Here’s an unusually simple and horribly stark analysis of US health system http://t.co/yhQirpMS3A @GuardianUS
— Jane Thynne (@janethynne) March 5, 2014
Both Homelanders and Americansabroad and especially those subject to the 3.8% Obamacare surtax will find the article referenced in this tweet to be of interest. It includes:
I recently went for a routine blood test as part of my yearly physical and went back to the same lab I had been going to for the same test the last few years. This time however, after handing over my insurance card, I was told they were no longer an “in-network provider” for my health insurance carrier (my carrier is one of the biggest in the country). At first, I didn’t care since my insurance plan allows me to see any provider, in-network or not. The difference is in the co-pay. No co-pay for the blood test with an in-network provider, a co-pay for out of network.
Given that the temperature outside was around 4F (-15.6C) with -10F (-23.3C) wind chills I was inclined to stay where I was and fork over what I thought would be a $25 or $50 co-pay. I figured that in the time it took to put on my sweater, scarf, coat, hat, gloves and warm up the car, I could stay where I was and just be done with it.
So I asked the administrator what the co-pay would be. She said she couldn’t tell me since she didn’t have my specific plan information, but she could tell me the cost of the blood test and the co-pay would probably be in the 20-30% range. I asked her to look it up since I had decided to stay and get it over with. Until she told me the cost of the blood test: $1,132.
I am resident in the US and I have to pay the 3.8% and the 0.9% medicare surtax.
I won’t get any benefit from this tax. I have to pay it because I have been defined by Obama as rich.
The benefit goes to others in the US.
People voted twice to tax the rich. It was pretty clear. If you are now subject to the 3.8% and/or 0.9% then you are rich as defined by Obama.
Most of the time you guys are claiming your small fish. Now you are crying you are big fish. Many of you voted for this policy.
If you don’t live in the US and want to be free of all US taxes then that seems fair to me. Claiming you don’t benefit from this one tax doesn’t make sense. I don’t really benefit from the massive amount of money they take from me each year but a lot of other people do.
@atticus,
re; “As for the dual citizenship issue. I respectfully disagree. There is nothing wrong with being dual. In some cases it is even necessary. ”
I agree. And for the same family and mobility issues you describe. If one has dependents or family with different status/citizenships it makes it very hard to relocate in order to help one another. Family support and re-unification is important. A society should want family members to be able to help each other in times of need, and provide the type of safety net that a government cannot provide. The US and Canada are so entwined that for the US to make dual status so burdensome just doesn’t make any sense in that regard. And that is also what makes being a dual more important than it might otherwise be. I never contemplated moving to the US for economic opportunity, but I did want to be able to go there unrestricted – when necessary in order to help elderly, or ill family – including one deemed incompetent.
And as for ‘serving two masters’, I still wouldn’t think that CBT and FATCA was ethical, just or rational, even IF I was a US homelander only – given what I know about it. It is possible and ethical to have a worldview in which one holds universal values which are compatible with being a good citizen. Being a good US citizen is not incompatible with being a good Canadian citizen. Loyalty and allegiance should never be blind and never awarded without critical analysis and an ethical worldview. I would not cheer on US exploitation of Canada if I was a US homelander, or the reverse. Just as I do not excuse Canada’s exploitation of other countries (ex. in the mining sector abroad) merely because I am a Canadian. Multiple citizenships and mobility is being made workable in the EU, so why not in our instance? Only the US attitude of might makes right and extraterritorial CBT is making that impossible for many of us to be or remain duals.
I never applauded US machinations at the expense of Canada even when I was not a Canadian citizen. And I would not applaud Canada besting the US on some issue if I thought Canada was wrong. I think it is possible to elevate a sense of right and wrong above blind allegiance.
@ShadowRaider,
I respectfully disagree that healthcare for those with low/limited income can be sufficiently provided by charity, rather than some kind of government funded program – with or without additional insurance programs.
