The median pay in the US is also half or more of the median pay in countries with much more generous healthcare.
I live in France, which is known for its good health coverage. However, I know a few people who worked both in France and in the US, and they made more there in terms of purchasing power, even after paying all the insurance required to get at least the same level of protection we get "for free" in France.
I suppose that the situation can be different depending on your occupation. But what I am saying is that it is just a different system. Healthcare is expensive by nature: highly trained personnel, state of the art research, unforgiving safety requirements, etc... and has to be paid for in some way, be it by taxes or by private insurance companies.
I basically agree that the quoted statement supports the idea of a dysfunctional system, the system is crazy. But it should also be acknowledged that it’s pretty rational for a country to spend more on health care as it becomes wealthier. Beyond basic health needs you notice all sorts of expensive marginal conveniences that get bundled into healthcare costs. One example is the ubiquity of motorized wheelchairs in the US. It’s really hard to go a day without seeing at least one in any US city, while I don’t recall ever seeing one in Berlin over a couple of years. People who couldn’t walk either used cheap old-fashioned wheelchairs, crutches, or presumably stayed indoors. I’m not really making a judgement on which approach leads to better health because I don’t have that data, but one costs thousands more. Comprehensive health insurance in the US may also cover modifications to a vehicle or hole to accommodate a motorized wheelchair, again thousands of dollars.
Another example: someone who has trouble concentrating at work in the US might spend (out of pocket, or through insurance) $1000 a year on an Adderall prescription Where in Germany it’s quite unusual to get an adult ADHD diagnosis, and even harder to get medication. People are more likely to just live with their genetics on this issue, or make non-medical accommodations, and their problems holding down a job or a relationship never become a medical cost on any spreadsheet. Again, I’m not saying one is better than the other, but culturally speaking, a larger number of personal problems faced by Americans are medicalized than in other countries.
On the motorized chair, specifically, it turned out to be an epic scam where all the wrong incentives were in place to get people who had no need for them to get one through their insurance. If only increased spending could be less wastefully applied...
Wow, that’s quite the story. I’d also add that I see them frequently in Canada where presumably the same scam didn’t happen, or at least to such a great extent. I still think there’s a cultural piece to it.
This also really shows how #medicareforall wouldn’t automatically solve every problem.
The taxes in France presumably pay for everybody, while the US premiums only pay for similar healthy working people.
Healthcare is expensive. The US government started providing healthcare to old people, rather than letting them die on the street outside the hospital.
But rather than the government paying the full cost of this program (ala food subsidies), the government dictated that providers give them special lower prices. The hospitals want to make up for that money some how, and so attempt to pass on extra costs to others. The next target (private health "insurance") doesn't want to subsidize that cost either, so they negotiate lower rates. The hospitals are still optimistic that they can still fool someone, and so attempt to take it out of helpless patients.
The entire system is essentially musical chairs. This is why after you receive medical services, the hospital will send you a fraudulent bill with a fictitious inflated price list rather than waiting for your "insurance" to cover their part first - they're hoping to luck into a sucker who will mindlessly pay the sticker price rather than the back room reduced rates.
I can foresee a trend of people setting up trust funds for themselves, to reduce the chance of losing their assets to the healthcare reverse lottery. That's really the point we're at - the last attempt at healthcare reform was basically jiujitsued by the health "insurance" industry into making patronizing their cartel mandatory!
When you tally up both government and personal expenditure the US is far more expensive for no valid reason.
Even government spending alone the US system is a bizarre outlier against OECD countries who all have universal healthcare as a core part of their system. When you include personal spending it's plain and clear that vested interests have corrupted your healthcare system.
I didn't mean to make it out like Medicare was the sole cause (eg how health "insurance" got started by being excepted from the wage restrictions of the time, and how it continues to be exempt from income tax). But I think the analogy of musical chairs describes the present constructive behavior of the system quite well.
A no brainer step to reforming the health care market is to force all providers to publish a price schedule, uniform across any payer. We wouldn't accept grocery stores forgoing price tags and instead trying to gouge each person for as much as they can, and any free market rhetoric needs to incorporate that fact.
