We've got a problem in the U.S. with so many people unable to afford good heath insurance. However, I shudder at the thought of a nationalized or any type of government managed health care system. I'm watching a show on the Discovery Health Channel tonight, one of those "real life E.R." type shows. A young girl has been brought in and the doctor determines that she has uterine cancer. The family's HMO refused a number of tests earlier, when the girl first started showing symptoms. Now she has to have her entire uterus removed, when early testing could have resulted in a much simpler treatment. So - the surgeon wants a CAT scan to precisely identify the location of the tumor - the HMO refuses. The doctor is furious, the family in tears, and the doctor decides the hell with it and orders the scan anyway, assuming that he or the hospital will just eat the cost. The CAT scan shows that the tumor has spread, and as he walks down the hall the doctor is so frustrated and furious that some "high school clerk" has determined this girl's treatment, and that because of that he has to tell the family that the cancer may now not be curable. All due to "managed" health care.
Managed health care, and nationalized health care systems, work really well if you're not seriously ill. But God help you if you have a serious problem. A very good friend of mine from grad school is in Canada - he loves the health care system when it comes to taking his kids to the doctor for the flu. But his father had a cardiac problem and was put on a waiting list for treatment - best guess is about a year. I've got a friend who is a doctor in Ann Arbor and he is constantly furious at having his treatment and diagnosis options dictated by statistics clerks at HMOs.
Just had to vent...
By Jeff Atwood (Wumpus) on Sunday, November 25, 2001 - 06:12 pm:
Capitalism doesn't work when it comes to health care, because the value of YOUR life is always infinite.
Eg, if you have some kind of cancer, you will pay any cost to have it cured. $80,000? $500,000? $1,000,000? It's worth it if you live, right? Because money isn't much good to you when you're dead.
By SiNNER 3001 on Sunday, November 25, 2001 - 06:25 pm:
"A very good friend of mine from grad school is in Canada - he loves the health care system when it comes to taking his kids to the doctor for the flu. But his father had a cardiac problem and was put on a waiting list for treatment - best guess is about a year."
Sounds fucking awesome to me. In this country, if you don't have health insurance, the waiting period for treating cardiac problems is ...literally fforever! You don't wait a year, you wait 'til you're dead or win the lottery. I'll take Canada's system any day.
By Kaiser Permanente Customer on Sunday, November 25, 2001 - 06:36 pm:
What is the alternative to either
1) HMO-style managed care, or
2) Nationalized government health care
By Jeff Lackey on Sunday, November 25, 2001 - 07:40 pm:
What's the alternative? I wish I knew - better yet, I wish the people who have the power to change the system knew.
Ideally, I suppose, some type of subsidized health insurance for those who need the help. Such that everyone had good insurance that did not have bean counters dictating treatment to doctors.
As for the comment that in this country, if you don't have insurance, you'll never get cardiac treatment - there are hospitals that treat those who can't afford to pay. But the system is far from perfect.
I find it hard to believe that a country as rich as the U.S. can't create and afford a system in which everyone gets high quality medical care, without the limitations of HMO's or the ridiculous parameters that were placed on the proposed national health care system from a few years back. I can afford good medical insurance - I want everyone in the country to have the same type of insurance I have, whether they can afford it or not. Unfortunately, both political parties are more interested (as usual) in political posturing than creating a quality solution. Bah.
By Jeff Atwood (Wumpus) on Sunday, November 25, 2001 - 07:42 pm:
What we need to do is push down this ridiculous overinflated value of our so-called "life". People need to be willing to die. Managed care plan pissing you off? Hospitals charging $200 for a bottle of asprin? You'll show them.. WHEN YOU'RE DEAD!
Or perhaps take the advice of your high school football coach and just "walk it off". This could be applied to a variety of health problems-- eczema, tuberculosis, yellow fever, AIDS, broken toes, etc.
But seriously. I'm sure as shootin' that capitalism is not going to handle health care effectively. I can't come up with a better system, though, so I guess we're just stuck with this imperfect weirdo insurance HMO system.
By Jason McCullough on Sunday, November 25, 2001 - 08:05 pm:
Clinton's plan was a horridly designed hybrid of single-payer and the current HMO system. If you're going to have a nationalized healthcare system, there's no reason to have private insurance companies involved at all; the only thing they can compete on is administration costs. Administration costs are 5% in Canada, where the government handles it, which implies there's little money to save. As it stunk, no one in the middle was willing to go to the mat for it, and we've been devolving to the current mess.
