You can get travel insurance for extended trips. I'm American and I've taken multiple 6-month trips abroad (usually after quitting a job). Backpacking just isn't part of the American culture.
Regular travel insurance != health insurance. It will basically cover you getting stabilized and shipped back home but then you're on your own. (And lost travel deposits.)
Don't even bother with the travel insurance, pay for health care out of pocket in another country. Travel insurance is only needed for traveling in America for the reason you stated.
IMO travel insurance sometimes makes sense. Circumstances like high altitude trekking that may require expensive evacuation. Expensive non-refundable trips, especially those that a broken ankle before or during the trip could put a rapid stop to.
That said, I've only purchased travel insurance maybe a half-dozen times out of probably hundreds of trips.
You need to make sure it covers that altitude. They top out around a certain altitude in the fine print you usually need to pay a little extra for altitudes like Kilimanjaro. Make sure it has helo evacuation covered for all altitudes.
Good point. The few times I was up at that sort of elevation or higher, the insurance was always through someone the guide company specifically recommended. Fortunately, I've never had any significant altitude issues.
You are not getting health insurance in most European countries unless you are working or registered as unemployed and remain at disposal of the local job centre.
And the whole meme that a 65% tax rate +25% vat on most products on top of it (I am in Sweden) is somehow worth it financially because "fReE HeAlThCaRe" is laughable.
To be clear, I'm merely saying "the complexities of the American healthcare system might be why Europeans are more inclined to take gap years". That said, I didn't know that European public health insurance was commonly contingent on employment. I would be curious to know more about this.
I am honestly very bitter about Americans glorifying the European system while happily taking home 2/3rds of their 100k+ developer salaries and enjoying much lower prices of everything.
With regards to insurance:
- in some countries (UK, Sweden) - the insurance is contingent on having a social security number, so the coverage is pretty much universal for residents, but people coming from other EU countries will still need to work or register as unemployed to get it.
- in other countries, you generally need to be working or looking for work (i.e. answer phones / invitations from job centre and attend any interviews/courses they send you to) to be covered.
Some countries (Poland for example, I'm Polish) allow you to buy insurance if you are neither working nor looking for work. But as of December 2020, about 1.5 mln Poles are not insured at all. [1]
> I am honestly very bitter about Americans glorifying the European system while happily taking home 2/3rds of their 100k+ developer salaries and enjoying much lower prices of everything.
I agree, although I think the ignorance extends to Europeans as well. Europeans are often surprised to hear that American software professional salaries are ~60% higher than European salaries even after adjusting for taxes, healthcare, vacation, etc. Some will argue that the US cost of living is more expensive, but they're almost always comparing some major US metropolis with some European village or perhaps an Eastern European city. I've seen other arguments that the cost of housing in the US is comparable or more expensive, but they're typically comparing some relatively tiny European apartment with a much larger American home. Europeans seem to fixate on medical bankruptcies, as though these are commonplace for upper-middleclass Americans.
This was all a surprise to me, an American, who has tried earnestly to live in Western Europe for a few years, but found that I can either live in Europe or I can travel in Europe but trying to do both would likely be economically infeasible (even if I can find gainful work as a software professional, it would specifically be difficult for my wife who isn't in a hot field). Fortunately, now that remote work is catching on, it seems likely that my wife and I will be able to do more frequent 1-3 month stints in Europe while remaining employed by our American companies.
To be clear, I think the United States healthcare system should be reformed, because it doesn't serve the poorest Americans very well. However, the US healthcare system works pretty well for the upper middle class (if not the whole of the middle class) and above, contrary to perceptions I frequently hear from some Americans and Europeans.
> To be clear, I think the United States healthcare system should be reformed, because it doesn't serve the poorest Americans very well.
This depends on the state; Medicaid expansion is doing good things for the poorest people in states where it exists.
The US benefit system is tilted towards the poor, old, and people with children (distant 3rd.) It has some bad welfare cliffs for disabled people, and is the worst for middle class self-employed who aren't on their parents' insurance.
Unfortunately this last group includes all online writers and popular social media users, which is why they pretend it doesn't exist for anyone.
