[JPKab]

I grew up in a family whose income put us below poverty line.

I didn't have to pay for college, due to Pell grants, yet she thinks that in the USA, a good student can't go to college without money. That's just not a thing. But the media in the US creates that impression for Europeans.

Also, the idea that poor people with cancer in the US are left to die. Not accurate. Medicare, medicaid, etc. Not saying its good, just saying she's deeply misinformed in the typical socialist left-wing media stereotypes and oversimplifications.

[africanboy]

> yet she thinks that in the USA, a good student can't go to college without money

No, she actually thinks that an average (or below average, or without some exceptional physical skill etc. etc.) student can't go to college without money.

That's a non issue here in Europe (generally).

> Also, the idea that poor people with cancer in the US are left to die

You still have to pay for it.

Without premium insurance premiums forget about premium health care.

Here in Europe is not perfect, bu paying more is not necessary to get better health care.

[biggermike]

> You still have to pay for it.

You don't, actually. Medicaid is a de-facto single payer system (with the caveat that it's funded by both federal and state governments).

[africanboy]

You can take for granted two things in life:

- death

- downvotes from Americans who do can't tolerate critics

Medicaid is not "free" there are requirements, but assuming you qualify, there are hidden costs. Like for example.

> The DRA created a five-year "look-back period." That means that any transfers without fair market value (gifts of any kind) made by the Medicaid applicant during the preceding five years are penalizable. The penalty is determined by dividing the average monthly cost of nursing home care in the area or State into the amount of assets gifted. Therefore, if a person gifted $60,000 and the average monthly cost of a nursing home was $6,000, one would divide $6000 into $60,000 and come up with 10. 10 represents the number of months the applicant would not be eligible for medicaid.

Maybe it's me as Italian that am a simpleton, but for me that's a cost.

If someone parents here get treated in a hospital, they are treated freely.

If after 4 years they want to gift their children with a few thousand euros to pay, for example, for their marriage, they don't have to worry about it.

Worrying has a cost.

The incentive of the Medicaid system is to lie about the real entity of the assets one possess.

[biggermike]

> Medicaid is not "free" there are requirements, but assuming you qualify, there are hidden costs. Like for example.

Totally different program (medicaid nursing home care) and not relevant because (1) it isn't medical care and (2) someone who has assets to draw down from is, by definition, not poor.

> If after 4 years they want to gift their children with a few thousand euros to pay, for example, for their marriage, they don't have to worry about it.

This isn't a realistic scenario (at least in theory). Medicaid nursing home eligibility is evaluated on a case by case basis and penalties are only incurred if the Medicaid applicant's intent is to defraud the government (i.e. you can't give away your money for the sole purpose of acquiring government benefits).

[africanboy]

> someone who has assets to draw down from is, by definition, not poor.

So it is a paid program

Payed by your poverty.

If you end up inheriting money from a distant uncle, you have to pay back.

> you can't give away your money for the sole purpose of acquiring government benefits

That's understandable.

And it's only necessary because the country with the highest spending per capita on healthcare cannot agree that the only reason why they don't create a free universal healthcare system is not because it is economically unfeasible (if it is for Italy, it is for USA, I usually argue that USA could do a much better job than us), but because they fear that without the incentive to become rich and distance yourself from State benefits, the system would collapse.

It's only a cultural problem: nobody wants to rely on the State providing base services because nobody wants to think of themselves as "being poor" because only poor people use public services.

When you come from countries where public figures, politicians, presidents, Queens and Kings and even the Pope go to public hospitals, you can't imagine why it should be a bad thing.

[biggermike]

> If you end up inheriting money from a distant uncle, you have to pay back.

If you inherit money from a distant uncle, your uncle is presumably no longer alive to utilize state provided long-term care and you don't have to pay anything back. You're trying to contrive a counterexample that simply isn't applicable.

[rayiner]

> Medicaid is not "free" there are requirements, but assuming you qualify, there are hidden costs.

There are low, published co-pays, similar to Italy.

The example you're quoting is for Medicaid nursing home care, a very expensive program with a distinct set of requirements: https://www.medicaidplanningassistance.org/medicaid-look-bac...

