I was interning in California (I'm a Canadian citizen) when I felt compelled to go see a doctor because I spent about a week coughing up various different colours of phlegm (was awoken pretty much nightly with really bad hacking cough). I visited the walk-in clinic at Palo Alto Medical Foundation (in Palo Alto). I had travel insurance offered through my (Canadian) university supplement insurance plan (which for some reason wasn't in their system), so I was asked (albeit very politely) whether I'd like to pay for the visit in cash or credit card ($300 up front).
The doctor listened to me cough and did a swab for a staph infection before diagnosing me with the common flu and advising me to come back if it didn't subside within another week.
I guess in hindsight the visit cost much more than average (since $176 apparently is the 95th percentile cost for a routine doctor's visit), but it just seemed strange that seeing a doctor (not even emergency room) cost roughly half as much as an iPad.
I was an international student. Had a terrible strep throat. Lived off campus. Called university, asked if going to a nearby emergency clinic would be covered. They said "yes". Did so. Got there, waited 1+ hours in the lobby. Then a young intern saw me for 5 minutes. Prescribed a codeine pill and sent me home.
It turns out outside of campus clinic visit was not covered. I did not record the phone conversation. Got a $400 bill (in 1999 money!).
Fuck you American medical system. Should have given them the wrong name or something. It seems they are out to rob people I wouldn't even feel back screwing them over. Charging a student who lives on rammen noodles $400 in 1999 could mean not being able to pay for housing or not being able to avoid food or books.
Now I just avoid doctors as much as possible. It is irrational but I just feel like both insurance and doctors are out to screw me and take all my money. Sad thing is, my rational part of the brain understand that the next time I will see doctors might be in the emergency being unconscious or really sick (maybe I should carry a wallet with a fake name with me ;-)
As an expat, absolutely nothing. It drops off the credit report after 7 years.
Now before everyone gets indignant. I was a Verizon customer and had taken a job abroad. 18 months into my 2-year contract I called to say I'm leaving next month and want to cancel. The fuckers wanted to put me on a 2-month pause, stop the line for 2 months add 2 more months on the contract. I told them this was a permanent move and I didn't want to bother, just shut it down. Then they wanted to hit me with a $250 cancellation fee, not prorated. I referenced the part of the contract about coverage but the rep wasn't hearing it. While at the airport I called them and paid my final bill (they charged me to pay by credit card over the phone, too). Told them to cancel the line and goodbye.
I got a few very large bills in the mail after that, a few creditors calling my Google voice line, and then silence. It's been that way for 6 years.
A few years ago, when I moved overseas, T-Mobile had no trouble waiving the termination fees (for both my line and my wife's) once I'd shown them proof of the move. And they'd already unlocked our phones for a previous international trip, which was handy because we could easily go prepaid until we picked a carrier post-move.
I've always thought the US healthcare system was bad but I never realised how expensive it really was. I pay nothing towards healthcare, I don't pay for prescriptions (those are free for everyone here), and although getting a doctor's appointment can take a week or so at times (unless it's an emergency) I get good service. And none of this is thanks to insurance, benefits provided by my employer or government - it's the same for everyone.
The US taxes the poor / middle class much lower than the rest of the OECD, but the rich more. So if you're poor / middle class, then your taxes are much much higher than if you were in the US.
It is common knowledge amongst all whom study comparative taxation that the US has the most progressive tax system in the OECD. One of the OECD researchers posted about this on reddit recently.
Intuitively, look at VATs, fuel taxes, other consumption taxes. These are regressive and low in the US. Income taxes in the US are steeply progressive - especially in relation to other OECD member nations.
Corporate taxes are incredibly high in the US, again relative to other OECD nations. And income taxes are now about as high (for the rich - ~50%+) in the US as the highest taxing OECD nations. Cap gains rate is about the same or higher in the US vs OECD (~32% in US). Estate taxes don't exist in most OECD nations as well.
Importantly, tax enforcement is incredibly strict in the US relative to typical OECD, again particularly for the rich.
There's a feeling in some parts of the left in the UK that low US fuel taxes are symptomatic of the libertarian anti-left strain of American politics.
I think this disconnect between perception and reality highlights the importance of stopping using identifiers such as "left" and "right" for complex issues.
The US governments will likely hit a wall soon - further tax increases on the rich will possibly yield little/no new revenues. Many suspect that a VAT and higher taxes on the poor/middle class - where 66% of the income is after all - is inevitable.
It's rather hard to run an aggressive modern welfare state by leaning heavily upon those whom earn 33% of the income!
>further tax increases on the rich will possibly yield little/no new revenues.
Possible, I suppose. I'd need to see evidence.
>Many suspect that a VAT and higher taxes on the poor/middle class - where 66% of the income is after all - is inevitable.
Who are the many who suspect this? And on that note - your "whom" should be "who". Apologies for the pedantry.
I'd really like to see some reputable articles to back up your assertions, purely because I've not heard anyone make them before. I don't mind if you don't provide them, of course, you don't owe me anything, I'd just appreciate it if you did.
>I'd really like to see some reputable articles to back up your assertions, purely because I've not heard anyone make them before. I don't mind if you don't provide them, of course, you don't owe me anything, I'd just appreciate it if you did.
Hey James,
Firstly there is the simple fact of arithmetic. 33% vs 66%. The 33% is already quite heavily taxes, the 66% much less so. Which bloc is able to fund a welfare state?
Tyler Cowen and The Money Illusion and to a lesser extend EconLib are my primary sources in these discussions (basically the GMU econ mafia plus a few outsiders). This is a very politically similar cadre for me to harvest my ideas from, but they pay quite a bit of attention to outside theories. Regardless, if you want 'articles' you'll find them there.
Another possibility is a one time wealth tax. This has some pull because it can easily target only the very rich, but also has some pretty big issues due to it's inherent "Banana Republic-ness." But it can happen.
The VAT just seems likely because almost every OECD country uses them, it's potentially politically feasible, and the amount of revenue it can raise is enormous. It also doesn't have the Banana Republic features of a wealth tax.
And I like my "whom"'s, grammatically correct or otherwise :)
For comparison: I'm from California, and was studying abroad in Holland. I had travel insurance, and went to the general doctor for a similar situation (lung infection).
How it's supposed to work is that I pay in full and get reimbursed from my travel insurance company. They had never done that before, so just waived the costs of the visit.
They wrote me a prescription for antibiotics and asked me to wait a few days before filling the prescription to see if it goes away on it's own. The pharmacist did bill me in full, but it was so cheap that I never even bothered to ask for reimbursement (€20).
Anyway, for many reasons (including health care) I permanently relocated to NL. :)
The doctor listened to me cough and did a swab for a staph infection before diagnosing me with the common flu and advising me to come back if it didn't subside within another week.
I guess in hindsight the visit cost much more than average (since $176 apparently is the 95th percentile cost for a routine doctor's visit), but it just seemed strange that seeing a doctor (not even emergency room) cost roughly half as much as an iPad.