McDonalds helps it's employees budget! (Irony)

[LaCroix]

This is baffling.
In Europe, McD is one of the "better" employers for unskilled labour.
In Austria :
1.211,-€/40hrs (which is minimum wage, but other companies would only take you part-time), about one third goest into tax and insurance, so you take 800€ home.
You get an Xmas and summer premium of 1 month's pay, each, 5 weeks paid vacation.

If I add the numbers on the employer side up, McD pays easily 3x as much per employee than in the US, with same sales prices, but less volume (we simply eat less), and still makes a shitload of money.

[Jub]

Just goes to show how much American's let themselves be pushed around by big business; wages don't get that low in places where people don't vote against their interests and agree to not work for peanuts. The worst part is that those types of policies tend to leak north to poison Canada too.

[GuppyShark]

This is a colossal beat up. It's probably a copy + paste of a sample household budget from whatever course McDonalds used to put this program together.

[PainRack]

Sometimes.... you guys don't know how "good" you have it.

There is no min wage here, but the average Mac salary is around 5 dollars an hour for fastfood workers.

Their age? A good portion of them are the elderly, the old old.

The "good" thing is that due to the pro housing policies of the past, most of these employed do have a house to stay in and are likely to have most of the mortage paid(a quirk of demographics and history, the old old who don't own a home aren't usually gainfully employed in steady jobs).

But hey, no worries. I'm sure the fact that they pay no income tax and most probably earn too little money to even contribute to payroll tax(a personal savings account rather than payroll) makes this all hunky dory.

[AniThyng]

Sometimes.... you guys don't know how "good" you have it.

There is no min wage here, but the average Mac salary is around 5 dollars an hour for fastfood workers.

Their age? A good portion of them are the elderly, the old old.

The "good" thing is that due to the pro housing policies of the past, most of these employed do have a house to stay in and are likely to have most of the mortage paid(a quirk of demographics and history, the old old who don't own a home aren't usually gainfully employed in steady jobs).

But hey, no worries. I'm sure the fact that they pay no income tax and most probably earn too little money to even contribute to payroll tax(a personal savings account rather than payroll) makes this all hunky dory.

That still sounds somewhat like the wages for a McD's worker here, which is something like rm800 a month last I checked.

A small fortune for a 17 year old on his long school break, but not for anyone else.

[TheHammer]

Just goes to show how much American's let themselves be pushed around by big business; wages don't get that low in places where people don't vote against their interests and agree to not work for peanuts. The worst part is that those types of policies tend to leak north to poison Canada too.

Why would anyone expect to make a lot of money working as a front line employee at a fast food restaurant? I also don't understand the presumption about McDonalds only paying "minimum wage". It was my first job when I was a teenager, and even then I didn't start at the minimum. I also was given a raise after my first yearly review. Quite frankly, if you were making a "career" out of working at McDonalds you'd like move into management at some point after a few years, unless you turn out to be a shitty employee. Where you go from there is up to your own talent and ambition.

[Jub]

Just goes to show how much American's let themselves be pushed around by big business; wages don't get that low in places where people don't vote against their interests and agree to not work for peanuts. The worst part is that those types of policies tend to leak north to poison Canada too.

Why would anyone expect to make a lot of money working as a front line employee at a fast food restaurant? I also don't understand the presumption about McDonalds only paying "minimum wage". It was my first job when I was a teenager, and even then I didn't start at the minimum. I also was given a raise after my first yearly review. Quite frankly, if you were making a "career" out of working at McDonalds you'd like move into management at some point after a few years, unless you turn out to be a shitty employee. Where you go from there is up to your own talent and ambition.

Australians, Canadians, and Europeans get more wage for the same job. Period. US wages for low end jobs are substandard among the Western world. Period.

Your justification of 'you can move up if you're good/lucky' is the entire reason why the US is in the state it's in. Everybody thinks like that, but the reality is very few people move up significantly in the corporate ladder for the simple reason that there are less good jobs than people who want them. In reality the low end jobs need to have higher wages so people can live on the jobs that many young families get trapped working in.

[lance]

Sure there is. Follow my advice and I'm sure you could cut costs to under $800/month. Forget the second job; you can still save money with only one McDonald's job. Save up for a few years, then go part time and get an associate degree from a community college.

How the FUCK are you going to pay for college on that budget? Seriously? You can't.

I did for over a year, and could of gone on longer if I sought out student grants, and public aid.

[Broomstick]

I flat out don't believe that.

Of course, if you could provide proof I might change my mind... but I just don't see that happening these days.

And your statement - that you did for a year, but couldn't continue without grants, aid, loans, etc. - would seem to work against your assertion.

