Candy Japan total sales cross $1M(candyjapan.com)
candyjapan.com
Candy Japan total sales cross $1M
https://www.candyjapan.com/behind-the-scenes/sales-cross-million-dollars
161 comments
Kudos to the author, Candy Japan has always been one of my favourite stories on hacker news :)
Congratulations!
Curious to know - do you need any type of FDA or import-export license to ship things in US from a foreign country?
Curious to know - do you need any type of FDA or import-export license to ship things in US from a foreign country?
Seems HN users are familiar and even enthusiastic with Candy Japan. I'm not sure I understand, though. It's just a dude offering intermediary shipping, right? Am I missing some interesting tech stuff here?
The service is simple, no fancy tech (it's just a bunch of Python). Possibly the initial appeal was that random-boxes-of-surprises services were rare, and my openness with the numbers.
Here's what's fun about it - it's literally just a random box of interesting candy that shows up at the door like a little surprise. I love little surprises. Shit, I love when I order something on Amazon, even if it's boring, and getting the package delivered. This is 100x more exciting than that!
Kudos to you, Bemmu, this is a very fun idea, and I hope you continue to see success from it.
Kudos to you, Bemmu, this is a very fun idea, and I hope you continue to see success from it.
You should expand the service (or start a new one) into other categories of physical goods: manga, novels, video games, figurines and other merchandise not found anywhere else outside of Japan.
Let subscribers pick their preferred categories and allow them to choose the amount of money they want to pay each month + shipping costs,
then you go out and buy random things from one or more of those categories (in order of user preference), and keep a record of which items you sent to each customer, to avoid duplicates.
Social fluff: Let users post on-site reviews of the items they receive from you.
Ideal outcome: People discover the uniqueness of Japan, share it with their friends and other users, and you help spread some joy and pocket the change.
Let subscribers pick their preferred categories and allow them to choose the amount of money they want to pay each month + shipping costs,
then you go out and buy random things from one or more of those categories (in order of user preference), and keep a record of which items you sent to each customer, to avoid duplicates.
Social fluff: Let users post on-site reviews of the items they receive from you.
Ideal outcome: People discover the uniqueness of Japan, share it with their friends and other users, and you help spread some joy and pocket the change.
How about just offering other kinds of snacks? I'm vaguely interested in this service, but I'm also trying not to eat too much sugar.
Japanese sweets, especially chocolate, taste like they have less sugar to me. They might be the same, but you could be better off with them than others.
It's already a combination of sweet and savory snacks.
Personally, what I don't like are the kits where you have to mix things with little cups of water and such. They're never satisfying, and I think they include too many of them.
Personally, what I don't like are the kits where you have to mix things with little cups of water and such. They're never satisfying, and I think they include too many of them.
> You should expand the service (or start a new one) into other categories of physical goods: manga, novels, video games, figurines and other merchandise not found anywhere else outside of Japan.
But then he'd be competing with established players like http://shop.j-subculture.com/
But then he'd be competing with established players like http://shop.j-subculture.com/
Of course there would already be other regular shopping/shipping services. What I was suggesting was for Candy Japan to pick and curate the items themselves, without the subscribers knowing what they’ll get. So it would be extending the theme of receiving random surprises from Japan.
What is exciting for me is that you documented the whole process from the start and, notably, that you actually built it, it didn't stay just an idea. I find that inspiring.
He has been consistently posting in-depth articles about his code base and business for years. People like him and his wacky business the same way we like Levels.
Levels?
Levels is a digital nomad who has consistently posted in-depth articles about his businesses and codebases for years. People like him and his travel lifestyle the same way we like Patrick.
Patrick?
Patrick has been consistently posting in-depth articles about his code base and business for years. People like him and his rational advice the same way we like the Candy Japan guy.
The Candy Japan guy?
Patio11. Similar to levels.
http://www.kalzumeus.com
http://www.kalzumeus.com
I think that a lof of people fell in love after this made front-page : https://www.candyjapan.com/behind-the-scenes/algorithmic-fit...
Nope, no interesting tech AFAIK. Just someone applying the hacker mentality to their business.
https://www.candyjapan.com/behind-the-scenes/algorithmic-fit...
Nahh, nothing interesting to a bunch of hackers </sarc>
Nahh, nothing interesting to a bunch of hackers </sarc>
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I think there's some curation by the business operator. It's pretty unlikely that overseas residents have a good grasp of the current market offerings.
Also I think it's an interesting case study of the growth and evolution of a business that started very, very small, that's been documented closely by the operator. He even wrote about dealing with cc fraud.
Also I think it's an interesting case study of the growth and evolution of a business that started very, very small, that's been documented closely by the operator. He even wrote about dealing with cc fraud.
No interesting tech stuff, but it's not just shipping, it's also curation. I subscribed to a similar service for over a year (Japan Crate) and the fact that I didn't have to go find these items myself is most of the point.
Personally I enjoy seeing a candyjapan link because it doesn't fluff on the details. The write ups don't hide numbers and other information just for the sake of hiding them. On top of that the write-ups are interesting
Not all geeky things are directly tech related, some of us are just geeks through and through :)
Not all geeky things are directly tech related, some of us are just geeks through and through :)
Curation is a valuable service.
No, you probably can't buy any of the stuff anywhere online that he packs into those boxes, from outside of Japan at least.
He makes items available you simply would not be able to easily obtain otherwise.
He makes items available you simply would not be able to easily obtain otherwise.
Good to see Candy Japan growing! I was a huge fan of the article about making an algorithm to pack the candy that showed up on HN [1]. After the article, I spent the next week or two looking into packing algorithms...
[1]https://www.candyjapan.com/behind-the-scenes/algorithmic-fit...
[1]https://www.candyjapan.com/behind-the-scenes/algorithmic-fit...
Box filling algos are rough. Working in ecomm for many years and trying to optimize costs, you spend a lot of time thinking about these kinds of problems. Apparently Amazon's answer is "F it" as they send massive boxes for tiny things frequently.
Slightly related, I worked in the sign printing industry for many years as well. There we also had fitting algorithms for ganging vector designs into runs for printing and cutting on large format printers. Those are a lot easier since it's 2D only, but they are still hard to get to perfection.
Slightly related, I worked in the sign printing industry for many years as well. There we also had fitting algorithms for ganging vector designs into runs for printing and cutting on large format printers. Those are a lot easier since it's 2D only, but they are still hard to get to perfection.
Yeah it's crazy when you think about it. We somehow manage with new break through on voice, image, and speech recognition but yet we still struggle figuring out how to efficiently pack things in a box or plate.
Congrats to the author. I remember first hearing about this as a side project and thinking it was a super cool and fun thing to work on!
As a side note, nearly half this thread is talking about health insurance...really?
As a side note, nearly half this thread is talking about health insurance...really?
So cool! well done :)
I found a minor bug, if you go to https://www.candyjapan.com/behind-the-scenes/ (note the slash at the end), then the server gives 500. Perhaps just redirect the user to https://www.candyjapan.com/behind-the-scenes for a better UX.
