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Although it's not nearly as bad as other people have it, even in a good job with good employer-provided healthcare, there are two things that still really bug me about US healthcare. One is a perennial worry that I'll somehow end up with a 6/7-figure bill anyway, for example because I ended up in an ER where some of the doctors were "out of network" (this kind of billing has now been banned in some states, but only a minority of them). If I had no savings I would just not pay the bill, but since I do have some, I worry this could wipe out years of savings overnight, which makes me anxious. The second issue is that it just takes so much time to manage all the bureaucracy. Usually health insurance will in fact pay (if you have a good one), but you can end up spending literally hundreds of hours on the phone, especially if you had the bad fortune to end up in a hospital. In hospitals it seems that every individual person you encounter sends a completely separate bill, half of which the insurance company will initially refuse to pay for various reasons. This can go on for many months after being discharged.

All well and good about healthcare being available and not-as-bad-as-people-say provided 'good healthcare by the company.' But there lies the problem, the dependence on those variables, "good", and "company."

a) What if you're self-employed? You're stuck with mediocre, expensive healthcare for the individual market.

b) What if the company is cheap or negotiates poorly the healthcare options? Sometimes they're mediocre.

c) Costs have been going up, and companies are finding ways to reduce costs (since someone has to pay for those padded healthcare executive salaries and healthy stock prices thanks for solid profit). Thus the same plan(s) get worse year after year.

d) there's a push towards 'high deductible, self-managed / pre-tax account' type healthcare, which is smiled upon as a fantastic way to give people choice. The reality is different, now not only is the healthcare company still the middleman that keeps a chunk that gets paid out to providers, but now it's up to you to 'negotiate' what healthcare service is important to you. Oh gosh, is it expensive? I'll skip this particular service.

The U.S. has got it all wrong, of course. I'm jealous of Swedish or other healthcare systems when I read through threads like these.

Bottom line: the mediocre healthcare system in the U.S. and the emphasis on giving middlemen lots of money for no reason is a barrier to innovation and self-employment. Why strike out on your own and take a risk on building something if you'll lose your precious company healthcare? This problem is only getting worse and clearly has an impact on the political discourse.

My point around the healthcare was that, yes it's an issue, no it's not really an issue for the HN crowd. If you are some sort of programmer/engineer, and want good healthcare, you can get it. And you will avoid making foolish decisions around it, and don't need people to make all your choices for you.

I ran my own small business, provided great healthcare for myself and a couple of employees, and managed to have good healthcare after I shut the company down and was unemployed for a while. I had to do a little research and make a couple good decisions, then it wasn't an issue. And that was before the Affordable Care Act, which provides free healthcare in many states for people who can't afford it.

The one thing is, if you are not working for a decent company, yes, you have to think about it and prepare for it before hand, it isn't all taken care for you without you doing anything. So I say, for the vast majority of people on HN it's not that bad.

And worst comes to worst, you are being irresponsible or have fallen through the cracks, and you get into a car accident, the hospital is going to take care of you anyway.

I ran my own small business, provided great healthcare for myself and a couple of employees, and managed to have good healthcare after I shut the company down and was unemployed for a while. I had to do a little research and make a couple good decisions, then it wasn't an issue. And that was before the Affordable Care Act, which provides free healthcare in many states for people who can't afford it.

Well, in my state the individual market is tied to the state healthcare marketplace, and all of these are PPOs. At the worst, you'll pay $1200 a month for a plan whereby you have to stick to a finite network, and get approval every time from the primary care provider. And there's still a several thousand-dollar deductible. Even if I chose to offer $2000 a month for a plan that's a more open one, there's nowhere to give that money to someone.

I consider that a barrier to innovation / entrepreneurship because many people don't want to quit cushy jobs as employees for a situation like that.

Yea, well that is the result of our more socialized system. My better health care plan was canceled when the affordable care act was implemented, and I had to get a worse one. These government healthcare systems (which, long story, I happen to be on now, I don't pay a cent) are even worse. You want to see someone, you need to get permission. First, get in line to get permission, then get in line to actually get the specialist. And there is no option to do it any other way. So I don't see how the European systems solve these problems. At least in the US, in some places, we still have choice.

In Sweden you don't really have a plan. Everyone is covered regardless including basic sick pay. You can have zero income, pay zero taxes and file zero forms and still be covered like everyone else. The maximum co-pay per year including everything (treatment, hospital, rehab, equipment, medication etc.) is $300 per year. Some other European systems are more like "US light" where you have to qualify and choose. Some employers in Sweden will cover private treatment, vaccinations and more extensive sick pay (you already get 80% of x1.5 of median income if you are employed). But it isn't really required.

This is one of those misconceptions that’s constantly stated by Americans which couldn’t be further from the truth. I know, because I am an American and used to think that. Having lived in the UK for the last 7 years, yes for noncritical issues or elective procedures, you may have to wait a couple of weeks for an appointment (acute care is excellent by the way), but you always have a choice. You can pay for your own private insurance which is extremely affordable compared to the USA and go nuts if you want, or you can wait for the free care. It’s a better system, full stop. America is literally nuts with regards to healthcare.

> What you said that's really interesting to me is that the high tax rate is paid in full by your company and not counted in your salary. Is that true all over Europe, like France for instance? I am always amazed by the really low salaries but if every bit of it is what you actually keep, it's not so bad. I didn't know it worked that way.

It is most certainly not how it works in the UK! However for balance I should say that the employer does pay some tax and pension costs on top of your salary (employers NI and auto-enrollment pension). Whatever the advertised cost, you will be deducted tax and National Insurance by your employer.

Good to know. In the US, your employer pays half of the social security, that's around 7% of your income, plus some medicare taxes that are a lot less.

Actyally there is another tax too, not mentioned. The company is paying something called Employer tax which is about 100% of your sallary before the working tax.

So you get 30k before tax, 20k ends up on your account after tax deducted per month, and company pays state 30k more on top of the other 10k.

That doesn't sound right...