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.
Thanks @US_Person_Foreigner,
My biggest ailment and cause of harm now is the burden that I inherited with US citizenship.
The other genetic ailment I can live with.
Unlike CBT and FATCA.
@calgary411
U do give back in many ways… your biggest contribution is allowing the world to know what is wrong with your situation with your canadian son who is an accidental american… Many are too scared to coming out & share… u are doing a great service that will make a difference…
Lord… yep… sad to say… we got our share of idiots in canada… its like that in my town in quebec.. want to separate from the rest of canada but still get federal funding… I think in the states.. they are called red necks… that is the term we use also… get as far as high school have deep hate for english speaking canadians… but here will be the kicker… lots & lots of snowbirds… I am really sure they know nothing about fatca & etc… Crap will hit the fans when they find out..
@Neil, my spouse and I are most certainly minnows and he’s not even American. The difference is as stated above we get NO benefit for being taxed or having to file to the U.S. where my son or spouse are not citizens and now I’m not anymore either because of the cost to file, the imposition on my Canadian family here.
If you live in the U.S. is your bank going to report directly to the IRS on your account numbers and balances? Citizenship *blood line* taxation is immoral and it’s causing a lot of completely unnecessary pain to a lot of innocent families who do not use the roads, schools, fire/police services, libraries or any other public service in the U.S. We use services where we live and pay tax to the countries we live in. Now the U.S. has sought to demonize every single expat family while calling what they are doing something else. They leave out facts to make it all sound good.
I don’t mind paying tax, filing where I LIVE and use services. The idea that the U.S. thinks people who do not live there and in some cases people who are not even American should pay paper tribute to them every year at great cost to their families is nonsense.
As to the medical care issues. Canada’s system is not perfect, none ever will be. I’d prefer our system to be far more inclusive than it is as it is already two or three tiered but, I’ll take it any day over what goes on in the U.S. At least I don’t have to go while sick pleading to an insurance industry shill, an industry that makes money denying care. The U.S. is very conservative when it comes to ideas like universal health care probably a hang over from the communism cold war years. Who knows? I’m glad I live here and not there. Who would want the battle they’re going to have for decades to come before there is ever anything resembling health care for all. Not me.
Sometimes just being lucky dumb can save you. My husband and I ran a small business in the USA — enough for survival but not enough to live even close to middle-class. We didn’t make enough to buy health insurance so we lived without it. We lived frugally and kept our fingers crossed that we wouldn’t need expensive medical treatment. Our plan was that if anything went badly for me, medically, I would return to Canada. (That’s one reason why I never even for a second entertained the thought of becoming a US citizen.) Perhaps this wasn’t fair to the health care system of Canada but it was our only choice. We never figured out anything for my husband except we believed, maybe incorrectly, that at least they couldn’t take our house if he ever had medical bills we couldn’t pay. Luckily we never had to resort to “my plan” and his “not so much a plan” either. Our few medical expenses were manageable and paid in full.
Anyway, we thought of starting a small business here in Canada (and this was pre-FATCA days) but then we also thought about how that would complicate my husband’s US tax filings. (Actually those filings would have been even more complicated than we were imagining.) Since we are DIY tax filers we decided to just forget about the small business and continue to live frugally here in Canada instead. My husband managed to find the best paying job he’d ever had here in Canada so we got lucky there too. I’m so glad we didn’t venture into a small business again because no doubt we would have done the US taxes all wrong and gotten ourselves into a huge mess.
I do not share Shadow Raider’s view that the poor should only get charity care. I believe everyone should get a fair share of care, no matter what their financial situation is. It just doesn’t sit well with me that a society would not do the best it can for everyone, because to not do so appears as a lack of compassion to me. Obviously I didn’t get the US medical system when I was there and I still do not get it. If the USA didn’t spend most of its wealth on destroying other countries it could easily offer health care to all of its citizens and residents — no insurance companies needed. Heck it could even offer advanced education to students without putting them in a debt death spiral too.
