ira

Hi Neil,

>When employed I paid an income tax surcharge of 1.25% to fund the system. People without private health insurance pay 1.75%.

In the US, the Medicare contribution is 2.9% of the gross earnings - 1/2 paid by the employer and 1/2 by the employee. Self-employed people pay the full amount - part of which is deducted from taxable income.

In additon, as noted above, we pay for private health insurance - currently about $3200 for my wife and myself.

My insurance cost was about the same when I was working, but my employer paid about 3x that.

Average income for a family of 4 in the US is about $40,000.

So, $1200 for medicare + about $13000/yr for private insurance = $14,200 for a family of 4.

ira

Rex remarks,

> and paid hugely by families at the upper end of the income spectrum... for a very large slice of the population pie at the other end...

I have no problem with this. "To whom much has been given, much will be expected." (Luke 12:48)

I wasn't able to find any numbers. Do you have a citation?

In the article at http://cameron.econ.ucdavis.edu/e132/Summary.pdf
Dr. Cameron states that 28% of health costs come from public funds.

BTW, he claims that median income for GPs was about $150,000 in 2004. I don't consider this high, considering the investment in education and the number of hours worked.

ira

>..I just don't believe that the problem in american health care is some legion of fat cat insurance executives getting rich, nor their employment of thousands of paper-pushers. The far greater problem is that people want it, want it, want "it" (medical care) and blindly think that it's okay to ask their neighbors to pay, endlessly, to provide it to them.<

OK, some people abuse the system, but that happens in every field of human endeavor.

Do you have any numbers on the fraction of patient visits, procedures, hospitalizations and Rxs that are NOT medically necessary?

GSteed

European, Western and Central, healthcare/medical service is more than adequate to care for the needs of visiting tourists. Tourists are afforded the same care that locals have available to them.

audere_est_facere

Just to emphasise- health care isn't free for tourists - you're supposed to pay, the fact that it often isn't demanded shouldn't stop you getting travel insurance - otherwise you could be looking at a very big bill.

Padraig

audere_est_facere's point does not apply equally to all tourists. As a citizen of an EU member state, I am entitled to the same level of health care when I visit another member state as would a resident of that state be.

I still choose to have travel insurance, principally to cover health matters (including repatriation by air ambulance, if appropriate). If I have a major health crisis, I would rather be brought home as soon as it is reasonably possible.

rex

ira - - having a busier than usual day today - - working on some replies, with figures to your questions, rather than dodging them, but can't right now.

I am already surprised that this thread is not deleted or closed, as it is quite far removed from Europe travel (the dialogue between me and you, especially so).

And while it has remained quite civilized, it could take a turn much more in the direction of class warfare yelling and screaming (not that you or I would ever do that!)

Would you care to write to me and take this off-forum?

Rex

kerouac

I think it is very important for visitors to Europe to know that they will be treated for any medical problems without being sent to debtors prison.

When my grandmother had a heart attack in North Carolina, my parents had to pay more than $10,000 for her treatment before French medical insurance completely reimbursed them. And that was amost 30 years ago.

PatrickLondon

We've been all round this ground on
http://www.fodors.com/forums/pgMessa...p;tid=35031741

For what it's worth, I earn slightly less than the national average salary and I reckon that paying for the NHS takes roughly 4.5% of it (about £900) a year in taxes. I haven't needed it much in my life (adenoids, appendix, wisdom teeth all out for free; probably barely half a dozen more trips to the GP apart from that; NHS rates for a scrape and polish at the dentist - £15 a time); but I don't mind subsidising other people - this is one instance where I am indeed my brother's keeper, so to speak. And I'm getting near the age where it's likely to figure a bit larger in my life, so I'll need all those fit young people to subsidise me.

ira

Hi Rex,

I agree with K, "it is very important for visitors to Europe to know that they will be treated for any medical problems without being sent to debtors prison".

It also is enlightening and entertaining.

