[mothballed]

Almost 40% of the USA is on medicare, medicaid, or entitled to VA benefits or military healthcare. It's only a narrow majority that depends on unsubsidized private healthcare, and those people skew in the upper income levels.

[jkartchner]

You believe the top 60% of the nation skew in the upper income levels? Median pay is $61k a year for the entire country. The top 1% skews to the upper income levels. The rest are charged $30 for a dose of aspirin and can't afford it.

[tptacek]

There are numbers on this, and their comment is probably directionally correct; the median household with private insurance earns more than 400% of household FPL (KFF). By subtracting Medicaid and fixed-income seniors from the picture, you are sharply biasing the median upwards.

[gusgus01]

I would say if you ignore the poorest 40% of the population, you've got quite the slim margin to go before you are no longer talking about "Most" Americans, which the OP was pretty explicitly talking about.

He was saying "Most people in the US" don't make 100-200k more, and that they probably don't even make 100k. This was in response to the generalization that "people from other countries ... underestimate how well paid people in the US often are".

Now there was talk of getting the political motivation to change things, so I guess everyone is assuming Medicaid/Medicare/VA recipients don't want to change the system, but that wasn't really established, nor was that really being refuted.

[tptacek]

I don't think I could be any clearer that I am (1) talking about Americans with private health insurance and (2) not making a normative judgement about which system is better, but rather a positive claim about the political challenge of changing the system (its large group of stakeholders who are better off under it).

[gusgus01]

Oh I'm clear about the demographic you are trying to discuss, my point was I'm not sure this all stemmed from a discussion about that specific demographic. It started at "people in US", then went to "most", then by the time you got involved in the thread you were defending a statement about people with private health insurance.

I could have made this comment at the level where it went off the rails, but I thought making it at the leaf level would help everyone involved see the deviation between what was said and what was being argued.

[nxor]

People in the US can't afford aspirin? Where do you live? It's just not true

[sumeno]

They are referring to the price that hospitals charge for aspirin, which is massively inflated, not the off the shelf cost of aspirin

[tptacek]

Where in their comment do you see them referring to hospital care?

[DennisP]

The article, talking about a patient's hospital visit, mentions "the $31 low-dose aspirin, of which they'd given him four."

[tptacek]

Ahh, good callout. Thanks!

[GuinansEyebrows]

i think in this case, if you're at all familiar with what US hospitals charge for the small stuff, it's a safe assumption that when someone says aspirin costs $30 a dose, they're not talking about buying it at a CVS. of many folks on hacker news dot com i trust you to bridge that gap instead of nitpicking!

[tptacek]

That's an odd argument to make in this thread, because whatever the drivers of burdensome consumer health spending are, they're not overpriced hospital aspirin.

[sumeno]

I'm capable of understanding context.

[nosianu]

So what about this? It is a question, not meant as a counter.

Although I have to say the rosy picture some paint here about the high incomes is counter to anything I ever heard - and saw, although I left the US in the early 2000s, after having lived there for almost a decade (still mostly paid from Germany, never ready to make a complete move).

"Medical Bankruptcies by Country 2025"

https://worldpopulationreview.com/country-rankings/medical-b...

"Healthcare Insights: How Medical Debt Is Crushing 100 Million Americans"

https://www.ilr.cornell.edu/scheinman-institute/blog/john-au...

By the way, Europeans don't quite all have a "nationalized healthcare system". Germany, for example, has "Krankenkassen" but also private insurance, and the "Krankenkassen" are private organizations.

We pay health insurance and get to choose the provider, those with higher incomes can switch to complete private insurance. We also have lots of our own problems and increasing costs because of immigration but more so aging population.

However, I personally know several people who had severe illnesses for a long time, and their normal "Krankenkassen" insurance never made any problems. One person with plenty of money, whose wife was dying, even asked US medical experts if he should come to the US with her, and those US experts said he should stay where he is, the German univ3ersity hospital right next door had some of the leading therapies in the field. She lived five more years instead of dying after less than half a year with the standard therapy, every single expense paid for with the standard insurance, additional private insurance unnecessary. Similar with my stepfather, who had soooo many severe conditions, and yet every single item down to the special medical bed brought into our house so that he could finally die at home was paid without question.

The problems are with more mundane expenses, e.g. glasses, or the dentist, where only some of the treatments are covered. The really expensive illnesses seem to be better covered than the more common and much simpler problems.

[onli]

Careful there, thats a rightwing propaganda point. Immigration into an aging society does not raise healthcare costs, it lowers it. See https://archive.is/XxfTH (and note that this is a NZZ article, a right-wing publication by now, so not slanted towards being immigration friendly).

[nxor]

Are people ever allowed to criticize migration?

[epistasis]

Who's not being allowed to criticize immigration? Critique of a critique is pretty much the furthest thing from "disallowing" critique.

[bleepblap]

Sure, but it helps to not misrepresent the facts while you do it

[nosianu]

Misrepresenting???

The costs DID increase.

I did not try to make a political statement, what happened here, anyway???

I have no idea what there is to defend - even if you assume they will all get high-paying jobs some ay, for the first few years costs will increase while they either learn the language, are not allowed to work (status pending), or get minimum wage jobs (food delivery and parcel services at least in my city now is dominated by immigrants).

Even with your most positive outlook, initially there will be lots more people and the same system (number of doctors), and the numbers of payers increases slowly.

I even wrote "but more so aging population", conveniently overlooked in this strange politicized discussion.

I am NOT against immigration!!! Don't make stuff up people.

[onli]

You are misreading this exchange. You just got a fact wrong, but thus repeated a lie that is planted often by nazis - and it's easy to get mislead. Anyway, you did not get criticized for an imagined stance on immigration, but those answers are to a comment I assume you missed, the one by nxor?

You wrote, incorrectly:

> We also have lots of our own problems and increasing costs because of immigration

As the NZZ article explained, health care / Krankenkassen are the area where it is the clearest that immigration is an economic benefit. Look at statements like the section title "Krankenkassen profitieren", followed by "Ein grosser Profiteur der Zuwanderung sind dagegen wohl die Krankenkassen." and the ending paragraph of said section:

> Laut dieser Analyse gab es in diesen sieben Jahren einen Wanderungssaldo aus dem Ausland in Höhe von 4,7 Millionen Menschen in das System der GKV. Für das Jahr 2019 ergab sich daraus eine Entlastung der GKV über etwa 8 Milliarden Euro (umgerechnet 0,6 Beitragssatzpunkte). Seit 2019 hätten sich die Rahmenbedingungen aber deutlich geändert, heisst es dazu von der TK.

So the numbers we have do not support that part of your statements. And I'm not aware of newer numbers that say the contrary - the recent cost increase sees completely different reasons for example, as in https://www.mdr.de/nachrichten/deutschland/panorama/krankenk..., the "but more so aging population" part of your comment fits there.

[yieldcrv]

And while European countries have various forms of nationalized welfare, their salaries are so low that they would be automatically eligible for the US' welfare too!

our blocs aren't that different

except in the US middle class and upper middle class