companies who make $12 billion on US soil have to pay some taxes in for the the infrastructure they benefit from so greatly.

[thesloppy]

Originally Posted by Arles

There are a ton of health insurance companies in Europe right now. Supplemental insurance is big business. Companies like Allianz, Generali and AXA do massive business and we would have a similar situation here. To get the same level of response most employer-provided care does today under a single payer, you would have to pay for supplemental insurance. If you want to get an ACL tear fixed in 2-3 weeks, you will need better care than the national single payer.

It's not removing the insurance companies that makes the difference, it's setting the price caps. Insurance companies don't want to pay $500 for a prescription drug, they would love to only pay $40. Whether we have private insurance companies or not, the price caps are the only thing that is guaranteed to control costs. If you removed the price caps from Europe tomorrow, their entire system would fall apart (even within the state-provided plans).

I don't necessarily agree or disagree with your reasoning about caps, but I am thoroughly confused as to how it fits into your argument that you don't want the government controlling your healthcare? Yes Europe can do universal healthcare at much cheaper costs than the US can run it's private system, but only by capping pharmaceutical prices, which you're not sure that the US will implement properly, so you 'd rather continue to pay effectively double for health care as long as your tax bill doesn't rise?

[Arles]

The 10 most stressful jobs and their median salaries:

Enlisted military personnel of three or four years: $26,802
Firefighter: $49,080
Airline pilot: $111,930
Police officer: $62,960
Broadcaster: $62,960
Event coordinator: $48,290
News Reporter: $39,370
Public relations executive: $111,280
Senior corporate executive: $104,700
Taxi driver: $24,880

There's certainly more "danger" in physical labor, but I wouldn't necessarily say more stress. If you take out the military, fire and police, most high stress jobs aren't that physically taxing.

[JPhillips]

Lowering drug prices through Medicare could be done very easily if the government was allowed to negotiate. They wouldn't even need to set a price, something like the average of your lowest three prices would work wonders.

[JPhillips]

Originally Posted by Arles

The 10 most stressful jobs and their median salaries:

Enlisted military personnel of three or four years: $26,802
Firefighter: $49,080
Airline pilot: $111,930
Police officer: $62,960
Broadcaster: $62,960
Event coordinator: $48,290
News Reporter: $39,370
Public relations executive: $111,280
Senior corporate executive: $104,700
Taxi driver: $24,880

There's certainly more "danger" in physical labor, but I wouldn't necessarily say more stress. If you take out the military, fire and police, most high stress jobs aren't that physically taxing.

It's not just about dangerous conditions on the job. If you look at life expectancy from retirement, generally, laborers live significantly fewer years than do professionals.

[RainMaker]

When I was living in Guelph I tore my ACL and had surgery 2 weeks later. The wait was only because the surgeon wanted swelling to go down and me to do some rehab beforehand because it speeds up recovery.

I never noticed much difference in the two countries outside of price. I had to wait a month just to see a surgeon for a consult to remove my gallbladder months back in the US. Specialists have long wait times too.

We also do have a single payer system working with Medicare. I don't see people dying often from wait times on that.

You can also reduce wait times by not allowing the AMA to act like a cartel limiting doctors.

[Arles]

Originally Posted by RainMaker

A person making $100k already pays more than $40k when factoring in health care, property taxes, and sales tax.

Most property taxes are under 3K and can be deducted off your gross. So, you are talking about an extra $1.5-2K per year in actual money, it's not that much. I didn't include sales tax or VAT tax in Europe, they pretty much cancel each other out. In terms of medical expenses, most plans have an out of pocket max so that even if you have a big expense, it's not costing 20K. Recent studies have found that families spent on average $714 or 1.6 percent of their take-home income on out-of-pocket health care spending.

There's just no way you are getting to even half what people pay in taxes in Europe.

Originally Posted by thesloppy

I don't necessarily agree or disagree with your reasoning about caps, but I am thoroughly confused as to how it fits into your argument that you don't want the government controlling your healthcare? Yes Europe can do universal healthcare at much cheaper costs than the US can run it's private system, but only by capping pharmaceutical prices, which you're not sure that the US will implement properly, so you 'd rather continue to pay effectively double for the devil you know?

