[marcinzm]

The US is really bad for the lower middle class in terms of social support. The poor can get passable benefits if they know how to apply but the middle class doesn't get that. As a note, there's other social issues with being poor in the US so I wouldn't recommend that either.

[rayiner]

That's why we spent a bunch of money creating the ACA. If I was a single person here in Maryland making $24,000 per year, I could get a low-deductible health plan for $115/month (and a high-deductible one for a fraction of that).

That's 5.75% of gross income, which is lower than the health-insurance tax a lower middle class person would pay in most European countries.

[marcinzm]

The issue is that insurance companies don't always pay out as they have incentive to find ways to avoid paying. Then you're on the hook. If I remember, deductibles for example don't fully cover many hospital stays so you get hit with out of pocket costs. Those have a maximum cap but I'm sure there's some caveats if you end up in a hospital that's not in network for example. This is what people talk about when they say they went bankrupt despite having insurance.

edit: For example checking the Maryland ACA page is showing maximum out of pocket costs of $7k/person for most plans and up to $17k/family for some. When you make $24k/year that will wipe out your savings for years.

[marcinzm]

To expand on this. The average healthcare cost in the US is $7k/year/person for the working age population. Children are an additional $3k/child/year. Since insurance companies are private businesses they will be paid $7k/year/person on average. No loopholes, no ifs, no buts. As such, no matter what your plan says or what the tradeoffs are (deductible, monthly, etc.), on average you will be paying them $7k/year/person. If you're paying for it yourself then that price will be paid by you. Now, you can avoid medical treatments to lower that price but I hope it's obvious why that's not a good social solution.

That price may come out of monthly premiums, deductibles, out of pockets or copays but it will be paid out on average.

In a universal healthcare system the government can use progressive taxes to subsidize this cost for the less well off. In a private system that isn't the case.

So if you make $24k/year that comes out to 30% of your income. Assuming you get the average standard of medical care in the US. You may get lucky and avoid this but lotteries aren't good ways to live life.

edit: Please note I'm talking about the working age population. I don't think the elderly make sense in this discussion given that there's government health coverage for them.

[rayiner]

> The average healthcare cost in the US is $7k/year/person for the working age population.... In a universal healthcare system the government can use progressive taxes to subsidize this cost for the less well off.

Except we don't have a fully-private system. We have Medicaid, which covers the working-age poor, and also people with disabilities which is a very high-cost group. Then we have Medicare taking the high-cost elderly population. And then we have ACA potentially subsidizing much of the rest.

> So if you make $24k/year that comes out to 30% of your income.

In Maryland, a low-deductible Kaiser ACA Gold plan for a 36-year old making $24,000 per year costs $3,864/year. But the government pays $2,533 of that, leaving you to pay $1,380 + out of pocket costs.

Out of pocket expenditures in the U.S. add up to about $1,100/year on average: https://www.healthsystemtracker.org/indicator/access-afforda.... But note that other countries have out-of-pocket costs too. Even in France, where point-of-use costs are very low, it's still $463/year.

Your typical person making $24,000 per year is going to be young, and not rack up $1,380 in out of pocket costs each year. But adding that in, you're looking at 10.3%.

[dragonwriter]

> The average healthcare cost in the US is $7k/year/person for the working age population. Children are an additional $3k/child/year.

Actual US healthcare spending in 2019 was $11,582/person.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta...

[tptacek]

That's not the average cost per person; it's simply the total amount of health care spending, in all categories, in the US divided by its population.

[dragonwriter]

Which is also the arithmetic mean cost per person, by definition. Which average did you have in mind?

The median might arguably be a more useful average here, but I doubt the data necessary to even identify the median individual cost are kept.

[scotty79]

It's 1.25% in Poland. Technically 9% but you can deduct 7.75 of those 9 diectly out of the tax you owe.

It doesn't depend on income and gives you access to whatever hospitals can provide for everybody. My SO had six brain surgeries, two radiation treatments (one with cyber-knife) and Temodar chemo twice, and months of rehabilitation and hospital stay for that. She still died in the end but she got few years of healthy life more (and a year of some life) for the 1.25% of patchy mostly freelancing income. All she had to spend on top of that was maybe 100$ on minor medicaments.

[rayiner]

> It's 1.25% in Poland. Technically 9% but you can deduct 7.75 of those 9 diectly out of the tax you owe.

It’s 9%. That’s the money that goes into the health insurance system. You can’t run a universal health insurance system with a 1.25% tax.

If you can take a deduction on your personal income tax for what you pay in health tax, then you have to compare those personal income tax rates as well. The proper way to do this is to look at the tax wedge: http://www.oecd.org/tax/tax-policy/taxing-wages-poland.pdf

http://www.oecd.org/tax/tax-policy/taxing-wages-united-state...

The tax wedge for an average single worker Poland is 36%, right at the OECD average. For the US it’s 29.8%. The Poland number includes health insurance, and the US number doesn’t. For workers who have to purchase an ACA plan, the effective tax rate probably works out to the same number.

But 70% of US workers get health insurance from their employer, which is a benefit on top of their income (so it’s not factored into the OECD tax wedge data).