I’m thinking about the folks who want to be the best in the world at what they do and are succeeding. We see this in finance and art for sure and in to a fair extent in academia. Similarly with tech entrepreneurs (though there are some extremely ambitious ones in Canada like Jean-Francois Gagne, but they probably have an uphill fight for capital and talent). Many of the best people in academia want to be with a critical mass of excellent colleagues. I’ve seen a few top tier US academics move to BC as a lifestyle move and know a young person who turn down a sensational position in genomics in Cambridge, MA for a position at a lesser Canadian institution because he wanted to live in his native Canada even though he knew the colleagues were weaker.
In the tech sector, I found the following article reports on a studying finding a brain drain in STEM fields (https://www.theglobeandmail.com/business/technology/article-canada-facing-brain-drain-as-young-tech-talent-leaves-for-silicon/). The study focused on Canada’s three best known universities for STEM: Waterloo, U of Toronto and UBC. The following day, a response argued that the conclusion was flawed because it focused only on the top school and grads of lesser schools were not migrating at such a high rate. This struck me as an incredibly Canadian response (the mediocre people are staying and only the best people are leaving so there is no problem with a brain drain).
I’m fortunate to rub shoulders with some of the best and the brightest on the east coast and now, to a lesser extent, in Silicon Valley, to have consulted to senior execs in Canadian companies, and to spend a fair bit of time in Canada – I’m in Western Canada now staying with relatives before going hiking. One of my Canadian nephews is very bright and ambitious. He wanted to thinking about Harvard for undergrad but his father said go to undergrad in Canada and then apply to Harvard for grad school. At the time, he asked me what the difference was between Harvard and McGill (which he attended). My sense at the time was that folks at McGill would target aspire to be the best in Canada while folks at Harvard would aspire to be the best in the world. He graduated top of his class at McGill (which was probably thought to be the top school for undergrads at the time), worked for a couple of years, and then attended a graduate program at Oxford. While he was there, he told me, “I didn’t really understand what you meant when I was an undergrad, but now that I’ve been at Oxford, I do.” While there are exceptions, as you mention, @BunsenBurner, I see ambitious Canadians coming to the US for career advancement and Americans going to Canada for better work-life balance.
DH and I could probably retire early at age 50 (in 3 years) if it weren’t for the cost of health insurance. We could either work in less stressful jobs just to pay for it or continue to pay premiums and hope they remain manageable. Does anyone have theories on what US health insurance would look like under a single payer system? We currently have an individual policy with no subsidies because our income is too high. If we retired and had less income - maybe under single payer health insurance would actually help?
Just ask any person 65 years old or older about what to expect when you get to be that age. And hope that the government budget can keep funding it.
But if you retire at 50, you have 15 years to figure out medical insurance before then.
Of course, predicting political and court changes to the medical insurance system is not easily done. Note that there is a court case trying to invalidate the ACA, so another possibility is the reversion to pre-ACA state, where a large percentage of older (but not Medicare eligible) people could not buy individual policies at all due to pre-existing conditions.
Not good. For the first time in my life, I am paying for the health insurance through the nose thanks to Medicare IRMAA. I know it will be down next year. Ir is still more than free.
I have worked in several countries where there is single payer health care, often with the availability of private health insurance as a supplement. In the UK and Canada, they handle preventive care and needed care pretty efficiently and imminent problems like a heart attack will be handled with very high quality care. Elective surgery is much slower and would have to be justified – e.g., if you are over a certain age, knee replacement surgery would need significant justification and would typically take months to schedule even if there were justification. In the UK and Australia, private insurance can get you faster scheduling and maybe nicer hospitals. or quicker availability of CT scans. There would be no inefficiency in bidding – the hospital would only bid to one specification. There is a massive savings that would come from not having to be able to submit claims to 270 health insurers, each with separate systems and requirements.
In the US, we give a tax deduction to companies for the payments we make toward private health insurance and do not consider that benefit to be income to the employee. Eliminating that deduction would substantially increase tax revenues with no direct tax hit to individuals. That alone would not cover all of the health care costs as well as the cost of also expanding the system to cover all people.
It is worth noting that in surveys of health care, non-US systems are higher ranked in terms of health outcomes than the US. But, to succeed politically, it is essentially necessary to have private companies offer access to private health care.
Companies are not just going to eat an extra $5-10K per employee if they lose the health insurance deduction. They will either cut employee’s pay to make up for it, or push an even higher percentage of the premium onto employees.
But then, many types of US employers are already at a substantial cost disadvantage compared to employers in other countries, because they need shoulder the substantial extra cost of medical insurance for their employees, versus in other countries where this cost is not an employer burden. Yes, it has to be paid somehow*, but in the US, it is done so in a way that is effectively a tax on jobs.
Also, health care costs are so high in the US compared to other rich countries that, as a percentage of GDP, *government* spending on health care is similar in the US as in other rich countries (8.5% of GDP in the US, versus 7.9% of GDP in rich countries overall, according to https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countries ). But other countries' government spending covers everyone, while US government spending covers a little more than a third of the population, leaving a much higher burden on private entities (8.8% of GDP in the US versus 2.7% of GDP in rich countries overall; mainly employers in the US).
In other words, the US has the worst of all worlds – government spending like that of socialized medical insurance or health care countries, but without getting the benefits of such for most of the population, leaving most of the population the burden (often indirect, e.g. though employers or fewer jobs available) of medical insurance or health care costs.
You are right, @notrichenough. The US is, I believe, the only country in which companies pay for health insurance. It is something of a historical accident. There is no obvious reason for companies to pay for health insurance as a benefit if it is single payer. Companies would mostly love single payer. They could pay for additional insurance for execs and others, which would allow for a tax deduction but would probably be counted as income to the employees who received it.
The subsidy the government is no longer paying for company-provided health care would be part of what pays for health care going forward…
So you (like my husband) are paying an additional $50/month due to higher income? Am I missing something? Before he qualified for Medicare I was paying $600/month to cover my husband on our high deductible plan. Maybe I’m misunderstanding but to us Medicare is a huge relief, even at higher income levels.
@dragonmom More like a couple of hundred dollars. We are each paying close to $500 per month this year. Not counting supplemental. We don’t pay for that. It will go down next year.
The part B premium starts at $135.50 per month, which is what most of us will pay, and maxes out at $460.50 per month - and that level only applies to couples with joint income in 2017 above $750,000, or individuals $500,000 or above.
We can only hope we wil be able to purchase health insurance going forward. Dh does have a pre-existing condition. We went into retirement knowing we’d have to cover that cost for 10 years (assuming the age 65 thing stays the same for Medicare). Not a fun way to spend one’s money, but we are thankful that, at least for now, we can get it.
Creating bells and whistles to entice retirees to sign up… Look! We have a movie theater! We have this and that! When in fact most folks, by the time they end up there, have no use for the majority of these amenities… but are paying for them
wink.