[lance]

It was about 5 or 6 years ago, so if that's out of these days then what I said doesn't apply. I don't think things have changed too much since then, but I could be mistaken

I was staying with a coworker who lived about 10 minutes from work for either 200 or 250 a month, took the bus to the CC. I think I was making minimum wage for Michigan then. So I was probably making 600 average month, 800ish in the summer 400 during the winter. I think a credit hour at the college was 66 dollars at that point. Save up during summer, I know I borrowed a some text books, and used the library for some of the other reading material.

I had to move back in with my parents due to the remodel that happened killing my hours, which I think I also could of filed for unemployment at one point but didn't as the store was fully closed for a week

[Broomstick]

When I checked last year, in-state community college in my area was $90-110 per credit hour, or nearly twice what you were paying. Sure IF you can get rent as low as you did, or free (like an 18 year old still living at home with the parents) you might pull it off, but around here the bus service is largely quite limited and does not go to most schools, which might make car ownership essential to get to work and/or school.

[fgalkin]

Living with parents changes everything. I went to a 4 year, $3200 per semester public university while living at home with my parents and ended up with a net $500 bonus per semester after FAFSA and scholarships which I used on books.

Have a very nice day.
-fgalkin

[Broomstick]

While there are some exceptions, most of the people I've known who lived with their parents while going to college lived rent-free, also with no utilities and no grocery bills. Makes a HUGE difference if you don't have to pay for those things, but that budget they listed clearly assumes the person is not living rent/utility/etc. free.

[energiewende]

This budget is quite similar to mine. I earn about the same salary (albeit from only one job). My rent is lower with all utilities inclusive. I do not own a car. My combined insurance costs (including private health) are about 70/month. I have a pay-as-you go handset and no landline; I probably spend about $10/mo on my phone and international Skype calls combined. So, this overestimates my spending by quite a bit.

The two sticking points, I think:

1. The car may be necessary for some, although I live several miles from work. PersonallyI see this as an advantage because I can combine exercise I would do anyway with commuting and come out ahead on free time over all. Assuming you work two jobs at McDonalds - I mean, do people in such a position really live >5 miles away in the suburbs in the US?

2. My health insurance is considerably cheaper than it 'should' be because I do not make old age care contributions. It's nonetheless quite a bit more than is listed in their budget. So I'm not sure what is going on there; I have no experience of the US system.

Australians, Canadians, and Europeans get more wage for the same job.

If at the very low end of the market, certainly not in general. Technical jobs in the US pay quite a bit more. USD also buys more than EUR, GBP or CHF even after the nominal exchange rate.

[Jub]

Australians, Canadians, and Europeans get more wage for the same job.

If at the very low end of the market, certainly not in general. Technical jobs in the US pay quite a bit more. USD also buys more than EUR, GBP or CHF even after the nominal exchange rate.

At the highest end, but quality of living at the lower end of the scale sucks a ton and only when you cross the midway point of middle class does it start to climb away to any real degree. Plus one good illness won't spike your premiums or run you dry and for the most part infrastructure is better. America is nice at the top and pretty bad down the hill from there.

[Broomstick]

1. The car may be necessary for some, although I live several miles from work. PersonallyI see this as an advantage because I can combine exercise I would do anyway with commuting and come out ahead on free time over all. Assuming you work two jobs at McDonalds - I mean, do people in such a position really live >5 miles away in the suburbs in the US?

Absolutely. Americans have some of the longest commutes, both in time and distance, anywhere in the world. It is far more common to live greater than 5 miles away from work than closer than 5 miles.

2. My health insurance is considerably cheaper than it 'should' be because I do not make old age care contributions. It's nonetheless quite a bit more than is listed in their budget. So I'm not sure what is going on there; I have no experience of the US system.

Well, if it weren't for the highly limited subsidized insurance I have the lowest monthly premium I've ever been quoted for just me, a healthy female with no pre-existing conditions other than allergies (and yes, that is sufficient to get you wholly excluded from some policies!) was $356/month and that was decades ago. Last quote I got for my spouse and me for private (not employer-sponsored) health insurance was $1,200/month. Let me repeat that - a premium of $1,200/month. Co-pays and deductibles were heavily featured in the policy. It's that crazy. Granted, a healthy 20 year old male with no pre-existing conditions is going to do better than that, but not all McDonald's employees are young, male, perfectly healthy, and 20.

[Simon_Jester]

There's a vicious cycle in American health insurance.

