I didn’t want to risk bankruptcy because of an insurance denial, so I left quickly. Aside from the dismal state of transportation, unwalkable cities, and a self-sabotaging healthcare system, I actually kind of enjoyed my time there. Now living in Europe, I’m poorer but happier too.
Source? I find this hard to believe given the US leads the OECD in terms of household disposable income[1], never mind whatever "Southeast Asian backwater" country you're talking about. It's unlikely "US healthcare profiteering" would affect this. Healthcare spending in the US is 17.6% of GDP, which provides an upper limit on how much it can eat into income. Even if you assume all that's borne by households and subtract that from income figures, the US would still be in #2.
[1] https://www.oecd.org/en/data/indicators/household-disposable...
That doesn't matter a slightest if people can't afford housing. Income is indeed disposed, without much to show off.
The problem with what you said is that it's a statistic lumping all households together. As such it's largely meaningless because it lumps Elon's household with some person living in a trailer park in Montana. They are unlikely to have similar disposable income.
Equally, while health care might represent 17.6% of GDP, this of course provides no limit on any one person or group. Indeed, assuming that most billionaires are not spending 17.6% one can assume the real cost to many I'd much (much) higher than that.
No to the parent's statement about "poorer". There are many things to measure here beyond just "cash in the bank". And there are terms like "middle class" and "majority" which are imprecise.
Nevertheless the point, as an anecdote stands. While America the country is rich, not all the people in it are. Indeed it seems to be increasingly split into rich and poor - the middle class is shrinking.
The good news though is two fold. Firstly most Americans seem happy with this setup (presumably because it maintains the illusion that they can obe day be rich.)
Secondly the majority of (not rich) people believe that having rich people in charge will benefit them. No doubt the incoming government of billionaires is something to look forward to.
Which is all yo say that each country gets what they want. The US _wants_ for-profit health care. They believe it is the best in the world. Other countries think its bonkers and have other approaches. That's perfectly OK.
Indeed this is democracy in action. We vote for people who will best do what we want them to do. Who guide us, not just by their words but their actions. We clearly understand the actions of the incoming guy (he's been there before). He's clearly pro-health-company (not pro health consumer) so this is (quite literally) what people want.
The future looks very bright indeed!
Poorer than people in Bangladesh? Unlikely. Bangladesh per capita GDP is 2,529.08. US is $81,695.19.
might be referring to Malaysia, Thailand, Indo or the PI
This is such a wonderfully HN statement to make because it's so preposterously wrong, yet the author is so confident it's right.
Yes, the worst-case scenario for health expenses is indeed bad in the US, this is true. However, this is not the average healthcare experience. It's not a matter of time until you're slapped with a bankruptcy-level bill.
My wife and I, both in our 50s, have had our share of insurance annoyances and frustrating phone calls, but we've had multiple surgeries fully covered by insurance. And this is the same with friends and family members, including at least 4 cancer treatments that did not lead to bankruptcy-level or even truly notable bills. This anecdote includes many people who died of "old age".
Worst-case scenario bills can be bad elsewhere too. For instance, a friend in Europe had to do a 250K GoFundMe campaign to pay for a life-saving treatment for his daughter because well, the only place in the world that performed the surgery she needed was... Guess where? The US. He faced bankruptcy for this bill, but friends and strangers were able to help him out to an extent. I think he's still recovering from the expense years later.
Medical bankruptcies and financially crushing bills are a sad possibility in the US, and certainly much more likely than in most other places. We need to keep working on this. But the vast majority of people will not have to face this problem in their lifetimes.
I'm also from a "backwater" place in South America that happens to be richer than most places in Southeast Asia. I've lived decades both in the "backwater" and in the US - I happen to know the US fairly well as a result. I choose to live here for a simple reason: the quality of life in this country is much superior than my comfortable lifestyle in South America.
I know dozens of people from different parts of Asia, and I can only remember a couple, let's say <3%, who went back to Asia after living in the US for a significant period of time. These are not poor Asians, in fact a lot of the Asians you meet in the US were relatively well off as they were able to afford the education in Asia which allowed them to immigrate. Nonetheless, they choose to remain here.
All of this said, there is nothing wrong with wanting to go to a low COL place sometime in our lives. I've done this within the US myself, and I would consider another country for a combination of weather, proximity to friends, desire of early retirement or a large property etc. But not because the US is a bad place to live, in fact its very high quality of life is what keeps me from making such move.
Interesting, do you have a link? It’s the first time I’ve ever heard of such a case.
Also you work in tech but weren’t provided or could not buy health insurance? That seems unlikely.
In short, laziest article ever.
Being gay for example is largely mainstream in the US - being trans, not so much.
That said, there are indeed lots of countries in the world that at a local, social level (as well as a constitutional level) are very accepting of all life styles.