(Note this is orthogonal to what level of care should be guaranteed by the government)
Different in the same way that Windows 3.1 is "just a different system" than MacOS X 10.14. The U.S. pays 2-3 times as much, and does not provide healthcare to vast numbers of people. Many who do receive health care go bankrupt paying for it; many who think they have insurance find that they are denied it by insurance companies.
That works precisely up until you get sick or a close relative gets sick, and then even with insurance you can be staring at medical bankruptcy. It works up until you lose your job and get sick while unemployed.
My guess is that it would be more like "get sick, don't seek healthcare until it's an emergency, go to emergency room, rack up many thousands of dollars in medical debt, be unable to pay it back, linger for a while, then die".
That has a very bad impact on the economy. When lots of people (it's a systemic problem, it's going to be LOTS of people) who are a part of this society start to become infirm, die out prematurely, leave the workforce, undergo radical drops in productivity, or merely become financially crippled from dealing with normal healthcare costs--that will send ripples through the economy. Our style of healthcare is a ludicrous expense for us all. It's a lot bigger than just the sticker price.
It's not just their own problem. They won't simply die and get out of the way of the more fortunate.
You know we didn't have this problem back in the early 1900s. It would be helpful if regulation didn't completely eliminate the ability of unions to pool together funds and create their own mini-insurance collectives. Regulation killed that by forcing all doctors to be licensed, a very expensive process that limits the supply of doctors and nurses.
> You know we didn't have this problem back in the early 1900s.
1900s... so, the X-Ray machine had just been invented. Antibiotics, Radiation, Chemotherapy, laparoscopy, endoscopy, the mri, titanium, stainless steel. Medicine was in a relative infancy and outcomes were much, much worse.
The good news is that most people don't have a pregnancy every single year.
I know, I know, other conditions apply. But even with young kids (and related pregnancies), my family has not consumed anywhere near what I've paid in premiums the last decade. I'd be shocked if we "got back" 10% of what I've paid in.
...if you have great insurance or live in a very, very cheap area. Our family was out of pocket over $10k with “standard mediocre” tech company health insurance. A UCSF study found that California women giving birth were charged from $3,296 to $37,227 for an uncomplicated vaginal delivery, depending on which hospital they visited. For a C-section, women were billed between $8,312 and nearly $71,000.
We had two home-births while living in Chicago and one in the suburbs. The fee of $2200 (cash price, without insurance) included all pre-natal care, the actual delivery, and several post-birth checkups. Four of the appointments (pre and post) were done at home, too. The delivery included the midwife (certified nurse midwife), assistant, and student. Across the street at Northwestern Memorial Hospital I was told the retail price was $30,000.
No, that is the bare price. Insurance drops it more. For a recent baby, my price went from about $3500 down to about $1000 due to insurance, though we had to prepay more and we're still trying to get back some of the difference. Back when I had better insurance and lived in an expensive location, the full cost was covered by insurance.
I've never heard of it being over $5000. I can imagine that an at-home birth in San Francisco might be that bad or worse, since the midwife needs to deal with the cost of living.
The problem here is "depending on which hospital they visited". There is no need to involve a hospital (full of exotic infections) for a normal bodily function. That is why your cost is so high.
Well, it isn't "figured out the world over". Hospital births are not the norm, generally and even in some developed countries.
It isn't even desirable that hospital births should be the norm. Besides the financial cost, directly to the consumer or spread out via higher taxes, there are reasons to prefer non-hospital births. Disease is one. Being able to calmly rest with the comforts of home is another.
There is tremendous waste in US healthcare. For every doctor there are a dozen accountants, marketers, insurance reps, sales reps, etc. Tons of bureaucracy trying to get a slice of that grotesque money pie.
The model you describe, a town subsidizing a few, is why the optimal state of healthcare affairs is the whole of a nation (through taxes) providing healthcare to everyone. It maximizes your healthy pool to offset the costs of the sick.
Turns out another part of keeping healthcare costs down is curing the sick as early as possible. In the US, even if you have insurance, you still often have deductibles and copays that strongly disincentivize you going to the doctor. So you don't, until that cold turns into pneumonia or you tear your trachea from a bad cough.