I found a minor bug, if you go to https://www.candyjapan.com/behind-the-scenes/ (note the slash at the end), then the server gives 500. Perhaps just redirect the user to https://www.candyjapan.com/behind-the-scenes for a better UX.
Have you considered offering a savory snacks crate, which doesn't consist of majority ramen?
Japan Crate has the Umai crate, which we (Tofugu) subscribed to for six months; majority of the contents were ramen :/ Was hoping for some chips and other goodies.
Japan Crate has the Umai crate, which we (Tofugu) subscribed to for six months; majority of the contents were ramen :/ Was hoping for some chips and other goodies.
as someone operating a similar candy subscription service, we have been considering that offering (a savory snacks box) but the issue with shipping things like chips is that they have so much air in the packaging itself. this is a problem because let's say we ship in a small box, which for us usually contains around 1kg of candies, it can only contain at most four small bags of chips. for four bags of chips, taking shipping costs into consideration, it would cost close to 40 dollars, with more than half of the costs coming from shipping. would people really be willing to pay 40-50 a month for 4 bags of exotic chips?
Ahh right. This is definitely a road block :(
What was the cost analysis like to include a diverse selection of savory items? Filling an entire box with chips is definitely not cost effective, but including one with a mix of other goods seems plausible? Is there demand for a "snacks" box consisting of sweet and savory?
The problem I had with Umai crate was nearly every box was just ramen. Might as well call it the ramen box.
What was the cost analysis like to include a diverse selection of savory items? Filling an entire box with chips is definitely not cost effective, but including one with a mix of other goods seems plausible? Is there demand for a "snacks" box consisting of sweet and savory?
The problem I had with Umai crate was nearly every box was just ramen. Might as well call it the ramen box.
well yeah there were some demand for snack boxes from customers who were keen on Japanese chocolates and confectionaries like Pocky, Glico as well as exotic chip flavors from Asia. interestingly, there was even a request for a ramen box. it's not something we've written off entirely, it's definitely something my business partner and i still discuss from time to time. if you genuinely are interested in a savory box, drop me an email at [email protected]. i'd be willing to start that new line if there is even a single interested subscriber. i will make sure there's no ramen haha.
Now I'm wondering if I should start mailing Finnish Salmiakki to people. Downside is I suspect repeat business might be rare!
Really happy to see the figures :), stories like this are highly inspirational to me. I am sure it's not going to take a long time to touch $1M in profits too. Keep up your hard work!
This guy spends 297 USD per MONTH on convenience store snacks??
That's insane. That's roughly $10 worth of "snacks" per day.
That's insane. That's roughly $10 worth of "snacks" per day.
having lived in japan, the amount and quality of food/snacks/drinks/alcohol at convenience stores makes them a pretty attractive option
something as simple as coffee and a sandwich in the morning and some beers and snack food after work could easily add up to a couple hundred a month, even though most of it isn't the kind of food traditionally associated with convenience store junk food
something as simple as coffee and a sandwich in the morning and some beers and snack food after work could easily add up to a couple hundred a month, even though most of it isn't the kind of food traditionally associated with convenience store junk food
Yep. I live in Japan and while I probably (...uh... probably...) don't spend $10 a day at the convenience store, it would be pretty easy. I also go at least once a day. $1 for coffee, 80 cents for daifuku (the best food in the world), $1.50 for yogurt, $2 for fruit... I notice he has a bag of beef jerky in his picture. That's particularly expensive (probably $3 or so).
I think the thing missing from the picture is that convenience stores in Japan are a lot more convenient than they are in many other places in the world. The 7-11 store near me sells vegetables, sliced meat, bacon, eggs, milk, etc, etc. So while it is common to buy months and months of food items from a grocery story (or possibly a yearly supply of mayonnaise from Costco) in NA, people tend to buy small amounts of things from smaller stores in Japan.
I think the thing missing from the picture is that convenience stores in Japan are a lot more convenient than they are in many other places in the world. The 7-11 store near me sells vegetables, sliced meat, bacon, eggs, milk, etc, etc. So while it is common to buy months and months of food items from a grocery story (or possibly a yearly supply of mayonnaise from Costco) in NA, people tend to buy small amounts of things from smaller stores in Japan.
Yeah, the convenience stores were one of the biggest surprises for me when touring Japan. I ate a lot of my lunches at 7-11 and Lawson, whereas I completely avoid 7-11 in the US.
While convenience store food in Japan is far superior to convenience store food pretty much anywhere else in the world (except maybe Thailand!), it's actually somewhat expensive and not as good as what you'd get in Japanese fast food chains. For example, a convenience store gyudon (beef bowl) costs more and is less tasty that Yoshinoya's standard Y300 gyudon.
I think it's mainly because you can't find a Yoshinoya in a town/road that isn't even on google maps but you can find 3 lawson's and a famlymart. (convenience≠cheap)
Also, afaik Yoshinoya doesn't carry anything that can compete with Family Mart Milk Cocoa. Japanese convenience store drinks are so good.
im actually quite surprised that the online candy market is still so small. candy in general is a multi billion dollar industry and with the benefit of the large hn community and its multiple first page posts, i expected them to have grew to a mega online mall for candies by now. its quite an interesting case, what could be the problem here?
There's something about candy that's very polarizing, at least in the USA. Candy used to be a very regional delicacy, every place had their specialities. At some point in the 20th century large candy companies addressed the mass markets and homogenized candy into less and less interesting treats. Now you really have to look for candy bars that are anything more than caramel, cheap chocolate and some nuts.
There's a whole book on this topic: "Candy Freak" by Steve Almond.
Italy, Japan and China still very much value a wide variety flavors and textures in their sweet confections. Where italy focuses on expertly maintaining tradition, the Asian countries seem to aim for extreme novelty. I like all of them.
There's a whole book on this topic: "Candy Freak" by Steve Almond.
Italy, Japan and China still very much value a wide variety flavors and textures in their sweet confections. Where italy focuses on expertly maintaining tradition, the Asian countries seem to aim for extreme novelty. I like all of them.
> and China still very much value a wide variety flavors and textures in their sweet confections
I don't know about Italy and Japan, but China doesn't really seem to go for sweet confections at all, and if you think cheap chocolate is bad in western countries, cheap Chinese chocolate is even worse.
I don't know about Italy and Japan, but China doesn't really seem to go for sweet confections at all, and if you think cheap chocolate is bad in western countries, cheap Chinese chocolate is even worse.
You're right that Chinese "confections" aren't sweet, at least in the way westerners expect. But they have a spectacular range of flavors and textures.
Partly my reluctance to expand to having a warehouse of products. As it is now I know exactly how many of each product I need, so there is no need to store anything except only for the duration of shipping. It also means mostly shipping can be done in batches, instead of daily like a mega online mall would require.
Any idea when you'll get the stats article done? :D
There are a few things removed in your assumption:
1. Most prefer what they're familiar with. They grew up with the candies in their local stores so they might not be too eager to purchase foreign candies.