For one, the insurance companies and the hospitals are in a sort of bidding war- the insurance negotiates reduced-cost services, but the hospitals have to worry about their bottom line, so they keep inflating the "baseline" cost of their services. Because the vast majority of their patients are going to have big chunks of that price subtracted automatically before the hospital sees a dime.

This makes getting medical care without health insurance ruinously expensive.

Meanwhile, because the care is so damned expensive ('charge what the market will bear,' when the market is people who will DIE if they don't get the service)...

...If you're not actually suffering from something you believe to be life-threatening in America, it is probably more cost-effective to ignore the doctor and live with a 19th century standard of medical care. That is, if you get sick, you take over-the-counter medications, hope you get better, and possibly listen to quacks and "self-help" experts who tell you you can meditate your problems away. Because the alternative is to risk paying hundreds of dollars for an hour with a guy who will tell you to take two ibuprofen and call him in a week if that doesn't work out for you.

But at the same time, this means that basically healthy people in America who don't automatically get health insurance by default don't have health insurance. The insurance companies (logically) assume that anyone who comes to them wishing to buy the insurance probably has something wrong with them, or expects there to be something wrong with them. So they jack up the prices on that assumption.

That's part of the point of Obamacare trying to force everyone to buy insurance whether they want it or not. If they can compel people to buy insurance on the "exchange," it expands the purchase pool somewhat, and hopefully breaks the deadlock. It'd be more efficient to adopt a nationalized system like the rest of the developed world, mind you, but I guess baby steps are all we can hope for.

[energiewende]

I live in Europe and have a fully private insurance. Admittedly I'm in an unusual situation; it is basically a travel insurance but gives full coverage for any illness or accident I may experience in the next few years. Old age care is another issue, but probably that should be paid for out of one's pension rather than out of a healthcare budget.

It's not at all clear to me why the US system is so expensive. Many in fact almost all countries have private doctors and hospitals, paid for by private insurances (even if they are subsidised or regulated by the government in some way). People from my country will fly to India &c. for non-urgent private care paid out of pocket, even though their government insurance will provide these services, because it's so cheap it's worth it just to jump the queue. I'd reason that the US's problem is therefore supply side rather than demand side. Too few doctors and too much liability. Both of these can only be solved with more competition, rather than less. In particular, the US should expand medical school to anyone who is able to pass the exams, like law school, and permit limited liability insurances to be offered.

I think that Obamacare will solve one big problem, that some people have no cover at all. But it is unlikely to make the system more efficient, and by increasing the customer base will make it more expensive in total.


edit: Another thing I'm not fully conversant in, so sorry if this is not true: but it seems like most of the 'pre-existing conditions' problem is caused by the link to employment. If you lose your job the coverage is interrupted and suddenly your condition becomes "pre-existing" even though you were insured when the condition began. This is very damaging. Any subsidy direct or indirect for employer-linked health insurance should be removed, and life-long transferrable plans should become the norm. Unfortunately Obamacare moves in the opposition direction. Alternatively, plans should offer payment for the life of a condition if it is discovered during the life of the plan, just like how if become permanently disabled a life insurance might pay out every year for the rest of your life, not just until you stop paying more premiums!

[Broomstick]

Old age care is another issue, but probably that should be paid for out of one's pension rather than out of a healthcare budget.

Great notion, except that very few Americans have actual pensions any more.

It's not at all clear to me why the US system is so expensive. Many in fact almost all countries have private doctors and hospitals, paid for by private insurances (even if they are subsidised or regulated by the government in some way). People from my country will fly to India &c. for non-urgent private care paid out of pocket, even though their government insurance will provide these services, because it's so cheap it's worth it just to jump the queue. I'd reason that the US's problem is therefore supply side rather than demand side. Too few doctors and too much liability. Both of these can only be solved with more competition, rather than less. In particular, the US should expand medical school to anyone who is able to pass the exams, like law school, and permit limited liability insurances to be offered.

Um... I really think you need to study the problem more before attempting to form an opinion.

The US is actually well supplied by doctors, both home grown and imported. Quite a few foreign doctor immigrate here because their compensation is vastly greater in the US than almost anywhere else in the world.

It's actually a multi-factorial problem. Among those factors are physician incomes (mostly among the specialties - general practitioners and those specializing in geriatrics earn much less than, say, surgeons), liability costs (including defensive medicine), for profit drivers, the insertion of the insurance company middle-men, all of whom have incomes sucking money out of the system, oversupply of advanced technology, over utilization of both technology and care, and perverse incentives that drive costs up that doesn't exist under universal health care systems.

Keep in mind that the private insurance sector in the US, for large segments of the population, have no competition because either you get private insurance or none. In other places, such as Germany, the private insurers have to compete with the public system and thus, if they drive up the costs too much people will simply abandon private insurance for the public.