Theres a completely different mindset in the first world compared to how people in the US behave - if there is anything unusual "its better safe than sorry" in any European country. You still go to the doctor even with a "routine" illness because there is often no expense to you to do so.
But that is the right behavior. You want that at the societal level. Because for every false alarm there is someone developing a crippling or lethal ailment that will dramatically reduce their productivity and cost you substantially more than 15 minutes of consultation and 30 pills would have had they seen a doctor right away.
The US is killing its own citizens to line the pockets of the money hungry just by having its healthcare system be insurance based at all, regardless of if people are insured or not.
> Look at how many counties this would be half or more of the median pay.
Even if your $20K is a correct national average figure for family insurance costs, you can't do that and get meaningful results; insurance costs vary widely between states and localities (e.g., of ACA exchange plans, the statewide as average second lowest cost silver plan costs for states using the federal marketplace range from $459 in ND to $1,185 in WY—and the range of local rates, and/or including the states that don't use the federal exchanges, is even wider.) So you'd need to map local income against local costs to get anything meaningful.
No, it shows < $20K, not > $20K as you claimed. But, the accuracy of the national average figure is mostly a side issue.
> The costs do vary, but they do not drop off the way median income does in rural areas.
The costs vary enough locally that you can't make anything like a reasonable point by comparing the national cost to local incomes (and, also, you need to consider the effect of subsidies, which are based on income in relation to FPL.) I suspect the reality, before subsidies, may be even worse than what your naive comparison would suggest, but I don't have a lot of confidence in that because I haven't seen, or had time to analyze, national locality data. The bits and pieces I've seen, though, seem to suggest that, while there isn't a simple relationship, local health insurance costs may overall be weakly inversely correlated with local income. But, then you still have to consider subsidy availability—and Medicaid eligibility—to get the real picture.
Blatant plug: for large scale analysis on census and survey data I'd recommend checking out nhgis.org. It lets you download the large pieces of demographic data that you may be interested in. Data harmonized across time is also available to investigate trends.
Note: We don't have the 5-year 2017 ACS data yet (it takes about 2 weeks for us to ingest the data once it comes out).
I've used ACS and IPUMS data previously for research while at university. What are your thoughts on the proposed "differential privacy" changes  coming this way? Is it a "sky is falling" kind of situation?
Lots and lots and lots of dual-income lawyers and consultants. This is one of the areas where, on average, women have their first child at a very late age. Lobbying across a wide array of industries but also defense contractors and such. I was actually just looking at median home sizes/prices in that area for June of this year. I live in Arlington, bought a house earlier this year and discovered $425k is pretty much the bottom of the non-condo market, we only saw about 1 go up per month and everything closed immediately. Feels nuts here.
Should have known I couldn't mention housing prices without comparisons to the literally-the-most-extreme outlier bay area. The DC area isn't geographically constrained the same way, doesn't have the same concentration of hyper wealth, has immediately-adjacent jurisdictions with regulatory setups more amenable to development to California, and a much better/more extensive transit system. Salaries for your typical fed or consultant here don't come close to the engineering compensation in the bay for lower level employees.
Also, it's not $425k for a single family home. It's $425k for a 60-70 year old brick or cinderblock townhome/duplex between 800-1000 sqft that was constructed as WW2-boom housing.
The $1.3M homes in Mountain View are also 60-70 year old post-war construction of roughly 800-1000 sq ft. A duplex will run you about $1.9M here. New townhomes are roughly $1.6-1.7M. The sort of house that would be considered a modest suburban middle-class dwelling in most other places go for about $2.2-2.4M; a "nice house" (like the one my sister paid $550K for in the Houston metropolitan area) goes for around $6M and can only be had in the wealthy towns like Los Altos Hills or Atherton.
Yes, this is basically an extreme outlier for the U.S. I was surprised to find that it's actually pretty reasonable compared to many urban areas in the world, though - cities like Sydney, Vancouver, Hong Kong and Shanghai are rapidly climbing past Silicon Valley in housing unaffordability.
Not just lobbyists. A lot of professionals working for the government, military and all the companies that provide service for the government. Being close to DC, the area is flush with government money which is also funding a healthy software development and IT environment. Money may be corrupting politics in DC and ruining the nation but everyone in the vicinity is getting some of that DC gold dust. Record taxes and increased government borrowing should keep that gravy train going for a while longer.