In my opinion and experience, we can’t rely on ‘charity’ for an essential universal service or good. An essential good is one which cannot be best served by the vagaries and limitations of charity – which is after all optional – and often associated with value judgements and questions of who is most ‘deserving’. The non-profit charitable sector often does not have enough resources and support in order to provide for all those who needed services. It is frequently dependent on volunteers and most often lacks core dependable operational funding. Services are often provided by community/charitable groups desperately trying to fill in gaps that government officially acknowledges as important, but chooses not to fund – or does not fund sufficiently or consistently – frequently even as it regulates it. The charitable sector is not sufficient to provide an essential universal societal good. We do not rely on charity to provide public education in the US and Canada – which we fund at a base level via taxes and government. Healthcare should be at least considered as urgent a social good as education. We do not fund critical infrastructure via charity. We do not fund highways and roads or sewers or government via charity.
Often ill health – particularly chronic conditions that have no cure lead directly into a sentence of lifelong poverty. It is very difficult to provide for oneself or a family with some diseases and conditions. Many conditions are random ill luck or inherited or congenital. They are not under individual control. Some are the direct result of the genetic lottery, military service or work hazards or accidents. A healthy population is a societal good that benefits everyone in many ways. Healthy people can turn their energies fully towards work and family obligations. Healthy people can better pursue education and contribute to their community. Healthy parents can better turn their attentions to the wellbeing of their children. Healthy people are less likely to become homeless and more likely to live stable lives. Our investment in health care for all benefits all of us.
I experienced the US healthcare system on behalf of an immediate family member with a terminal condition, who thankfully had very good coverage through an employer. The billing was unpredictable, complex and difficult to understand, much less to anticipate and it would have been impossible to predict, save or prepare for. It took years after the death of the patient to sort out the medical claims and insurance and provider disputes, and near the end, despite full coverage at that point, the tragedy of impending death was plagued by unremitting calls – multiple times a day, every day, from a collection agency – not because the patient owed anything, but because the providers and insurance could/would not work things out between them – and apparently had no real incentive to. The collection agency only stopped after a final call on the day of death when I informed them that the person had just died that day – and they’d have to wait for probate IF there was anything actually owed by the patient that was not covered by their insurance (which we and they already knew). At one point, waiting for pre-scheduled and desperately needed treatment, without prior notice, the severely ill patient was forced to put up their own cash to cover a fee on the spot – because the hospital was locked in dispute with the insurer.
Even after death, we had to travel to the last hospital to go in person to their billing dept. in order to sort things out. It could not be done by phone or mail. Their files were in disarray and the person responsible was nowhere to be found. This was a hospital located in one of the wealthiest communities in the US, and the insurer was one of the largest – serving a government funded organization.
Even more recently, a US relative had to canvass family in order to raise their own money to pay for her cancer treatment due to shortfalls in coverage – and they were a government employee – ironically working in public health. At the same time, their spouse had a serious health crisis, and also an elderly parent.
When I was younger, a sibling needed multiple expensive medications since childhood and would not have been able to live without them. Charity was not available, and would not have been sufficient, and without insurance coverage our family had to dedicate a large portion of income to medical and medication expenses – before universal health care was put in place in Canada. Universal health care plus insurance coverage for the medications – available eventually through an employer made an incredible difference to our whole family.
I have been so lucky not to have experienced the fear and stress of facing how to pay for catastrophic or chronic illness, or to go into debt to pay for treatment, or fear of losing coverage if I or a spouse lost our jobs. Life without and then with dental insurance and other associated health insurance illustrated for me what life can be like with and without essential health coverage and affordable services for an individual or family.
@neill
Yes, but you benefit from everything else your taxes pay for – we don’t.
@all brockers. concerning dual citizenship.
What does not work is CBT plus the difficulty in getting rid of US Nationality.
Getting rid of clinging US Nationality is suppossed to be easy per the US Expatriation Act of 1868.
In hindsight, it was the Supreme Court that screwed things up because prior you could scuttle your citizenship by things like going to vote! That in reality was good.
I could support CBT in principal if the old nationality rules applied.
IF the US does not move to RBT then it must move to easily getting rid of clinging nationality and make it no more burdensome than the procedure in the UK or Canada!! Relinquishment should only entail mailing a form, maybe witnessed, with a small fee.