I'm starting to think there's no foreseeable solution in the current political climate. Conservatives have such a hammerlock on public debate that it's ludicrously difficult to turn the majority support out there for single-payer into legislation.
As to the waiting lists for expensive treatment and the like: the only thing I can think of is that those expensive treatments aren't worth it from a strict societal cost-benefit analysis. The US spends roughly double per-capita what Germany does on health-care, yet the average German had a life expectancy of 77 years in 1997, compared to 76.7 for the average US citizen in 1998. The obvious explanation to me is that we're wasting an absolutely ridiculous amount of money somewhere; the uninsured working poor and lower middle class going without antibiotics while the rich get experimental treatments seems like the obvious culprit. This assumes life-expectancy is the best indicator, of course.
Basically, if you're middle class you get to play the HMO crapshoot to stay alive; if you're rich, you pay for it out of pocket; otherwise, you die. The class-warfare components of the regressive US tax system pale in comparision.
Initiatives are popping up in the more liberal areas (WA, MA) for single-payer at the state level. It'll be interesting to see how it turns out.
By Dave Weinstein on Sunday, November 25, 2001 - 08:27 pm:
We have a very inefficient form of subsidized health care now.
We decided, as a matter of law, that emergency rooms can't turn people away because they can't pay. Certainly, most people would be horrified by the notions of the seriously ill or injured being turned away at the doors of the emergency room.
The cost of this is absorbed by those patients (and their insurance companies) who can pay.
The problem is that prevention and basic maintenance is far more cost-effective than treating preventable situations later.
By Met_K on Sunday, November 25, 2001 - 08:53 pm:
I've had upwards of seven ear surgeries my entire life.
Tubes in, tubes out, remove bone, replace bone, replace hole in ear drum x3.
The tubes in and tubes out, I'm not sure if the insurance paid for. But the remove bone/replace bone, they didn't want to pay for.
They called it a "cosmetic" surgery. Had I not had the bone replaced, the disease infecting it would have spread, and I would have eventually gone deaf. Eventually, it would have effected other areas on my sinus's.
Yet, the insurance companies called this cosmetic, all because they didn't want to pay for it. Why'd they end up paying for it? A very long talk to the vice president from a very mad doctor and parent. I was 8.
My hearing and my fate were being decided by a bunch of bean-counters who think that money is better than a major part of someone's life.
The insurance companies need to change their ways, or the government needs to charge them with something. I'm sure they could. If the politicians pocket's weren't so fat from bloodmoney from all these companies, I'm sure alot about the US would change.
But that's the saddest thing, we're the most free country in the world, but we're also the most manipulated.
By Jeff Lackey on Sunday, November 25, 2001 - 08:54 pm:
"Conservatives have such a hammerlock on public debate that it's ludicrously difficult to turn the majority support out there for single-payer into legislation."
Heh, I suppose it's always a matter of perspective. On many issues I'm pretty conservative, and from my POV the liberals controlling the debates in the Senate, trying to move towards a government-controls-the-medical-decisions type approach is the problem. Frankly, I think that the real problem is that, while there are certainly sincere, good folks on both sides of the aisle, by and large both liberals and conservatives are far more concerned, 24/7, with their side gaining power and getting re-elected than in actually sitting down with each other and deciding where the common ground is on improving the nation.
By Ben Sones (Felderin) on Sunday, November 25, 2001 - 09:02 pm:
"What's the alternative? I wish I knew"
One alternative that seems to work well enough is the way our health care system used to work. Doctors/hospitals would treat everyone that came to them, the people who could pay paid, the people who couldn't, didn't. The hospital would eat the cost and offset it by charging the paying patients more. Capitalism doesn't have to mean that everyone acts like an ass--sometimes things just work on their own.
The funny thing is, that's pretty much how our managed care systems still work, but now we've added an enormously costly beareaucratic overhead that makes the system unaffordable for everyone. The result is lower quality care at an inflated price. Gotta love progress.
By Sean Tudor on Sunday, November 25, 2001 - 09:20 pm:
In our country (Australia) we have the Medicare public health system. This covers most things except for elective surgery where you get placed on a waiting list. The other limitation with public health care are the limited numbers of hospital beds available.
We have a system where if you don't take out private health cover after 30 years old the rates become progressively higher with each passing year. Also if you don't pay for private health care the government will tax you this amount anyway come tax return time.
So people in this country are sort of forced to take out private health care whether they want to or not.
