ira

>Some medical providers do not accept public health scheme patients.<

Uh, oh.

logos999

>600 euros per month
Tax deductible for self employed and freelancers.

logos999

>28 euros a day for hospital stays, up to 10 euros for prescriptions, etc.
Only if you can afford it. Copayments in one year musn't exceed 2% of your income before taxes. (resp. 1% if you're chronically ill.)

tomboy

So, if you're hospitalized January 3 and hence have a co-pay, how does the hospital know how much you'll make in the remainder of the year? Or is the co-payment a tax deduction? Or must the hospital wait for payment until the patient brings in his yearend earnings statement?

logos999

>how much you'll make in the remainder of the year?
It's last years income that counts.
>Or is the co-payment a tax deduction?
No
You have to inform your public health scheme insurance company at least once a year of your income. You just send them a copy of your tax statement. This will be taken as your income for a maximum period of 12 months.

tomboy

1. And they just take your word for it? Is there any penalty if you send them fake numbers? What an opportunity for fraud?
2. How does it work in Italy, where so few people file income tax returns and, as a result, there'd no year end "tax statement"?

logos999

>And they just take your word for it? Is there any penalty if you send them fake numbers? What an opportunity for fraud?
No, there's a 5 years max prison term on that. (§267 StGB) And of course the FA (=irs) has all the data too.
>How does it work in Italy
No idea, in Germany they'll lock you up.

kenderina

I think in Italy works very similar to Spain..it doesn't depend on income taxes.

altamiro

> And they just take your word for it? Is there any penalty if you send them fake numbers? What an opportunity for fraud?

No, you don´t just write some numbers - you send them the copy of your tax statement which you receive from the FA.
If you are employed, your taxes are automatically deducted from the salary, then you file for returns&deductions.

ira

Hi all,

The American Medical Association, when of the firmest bastions against "socialized medicine" has taken the first tentative step toward a national health policy.

http://tinyurl.com/2x7ewv

thursdaysd

No, unfortunately the AMA just wants everyone to have insurance, funded by changes to the tax system. They are absolutely not advocating any form of single-payer system. Quote: "The AMA believes tax credits are preferred over public sector expansions as a means
of providing coverage to the uninsured."

So, we would keep the ridiculously expensive and inefficient private insurance system, and add even more complexity to the tax code.

Thanks but no thanks. BTW, the full proposal is at tinyurl.com/3xrq7n

sjj

I agree with thursdaysd that the AMA proposal is useless, but not for the same reason. A large number of countries, for example Singapore, the Netherlands, and Germany, provide medical insurance for all their residents by subsidizing private insurance for people who don't receive medical benefits at their jobs. These programs work, and they're popular. The AMA plan fails because it doesn't provide enough money for the insurance subsidies and because it doesn't call for tighter regulation of the medical insurance industry. I'm convinced that a subsidized insurance program can work here, as it does in the countries I cited, if it's properly implemented.

Neil_Oz

It seems to me that subsidising private health insurance is just subsidising inefficiency and thereby adding just another layer of cost.

As a matter of interest, the leader of the Australian Labor Party (and likely next Prime Minister), Kevin Rudd, has just announced the broad outlines of the party's health policy for the upcoming election campaign. It's targeted at eliminating duplication, overlaps and blame-shifting between the federal government (which supplies most of the funding) and the state governments (which manage delivery).

Initially he proposes to supply extra funding tied to specific outcomes, and if that doesn't work move to take over direct control from the states.

The specific objectives are to:

* Reduce preventable hospital admissions through greater emphasis on often cheaper primary care by doctors, nurses and others outside hospitals;

* Improve management of chronic diseases such as diabetes;

* Reduce waiting times for elective surgery by increasing "capacity and throughput";

* Have fewer and shorter stays for frequent hospital users by improving facilities for transition to outside hospital care;

* Increase access to medical and specialist services.

This surgery isn't radical enough for some who'd like to see an immediate federal takeover of Australia's 750 public hospitals, but Rudd would prefer to avoid a war with the six state and two territory governments, all of whom have Labor governments. It's generally seen as a reasonable start, though.

With a 3-level federal-state-local government structure there's an increasing sentiment that we're over-governed and that the state governments should be abolished entirely, but the practical obstacles to that are daunting.

jsmith

Ron Wyden, the Democrat Senator from Oregon, filed his Healthy Americans Act in December 06. A PROGRAM THAT WOULD COVER ALL.

He also proposed comprehensive tax reform legislation this year.

Oregon should be very proud of their Senator. Where are Harry Reid and Nancy Pelosi?

http://wyden.senate.gov/

Senator Wyden Leads Federal Debate on Health Care Reform. Employer-based health coverage is "melting away like a popsicle on the summer sidewalk" and Senator Ron Wyden, a member of the Finance Committee, has offered a groundbreaking proposal that will revolutionize the way Americans get health care. Wyden's Healthy Americans Act will provide affordable, high-quality, private health coverage for every American regardless of where they live or work.