How difficult is it to work remotely in a different country? I’ve thought about doing this but it seems like it’s be a lot of hassle with my employer and navigating local laws in Europe.
My wife and I work for smaller firms. Both of our managers seem okay with it provided we keep American-ish hours. I get the vibe that they're just not worried about it, perhaps out of ignorance or perhaps because it just seems unlikely that a single employee working remotely for a short amount of time is likely to provoke the ire of any tax authorities.
> I am honestly very bitter about Americans glorifying the European system while happily taking home 2/3rds of their 100k+ developer salaries and enjoying much lower prices of everything.
Why do you believe those salaries are the result of the American healthcare system? Per-capita, Americans pay more than anyone for healthcare, just in a very unbalanced way that dramatically favors those with a job over those without.
Regarding comparing tax rates, those six figure job numbers don't include the substantial amount the employer is paying to the healthcare company.
Bitterness about the salary gap is understandable, but it's misguided to say that the fucked-up parts of the US system are what has produced the high-revenue/high-profit companies that are driving the compensation levels.
> Why do you believe those salaries are the result of the American healthcare system? Per-capita, Americans pay more than anyone for healthcare, just in a very unbalanced way that dramatically favors those with a job over those without.
It doesn't really matter whether or not the salary difference is caused by healthcare or indeed that Americans pay more for healthcare. The only thing that matters is the post-healthcare take-home pay; if that figure is larger in American than Sweden for a given individual, then that individual is economically better off in America pretty much tautologically.
But what matters from the perspective of the American complaining about their healthcare system, though, is if they would be even better off with their same salary but a less fucked up healthcare system.
As long as that seems to be true, you'll see people complaining about it, and they'll have a valid reason for their complaints.
Your point is valid, but I don't think that's what we're talking about in this thread. Rather, we're talking about Europeans and Americans who have the perception that the overall economic situation of professional employees is dramatically rosier in Europe.
Personally, I think we should have a single payer system if only for the fact that it likely better serves poorer Americans.
Yeah, I was talking specifically about the "it would be nice to easily take a gap year"-sourced comparison of healthcare alone - though even that apparently is not so pro-Europe after all, with the folks discussing how you'd have to be actively seeking work to be covered.
Notably, Americans pay more per capita for Medicare and Medicaid alone than many European countries pay per capita for universal coverage.
> Regarding comparing tax rates, those six figure job numbers don't include the substantial amount the employer is paying to the healthcare company.
To be fair, in many European countries - and certainly for Sweden - there's substantial payroll taxes paid by employers as well. Though to end up at 65% in Sweden even with employers payroll taxes tacked on, you're already earning a multiple of an average salary.
Most (all?) European health care is not contingent on employment. With a few exceptions (notably the UK) it is contingent on being able to afford it, and one way to do that is following the rules to have the gov't pay for it. It's guaranteed, and highly regulated in price; it's not free.
The easiest way to afford it is to have a job. However, if you are willing to pay more (still much less than equivalent US health insurance, e.g. in Germany around 180€/mo) you can buy it directly. Or, you can participate in that country's social safety net which, yes, usually requires you to actively seek a job (often for some loose definition of "actively.")
This is just semantics. If you have to pay more because of your employment status, then the system in question is contingent on employment for all useful purposes.
The claim is that "European public health insurance is commonly contingent on employment", not "European public health insurance monthly payments vary based on employment status."
The only way you could end up paying more is if you previously made an average amount of money, have a lot of savings, but now make nothing. Normally this is called "retirement" and if you didn't save enough for it, you don't do it.
While I agree that vårdcentralen-level health care is hit or miss, the point is that _everyone_ has a basic level of health care and getting sick won’t bankrupt you.
This has the second-order effect that _I_ won’t have to worry about _someone dear to me_ will be personally bankrupted by a medical condition. It saves me having to decide whether or not I should indebt myself to pay for their treatment.
Not having to raise fundraisers for my family members cancer treatment is worth a whole lot of disposable income for me.
In the US, we pay 5x-10x that amount for a crappy high deductible plan that has measurably worse outcomes than your free insurance.