1. Candy is often a very impulsive purchase. You might grab a small bag or a bar at the checkout aisle. As a result, a monthly scheduled purchase might not be what people are looking for.
1. Most prefer what they're familiar with. They grew up with the candies in their local stores so they might not be too eager to purchase foreign candies.
1. Candy is often a very impulsive purchase. You might grab a small bag or a bar at the checkout aisle. As a result, a monthly scheduled purchase might not be what people are looking for.
It's interesting to me to see the huge level of nostalgia for local sodas and candies that people often have. (I have it too, like Moxie from New England, distinctively flavored with gentian violet roots.)
It seems some candy and soda shops with a broad selection are doing really well with this nostalgia, maybe especially with the amount that people move around these days. ("Oh, I haven't had this in ages!")
It seems some candy and soda shops with a broad selection are doing really well with this nostalgia, maybe especially with the amount that people move around these days. ("Oh, I haven't had this in ages!")
Most prefer what they're familiar with.
Don't they just. Convincing people who grew up eating ketchup that it's revolting is almost impossible.
Don't they just. Convincing people who grew up eating ketchup that it's revolting is almost impossible.
Ketchup is a good mix of acidity and sweetness - nothing wrong with it.
As far as I can tell, its primary purpose is to act as an ingestible food lubricant, designed to smother the taste and texture of what it goes around with as much sugar and salt as they can get into vinegar without a crust of salty sugar spontaneously forming.
There are many different kinds of ketchup. Japanese ketchup is less sweet, and tastes like it has more tomato in it for example.
Congrats!!! You are one of my favorite stories to follow. Keep up the great work, and congrats on the new family member. :)
Thank you. Went from balancing "dev mode" and "business mode", to having "daddy mode" added on top.
I'm surprised it still succeeds despite CrateJoy having a bunch of Japanese candy subscriptions
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Japan has plenty of unique stuff not found anywhere else (not counting the inevitable Chinese knockoffs, which, tangentially, almost seems to be a law of physics; if something exists China will make a copy of it, but I digress.)
#IdeaForHN: Someone could start a service where people sign up for receiving random goods from Japan, from their preferred categories (e.g. video games, figurines, sex toys, etc.)
#IdeaForHN: Someone could start a service where people sign up for receiving random goods from Japan, from their preferred categories (e.g. video games, figurines, sex toys, etc.)
I love Candy Japan - are there any services like this for other countries?
shameless plug - i run supercandyshop.com and i can confidently say our box is way more value packed than any other box out there. we ship Asian candies, mostly premium Japanese and Korean candies, but we also search for high quality and seasonal candies from other parts of Asia like Singapore, Malaysia, Thailand, etc.
Don't know but there is another for Japan called Japan Crate.
http://www.japancrate.com
http://www.japancrate.com
Great idea! Is there any interest in shipping instant Miso soup from Japan? Trader Joe's has discontinued their offering and I am looking for a replacement.
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>"Health insurance
To me this was the biggest sticker shock, which I didn't mention at all in my old post as I wasn't paying it yet, as I was still tax resident in Finland. Now I'm currently paying 508 EUR or 569 USD for my health insurance here [for a family of 3]. That's not a typo or a yearly cost, that's what it costs every single month."
Sounds like a bargain
Sounds like a bargain
I am paying $50 for a single person per month for premium health insurance, no lines service, priority entry, private cliniques, private hospitals, accident insurance, over 200 diseases included, free checkups, worldwide coverage, up to 6 months in a hospital during the year covered, money payments for each accident/sickness that forced me to the hospital, emergency transportation, blood tests etc. on demand and so on, and so on. I love Europe.
Ah, but you are paying for the items you listed. Presumably the core of your cover is hidden in your taxes?
There are massive tax savings in single payer systems due to vastly simplified billing. To the point where US government spends enough on healthcare to fully pay for a single payer system.
Thus, Americans also pay enough for a single payer system they just don't actually get it.
Thus, Americans also pay enough for a single payer system they just don't actually get it.
Magical thinking right here. The savings by merely switching to simplified billing are miniscule. It's also a bit magical to think that switching to single payer in the USA would result in savings. There is no reason to believe that costs would go down without massive price controls (and thus, shortages/rationing).
EDIT: I'd love anyone down-voting this comment to demonstrate how switching to single-payer in the USA would result in savings without shortages, rationing, or lower quality care. Maybe switching is the right thing to do, but it's best to be honest about the costs.
EDIT: I'd love anyone down-voting this comment to demonstrate how switching to single-payer in the USA would result in savings without shortages, rationing, or lower quality care. Maybe switching is the right thing to do, but it's best to be honest about the costs.
Medical billing is ~1/3 of all heathcare costs in the US. That's everything from doctors filling out extra paperwork to advertising and profit for insurance companies. It's not uncommon for close to half the man hours at private practice to be spent on billing related activities, doctors just get paid a lot more.
Quality of care is not the only factor. Medicare spends a lot on end of life care without significant benifit. It's not a question of if there is rationing as we only have finite money, it's a question of what form it takes.
Worse a lot of unnecessary procedures and medication degrade quality of life.
Quality of care is not the only factor. Medicare spends a lot on end of life care without significant benifit. It's not a question of if there is rationing as we only have finite money, it's a question of what form it takes.
Worse a lot of unnecessary procedures and medication degrade quality of life.
> Medical billing is ~1/3 of all heathcare costs in the US.
Citation needed. Just looking up health insurance profits ($13B) vs. total healthcare spend ($2T) shows that profit for insurance companies is only 0.65% of the total healthcare spend.
Citation needed. Just looking up health insurance profits ($13B) vs. total healthcare spend ($2T) shows that profit for insurance companies is only 0.65% of the total healthcare spend.
> Citation needed.
Probably traces back to this which is just hospital costs but I think maybe even worse for smaller practices:
A 1999 report found that after exclusions, administration accounted for 31.0% of healthcare expenditures in the United States.
https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_s...
The study:
http://www.nejm.org/doi/full/10.1056/NEJMsa022033
> Just looking up health insurance profits
It wouldn't show up in profits as sibling mentions.
I've seen slightly lower but more recent numbers for hospital admin in the US. Not all of this is 'medical billing' but the majority is (look at the Canadian numbers) and you also have to account for the portion that shows up in the insurer's admin as well (~12% US vs ~3% Canada). There are also substantial admin costs soaked by employers and the subscribers in the US as well although technically not 'medical billing' either.
Probably traces back to this which is just hospital costs but I think maybe even worse for smaller practices:
A 1999 report found that after exclusions, administration accounted for 31.0% of healthcare expenditures in the United States.
https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_s...
The study:
http://www.nejm.org/doi/full/10.1056/NEJMsa022033
> Just looking up health insurance profits
It wouldn't show up in profits as sibling mentions.
