[greenavocado]

INOVA in Northern Virginia charges $3000 for an uncomplicated vaginal birth. They have a code which rolls up many services into that code. There are additional in-hospital expenses such as the newborn hearing test which aggregate to about $400. If you have insurance your maximum cost out of pocket for the calendar year is between 5 and 15 thousand dollars (insurance covers everything above it). If you can't pay it all at once there are charities and payment plans you can discuss with the provider. If you don't have insurance you can possibly negotiate the bill down sometimes drastically or if necessary declare Chapter 7 or 13 bankruptcy if you really can't pay the bills. Bankruptcy sounds scarier than it really is. Chapter 7 bankruptcy lasts about 3 months and Chapter 13 bankruptcy lasts about 5 years during which you pay everything above your normal average household expenses to a special account for the creditors. Medical debt is unsecured debt and can be defaulted on and purged by the court following bankruptcy proceedings. Bankruptcy is much more problematic in Europe for the individual. Americans can keep their assets in a Chapter 13 bankruptcy. Health insurance in America costs between $500-$1000 a month for an entire family.

[mikestew]

I'm sure this was meant as a "oh, it's not so bad in the U. S." type post. But I read it, and am reminded of what a suck-ass system the U. S. has. Sure, almost everything said is true. But let's reiterate:

1. One might pay up to $15K out-of-pocket for childbirth.

2. If you can't pay it, you have to go out-of-band to seek a non-standard procedure of taking care of the debt. The system is not otherwise built to handle a situation that's probably pretty common given the expenses involved.

3. If all else fails, file for bankruptcy.

All just to have a child.

What you've described is not "not so bad", but rather the plot of a bad movie from the 70s about how corporations have taken over the country and we all live in this dystopian hell where you have to give all of your assets to the corporation to be allowed to have a child. Only it's not a bad movie from the 70s, it's the U. S. healthcare system.

And I don't know what kind of low-end plan one gets for $1000/month for a whole family, but I'd bet real money that the deductible would make my eyes water.

[greenavocado]

Yes, the situation is bad.

Anyway, comparing earning 175k USD to 162.37k EUR:

Germany, married with 2 children, Stay At Home Mom Scenario, Tax Category 3, Berlin Region:

Solidarity + Salary Tax is EUR 40.428,00 Pension Insurance: 8.314,20 € Unemployment Insurance: 1.162,20 € Care Insurance: 900,45 €

Total: 50.805 € = $54,706 before health insurance

Virginia, USA, same scenario as above, incl. 2 child tax credit of $4000, four state exemptions: FICA + Federal + State Tax - Child Care Credit: $44,162-$4,000 = $40,162 before health insurance

Germany costs $14,544 a year more for a family with two kids before health insurance. To be fair though, the differences are lesser for most Germans, as almost no common jobs pay over 120k EUR gross.

[Ringz]

> INOVA in Northern Virginia charges $3000 for an uncomplicated vaginal birth. They have a code which rolls up many services into that code. There are additional in-hospital expenses such as the newborn hearing test which aggregate to about $400.

Free of charge in Germany

> If you have insurance your maximum cost out of pocket for the calendar year is between 5 and 15 thousand dollars (insurance covers everything above it).

In Germany, insurance covers everything over 0€. It depends on the insurance whether you have to pay extra for individual treatments (treatment methods without, or with disputed scientific evidence) or not. Rarely more than 100€. If expenses for illnesses exceed a certain amount in a year (about 3000€), it can be deducted from taxes.

> Health insurance in America costs between $500-$1000 a month for an entire family.

In Germany, it depends on your income how much the insurance costs for the entire family. 500-1000€ is also possible in Germany. But without all the extra expenses, negotiations with doctors, clinic, insurer, and bankruptcies...

[burnerthrow008]

> In Germany, insurance covers everything over 0€. [...] If expenses for illnesses exceed a certain amount in a year (about 3000€), it can be deducted from taxes

But how can you have anything to deduct if insurance covers everything over $0?

[Ringz]

You can go to a private doctor even if you are not in a „private insurance“ and pay him by yourself (Selbstzahler). He can prescribe meds which are not covered by the public insurance. So you have to pay them by yourself. That’s just one example.

[Beijinger]

"In Germany, insurance covers everything over 0€. "

Yes. But you wait >6 months to see a specialist. And Germany has not the same level of health care than the US. Sorry to break the news to you.

