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)

It's possible if you're disabled, since disabled people are also on Medicare. But yes, for the 40%, I meant Medicaid.

Americans often mix up the two programs because the names are so similar. And because Medicaid is administered by the states, some rebrand the programs. In California, for example, Medicaid is called Medi-Cal.

seniors.insurance.ca.gov/hc/medicare-and-medical.cfm

This is also the interesting thing about the US. With medicaid, medicare, CHIP, the different state subsidies (expanded medicaid etc) , veterans' care and support to government hospitals, the public spending (as % of GDP) is about the same as the UK. So Americans pay about the same in taxes for health as they do in the UK. But then they have all the private spending on top (employer and out of pocket) which mean that they spend more than double but still have significant numbers uninsured and poorer health outcomes on many indicators - not to mention medical expenses being the number one cause of bankruptcy (which can happen even with insurance). The US health system is probably (as a system) the worst possible.

The quality and availability of medical care is not the only determinant of health outcomes. What drags the numbers down in the US is obesity and substance abuse.

Medical expenses were a much more common cause for bankruptcy before the ACA, which caps annual out-of-pocket expenses for insured patients.

www.healthcare.gov/glossary/out-of-pocket-maximum-limit/

In the last census, I recall 92% of the population had medical coverage, either private or public. The system is bonkers but does have some redeeming characteristics.

And, it seems, the more you make here in the USA, the less you pay in taxes. For a few years, I had about $2,000-$3,000 taxable income (Social Security is not normally taxed) annually. Not enough to have to file for. One year I did have to file in order to get a stimulus check (during the early part of the pandemic). My taxes were less than $200. I found, to my horror, that I paid MORE in taxes on my little income that year than then-"President" Trump paid.

Of course it's not fair to evaluate the US healthcare system on outcomes like life expectancy and infant mortality due to the impact of social and evironmental factors.

And things definitely got better under ACA

I'm not bashing American but, nonetheless, as a SYSTEM, the US healthcare system is the worst possible model. Tying healthcare to your employer is a terrible idea (it only happened due to caps on salaries in WW2 when there was a labour shortage and employers started to offer extra perks). Massive amounts of money are spent on administration (someone has to decide what's covered and what isn't and deal with all the back and forth). The system is terribly fragmented between different suppliers. Even with ACA there are still many who are not covered or who do not have sufficient coverage. And the pricing is insane with costs off the charts (especially prescription costs, even for things like insulin), it's not even like a marketplace where you can shop around for the best deal.

And yet we don’t have to spend our hospital stays in a 4-8 bed ward eating soggy sandwiches. or worse in a hallway. We can see any doctor we want in a reasonable timeframe. And our parents aren’t left for over 24 hours on the floor waiting for an ambulance after a fall.

Pssst…here’s the big secret in the US…most people are ok with what they spend for the services they receive.

Women see gynecologist yearly, their children see pediatricians as the norm, if I know I have a specialist need I call that specialist for an appointment. I don’t wait for a GP to tell me my problem is worthy. The poorest among us give birth in the same private rooms as the the well to do. My mom…on Medicare had a 24 hour 1 to 1 aide assigned to her in the hospital.

Oh and if I call for an ambulance, be it a stubbed toe or a heart attack. The response time is 4-6 minutes.

All of the above is an average experience of an American in our system.

The difference between the poor and those with insurance is how much is written off by the the providers… and yes I’d rather be bankrupt than in pain or dead.

If you’re enrolled in some of the medical assistance programs you may have a few more hoops to jump through. But they are out there.

This is related to what I do for work (so I really should not have made that typo about Medicaid! I shall blame autocorrect). The US system is a giant set of kludges. It's not something anyone would intentionally design, but it was set up piecemeal, and once a block is in place, it becomes very difficult to dislodge.

It is true that our relatively poor outcomes don't necessarily reflect the quality of care, though it's doubtful that obesity is as big a contributor, because obesity maps strongly onto other social determinants of health such as poverty and race; obesity itself may be causing a lot less than we think. The US invests relatively little into closing social gaps and that winds up on the back of the healthcare system. There's issues such as the "deaths of despair" amongst working class whites, especially men. We wind up with a system where some people get too much healthcare and others don't get enough. Here near a major city, the health care is world class. Not only does DC have several excellent hospitals, I'm an hour from Baltimore, which has two more, including Johns Hopkins which is one of the best in the world. Now go to the Mississippi Delta and it's like being in an entirely different country. The gaps in health insurance snowball: when a woman only gets proper medical care during and for a short period after pregnancy, chronic health conditions aren't properly treated. There's no real system for resource allocation other than the market. Because Medicare pays less than private insurance and Medicaid least of all, hospitals in poor areas (and often in rural areas) struggle to stay open. There is a crisis in rural healthcare that people in cities don't really hear about. A work friend of mine worked on the rez for IHS and her stories were heartbreaking.

In an ideal world, we would spend less than we do, but more than the UK does. Administration and insurance profits aren't as huge as some politicians would have you think. What drives up costs is that Americans pay far more for identical products and services and there is little to no cost control. It's good that nurses here are properly paid, but look at device and drug costs: A Mirena coil costs the NHS about £90 last I checked whereas the US cost is nearly $1,000.

It's good that nurses here are properly paid, but look at device and drug costs: A Mirena coil costs the NHS about £90 last I checked whereas the US cost is nearly $1,000.

