amideislas

I don't want to get into a war, but I think it's worth pointing out that every major city has homeless.

Certainly I'd have to believe the US has more of it, since it has less of a safety net than the UK, but if you've ever visited Paris, Berlin, or Madrid, you'll find your fair share of obviously indigent people on the streets in those cities too.

I reckon if you come from Devon or Cornwall and visit NYC or San Francisco, you'd be in for a shock. I'd expect one to reasonably conclude that Americans = homeless.

Conversely, this reminds me of an American couple from Indiana (acquaintances of some friends who connected us) who visited Mallorca some time ago. They had a day's layover in Madrid, and decided to explore the city. When we finally met up, one of the surprises they mentioned was that they'd never seen so many homeless as they had seen in Madrid - and were always led to believe that homelessness doesn't exist in Europe. Surprise!

And if you've ever been to Cairo or Istanbul, well, I need not elaborate.

Moses2013

The big difference in the UK is that the hidden homeless are included as legally homeless.

Sally Redux

I don't know what your problem is. You should use the ignore function if you don't like what I'm saying.

I agree with the person who said the OP is a troll anyway.

There probably is a drink problem in the UK. It's good to examine ways your country could improve.

WriterChick

I'm originally from NYC, and in NYC we DO have a lot of mentally ill, homeless people wandering the streets. It has been that way for at least the 45 years I've been on the planet. It is heartbreaking.

I do see manually ill, homeless people in London, and I saw so many in Liverpool, and Manchester... Even more than in London.

Maybe the council housing and NHS make the situation a bit easier on people in the UK?

It is pretty hard to get council housing of any kind in the USA, and it is pretty hard to qualify for any free medical - the massive paperwork alone would require one to have their wits about them.

People in the UK complain about how the NHS responds to mental illness, but, at least the NHS does respond. That in itself is an improvement over the American system if you ask me.

In university, my friend Meg, an artist studying architecture on a full scholarship, developed full blown schizophrenia, seemingly out of no place... She wandered off campus and started living in the woods. There was NOTHING that me or any of her friends could do. She was not 'a danger to others' so there was nothing that could legally be done about the situation. Only a family member could do something and she did not have any family. And even then, there did not seem to be much they could do. We wanted the police to pick her up and take her to a hospital. She had medical insurance through the school. They couldn't do it. We wanted the school to do something. They couldn't do anything. The only thing we could do was accuse her of a violent act, and even then, she would be arrested, not medically treated! We begged her to come back. We took food and blankets to her 'campsite' for a few months and then one day... she just disappeared. We never saw her again. It was horrid.

As for waitressing and tips: I used to work in nightclubs as a bartender. My 'pay' was something like $2.00 an hour. My check was often blank - all zeros. It went to taxes. I made all my money in TIPS. I made up to $800.00 a night on many nights - my average was $600.00. I worked three nights a week. Maybe four if someone needed a shift covered. So, I wasn't living below the poverty line. With that industry, it is very hard to know what people really make. Someone working at an IHOP is not going to make as much as I made bartending in trendy Manhattan nightclubs, obviously.

Basically, the way it seems to work is that you have your wage, and no matter what you earn in tips, $30 is declared each week. So, the check ends up paying taxes on that $30, and anything else that is made in cash is undeclared, and that is money that is tax free - unless they pay and tip on a credit or debit card - that must then be declared. But, even credit and debit card tips are 'gotten around' somehow in many places. I'm not sure how. The owners do that stuff, not the servers.

The thing with the NHS is... if someone brings a person into a hospital in the UK, and they are in a full blown psychotic meltdown, no matter where that person is from, or how much money they earn, the NHS will treat them. Even if it is a tourist! In the UK, help IS available.

In the USA, they ask, 'Can I have the insurance card please' before even considering treating them. If you are homeless, jobless, and witless, chances are you are also insurance-less.

Michael

I have no problems what you are saying but you seem to be hesitant about answering my question? I'm not asking anything complex.

You can also you the "ignore function" if you don't like what I am asking or saying.

Sally Redux

I don't even know what you're on about.

I will do that.

amideislas

I've always understood that >one< of the problems that the healthcare system has in the US, is that it's flat-out illegal to refuse critical care (at public hospitals), and because of that, and the high volume of uninsured patients, there is a substantial expense incurred in treating the uninsured, which only increases the overall cost of healthcare.