@neil. “Many of you voted for this policy.”
Ever since obtaining another citizenship have note voted in a US election and in fact returned my voters registration card. 🙂
As someone taking on another citizenship and leaving the US, I did not feel it was right for me to vote on homeland issues.
The problem with folks here is that we are now tied into form nation with CBT that generates only forms and no tax but huge compliance costs AND nationality we would like to get rid of but it is damn difficult to get rid of.
@badger
Great points. Universal healthcare makes sure that everyone gets the same level of care, regardless of their income level. Studies have shown that Canadians also have a longer life expectancy than Americans because of it.
@badger, I am sorry for your family member. I wrote that charity would be enough in an ideal world, where enough people would provide enough money and resources to help others without judgment. The voluntary nature of charity is voluntary is precisely why I believe it is better, in theory. But I understand that in practice it doesn’t work that way, and I agree that the urgency of health care requires other solutions.
What you wrote is an example of the terrible billing system in the US, and more evidence for my argument against health insurance. It would be much easier if people would just pay for everything themselves, or for each other voluntarily, therefore eliminating the entire monstrosity of insurance claims and disputes.
I am also not opposed to government health care as a practical alternative, but I have a few questions. I’ve heard that in Canada people have to wait months for simple procedures that are quickly available in the US. A frequently mentioned example is knee surgery. I’ve also heard that many Canadians travel to the US to get faster health care, which in some cases is critical. Is that true? Are you satisfied with health care in Canada? Is there anything that you think could be better?
@neil, I think the claim that ‘many’ of us here voted for Obamacare isn’t accurate:
There are people here who gave up US citizenship decades ago – most understood that they lost it when it was by US law of the time automatic with swearing allegiance to another country during the naturalization process – in Canada and elsewhere. Or performed any one of the other relinquishing acts like swearing oath to serve in a foreign country’s civil service, etc. Most of those then couldn’t and wouldn’t be currently voting in the US.
Many others who never lived in the US but only inherited US citizenship status via a US parent, and were born and live outside the US can never register or vote in the US without ever having lived there for some minimum period of time – because over half of US states require an established period of US residency to do so. Only some allow children born and living outside the US to register as adults and vote using a US status parent’s last state of residency. It is a fallacy that all those with US citizenship living outside the US can vote from abroad.
Others here won’t have voted in the last US elections because they didn’t/don’t want to invalidate their relinquishment – and are no longer US citizens – even if they haven’t gotten a CLN yet. Renunciants gave up the ability to vote when they actively swore the oath of renunciation in front of a US consular/embassy official.
Some are merely EX-greencard holders – and they never ever even had the right to vote in US elections – before or now. Nor do current greencard holders who left. Those who did not formally surrender their greencards in the approved manner neither have permanent residence privileges NOR do they or have they ever been able to vote one way or the other.
There are several categories of people living entirely outside the US who cannot vote in US elections but whom the US extraterritorially deems to be a ‘US taxable person’ and who if they meet the threshold for the Obamacare investment tax would be subject to pay it or be penalized. It is entirely possible unfortunately to live outside the US, have no US citizenship, no PR status, no US income, no US economic connection or property, and still be assessed with the Obamacare investment tax liability – also despite not having the ability/right to vote in US elections. Neither can ‘covered expatriates’. Or those with ‘substantial presence’ – like visitors who stayed in the US too many days, etc. And none of those living outside the US will receive any services or benefit from the Obamacare tax either.
@shadow raider
The wait lines in Canada are a choice Canadians are making. Please read the article on “Five myths about Canadian healthcare” posted here:
http://isaacbrocksociety.ca/2014/03/16/americansabroad-must-pay-the-extra-3-8-obamacare-surtax-for-this/comment-page-1/#comment-1237730
@Neill
I have a gc for the US & I am canadian… I can’t vote but I am on the hook for taxes I knew nothing about in the states… or the 8 million forms that I need to do… no one told me boo. If I knew the rules… it would have been different.. would never have taken this toxic card & I can’t give it back since alot of my family is there & If I do give it back then I am treated as an ex-pat with an exit tax which would probably wipe me out faster… Taxes are used for improvements… roads… airports.. schools.. sanitation… snow removal… I could go on but u get the idea.. its not free… your taxes pay for it… the same that non-residents living in another country pays. Point being made is… they do not use or get any services in the US… why should they pay then?