Moving country though is not trivial, even for US citizens. It's not like you can up sticks and just move anywhere that best suits you.
If that were going to happen, then it would have already happened. It hasn't, and it won't. It's not healthy to worry about things you have been conditioned to believe by people that don't have your best interests at heart but will say anything to get your vote.
Primary care repeatedly rescheduling appointments further down the road, 2-3 months at a time. At one point it got so bad for my elderly aunt that I straight up asked if they were just trying to "run down the clock".
Primary care doctors saying they will put in a referral to a specialist. Then a month later just getting a photocopied list of specialists in the mail for us to call directly. Go down the line and most are closed or not accepting new patients. Some were even straight up dead (... like rigor mortis, habeas corpus).
One of the two remaining specialists booking 8 months out for an initial consult, the other 5 months.
Billing departments that don't feel it necessary to do the work of completing insurance claims, yet feel entitled to still continue sending fraudulent bills to us personally instead.
Medical equipment providers outright lying about the validity of their fraudulent bills even when challenged with concrete reimbursement rates, and then doubling down with bullying - aka willful fraud.
Needing to put in a bunch of paperwork, then follow up with appeals, merely to see the second geographically closest in-network provider (closer one was having issues) due to living near a state border.
And none of this covers the harder-to-capture dynamics of getting shortchanged on time talking to a doctor because the bureaucrats have deemed that 15 minutes is enough time for an appointment, or having to continually make sure the ball doesn't get dropped on care due to the proliferation of different moving pieces.
The problem isn't all on insurance companies themselves. The real problem is the entire system is broken due to poor incentives where these gigantic entities have been allowed to pass blame back and forth instead of having to own any responsibility themselves. This puts patients in the middle (often when they're in pressing need of healthcare), to get ground up in an ever-growing runaround, rather than any of these businesses having an incentive to minimize the administrative complexity. The "approval/denial" charade for in network care is just one of the most galling games they've made up, so it gets focused on.
I think this is a real case of [citation needed]. Many people will, rightly, point at a myriad of statistics to demonstrate how this can't be true, and that's fine. But, I think we can just use some common sense; what are we talking about? There is no way this is true. Why would even need an immigration policy if this was true? This is just some kind anti-Americanism or anti-capitalism nonsense; that is really the only explanation for such an assertion that I can surmise. I'm also not really sure why working in tech you would be "constant fear of needing healthcare". If that is true then if nothing else the placebo of effect of moving to Europe may have been the best treatment psychologically, certainly cheaper than seeing a therapist.
“Most bankruptcies occurred in middle-class citizens with health insurance” https://www.amjmed.com/article/S0002-93430900525-7/fulltext
If you haven’t been harmed by our system, it’s not because you’re immune. It’s because you’re lucky.
Do you think Southeast Asian countries don't have an immigration policy?
Profiting.
https://www.aha.org/guidesreports/2017-11-03-regulatory-over...
This is inevitable when government is handing out money. Recipients will always game the bureaucratic rules that specify payouts.
Directly paying for cash-priced surgery has become cheaper than the heavily regulated insured coverage. Not only cheaper when including the overhead of having insurance, but cheaper in real terms of a single surgery event.
Here, the test providers get paid by the test. Easy enough to kick back test payments to the doctors.
As for paying by capitation, why would they work extra hours to serve more patients? Or just see fewer patients and relax?
This seems inappropriate for an award for "profiteering". I believe that profiteering requires making a profit at some point. What did they want him to do, take the company to bankruptcy faster? And just eyeballing the margins on #2 [0] it looks they don't make that much money either. Those aren't particularly impressive margins. They compare more to Walmart than Google.
[0] https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-g...
De la torre led a company that sucked cash out of a hospital by separating it from its real estate, and literally sailed off with a couple yachts.
https://www.wbur.org/news/2024/07/11/steward-health-care-inv...
https://www.wsj.com/business/steward-health-ceo-ralph-de-la-...
https://www.beckershospitalreview.com/finance/as-stewards-fi...
This group tore down an institution that took decades of work by extremely smart people to build, and now tens of thousands of people will get less and worse healthcare because of their actions.
Well, obviously. He was CEO of Steward Health Care. I suspect you have misread my comment.
The GP is Bangladeshi. The median Bangladeshi is not an English speaking Dev, and that is probably skewing GP's view - same way how plenty of Devs here in the states think it's common to travel to Japan or Europe multiple times a years or afford $3k in rent.
You can take tap water safety for granted across the US (and why stuff like Flint becomes such a major news story). You can't across much of Asia.
> might be referring to Malaysia, Thailand, Indo or the PI
Doesn't make sense in either of those countries either. Once you leave the capital city and go to Kelatan, Isaan, Aceh, or Mindanao stuff gets pretty bleh (despite the massive strides made in human development).
