Hurlabrick

Holy cr*p!!!!!

Pulaski

On moving to the US from the UK I found that tax deducted from my US salary including health insurance costs as a quasi tax, was significantly less than the tax deducted from my previous salary in the UK. We have since switch to "high deductible" health insurance which substantially cut the premiums, by which I mean a cut of around 80% of the cost. We have then been allowed under IRS rules to take those savings tax free (about $7,000 per year between Mrs P and me) and put them in a Health Savings Account, which operates like an ISA for health purposes, allowing me to accumulate tax free funds to meet future healthcare costs without needing to use our taxed-income.

In short, there is a lot about the US healthcare system that is not understood by people who have never lived here, and often by new/ recent immigrants too, who may not have dug into the options open to them and/or not realized how health insurance alternatives might work for them. Also the media, even US-based media, often misrepresent the US health insurance alternatives that are available.

It is a source of continued frustration to me that there is so much misinformation being circulated about the US healthcare system, often using FB and other socal media, and often by people who have no personal experience of living in the US and using US healthcare.

iaink

I have an HRA (work reimburses a certain annual amount that cant be carried forward) and HSA to which I contribute $x pretax per month and they front me a sum at the start of the year that be carried over if its not spent) The HSA helps to budget for the out of pocket expenses for sure, but with a wife and kids there is never anything left to carry over in any case. The company is at pains when you sign up to show you how much it actually costs them compared to our contribution. In my case its about $29k (US) a year for medical. To put that in perspective my State and Federal Taxes, Social Security and Medicare deductions totalled $15-20k and while I lived in Canada the most tax/EI/CPP I ever paid as a married father of two was somewhere around $20-25k CDN, way less than just the cost of my US medical policy.

With recent changes to simplify most US tax returns, unless you have crippling health care costs (which hopefully the insurance prevents) its really not worth​​​​​​ doing an itemized return for a simple salaried employee such as myself. Then you get into having to fight both the providers and the insurance companies half the time to get the bills sorted. Maybe its just South Carolina, but the whole thing sucks muchly.

Pulaski

Well I have a wife, plus one, who has a potentially life-threatening allergy, and enough accumulated in our HSAs to fund maximum annual OoP healthcare expenditure for at least five years even if we didn't contribute a penny more to our HSAs. In practice our IRS-capped annual contributions mean that it would take about 20 years of maximum OoP payments to drain our HSAs.

I agree that my employer contrubutes generously to the cost of my health insurance.

bc2015

There is also a mental tax to pay. I happened to sit through a presentation on US benefits a while ago and found the whole section on healthcare to be overwhelming in terms of choices between picking plans based on deductible/co-pay and then deciding how much to put away in HSAs and FSAs. And the plans can change every year? That's even before you get to making sure you are treated by in-network doctors etc. And the whole healthcare tied to employment thing is just wrong on so many levels.

Compare that to Canada where the most stress I had was making sure I had personal details correct on one form.

carcajou

I pay thousands more each year for the universal system in Australia, then I did my last year in the US, when I had no employer insurance and was 100% in the private insurance market.

The answer to your question Pulaski is there are some posters on here who think that having something funded by taxes makes it "free." As well, paying at a time and place other than the point of use, also makes it "free."

As you noted, the proper comparison is to look at the whole system and potential costs. Yes people who have never lived in the US or utilised its health care love to pontificate.

dbd33

Even if one saves heavily, it is still possible to incur bankrupting costs. I lived for many years with an American in Canada. Her step-father is a doctor in the US so, when she was sick, she phoned him from the hospital (Toronto East General) and said "they're going to do this test and that test" which impressed him because, he said "no way the HMO would let me do all of that". Eventually she returned to the US where she became seriously ill and had an extended stay in hospital. The bill was in the order of $800,000. That is beyond the means of many people but not an unreasonable cost for, say, treating someone unsuccessfully for a COVID-19 infection. I know from working for health insurers, including Aetna US Healthcare, Tenet Healthcare and Delta Dental, that many policies have epidemic exclusions; if lots of people are ill, no one gets paid. Today's costs likely fall on the individuals who are sick (or their families if they are not cured).

If you've made good use of HSAs you may have a million dollars towards hospital costs and that's fine if only one of you becomes seriously ill. Still, illness is a risk in the US to a degree that it's not in other countries. Here the problem is that illness means no income, I don't get sick because I can't, but it doesn't mean no income and huge bills.

I wouldn't avoid living in the US because of the risk that getting sick means losing the house but it's unrealistic not to acknowledge the risk.

dbd33

Go on then, show as an example of a post that supports that contention.

carcajou

No, you go do it. This site is littered with about a gazillion examples.