My further understanding is that this is one of the issues Obamacare originally sought to minimise, by providing some level of insurance support for everyone, so that hospitals could achieve some cost relief through state-sponsored coverage of those at poverty level, theoretically reducing the overall cost of healthcare.

In fact, I remember a rather embarrassing speech given by (at the time) French president Sarkozy, who was pointing out that unlike the US, in France, you don't need a credit card to get medical care, which was followed by a speech from the US French ambassador, who presented Mr. Sarkozy with a copy of the law that prohibited refusal of care by any public hospital.

Just for the record, I am not suggesting that the US healthcare system isn't in bad need of repair, it certainly is.

I'm only pointing out that my understanding is that it's actually illegal to refuse treatment - at public hospitals anyway, and that has traditionally had a more-than-non-zero impact on the overall cost of healthcare in the US.

Michael

That is true and that also includes private hospitals when it is an emergency. The costs for hospitalization defaults and unnecessary expensive ER defaults is a very significant amount that is either picked up by state, local, or federal governments or by the hospital and doctors which passes the cost on to people that can pay in higher premiums depending on the locality and state. When Florida was about to reject the ACA Medicaid provision that was paid 100% for three years by the federal government and 90% after that, the hospitals launched a major lobbying effort to get it passed but to no avail.

The state of Texas has an $84 billion dollar budget for Health and Human Services with $67 billion going towards Medicaid coverage with the federal government paying $47 billion of the budget. If Texas would have approved the ACA Medicaid provision, the federal government's share would have increased and the state's share would likely have decreased since they wouldn't have to cover some of the default and ER costs. Texas lawmakers are not mathematical geniuses.

Texas Health And Human Services Budget

Texas also has the highest rate of uninsured in the nation so turning down the ACA Medicaid provision, really hurt Texans. The ACA provision that the republican are now trying to overturn is the federal subsidy for non Medicaid coverage to 400% of the poverty level to states that use the federal exchange (all are republican controlled states). Again the federal government is paying 100% of the subsidy and if that provision is overturned, it will hurt the republican controlled states.

WriterChick

Yeah they are not supposed to refuse someone in a life threatening situation.

Mental illness isn't considered a 'life or death' situation.

It applies much more to someone with traumatic physical injuries or issues.

My friend who is a nurse in Miami once told me that if someone comes into the hospital and they are out cold that they get MUCH better treatment if they have a valid insurance card in their wallet. They look in the wallet, and if they find the card, they check the date to see if it has expired or not!

Frightening.

Michael

The law has changed since then.

If the total tips reported by all employees at your large food or beverage establishment are less than 8 percent of your gross receipts (or a lower rate approved by the IRS), you must allocate the difference among the employees who received tips. The allocation may be based on each employee's share of gross receipts or share of total hours worked, or on a written agreement between you and your employees. You are required to report the amount allocated on Form W-2 in the box labeled "Allocated Tips" for each employee to whom tips were allocated. Penalties may be imposed for both failing to file and failing to furnish a correct Form W-2 for each form on which you fail to include this required information. Do not withhold income, social security or Medicare taxes on allocated tips, since these amounts have not been reported to you by your employee.

Tax Topics - Topic 761 Tips – Withholding and Reporting

Basically the IRS law says that if tips are less than 8% of gross receipts, the employer must make up the difference to the employees and report at least 8% of gross receipts to the IRS. There are some exceptions to that law for establishments that normally don't get tips (some fast food restaurants).

amideislas

I completely agree.

But here in Spain, it's not all that different. If you enter a hospital, you must first produce either a valid Spanish insurance card, EHIC card, or another verifiable form of insurance, or a credit card. Failing that, they'll treat you, but in a very, very minimalist way. AND they'll come after you for the costs later on.. just like in the US.

Further, if you hold an expensive private insurance card, then you will be instantly treated as royalty in any hospital. I can personally vouch for that.

At a macro view, it seems to me that the fundamental difference between the US system and the European system is that in Europe, it's mandatory to have health insurance, and if you don't, the state will provide it at reasonable cost. Not to mention that there are far more public hospitals in Europe than private.