How about continuing the discussion until it is pulled?

LJ

I am very interested in the comments about tourists to Italy being treated in hospital emergency rooms (and beyond) for free. I am wondering how much of this is because the hospital staff/bureaucracy is in a paper war with the national health care system? It sounds like the hospital administration are just not bothering to do the paperwork required to get payment.

I mention this because my husband and I (Canadians) taught for some time in a small town in Italy. Both for ourselves and for all our students, regardless of country of origin, entry to the country and the municipality (i.e. acquisition of a visa and a municipal "permesso&quot was dependent on proof of health insurance for the full term. In other words, the kids for 4-8 months and for us a year at a time, to be renewed upon re-entry.

This was a strict provision: we actually had to deny admittance to the school to one youngster whose parents did not get their act together.

When any of "our" kids was sick and we called the doctor, we got a bill and that bill was paid by parents who sent the bill on to their health care provider. When we took them to the hospital, a bill sometimes followed and sometimes did not...I have no idea what the criteria were.

It is not unusual for different levels of Italian officialdom to war with one another...the French may have hi-jacked it, but the Italains invented bureaucracy.

But having said all that, as a Canadian, I WANTED to pay that Italian hospital bill. It seemed wrong not to. Just as, frankly, it seems wrong to me when tourists come to my country and expect our "free" health care system to be "free" to them.

PatrickLondon

But then again, it's probably not worth collecting half the time: and no-one would want to charge for a genuine emergency.

GSteed

Hey! What could be more important than; how to handle a health problem in a foreign country while traveling?

RM67

How can anyone equate flying (a luxury rather than a necessity for 99.9% of us) with healthcare. Ludicrous.

rex

<<How can anyone equate flying (a luxury rather than a necessity for 99.9% of us) with healthcare. Ludicrous.>>

I suppose this is directed to me since I posted

<<...just think if there were "Flight-i-caid" and "Flight-i-care" so that the "uninsured" could show up at the airport and insist that they _need_ to be flown from A to B, based on their complaints.>>

I am not equating the two - - I was proposing that you use your imagination - - and think how the entitlement notion would lead to never-ending demand for flights (such a demand is out there right now, but held back by the need to pay for the flights).

rex

As promised to ira...

I hope this doesn't sound like so much jibberish, and rambling...

I am seriously trying to answer your questions with some quantitative support for why I see things the way I do (- - and again, I acknowledge that this is rather far from the mainstream - - as you will read below... I thought that the essay by Profesor Cameron that you referenced was quite instructive and a worthwhile big picture overview).

===================================

This is some back of the envelope math, and I may be basing some of it on assumptions that are shaky at best, and may be totally unfounded.

I'll talk about two groups of American households: the superwealthy (top 1% or roughly 1.2 million households; minimum household income $325,000; mean $ 1.1 million; mean federal tax $300,000 - - it goes without saying that this is very much NOT a bell shaped curve) and the wealthy (the next 4% or roughly 5 million households; household income ranges from $130,000 to $325,000 with a mean of $180,000 and a mean federal tax of $38,000). Now, federal tax is only one source of "public funds", but it is a reasonable proxy. Excluding Social Security (see below; I assume that Social Security is money in/money out)... I think that state and municipal taxes are roughly 20% of "public funds"; federal about 80%. And of course, I am kinda sweeping under the rug the 15% of federal revenues that come from corporate income taxes, excise taxes and "other" - - ultimately, these dip into the same pockets as the income tax bill (as share holders, for example) - - that is... 96% of the money comes from the upper half; 50% comes from the top 5%; 33% comes from the top 1%. For simplicity sake, I will cling to the delusion that all social security collections go to social security payouts.

I cannot find any figures on how much these respective groups of households spend on medical insurance and out-of-pocket medical care costs - - but I will take a wild stab - - it is relatively similar at $20,000 per household. For this analysis, I am assuming that health insurance paid "by the employer" is actually an expense borne by the employee/taxpayer, since if the employer did not pay it, the employer would simply offer higher compensation to recruit and retain an employee at that level of value.

