Hacker News new | ask | show | jobs
by robert_foss 2706 days ago
I don't know if moving is an option for you. But there are plenty of countries that offer free healthcare.

Sweden, UK, Norway... the list goes on.

4 comments

Countries with proper (ie almost everyone has it so it is reasonably affordable) paid-for healthcare exist as well, though I'm not aware of one that would be as cheap as the US could be in terms of cost of living.
Technically Sweden has very heavily subsidized health care, not free health care. There is a small cost involved with almost every healthcare visit and hospital stay in Sweden.
I can't leave USA due to Green Card constraints.
About that "free" healthcare in Sweden, etc...

If you make $60,000 here in the USA, you can expect to pay about 22% in taxes (https://www.bankrate.com/finance/taxes/tax-brackets.aspx) so ~$12,600.

You move to Sweden and make that same $60K USD equivalent. Their tax rate is 61.85 percent (https://tradingeconomics.com/sweden/personal-income-tax-rate) so ~$37,110.

I bet you can stay here and buy some pretty great healthcare (plus a lot of other stuff) with that $24,510 difference.

There's no such thing as a free lunch (or free healthcare). Not only are your taxes covering your "free" healthcare, but they're also covering "free" healthcare for several people who aren't working while you are.

I'd just like to point out that your figures don't add up. First of all, you're not taking into account that Sweden has a progressive tax rate, like the US. The figure you quoted in your second link is for the highest marginal tax rate.

If you were to be consistent, you could use the figure for America's marginal tax rate listed in your second article, which is 37%. So apples to apples comparison would be that the US pays $22,000 in taxes at the highest marginal rate on 60k.

Keep in mind that the US also has state income tax, which can be upwards of an additional 15%.

Anyway, these figures are all kinds of wrong. You need to account for the progressive tax rate for each country, the state taxes you might be subject to, and the tax benefits / write offs that are available to you for your tax bracket.

Sweden also has a 25% VAT (sales) tax on just about everything you buy there. After they rake hard from your paycheck they rake hard again when you spend what's left.
Sure, but my point is that these sorts of comparisons are complicated, and the facts matter. Anyone can hand wave the figures and come up with favorable comparisons by including or omitting important figures. I don't think it's fair to make simplistic comparisons and say that Sweden pays 24k more in taxes on 60k income.
Every time I've sat down to do the actual math the difference between "typical HN wages in a high cost state" (call it $200k/yr) to western europe - the numbers are always within a 10% difference. Everyone likes looking at just the federal tax rate and ignores state income tax, local income tax, SS/Medicare tax (which is massive), and real estate taxes. I do ignore VAT and sales taxes typically since they are so difficult to calculate effectively.

When you add everything up, it really comes out that the US isn't very low cost comparatively. The striking thing for me is how much more progressive US taxes are than in Europe - where even the lower middle class seem to get taxed heavily.

> in Europe - where even the lower middle class seem to get taxed heavily.

This is because, at least in Sweden, the first ~25% isn't strictly taxes, but fees for public benefits. Like 10% pension and 2% parental leave.

Also, you get more from the taxes than just healthcare. Free education, eg.
Is higher education free?
There’s a ton missing from your calculations. For example, insurance is a system where some users (healthy ones) subsidize others. Since you’re against that idea, I’m assuming you want people to pay for healthcare ala carte. That adds up to a lot more than 24k a year.

Also, let’s look at what that 24k gets you in Swedish healthcare:

* Automatic paid sick leave for any duration that your physician orders you not to work.

* Capped payments on drugs per year, after which the government pays for you

* Cheap visits to generalists or specialists, capped at a low level, after which the government pays.

On top of all of that, they have lower infant mortality rates, lower rates of preventable deaths, higher average lifespans, and employ _more_ nurses and physicians per patient despite spending HALF of what we do as a percentage of GDP.

The most revealing statistic however, is that Sweden dedicates a lower percentage of government revenue to healthcare than we do. They get much more than the average American citizen while spending much less percentage wise.

Free healthcare isn’t free, but it’s sure as hell better than what we have.

Sources: https://en.m.wikipedia.org/wiki/Health_system#International_... https://en.m.wikipedia.org/wiki/Healthcare_in_Sweden

I don't live in Sweden so I can't claim to be an expert (I like in the UK), but I find it highly unlikely that your claim of a 61% tax rate in Sweden is correct. It's likely the highest tax rate possible (in the UK that's 45%).

If you look at a tax calculator you will see that for a Swedish salary equivalent to $60K, the effective tax rate is actually ~27%.

$60K USD == ~540K SEK, which is 45K SEK a month.

Plugging 45,000 into [1] and choosing the municipality of Stockholm results in a net monthly income of 32,587 SEK.

That's a tax rate of ~27%...

https://statsskuld.se/en-sv/jobs/berakna-nettolon

Well, first you have to calculate that the company pays 31.42% of your total salary in payroll taxes. This is illegal to print or show in any way or form to the employee from the employer.