I am currently paying about AUD$70/mth (US$35) for private health care. How does this compare to the US ?
I notice companies in the US tend to pay for their employees health cover - we don't have such a thing here in Australia (or at least that I know of).
By Bub (Bub) on Sunday, November 25, 2001 - 09:27 pm:
"Everybody complains about the weather, but nobody does anything about it."
-Woodrow Wilson as quoted by Floyd the Barber
By Jason McCullough on Sunday, November 25, 2001 - 09:43 pm:
'Heh, I suppose it's always a matter of perspective. On many issues I'm pretty conservative, and from my POV the liberals controlling the debates in the Senate, trying to move towards a government-controls-the-medical-decisions type approach is the problem. Frankly, I think that the real problem is that, while there are certainly sincere, good folks on both sides of the aisle, by and large both liberals and conservatives are far more concerned, 24/7, with their side gaining power and getting re-elected than in actually sitting down with each other and deciding where the common ground is on improving the nation.'
Maybe it'd be more accurate to state that interest groups, somewhat conservative, have a more-or-less monopoly on public debate. Clinton was more or less shouted down by insurance-company funded advertising, although the GOP happened to agree with them on this issue.
As to the government making the medical decisions: I'd rather they do it than HMOs.
By Supertanker on Sunday, November 25, 2001 - 10:17 pm:
$35 a month? Time to emigrate. When I was single, I paid US$107/month for Kaiser, which is a managed health care organization. I now pay about $450/month for my family (wife & three kids) in Blue Cross HMO, and my employer only covers my portion of that, which is about $150/month as I recall.
Part of how I know the system is screwed up is how I see doctors acting. We've had four excellent doctors either leave medicine or dump HMO patients and go entirely to PPO or cash patients. One of them was the high-risk OB that delivered our kids. My insurance changed during the last pregnancy, and the new company assumed the costs, but would only pay $1600 on a $5500 bill. No wonder he bailed on HMO coverage.
By Sean Tudor on Sunday, November 25, 2001 - 10:56 pm:
Bloody hell - you Americans must have good wages !
I have just requested an online quote from one of our more popular private health funds for a family - Medibank Private.
They quote AUD$160/mth (US$80/mth) for a typical family with premium cover.
Why do Americans pay so much ?!
By Jeff Atwood (Wumpus) on Sunday, November 25, 2001 - 11:39 pm:
"My hearing and my fate were being decided by a bunch of bean-counters who think that money is better than a major part of someone's life."
Well, exactly. These are two concepts that just don't belong together. How much is hearing worth, anyway?
It's a shame, because capitalism works so well with refrigerators and televisions.
By Mark Asher on Monday, November 26, 2001 - 01:07 am:
This discussion strikes a chord with me because my family literally will not be issued health insurance by private firms -- no matter how much we are willing to pay, it's not there for us as a family.
Why? Because my oldest son, the strapping 6'3", 220 pound varsity high-school football/basketball player has diabetes. He's probably healthier than most of us reading this board because his diabetes is well under control and he runs, lifts weights, and practices or plays a sport every day - believe me, the kid's a granite statue - but private insurers will not offer us a family policy due to his diabetes.
So put me firmly in the camp in favor of some kind of nationaly health insurance option. People with health problems shouldn't be denied affordable insurance. This is just a cost we should bear as a nation, like national defense. Call it national health.
By Jeff Atwood (Wumpus) on Monday, November 26, 2001 - 01:41 am:
Oh yeah? Well I bet Jeff Lackey's son could kick your son's ass. He knows kung fu!
But seriously. So what do you guys do, Mark? Not having health insurance isn't really an option.
By Kaiser Permanente Customer on Monday, November 26, 2001 - 04:28 am:
My Kaiser bills have just been raised to $132/month. They were $87/month when I started four years ago. When I turn 30 in 3 years, they'll be $160 a month -- based on this year's rates. Which means by the time I actually turn 30, they will probably have risen to something like $190/month.
By Brian Rucker on Monday, November 26, 2001 - 08:14 am:
There's more to it in regards to beaurocratic overhead. Insurance companies are making money not only from consumers but the providers by making medical malpractice insurance an institution. Oftentimes the individuals managing insurance reciprocals, hospitals, retirement homes and the law firms that specialize in this field are joined at the hip making money hand over fist. Then there are the drug companies who spend more on advertising than research and have personal and professional ties to the above groups.