Your essay by Professor Cameron estimates a mean annual medical care expenditure of $7600 per person. And by the way, the figure cited for percent of healthcare costs from public funds is 47% not 28% as you said in your posting. So, a little over a trillion. This actually does seem high to me, since there is less than 2 trillion in the non-Social security federal budget. I'll back it down to $800 billion coming from public funds, despite what the good professor says.

The other missing figure is how much does the average household spend in the bottom 50%. Again, this is such a guessing game - - but the figure ought to include what is spent "on their behalf" from public funds - - I'll offer up an assumption that they _receive_ less health care than the wealthy. Perhaps much less. My argument about "paying for three other families" depends heavily on what this denominator is - - and of course, whether I am talking about the superwealthy... or merely the wealthy.

Let's suppose that the true "cost" of medical care for a household in the bottom 50% is about $8000 per year, i.e., the amount they pay out of pocket and on insurance (of whom, 30-50% have none) plus the amount spent on their behalf from public funds. Another totally wild guess: the families in this bottom 50% are spending $2000 of "their own money" - - so somebody else is paying the other $6000 for them.

Now, to assimilate all these numbers.

A superwealthy family contributes $100,000 to the federal coffers for health care expenditures and $20,000 from its own pockets. Probably another $10,000 in state and municipal - - so the total contribution is about $140,000.

A wealthy family contributes $15,000 to the federal purse and $20,000 from its own pockets, and maybe another $2000 state and municipal, thus $37,000.

A bottom 50% family contributes $2000 and draws $6000 subsidy from the families in the top 50%.

Therefore (and believe me, I am shocked that this works out even vaguely as I asserted it might!) - - a superwealthy family pays for their own medical expenses and subsidizes about 20 other families ($140k-$20k divided by $6k). A wealthy family pays for their own expenses and subsidizes about 3 other families.

No, now doubt you can say that the same ratios apply to defense expenditures, roadbuilding, and running the government in general.

The disturbing part is the trend, as Professor Cameron points out. 17% of GDP today; forecast for 20% of GDP in 2015. Do you think that the bottom half are going to be in a position to pay more than (the current) one-fourth of what they "consume"as the fraction of our nation's total GDP goes ever higher and higher? Get ready to support that fourth family - - or, if you are in the upper half of the wealthy fraction ($180k-325k - - how many Fodorites are in that fraction? presumably your own personal physician and many more...) then you will soon start subsidizing your 8th or 9th or 10th)...

No one wants to face the ugly truth - - by building this universal appetite for no holds-barred medical expenditure (because supply-demand has been thrown out the window) - - there is a larger and larger segment of the population whose medical care costs approach, or even greatly exceed 100% of their entire contribution to society.

You asked what fraction of medical care is "unnecessary"? I don't think that "unnecessary" is the way I choose to look at it. I call it economically unjustifiable. I don't mind subsidizing the Adams, Brown and Carter families (and maybe 3 or 4 other others) - - but I really resent all the things that society does not and can not have - - because we pay so many thousands to rich Dr. Jones the xyz-ologist to catheterize, or "scope" or read scan after scan of poor old Mrs. Smith's deteriorating body. Whether he made a big educational investment or not, whether he works long and hard... Dr. Jones is sucking the American public dry, and too often... really not making life in America better for it.

It's equally true of centerfielder Jones (or maybe much worse), but at least there is vaguely a market connection. The advertisers who underwrite the broadcast of games played by centerfielder Jones' team do a hard pencil and paper analysis of those advertising costs, and they evidently know that they can sell more soap to those listeners, because centerfielder Jones draws in all those eyes and ears.

