There are two things that give me serious pause about living and working in the USA, and that have made me not pursue or accept opportunities that I've been offered in Seattle and San Francisco.
Should also add that if you are married, your wife / husband cannot work if you are on H1B.
I found this deeply disturbing, as my wife is a skilled professional in another field and if I were to accept an H1B offer, she would had to become a house wife more or less.
A minor correction, if you are married, your spouse cannot work if they hold a H-4 visa. They are allowed to work if someone is willing to sponsor their H1B, L1. They are also allowed to work on F1-Visa, using OPT/CPT.
When I was in us, my wife has a non working visa. It didn't prevent her to find a job at a company who sponsored her to get her own work visa, about a year after we arrived.
I agree those things are less than optimal in the US, but at a personal level:
1) The visa stuff is a PITA, but if you are in a situation where you can tell some company to deal with it, it shouldn't be too bad.
2) You get pretty good health care working for most companies in the US as a programmer. If you lose your job, you can presumably relocate to where you were before that has a different health care system.
Speaking as a Canadian on #2, I have a couple problems there that prevent me even considering moving to the States:
1) My wife has a chronic health problem. What guarantee do I have that if she needed treatment, for that or something else, that insurance wouldn't find a way to weasel out of covering it? Also, eventually I would lose coverage under OHIP, the Ontario Health Insurance Plan, after an extended absence (1-2 years? not sure exactly), so going back to Canada for treatment would not be an option forever.
2) My health insurance would be covered and sponsored by my employer. I'm already dependent on my employer for my income. In my mind, also depending on them for health care coverage is putting too many eggs in one basket.
To your first point, in general you face far fewer risks regarding such issues on employer covered plans within the US than on self-bought plans. The group policy should cover these types of issues, without risk of rescission[1].
As to your second issue, I agree with this. I think tying these things together has had a large and unfortunate impact both on people and on the US economy. The ACA is far from perfect, but it does at least move some of this in the right direction.
[1] If it isn't obvious, I am speaking in generalities. As with all insurance, some conditions and medications are covered more prevalently and conveniently than some others.
To be fair, this can make it difficult to move anywhere. Countries like Canada and Australia can refuse you an immigrant visa if you have pre-existing health conditions (much like insurance companies will refuse to take you on):
If he proves that his wife had coverage before enrolling in the plan (for example from Canadian health care) the insurance company shouldn't be able to play the preexisting condition card. Then again, that does not mean the insurance will have a good coverage for that. The best thing to do is to check that with the company you're applying to before signing.
Anyway, I agree that it sucks to live in a country where you have to think about this shit. Even with the best network (blue cross or blue shield) it's still not as good as France with a decent mutuelle for example.
Do people with this condition manage to exist in the US? Does their insurance cover it? Are there ways to ensure that they get coverage? Things worth looking up if there's a tempting offer, because it might be worth your while. If it's not an offer that's worth the hassle, well, then, no, don't bother.
Point being, if it's a good enough offer, you might be able to make it work if you're not bent on rejecting it because of your general disdain for the US healthcare system (which I can certainly comprehend).
Most European countries have a health-care system that depends on you being part of the system: children of someone insured, student, employee, spouse, unemployed who was employed before and often manager of a company. Having worked abroad and recently coming into the country after non paying taxes (with presumably your life in disarray because the company you dedicated yourself too fired you, closed or proved to be a sham) sets you clearly out of that system.
In Britain, if you are a resident, that is if you have accepted a job in Britain or are a spouse or child of a person who has, you are automatically covered through the NHS. This is based on residence in the country, not on an employer-employee relationship. If you have been legally present in Britain for a year you continue to be covered even without a job, and if you intend to settle there you are covered from day 1 for as long as you live there.
The best thing: the health insurance headache that US citizens have been conditioned to accept as a natural feature of life is totally missing. If you are ill you just go to the physician.
> if you are a resident, that is if you have accepted a job in Britain or are a spouse or child of a person who has, you are automatically covered through the NHS. This is based on residence in the country,
I see a contradiction in what you wrote: for all resident; but you have to work, or be the spouse of someone who does? These are different things.
I have personally been in that position, and I was refused coverage when I moved to UK for a new job, and was made redundant after three months. I then went back to Spain where I had work prior, and was refused coverage there, because my previous dues were only good as long as I stayed in Spain.