I look at this like I look at unions. I like free markets, but some industries that work in the "public good" sectors need a union. I think Police and Fire unions are extremely important given the need to society. A software developer's union? Not so much. I think you could make the argument that capping prescription drug and medical costs is required for the health of the population. That's exactly what Europe has done and why everything is so cheap compared to the US. Now, there are negatives in terms of the US basically subsidizing world health research with the costs they pay, but maybe it's time to start sharing that burden. Either way, I would much rather make a massive change that I know will fix the issue (price costs) as opposed to one that may just end up costing tax payers a ton without any significant cost solution (single payer).

[RainMaker]

Originally Posted by Arles

Most property taxes are under 3K and can be deducted off your gross. So, you are talking about an extra $1.5-2K per year in actual money, it's not that much. I didn't include sales tax or VAT tax in Europe, they pretty much cancel each other out. In terms of medical expenses, most plans have an out of pocket max so that even if you have a big expense, it's not costing 20K. Recent studies have found that families spent on average $714 or 1.6 percent of their take-home income on out-of-pocket health care spending.

The average monthly premium for a family is $1,168 a month. So just over $14,000 a year plus that $714 in out of pocket expenses.

We haven't even touched sending those kids to college someday.

[Arles]

Originally Posted by RainMaker

When I was living in Guelph I tore my ACL and had surgery 2 weeks later. The wait was only because the surgeon wanted swelling to go down and me to do some rehab beforehand because it speeds up recovery.

I never noticed much difference in the two countries outside of price. I had to wait a month just to see a surgeon for a consult to remove my gallbladder months back in the US. Specialists have long wait times too.

We also do have a single payer system working with Medicare. I don't see people dying often from wait times on that.

You can also reduce wait times by not allowing the AMA to act like a cartel limiting doctors.

When no one pays for medical services, people tend to want to use it more often. So, it makes sense that wait times are much longer in Canada and the UK. If we went to a single payer, our wait times would grow to what Canada has (if not worse given we don't really have the infrastructure for the massive increase in requested services).

[thesloppy]

Originally Posted by RainMaker

I had to wait a month just to see a surgeon for a consult to remove my gallbladder months back in the US. Specialists have long wait times too.

I have had a hell of a time and multiple months wait any & every time I want to see a specialist and I'm on the best/platinum tier of insurance. You literally can't find mental health care in this town, regardless of any kind of insurance or urgency. When I hear folks talk about how awesome American private health care is I wonder if they've ever been to a doctor/hospital, and/or where they live, so I can make an appointment there.

[Radii]

Its completely disingenuous to compare our own situations to what they might look like in a country that takes care of their less fortunate. Basic healthcare, a basic education without crippling debt, and so on... my income is in the top 10% of people in the US (low 6 figures). Even someone making half what I make is still in the top 30% of earners. These conversations read like we somehow expect to provide those basic services to all citizens without making any changes to someone who makes more than 90% of the nation. That's an unreasonable starting point that makes entire conversation meaningless.

[Lathum]

Originally Posted by JPhillips

Physical laborers, on average, die younger. Our desk stresses don't compare.

I wonder if any of that has to do with lifestyle?

In general physical laborers are lower paying ( yes I know there are some well paying jobs). I wonder if they tend to eat more processed foods, etc...

In my experience, and it's purely anecdotal, physical laborers tend to drink a lot. A buddy of mineis an iron worker and has some crazy stories.

[ISiddiqui]

You realize that a lot of the cost capping is only done because the government as a single payer has massive negotiation power, or they mandate what the cost will be and providers cover it due to the government being single payer. Simply trying to mandate cost caps for services and drugs without having the government being the single payer makes little sense.

In addition, costs likely wouldn't nearly come down enough for the poor to afford good health care.

And man, do I completely disagree with you on unions. A software developer's union is multiple times more important to society than a police union.