It is hard to overstate how bad US healthcare is for the typical American. If you are wealthy, you have access to some of the best doctors in the world, but for the rest of us we are entirely dependent on our employer for access to reasonable health care.
The vast majority in Sweden pays nothing like "65% tax rate + 25% vat", though. To get to that tax rate you need to earn far above average.
Someone who is single with no child earning 167% of an average wage pays ~35% income tax and social security contributions [1].
The effective VAT also for most ends up far lower as a proportion of income, as most people don't spend anywhere near their whole income on VAT-rated products. For starters, you can't spend what you've already paid in tax. As such the VAT rate has a relatively low impact on total tax paid - the difference between the UK vat rate when I moved here (at the time 17.5%) and the Norwegian VAT rate of 25% added up to only about 1 percentage point difference in total taxation for me.
> The vast majority in Sweden pays nothing like "65% tax rate + 25% vat", though. To get to that tax rate you need to earn far above average.
First of all, the OP is including the social security tax in the 65% figure. But more importantly, arguing that "the average Swede doesn't pay that much in tax" isn't very consoling for the American who would have to (1) take a salary hit to live in Sweden and (2) have to pay that higher tax rate. Universal healthcare doesn't remotely make up the difference in take-home pay.
As a reference point, taxes, retirement/pension/social-security, and healthcare account for ~30% of my gross salary in the U.S. If I moved to just about any Western European country (not sure about Sweden in particular), my take-home pay would likely fall by 40% (conservatively) while taxes and cost of living would likely rise.
Of course, the tradeoff for the Swedish system is that you have a stronger social safety net, which is certainly worth something. But the issue at hand is the notion that the European systems are better than the American system for professional employees.
The numbers I quoted also include the social security taxes (I edited to make that clear, so apologies if you replied before I made that edit). Swedish marginal rates certainly are among the highest in Europe, but the proportion who pay that much is tiny.
And yes, there are people who will end up paying more, and it sucks for them.
The point is there's always this scaremongering about tax rates when it comes to Europe, and most of the time the tax rates that comes up are marginal rates that are not at all representative.
> The point is there's always this scaremongering about tax rates when it comes to Europe, and most of the time the tax rates that comes up are marginal rates that are not at all representative.
As an American, I find the tax rates much less scary than the raw differences in salary. If I could keep my US salary, healthcare, tax rates, etc and move to Europe for a few years, I would do so in a heartbeat.
I don't think that's a considerations for most. Salary differences internally in both the US and Europe are large enough that there's a huge overlap. For my part in the instances where taking US jobs have come up the salary differences ended up being small enough not to be worthwhile.
Tax rates also depends greatly on which locations you're comparing. Between e.g. California and the UK the difference was small enough when I looked into it that it'd be easily eaten up by healthcare.
For my part, I spend about $5k/month total on living costs including sending a kid to private school and mortgage on a 3 bedroom house in London, and ordering food in most days, and I'm being hugely wasteful and could make do with far less of I had to.
> I don't think that's a considerations for most. Salary differences internally in both the US and Europe are large enough that there's a huge overlap.
How does that work? Presumably if the median salary for a given field is 40% lower, then the jobs which pay at my well-above-the-median salary are going to be much fewer and farther between with more competition. Add to that laws that (understandably) favor EU citizens and it seems like it would be quite difficult to get one's hands on those positions?
> Tax rates also depends greatly on which locations you're comparing. Between e.g. California and the UK the difference was small enough when I looked into it that it'd be easily eaten up by healthcare.
Yeah, like I said, I'm less concerned about tax rates. No surprise that California tax rates are comparable to London tax rates though; California is notoriously expensive and many Californians seem eager to move to other parts of the country.
The point is that it's meaningless to make blanket statements about whole continents when the differences are so substantial within them, and mobility within them is much less than you might expect. E.g. consider the number of Eastern European developers who could significantly increase their salaries by moving to higher paid locations in Europe, but you instead stay and e.g. work for local agencies. As such, you're not competing against all of Europe if you go to the highest paid locations in Europe any more than you're competing against all of the US in Silicon Valley.