I've seen slightly lower but more recent numbers for hospital admin in the US. Not all of this is 'medical billing' but the majority is (look at the Canadian numbers) and you also have to account for the portion that shows up in the insurer's admin as well (~12% US vs ~3% Canada). There are also substantial admin costs soaked by employers and the subscribers in the US as well although technically not 'medical billing' either.
This takes a more restrictive view of medical billing and excludes said profits still: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/
"Conclusions:
A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending."
It also says "Morra and colleagues estimated annual BIR costs in physicians’ practices at $82,975 per physician in the U.S. versus $22,205 in Ontario, Canada [5], i.e., 73% lower."
PS: I would say 100% of the insurance industry excluding doctor payments is medical billing and "Insurance carriers and related activities contributed $450.3 billion, or 2.6 percent, of U.S. gross domestic product in 2014, according to the U.S. Bureau of Economic Analysis." http://www.iii.org/fact-statistic/industry-overview
"Conclusions:
A simplified financing system in the U.S. could result in cost savings exceeding $350 billion annually, nearly 15% of health care spending."
It also says "Morra and colleagues estimated annual BIR costs in physicians’ practices at $82,975 per physician in the U.S. versus $22,205 in Ontario, Canada [5], i.e., 73% lower."
PS: I would say 100% of the insurance industry excluding doctor payments is medical billing and "Insurance carriers and related activities contributed $450.3 billion, or 2.6 percent, of U.S. gross domestic product in 2014, according to the U.S. Bureau of Economic Analysis." http://www.iii.org/fact-statistic/industry-overview
Medical billing would be a cost not a profit center, so I think this may support the idea, not reject it.
I agree with this take. A big reason why other countries have lower healthcare costs is because they ration care. I moved from a single payer system (Canada) to the US and saw exactly that.
Want the best, experimental treatment for your cancer? A lot (not all) US insurance companies will pay for it. Canada? You need to wait until the gov't does it's review and says "yes". They often say no.
Now, rationing is not all that bad, as obviously healthcare outcomes in the US aren't X% better (X% being the extra amount we pay for healthcare).
The best analysis I've seen as to why healthcare is more expensive in the US is the McKinsey report.[1] It's a huge report, but what they did was breakdown spending in the US by category and compared it to the average across developing nations.
Interesting findings:
- 2/3rds of the excess spending are out-patient care (i.e. stuff that doesn't happen in the hospital). In other words, Americans get a lot more out-patient things done than in other countries
- In-patient care is barely 10% higher than comparable countries
- Health administration and insurance is ~50% higher, but it's not a big piece over the overall spending pie (~7%)
- The US spends about ~20% less on long term care and 50% less on durables (this is shocking to me)
- Finally, the US spends about 300% of other nations on healthcare investment (you'd need to look at the report to see what that means)
[1]http://www.mckinsey.com/industries/healthcare-systems-and-se...
Want the best, experimental treatment for your cancer? A lot (not all) US insurance companies will pay for it. Canada? You need to wait until the gov't does it's review and says "yes". They often say no.
Now, rationing is not all that bad, as obviously healthcare outcomes in the US aren't X% better (X% being the extra amount we pay for healthcare).
The best analysis I've seen as to why healthcare is more expensive in the US is the McKinsey report.[1] It's a huge report, but what they did was breakdown spending in the US by category and compared it to the average across developing nations.
Interesting findings:
- 2/3rds of the excess spending are out-patient care (i.e. stuff that doesn't happen in the hospital). In other words, Americans get a lot more out-patient things done than in other countries
- In-patient care is barely 10% higher than comparable countries
- Health administration and insurance is ~50% higher, but it's not a big piece over the overall spending pie (~7%)
- The US spends about ~20% less on long term care and 50% less on durables (this is shocking to me)
- Finally, the US spends about 300% of other nations on healthcare investment (you'd need to look at the report to see what that means)
[1]http://www.mckinsey.com/industries/healthcare-systems-and-se...
The weird stat that always sticks out to me is the maternal mortality rate being so bad in the USA versus other developed nations in spite of unrationed care. There's a big racial component in that but it doesn't explain the difference (You're more likely to die if you are a black mother in the USA, and there is no physiological reason for that.) https://www.scientificamerican.com/article/has-maternal-mort...
It's an interesting problem to find the cause of. I think some of it is due to unequal access to care, but that doesn't explain all of it.
Some of it is due to how a country measures a "live" birth. Some countries say if the child dies within 24 hours of being born, it was never "alive". That certainly helps improve child mortality measures!
Some of it is due to how a country measures a "live" birth. Some countries say if the child dies within 24 hours of being born, it was never "alive". That certainly helps improve child mortality measures!
The main source of savings in a single-payer system isn't simplified billing, but increased negotiating power on everything from drug prices to salaries. With that being said, I agree that if every US citizen should enjoy the quality of service, that people with premium health care coverage has, it would probably be more expensive than most European single-payer systems.
> The main source of savings in a single-payer system isn't simplified billing, but increased negotiating power on everything from drug prices to salaries.
You're agreeing with the parent's original point. Salaries in healthcare are far higher in the US than they are in eg the UK or Germany. The US median income is significantly higher than all but a few nations. In the US we don't ration care nearly to the extent that they do in eg Canada, wait times are lower and Americans over-use (abuse) their healthcare and always have.
In France a radiologist will make $150,000. In the US it's closer to $450,000. Nurses in the US will typically make 40%-50% more than nurses in Germany. Good luck hammering all of those pay scales back down without causing huge strikes.
You have to remove a trillion dollars in cost from the system. Only about $100b can be removed from big pharma's cost share. You have to destroy a million jobs (eg the health insurance industry), and slash the pay for hundreds of thousands of healthcare workers by at least 20% to 30%. Even if some of those lost jobs can eventually be reclaimed, the upheaval will be epic.
You're agreeing with the parent's original point. Salaries in healthcare are far higher in the US than they are in eg the UK or Germany. The US median income is significantly higher than all but a few nations. In the US we don't ration care nearly to the extent that they do in eg Canada, wait times are lower and Americans over-use (abuse) their healthcare and always have.
In France a radiologist will make $150,000. In the US it's closer to $450,000. Nurses in the US will typically make 40%-50% more than nurses in Germany. Good luck hammering all of those pay scales back down without causing huge strikes.
You have to remove a trillion dollars in cost from the system. Only about $100b can be removed from big pharma's cost share. You have to destroy a million jobs (eg the health insurance industry), and slash the pay for hundreds of thousands of healthcare workers by at least 20% to 30%. Even if some of those lost jobs can eventually be reclaimed, the upheaval will be epic.
"In the US we don't ration care nearly to the extent that they do in eg Canada"
Sure you do. Poor people don't get any health care, people with insurance get all the health care they want.
You ration based on income and geographic location, as opposed to making people queue for care.
But it's rationing both ways.
Sure you do. Poor people don't get any health care, people with insurance get all the health care they want.
You ration based on income and geographic location, as opposed to making people queue for care.
But it's rationing both ways.