This isn't paranoia this is just some stuff I've observed first hand. It's taken for granted.
By Mark Asher on Monday, November 26, 2001 - 11:30 am:
"Oh yeah? Well I bet Jeff Lackey's son could kick your son's ass. He knows kung fu!"
Heh -- I don't think my son has ever been in a fight. He's always been one of the biggest boys in his class.
"But seriously. So what do you guys do, Mark? Not having health insurance isn't really an option."
Right now we're continuing my wife's coverage from her old job, paying it out of pocket. They have to offer it to us by law or something. I've talked to Blue Cross and others and they've all told me the same thing -- they won't offer my son health insurance. It really sucks. The only other option is that the state has some kind of plan for cases like ours, but it's prohibitively expensive from what I've been told.
By Jim Frazer on Monday, November 26, 2001 - 11:32 am:
The only true solution, IMHO, is non-profit hospitals. Back in the days when most hospitals were run by the church, they were able to claim tax exempt status. This lowered their costs significantly. Also, since they weren't a corporation out to make millions a year, they could afford to eat more of the costs of the uninsured.
Now-a-days, the system is feeding on itself. Drug companies need to make a profit. Hospitals need to make a profit. Insurance companies need to make a profit as well. Drug companies spend $4 billion on research to help you get an erection. Problem is, if it doesn't work, they spent $4 billion on nothing. So they bump the costs of their flu treatments and nontoxic tongue depressors. The hospital in the meantime is eating the cost of uninsured folks AND paying more for the basics from the drug companies. Thus, they start charging $8 for a toothpick knowing that the insured people with have an insurance company pay it all anyway. The insurance comapnies are now paying $150 for a flushot...so they charge higher premiums. Now, anyone who doesn't work for a major corporation can't afford the higher premiums. They drop their insurance, but still go to the emergency room. The hospitals bump their prices up to compensate for the new uninsured patients. Now the snake eats its own tail.
It's spiraling out of control. Real life example here: Before we got married, my wife had no insurance. She had a really bad runny nose for almost 2 weeks, so we went to my doctor. We had to mark her as self pay because, well, she was. The physicians assistant (wasn't even my doctor. He didn't have an appointment open for over 3 weeks) looked up her nose for 30 seconds, said "Yuck, bad sinus infection", and wrote a perscription. No lab cultures, no x-rays, nothing but a 15 cent plastic thing to look up her nose. We get the bill 2 weeks later; $167. I called them up and demanded to know what was going on. Turned out the bill for the PA's time and the examination was $47 with administrative costs of $120! I asked what kind of administative operation could possibly cost that much and her explination was that they had to start a new chart and put her information into the computer. I told her that was rediculous and she agreed, saying "But the HMOs pay all administrative costs. It helps us keep the cost of the actual examinations down".
Thank god we're married now and she's on my PPO. Only problem there is that the doctor can order whatever he wants, but the insurance can choose not to pay it. When we first discovered that I had a faulty heart valve, I thought I was having a heart attack. I went to the emergency room, got hooked up to a machine and monitored for an hour. They detected a problem but it wasn't a heart attack, so I had to go get a cardiac echo a few days later. Turned out I have a bad valve in my heart that lets blood leak back into my heart. I had been working out and was loaded with caffine, which exhaserbated the problem, causing me intense pain. My insurance company disputed the emergency room cost saying "Since it was just a bad valve and not life threatening, the emergency room visit wasn't necessary". I had to threaten to contact a laywer before they finally let me talk to someone where I could explain the order of events. Eventually, they paid.
Whew, babble on. Healthcare is just a major sticking point with me. I see insurance companies and hospitals as just one step up from the Mafia.
By Desslock on Monday, November 26, 2001 - 01:02 pm:
>Whew, babble on. Healthcare is just a major sticking point with me. I see insurance companies and hospitals as just one step up from the Mafia
It's a major sticking point with everyone, at least once they're affected by the system, because no one every choses to get sick, and it seems outrageous when there's a cost associated with treatment -- or you're forced to accept something worse than you could otherwise receive if you were in a different location or had more cash.
The Canadian system is in shambles -- horrific costs to the government (more than 35% of all money received by the government) and care that is often regarded as not good enough (long waiting lines for complex operations, very short hospital stays even for major surgery), and there's a significant "brain drain" to the U.S., since the pay doctors can receive is capped here. And it's an illusion to state that our system is "free", since we pay significantly higher taxes to pay for a system that doesn't provide as good care as is available in the U.S. (if you can afford it).