> The point is that it's meaningless to make blanket statements about whole continents when the differences are so substantial within them
Apologies if I'm dense, but I still don't understand. You can have a lot of variance in Europe and the US, but if the median is 40% lower in the Europe than in the US, doesn't it still suggest that any given American moving to Europe would have a dramatically harder time keeping his American salary?
> E.g. consider the number of Eastern European developers who could significantly increase their salaries by moving to higher paid locations in Europe, but you instead stay and e.g. work for local agencies
Fair enough--I wouldn't be competing against all of Europe, but there are far fewer jobs that pay $200K in Paris than, say, Chicago and the number of developers competing for those jobs is probably pretty comparable. I suspect it would be a lot harder for me to make $200K in Paris, but I would love to be wrong.
> Apologies if I'm dense, but I still don't understand. You can have a lot of variance in Europe and the US, but if the median is 40% lower in the Europe than in the US, doesn't it still suggest that any given American moving to Europe would have a dramatically harder time keeping his American salary?
I don't know. That would also depend on what the distribution around the median are in the respective locations. And again, a blanket comparison isn't really useful because you're unlikely to be looking to move to the lower paid places. If the distribution was the same, and you had to move, you'd have a point. But you don't have to move, and so you'll inherently discard a whole lot of places that doesn't fit what you want.
For my skillset and levels, all I know is the number of places in the US where I can earn more than I do in London is fairly small. They exist, and Silicon Valley is one of them, but it's not like there are a lot. So I'd likewise instantly disregard most of the US.
But last time I considered it (I worked for a Palo Alto based startup, and flew over every 6-8 weeks for a couple of years, and I do love the Bay Area - to visit anyway), the costs of living just didn't add up for me. If I'd wanted to, I could have made it work, certainly, but it was not like the financials looked attractive enough to sway me much (either direction).
Things like food were cheaper, but even compared to my house in London, housing in the Bay Area is insane. E.g. I just checked on Zillow again now, and to put it this way: I'd need a fairly massive raise to afford a house similar in size and standards within a similar distance to downtown SF as I am to the centre of London today just to break even on a move. It's likely doable, but it's not all that obvious I'd come out ahead.
[this is while disregarding the complicating factor that I've never had a need to take a drivers license, because I've always lived places where public transport is good enough]
But your mileage may vary - it'll depend greatly on what specifically you value, what niche skills you have, and what type of areas you'd like to live in - all of it greatly affect the financials.
As self-employed, you'll be paying social security rates set to cover what would otherwise be paid by the employer via payroll taxes, as otherwise using self employed people would be an easy way of evading tax.
(My point was not to dismiss that you might well pay a very high tax rate, by the way, because the rate you gave is certainly possible, but to point out that paying a rate that high is highly unusually high, even in Sweden)
> You are not getting health insurance in most European countries unless you are working or registered as unemployed and remain at disposal of the local job centre.
Or your partner has health insurance. Or you are studying (even if you take gap year at university). Or you happen to have farming land. Etc, etc - lots of exceptions.
Or you pay for it yourself from your savings (under 100 USD a month last I've checked).
> You are not getting health insurance in most European countries unless you are working or registered as unemployed and remain at disposal of the local job centre.
Not the case in France (at least for the past 20 years), and I doubt it's the case in most other European countries.
>Not the case in France (at least for the past 20 years), and I doubt it's the case in most other European countries.
Nope, your parent is right, in Austria you also don't get healthcare if you don't work or are looking for work via your local job center.
Maybe France is an exception due to having stronger social system that heavily favors the workers (insert memes about strikes) while in Austria the system is very rigid, designed to favor businesses and the government rather than the workers and to discourage abuse.
It is not - you get access to healthcare at all times (employed or otherwise, young or old) and simply pay a slightly higher tax rate when you are working to pay for it.
definitely the case in Germany. If you're unemployment and not looking for a job or exempt from it(sickness, poverty, ...), you're going to need to pay on your own.
So... not the case in Germany. You don't need to be employed or in social programs, you can just pay money. In Germany it's a fixed amount, less than you would pay if you had income, and they can't refuse you.