So in other words Americans are subsidizing the NHS. You’re welcome ☺️

That’s the other part of the equation that doesn’t ever seem to get discussed. All of those fancy new drugs that are developed by US drug companies… Get paid for by US health insurance companies>consumers but sold at a discount to other health care systems. I haven’t seen the NHS develop a life changing drug in awhile. Why is that?

Dont you even have to pay to subscribe to the fire engine?

It’s a mad world.

What?! No. Sheesh.

Some very rural people do, it’s because they don’t pay for it their property taxes. If they don’t pay the subscription they will be charged for the response. It is not the norm. In these areas the typical fire department is volunteer and the fee goes toward equipment

Well just googling now and in big cities it seems not. But I swear I remember watching something where the neighbours hadn’t paid their subscription and their house was on fire but the fire service turned up to wait for the fire to jump to the next house who had paid so they could put those specific flames only out. Mind boggling.

Mind-boggling indeed. It's completely obvious that this makes no sense and did not happen.

It really does happen but think ass end of Montana or North Dakota. Not NYC or Cleveland suburb

To add the taxpayers of those rural cities could vote to fund a fire department through taxes, but choose not to. So they pay the fee as a subscription or gamble they won’t need the service. Really their choice all around at the end of of the day.

It happens but it's extremely rare. My county doesn't charge residents for ambulances either. There are some parts of the US that are extremely rural and have almost no public services.

the data suggests that in most cases the US isn't subsidising the NHS. It's just pure profit. See, for example, how insulin prices have risen since 2006 despite the product not changing.

pharmaceutical companies are international, not just American (eg GSK is British, Novartis is Swiss, etc). The NHS doesn't really develop its own drugs, though research is certainly done at NHS hospitals and facilities. American pharmaceutical companies do benefit from the government sponsored research at the NIH and universities. This is why Boston is such a biotech hub.

This and @knitnerd90 are both correct.

We pay the highest prescription costs in any country, I think. I am no expert. But all these US companies are doing all the research and then charging us high prices, while we get to watch other countries pay much less for the same drugs. Plus, the US Government may have helped with funding those projects through research grants and tax breaks.

So basically, we are paying for the research and then paying again to use it.

My family is lucky as we have excellent healthcare because it is a global company not based in the US, but has offices in nearly every large city, our health insurance costs are fairly low.

I can be seen same day in many cases for acute illnesses and surgery schedule happens within a month. I can see a specialist without a referral for anything. Our insurance pays for mental health treatment (ACA law iirc) the same as medical appointments. $25 or $40 co-pay to see a therapist or Psychologist.

Canadian's come across the border all the time for quicker healthcare.

I think the idea of the NHS is good, but I prefer our system. Best would be to somehow figure out the mix of the two. I cant not imagine calling an ambulance and having to wait 24 hours.

Also, I have a relative on Medicaid who has an autoimmune disorder and gets the same treatment I do with the same doctors. She pay 0 for her Medicaid and 0 for any visits, including the infusions she needs.

Fire and rescue, and police, are paid through property taxes. I have never heard of a subscription service for these and have lived in 5 different states in all areas of the country. Though maybe it does happen in very rural areas.

My mom lives in small town that has a volunteer fire department. Still funded through property taxes (they usually have 1 paid employee plus the cost of keeping the equipment). Though they do bill you for mileage if they have to drive you into the next biggest city.

On another note, it is helpful to remember when talking about medical costs in the US, the Health and Pharmaceutical industries are the #1 contributors (higher even then the NRA) to campaign finance and their lobbyists are very successful. Both Democrats and Republicans take campaign donations. That is why our healthcare system is the way it is. But guess who has to change it? The very people who benefit from it.

You also don't need to be far flung to require a car, you just need to be out of the city centre

That's not true at all.

Most larger metropolitan areas have decent public transport networks. Suburbs that were developed before WW2 - a huge number of communities, which are home to millions - enjoy the benefit of the networks that were built before the car culture of the 50s and 60s.

If you move to a smaller city, your options may be limited. Similarly, moving to a rural or semi rural area will limit your public transport options in the UK.

@nudnikit

I've had a good few different health insurance policies over the course of 30+ years. One of the first things I've done is check what hospitals are in network, and tbh, my experience of taking DCs to emergency rooms is that the ER receptionist has taken my insurance card and verified acceptance before any medical assessment is started.

The No Surprises Act has eliminated the need to wait until you're home from a vacation, etc, before seeking medical help.

There is a big sign in every ER in the country that says all patients will be treated and stabilized regardless of ability to pay. If you don’t have insurance a social worker will come to you to help you apply for assistance if applicable otherwise you will receive a bill and can work out payment arrangements with the business office. No one is turned away for emergency care.

Here is an example… Guthrie OK, population 10K. (Located in the middle of OK…and found through a quick google search)

It is really not common and the vast majority of people in the US are covered by fire departments paid for by local property taxes, even if staffed by volunteers.

www.cityofguthrie.com/261/Rural-Fire-Subscription-Program

I'm in the US and I get 6 weeks vacation a year, 10 sick days, my birthday off, 14 holidays and what we call 4 recharge days. I can also take off 4 days a year to volunteer.

I have been with the same company for 25 years. I work in the software industry.

My husband is in the manufacturing industry. He has been with the same company for 5 years and gets 3 weeks vacation a year along with 10 holidays.

The days off I mentioned above are all paid.