I think that Obamacare will solve one big problem, that some people have no cover at all. But it is unlikely to make the system more efficient, and by increasing the customer base will make it more expensive in total.

Two factors that make the system as is currently more expensive is that the enrolled people are weighted towards the sick - healthy people can and do forgo insurance and pay nothing into the system. This means the costs are not spread widely and the cost per person goes up. The second problem is that preventive care is often avoided or unaffordable, meaning that illness and other problems progress much farther before being seen by a doctor and wind up costing much more than if they had been caught early.

edit: Another thing I'm not fully conversant in, so sorry if this is not true: but it seems like most of the 'pre-existing conditions' problem is caused by the link to employment. If you lose your job the coverage is interrupted and suddenly your condition becomes "pre-existing" even though you were insured when the condition began. This is very damaging. Any subsidy direct or indirect for employer-linked health insurance should be removed, and life-long transferrable plans should become the norm. Unfortunately Obamacare moves in the opposition direction. Alternatively, plans should offer payment for the life of a condition if it is discovered during the life of the plan, just like how if become permanently disabled a life insurance might pay out every year for the rest of your life, not just until you stop paying more premiums!

You are incorrect. During the Clinton years the laws were changed. If you are presently insured and change insurers (usually due to job change) you can NOT be excluded due to pre-existing conditions. If, however, you ever have an interruption of coverage longer than a certain amount (30 days, if I recall) they you can be excluded at will, or anything to do with your pre-existing condition, which I assure you will be interpreted as broadly as possibly by the insurance company.

They also put a stop to classifying birth defects as a pre-existing condition, thereby letting the insurance companies off the hook for things like correcting a cleft palate.

[Simon_Jester]

edit: Another thing I'm not fully conversant in, so sorry if this is not true: but it seems like most of the 'pre-existing conditions' problem is caused by the link to employment. If you lose your job the coverage is interrupted and suddenly your condition becomes "pre-existing" even though you were insured when the condition began. This is very damaging. Any subsidy direct or indirect for employer-linked health insurance should be removed, and life-long transferrable plans should become the norm. Unfortunately Obamacare moves in the opposition direction. Alternatively, plans should offer payment for the life of a condition if it is discovered during the life of the plan, just like how if become permanently disabled a life insurance might pay out every year for the rest of your life, not just until you stop paying more premiums!

You are incorrect. During the Clinton years the laws were changed. If you are presently insured and change insurers (usually due to job change) you can NOT be excluded due to pre-existing conditions. If, however, you ever have an interruption of coverage longer than a certain amount (30 days, if I recall) they you can be excluded at will, or anything to do with your pre-existing condition, which I assure you will be interpreted as broadly as possibly by the insurance company.

They also put a stop to classifying birth defects as a pre-existing condition, thereby letting the insurance companies off the hook for things like correcting a cleft palate.

I think you misunderstood energiewende here. His point is that it is BAD for people to be excluded due to preexisting conditions when changing employers; yours is that this only happens if people are out of work for 30 days or more and thus have an "interruption in coverage."

Guess how often that happens to people in modern America...

[Broomy knows this but I'm saying it for others too]

There is such a thing as continuation insurance under something called COBRA, but it is very expensive. The costs really add up fast, and a typical unemployed person who doesn't have unusually large savings won't be able to hang onto their insurance for more than a few months. If you are now or have ever been long-term unemployed, you can just forget about it.

[Broomstick]

I didn't misunderstand him at all - it fucking sucks and I doubt very much his has a visceral comprehension of the situation. I giving him more information and correcting his belief that losing one policy would inevitably screw you up for all others. That used to be true.

Granted, the current mechanism for continuing coverage suck, but at least it is possible to avoid that particular trap, at least for some.

[energiewende]

Old age care is another issue, but probably that should be paid for out of one's pension rather than out of a healthcare budget.

Great notion, except that very few Americans have actual pensions any more.

Right, and that's a big problem. Poor countries like China have large savings rate; US does not. The reasons for this are systemic however so I won't go further on this tangent now.

It's not at all clear to me why the US system is so expensive. Many in fact almost all countries have private doctors and hospitals, paid for by private insurances (even if they are subsidised or regulated by the government in some way). People from my country will fly to India &c. for non-urgent private care paid out of pocket, even though their government insurance will provide these services, because it's so cheap it's worth it just to jump the queue. I'd reason that the US's problem is therefore supply side rather than demand side. Too few doctors and too much liability. Both of these can only be solved with more competition, rather than less. In particular, the US should expand medical school to anyone who is able to pass the exams, like law school, and permit limited liability insurances to be offered.

