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)

@saltinesandcoffeecups that is a great example. Thanks for sharing that.

Yes, I know that but has nothing to do with what I wrote.

Of course you'll be treated in the ER but that doesn't mean it's free. You WILL be chased to pay the ER bills if you don't have insurance. You MIGHT be able to negotiate them down but that's up to the hospital and providers (don't forget you don't JUST get a bill from the hospital). Worst case, you'll have huge medical debt and end up in bankruptcy as a result including losing your own house.

Also note that stabilized does not mean treated. You can still be very ill but you won't be treated if you're stable (and can't pay).

YY, @saltinesandcoffeecups

And patients can also apply to the hospital financial assistance office if a bill is going to cause financial hardship or isn't affordable at all.

My experience, living in a US suburb, was totally different to yours clearly. I found public transport woefully lacking. And I was in between two major metropolitan areas, just an hour from each, most certainly not rural or far flung.

The US isn't subsidizing the NHS with meds, at least not intentionally. Any normal healthcare system as in most developed countries has purchasing power and can negotiate prices down. The US can't do that because it's too fragmented so the pharma companies can make all their profits off their backs and there's no regulation to prevent it - even insulin is ridiculously expensive. They do it because they can and the US system does nothing to protect the patients, even for life saving drugs. IIRC the dems have tried to pass legislation which has been blocked by the reps.

Yes, you can ask and beg for charity. But if they know you have assets, you can bet your life that they are coming to come after you. That's why medical expenses are the number one cause of bankruptcy in the US. It's a disgrace.

Your hostpital may be in network but your provider might not be. I never had a ER receptionist decide which doctors would be providing service or checking who is in which network. But hopefully this has changed with the new legislation. Thankfully I didn't have a mjaor medical issues when I lived in the US, I shudder to think of dealing with all the bills if I did.

@knitnerd90
the US also puts relatively little into public health. It's not profitable after all and has to come from gvoernment mainly. Together with the high level of inequality, it's little surpise health outcomes are so poor in the US. The awful health care system (and i mean this as a system - I know individual care can be excellent if you can afford it) is just the icing on the cake

@mathanxiety
Read these experiences of Americans and tell me that medical debt and bankruptcy is not a major problem and that the hospitals and providers are so charitable
www.nytimes.com/interactive/2016/01/11/upshot/12up-medicaldebt.html

@nudnikit

'Asking or begging for charity' consists of filling out a form online, or printing it out and handing it in at the hospital office. I've accompanied a neighbour who was hard of hearing and helped her do this on behalf of an adult family member. It wasn't complicated or in any way embarrassing.

I have personally entered into payment agreements with a dentist when exH neglected to tell me he had dropped dental insurance for the DCs and one of them broke a tooth. This is possible with hospitals too.

I'm not disputing your contention that medical bills are the leading cause of bankruptcy in the US. However, bankruptcy in the US doesn't have the same effects as it has in the UK. Lots of people come out the other end of chapter 11 and move on with their lives.

@mathanxiety
With all due respect, I think you have some serious rose-tinted glasses on the impact of medical bills on people's lives because your experienes have been positive.
The system as it is is ruining people's lives. As a system, it is possibly the worst possible one out there on nearly every metric on which these systems are evaluated (particularly on equity and efficiency) and the fact is that no other country has emulated the US model because it is a failing one. Of course, I know it works for a lot of people. I know that ACA, expanded medicaid, CHIP and other provisions help but they are plasters on a gushing wound. The core of the problem is the way the system itself is set up.

IIRC the dems have tried to pass legislation which has been blocked by the reps

The Dems had both chambers for the last two years but did fuck all to fix it because they simply don’t care to.

tbh medical care is fine for the majority of people, I think people fear changing it will make it even worse.

The actual service is amazing compared to anything I’ve experienced elsewhere, hardly anyone in the US would accept NHS style treatment tbh. But there are definitely other systems worth studying and emulating for sure.

And I have to reiterate, I don’t understand why it should be surprising that American salaries are higher, or why British people don’t want to believe it’s true! Sounds like a lot of cope here tbh

The American economy has been the most productive economy for decades now, and the living standards and wages reflect that

@Krayvon2

having lived in the USA and have had green card the salaries are completely incomparable as costs in the different countries are so different

ie medical costs
local taxes
car insurance etc.

until you live there you won’t understand it all

@peeweechigs they qualify for Medicare or whatever the alternative is now

In our company there are different salary grids for different countries.