I know to a European this might sound like the only two options, but pre-Obamacare, and very possibly again if the US can't get its shit together, it was impossible to buy health insurance no matter how much money you had for a large number of unemployed or self-employed people.
> You don't need to be employed or in social programs, you can just pay money
If there are different pricing tiers based on employment status, then the healthcare system is contingent on employment by definition. It's commendable that the American and European healthcare systems aren't contingent on pre-existing conditions, but that's a distinct issue.
If you are employed the employer pays half and if you are not they don't (somewhat obviously, since if they don't exist they can't). This is only "pricing tiers" in the most vapid sense.
That description could just as easily be for the US. Maybe you disagree with the terminology, but when people talk about their health insurance being predicated on their employment, this is what they are talking about.
Obamacare, for all its controversy and limitations, removed the ability to screen for pre-existing condition which was a very important feature. Prior, some people who weren't covered by an employer's group policy simply couldn't get insurance for any amount of money.
Now, yes insurance is expensive, but anyone can get it for about 2x what most people who get healthcare as a benefit are paying into an employer's health care plan.
Maybe it's more lax in the more worker friendly socialist regions like France or Scandinavia but in Austria you only get healthcare coverage if you work or are unemployed and registered as a job seeker which means staying in the country and proving to your local job center on a regular basis that you are looking for work.
Traveling abroad for leisure while unemployed automatically disqualifies you from receiving any healthcare coverage and unemployment benefits until you return.
Doesn't mean there aren't people cheating the system and taking vacations abroad while receiving unemployment but the rules are strict and being caught cheating is really bad for you.
Also doing courses on your own dime during unemployment, that are not on the job center's curriculum, like a boot camp in data science, automatically disqualifies you from unemployment benefits during that period. I tried explaining to my case worker at the job center that a data science certification gives me the opportunity for a better paid job afterwards and I need the unemployment benefits for that period and her response was "sorry sir, that's the law".
Yeah, the system is extremely stupid and archaic in some cases here and if you're an ambitious high achiever it can screw you over sometimes more than it helps you.
In Germany, there is obligatory health insurance (when you're employed in a normal job up to certain income, or receiving welfare), and voluntary insurance (otherwise), but having health insurance is compulsory. In other words, if you're not obliged to have obligatory health insurance, you must take out voluntary insurance.
With some historical context it can be made to make some sense, but when dealing with it the first time it is prima facie absurd.
I find that strange for Austria, considering that in Romania; when unemployed, and not being registered as a job seeker, you can still have insurance.
It's automatic in those situations you've described, but you can buy into the system otherwise.
At today's exchange rate if you'd like to benefit from the healthcare system, for a year, you'd have to make a 271 EUR contribution, with no other criteria required.
The system in Austria is extremely rigid and sometimes verges on idiotic in some cases due to how archaic and pro-business it is.
As a Romanian I can say you'd be surprised how many things the Romanian system gets right in favor of the workers in comparison to some western countries. At least on paper.
Indeed. In Canada if you’re out of the country longer than 6 months you’re not longer insured (in Canada). And in fact, insurance doesn’t cover you outside the country anyways.
Anything that starts "In Canada, ..." is generally suspect. Canada is a confederation. Most things are in the purview of the provinces, so there's rarely a globally applicable rule. Canada does not have a single healthcare system, but thirteen separate provincial and territorial healthcare plans.
You're not guaranteed to be covered for 6 months. If you leave permanently and settle within Canada, BC will cover you for the remainder of the month plus two months (enough time to establish residency in the destination and get coverage). If you leave the country, you are covered for the remainder of the month.
If it's a temporary leave, however, several of the provinces do cover you outside of the province, and many will extend your coverage for quite a long time depending on the circumstances. BC allows you to retain coverage for a 2 year trip during every 5 year period. They also (like many provinces) will extend your coverage as long as you're in school full time in another location.
BC does not cover care outside of Canada (assuming that’s what you meant by “2 year trip”) with the exception of emergency care at a max of $75 per day.