>From 2013-2017 among geographic areas with 10,000 people or more, the locations with the highest and lowest poverty rates were:
>By metropolitan statistical area:
>Barnstable Town, Mass
As someone unfortunately familiar with the local economy in that cesspool (will global warming hurry up and wash that glorified sandbar away already?) this is a great illustration of how stats like this can be limited.
There is no shortage of money in Barnstable county. It is chock full of old retired people and rich people (with a significant overlap). They mostly happen to have primary residences elsewhere. Lots of people have their primary residence in Florida. The only industry is tourism. For three months of the year there is a firehouse of money directed at Barnstable county. The economic incentives that come with that mean that everyone tries to rip everyone else off and extract maximum value from everyone else (I could go on a pretty good rant about this). The blue collar tradesmen get very good at keeping their income off the books (I don't blame them, not doing so would be a competitive disadvantage). Everyone has an under the table side gig. Many "businesses" pay employees in cash. Jobs are often paid in cash.
Cape Cod is the Long Island of New England. While it's no SF suburb there is a ton of money in Barnstable county. It's just that most of it gets reported elsewhere or never gets reported at all so the county looks poor on paper. The absurdly high cost of living doesn't help (doesn't help the people actually struggling to get by that is). Housing is not as insane as Silly Valley but every other thing is priced outrageously (what the market will bear thanks to tourism) and you can't avoid those costs because you're basically on an island.
So yeah, take those stats with a grain of salt. I suspect the national stats are quite accurate but the county by county numbers are probably not that great.
This summary of facts seems quite useless, presented as it is by county. If poverty declined in two counties and increased in two counties, it makes a difference which counties were which. If Mono County and Alpine County are declining and San Mateo and Santa Clara are increasing, that is a very different phenomenon than the reverse.
I agree. The maps weight counties by area (naturally), but it would have been more useful to weight counties by population. A 2% increase in poverty in a county with 1 million people is more significant than a 2% increase in poverty in a county with 1000 people.
As you note, this is just a summary of some highlights. The “new” in this news just happens to be the availability of data at the regional level. Overall data waspreviously released, and is therefore not featured in this press release.
Yep. My father works at an oil refinery in Northern Alaska and everyone there is making well over 100k, around 200k for middle management, plus benefits like a pension. Downside is that it's a frozen tundra where you can't go outside without protective goggles to keep your eyes from freezing shut, but they also work 2 weeks on / 2 weeks off, so it's basically 6 months of vacation every year, in addition to normal vacation days. He said some people chose to live in warmer places like Puerto Rico and just fly back and forth every 2 weeks.
I haven't been in the oil business for a very long time but that was a very common pattern for offshore drilling rigs and the like. The interval of weeks varied from 1 to 4 as I recall generally based on how remote the location was.
Caveats: I'm still using an older dataset (the 2011-2015 one, IIRC), but I'm hoping I can migrate to the new one soon. And because of some boneheaded design decisions I made, the income and housing data is only available at the county level and below, not at the state and statistical area levels.
I also had to wrangle the data in certain ways to get the data in the format i want (median income, median housing cost, and median housing cost as a percentage of income; the source data is segregated by renters, homeowners with mortgages, and homeowners with no mortgages). I've written about this before, and you can find my calculations at https://news.ycombinator.com/item?id=14196287 (and yes I'm comfortable linking it now because I've since set up a robots.txt so Google doesn't crawl every endpoint that algorithmically generates graphics)
And, yes, at some point I'm going to get off my lazy ass and implement Let's Encrypt.
Serious none snarky question. Is there anything about Mississippi that is not bleak? I’ve lived in GA all of my life and at least we have the Atlanta metro and to a lesser extent Macon and Savannah. Tennessee has some cities that I wouldn’t mind living in.
It’s not small town vs city, it’s the lack of opportunity, and just the backward thinking from years of baggage and history. I’m not just referring to the stereotypical MAGA small town “rural America”, I see it from minorities too (I am Black).