Um... I really think you need to study the problem more before attempting to form an opinion.

The US is actually well supplied by doctors, both home grown and imported. Quite a few foreign doctor immigrate here because their compensation is vastly greater in the US than almost anywhere else in the world.

It's actually a multi-factorial problem. Among those factors are physician incomes (mostly among the specialties - general practitioners and those specializing in geriatrics earn much less than, say, surgeons), liability costs (including defensive medicine), for profit drivers, the insertion of the insurance company middle-men, all of whom have incomes sucking money out of the system, oversupply of advanced technology, over utilization of both technology and care, and perverse incentives that drive costs up that doesn't exist under universal health care systems.

Keep in mind that the private insurance sector in the US, for large segments of the population, have no competition because either you get private insurance or none. In other places, such as Germany, the private insurers have to compete with the public system and thus, if they drive up the costs too much people will simply abandon private insurance for the public.

Well let's think about what you're saying here

- Differentiated incomes - fine. Not all "doctor" jobs are equally valuable or difficult.
- Liability - a big problem, I agree.
- Insurance middle men - well, you have some kind of middle man whatever we do. If there is a fully nationalised system it needs a large national bureaucracy. And in any competitive industry profits are a small % of the gross costs, not a driving factor in costs. This is necessarily the case because if companies were making "excessive profits" it would be easy for competitors to accept smaller (but still worthwhile) profits and undercut them. And a lot of the private providers are already non-profits, so it cannot be argued this competition doesn't exist.
- Improvements in technology - can only improve things! At worst, you would be limited to 1970s technology for 1970s costs (and 1970s care was hardly terrible, just not quite as good as now). At best, new technology can reduce costs, eg. GM insulin production, antibiotic treatment of stomach ulcers, etc. So it doesn't seem to me that this can be driving costs of anything except discretionary additional spending of those already insured, and there's no problem with that.

So, it seems like liability is the only issue. An easy way to solve this is to limit liability as part of the plans: if you want to be able to sue your doctor for not giving you 10 CAT scans then you have to buy the gold plated insurance. If you want to be limited to suing for egregious gross negligence like in UHC countries, you can cut a large chunk off your premium.

But I don't think liability is the whole story, I think the limited supply of doctors is a major issue; in fact a few weeks ago I was linked an absolutely devastating rebuttal to any claim that the AMA is not deliberately driving up costs. Basically the AMA has capped the absolute number of people who can become doctors. This is despite the increase in the size of the population and despite the much faster increase in demand for medical services. The reason it's so devastating is that he shows that the dramatic increase in number of female doctors has been completely offset by a decrease in number of male doctors! So even accepting the spurious assumption that the AMA's medical student cap originally represented some kind of limit to the number of people even in principle competent enough to be doctors, there are only three possible explanations for this: 1. men have become less competent at medicine in the past few decades 2. men have lost interest in joining what you have correctly identified is the highest paying technical profession in the world 3. the AMA have blood on their hands.

I think that Obamacare will solve one big problem, that some people have no cover at all. But it is unlikely to make the system more efficient, and by increasing the customer base will make it more expensive in total.

Two factors that make the system as is currently more expensive is that the enrolled people are weighted towards the sick - healthy people can and do forgo insurance and pay nothing into the system. This means the costs are not spread widely and the cost per person goes up. The second problem is that preventive care is often avoided or unaffordable, meaning that illness and other problems progress much farther before being seen by a doctor and wind up costing much more than if they had been caught early.

Former can only make it more expensive per person, not overall. It's also not clear to me why a young, health person should not expect to pay a much lower premium. Again this is a problem of trying to use insurance as a pension fund. Old age care is only practicable if people save money for their retirement during their lives. Soaking the young to pay for the old is becoming increasingly unsustainable as the population pyramid inverts and more money is spent for increasingly shorter periods of life extension with increasingly low quality of life.

edit: Another thing I'm not fully conversant in, so sorry if this is not true: but it seems like most of the 'pre-existing conditions' problem is caused by the link to employment. If you lose your job the coverage is interrupted and suddenly your condition becomes "pre-existing" even though you were insured when the condition began. This is very damaging. Any subsidy direct or indirect for employer-linked health insurance should be removed, and life-long transferrable plans should become the norm. Unfortunately Obamacare moves in the opposition direction. Alternatively, plans should offer payment for the life of a condition if it is discovered during the life of the plan, just like how if become permanently disabled a life insurance might pay out every year for the rest of your life, not just until you stop paying more premiums!

