> 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 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.
I've had a sports hernia and the bill was about $30k.
No, nobody benefits from insurance in America. Well, nobody ill.
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.
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!
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.
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.
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
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.
Did we discover a new kind of monopoly perhaps? It’s not quite full blown corruption as there still (for now) exists a somewhat adversarial relationship between insurance and hospitals. However, at the same time, they seem to be pulling each other into the abyss, and our society is the victim.
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.
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
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..
I'm not advocating against health nor preventive care, however they don't decrease costs nearly as much as you'd expect.
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.
Insurance? Hospitals? Doctors? Pharmacists?
Even public system that are fee for service have problems with profit motive - doctor “does more” and they make more.
The idea that cost inflation is downstream of subsidy is... well, it's not entirely wrong, but it's also propaganda written by the people doing the inflation. The government can't distribute economically effective subsidies if industry is conspiring to eat the subsidy and hold the consumer hostage to get more. In an unconsolidated market, the underlying actual costs don't change beyond the increased demand. Consolidation transfers the subsidy premium away from the customers, who can't consolidate. You can't give a bullied kid more lunch money.
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.
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.
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 :\
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.
FTFY
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.)
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.
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.
(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.
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.
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
Private health insurance is nowhere near $40k here. Can be down around US$100/mo for a single or US$300ish/mo for a family, depending on inclusions.I don't think benefitting society is a common reason for people to want to have kids. I don't know if there is any data on this, but certainly doubt that any of my friends with children would give a reason to that effect.
Bluntly put, each child is an additional strain on the depleting resources of an already grotesquely overpopulated planet. Ever since it no longer is an economic necessity, having children is a vanity project. I don't see why society should financially incentivise that, especially as we're trying to encourage more environmentally conscious lifestyle.
$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.
https://www.kff.org/affordable-care-act/annual-family-premiu...
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.
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.
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.
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.
Find a long Covid specialist, those things aren't normal but are known to be effects of long Covid.
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 ..
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'.
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).
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).
In 2015 I had my first child while self-employed, and I paid for the most expensive Aetna plan I could find, about $2k per month if I recall correctly. We had an excellent experience at Mt Sinai, private recovery room for two nights, etc. I don't think we paid hardly anything out of pocket.
Granted, I agree that our health insurance system is a complete mess, but judging by this post and the angry responses of the author here, it sounds to me like they're making it worse on themselves by misunderstanding what's available and needlessly paying for a more expensive option than needed.
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
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 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.
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]).
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.
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.
If you're planning to adopt, broadcast it via your social network as much as possible. If you can avoid going through an adoption agency, you'll only have to pay for the legal work ($7,000 - $10,000).
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?
At least, that is what they did to me.
It's all a scam.
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.
Unfortunately I'm type 1 diabetic which is either a death sentence there, or you are rich. But then I also accidentally broke my collarbone this summer. And I had this weird throat infection.
As a type 1 diabetic I have had to go to the ER numerous times in my life, and as traumatising as that experience can be, I can't imagine the feeling of also being financially ruined for the pleasure of not dying.
It's weird, I know plenty of people who avoid going to the doctor because it's annoying to wait for over an hour.. but I could see that for an American you might just NEVER go. I guess it's like, ok someone in the family is sick, and we're not rich, so we will sacrifice them to the sun gods. Or I guess you go into indentured servitude? There are people for whom $100k is made very very slowly.
I just do not get it! I guess these things add up properly if you are very wealthy, but people here think that it's the function of the society to make sure you can have basic things like medical treatment. Of course it's not perfect here... try going to the dentist for example. Then you're almost in the USA. Somehow it's not considered medical. A long session could run you over $500 or more.
I have compassion for all the USAians out there! If I was USAian and planning to have a child.. I guess I would consider just going to a civilized country for a while, like... I don't know, Rwanda or Ghana or somewhere that can afford people to be alive(?). In seriousness though (as those countries are very far) you could just go North or South. It's closer. If you go to Canada, a lot of times you wouldn't even need to present ID.. you could just.. get treated right there by walking into a hospital, being triaged, and then waiting (admittedly for maybe almost a day).
Always bring fun things to the hospital if you aren't literally bleeding out all over the place, because you'll be in the waiting room for 12 hours if you're in a big city.
But when it's over you're alive and about as rich as you were before. Seems like a good societal deal to me. I'm scared of being trapped somewhere like the US honestly. It's a nightmare scenario. Although I'm sure it's pretty great if you're a billionaire with slaves and so on... but someone has to incur that cost (the slaves from the lower castes).
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.
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.
keep running US business, but live in a different country n get private healthcare.
It will require nothing short of a full revolution and violence is never ideal.
I think the solution is to create a new parallel medical system, that can slowly replace the old system. Start with medical schools that train Doctors and Nurses that are affordable/free but also require working at this new parallel medical system. They would earn less but would avoid massive loans and have less bureaucracy.
When for-profit hospitals go under, which happens all the time, they can be folded into this new system.
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
The parent thread is right though medicare for all would definitely be cheaper. Larger pool to spread the risk. But more importantly we make every N healthcare provider work with M insurence. NxM complexitiy is scaling the cost of healthcare. There are simplifications but the the M insurence providers are the producer of all complexity not the N healthcare providers so basically all that bueracractic overhead also kill costs. Arguablly that wasted bueracracy equals quite a few healthcare insurence employees which I think politically complicates M4A in a stupid way.
Be kind. Don't be snarky. Converse curiously; don't cross-examine. Edit out swipes.
Comments should get more thoughtful and substantive, not less, as a topic gets more divisive.
When disagreeing, please reply to the argument instead of calling names. "That is idiotic; 1 + 1 is 2, not 3" can be shortened to "1 + 1 is 2, not 3."
Don't be curmudgeonly. Thoughtful criticism is fine, but please don't be rigidly or generically negative.
Please don't fulminate. Please don't sneer, including at the rest of the community.
Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
Please don't post shallow dismissals...
Someone doesn't get to 400k karma (almost double the second-ranked user) without contributing a lot of value to the community over a long time.
It's fine to disagree with someone, of course. There'd be nothing to discuss otherwise. But we need you to engage with the substance of the comments you're replying to, and not sneeringliy attack somone's character or motivations like this.
https://news.ycombinator.com/newsguidelines.html
We detached this comment from https://news.ycombinator.com/item?id=46119115 and marked it off topic.
;-)
Seriously, though, I suspect it has to get a lot worse. 23% unemployment might be something.
A. You have a child.
B. You don't have a child and decide to never have a child. To make up for the decline in population that year the government issues a working visa to an immigrant. The immigrant relocates to your country and sets up their life there.
Do you think that A or B raises GDP more?
The simplest model of GDP is productivity per capital times population. And the simplest model in finance is moving cash flows around in time.
A. A child of any age.
OR
B. A migrant worker.
My guess is B because that person can produce goods for export while consuming local goods. Children (at least for the first few years of their life or so) do not contribute to production. They only contribute towards consumption. You could argue that they motivate the parents to produce more but increasing skilled migration in the parents industry can do the same.
From an economic perspective increased immigration is better than births. Why have non productive people around when you can just import productive people that pay the government income taxes?
<sarcasm>If there are no children around then we don't have to worry about the children anymore and can worry about important things like the economy!</sarcasm>