I own a house in a rural area with no internet options other than cellular (not in Mississippi though) and gigabit up/down fiber is coming from my electricity company next year. I could do anything via internet then and the houses and cost of living are incredibly cheap.
I realize we're discussing this on HN but developers are a small microcosm of the communities being listed. Sure, there's examples that might combat the generality of my statement...but let's not be pedantic when that wasn't the subject to begin with.
I can work remotely with a very basic internet connection. So can others. And you can be a successful developer (in your country, let alone your county) without working remotely.
I stayed with my parents for a summer (long story) and worked remotely - it was painful. I could barely do video conferencing let alone upload and download large datasets fast over DSL. I ended up setting up a VM on AWS to work from.
But on a less anecdotal note, legitimate companies are doing “rural sourcing” of call centers where everyone works remotely and they give you a special boot disk that only runs thier software. They pay better than minimum wage and the requirement is a decent - above DSL internet connection.
My dad in Maine is the last house that can get DSL on a private road. Internet "works" but you can't do video or anything like that. One neighbor I know has a hot spot through Verizon though mobile signal isn't great either. I believe some others have satellite. If I had to work from there, I'd have to do something to supplement the DSL.
I've worked with people who didn't have broadband available. Basically, they got satellite and dealt with the outages due to weather and the costs. So you don't do much video streaming for entertainment and just dial in to calls unless there's some need to do video. It's a pain and you have to make compromises, but it can be done.
Or a non-developers use case for high speed broadband: a contract data entry job through Upwork is likely a much more sustainable job in Mississippi than it would be for someone in Brooklyn, but quality internet connections are required (minimum wage in Mississippi is $7.25…).
I was listening to an interesting podcast talking about education in Mississippi that talked about the interesting angle of basically, when you're ranked the worst in the country, you're willing to think more radically & don't have to fight as much entrenchment. Not that I'm looking to move there, but who knows, maybe in thirty or forty years we'll be studying Mississippi on how they turned it all around.
Anecdotally I have friends from 20-26 and not a single one is without a computer. Phones getting more powerful doesn't eliminate the computer. In fact, I know way more people without a TV than without a comnputer, as the computer replaces the TV.
Most of the counties with below 50% have populations smaller than most big city suburbs. While it's certainly still bleak given these are mostly just poor communities that at most subsist from agriculture, the vast majority of people in the state live in the blue area.
> Of the 3,142 counties in the United States, median household income declined in 222 counties (7.1 percent), while median household income increased in 521 counties (16.6 percent)
Does this mean that ~75% of counties had excatly zero change in median income? Like down to the cent? With or without inflation? This is difficult to believe. Even with stagnant wages you would expect some up and down across the whole country.
It's a census, so they're taking a sample. I would assume that 75% of counties had statistical outcomes that weren't statistically significantly different from the previous measurement. Consider if you sample the same county on the same day 10 times, you'll get 10 different outcomes, that doesn't mean income changed that day.
In addition, they may have used a threshold value. But it's not noted anywhere.
I'd also assume indeed there was inflation-adjustment.
But if you take a mean of those samples' means it would approach the population mean with an approximately normal distribution. Isn't that only an improvement? (Disclaimer I've only taken intro to stats at an undergrad level, exam next week)
> Does this mean that ~75% of counties had excatly zero change in median income? Like down to the cent?
Well, no, the ACS uses whole dollars as the indivisible unit for income stats. And it is estimated, not actual, with a reported (non-zero) margin of error for each figure in the source. E.g., here's the national median income table for 2017, by various characteristics:
I think it makes sense, since broadband internet is relatively expensive compared to other utilities that are more necessary. For example, if you have $50 a month to spend on either electricity or broadband internet, you're probably going to spend it on electricity (nevermind the fact that an inet connection is useless if you have no electricity).
I agree it makes sense, but I think your example is ridiculous.
In my (rural) area, DSL internet is the only decent option, and I pay about $72/month for it. It's acceptable, streams netflix okay, but I could never be competitive in a FPS. But people around here are more interested in more traditional activities. I think their rate of watching TV and engaging with their phones and other similar measures would be far, far less than the national average. I simply think internet is not a priority; they'd rather be outside. At least in my small bubble.