As typically understood, rationing is allowing each person to have a fixed amount of something no matter what. In the USA, if you want more healthcare, you have many options to increase your consumption. If you want to redefine rationing as anything that isn't yet post-scarcity, sure we have rationing.
Aside: Poor people do get health care in the USA. My brother was unemployed and received over $1 million in healthcare for his son with cancer, and hundreds of thousands of dollars in care for his dialysis treatment and eventual kidney transplant.
Aside: Poor people do get health care in the USA. My brother was unemployed and received over $1 million in healthcare for his son with cancer, and hundreds of thousands of dollars in care for his dialysis treatment and eventual kidney transplant.
1 million in heathcare is still rationing. If say bill gates kid had cancer they would likely spend more money on care in the same situation.
But, as you say until we are post scarcity there is going to be cost benifit analysis. All I am saying is our current system is inefficient, I don't expect we are going to transition before the next revolution.
PS: A lot of government money ends up going to healthcare independent of patient care. Ex: HRSA Grants for Rural Heath systems add up to ~16 billion and are not counted as Medicare Medicare etc https://www.hrsa.gov/ruralhealth/
But, as you say until we are post scarcity there is going to be cost benifit analysis. All I am saying is our current system is inefficient, I don't expect we are going to transition before the next revolution.
PS: A lot of government money ends up going to healthcare independent of patient care. Ex: HRSA Grants for Rural Heath systems add up to ~16 billion and are not counted as Medicare Medicare etc https://www.hrsa.gov/ruralhealth/
> Poor people don't get any health care, people with insurance get all the health care they want.
You just revealed that you don't know anything about the US healthcare system. Poor people have free healthcare in the US. It's the lower 20% to 40% income bracket that is getting particularly hammered. The top 50% have mostly good health coverage. The bottom 15%-20% is and has been covered by government healthcare for decades.
I'll repeat it again for emphasis: if you're at or below the poverty line, you get free healthcare in the US. See: Medicaid and several other connected programs that are built just for that and are very large. If you earn near minimum wage, you're going to qualify for free healthcare in pretty much every state. And it's actually decent healthcare.
You just revealed that you don't know anything about the US healthcare system. Poor people have free healthcare in the US. It's the lower 20% to 40% income bracket that is getting particularly hammered. The top 50% have mostly good health coverage. The bottom 15%-20% is and has been covered by government healthcare for decades.
I'll repeat it again for emphasis: if you're at or below the poverty line, you get free healthcare in the US. See: Medicaid and several other connected programs that are built just for that and are very large. If you earn near minimum wage, you're going to qualify for free healthcare in pretty much every state. And it's actually decent healthcare.
Has the situation where few doctors accept Medicare changed since 2009?
http://www.nytimes.com/2009/04/02/business/retirementspecial...
edit: and I should clarify that yes, this is Medicare and not Medicaid and while I do understand the US medical system I'm not a health policy expert so I sometimes get specific points confused. Sheesh. Why does it take a PhD to figure out how to get medical coverage in the US?
http://www.nytimes.com/2009/04/02/business/retirementspecial...
edit: and I should clarify that yes, this is Medicare and not Medicaid and while I do understand the US medical system I'm not a health policy expert so I sometimes get specific points confused. Sheesh. Why does it take a PhD to figure out how to get medical coverage in the US?
Salary slashes are inevitable because healthcare costs are growing like metastatic cancer. The twin dragons are health and milsec.
So we are about to have net neutrality repealed over the objection of everyone except ISPs basically. Medicare isn't even allowed to negotiate drug prices, but our govt run single payer system will definitely be immune from regulatory capture. Right?
The drug price thing is overblown. The private companies that administer Medicare Part D are free to negotiate prices and do so.
http://www.kff.org/medicare/issue-brief/searching-for-saving...
At the bottom it mentions saving billions of dollars by extending a Medicaid program to some Medicare drugs, but that is not negotiated, those discounts are required by law.
http://www.kff.org/medicare/issue-brief/searching-for-saving...
At the bottom it mentions saving billions of dollars by extending a Medicaid program to some Medicare drugs, but that is not negotiated, those discounts are required by law.
increased negotiating power on everything from drug prices to salaries
Not really. Take a look at drugs. Canada has an entire population of ~35M. United Healthcare (biggest US private insurer) has 40M lives. UHC pays a lot more for things than Canada does.
I would say the single payer benefit is that things can be done by fiat. When the gov't says you'll be paid $X for a procedure, there really isn't anything you can do about it.
Not really. Take a look at drugs. Canada has an entire population of ~35M. United Healthcare (biggest US private insurer) has 40M lives. UHC pays a lot more for things than Canada does.
I would say the single payer benefit is that things can be done by fiat. When the gov't says you'll be paid $X for a procedure, there really isn't anything you can do about it.
As a doctor, you could not do the procedure, and focus on procedures that pay more.
The United States pays more than twice per capita than Canada for healthcare, but with worse outcomes.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
The system in Canada isn't even close to the most efficient in the world. Many european countries manage to pay even less and produce even better outcomes.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
The system in Canada isn't even close to the most efficient in the world. Many european countries manage to pay even less and produce even better outcomes.
You're link says nothing about outcomes. Have a source?
It also depends on how you measure outcomes. The US exceeds other countries when it comes to things like cancer outcomes. It does poorly in things like life expectancy which is a terrible way to measure outcomes since so many other things other than medical care impact it.
It also depends on how you measure outcomes. The US exceeds other countries when it comes to things like cancer outcomes. It does poorly in things like life expectancy which is a terrible way to measure outcomes since so many other things other than medical care impact it.
Every time US healthcare comes up the insane cost and relative poor quality is mentioned, it is met with "hmmm citation needed?" like it's not been covered to death already, then the citations are then generally ignored (like here: https://news.ycombinator.com/item?id=15136962). I do not understand why people are so defensive of such a plainly awful system
I'm asking because I'm curious how they measured outcomes. Most of the studies I've seen are pretty bad. They measure outcomes with a very blunt tool. I was curious if something better was out there.
Access to primary care doctors, life expectancy, infant mortality, infectious disease rates. etc.
A national single-payer spreads risk across the entire country, so states that are relatively healthy will end up paying for health care in states where people eat bbq ribs and sausage for breakfast.
I like the idea of a county based single payer systems where counties manage healthcare and they are incentivized to promote healthy lifestyles.
I like the idea of a county based single payer systems where counties manage healthcare and they are incentivized to promote healthy lifestyles.
This is a social responsibility. Most European countries do this, Canada does this. While not perfect, the system works. It is exposed to any other warfare system to cheaters, but I would say on a much smaller scale than unemployment benefits for example.
> It's also a bit magical to think that switching to single payer in the USA would result in savings
>There is no reason to believe that costs would go down without massive price controls (and thus, shortages/rationing)
He didn't say either of those things.
We can't just switch. It's not a realistic option. He's pointing something out, not saying "hey we should switch now and x would happen".
>There is no reason to believe that costs would go down without massive price controls (and thus, shortages/rationing)
He didn't say either of those things.