[Radii]

dola (maybe, lots of people in here) - I'm not saying we shouldn't have the conversations we're having, by the way. I'm just saying that we should be looking at the entire picture to frame the conversation in a way that more matches the full reality of the differences.

[RainMaker]

How does someone who supports a free market not support unions?

[Arles]

Originally Posted by RainMaker

The average monthly premium for a family is $1,168 a month. So just over $14,000 a year plus that $714 in out of pocket expenses.

That's for familes without employer-sponsored coverage and doesn't factor in state subsidized coverage for lower income people. If you factor in people with employer sponsored care and state "Access" subsidized care, the premiums actually paid by families are much lower. Very few people actually paid $1,100 a month. Most pay closer to $450 a month if you consider employer-sponsored plans for workers and state-subsidized plans for lower income:

For family coverage, the average policy totaled $19,616 a year with employers contributing, on average, 71 percent, or $13,927. Employees paid the remaining 29 percent or $5,689 a year.

[Radii]

Originally Posted by thesloppy

I have had a hell of a time and multiple months wait any & every time I want to see a specialist and I'm on the best/platinum tier of insurance. You literally can't find mental health care in this town, regardless of any kind of insurance or urgency. When I hear folks talk about how awesome American private health care is I wonder if they've ever been to a doctor/hospital, and/or where they live, so I can make an appointment there.

I agree with this completely. Switching to a dermatologist from my GP, my wait for my first dermatologist appt was 4 months. Not life threatening in any way, but holy damn.

I recently discussed switching to a psychiatrist instead of using my GP to try to find the right meds to deal with some issues there. GP wrote me a referral and said "if you're even thinking about making this change, call them today and make an appointment, you can always cancel but it will likely be 3 months minimum before you'll be seen".


Neither are life threatening, but... damn.

The other thing is just getting sick in general and needing to see your primary care doc. If I don't want to wait a week to see the doc - and often I don't because I don't make an appointment when I feel something coming on, I wait until I'm sure I have to go - I just go to Urgent Care.

[ISiddiqui]

Originally Posted by Radii

I agree with this completely. Switching to a dermatologist from my GP, my wait for my first dermatologist appt was 4 months. Not life threatening in any way, but holy damn.

I recently discussed switching to a psychiatrist instead of using my GP to try to find the right meds to deal with some issues there. GP wrote me a referral and said "if you're even thinking about making this change, call them today and make an appointment, you can always cancel but it will likely be 3 months minimum before you'll be seen".


Neither are life threatening, but... damn.

The other thing is just getting sick in general and needing to see your primary care doc. If I don't want to wait a week to see the doc - and often I don't because I don't make an appointment when I feel something coming on, I wait until I'm sure I have to go - I just go to Urgent Care.

That's true. I remember when I first made an appointment to get a doctor. It took me 3 months before the first 'physical appointment' was open for new patients. And if I want to see my doctor, it's at least a week if I go through official channels (if I contact him directly, he squeezes me in - usually by double booking).

My doctor wanted me to get a endoscopy. It was 4 months until the first opening. I called around and at a farther out location it would only be a month (though only because someone had juuuust canceled).

[Arles]

Originally Posted by RainMaker

How does someone who supports a free market not support unions?

I support unions in fields where the market will not balance out the compensation. There is no revenue brought in by police or fire, so local areas could vote to cut their salaries until they were non-existent with no checks or balances. For a software developer, the company they work for either generates products for sale or their skill has a value to the company at a certain rate. If a company cuts a software developer's salary 30%, there are dozens of other companies willing to pay them a market rate. If a city cuts a policeman's salary 30%, his options are to either move to another city/state or find a new profession. Plus, you have the city safety aspect of having all the police officers leave.

This isn't Upton Sinclair's jungle when it comes to most jobs in the US. But, we do still need unions for public good professions to protect the workers and ensure they get a wage that keeps good people doing those jobs. I'd even classify Teacher's unions in the police/fire as needed areas.

[JPhillips]

Originally Posted by Arles

Most property taxes are under 3K

That's true in a lot of states, but wildly low in other states. My fairly modest home includes 8k in property taxes. It's very easy for middle class folks to have 10k or more in property taxes.