You are incorrect. During the Clinton years the laws were changed. If you are presently insured and change insurers (usually due to job change) you can NOT be excluded due to pre-existing conditions. If, however, you ever have an interruption of coverage longer than a certain amount (30 days, if I recall) they you can be excluded at will, or anything to do with your pre-existing condition, which I assure you will be interpreted as broadly as possibly by the insurance company.

They also put a stop to classifying birth defects as a pre-existing condition, thereby letting the insurance companies off the hook for things like correcting a cleft palate.

As best I can parse your post you are restating my description so in what way is it incorrect?

[Broomstick]

- Differentiated incomes - fine. Not all "doctor" jobs are equally valuable or difficult.

One of the current problems of the US system is that there are immense pressures driving new doctors into specialties, including economics. A general practitioner at a city clinic may not make sufficient income to cover both liability insurance AND pay off student loans, leading to a doctor living at a net wage that's pretty dismal, or even unworkable. While there are a few saints that will put up with such circumstances they're pretty rare and not nearly sufficient to provide for basic medical needs of the society.

My college roommate entered a Federal program where the government pays for medical school provided the new doctor agrees to work wherever the government puts him or her for a span of years (if I recall, it was seven in her case but it might vary). This is done because vast tracts of the US are horribly under served and that is the only way to get even minimal care to these folks. My former roommate was working in, essentially, 1950 level conditions regarding technology and facilities in a clinic that was never fully staffed.

The medical situation in large, urban areas is excellent - if you have the money to get into the system. If you are outside the urban areas, or poor, you have third-world medical care. That's one reason why "medical tourism" is getting popular in the US, where US citizens find it cheaper to buy a plane ticket to elsewhere in the world and pay cash for surgery there than to have medical care done in the US. We have SD.net members who have done exactly that.

The outlying areas of the US are under served because the money isn't there to fund even basic medical care. What little there is is usually provided by the government at one level or another, but because of ideological opposition to government health care the result is shit. Oh, don't get me wrong - there are some very dedicated people working their asses off to do the best they can, but the fact remains there are millions of Americans who would have to travel hundreds of kilometers to get modern medical care.

- Liability - a big problem, I agree.

I don't think it's as big a problem as you do.

- Insurance middle men - well, you have some kind of middle man whatever we do. If there is a fully nationalised system it needs a large national bureaucracy. And in any competitive industry profits are a small % of the gross costs, not a driving factor in costs. This is necessarily the case because if companies were making "excessive profits" it would be easy for competitors to accept smaller (but still worthwhile) profits and undercut them. And a lot of the private providers are already non-profits, so it cannot be argued this competition doesn't exist.

Although the insurance group I used to work for proudly boasted a mere 4-5% profit margin (which I would think would be adequate, and comparable to what, say, grocery stores survive on) I recall in the 1990's data on other for-profit companies making 25% or greater profits. Across the board, non-profit insurance companies (such as what I worked for) inevitably had lower administrative costs than for-profit, and this will never change because, in addition to covering the actual costs of providing healthcare (including employee wages and benefits) they have to generate income above and beyond that for their stockholders. There are only two ways to do that: reduce pay out or increase income.

There's a constant back-and-forth on this. But I also saw a LOT of completely needless spending, even in non-profits. For example, all business travelers were required to stay in 4 and 5 star hotels, at a typical nightly price of $250-350/night (I used to do a lot of travel arrangements). WTF? There are entirely adequate hotels at $50-80/night that provided all the amenities of the upper end hotels (I have stayed in both) at a much lower cost. Why is that sort of extravagance tolerated? I am, frankly, appalled. That's just one example of the extravagance and waste in private healthcare.

Also keep in mind that a UHS has just ONE bureaucracy - the US has multiple ones. That means many, many more people involved than actually required to perform the needed tasks. The multiple insurance companies, each of which has different forms, rules, and requirements, result in bloated administration at every provider's location. Prior to working for the health care company I worked at a clinic and a MAJOR part of my employment was dealing with the administrative requirements of billing so I have some idea of what I'm talking about. In a place like Canada you have one set of rules, one set of forms, and billing departments are miniscule compared to those in the US. The US way of doing things again drives up costs of healthcare.

- Improvements in technology - can only improve things! At worst, you would be limited to 1970s technology for 1970s costs (and 1970s care was hardly terrible, just not quite as good as now). At best, new technology can reduce costs, eg. GM insulin production, antibiotic treatment of stomach ulcers, etc. So it doesn't seem to me that this can be driving costs of anything except discretionary additional spending of those already insured, and there's no problem with that.