Here in Italy, if you're a citizen, you are covered, period, as far as I can tell. Naturally, you have to be in Italy, but other than that, I don't think there's any reason for them to refuse to treat you.
It is a common misconception. The official website is very clear: it reads “The Italian Social Security offers all people working in Italy” Until you find a job, you don’t have any benefits.
You're looking at the pension system for the Friuli Venezia-Giulia region. That's like social security in the US - very different from health care.
If you're in Italy and a citizen of Italy, you are covered. There are likely gray areas for non-Italian citizens. They generally see you first, and ask questions later though, especially if you have the health service card, which any Italian would. I (US citizen) went to the emergency room once before getting mine, and the bill was €0.00, although I did have to buy some stuff at the pharmacy and was charged full price for it, for which the pharmacist was quite apologetic.
In Germany if you are hired by a company you join the public health system (through a "public" health insurance company), you can pick a private insurer if you earn more than 5k€ per month if I'm not mistaken
Dont believe the hype if you work for a company that is going to sponsor your visa, chances are they will provide health insurance. I pay $25 a month for myself and $175 if I had a family of 4.
My girlfriend uses Obama Care and pays $21 for basic insurance. Unless you are self employed then chances are you wont be paying much and now with the new health plans even these plans are affordable.
> My girlfriend uses Obama Care and pays $21 for basic insurance.
I used Obamacare for the month of January. My plan cost $507, I received the card on the 30th of the month (so the plan was unusable before then), and they (Blue Shield) were impossible to reach. They have a very understaffed phone line for Obamacare users, separate from their "regular" service for group plans.
She also paid $600 for January on a nonObama plan and was just issued a refund of $500 once she switched to an Obama plan. Sounds like you choose the wrong plan and network.
Even with healthcare coverage however, it's just a lot more complicated.
I'm from the UK, and if something is wrong, your biggest challenge is making appointments with the right people.
Some of my colleagues from the UK who have had to go and see someone in the US report that it's a minefield of:
a) Checking which doctors take your kind of coverage
b) Co-pays
c) Ensuring you know what you are/aren't covered for
d) Random bills that may appear after you visit someone, depending on whether their interaction with the insurance company
Here's how paying for a hospital visit works in the USA if you have insurance: You go in, and before they treat you, the deal from the hospital is:
1. You'll get a number of bills. We don't know how many you'll get.
2. Each bill will be for some amount of money. We don't know how much, not even an order of magnitude.
3. Your insurance may pay anywhere from 0 to 100% of your bill. We don't know what they will do.
4. Whatever your insurance doesn't pay, you are responsible for. We don't know how much that will end up being, but you need to agree now to pay it later.
4 months in advance you are seeing the wrong GP! I could easily switch to a new GP if I tried to make an appointment and they were booked that far in advance.
Can you choose you GP in the UK or are they assigned?
It does depend on whether they have space on their books of course. But by and large, people choose a GP close to where they live, and pick the first one they like the name of on the list at one of the closest surgeries.
The way the system works here is if anything is life threatening, you just go to Accident & Emergency at the nearest hospital.
Otherwise you go to your GP for pretty much everything. You'll have an appointment within a couple of days if it's non-urgent, or told to go in immediately. They perform a basic diagnosis, and either take care of you then and there (minor first aid, basic procedures, prescriptions), or you get referred to a specialist. If you are getting referred, you can say which one you want to be referred to.
And from all of that, you never ever get a bill or see anything relating to accounts. You just get your treatment and care.
All the Chinese public hospitals are about long waits, giving red envelopes to your doctors, overprescribing antibiotics and IV drips, and scammy Chinese medicine.
I have private insurance; the hospitals are way better but the prices make the USA look cheap.
Put it this way: USA has first world health care problems, china has developing world health care problems. If you want cheap quality medical tourism, try Thailand.
> Put it this way: USA has first world health care problems, china has developing world health care problems.
As one might expect of countries that are first world and developing world, respectively. When people complain about the US healthcare system, the implicit comparison is probably other first world countries.
Honestly, the visa and immigration stuff is more of a problem for the company hiring you than for you yourself. As someone originally from the UK, I'll agree with the health stuff, though. The system here is an utter mess.
1) Visas & immigration
2) Health