That's not really true. They had 49 votes plus Joe Manchin in the senate, and no hopes of overcoming the filibuster.

There is significant variation, based both on state law and hospital policy, on how easy it is to get financial assistance. I would not have rose-tinted glasses over it, but some states have stricter charity care laws than others, and some hospitals are much more aggressive about pursuing debts (and there are different state laws governing their collections).

That's not really true. They had 49 votes plus Joe Manchin in the senate, and no hopes of overcoming the filibuster

You are making excuses. Joe Manchin votes with his party most of the time. Keep in mind the health insurance lobby in America maxes out their donations to Dems, so their ‘clients’ aren’t going to change the status quo in a meaningful sense

It's not a 'system' - it's a hodge podge.

www.cnbc.com/2022/06/22/100-million-adults-have-health-care-debt-and-some-owe-10000-or-more.html

The majority of patients with debt owe less than $2500. The vast majority owe less than $5000.

Many patients put medical debt on a CC. Many have payment plans. Some get either a total or partial write off from the hospital or lab that charged them.

Personal bankruptcy filings have fallen by approximately 25% since 2020 to approximately 370,600 in 2022.
www.statista.com/statistics/817911/number-of-non-business-bankruptcies-in-the-united-states/

And again, bankruptcy in the US and the UK are two different animals.

I've noticed this OP - I work in law and some of the American law firms with UK branches offer significantly higher wages than some of their UK equivalents (although not always the case). The wages of these American companies continue their "American style salaries" even in their UK branches and offices meaning that they're much higher than the average for a similar UK firm. I'm sure there's a multitude of reasoning behind this but it does make these firms more attractive to work for.

I've had two babies in the Uk and not paid one penny before or after to have them. And that's the norm in the Uk unless you specially opt for private and most people don't. I can't imagine saving up and paying afterwards 2-300 $ per baby!

Saving up is a lot easier when you are on a decent salary.

I'm not saying about the ability to save up, it's the idea of it! I love our nhs and that our healthcare is free at source.

A simple comparison of NHS vs our insurance coverage:

NHS: My brother became ill in July, told finally in October he'd be seeing heart surgeon - kept getting bumped, finally saw him in January, major surgery scheduled for late April. He's in very bad shape, but has to wait. I hope he makes it that long.

US: My DH had his annual physical on a Monday, heard a murmur, sent for tests same day. Next day met his doctor who said he needed to see a surgeon - but the best one in California (world renowned in this particular area) might take a while to schedule - did he want to wait or see someone that day? He elected to wait. Saw the superstar surgeon 8 days later,, who said 'well, it is not a critical emergency, so we can wait. How about next Tuesday? Had the surgery, was in ICU for 7 days then CCU for 3 more, then discharged with home care daily, if he wanted it. Had follow up exercise class for 8 weeks. All went extremely well.

Our bill? $4,000 - which is the annual maximum out of pocket for a couple, on our plan. Cheap at the price, and once that is paid every other appointment, surgery, medication, whatever, is covered for the calendar year. My work gives me $1800 annually towards that out of pocket, so actually only $2,200 out.

It is very expensive for my employer to cover us both (about 32k a year for medical/dental/vision) but it is a Cadillac plan, and one for which I'm ever grateful. Not everyone is so lucky.

My parents both got incredible care from the NHS, pre-pandemic, which continued until their deaths. I wish it was that way for everyone.

A simple comparison of NHS vs our insurance coverage:

I've never received care from the NHS, but my experience with surgery with my insurance in the US was similar to your DH's. I've had surgery twice in the last two years. One was outpatient surgery to resolve a case of IT Band Syndrome, and the second was spinal surgery to treat sciatica. Neither condition was life-threatening; they were just painful and limiting.

In both instances, I had an initial exam with a specialist orthopedic surgeon, then MRIs within a week, a presurgical exam with my GP as both were done under GA, and then the surgery. All was done within six weeks. The follow-up care was scheduled when the surgery date was booked. The system may be bonkers, but it does deliver very high quality care without unnecessary delays.