I didn't limit the problem to improvements in technology. There is a problem with over supply of technology in the US. A good example is MRI machines. There are about 26 MRI machines in the US per million people. Canada has about 6 per million people. Does the US really need 4 times the MRI machines? Every one of those machines purchases must be paid for, and the only way to pay for them is use them. This drives a "need" to use MRI's more frequently in the US than in Canada, with the associated upward drive in costs. Between needing to pay the bills AND greater profit from using and MRI machine AND the threat of liability lawsuits Americans get MRI'd much more often than anyone else in the world, with no evidence that scanning a typical sprained ankle (as an example) improves patient outcomes.

Another example is C-sections. There are places in the US where C-sections approach 1/3 of births. This is insane. If the human race really required surgical birth that often we probably would have died off before the invention of agriculture. But, between everyone getting higher fees for a surgical birth and, again, liability fears doctors wind up pressured to cut open wombs which, again, drives up costs.

Now, for those who really need them MRI's and C-sections are godsends and absolutely a net positive, but the problem is they are over used technology and that means spending money we don't have to. Overused technology wastes money and needlessly drives up costs.

So, it seems like liability is the only issue.

No, it's not - bloated multiple bureaucracies, for-profit health coverage companies, lack of access that leads to greater expense when something finally is treated, over use of technology, perverse incentives driving doctors out of basic care and into specialties resulting in a lack of basic health care providers... there is a LOT broken with the US system and saying "it's just liability" is over simplifying it to a degree that boils down to making it obvious you really don't understand the complexity of the problem.

An easy way to solve this is to limit liability as part of the plans: if you want to be able to sue your doctor for not giving you 10 CAT scans then you have to buy the gold plated insurance. If you want to be limited to suing for egregious gross negligence like in UHC countries, you can cut a large chunk off your premium.

Great - then EVERY person on the gold plated plan will get 10 CAT scans whether or not they're needed. So if, hypothetically, a CAT scan costs $1,000 (actual prices vary enormously, depending on part, contrast material, and other factors) and a person only needs one then the cost is $1,000 (and a bargain if the alternative is something like exploratory surgery). But under your gold plate plan the doctor(s) worry about liability and order 9 additional ones "just to be sure" or whatever. Congratulations, the cost is now $10,000, or ten times what it should have been without the perverse incentive.

Part of the problem with medical liability is that medicine is not an exact science. You can do everything right and still have a bad outcome. Assuming the person isn't outright dead, that means on-going expenses for life in a system that's brutal to the disabled and chronically ill. You probably can't seen the US commercials for medical liability law firms that advertise on TV here, but one phrase that crops up over and over again is "how are you going to pay for medical care for your loved one for the rest of his/her life?" Because the disabled and chronically ill are so routinely shut out of the system, and the costs are so high for those that can get access, there is a perverse incentive for families to sue NOT because of actual negligence but because a high-dollar award is the ONLY way to get the funds for the medical care required for their loved one to survive! This does not happen under a UHS. The removal of that incentive alone removes much of the impetus to sue doctors and hospitals.

This is one reason why obstetrics in the US have insanely high malpractice insurance premiums - the baby isn't perfect at birth the parents may sue not because they really think the doctors fucked up but because that is the only way for them to get money to get care for their kid. The liability lawsuit problems in the US are more about fucked up access and costs than actual malpractice and gross negligence.

But I don't think liability is the whole story, I think the limited supply of doctors is a major issue; in fact a few weeks ago I was linked an absolutely devastating rebuttal to any claim that the AMA is not deliberately driving up costs. Basically the AMA has capped the absolute number of people who can become doctors. This is despite the increase in the size of the population and despite the much faster increase in demand for medical services. The reason it's so devastating is that he shows that the dramatic increase in number of female doctors has been completely offset by a decrease in number of male doctors! So even accepting the spurious assumption that the AMA's medical student cap originally represented some kind of limit to the number of people even in principle competent enough to be doctors, there are only three possible explanations for this: 1. men have become less competent at medicine in the past few decades 2. men have lost interest in joining what you have correctly identified is the highest paying technical profession in the world 3. the AMA have blood on their hands.