Senator Wyden Provides Real Tax Relief for Middle Class in “Simpler, Flatter, Fairer” Reform Plan As millions of Americans scramble to finish their taxes on the eve of Tax Day, U.S. Senator Ron Wyden (D-OR) and U.S. Rep. Rahm Emanuel (D-IL) introduced comprehensive tax reform legislation that contains major tax relief for America’s middle class by making the 1.4-million word U.S. income tax code simpler, flatter and fairer.

smueller

"So, we would keep the ridiculously expensive and inefficient private insurance system, and add even more complexity to the tax code."

I thought we went over this. Granted, the US system does not provide universal coverage, but it is certainly not inefficient in terms of results (e.g., nearly a 20 percentage point greater chance that a male will survive cancer than the western European average - see above).

The full AMA proposal (link provided by thursdaysd) includes a number of statements that could certainly fuel this debate, such as "Single payer systems are beset with problems such as undersupply of medical personnel, long waiting lines, and lack of patient choice."

Another interesting statement contradicts the arguments presented above that universal coverage would actually be less expensive. The report states that "Virtually all analysts agree that achieving health coverage for all Americans will require a net increase in government spending."

The AMA proposal also references a more recent report on US health coverage by the Census Bureau. The report is titled "Income, Poverty, and Health Insurance Coverage in the United States: 2005". Google the title and you will find the report.

Regardless of one's stance on the issues, the US Census Bureau report has some useful statistics.

Total Uninsured Americans in 2005: 46.6 million.

Coverage by Type of Health Insurance
Employment-based: 59.5%
Direct-purchase: 9.1%
Medicare: 13.7%
Medicaid: 13.0%
Military: 3.8%
Not covered: 15.9%
Note that these percentages total 111.2%. I assume that this is because roughly 11% of the population has more than one type of coverage.

The income-based numbers that I listed earlier for 2002 can now be updated to 2005 values.

Annual Household Income = $50,000-75,000: 8.3 million uninsured
Annual Household Income > $75,000: 8.7 million uninsured

The median income for 2005 was $46,326 per year. At least 17 million uninsured Americans are from households that earn above the median. It is plausible that most of these people could afford insurance, but accepted a calculated risk not to purchase coverage.

Seventeen million is a significant portion of 46.6 million.

jahoulih

"Another interesting statement contradicts the arguments presented above that universal coverage would actually be less expensive. The report states that 'Virtually all analysts agree that achieving health coverage for all Americans will require a net increase in government spending.'"

Did you miss the word "government" in there? A net increase in government spending does not necessarily mean a net increase in overall spending.

Neil_Oz

And I fail to see how a system that costs at least 60% more that those of most other OECD member countries can be considered "efficient", even if that 20% cancer survival figure were indicative of outcomes across the board - which it isn't.

And yes, why is it assumed that extra government outlays would simply be loaded on top of the existing ramshackle private insurance model?

Here, I suppose it's possible that some employers might pay an employee's private insurance as an afterthought in an executive remuneration package, but I haven't encountered it.

I think someone raised the impact on US companies' international competitiveness. This appears to be a real issue. A while ago I read that despite the generous tax breaks and very low wage levels being offered by some Southern states, Toyota had decided to establish its North American RAV4 plant in Ontario. One reason was access to a better educated workforce, the other was not having to pay through the nose for their health care.

altamiro

>provide medical insurance for all their residents by subsidizing private insurance for people who don't receive medical benefits at their jobs.

What comes with it is however a tighter regulation of the treatment options. So no "previous illness" clauses, and no "dumping bad risks". An insurance under a comprehensive insurance system would be required by law to take everyone. There are still possibilities to earn money under this system, but the margins will fall considerably, subsidies or not. So I expect that the insurance companies will fight the comprehensive system tooth and nail.

elina

>>>Granted, the US system does not provide universal coverage, but it is certainly not inefficient in terms of results (e.g., nearly a 20 percentage point greater chance that a male will survive cancer than the western European average - see above)<<<

I am just wondering how much that has to do with prostate cancer. They seem to do a lot more PSA testing in the USA, and catch prostate cancers at a very early stage. Autopsies show that many old men have a prostate cancer, and they have not even known about it, and have died of some totally different cause. So do these tiny prostate cancers that would never even have spread go to those statistics?

ira

Hey t,

>No, unfortunately the AMA just wants everyone to have insurance, funded by changes to the tax system. <

I said, "has taken the first tentative step..". Considering that they have been so adamantly opposed to any "government interference in the free market" in the past, this is a major departure.

SM notes:
>The report states that "Virtually all analysts agree that achieving health coverage for all Americans will require a net increase in government spending."

Of course it will. There is a large number of uninsured Americans. Who else is going to insure them?

However, that doesn't mean that it will produce a net increase in overall spending. For the reasons noted above, I think that universal coverage would decrease cost.

> It is plausible that most of these people could afford insurance, but accepted a calculated risk not to purchase coverage.<

Conceivable, possible, arguable? A family of 4 living in NYC (median income about $60,000) making the US median income can't afford health insurance if it isn't offered by the employer.

Elina offers:
>I am just wondering how much that has to do with prostate cancer. They seem to do a lot more PSA testing in the USA, and catch prostate cancers at a very early stage.<

An excellent point.

The US seems to have the world's highest rate of prostate cancer, but we do a lot of screening. Thus, we catch it early and treat it quite successfully.

We don't know if the cancer would have developed or not.

I, personally, am not interested in finding out.