In spite of the fact that the Canadian system needs significant reform, I still prefer it, for the very reason I stated at the outset of this post-- no one chooses to get ill, and in those circumstances shouldn't have to make "cost/benefit" analyses just to determine whether or not to get treatment. No family should be bankrupted, or forced to watch someone suffer, simply because they have inadequate insurance (if it's even available). Paying for healthcare through the tax system means people how make more money pay more of the costs, but I think most people in higher income brackets would be fine accepting that burden if the system was rationalized and more efficient. But even under the current, flawed system, people can get treatment that's at least "pretty good" (not as good as the best treatment available in the U.S., but better than most other places in the world) and accessible.
Obviously if you're one of the persons who suffers because you can't get a treatment that is available in the U.S. you'd likely have a different perspective, but on the whole the Canadian system seems to benefit more people. The fact that the vast majority of Canadians support the system's retention (even while recognizing its flaws), provides some meaningful validation that it may be preferable to the perceived alternatives, including the U.S. system.
By Supertanker on Monday, November 26, 2001 - 02:04 pm:
The better care in the US is an illusion for most people. As I noted above, when doctors get a good enough reputation or have a practice in a wealthier area, they will dump HMO patients and go to PPO or self-pay. If you can afford the care, better care is available, but there are lots of folks who could use that care that must make do with what they can afford.
One of the more obvious examples in L.A. is the placement of County/USC Hospital and University Hospital. County/USC is the publicly funded hospital that serves a significant portion of L.A.'s indigent and poor population. It has all of the usual problems of insufficient staffing, funding, aging facilities, etc.. About 10 years ago, literally across the street, USC (and others?) built University Hospital. It is the super-expensive, private pay only hospital, with every "machine that goes bing" they need and world-class staff. It is where Arnold Schwartzenegger (sp?) had his heart surgery. I'm sure that County/USC has a pile of folks they could send over for some much-needed help, but it ain't happening.
By Met_K on Monday, November 26, 2001 - 02:37 pm:
A bit off-topic, but I've been kind of writing an on-going report for the last 5-6 years on why ancient Rome is better than the United States: Free health care.
Oh, and if I remember right, Canada has the highest taxes in the world. Something like 48%. I'm sure one of the Canadians here can verify that.
I tried immigrating to Canada this year. It's really kind of sad, because the only way you can get into Canada is if you're the only person on Earth who can seemingly do a job that the Canadian work-force needs. So after hearing numerous horror-stories (someone getting a head-injury in Vancouver from turbulance on a plain and having to wait 90 minutes for an ambulance) about the Canadian health-care system and the taxation, I almost was thankful I couldn't move there.
heh, I still want to move there tho. So you guys should definitely kick the Quebecers off your Parliament and kick that French Prime Minister you guys have out. No offense to any Quebecers. =)
By Jim Frazer on Monday, November 26, 2001 - 02:50 pm:
I went to Ontario for vacation in February and I can attest that the taxes are huge there. Not only is the income tax roughly equivilent to U.S. income taxes, but they also have something called the GST. It stands for Government Sales Tax (I believe). I'll have to check again, but the GST is pretty durn high. Add that to the Provincial Sales Tax and I have no idea how anyone in Canada can afford anything.
I can see having a consumption based tax system. As a matter of fact, I would prefer a national sales tax over national income tax. But adding income AND sales tax together = ouch.
By Mark Asher on Monday, November 26, 2001 - 02:57 pm:
"A bit off-topic, but I've been kind of writing an on-going report for the last 5-6 years on why ancient Rome is better than the United States: Free health care."
Thanks, but I'll pay a little bit extra to avoid doctors who use leeches. :)
By Mark Asher on Monday, November 26, 2001 - 03:08 pm:
The health care system needs reform, that's for sure. I'm not convinced that for-profit hospitals and insurers are the best system. Certainly in my case I'm discriminated against on the basis of cost analysis by the insurers.
What good is a health care system if it can say, "You're a risk to our bottom line. Therefore we'll exclude you."
By Jason Levine on Monday, November 26, 2001 - 03:37 pm:
No disagreement with Mark's last post, but just to note that the "for profit" or "not-for-profit" status of the hospital is not the problem. While there certainly are "for profit" hospitals in the U.S.--any hospital that is a member of the Humana system for example is a "for profit" hospital--most U.S. hospitals, including those owned by private instiutions, are not-for-profit. Familiar examples of not-for-profits would be hospitals owned by universities or religious institutions. That not-for-profit status has a big effect on the taxes paid by the institutions, and, of course, its accounting. It most certainly has no effect on the institution's need and/or desire to raise and collect money. Not-for-profits are every bit as money-driven as for-profits. It's a very safe bet that the super-exclusive private payer only hospital that Supertanker wrote about is a not-for-profit.