The AMA can not control the immigration of foreign doctors. They certainly try - it is MUCH more difficult for an immigrant doctor to become board-certified than one trained here - but one of the reasons that the US has a lot of foreign-born doctors is that demand gap you speak of. Also, the AMA does not control the number of Osteopaths in the US. Now, it is very important when reading that statement to understand the US "osteopathy" is very different from European "osteopathy". In the US, osteopaths have converged on the allopathic model, with very similar training, with the result that there is very little difference between an MD and a DO in the US. The AMA likes to tell people it has some sort of stranglehold on US medicine but it doesn't. A lot of influence, sure, but the number of even MD"s who are AMA members has been falling for decades, they can't keep foreign doctors out, and they can't control the generation of more DO's (although, ironically, DO's are now allowed to join the AMA - really, a full exploration of this subject requires much more room than available here)

Two factors that make the system as is currently more expensive is that the enrolled people are weighted towards the sick - healthy people can and do forgo insurance and pay nothing into the system. This means the costs are not spread widely and the cost per person goes up. The second problem is that preventive care is often avoided or unaffordable, meaning that illness and other problems progress much farther before being seen by a doctor and wind up costing much more than if they had been caught early.

Former can only make it more expensive per person, not overall. It's also not clear to me why a young, health person should not expect to pay a much lower premium.

It's a longstanding principal of insurance that the greater the pool of people paying into the pot the lower premiums go for everyone because costs and risks are spread out. There are two ways to manage the premiums in a subscriber pool: you can either make everyone pay equally (which is actually what happens in a tax-support UHS system, usually with everyone paying the same percentage of income into the system, although there may be a limit on maximum total money units paid by the wealthy) or scale according to that person's cost. The problem with the latter is that those who have the most need are usually those with the least ability to pay. Chronically ill people are not as efficient or productive generators of income.

The other problem is that no one can really opt out of the system as it stands in the US. No one. If you're in a Horrific Accident or acquire a Horrific Illness the system will start to treat you when things get bad enough (typically, when you're in immediate danger of dying). Thus, even if you've opted out you may still, through no fault of your own, wind up with a ruinous bill. Until the US public is willing to simply discard the dying this will continue to happen.

So the only way to make the system work is to make the healthy pay a little more than they "should have to" in order to cover those who can NOT pay their own way. Again, the larger the covered pool of people the less any one individual health person has to pay "extra". It can be argued that this is morally acceptable because, through no fault of their own, it is possible for one of the young-and-healthy to become one of the disabled-chronically-ill at any point in their lifespan.

The other flaw in the reasoning is that no matter how young and healthy you are, you can still wind up in a medical emergency. Being young and healthy does NOT make you immune to accidents and illness. Young people suffer traumatic amputations, paralyzing accidents, burns, and devastating infections just like everyone else. If they opt out and don't buy insurance, yet suffer one of these, they will STILL receive treatment (and if they're unconscious, they won't even have the option to refuse treatment). By running that risk they will pay far, far, far more in the end than if they had opted in for insurance. Going "bare" is a high-stakes gamble. If you lose, you lose big.

Again this is a problem of trying to use insurance as a pension fund. Old age care is only practicable if people save money for their retirement during their lives.

The US eldercare system is split from the healthcare of those under 65 and has been for decades, which is where your argument fails. We already have a near-universal over-65 government-run healthcare system JUST for those people in the US, funded by a specific tax, paid mostly by young people. It is, in fact, the ONLY "pension" the average US citizen reliably has access to. It's called "Medicare". One of the perversities of the bullshit US health system clusterfuck is that ONLY old, retired people have UHS and they will NOT extend it to everyone else.

But one of the stupidities is that if the younger part of the population has better access to healthcare, and were able to reliably and consistently treat problems from arthritis to heart disease to diabetes BEFORE the age of 65 then the old people would be healthier to begin with! I've long wondered if, at the age of 65, there is a sudden uptick in things like joint replacements, cardiac procedures, diagnosis of diabetes and high blood pressure because people can finally get medical care. It would be interesting if there was, wouldn't it?

Soaking the young to pay for the old is becoming increasingly unsustainable as the population pyramid inverts and more money is spent for increasingly shorter periods of life extension with increasingly low quality of life.

The problem is that the oldest and sickest can NOT pay for the cost of their care. Are you OK with condemning such people to death, perhaps a slow and painful one? Or maybe not death - maybe just life in a wheelchair and in constant pain rather than an operation to get their hips working again.

I agree the current system, where the young pay taxes but can not access the government UHS until 65 sucks donkey balls and is inherently unfair and destructive. But cutting the old people off, saying they get nothing if they can't pay their own way, is just as morally evil in my opinion.

As best I can parse your post you are restating my description so in what way is it incorrect?

It was lacking in details.

[Spyder]

Yeah, you guys are getting dicked on minimum wage. NZ's $13.75/hr ($10.70US), and Australia's $16.37 ($14.58US).

Wow, Australia's really leading the charge on this, good work guys!

[Jub]

BC at least is at $10.25 ($9.87 USD) and I doubt that most of the US has that much great purchasing power for dollar to make up the gap especially with the joys of online out of market shopping.