@Em, I’m not talking about “charity care” that some kind of organization offers that is inferior in quality to “regular care”. I’m talking about people simply paying for each other. Isn’t government health care essentially the same thing? The only difference is that people are forced to pay for it, while charity is by definition voluntary. I totally agree with you that a society should take care of its people who are less fortunate, out of compassion, but if you force everyone to pay, they are not really paying out of compassion anymore. In fact, I believe that all taxes should be voluntary, at least in principle. But my opinion is not set in stone.
The US government already spends more money in health care per person than other developed countries. For example, the US spends $3,310, France $2,845, Canada $2,718, UK $2,444, Japan $2,098. And that’s just what the government spends, not the people individually. In other words, the US could offer universal health care and reduce taxes at the same time, if it wasn’t for the messed up billing system that inflates the costs to totally artificial values.
Canadian government to provide health related tax relief. Maybe they should not have signed the IGA for one!
http://www.fin.gc.ca/notices-avis14/2014-03-17-eng.asp
It’s not necessary to argue for or against health care in the USA. It’s just simply a desperate act of theft to deliberately get the bill paid by people outside the USA. It’s just a bunch of mean spirited get-the-“rich” people mentality that is out to take away stuff from people that aren’t them to pay for things they could just as well pay for themselves. It goes well with the better than thou image that is put on whilst stealing money from people outside the USA.
@bubblebustin,
I want to see Flaherty announcing that due to the FATCA IGA he and MP Findley agreed to, “the Government of Canada is to Highlight Support For Families With New CBT/USTax-Related Health and Financial burdens.”
It is all smoke and mirrors. Pay no attention to the man behind the curtain.
@ Shadow Raider
Okay I think I interpret charity care somewhat differently. It sounds like poor people are at the mercy of those who volunteer to help them. One great thing about Americans is that they often demonstrate magnificently their willingness to help others. But for those who are in need, this is almost a catch-as-catch-can approach. It too often boils down to how appealing they are and how appealing is their situation. I just happen to think all people are appealing and all their situations are too. One thing is for sure though, the US health system should not be dipping into the economies of other nations to sustain itself. The USA is better positioned than almost every other country on earth to take care of its own — if it has the courage to do so and the will to change. I definitely agree about the messed up US medical billing system. We had first hand experience with that while trying to manage my US mother-in-law’s healthcare affairs when she became unable to do it for herself. The billing system alone is enough to make a person’s health suffer even more.
@all
Like I said earlier. If you were complaining that you get taxed by the US but don’t live here that’s a valid argument. To claim you won’t get any benefit from the 3.8% medicare surtax doesn’t make sense because I won’t get the benefit from the vast majority of taxes I or you pay. Remember the surtax is on income above 200/250k. By that stage your paying a lot in taxes. A few years ago the US was running a transfer rate of 44%. So 44% of every dollar got taken from one person and paid to another. With the new healthcare subsidies and extra for food stamps I can expect it to be higher now.
The US doesn’t provide any infrastructure to help me earn my dividends in foreign countries. They expect a cut of that income though. When I lend money to a foreign governments the US government expects a cut of that as well. Well over 50% of my assets earn income overseas. So taking the high ground on paying for stuff where you live doesn’t really cut it. I don’t use anywhere near the amount of government services I pay for. Most of what I pay goes to make up the money that poorer people don’t have to pay.
Don’t bother giving me your health care sob stories. I have to get out my check book every year to pay for this for other people. I have to fill in the new Obama case tax forms to pay for it for other people. If you got RBT I am sure you guys would vote for people like me to have to pay an exit tax for RBT to apply. It’s ok so long as the little guys don’t have to pay it.
@Neill said: “If you got RBT I am sure you guys would vote for people like me to have to pay an exit tax for RBT to apply. It’s ok so long as the little guys don’t have to pay it.”
You make a very good point. One should not have to pay more to expatriate just because they’ve been successful. It’s a form of discrimination.
@nell
I don’t really get what you are saying.The essence of health INSURANCE is that it is INSURANCE- and that means that should you ever need it- it is there for you. Expats pay for their own health insurance where they live. So in effect- they are being doubly taxed.