If u are middle class in the states… your savings can be wiped out with or without health care… In the hospital when my mum was sick… 2 tylenol cost US $50 a pill… this was like 10 yrs ago.. Every time the dr said hi… that cost money… ambulance is over $1000… Dr starts about $750 per visit up front… When her hospital care was over… we kept on getting bills… It was unbelievable the costs… Parents have the usual old people things… diabetes, high blood pressure & cholesterol.. use to cost about $8 for 100 pills before Obama care.. now diabetes pills.. is over $100 for 90 pills… Dementia pills cost over $300 a month… all prescription prices double.. tripled or more… just in a few months prior to Obama care. I would not have believed it until I saw the bills… My uncle in canada had heart surgery… it cost like $10 for my cousin… for parking… If u are poor in the US… nothing to worry about… gov’t takes care of it all… medical… housing… food… they even give over $100 a month for health care products… I was amazed… & public transportation
Shadow Raider,
*Most* in Canada ARE satisifed with their health care in Canada! It is not perfect and it is a continual process to make sure it works well. But, Canada’s system is caring in that it serves all. I am so very thankful every day that I did not have to depend on “charity” for my family’s healthcare needs in Canada. In Alberta’s triage system, I have NEVER experienced a wait for any emergency care that I or my son needed. Canadian taxes for provincial healthcare provide for all, and that is the way, I think, most Canadians want it.
As the debate about Obamacare rages on in the United States, a Toronto doctor calmly defended her country’s health-care system before a partisan U.S. Senate committee in Washington this week and explained that the single-payer model is not to blame for wait times — and that Prime Minister Stephen Harper is not a socialist. Dr. Danielle Martin, a family physician who is also vice-president of medical affairs and health system solutions at Women’s College Hospital, was the Canadian voice on an international panel at a committee studying what the U.S. can learn from other countries.
Another view: Is charity the answer to healthcare?
This is not related, but why is Uncle Carl punching holes in FATCA and taking the boots to the DOJ?
http://blogs.angloinfo.com/us-tax/2014/03/17/how-to-avoid-fatca-tips-from-us-senate-subcommittee/#.UyZ6RrrZRH8.twitter
@Neill, I agree with you. The justification for progressive taxation is that people with more income use more government resources. This is true, but it does not mean that their use of resources in proportion to income in higher. In fact, I believe that it actually decreases with income. A flat income tax, with a constant rate, still means that people with more income pay more income tax, but not proportionally more. And combined with other taxes that are not based on income, the tax system would become regressive. I do not think this would be unfair, because it would reflect the use of government resources by each person more accurately.
My argument is based on the idea that the purpose of taxes is solely to pay for government resources and services. Many people, especially politicians on the left, don’t agree with this idea. They believe that another purpose of taxes is to reduce income or wealth inequality, as if these things were intrinsically wrong. And that is why you are paying the Medicare surtaxes.
The difference between CBT and progressive taxation is quantitative. US residents benefit from at least some of the taxes they pay, but Americans abroad don’t benefit from absolutely any taxes they pay to the US (unless they have US income, which would continue to be taxed under RBT).
@Shadow Raider
The services u receive & the wait time depends on where u live… In Quebec.. the wait time is long.. depending on what u have… My uncle moved to Toronto a few yrs back… found out he had a heart issue… he was able to get an appointment with a specialist in a week or so… We were amazed… in Montreal.. it could take weeks or months… I live in a small town… drs here… already have their patients & take no more.. so if u are sick… u need to go into Montreal. Funds & Drs are limited so there is a priority system in Quebec… they sicker u are… they faster maybe they may see u… it also helps if u *know* someone who can move the process faster.. Knee surgery is not considered necessary so that is why it may not be a priority
@Neill
I emigrated to Canada over 4 decades ago with my late husband. We became Canadian citizens. Our two sons were born here. I have no desire to live in the USA again.. We had visited our families but they are dead now. I have siblings but we do not keep in touch. My Canadian health care got me a hearing aid that I never had when living in the USA. The government gives me $500 toward it. My own supplemental insurance pays $400 and I pay the rest, but it is tax deductible. My Cdn health care saved my eyesight. I saw the optometrist one morning and in the afternoon the Eye surgeon who did laser surgery that evening. I live in a northern rural town with a hospital but no eye surgeon. The eye surgeon is a 2 hour drive north in another hospital. My provincial health care paid for my car gasoline in a travel grant.