> When a senior is applying for long-term care Medicaid, whether that is for services in one’s home, an assisted living residence, or a nursing home, there is an asset (resource) limit. In order to be eligible for Medicaid, one cannot have assets greater than the limit. Medicaid’s look-back period is meant to prevent Medicaid applicants from giving away assets or selling them under fair market value in an attempt to meet Medicaid’s asset limit.

Italy does not have universal long-term care for the elderly: http://www.ancien-longtermcare.eu/sites/default/files/ENEPRI.... Like the U.S., it has some support for lower-income people who need long-term care.

[africanboy]

> There are low, published co-pays, similar to Italy.

You don't need to qualify, you just need to go tot the hospital.

> Ialy does not have universal long-term care for the elderly

That's not the exact picture though.

If you read the document you posted, it clearly says that

"Only 35% of the residential care beds available are public, whereas 43% belong to private not-for-profit institutions and 22% to private for-profit ones (Table 7). The number of elderly persons in institutional care is still relatively low by international standards, being 19.8 per 1,000 inhabitants aged 65 or older."

The key points are

- elderly care in Italy has always been in the hands of religious intitutions, that's what the 43% of private non profit institutions are. (and that is honestly an entirely different can of worms, but a can of worms nonetheless. I could talk about what opus dei does here it for hours ...)

- Italy is an old country, 25% of the population is >=65, most of them are in relatively good health conditions, as the study confirms.

- only 22% of the long term beds for elderly are private for profit, usually they are for richer people, who want to separate themselves from the rest of us.

- in total, on 15 million elderly, only less then 300k are hospitalized and only 60k of them are paying.

- the vast majority of the elders are taken care of at home, if they are not self sufficient, the State gives the family an allowance to take care of them.

- the problem here is the opposite: many try to trick the State into thinking they need monetary help faking disabilities they don have.

Not counting that elders in Italy have pensions, all of them, regardless of the amount of retirement savings (savings here are mandatory, a minimum of 23% of the salary, of course more savings mean higher pensions, but with zero savings people still get a - fairly low - pension) , payed directly by the State, adjusted for inflation, and that we spend around 15% of our GDP in pensions.

[vladvasiliu]

> Here in Europe is not perfect, bu paying more is not necessary to get better health care.

I would say it depends on your illness. Here in France, if you have teeth problems, need glasses or eye surgery in order to not go blind or need to stay in the hospital, you better have good insurance (mutuelle). The state social security /does/ pay for this, but the amounts are ridiculously low. I'm not sure what the prices are in the US, but healthcare over here is not free. Source: my mom had to undergo eye surgery (the mutuelle had to cover a fair chunk of the cost) and my father had to spend some time in the hospital for surgery; both where in "state-approved" clinics.

I'm not familiar with how the US system works, but from what I understand this "mutuelle" thing looks like the employer health plans in the US. It's also paid for by the employer over here, but you have to pay income tax on it.

I think that many people, at least when they compare the US to France, consider that the insurance paid-for by the employer is somehow "free", or don't even realize it's there.

[africanboy]

Form what I understand Mutuelle is an integrative insurance policy that covers medical expenses if the patient decide to go to private hospitals (which need to be approved by the State).

AFAIU Mutuelle costs tens of euros a month, not hundreds or thousands.

In Italy it's the same, you can go to public hospitals which are always free if the procedure is necessary, or you can go to private hospitals or clinics and pay by yourself or through a medical insurance policy, but you absolutely don't need it, it's a choice people make.

The company I work for pays for my insurance policy, it costs them 25 euros/month and I can spend up to a couple thousand euros a year on medical procedures.

Usually people use those for things like fixing your teeth as an adult (up to 18 years the State here covers 100% of the expenses)

I used it to get two dental capsules at 70% discount rate (it was manageable anyway, less than 15 hundred euros, all included)

[JPKab]

if you are below a certain income in the United States you don't have to pay for your health care. End of story.

Most Europeans don't know anything about the US other than Michael Moore documentaries and reports from very biased journalists. I think the US medical system is incredibly flawed and has horrific inefficiencies and other things that make me hate it, but I live here and I actually know a lot about it as opposed to the typical European who comments on it based on the second hand information.

[africanboy]

> if you are below a certain income in the United States you don't have to pay for your health care. End of story.

That's the problem.

End of story.

> Most Europeans don't know anything about the US other than Michael Moore

Most Americans assume they know what European know, based on stereotypes 100 years old.

And have never been here.

But I've lived in the US, for example.