[Ringz]

Not 6 months: https://news.ycombinator.com/item?id=39395329

Yes, Germany has not the same level of health care. Most of the time it’s better than the US. According to studies and data. All sources are not from Germany:

https://www.healthsystemtracker.org/chart-collection/quality...

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

https://www.nytimes.com/interactive/2017/09/18/upshot/best-h...

„Germany would have tied Switzerland had we averaged our rankings of the nations instead of using head-to-head matchups in a bracket system (Switzerland eliminated Germany in the first round). It’s an example of how close the voting was.“

Wow!

Sorry to break the news to you.

[Beijinger]

"Not 6 months"

I don't care what the internet says. I know from my own experience it is 6 months, at least for some categories. Some sources say 30 days. A joke! I could call the office of my average XYZ doctor now and ask. And it will be 6 months, for sure.

"Most of the time it’s better than the US. "

The US has a lower live expectancy. Whatever the reasons may be. While this is concerning and not good, as long as you have a good insurance, Germany can not match the standard of US health care. Trust me on that one. With dentists it may be a different thing.

Yes, if you are poor or unemployed, your access to health care is likely much better than in the USA. But otherwise, not so much.

[mk89]

Not sure where you live. I (and the people I know, some of them 65+) never had to wait for 6 months - even for surgeries. And I can speak about a decently wide range of categories.

You also mention "at least for some categories", then you mention that "you could call the average XYZ doctor", as it that was applying to all categories. You seem to be generalising out of emotions, to be honest.

[Beijinger]

I don't have diabetes, for example. So I can't say anything about seeing such a specialist.

[staringback]

> Free of charge in Germany

Paid solely by taxes instead of some taxes and some out of pocket

[albert180]

If Access to Health Care in the US is so great, why is infant mortality worse than in Cuba and they score dead last in every Health or Life Expectancy Metric among the G7?

[jandrewrogers]

None of these are primarily medical outcomes. Life expectancy, for example, is skewed by an anomalously high rate of fatal injuries when people are young, which has nothing to do with healthcare quality. For better or worse, trauma medicine in the US is arguably the best in the world because serious injuries are so prevalent.

There is also the practical matter that the US is a continent-sized country and regional effects matter. Some US States have life expectancy on par with the best European countries despite the anomalously high fatal injury rates among young people.

[albert180]

Uhm no, even the richest households are worse off than the poorest in UK https://www.ft.com/content/653bbb26-8a22-4db3-b43d-c34a0b774...

[jandrewrogers]

Nothing in that article actually addresses the point. The average life expectancy where I live is currently 83+, despite notably higher fatal injury rates.

In terms of actual medical outcomes -- survival rates for cancer, cardiovascular events, trauma medicine, etc -- the UK is quite a bit worse than the US. The only countries that stand out as consistently competing on medical outcomes are France and Switzerland.

[albert180]

Nope, even the richest Americans don't get better health outcomes than the richer European countries https://jamanetwork.com/journals/jamainternalmedicine/fullar...

[greenavocado]

In case you haven't noticed, the demographics of America have changed a little bit since 1990.

We also have a small problem with fentanyl.

[staringback]

Have you seen the health of an average American?

[skeeter2020]

It's a little more subtle than this, and of course subtlety is doesn't play well these days, but the US stats vary greatly across geography and ethnic lines. Cuba isn't a great comparison, beyond the shock of "they're worse than a bunch of commies!"

[jjav]

> (insurance covers everything above it)

Be aware that this is not true!

What insurance-speak calls max out of pocket is not what a normal person thinks max out of pocket means.

If you have a year of high medical bills you can easily pay much more out of your real pocket than your so-called "max out of pocket" in the insurance paperwork.

That is because the insurance company only credits what they feel like it towards their accounting of max out of pocket, not what you actually paid.

I don't have an insurance bill handy here to quote numbers but in their monthly or quarterly statements you can find what you have to pay and what they credit against your tally of yearly out of pocket. The latter is often less than the former.

> Health insurance in America costs between $500-$1000 a month for an entire family.

You're off by a lot. About $3500/mo here in CA for my family. Employers usually pay a good portion of that (but it varies) but if you go unemployed on COBRA, it's all out of pocket.

[dkekenflxlf]

500-1000 USD per month for a WHOLE family is fucking cheap!?