Dr, Jones increasingly returns Mrs. Smith to the nursing home, for an ever greater number of days - - and the soap salesman, her son Joe Smith, has to subsidize those also. I remain cynical as to how it improves his life to do so.

sjj

Rex must be exhausted after all that math. I suggest a movie. Soylent Green seems appropriate.

fnarf999

What I think is interesting is that Americans pay far more for health care, and receive far less. My employer pays for my health care insurance, which I have been fortunate enough to barely use, and which would otherwise be about $500-600 a month. Probably two of the HR employees at my company are also required only because health insurance is handled through work. Health doesn't have anything to do with employment, though.

If I did need to use it, I would pay fairly low co-pays, but it tops out very quickly, so that if I needed truly expensive care, like advanced cancer treatment or anything with a prolonged hospital stay, my million-dollar limit would be quickly breached and I would be forced to give up all of my assets including my house and retirement to pay for it. A million dollars is no longer a particularly large amount for a serious illness.

My wife's healthcare insurance has an even lower ceiling.

People love to talk about the efficiency of the market, but the market in health care insurance has proven to be far, far less efficient than government-managed programs.

Sarvowinner

Hi - interesting discussion and I hope it doesn't get pulled. Neil_Oz and I have both remarked that it is difficult to have a global discussion on serious topics in the Fodorite Lounge as it becomes a case of "How dare you criticise America" or it's totally subverted by little men who like P...Weak Beer.

All dollars are Australian dollars - currently worth about USD 0.85.

Now in Sydney, I pay nothing to visit my GP as the practice bulk bills - ie. accepts the standard government reimbursement as payment. My prescriptions cost a maximum of $33.00 as the federal government agency PBS (Pharmaceutical Benefits Scheme) buys the drugs for the entire country. They therefore get a great buying advantage. However, not all drugs are covered. The effiiciacy has to be proven. When Avonix first came out as treatment for MS, it cost $18,000 per year. It now costs $360.00 as it has demonstrated its efficiacy.

There are currently arthritis drugs that are very expensive and are suited to only a small proportion of sufferers. Obviously, everyone wants to try it but it is only approved at the reduced rate for very particular patients.

I also pay a medicare levy of 1.5% of my income.

I also pay private health insurance which covers private hospital and ancilliary (dental, eye, physio etc) for my family of $4,800 of which 30% is rebated by the government. If I didn't take private insurance, I would have to pay a tax surcharge as my income is over $50,000.

I have just come in from visiting an orthopedic specialist. I can only visit him with a referral for a GP. Specialists don't bulk bill. His consult cost me $80.00 - my private insurance doesn't cover visits in his rooms, but having that insurance means I can have the doctor of my choice if I need to be hospitalised. I will get a proportion back for Medicare.

Just on drugs - prescription drugs cannot be overtly advertised. You do get subtle ones suggesting that you see your doctor about obesity, impotence etc.

fnarf999

Oh, how I wish advertising drugs was still illegal in the States! I know the free market boys think it drives the cost of drugs down, but that's been shown to be false -- the price of drugs never goes down until the day they go off patent. And even if it was true, to me that just means they've been flogged off on millions of people who don't need them.

And then I wouldn't be assaulted by the barrage of erectile disfunction drug ads every time I turn on the TV, and the long list of repulsive side effects. I'm trying to enjoy my program and I have to hear about diarrhea and four-hour erections.

My favorite is the new ads for Mirapex, which used to be marketed to Parkinson's Disease sufferers but is now sold for "restless leg syndrome". One of the common side effects is "compulsive gambling". I about fell out of my chair. But I looked it up on the internet, and lo and behold, there are THOUSANDS of stories, and lawsuits, from people who never gambled a day in their life, started on Mirapex, and immediately went out and threw away millions of dollars on the blackjack tables. Bizarre.

I think the drug companies have ended up overreaching on advertising, and have now convinced a lot of people like me that they're not even interested in health, only cheesy marketing and worthless gimmicky products.

Are prescription-only drugs allowed to be advertised in Europe?