We can't just switch. It's not a realistic option. He's pointing something out, not saying "hey we should switch now and x would happen".
I didn't say he said them. He strongly implied them. You're being uncharitable with this reply.
Exactly. Just repeat 'free healthcare', never mind that many people in Canada can't even find a family Dr, let alone get things like MRIs. Michael Moore said we have wonderful healthcare just like Cuba, so it must be true.
Oh it appears that now ERs are shutting down, but hey, free healthcare. Did I mention that you won't get a bill for dying on a waiting list if you use free healthcare in Canada? It's amazing and you can pay for it easily. Don't even have to leave your house to get free treatments.
http://www.cbc.ca/news/canada/british-columbia/doctor-shorta...
Oh it appears that now ERs are shutting down, but hey, free healthcare. Did I mention that you won't get a bill for dying on a waiting list if you use free healthcare in Canada? It's amazing and you can pay for it easily. Don't even have to leave your house to get free treatments.
http://www.cbc.ca/news/canada/british-columbia/doctor-shorta...
Canada beats the US in just about every metric you can imagine... From infant mortality to overall patient (and doctor) satisfaction.
That's true on average. But if you split the US into wealthy and non-wealthy, the wealthy get excellent care and have better outcomes than almost any other country, whereas the poor fare significantly worse than even many 3rd world countries.
That's why people get upset when we talk about this. Some wealthy people point out that their care is far better than Canada's (which is true) while other wealthy people who care about other humans point out that while their care is better than Canada, not everyone's is. And then of course the poor in America just want to not die of totally treatable diseases.
That's why people get upset when we talk about this. Some wealthy people point out that their care is far better than Canada's (which is true) while other wealthy people who care about other humans point out that while their care is better than Canada, not everyone's is. And then of course the poor in America just want to not die of totally treatable diseases.
Exactly, so if you are a median Canadian you're getting very shitty healthcare compared to the median American.
In Canada you still get really shitty outcomes for any chronic illness. Basically if any idiot can identify what problem you have heart failure, broken arm, profuse bleeding you get treated for free, and in a reasonably efficient manner.
If you have anything that requires tests, scans, diagnostics, a specialist, or isn't going to kill you in the next week plan on spending 5 to 10 years on a waiting list / various waiting lists. My friend has been waiting 4 years for knee surgery that prevents her from working.
One of the best things about having a private Dr in Canada is that they know how to work the system and will basically harass the list keepers to bump you up so that the keepers of the lists can go back to doing nothing. Also, most clinics have some sort of consult that you can opt for which makes the waiting list magically disappear. Get a out of pocket brain scan? Voila, brain specialist is available in 2 weeks instead of 2 years.
In Canada you still get really shitty outcomes for any chronic illness. Basically if any idiot can identify what problem you have heart failure, broken arm, profuse bleeding you get treated for free, and in a reasonably efficient manner.
If you have anything that requires tests, scans, diagnostics, a specialist, or isn't going to kill you in the next week plan on spending 5 to 10 years on a waiting list / various waiting lists. My friend has been waiting 4 years for knee surgery that prevents her from working.
One of the best things about having a private Dr in Canada is that they know how to work the system and will basically harass the list keepers to bump you up so that the keepers of the lists can go back to doing nothing. Also, most clinics have some sort of consult that you can opt for which makes the waiting list magically disappear. Get a out of pocket brain scan? Voila, brain specialist is available in 2 weeks instead of 2 years.
The US is dead last in the G20, Canada is 2nd last. Our system still sucks.
adventured(1)
Single payer isn't free or a panacea to health care costs, and there are problems in Canada, but the problems you cite are also problems in the US. I end with some thoughts on how free markets and optimization can save us lots of money, so stick with me.
That's rural ERs in Canada in the article you link. Same problem is happening in the US, because many doctors want to live in a city, where there is potential job growth and a host of other benefits, rather then out in rural hospitals, which usually can't pay very much.
This is a systemic issue that affects all rural health care, not a problem with Canadian health care specifically.
Here's a couple of articles from just August about the issue in the US.
http://www.spokesman.com/stories/2017/aug/26/rural-america-s... https://www.nbcnews.com/health/health-news/new-program-aims-...
As for wait times, again, also a problem in America. Even if we moved to single payer, it would probably get worse before it got better, since it means more people with health insurance for the same number of doctors in the short term, but then the market would likely correct that. Heres an article on us wait times.
https://www.forbes.com/sites/brucejapsen/2017/03/19/doctor-w...
Demand for health care will continue to increase as baby boomers age, new techniques arrive etc. That will always drive up prices or other costs, regardless of if we go single payer or keep the current system here. And it's a big enough system no matter what you do that there will always be some waste and greed that can't be cut.
Currently though, what is waste/greed and what is actual increasing cost is very unclear because PBMs and other companies keep things like drug pricing confidential.
If conservatives want to fight single payer, they need to lay out an alternative strategy that will actually keep costs in line without sacrificing care.
Single payer or our current system, most of the health care dollar doesn't go to the insurer under obama care (obamacare mandated a minimum of 80% for smaller carriers or 85% for larger ones, previously it was 50 - 60% so we did get some savings there), so if you want to cut costs, we really need to cut it at the middle or at the provider/manufacturer level.
Now single payer could save something, because operating costs are still higher then in simpler systems (https://newsatjama.jama.com/2017/04/25/jama-forum-where-does...). But single payer has a lot of requirements to be cheaper like the govermnent being allowed to negotiate drug and provider prices. These are things that, except on the state level, most likely would be heavily opposed by medical providers.
Total costs for the health care procedures/devices/drugs/providers are higher to insurers, and that's where most of your money goes, and as any developer will tell you, if you want to optimize, you want to optimize where you are spending the most be it in dollars or in processor cycles. So we have to cut that. And that's what conservatives should be focusing on, cutting the underlying costs, and making the pbms and brokers in the middle be transparent, so that cost savings get to insurers which can then be regulated at the state level.
My first suggestion to that end is always going to be more transparency to allow for a better free market, but that means adding and enforcing regulations to provide transparency, something which conservatives have resisted, despite the success of regulated open markets like stock exchanges. Drug companies spend more of their money on marketing then R&D, ( http://www.randalolson.com/2015/03/01/design-critique-puttin... ) so there is plenty of fat to cut before you start affecting R&d expenditures, and drug companies are one of the biggest beneficiaries of US research grants and tax benefits. Even a congressional committee investigation would be a start. So it's still possible to keep private insurers, but conservatives need to step up.
That's rural ERs in Canada in the article you link. Same problem is happening in the US, because many doctors want to live in a city, where there is potential job growth and a host of other benefits, rather then out in rural hospitals, which usually can't pay very much.
This is a systemic issue that affects all rural health care, not a problem with Canadian health care specifically.
Here's a couple of articles from just August about the issue in the US.
http://www.spokesman.com/stories/2017/aug/26/rural-america-s... https://www.nbcnews.com/health/health-news/new-program-aims-...