By Brett Todd on Monday, November 26, 2001 - 03:54 pm:
Canadian taxes are nothing in comparison with those in most, if not all, of Europe. Yeah, we've got the hated GST, but it doesn't apply to everything. And almost everyhing here is cheaper when the exchange is taken into account. Cars, for example, are almost always significantly cheaper in Canada. So much so that there's a huge business around exporting new cars here to US buyers. It's illegal, but I read a big story in the Toronto Star a couple of weeks ago on how common the practice is. Same sort of thing with houses, a lot of groceries, etc. What you'd pay a US buck for, we'd pay a CDN buck for, or maybe $1.10-1.20 on average.
By Brett Todd on Monday, November 26, 2001 - 03:55 pm:
"Canadian taxes are nothing in comparison with those in most, if not all, of Europe."
Sorry, forgot about Quebec. Stay the hell out of there. ;-)
By Jason McCullough on Monday, November 26, 2001 - 04:45 pm:
'The health care system needs reform, that's for sure. I'm not convinced that for-profit hospitals and insurers are the best system. Certainly in my case I'm discriminated against on the basis of cost analysis by the insurers.'
The thing that confuses me is why you can't get insurance for your son at *all*. You'd assume someone would at least quote you a price of a jillion dollars a month; it's not like diabetes is flagged in their computers as "the bankruptcy disease." Sheesh.
By Sean Tudor on Monday, November 26, 2001 - 04:48 pm:
I forgot to mention Australia's highest tax rate is 49%. Most of the population are sitting on 42%. What is the current US tax rate ?
By Jim Frazer on Monday, November 26, 2001 - 05:27 pm:
Not counting Social Security and Medicare, I'm at 31% (maybe 28% now after the new tax law). Add those in and I'm around 38.75% (or 35.75%).
25 - 31% (32 - 39%) are going to be your common middle class tax rates. Pretty sure we max out at 33% (41.75%) before the new tax code went in.
That's for national income tax. State income tax tacks a little more on that and some cities (like St. Louis) have a city income tax.
By Jason McCullough on Monday, November 26, 2001 - 05:38 pm:
Well, lessee. US median household income is $42,000. Of that, you'll pay about 15% in federal income taxes; 0-6% in state taxes; 7% social security + medicare tax; 7% social security tax on the employer's payroll (no difference economically from taxing the employee directly).
So, the tax on income for the median comes out to about 29-35%, with a 7% sales tax rate or so on top of that.
This leaves out some of the quirks of the tax system, though; the really, really poor with kids pay negative taxes to the government, and the really rich, although technically being in the federal 39.6% bracket, can normally shunt all their income into 20% federal long-term capital gains treatment, though the AMT increases that a bit.
In researching this, I found out I make enough to qualify for the alternative minimum tax. Stupid 1986 reform bill.
By Jason McCullough on Monday, November 26, 2001 - 05:39 pm:
'That's for national income tax. State income tax tacks a little more on that and some cities (like St. Louis) have a city income tax.'
You have *got* to be kidding me. It's 1%, but still. Does anyone actually pay this?
By Jim Frazer on Monday, November 26, 2001 - 06:12 pm:
"You have *got* to be kidding me. It's 1%, but still. Does anyone actually pay this?"
I live in Omaha, so I've never had to deal with a city income tax. Most of my family still lives around St. Louis, which is how I heard about their city tax system. My Dad used to live outside city limits but worked in St. Louis, so they took the city tax directly out of his paychecks. He's living inside the city limits now, so there is some kind of strange system for paying the taxes.
By Chris on Monday, November 26, 2001 - 06:41 pm:
Back to Healthcare for a bit, the US system will not change unless more young people get involved. Right now the majority of citizens concerened about healthcare are the elderly contigent. I'm 35 and 2 years ago I didn't much think about healthcare, that is until I had a recurring pain in one of my testicles. I figured out pretty quickly that it was cancer and a few tests confirmed it. Luckily, my HMO, Aetna, never balked at any of the tests or procedures and after a couple of operations and 4 months of chemotherapy I'm showing no signs of cancer, at least for now. I will have checkups for the rest of my life and under current law, I have to stick with HMOs as they can't deny me for prior ailments like a traditional health plan can.