Really I pay $25 a month in the UK and that's for a high end one not the cheapo ISP's like plusnet. An your paying almost as much as my last employer did for ELM when we moved offices at short notice < a month.
> Country people drink their beer standing around a pile of burning pallets.
I suspect they city and country people both mostly drink their beer outside of business establishments, though, sure, standing around a pile of burning pallets specifically may be more common for country folk.
During the summer, our local "biker" bar offered bonfire seating. The fire was fed with, among other stuff, old pallets. Also landscaping waste, contributed by patrons. And the occasional deadfall and collapsed shed.
Compare the nature of available forms of employment and recreation in urban areas to those in rural areas.
The outdoor options for recreation are somewhat more sparse in urban areas.
The indoor options for employment are much more sparse in rural areas. White collar jobs are overwhelmingly located in urban and suburban areas. You've got teachers and dentists and stuff like that in rural areas but those scale with population so they don't affect the proportional difference between urban/rural.
I mostly agree that rural areas have a higher proportion of outdoor jobs, but it’s still a super small fraction.
> “The outdoor options for recreation are somewhat more sparse in urban areas.”
Do you have evidence for that? My initial reaction is that it’s very likely false. And if it’s not false, the actual difference is not enough to be meaningful in terms of population statistics of how much indoor time / outdoor time people spend as dense urban dwellers vs rural dwellers.
For example, in the northeast US, I exercise outdoors all year except when the weather literally prevents it. But then, it also prevents it in rural places too, likely more often given the city resources that can clear areas for running / biking that couldn’t be similarly cleared in rural areas.
Having grown up in the rural Midwest, I can only say anecdotally that people in large east coast cities exercise much more, do outdoor activities year round much more, go to public beaches, have large city parks, and generally spend more time doing outdoor activities.
Where I’m from in the Midwest, people exercise less, only use cars to go anywhere (even short distances), and the rural roads are such safety hazards that they can’t be reliably used for jogging or biking and people end up driving to fitness centers to do that stuff indoors.
I’ve lived in Boston and Manhattan before and it was super easy to do all those things apart from climbing a mountain (which is hard to do anywhere there’s not a mountain, regardless ofbeing rural or urban) or hunting.
In fact, I would usually just walk or take a train to these activities, and likely could commute to do them faster than people not in a city. Hunting is probably the main exception, but I don’t think it's meaningful for the point of this thread.
One of my primary hobbies in Boston was taking a bus to the Middlesex Fells nature reserve and hiking all day to find geocaches. Most people I knew also primarly engaged in outdoor, physically vigorous activities like kayaking/rowing, long distance jogging and bicycle riding.
>I think it makes sense, since broadband internet is relatively expensive compared to other utilities that are more necessary.
An internet connection isn't regulated as a utility. As far as the law is concerned, the internet is a luxury item so access/quality/cost is set by the market. Telephone companies (or I should say, company: Bell) operated in much the same way 100 years ago until state utility commissions started to regulate them as utilities and cap the price they could charge for local calls. Since the state had no jurisdiction over long-distance charges, those prices skyrocketed to make up the difference. In the 80's the DOJ finally wrapped up the antitrust case against "Ma Bell" that broke the company into several smaller phone service providers. With a lot of competing operators the prices were reasonable. More importantly, while telephone service was regulated as a utility the state utility commissions had largely required Bell to wire rural areas for service the same as they had wired cities.
Just because one government chooses to not regulate it as a utility does not mean it is not a utility.
It can be argued that internet access is more of a utility today than it was in the past, and is likely to become increasingly more crucial for folks to have. Many local, state, and national communications are over the internet, more and more jobs require it to some degree (and having internet helps find new jobs more than not having it). donald's 'official' communication mechanism is twitter, which requires internet access.
> The term utilities can also refer to the set of services provided by these organizations consumed by the public: Coal, electricity, natural gas, water, sewage, telephone, and transportation. Broadband internet services (both fixed-line and mobile) are increasingly being included within the definition
Why is the government still bothering with such a variable quantity like household income, why not per capita? Household income introduces unnecessary complexity with how family sizes change over the decades, between ethnicity, by divorce, and all sorts of other confounding factors.