As for wait times, again, also a problem in America. Even if we moved to single payer, it would probably get worse before it got better, since it means more people with health insurance for the same number of doctors in the short term, but then the market would likely correct that. Heres an article on us wait times.
https://www.forbes.com/sites/brucejapsen/2017/03/19/doctor-w...
Demand for health care will continue to increase as baby boomers age, new techniques arrive etc. That will always drive up prices or other costs, regardless of if we go single payer or keep the current system here. And it's a big enough system no matter what you do that there will always be some waste and greed that can't be cut.
Currently though, what is waste/greed and what is actual increasing cost is very unclear because PBMs and other companies keep things like drug pricing confidential.
If conservatives want to fight single payer, they need to lay out an alternative strategy that will actually keep costs in line without sacrificing care.
Single payer or our current system, most of the health care dollar doesn't go to the insurer under obama care (obamacare mandated a minimum of 80% for smaller carriers or 85% for larger ones, previously it was 50 - 60% so we did get some savings there), so if you want to cut costs, we really need to cut it at the middle or at the provider/manufacturer level.
Now single payer could save something, because operating costs are still higher then in simpler systems (https://newsatjama.jama.com/2017/04/25/jama-forum-where-does...). But single payer has a lot of requirements to be cheaper like the govermnent being allowed to negotiate drug and provider prices. These are things that, except on the state level, most likely would be heavily opposed by medical providers.
Total costs for the health care procedures/devices/drugs/providers are higher to insurers, and that's where most of your money goes, and as any developer will tell you, if you want to optimize, you want to optimize where you are spending the most be it in dollars or in processor cycles. So we have to cut that. And that's what conservatives should be focusing on, cutting the underlying costs, and making the pbms and brokers in the middle be transparent, so that cost savings get to insurers which can then be regulated at the state level.
My first suggestion to that end is always going to be more transparency to allow for a better free market, but that means adding and enforcing regulations to provide transparency, something which conservatives have resisted, despite the success of regulated open markets like stock exchanges. Drug companies spend more of their money on marketing then R&D, ( http://www.randalolson.com/2015/03/01/design-critique-puttin... ) so there is plenty of fat to cut before you start affecting R&d expenditures, and drug companies are one of the biggest beneficiaries of US research grants and tax benefits. Even a congressional committee investigation would be a start. So it's still possible to keep private insurers, but conservatives need to step up.
Note: on a per capita basis countries that don't have universal health care (like the US) spend more on health insurance than countries that do (like Australia)
Presumably the single government-run insurance system is in a much stronger negotiation position with the healthcare providers, forcing healthcare providers to operate more efficiently.
So we are about to have net neutrality repealed over the objection of everyone except ISPs basically. Medicare isn't even allowed to negotiate drug prices, but our govt run single payer system will definitely be immune from regulatory capture. Right?
Why would you presume these things that are almost certainly false for the US.
Why would you presume these things that are almost certainly false for the US.
We pay much taxes, but then again. Everyone does here. If you get sick. A doctor can cost 5€ for a visit, we go to the dentist because we can easily. Our medicine is 10x as cheap easily and if we lose our jobs, we still have a home.
But yeah, if we earn a lot. We pay a lot. No reason to be sarcastic about it. I've always had a job and I'm never ill and I hope it never happens. The system works though, even if we have the largest taxes in the world ( Belgium)
But yeah, if we earn a lot. We pay a lot. No reason to be sarcastic about it. I've always had a job and I'm never ill and I hope it never happens. The system works though, even if we have the largest taxes in the world ( Belgium)
Yes. It is $50. Private insurance company. One of the largest in the world.
[deleted](1)
UK here, sounds expensive to me. I mean, it's calculated as a percentage of your salary - so if you don't work at all, or earn below the taxable threshold, you never pay anything and still have full coverage. Earn loads of money = pay loads towards health insurance. As someone on a moderate salary, ~569USD/month sounds like a lot to me, but I can only assume that with his profits, it's not bad at all.
$6/gallon gasoline sounds expensive to me. I'd much rather live here on a moderate salary. Enjoy paying VAT taxes!
VAT adds up to a very low percentage of what a typical family spends, as firstly, most people only spends a small proportion of their salary on things that VAT are due on. E.g. if you pay 25% in tax + national insurance, then your net salary is 75% of your gross. If you spend 1/3 of that on mortage/rent, you're left with half of your gross salary. This leaves you with VAT adding a theoretical maximum of 10 percentage points to your taxes.
But of course, in reality you have a bunch of other costs that VAT aren't charged on, and a number of essential goods such as most food are zero rated, and a number of additional goods are charged at reduced rates.
Last time I did the maths for myself (earning well beyond average), despite the headline VAT rate for the UK of 20%, I paid less than 4% of my salary towards VAT.
Overall my tax level was comparable to e.g. California (and if factoring in health insurance etc., California would have been much more expensive if I wanted to ensure equivalent coverage). Your mileage will vary depending on what you spend your money on.
Now, if you spend a lot of your income on gasoline, you have a point - it will drive up the taxes you pay a lot. And also, there certainly are US states that would be cheaper.
But a comparison like that is pretty meaningless without factoring in cost of living and salary levels as well.
But of course, in reality you have a bunch of other costs that VAT aren't charged on, and a number of essential goods such as most food are zero rated, and a number of additional goods are charged at reduced rates.
Last time I did the maths for myself (earning well beyond average), despite the headline VAT rate for the UK of 20%, I paid less than 4% of my salary towards VAT.
Overall my tax level was comparable to e.g. California (and if factoring in health insurance etc., California would have been much more expensive if I wanted to ensure equivalent coverage). Your mileage will vary depending on what you spend your money on.
Now, if you spend a lot of your income on gasoline, you have a point - it will drive up the taxes you pay a lot. And also, there certainly are US states that would be cheaper.
But a comparison like that is pretty meaningless without factoring in cost of living and salary levels as well.
Germany, self-employed, single: I pay about 760 EUR/month for the statutory health insurance. This is the max, it can get cheaper if you make less revenue. Price increases about 2% every year. Can be fully deducted from taxes though. I think the system is kind of fair. I paid 80 EUR/month when I was a student.
I'm in the US and my health insurance costs $1600/month for a family of three.
Luckily, my employer picks up half of that tab.
Even with that amount of expense we still have a $2000 deductible each!
Luckily, my employer picks up half of that tab.
Even with that amount of expense we still have a $2000 deductible each!
In the US, if you are insured, you end up paying about the same as an uninsured for health expenses (if you don't include the insurance costs)....
In The Netherlands this would be quite expensive, though it depends a bit on what your insurance would cover. For example, my health insurance plan (covering just me, not a family of 3) costs around €110 / month ($130) but is a fairly basic plan and requires that I pay the first €300 myself (which is stupid if you ask me) per year, anything after that is covered.
You can get cheaper or more expensive plans depending on the amount of value you pay yourself (known as the "eigen risico" or "own risk"), but the cheapest I could find was around €80 / month.