You won't see open sewers in Turlock or Volta, but you absolutely will in equivalent small towns across SEA (excluding Singapore). Furthermore, while the governments there might provide some welfare, it's not at the same level as the US nor is quality the greatest.
And housing affordability sucks in all those countries as well - just like the US. Sure a 2 bedroom apartment might be $300-400k at most, but median salaries are also around $3-10k (depending on the country).
There's a reason why you see the median Indo, Thai, or Pinoy working as a migrant laborer in the Gulf, or the median Malaysian attempting to migrate abroad to Australia, UK, etc.
The average SEAian isn't going to be a English fluent programmer (the target demographic on HN), so what OP thinks is middle class might actually be that country's upper class.
It's the same way you see Indian techies making $20k a year calling themselves middle class when the vast majority of the country makes less than $5k a year, or the tech bro on HN saying $300K TC is middle class.
I don’t see how he didn’t profiteer from his actions regarding Seward, though. It seems pretty clear that the real estate play he led caused Seward’s financial woes, which he benefited from.
https://en.wikipedia.org/wiki/Rick_Scott
At worst, you pay some fines:
https://abcnews.go.com/Health/wireStory/settling-fraud-case-...
> While dozens of CMS audits have concluded that health plans overcharged the government, the agency has done little to recoup money for the U.S. Treasury.
>In a surprise action in late January 2023, CMS announced that it would settle for a fraction of the estimated tens of millions of dollars in overpayments uncovered through its audits dating to 2011 and not impose major financial penalties on health plans until a round of audits for 2018 payments, which have yet to be done. Exactly how much plans will end up paying back is unclear.
In 2023, GDP per capita in terms of PPP for Bangladesh and USA was $8,242 and $74,578 respectively (per World Bank).
Clearly the USA and Bangladesh are different. Comparing their GDP is simplistic and doesn't really speak to quality of life in either place. Much less does it take into account that two people in each country may in turn have vastly different quality of lives.
In short, using national statistics tells us very little about your life, or my life, or any specific persons life.
I'm not sure this "comparisons are hard" speech is adding much. Differences in wealth are real, measurable, and meaningful, even if they can't be boiled down to a single number. Obviously there are other factors to quality of life; nobody here stated anything to the contrary.
Even more dangerous is they have shown signs of boredom and disinterest in certain areas which would likely allow the unimpeded progression of oppression by those in the administration most motivated to do so. In 2017 there was also a less united front within the federal government as many ideas were considered fringe, but politics in the U.S. has been shoved very far to the right in the intervening years and the Republican party as a majority has embraced being extremists instead of the extremists being a tiny but loud faction.
This is due to the two party system creating a fitness system which necessitates that factions either overtake a party or leave it as otherwise they get no votes, and older party members dying out and leaving seats open to the newer extremists who get an outsized amount of power because the party as a whole needs to vote collectively for a majority decision and just a handful of people can halt that entirely.
EDIT: Moved "unimpeded" so that it clarified who I was talking about.
No, because it's a median value, thus outliers are irrelevant.
But even if it's a median, the point stands. At least half the country falls below this standard.
Equally the distribution of outliers is not balanced. There are a lot lot more outliers (far from the median) on the up side than the down side.
If a sibling comment[1] is to be believed, the "Southeast Asian backwater" in question seems to be Bangladesh. Looking at GDP per capita PPP (ie. adjusted for cost of living), united states is nearly 10x as rich. Is it possible to construct a hypothetical where a country has 10x higher GDP per capita than other, but the average citizen is poorer? Yes. Is that actually occurring? Unlikely.
[1] https://news.ycombinator.com/item?id=42630667
>Nevertheless the point, as an anecdote stands. While America the country is rich, not all the people in it are. Indeed it seems to be increasingly split into rich and poor - the middle class is shrinking.
I don't know how you can possibly interpret the parent comment as just an "anecdote". It's specifically making claims about "the majority of middle-class Americans".
> The US _wants_ for-profit health care
> We vote for people who will best do what we want them to do
> The future looks very bright indeed!
What did I just read.
(Feel free to read some sarcasm / blind adherence to democracy into the earlier post, but its hard to interpret the election results in another way.)
- it’s politically advantageous to never explicitly legislate which rights are taken away. This keeps the issue alive among your base. You never want to effectively enforce that.
- You make an in-group based on obedience to the spirit of a law; a spirit that’s risky to spell out in writing because you know it’s on the wrong side of history.
So, the status quo benefits one party; and is the best that the other party could hope to negotiate.
Disposable income means income after taxes. It does not include any expenses, housing, health care, or otherwise.
from the OECD website:
> Income includes wages and salaries, mixed income (income from self-employment and unincorporated enterprises), income from pensions and other social benefits, and income from financial investments. It is less taxes on income, wealth, social security contributions paid by employees, the self-employed and the unemployed, interest on financial liabilities, and the change in net equity of households in pension funds.
