Am I missing something about US salaries here?

[Krayvon2]

I work in the UK, colleague works in the US for the same company.

We do a very similar job - Colleague earns around $158k per year. My salary is in £ and still a very good one but considerably less if you look at the exchange rate (probably half of US salary). However, this is a common trend with US vs UK employees in our company due to job market differences, experience etc (the sector we work in commands more of a premium over there).

With my UK salary I still manage to save a decent amount each month and pay all bills and mortgage etc.

Talking to US colleague about how in the UK we get paid on one set day every month (over there salary is paid in two installments each month) and they asked me how on earth I managed to make the money last all month.

They seemed to find it hard to believe it was possible to make a salary last 30 days and implied they struggled to make what they earn last over a couple of weeks! They've also made comments in the past about struggling with a surprise bill or having to put off a purchase.

I know lifestyles are more expensive over there but they spoke as if they earned peanuts so I'm wondering if I'm wrong to think that's a good salary? They get health cover through the company too so that's not an issue. Is there some other tax or something that I'm missing here? They are East Coast but not in most expensive area (not New York or Boston)

I went to my doctor on a Friday with some symptoms. He scheduled me for a colonoscopy on the following Monday. I definitely prefer that to waiting around for the nhs.
My health insurance copayments are well worth it.

US healthcare, if you have good insurance (and it's not confined to top executives, most cover all employees), is leagues ahead of the NHS, or any other healthcare system in the world. The most advanced treatments and the cutting edge pharmaceuticals, best access to clinical trials at world class hospitals and university hospitals. In big cities.. but not in rural areas.

At an everyday level, the European mutually funded systems are very nearly as good. And more evenly distributed.

The NHS is great in emergencies, but struggles to decide whether Mrs Jones' need for a hysterectomy trumps Mr Smith's hernia. Both Smith and Jones medical requirements are severe enough to prevent them working, but there isn't enough money to do either promptly and get them back to working, earning and paying tax. So they wait and get even more sick.

The NHS was created in 1947 to deal with medicine as it was practised in 1937, plus a bit of WW2 battlefield triage. The current tsunami of demand springs from an ageing population who read about what's happening in the US for similar conditions in 2023, and assume, because they are paying for the NHS via tax, that it should all be available to them. The NHS is very, very good internationally, and highly rated for research but it's not going to stop people getting old and dying.

Hence on balance, I believe that we/UK should be adopting (gradually) a shift to the European model where every individual between 18 and 66, without a serious life-threatening disability, should expect to make a contribution to the cost of healthcare as they consume it. Over retirement age but with a private pension, like me? You pay a proportion of the cost, in cash or on a card, at the desk. The UK seriously needs an intelligent ID system recording a person's residence and employment status and the level of their entitlement to care and benefit. No health card? No record? You don't exist.

My brother in law took a tumble on Subday. Went to urgent care, a step down from the ER, ans got Xray. Fractured his elbow and dislocated his thumb.

The put on a soft cast and sent him to a specialist, who he saw today.

His has surgery scheduled for Friday because the dislocation tore the tendon. His out of pocket cost is $500 + 80% of the singer cost. It will be less than $1000 out of pocket to treat his injury in less than 7 days.

Our out-of-pocket Max is now $6,000 per year for all 4 of us and my kids sre covered until they are 26 years-old. Once we hit the $6,000, our cost is 0 for the rest of the year. We have never actually have hit our out of pocket max.

Plus, when I travel to any other country in the world, I do not have to purchase medical insurance separate. My insurance will cover everything up to and including evacuation back to the US for treatment if needed.

My mom did after spending 6 months in an out of ICU last year. Bills totalled over $1 million. Her out of pocket max was $2500.

Is the "system" perfect? No. Is any system perfect?

Americans and the "American way" are not as horrible as we are made out to be. There have been great strides made after the ACA to ensure that all people get medical care at cheaper cost. Still not perfect, but there is headway.

Sorry, just saw all my typos. Eek!

US healthcare involves lots of unnecessary interventions that are possibly actively harmful. We were on holiday when toddler DS had a seizure. He was given a CT (radiation risk, unnecessary and distressing) and a urine sample was taken via a catheter (INCREDIBLY distressing, but I didn't know what they were doing until it was half way through) rather than a simple pad in his nappy.

A CT scan is pretty standard after a seizure.

Diagnosing Epilepsy & Seizure Disorders

CT Scans
A CT scan is a type of X-ray that creates detailed images of tissue and internal organs. CT scans can help doctors identify any brain abnormalities that might be causing seizures, such as scar tissue, tumors, or malformed blood vessels. They can also identify any spinal fluid circulation problems.