From what I understand, the US system is not uniform, and is terribly inefficient by comparison. There is no uniform "public" health system. It's a mish-mash of different systems, different rules, different everything, and therefore, inherently unable to leverage any economies of scale. Not to mention having to treat a large number of people who are without sufficient means to pay the inflated costs of it, even when they do not suffer from impoverishment. Without a uniform public healthcare policy and state-supported coverage, it's just too damned expensive for a large part of the population.

The NHS, for all its faults, and even though it's far from "free" (as many people would like to believe), still is far more efficient at providing healthcare for 60 million+ than anything the US has. Or Europe, for that matter.

WriterChick

Yes, my point is that very often, based on my experience and the experience of many others in the trade, owners do not actually follow the laws.

If it is a big, national chain, they are a bit more inclined to do so, but even then, they get away with a lot.

My father owned bars, nightclubs and restaurants in NYC, and I worked in the industry for about 20 years, as did many of my friends and family members, and we worked in many states, and the NORM is for the business owners to NOT follow the laws.

Also, for the most part, the law isn't enforced at all.

It is a bit of a 'rogue' industry in the USA.

Plenty of rules exist, but they are often ignored.

Example: That industry is full of 'undocumented' workers.

There is even an age requirement for people to work in establishments that serve alcohol, and even that is commonly ignored.

Stuff like that is just a reality of that industry in much of America.

Michael

But if someone show's up at the ER, they can't turn them away even if it is for a minor problem. Therefore many without insurance use the ER for normal care and just default on the bill. Very inefficient and about 10x the cost of seeing a doctor in a private office. Also most large including all of Texas large cities and many small cities are Sanctuary Cities which means they can't notify Homeland Security if they treat an illegal immigrant unless they believe that the person has committed a serious crime.

Sanctuary city, sanctuary, sanctuary cities, sanctuary city list, list of sanctuary cities, list, Ohio, jobs, OJJPAC, justice, illegal alien, immigration, amnesty, undocumented, ICE, NYC, IIRIRA, Huston, Chicago, Phoenix, Steve Salvi

The whole system is insane.

WriterChick

The NHS isn't perfect, but nothing ever is... In my humble opinion, I must say that do very much appreciate the NHS.

Very much.

In the four years I have lived here, I have NEVER had a bad NHS experience.

I had a sudden and unexpected medical emergency shortly after arriving, and I woke up in a hospital bed to discover that they had saved my life. No one asked me if I was a resident or a citizen or a tourist... they just saved my life.

What did we pay for?

Parking.

That was it - just parking.

This country has a lot to be proud of, and the NHS, although imperfect, should be extremely high up on that list.

amideislas

Again, I would argue that the US isn't all that unique.. again using the example of Spain because I know it well, and in particular it serves my argument well.

Spain has one of the largest black economies in Europe, and it's quite obvious on the ground. When you hire a service, the service itself may be legitimate, but the work is very often conducted by <apparent> illegals - at least foreigners from less fortunate countries, obviously making a pittance compared to those they work for. Unlike the US, these are often North Africans or Eastern Europeans. Not to mention that cash is always a preferable means of payment, and it often renders a 21% "discount" (no VAT) But that's Spain.

I lived in Germany, too, and whilst it was a lesser occurrence there, it wasn't all that unusual. Different set of metrics, but there's a healthy black economy there, too.

I can't speak for the UK as it's been decades since I've lived there, but I have to believe it's not exactly "nonexistent" there either.

My point is only that the US isn't as unique in that regard as many would like to believe. Perhaps (in the public view) it's less tolerated there, so the headlines may be a bit more prominent, much like in the UK.

And as for THIS:

I think it's important to distinguish that the NHS is not even remotely free. It's efficient, yes, but it still represents the single largest expense to the UK taxpayer, much, if not most, is paid for by the wealthiest. The NHS is constantly under fiscal pressure, and understandably has serious difficulties staying within budget.

One reasonable theory is that since it's "free" it's subject to widespread abuse. GPs are overwhelmed, and getting an appointment is lengthy. Prescriptions are becoming widely over-prescribed, So, thousands go to A&E whenever they get a sniffle, and the cost of that alone is alarming.

The proposal, of course, is to start charging some token amount for needless A&E, prescriptions, GP visits (as is almost everywhere else on the planet), so that people don't abuse the system so readily. As you can imagine, there is outrage that any politician could even consider such a thing.