My younger son and husband were diagnosed 2 months apart with cancers. They had 4 operations, radiation treatments, several kinds of chemos, blood transfusion, stem cell transplant. nursing home care visits, individual and family psychologist sessions between them. My son was in ICU for 4 weeks after his last operation. He then was in the hospital Palliative Care for 1 week. My husband was in the hospital Palliative care for 3 months. Our costs were Parking fees in the hospital. other wise. no medical bills.
My husband and I worked union jobs We were able to have good pensions and health benefits. I also worked a job that was not union but it paid wages and benefits as good as a union job and a good pension. My husband did not live long enough to enjoy any retirement, dying at 54. I am his widow and now benefit from his pension. I am not a tax evader. I paid much higher taxes than you would . I am happy to because of the great benefits being a Canadian offers me. I am a firm believer that health care should not be for profit.
@Calgary411
Thanks for putting up Dr. Martins Senate Committee interview. She fully explained our health care very well.
@Badger
Your family health care situations in the USA were an eye opener.
I am familiar with the costly US health care system. Family relations would always be promoting spaghetti dinners or fund raisers for friends facing big medical bills. Thank you for letting us know about these problems and hardships. So sorry you and your family had these worries and expenses.
@ShadowRaider,
Not long ago both a relative in the US and I experienced a sudden unforeseen onset of the same exact hidden genetically inherited condition. We both received similar treatment in almost the same exact period of time in terms of access to a specialist. Mine in Canada, theirs in the US. I did not have to pay for treatment, which was good because it required surgery and days of hospitalization. I don’t know what co-payment they incurred – they were lucky to be fully employed and have private healthcare as a work benefit (this is before Obamacare). Another parallel that I know of involved maternity care. One person’s care in Canada was fully paid and options were not dictated by what was covered. The other parent in the US had their treatment plan determined not by what options their doctor presented or advised, but by what their insurance would pay for. The doctors were up front about that. Ditto for the length of their hospital stays during subsequent births – to the hour.
There is some variation of treatment, coverage and wait times between provinces here, just as there is in the US. A US relative had to go out of state in order to receive faster treatment. There are some things which are not covered and require private insurance or payment. Some treatment is rationed. Some is not covered at all. There are no doubt also people who jump the queue here because of connections. But overall I am happy with what I have received. I could never have paid for the necessary services I have received to date personally. And neither could most people I know. We fear going to the US even for visits without purchasing insurance – because I have experienced how even just a small injury incurred there on a casual short visit can cost visitors a big bill.
It is not perfect, but I do not have to routinely fear bankruptcy if I or my family members get sick here, and my fears about potential unemployment don’t have loss of medical coverage aggravating that fear. I did and do worry about my US family. We did have to consider whether to all personally contribute to the thousands that one in the US needed for cancer treatment – despite having been fully employed for decades in a secure well paying government job. What kind of situation is that? Their spouse had to decide whether to mortgage their house, borrow from family or forego treatment. That makes no sense.
I worked in programs with people who were in poverty and homeless or with insecure shelter due to chronic conditions (physical and/or mental) that there is no cure for and limited effective treatment. Some had to ration their meds and other critical medical supplies and the types of food they required because they could not afford them – in addition to having insufficient food and insecure housing. And that is WITH universal health care. Imagine what their lives would have been like if healthcare costs were not available here. Poverty is a significant determinant of health http://www.cma.ca/to-improve-health-tackle-poverty , and ill-health is a significant determinant of poverty http://www.who.int/hia/evidence/doh/en/ . Medical debts – one’s own or that of a family member in the US can result in bankruptcy, poverty and homelessness http://en.wikipedia.org/wiki/Medical_debt .That just makes no sense to me.