CT scans are not as detailed as MRI scans, but they are performed quickly and can be helpful during emergencies. They are also used when MRI scans are not recommended, such as in people who use certain medical devices or metal implants.

Us doctors, before the ACA, were getting heavy handed with tests. That has cut back quite a bit as well.

I would not consider a CT scan for a child having a seizure unnecessary, but I would have been pissed had the nurse done a catheter without telling me what was happening first and offering other options.

After reading the issues the NHS has with A&E overcrowding, I would think that our Urgent Care process would be a huge benefit there.

Child has an ear infection amd.camt get to the GP? Drop by urgent care and skip the ER. Need an xray or stitches? Go-to Urgent care. Less then 2 hours in and out on a busy day. After hours times available as well.

It is our regular doctor copay of $25 vs the ER that starts at $500 copay just to walk in the door. It was designed to keep unnecessary patients out of the ER. (ER copays are not applied if a patient is admitted to the hospital. Hospital copays would then apply)

It would be interesting to see a medical system built from scratch today in any country. What would be picked from each country in the world to make it a utopia?

I know a lot of Americans have been scared about changing the system. Also quite a number are convinced that they have the best healthcare in the world.

And, yes, I also got great care as well when I lived in the US.

Also agree a NHS style system wouldn't work in the US culture (but imagine how amazng the NHS would be if it had the same money that is spent on US healthcare). In fact, there are so many people employed in administering health care (insurance companies, coders, every large employer will have someone dealing with health) that a NHS model would lead to a rise in unemployment (not kidding - it's that big!!). Plus Americans are well used to paying for health care and appreciating its cost in a way that Brits don't. But there are SO many other models which could be used, the US one is really the worst possible. It only performs well in terms of outcomes once you do get treatment but there are many other metrics on which health care systems are assessed and the US performs dismally on all the others.

And to bring to the topic of the thread, no country spends as much on healthcare as the US does (without even covering all the population) whcih goes some way to explaining why a higher salary in the US might not translate into higher disposable income.

I've lived in other countries with different healthcare models which controlled access to A and E in different ways. There is no one perfect healthcare model, each country has a different context and culture. And it's a decision which metric is important. The NHS does well, for example, on equity and efficiency (yes, surprisingly so but little money is wasted on deciding who is covered by what and seeking payments plus there are economies of scale)

One country, with an NHS style system (i.e. free at the point of service and every resident automatically covered, paid through central taxes) required you to phone the equivalent of the NHS helpline and they would direct you to the appropriate service with an appointment. If you just turned up at A&E with anything less than an immediately life threatening injury, you would wait hours while people with appointments would just waltz in. My DH had a torn knee ligament in an accident, people on the street called an ambulance for him and he was taken to A&E. But because he hadn't made an appointment, he was there for hours waiting to be seen. But when we've gone to A&E with an appointment, we've been seen immediately. And the whole system is integrated through personal ID numbers. When my child was struggling with a chronic illness and we had to call an ambulance and ended up in A&E we were seen immediately with the ambulance sending DC's number ahead to hospital so their file had already been reviewed by the time we had got there and a doctor was ready and waiting to treat on arrival without us having to explain the illness. Amazing service and this with an NHS style model. This would NEVER happen in the US, healthcare is very fragmented (another issue)!!

Another country had competing HMOs providing a government stipulated basket of health services with premiums set as % of income and paid through national insurance. Some minimal copays for some services. HMOs could then compete on additional private services and insurance and differentially charge by age. If you just turned up at A&E and were not hospitalized or and had nothing from a list of things wrong like a broken bone or were not referred by a doctor, you'd be charged for the visit (not crazy like the US but not negligible - like 100 pounds). Urgent care/minor injuries was free. So people think twice before just turning up at A&E

I think I know which country you're talking about @nudnikit - and yes their system works very well. (the last example) although all health systems are showing strain post-Covid.

The NHS has a tendency to undertreat because of scarcity of resources so in its own way it's not a good contrast to the USA. If you look at, say, Switzerland, Germany, France they all tend to come in between the US and UK. And in some cases (like the routine CT scans) there is an evidence base to support the US decision. (Sometimes there is not, such as overprescription of antibiotics for ear infections; US paediatricians are trying to move away from that, but it's more entrenched.)

Thanks for that info.

No system is without challenges I am sure.

I was in Costa Rica last summer and I love what they have.

One of my travelers had a UTI. We just went to the pharmacy. Told the pharmacist the issue and he sold us what we needed.

I can see how, for an adult who knows when they have a UTI or a sinus infection can get treatment without seeing a doctor, thay would be advantagous. Not sure I would feel comfortable for that with a child though.