Anyway, it brought home that anyone can have a major health issue in their life, I just had mine about 20 years before I figured I would.
Now of course I do wish there was a better healthcare system in place, one that would prevent the occurance that Jeff started this thread out with.
I do urge everyone to check things on a monthly basis, I was lucky enough to catch my cancer early, and was unlucky enough to have it spread. But catching it early prevented it from spreading too far and I had a rarer form of testicular cancer as it was. The doc was amazed I could feel pain at the stage it was, normally that doesn't happen. For you guys out there, it felt like I was being continually racked. Not a whole lot of fun.
Again, this was all under an HMO and I'm grateful that they never denied me anything while I realize that not everyone has that luxury. Even now my oncologist is dropping Aetna due to payment issues and I'm changing my HMO to keep him. The system does need to change.
Just take care of yourselves and maybe think about supporting changes now, not 20+ years from now.
By Desslock on Monday, November 26, 2001 - 06:54 pm:
>Canada has the highest taxes in the world
Not even close. Most of the European countries, other than Great Britain, have higher taxes than Canada. Relative to the U.S., however, Canadian tax rates are considerably higher (although the exact rates vary significantly depending upon where you live, since the provinces set a portion of the rates).
By Desslock on Monday, November 26, 2001 - 07:00 pm:
>I went to Ontario for vacation in February and I can attest that the taxes are huge there. Not only is the income tax roughly equivilent to U.S. income taxes,
>but they also have something called the GST. It stands for Government Sales Tax (I believe). I'll have to check again, but the GST is pretty durn high. Add that to the Provincial Sales Tax and I have no idea how anyone in Canada can afford anything.
"Goods and Services Tax". It's essentially a federal sales tax, of 7% on most goods and services. It replaced (and rationalized) the transparent manufacturer's tax, but unfortunately most manufacturers didn't pass on the savings. Provincial sales tax varies from 0% (in Alberta) to 8% in provinces such as Ontario. So in Ontario, you pay an additional 15% taxes on most goods and services, other than some stuff like basic food and drugs.
The provincial income taxes in some provinces such as Alberta are pretty low as well -- so in some parts of Canada, like that province, the cost of living (and taxes) are actually lower than in many parts of the U.S. (especially areas that impose city taxes, like NY). But it's definitely true that, in general, Canadians pay much higher taxes than U.s. residents.
By Desslock on Monday, November 26, 2001 - 07:03 pm:
>And almost everyhing here is cheaper when the exchange is taken into account. Cars, for example, are almost always significantly cheaper in Canada.
That's true, at least for a lot of consumer goods (including computer software), but it doesn't help Canadian residents, since we get paid in Canadian dollars. A GM employee in Detroit will get paid more than a GM employee in Oshawa, Ontario, and have more purchasing power notwithstanding the fact that consumer goods are cheaper in Oshawa.
By Desslock on Monday, November 26, 2001 - 07:21 pm:
>>Does anyone actually pay this
>so they took the city tax directly out of his paychecks.
City taxes are very real for people who live in New York, at least.
In terms of ranges of taxation, here's the situation in Canada:
You don't pay a set rate (which I think is the same in the U.S.), you pay a different rate depending upon which bracket that income fits in.
In other words, you pay 15% federal income tax on income up to $25,000, 21% on income between $25k-29K, etc. In Canada, rates have thankfully been going down over the past few years, but until this year you actually hit the "top income bracket" at a ridiculous $60k (around 40K U.S., meaning you were considered "rich" at that level, while Americans don't max out their "richest" tax level until over 200K U.S.). So you'd pay 29% federal income tax at any income above that, as a base rate -- then there are surtaxes and provincial income taxes and provincial surtaxes.
On top of that base rate, there are federal surtaxes of 3% and 5%, and provincial taxes that vary between almost nothing to almost 50% of the base federal rate (so an additional 14.5% of your income), plus there are provincial surtaxes as well. So if you're living in a larger city and have an income large enough to support more than yourself, you could pretty easily be paying over 50% of most of your income just in income taxes, plus sales tax of 15% on most purchases. Pretty ugly.
But those rates are coming down, and the surtaxes are being phased out. The average family probably pays around 25-35% income tax in total, plus 7-15% sales tax depending upon which Province they live in. Then there's UI (unemployment insurance) and the Canadian Pension Plan, which collectively cost about another $2k per year (capped regardless of income, although lower income individuals don't have to pay the entire amount).