@neill
If anything, a switch to RBT would involve a departure tax such as Canada’s. This is currently being considered by the Senate Finance Committee. It’s a fee many of us would rather pay than to renounce US citizenship or continue paying the US’s diaspora tax.
@Polly
The medicare surtax is to pay for the expansion of medicare. The largest group of people joining the Obamacare programs are people newly eligible for Medicaid and medicare.
Obama care has only increased my costs. We now have high deductible health care plans because there is a tax on the so called Cadillac plans.
So if you are paying the 3.8% or 0.9% medicare surtax you are:
1) Earning more than 200k/250k and hence are rich according to Obama
2) You are rich so you can afford to pay for then healthcare of others according to Obama.
So crying that you have to pay the tax and not get anything for it is rubbish. If you live in the US and pay the 3.8% you don’t get anything for it. In fact your better off because the quality of your healthcare wasn’t capped!
@Polly,
Maybe your missing the fact that the 3.8% surtax isn’t insurance. If you earn less than 400% of the poverty level Obamacare gives you additional money to buy health insurance. This is paid for (well supposed to be paid for) by healthy young people being forced to buy health insurance and by people who earn more than 400% of poverty having higher costs. As a final redistribution people who earn more than 200k/250k are expected to pay the surtax to help fund this also.
@Neill, boo hoo. You live in the US it’s your problem. But when the US reaches across the border and taxes Canadians to pay for the health care of US homelanders, that’s our problem.
@Petros,
I don’t think your should have to pay it. I don’t think I should have to pay for it. Many of the people posting here voted for the guy though. And the argument that you don’t get anything for it doesn’t hold water because the people paying it in the US don’t get anything for it.
When you ticked that box for the guy who said the rich should pay their fair share you accepted this.
I didn’t get the chance to tick the other box!
@Neill
Maybe if America used less tax money to pay for warfare and more to care for its citizens healthcare- it would all make sense. As it is, I don’t live in America, I have not lived in America for 50 years, and I think it is a damned shame that the so-called “richest nation” on earth didn’t have good healthcare for its people in the same way that France or Canada does. But whatever- I CERTAINLY don’t think that I should pay for it. Thankfully I am no longer an american citizen.
@Neill, I didn’t vote for him or for anyone from his party. I agree that the Medicare surtaxes are nothing but a forced transfer of revenue, since they are specifically imposed on people at one level of income to pay for people at another level. I also agree that it doesn’t make much sense for you to pay tax to the US on income you earn from other countries. Territorial taxation would make everything much more simple and CBT would not exist either. Some developing countries have that system. Here is my idea of how taxes should be, in order of preference:
1. No taxes, only voluntary contributions. This is the only system that I believe would be moral in a democracy under majority rule. However, I don’t think anyone in Congress would agree, so I don’t even try proposing that.
2. Territorial taxation. Some in Congress agree, but most don’t because it would make it too easy for the “rich” to avoid taxes. So I don’t try proposing that either.
3. RBT. Many in Congress agree, and I suspect most would if it were brought to a vote. I’m actively proposing that. Regarding the exit tax, my primary suggestion is still that it should not exist. The exit tax was Congress’s idea. But even if Congress approved RBT with an exit tax, it wouldn’t be any worse than the current system, since people could still opt to remain under the current CBT. In fact, I am very careful not to propose anything that would make the system worse than it already is, for anyone. I live in the US too.
4. Renunciation of citizenship while retaining nationality. My alternative plan in case RBT doesn’t go anywhere.
@Polly, The US government doesn’t need more money for health care. It already spends more money per person on health care than most other developed countries. It just needs to correct the prices. But I agree that it should also spend less money on war. A lot less.
@Shadowraider
You might be right. And for education too.
I sent in my 8854 on Saturday after much stress making sure I will not be a covered expat. Today just checking what I might have owed to Uncle Sam now (I told Petros about saving $100K by renouncing). Now my tax increased by $17,000 for Obamacare. I am at the top tax bracket so 20% capital gains on owning a house in Canada goes to 23.8% to fund health care in a country I have not been in for 38 years. I live in Vancouver where most people have large capital gains on their principle residences which would be taxed in USA but not Canada.