In Germany, i'm paying more than 1150€ per month as single (and im not privately insured but publicly)

[pflenker]

1) I doubt that you pay as much. I pay less than half of that and have a comfortable salary. Did you include the "Arbeitgeberanteil" (which is not part of what you are paying)? 2) You can't easily extrapolate that number to a whole family. Kids are usually insured for free if the higher-earning parent is not privately insured.

[greenavocado]

No, this is on par with what my friends in Germany pay for their family. The difference is Germans have nearly no deductible and there is little worry about in-network vs out-of-network treatments.

[shasts]

This is quite possible, right?

For eg: if you work for a Swiss or US employer and make more than 69k(?), say 100k, as a freelancer, and have a family, you have to pay around 14%(upper limit somewhere around 1000) of the income as health insurance contribution.

I think it is costly. It is difficult to digest for me that the health insurance costs more than housing.

[Scharkenberg]

1150? That's literally impossible. The current maximum is about 1050. See "2024 Höchstbeitrag GKV inkl. Pflegeversicherung (ohne Kinder)".

[rusticpenn]

I think the upper limit is 800€

[wyre]

No one should have to declare bankruptcy for birthing a child. To suggest it is obscene.

[lupire]

Why do I pay $25K/yr for my family? Is yours high deductible?

[greenavocado]

6,000 dollar deductible per person with total 15,000 dollar out of pocket maximum for the family. My current health plan is better because my company found a partner that aggregates many smaller companies to get better rates from insurers. Before this I was uninsured and would call many different providers to negotiate the best cash price for various procedures such as wrist MRI with contrast. I got cash quotes ranging from $850 to $3500 and got exactly what I needed from a local provider for $850. I called up several providers in Canada and they offered similar cash prices (on the low end) so it wasn't worth the 8 hour drive each way.

[mschuster91]

> INOVA in Northern Virginia charges $3000 for an uncomplicated vaginal birth.

In Germany all of that is being covered by the government insurance scheme. The only thing you have to pay is stuff like a private room for postnatal recovery time [1]. Oh and you get a very long time paid post birth to recover and bond with your child. No such nonsense as giving birth and having to work the next day like it's common in the US.

> If you have insurance your maximum cost out of pocket for the calendar year is between 5 and 15 thousand dollars (insurance covers everything above it).

We don't have that at all, insurance covers everything, you never even see a bill or have to deal with stuff like "in network". The only thing is a 5-10€ co-pay per prescription (utter nonsense if you ask me, it was introduced as a "cost control" measure to prevent people from... diverting medication? idk, it's ridiculous but small enough that it's harmless).

> Bankruptcy is much more problematic in Europe for the individual. Americans can keep their assets in a Chapter 13 bankruptcy.

Agreed on that one. It's also a huge contributing factor into why Americans have it easier to start up side hustles.

> Health insurance in America costs between $500-$1000 a month for an entire family.

Assuming I were the sole earner and my wife would be a SAHM with an arbitrary number of children, I'd (at a gross wage of 52k/y) pay 340€ a month to health insurance and my employer another 340€, so in total (including a per-insurance surcharge of, in my case, .5%) my healthcare costs are capped at about 700€ - for all of us.

On top of that we'd get, like all parents in Germany, "Kindergeld" of 250€/month per childpaid by the government to assist in child rearing.

Pretty awesome if you ask me. I honestly don't know how y'all survive.

[1] https://www.eltern.de/kosten-geburt

[burnerthrow008]

> In Germany all of that is being covered by the government insurance scheme.

Ok, but you agree, don't you, that $3000 is quite different from "parents have to pay five digits worth of money just for the birth of a child"? That is off by an order of magnitude.

> No such nonsense as giving birth and having to work the next day like it's common in the US.

I think you should stop consuming so much media from Russia Today :) Or maybe re-consider the trustworthiness of wherever you read that.

The fact is that, at the federal level, Americans may take 12 weeks (unpaid) time off work after giving birth under the FMLA, and it is prohibited to retaliate against an employee for taking that time.

Additionally, the majority of Americans live in states which mandate paid time off after giving birth, (usually 8 to 12 weeks) plus additional unpaid time. California, to use the most populous state as an example, mandates 8 weeks of paid time, plus 28 weeks unpaid. New York, on the opposite side of the country, goes even farther by mandating 12 weeks paid time.

Part of the reason you may be confused is that this is not always explicitly named as "maternity time". It is often called as "disability leave", and nearly all disability statutes include recovery from pregnancy as a disability.

Unless you are maybe trying to argue that Europeans are legally prohibited to work the day after giving birth, you are way off base here.