Varies by province. In Quebec, they have a similar absence rule to what you described (for being outside Quebec even if in another Canadian province), but they entirely exclude absences of under 21 days from the calculation, and they have a bunch of exceptions, including a "once every 7 years" exception for miscellaneous personal reasons including leisure vacations that just requires you to notify them in order to qualify. And in theory they will reimburse expenses outside of Quebec, even outside of Canada, but only at Quebec's very low rates.
Still, yeah, very different than how US health insurance works, agreed.
That might not be an accurate way to measure it, because "bankruptcy" can mean very different things by country.
In some countries, individuals often don't qualify for bankruptcy. In others you might be able to restructure your debts, but they might not be discharged. In some, you may need to give up significant possessions to pay for your debts.
The US, for all of its healthcare issues, actually has a relatively progressive and accessible bankruptcy system. The majority of people in the US who file Chapter 7 have all of their assets exempted from liquidation by law. For these people, bankruptcy is literally as simple as a matter of trading all of their debt for 10 years of a bad mark on their credit report.
If you live in NY or CA (not sure about other states) and are under retirement age, Medicaid is a thing and works great. No asset limit, just income, so regardless of what you've saved you're likely eligible - so you can quit your job and without paying COBRA things will be ok
Most gap years happen in the early 20s where most Americans can be on their parents coverage. Even if they're not, it's pretty cheap with subsidies for a young healthy person to buy insurance on the marketplace. Possibly even free depending on income.
You can continue your employer insurance for 18 months. But, as you say, it's more out of your pocket because your employer is now no longer subsidizing it.
You're referring to COBRA, and when my wife and I had a month lapse because of her switching jobs, it would have cost us $1300/month to continue her insurance. Not cheap.
I just got off 2 months of it between jobs, was around $1,100 for me as well. Certainly not cheap without the subsidization but also probably not a real concern if you're looking at taking a year off work anyways.
In Germany, I can buy travel health insurance that covers an unlimited number of trips abroad of up to 8 weeks each (including basically any doctors and hospitals abroad, as well as transport back home when medically recommended) for about 15 USD a year, and similar insurance for trips up to 1 year for about 500 USD a year. (Valid worldwide, or excluding North America for a cheaper rate.)
What’s the limit on that? If it’s like 100-200k then i got bad news for you… also as other thread says they will deny everything that is even remotely chronic and likely also that wasn’t preapproved with them before the visit
I don’t think any country with single payer national health care covers travel insurance, so this would not put Americans in any different situation than others who are travelling for that gap year, which seems to be the topic here.
It assume it depends on the destination. I suspect most European healthcare systems cover you in most of Europe (maybe Schengen or EU?) while American systems only cover you in America. But yes, I suspect traveling to Africa or Asia puts the American and the European on equal footing.
How about the entirety of the US medicaid program? If you literally have no income you get free healthcare, even if you have limited income you may qualify for Medicaid or a heavily discounted marketplace plan.
Based on that article, the programs vary widely by state including eligibility standards and rates of reimbursement.
> As of 2013, Medicaid is a program intended for those with low income, but a low income is not the only requirement to enroll in the program. Eligibility is categorical—that is, to enroll one must be a member of a category defined by statute; some of these categories are: low-income children below a certain wage, pregnant women, parents of Medicaid-eligible children who meet certain income requirements, low-income disabled people who receive Supplemental Security Income (SSI) and/or Social Security Disability (SSD), and low-income seniors 65 and older.
This makes it seem like it's not just "low income", but also membership in one of those other categories.
I also didn't see anything on the page that indicated what share of expenses were covered by medicaid, but perhaps I missed it.
Though I suspect it's a lot more complicated than calling them up, telling them you've decided to take a gap year, and asking for your insurance card. It also wouldn't surprise me, never having looked into it, if the coverage is US only.
There's an online form where you upload your info, they verify your income level (duration does not matter), and that's it (at least in NY). I don't think any government healthcare programs cover care outside that government's country, do they? I suppose the EU ones cover care in other EU countries but that's the only case I can think of.
Yeah, for Americans it means buying health insurance which is quite a lot more expensive than what you get from your employer.