Neill, the difference btwn you and us is that someday, you will qualify for Medicare (and Social Security – if either still exist) because you live there. Expats cannot receive Medicare and there are many people with US citizenship – in the eyes of the USG – who have never and will never live in the US and they can’t access Medicare either. Which makes sense, right? You don’t live somewhere therefore you don’t benefit.
Medicare surtax is a band-aid on the the fact that the program is rapidly expanding due to the huge increase in retirees thanks to the Baby Boomers. It would have happened even in Obama’s ACA hadn’t. Old people vote and they vote for candidates who promise to prop up Medicare and keep the SS checks coming. Place blame where it belongs.
Medicaid expansion is simply the Feds printing more money. The states are, correctly, concerned that they will be left holding the bag when the Feds stop kicking in. A little known fact about Medicaid, however, is that states are allowed to put liens on the assets and estates of those over the age of 55 who use it as a gap between losing the stipend for the health care exchanges and Medicare. That’s right. Low income people between 55 and 64 aren’t eligible for the stipend to cover the cost of buying health insurance. They have to use Medicaid and when they die, the states can, and probably will, come after their homes to recoup. It will be a tidy little industry in a few years. Just wait.
But don’t confuse Medicare and Medicaid. They are different programs that serve different populations and have different funding sources. The latter is primarily the problem of the states to fund with the Feds kicking in a pittance really though they have dug up money from somewhere (my guess is a printing press) to coerce the states into expansion.
Day after day the evidence keeps coming in:
Unless you have a very very specific and definite reason for wanting to be a U.S. citizen, in order to protect yourself and your family you MUST renounce!
U.S. citizenship will destroy any person who does not live in the United States (of course it will in the end destroy those who live in the United States too).
@YogaGirl ,
Medicare is truly for losers. They are paying doctors just a few dollars to see a medicare patient.
If you need this stuff then you have done a terrible job of retirement planning. My only worry is that medicare forces me to fill in a lot of forms when I get real treatment. I don’t want my insurance company hassling me to try and get back a few dollars for them with this rubbish. At 50 I already have had to fill in a few forms saying I am not eligible for this.
So I guess if this would be a real benefit to somebody I doubt America is going to miss them if they renounce.
With savings I don’t really expect to get any of the quarter million I have paid into SS and medicare (and that was from a few years back).
@Neil, I did not vote for him. Even those who did vote for him couldn’t have had any reason to know FATCA would be coming at them. They are betrayed twice, once by listening to Obama that he was going to “listen to the concerns of Americans abroad” Here: http://obama.3cdn.net/610c7f29ee85b124a3_3cm6bxltu.pdf
Medicare is not just for “losers” my sister works for a hospice in the U.S. as did my mother. Medicare and medicaid help paying for care for the dying so they can die with dignity in their own homes. Cuts are coming to those programs that supported hospice though so cheer up. “A poor job of retirement planning” Are you blaming the poor for being poor? You do realize that funds saved are quickly eaten up by doctor bills, nursing homes, and other costs. It doesn’t take long for all you’ve carefully saved to be emptied out. Sorry I’m not into blaming the poor for being poor and think to do so is cold and crass and hateful.
“I doubt America is going to miss them if they renounce” and that is a sorry and sad shame to America then. Most expats were representing the U.S. in a very positive manner in cities and towns across the world. The U.S. may think they do not value this though they have said otherwise in the past but, one day they will regret it. The renouncing to protect our families thing? It isn’t playing well in the foreign press and a country that once had advocates all over the world is losing those advocates. Families back in the U.S. are being damaged when their loved one is forced into a position to have to renounce. Those families will have a voice too. NONE of this has come out of the woodwork yet but, it will.
So long America, I hardly knew ye. And to think for decades I felt it my duty to politely counter and to show Americans are good people while living here. YOU’RE WELCOME.