You can get cheaper or more expensive plans depending on the amount of value you pay yourself (known as the "eigen risico" or "own risk"), but the cheapest I could find was around €80 / month.
Yeah I pay around €80 / month but my "own risk" is around €885.
That there's an "own risk" is not stupid, insurance that protects you from every little thing is necessarily more expensive than insurance that only protects you from an unlikely catastrophe.
I save €17.50/month by setting the "own risk" to €885 instead of €385, a difference of €500. This means that if I don't use the health insurance for around 2.5 years I make up that difference and then get a "free" €17.50/month.
I would set it even higher than €885 if I could, but at least with CZ that's the maximum they seem to offer.
The difference in premiums is probably artificially low in The Netherlands since the market is so heavily regulated. I.e. if I expect to get "sick" I can just adjust the premiums yearly, e.g. women expecting to be pregnant do that, so it distorts the market. The insurer needs to eat the cost of your premium adjustment, even if you adjusted it because of a pre-existing condition or expected future medical cost.
Also, you should be careful when bragging about the price of health insurance in The Netherlands. It's a hybrid privately paid & publicly paid system, so most of what you're paying for it is probably coming out of your taxes, not the premiums you pay to the insurer.
That there's an "own risk" is not stupid, insurance that protects you from every little thing is necessarily more expensive than insurance that only protects you from an unlikely catastrophe.
I save €17.50/month by setting the "own risk" to €885 instead of €385, a difference of €500. This means that if I don't use the health insurance for around 2.5 years I make up that difference and then get a "free" €17.50/month.
I would set it even higher than €885 if I could, but at least with CZ that's the maximum they seem to offer.
The difference in premiums is probably artificially low in The Netherlands since the market is so heavily regulated. I.e. if I expect to get "sick" I can just adjust the premiums yearly, e.g. women expecting to be pregnant do that, so it distorts the market. The insurer needs to eat the cost of your premium adjustment, even if you adjusted it because of a pre-existing condition or expected future medical cost.
Also, you should be careful when bragging about the price of health insurance in The Netherlands. It's a hybrid privately paid & publicly paid system, so most of what you're paying for it is probably coming out of your taxes, not the premiums you pay to the insurer.
In the US its common to have the lowest rung be about $500 USD a month with a $5000 deductable. Thats $11,000 a year - the only reason most people have insurance is the subsidies that the government provides (Obamacare, or if you're very poor Medicare). Its like a sick joke - so many layers are making massive amount of money.
IIRC in the Netherlands about half of the premium is subsidized by the state (and 100% for children). The actual premium would be around 200 EUR per person.
It doesn't seem like an expensive premium for a family of 3 compared to what's on the federal exchange (what people ignorantly call Obamacare, as it were an insurance plan in and of itself) for the State of Florida.
Still the premium means relatively little, what matters is what kind of network coverage he/his family gets as well as the deductible and copay. As many have found especially with some of these fly by night insurance companies that initially popped up on the exchange in Florida and after two years are no longer in business, there is no point in claiming people are insured just because they are paying premiums, if the have relatively limited access to care and/or can't afford the deductible.
Still the premium means relatively little, what matters is what kind of network coverage he/his family gets as well as the deductible and copay. As many have found especially with some of these fly by night insurance companies that initially popped up on the exchange in Florida and after two years are no longer in business, there is no point in claiming people are insured just because they are paying premiums, if the have relatively limited access to care and/or can't afford the deductible.
I'm on COBRA in SF and pay close to $1000/mo. Ridiculously expensive.
I pay $1200 on cobra for me and my wife. It's a pretty good plan though.
Considering I'm a single healthy guy in SF and have gone to the doctor maybe twice in the past ten years… this is straight up highway robbery! I should just ditch health insurance altogether…
I used to work for a NY based startup as their first employee in London. As part of the package they simply put an extra £1000 a month in my wage under the line "item health insurance contribution".
At the time I too went to the Dr approx once a year for something routine and of course in the UK there is a completely free at the point of access healthcare i pocketed the fee.
At the time I too went to the Dr approx once a year for something routine and of course in the UK there is a completely free at the point of access healthcare i pocketed the fee.
As a 32 y/o m with no preconditions my silver-ish plan in the US is $500/mo though I get reimbursed some of that by my employer (while the ACA is in place at least).
Germany: For employees in the national health insurance 7.6 % of your gross salary capped at currently 4350,- Euro per month and the employer has to pay the same again.
So you mean 7.6% of 4350 correct? Not 4350 max?
Yes, but I got the number slightly wrong, 7.3 %, not 7.6 %. So a maximum of 317.55 Euro per month, at least roughly, insurance companies can and do charge an varying additional premium from employees of up to about 2 %. I, for example, currently pay additional 1.4 %, so 8.7 % in the end, my employer pays 7.3 % on top of that.
What was the amount of Finnish taxes going to healthcare? Probably a few thousand euros per year.
Once your income passes a certain point, America has some of the cheapest health care in the world.
I see what you're trying to say, but not really. There are several countries with comparable or lower top tax brackets and much cheaper health care, particularly if you live in California or New York.
A certain point around 7 digits I'd say
Not even close. Let's pick Canada as an example. If you make $95k USD (household) you're better off in the US.
https://www.cnbc.com/2017/06/23/heres-how-much-the-average-a...
We spend a little more than $10k USD on medical expenses or $13k CAD.
https://www.fraserinstitute.org/sites/default/files/price-of...
Around $120k CAD is the tipping point where you spend more than the average person in the US which is about $95k USD.
https://www.cnbc.com/2017/06/23/heres-how-much-the-average-a...
We spend a little more than $10k USD on medical expenses or $13k CAD.
https://www.fraserinstitute.org/sites/default/files/price-of...
Around $120k CAD is the tipping point where you spend more than the average person in the US which is about $95k USD.
Income tax load in Canada is pretty close to California / NYC, but your also paying for health insurance on top of the tax load. So living in Canada is cheaper than the USA for healthcare costs if your paying similar tax rates.
It only starts becoming an extra cost if you live in an area of the USA with lower taxes than Canada, and you have to add a $9k credit for the Canadian side to account for the out of pocket healthcare expense they would be paying for in the USA.
It only starts becoming an extra cost if you live in an area of the USA with lower taxes than Canada, and you have to add a $9k credit for the Canadian side to account for the out of pocket healthcare expense they would be paying for in the USA.
Very funny, even if not intentionally so.
Am I doing something wrong? I'm paying about ~$300 a month for minimal coverage for a single under 30 year old person here in the US.
No. I pay 900/month for a family of 4 with a 12,000 dollar deductible.
no kidding.. mine is $1800/mo for a family of 4..
For sure. 1200 per month to cover my family at the same level I had when I was a W2 employee.
I pay 700ish USD a month for 3 healthy people.
> Most of this money has been spent on product and shipping, meaning I haven't made anywhere close to a million dollars in profit with this.