A bit of a clearer explanation here: https://en.wikipedia.org/wiki/Disposable_household_and_per_c...
The reason why the US has such high disposable income is because Americans have to pay for so much more out of pocket than other OECD countries do. Once you factor in health care, education and other social services that are cheap or free elsewhere, Americans are generally worse off than many OECD countries.
The Oxford dictionary states "income remaining after deduction of taxes and other mandatory charges, available to be spent or saved as one wishes."
Mandatory charges, to most people outside of this HN thread, are their bills and other common expenses. Mortgages, utilities, school and incomes taxes, etc are considered mandatory charges.
I'm not saying this to argue with you. Ya'll are welcome to interpret it how you like. But if you don't consider this perspective, you are going to misunderstand what other people intend to express when they use the term disposable income.
> It may include near-cash government transfers like food stamps, and it may be adjusted to include social transfers in-kind, such as the value of publicly provided health care and education.
Additionally from the OECD website:
> Household adjusted disposable income additionally reallocates "income" from government and Non-Profit Institutions Serving Households (NPISHs) to households to reflect social transfers in kind. These transfers reflect expenditures made by government or NPISHs on individual goods and services, such as health and education, on behalf of an individual household.
So you have at least one other person who uses the word like that.
I suppose you can live on the street, or move in with relatives.
On that note, you can also choose not to pay your taxes, but you'll also have to deal with those consequences.
not based on the data
change in median housing prices as per Zillow, since 2017
Minneapolis: +50% https://www.zillow.com/home-values/5983/minneapolis-mn/
Omaha: +80% https://www.zillow.com/home-values/40152/omaha-ne/
St Louis: +62% https://www.zillow.com/home-values/6891/saint-louis-mo/
KC: +94% https://www.zillow.com/home-values/18795/kansas-city-mo/
OKC: +68% https://www.zillow.com/home-values/33225/oklahoma-city-ok/
Des Moines: +68% https://www.zillow.com/home-values/17759/des-moines-ia/
Milwaukee: +119% https://www.zillow.com/home-values/5976/milwaukee-wi/
Indianapolis: +103% https://www.zillow.com/home-values/32149/indianapolis-in/
Little Rock: +38% https://www.zillow.com/home-values/52998/little-rock-ar/
etc.
The housing market in Madison, Wisconsin is crazy. I sold my house 8 years ago, and now its estimated value is 70% higher than my selling price. I know a lot of people in the area who are despondent about the prices.
almost any major city these days housing is much more expensive than it used to be relative to income
Edit: That can never change either, in aggregate, so it’s literally futile to complain about it in general terms.
mandatory charges are "mandatory" in the sense you are "mandated" by the gov to pay them; besides taxes these include social security contributions (some countries have more such "contributions"). The are no mandates (laws, regulations) that require you to pay for housing, food, education, etc.
I think the confusion is that _colloquially_ we refer to "disposable income" as meaning the money we can spend on things we want after we've covered all the essentials.
Also housing is more expensive in the US (total cost, not per sqft), as is food; in fact, the cost of living in general in the US is more expensive than Europe or Japan, with the notable exception of cars and gas.
For example, I just searched cost of living in France vs USA and the first two sites I found gave similar figures of 30% more in the US. Not representative of all of Europe of course but an interesting data point.
https://www.mylifeelsewhere.com/cost-of-living/france/united...
https://www.numbeo.com/cost-of-living/compare_countries_resu...
[0] https://en.wikipedia.org/wiki/Disposable_household_and_per_c...
"Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith."
https://fred.stlouisfed.org/series/TXSTHPI
It's worse in San Francisco, but it's a nation-wide problem.
Florida: https://fred.stlouisfed.org/series/FLSTHPI
Pennsylvania: https://fred.stlouisfed.org/series/PASTHPI
Virginia: https://fred.stlouisfed.org/series/VASTHPI
Vermont: https://fred.stlouisfed.org/series/VTSTHPI
Tennessee: https://fred.stlouisfed.org/series/TNSTHPI
Ok, but what's the empirical justification for this claim? Why is Madison, Wisconsin a rare exception?
When people talk about low cost of living in the Midwest they generally mean more depressed areas. I live in a very low cost of living rural (15k ppl) community in Illinois, with half an acre on a lake in a 3000 sq foot house where the mortgage is only 250k. Of course, if I ever lose my remote job, I'd never be able to find work. Most of the people here work at one of 2 medium-sized factories or the hospital. The median household income is only $40k.
The town I live in is a far more common case for the rural Midwest.
> most of FAANG has outposts there to draw the CS talent.
I'm aware of a small Google office in Madison, but that's it.