As one instance, I recall a heated health care argument a few months ago with another poster in Australia, a longtime poster, who argued with me and had no idea that the "free health care" system here is funded through personal income taxes. Where do people think governments get money to fund these things? The Health Care Fairy? The flip side to Pulaskí's Theorem is the same people who don't understand the US system also often don't understand how universal health care works either.

I deleted my previous post about bankruptcies due to the complexity of the issue and the risk of making sweeping statements. In my state, your comment about losing the house over medical debt is simply wrong. The family home is protected in family bankruptcies and can't be sold off as part of a judgment. Many other states are the same but I'm going to refrain from saying a blanket statement about national bankruptcies. The vast majority of medical debt is unsecured, non-priority debt that often gets discharged which is why health care providers are so quick to sell outstanding bills to debt collectors for pennies. This is why I always advise people with substantial medical debt, to seek the advice of a bankruptcy lawyer and see if that option will work for them.

I have one relative who, some years back, spent several nights in the hospital at the tune of $50,000 a night. He paid zero because of his plan. I have another relative on Medicaid, a very poorly understood program by many, whose hospital visits are capped at $75 per stay and doctor visits are capped at $4 per visit.

The health care system in the US is actually a reason I would consider moving back there, from a universal health care country.

TheAwesomeMatt

I would say there are many other issues finding a family doctor is almost impossible, I've been a resident of BC for almost a decade and have given up, and wait times are apparently very long (though I have no direct experience, fortunately).

DarwinCharles

This is so interesting. My ex MIL has trouble affording health care and her co pay can be a struggle too. I wonder if this would help her.

Thanks for this info.

Hurlabrick

The availability of family doctors clearly varies according to where you live. We got a family doctor within 6 months of living outside Ottawa, then again within 6 months when we moved to London.

dbd33

Even if one is in a jurisdiction where that is true, it's a technical consideration. If one has no income due to illness and huge medical bills, the effect will be the loss of all assets. It doesn't matter if the house can be directly seized by one's creditors or if they take everything else and the house is sold for food.

Here's a piece explaining the obvious:

"Although the tipping point is often the loss of a job, sickness or injury often precede it. Sickness and injuries make holding a job difficult, which leads to income declining and homelessness for those without a safety net. Due to the mostly employer-based health insurance coverage system in the U.S., no job means no health insurance. The combination of unemployment and poor health can then lead to financial ruin. "

https://www.theatlantic.com/politics...ically/458871/

If you don't get ill, then the lack of a healthcare system in the US is an advantage because you're not supporting people who do get ill. It's only if you're subject to illness or suffer from a minimal social conscience that it's worse than having a single payer system.

carcajou

Sickness and illness leading to loss of a job, and associated financial problems from that, is not something unique to the United States and happens plenty in Canada and the UK. In the US, the unemployed and uninsured can go to, for example, the specially-designated Community Health Centres that exist specifically for low-income, uninsured people who don't fit other programs. They charge a personalised rate on a sliding scale based on income, unique financial situation and number of dependents and it is often free. HHS's web site keeps a database that anyone can access to find one by entering their zip code.

I am not sure what your point is about asset disposal. Anyone in financial distress has to deal with that. Most people who are middle-class who lose their jobs, with their house being exempt, don't have assets that can be disposed of for creditors in bankruptcy proceedings. Things like laptops and electronic devices up to a certain value are also usually exempted and transportation often is too, as are essential goods. They don't raid your closet and confiscate your jeans to sell at the flea market, or make you sell your refrigerator and tell you to dumpster dive. They will probably make you get rid of a Lexus but they will hold back a certain amount from the sale so you can have access to alternate transportation like a used car. Again, avoiding generalities, that is my state but the others differ usually by shades and not palettes.

Further to Pulaski's points, about ideological leanings superseding practical information when it comes to health care discussions - I have never, ever seen anyone on BE, ever discuss things like Community Health Centres; and if I was going to make a list of US-based media who were out of touch and out to lunch on what health care is like in the US, The Atlantic would be right near the top of the list.

This is now extreme thread drift. If you want to continue this, please start another thread in TIO.

TheWorldIsMyOyster

That's true. Though I will admit that the thought of not having to trip over my husband's tools everyday is something I really look forward to. Dinky wee flat with no storage.

The sun is also one factor, not a big factor but it's there. A few years ago, I didn't see the sun for more than a month. I'd go to work at 7 before the sun rose and finish work at 5.30 after thr sun has set. Gales every weekend. The darkness was grim.