I'm into the health care system stuff because I studied for a post grad diploma in health care policy while I was in the US. All the policy wonks who taught me - American ones in this case - agree that the US system is totally messed up and no one in their right mind would have intentionally designed it.

It kind of worked when health care was generally cheaper and populations were younger (post WW2). Now with an increase in the elderly population, especially the old-old and lack of robust social safety nets, it's just not fit for purpose any more. US Government has no way to control costs in the way they do in other countries so either they have to restrict care in the public programs provided (mainly medicare but also medicaid and veterans) or suck up the increasing costs (both are happening). With covid this is really hitting home with some hospitals also writing up massive losses due to un- and underinsurance and government committing to cover some costs (but not others).

All in all, US health care costs, including for prescriptions, are increasing way more than inflation. The US is the only developed country in the world where bankruptcy due to medical bills is even a thing and it is now the number one cause of bankruptcy! It's really worrying and despite government efforts to regulate the system (which are generally positive - like ACA forbidding exlcusion of pre-existing conditions) the trend is not in the right direction. The costs are just crippling and a massive economic and social burden.

Yes, my master's degree is in a related area. None of the experts in my program thought the US has a good system. They don't agree on precisely what the "best" system is as different models have different strong points (so it also becomes a question of values and priorities) but I've yet to meet one who says the US is good, as a system.

you'll find some economists who love the free market but not one of them can point to a working example on any kind of scale. The free marketeers also love the consumer directed model but as we can see, shoving increasing costs onto consumers in the form of cost shares doesn't actually slow spending and patients don't actually have the information (and frequently not the time) to make cost directed decisions the way they envision. The most successful cost controls come from the top down.

@MissConductUS A CT is neither necessary nor standard to diagnose epilepsy. DS now has a diagnosis and I know of no child in the UK with his diagnosis who had a CT following a toddler seizure. An EEG is diagnostic.

@onlylarkin that's why we have global antibiotic resistance.

It's not necessary for epilepsy, but what they're looking for is to see if the seizure was caused by brain injury. It is the recommendation of the American Academy of Neurology, so an ER doctor who insists on a CT is practicing within the accepted standard of care.

Exactly. I think any supporters of the US healthcare system are more ideologically driven than any evidence-based analysis.
I recognise that there are excellent treatmeants and interventions in the US and if I had a rare serious disease (and good insurance) I would rather be there than most other places but, at the end of the day, far far more people would benefit from, say, good diabetes care which is much less lucrative and more common among poorer people. If I were a low income diabetic, I would rather be in any developed country than the US for healthcare.

Our healthcare experience in the US was excellent. We had good insurance and lived in a suburban area just outside a major city, so there everything you could possibly need and lots of choice of providers

I could ring my gp, ob, pediatrician, dermatologist, kids neurologist etc and have an appointment usually at a convenient time for me in their lovely office. or go to the walk in center when my DC got stitches. Prescriptions were quick, 24 hour pharmacy open near me! We were happy to pay because the service was great and we had the salary to match.

BUT the stories of people with no/wrong type of insurance! It was just heartbreaking. ACA has helped that a lot, but still people would refuse ambulances, only go to certain hospitals, not go to the doctor or get their prescriptions because they can’t afford them! Medicare kicks in at 65 so many people cannot afford to retire before then as they can’t self fund insurance.

Agreed, the best system is probably a mix where those that can, pay something for healthcare, but we don’t end up with the huge US style inequality.

I think any supporters of the US healthcare system are more ideologically driven than any evidence-based analysis.

Like so much else in the US, I think that support is not so much ideologically driven as vested-interest (at many different points in the "system") driven. I despair that we will ever achieve anything close to health equity in this country.

I don't think we will - because so much of health comes down to genetics, family culture and socio-economic levels.

If being ideologically driven means I don't believe we should sacrifice excellent healthcare for most in order to achieve equal but subpar, government-controlled care for all, count me in. I have 0% faith in any government, particularly the current US government doing anything well, fairly or efficiently.

In the US people also frequently use the words health, healthcare and health insurance interchangeably. These are not even remotely the same concepts.

Food costs a lot more over there tbf as does healthcare.

But yes generally they're paid a bomb more than us over here

Nursing salaries are at least double here vs the UK. A good hospital nurse here with five years of experience will make $100k per year with no problem and with great benefits.

@MissConductUS I saw a journalism assistant role advertised at $65k over there last week.

Assistants in the UK for journalism are paid between £19k and £25k

Funny how the AAN recommends something expensive that isn't used in the UK.

Your comment can be taken at least two ways.

Is it “funny” to you that a standard tool for assessment in the US is not available in UK?

Or do you believe that because of the expense and it’s lack of availability in the UK that it’s not a valid tool?