I want my society to be publicly educated and healthy. I am willing to pay for that with my taxes here, and I do. We are not born into equal circumstances. That is entirely random luck. At least public education and public healthcare helps towards leveling the playing field somewhat. There are real costs associated with ill health. Just as there are real costs associated with poverty or housed in prisons http://www.ibtimes.com/prisoners-100000-us-has-highest-incarceration-rate-world-chart-1384305 http://www.prisonstudies.org/country/united-states-america Why not invest in our fellows and social services now rather than more later?
Thank you as well northernstar. Take care.
@bubblebustin, calgary411, US Person Foreigner, badger, Thank you for your answers and links. Now I’m more informed and more supportive of the Canadian health care system.
badger,
Thank you for your well presented differences in philosophy of important benefits provided in Canada vs what the US prefers to provide with their taxpayer dollars. What you said is so important to me:
@ShadowRaider, you are very gracious.
Thanks for listening to what we value here in Canada, Shadow Raider. We cringe when we hear those in the US label our healthcare system as socialism, verging on communism. Words hurt in many ways and those words limit the alternatives many people in the US will even think about in coming to an equitable and cost-effective way to deliver US healthcare.
@calgary411
Never had to wait for emergency care? OMG… I was at the hospital for like over 8 hrs waiting to get my accident prone cousin stitched up… they should just set a dr aside for him outside of Montreal. I am so close to the US border… when the wind blows from the south… we smell the manure from the US….lol
@badger
Hope u are feeling better now & hope your health stays well…
@bubblebustin
Cause the treasury & irs haven’t taken over switzerland yet & just take what they want… law.. what is that??
He is doing everyone a favour… how to work the fatcrap better… And the treasury & IRS hasn’t rounded all of us… stick a big butt sticker on us, prod us into the death rooms fast or hard enough… we should all go faster… here is my advise to him… hope the heck u get a disease that makes u suffer before u croak… ok.. my bitterness is over for a sec
In Canada most people pay more into the healthcare system than they take out, at least when they are under age 40. We also don’t begrudge those who do have to use more healthcare services. We think better him than me. We don’t think gee I’m paying for that!
If my husband, my son and I can get through life without ever having a major illness, we’ll happily pay to cover the healthcare costs of someone who has cancer through our taxes. If that’s communism, sign me up. I’m an entrepreneur but that doesn’t mean I have to be heartless. I would hate to live in a society like the US where on top of dealing with the stress of someone being critically ill you have to also cope with the idea that you are about to go bankrupt.
I think having a functioning universal healthcare system makes for a kinder, gentler society.
Why is it that America can justify spending trillions of dollars on war but won’t spend the same amount of money on it’s own citizens to keep them healthy. They paid the taxes that pay for the wars, why can’t they choose to not fight wars and have better health instead?
US_Person_Foreigner,
No, never had to wait for any amount of time for emergency care for my son during his many childhood experiences with severe asthma and not being able to breathe in over 35 emergency room episodes in his pre-school years, usually resulting in at least a week’s admission to recover. Nor, my renal failure last year. Nor life-threatening intestinal blockages due to scar tissue from repeated surgeries relating to inflammatory bowel disease. Not much waiting for those surgeries either, including specialists eventually removing my colon and giving me an ileostomy, which many would not even consider as an option as they’d rather die than go through that. Instead, it gave me my a renewed quality of life in which I’ve been able to carry on in relative health for many years. I do know that my family has had more than its share of the benefits of the Canadian healthcare system dealing with chronic pre-existing conditions. Heck, some commenter even told me in the CBC news article that I was interviewed for in January that I came to Canada to suck money out of the health system for my developmentally disabled son. I guess I would have hated to have to wait for that person’s charity for healthcare. The Canadian healthcare system is among my many gratitudes in life. I do count my blessings and try to give back as best I and my family can.