Then on most goods there is a 25% tax, additional taxes other categories of goods such as gas, cars, alcohol and so forth.

So if the company pays you 60k SEK, you'll see ~45k on your payroll slip. The 61% percentage is the average total tax burden on a individual from all of these taxes.

Payroll tax is not your salary - it's tax on their employment of you, of an amount due that's proportional to your salary. It's the company's money, not yours.

(Would they pay you more if that tax wasn't due? Well, possibly, I suppose. Or they might just pay you the same, and then buy more stuff, employ more people, pay the company owners more money, that sort of thing.)

What are you smoking? Change it, it is bad for logic: any tax a company pays for you is from the money you bring in, not from the shareholders personal bank accounts. Nobody pays for the pleasure to have someone as an employee, but for the employee to deliver more than what is paid, otherwise you go under.
Reduce the payroll tax, and, what then? Same amount of money coming in, same going out on salaries, less going out on payroll tax. Now the business has options. It can buy more stuff; it can employ more people at similar salaries; it can give the owners more money.

But the argument being made appeared to be that it will give its existing employees pay rises, to each one in line with how much payroll tax it was paying for each of them previously - but this just strikes me as a bit unlikely.

In Romania by law the company contribution was included in the payroll; there was no change in salaries, but people were finally able to see the total taxes they paid and calculate the percentage correctly: it was about double vs what they thought.
The 61% number in this case came from the top marginal tax rate on income in Sweden. The fact that it's roughly the same is payroll + income tax is a coincidence.
Sweden absolutely has higher taxes on the middle and lower classes than the United States in order to fund its safety net (one old source: https://lanekenworthy.net/2008/02/10/taxes-and-inequality-le...). You are correct about that.

However, you are just presenting numbers in misleading ways that do not accurately reflect the actual taxes paid. Please stop.

You're comparing apples and oranges. 61.85% is the top marginal rate in Sweden, not the flat tax rate. On $60K USD pay you pay ~30% in taxes.

If you actually wanted to make a factual argument about high taxes in Sweden the tax you're better off looking at payroll taxes.

US spends more tax dollars per capita on health care than Sweden, and most other OECD countries, so the extra tax expense goes to other things. Ignoring of course that your tax calculation is way off.

https://www.commonwealthfund.org/publications/issue-briefs/2...

You're also not accounting for the chance that someone would end up more dramatically ill than just the odd flu or a broken bone.

[Anecdote from the Canadian socialized healthcare system]

For instance, when my brother was 11 he was diagnosed with an advanced brain tumour the size of an average naval orange. He was admitted to one of the country's leading children's hospitals (McMaster in Hamilton) one day and was in surgery the next. He spent a week in recovery, half of that week in a private room, then shared with two others. He received follow up appointments there for the following year or two. They were able to remove the entire tumour in one session, with no remaining traces, and without the [temporary or permanent] paralysis they supposed could occur (they gave it a 50% chance he would lose all feeling and motor ability on his left side). He was in hospital, and they accomplished this all in inside of 36 hours.

The cost out-of-pocket to my family was the gas to drive there, and the parking in Hamilton over a couple of days.

Oh yeah, and we bought the doctors a Tim Hortons coffee and donuts...

edited to add: The mentioned visits included a large number of MRI and CAT scans, among other tests.

I'd like you to compare that situation with a like American anecdote: https://www.thebillfold.com/2015/06/the-cost-of-things-a-bra...

Nobody lives in a vacuum, my friend. Wouldn't that be nice if we could account for all cases as you have?

Your 61.85% seems pretty weird. If you look at the same site they point to 37% in the US instead of your 22% (https://tradingeconomics.com/united-states/personal-income-t...) and that's for an individual with an income above $400K.

I strongly doubt that someone winning $60K pays 61.85% in Sweden. Your source seems strongly geared towards rich people.

In most countries in Europe there are hidden taxes that don't appear in your payroll, but the company pays for you. It is called the "company contribution" that comes from the money you earn for the company. If you do $100,000, for example, and the company does not want any profit, the company will give you 75,000 and pay 25,000 as company part, then from your 75,000 you pay 30,000 (heavily rounded), so in total the government gets 55,000 in taxes and you get 45,000 home, but you thing the taxes are lower than in reality. In Romania one year ago the taxes were united in a single set, so now you see on the payroll that you pay double the taxes than a year before, but you take the same money home. The company part is just visible in the payroll, nothing else changed.
The US has employer payroll taxes and other corporate taxes, too.
I'm pretty sure Sweden have progressive taxes!

The number is closer to 16k USD if you make 60k USD, see: https://statsskuld.se/en-sv/jobs/berakna-nettolon

> About that "free" healthcare in Sweden, etc...

This "free" in quotes is such a stale talking point. No one thinks it's literally free, it's free AT THE POINT OF USE, which is assumed anyone knows, but apparently not.