By Tim Elhajj on Monday, November 26, 2001 - 07:57 pm:
"City taxes are very real for people who live in New York, at least."
And Yonkers! ;)
When I lived in NYC, I always got a kick out of seeing the state tax form included a place to collect local taxes for NYC *and* Yonkers residents. Assuming you're getting taxed at a higher rate because it's more desirable to live in some parts of the world than others, I always wondered why Yonkers made the cut.
By Met_K on Monday, November 26, 2001 - 08:45 pm:
>Canada has the highest taxes in the world
"Not even close. Most of the European countries, other than Great Britain, have higher taxes than Canada. Relative to the U.S., however, Canadian tax rates are considerably higher (although the exact rates vary significantly depending upon where you live, since the provinces set a portion of the rates)."
So tell me, why is it I've never heard a European person complain about their taxes?
I'm not doubting they're high, but as far as everything I've ever heard, Australia and Canada have the two highest tax rates in the entire world.
By Desslock on Monday, November 26, 2001 - 10:38 pm:
>why is it I've never heard a European person complain about their taxes?
How many have you listened to? To the extent they don't complain as much, it's because they don't have a comparative tax haven right next door. But Scandinavian celebrities frequently relocate to avoid their respective countries' punitive tax rates. Sweden's tax rates are particularly harsh.
...believe me, the Canadian government used to crank out those statistics all the time whenever they were trying to justify Cdn. taxes, by showing how relatively modest our tax rates are, relative to western countries other than the U.S. There's also a ton more social programs in those countries as well (state funded childcare, for one).
By Met_K on Monday, November 26, 2001 - 10:44 pm:
"How many have you listened to? To the extent they don't complain as much, it's because they don't have a comparative tax haven right next door. But Scandinavian celebrities frequently relocate to avoid their respective countries' punitive tax rates. Sweden's tax rates are particularly harsh."
I knew Sweden was particularly hard, since my sister lives there. She essentially thinks the country is the devil and that the Green Army are his minions.
And probably true, I thought about that as I was writing: North Americans and Aussies are also the biggest whiners on Earth. No wonder I've heard more from them.
"...believe me, the Canadian government used to crank out those statistics all the time whenever they were trying to justify Cdn. taxes, by showing how relatively modest our tax rates are, relative to western countries other than the U.S. There's also a ton more social programs in those countries as well (state funded childcare, for one)."
Another point I thought about bringing up was something you just did. =) Most of those countries have more programs than the U.S. and Canada do, well, at least social programs. Which would also be why the tax is so high.
I guess it's all relative.
By Sean Tudor on Monday, November 26, 2001 - 11:52 pm:
Well, lessee. US median household income is $42,000.
I'd expect the median housing cost in the US to be lower than that, actually, but I have no hard-core figures to quote.
We have a pretty good HMO. They'll pay anything prescribed by our doctor, though it occasionally requires a phone call. It's fairly cheap (to us) too, but that's due to the companies we work for.
Oh, and health care is always free in Tropico.
By Jason McCullough on Tuesday, November 27, 2001 - 12:41 am:
'In Canada, rates have thankfully been going down over the past few years, but until this year you actually hit the "top income bracket" at a ridiculous $60k (around 40K U.S., meaning you were considered "rich" at that level, while Americans don't max out their "richest" tax level until over 200K U.S.). So you'd pay 29% federal income tax at any income above that, as a base rate -- then there are surtaxes and provincial income taxes and provincial surtaxes.'
That's absurd; so pretty much every two worker family in the country is technically in the top bracket?
'Bloody hell ! You yanks are rich !'
The $42k is for a two-earner household, and it's a median, not an average. Adjusted for purchasing power and all that, the per-capita income for the US $36,000, compared to $23,000 for Australia, according to the 2000 CIA factbook. This doesn't show you the increased inequality of the US, though.
It's an amusing read. You're $200 richer per head than the mother country is, incidently.
By Mark Asher on Tuesday, November 27, 2001 - 02:19 am:
"You have *got* to be kidding me. It's 1%, but still. Does anyone actually pay this?"
You kind of have to. It's the law. I'm sure some dodge it, but they have ways of making you pay, like taking you to court.
It's also one percent right off the top before IRA deductions.
By Brett Todd on Tuesday, November 27, 2001 - 04:04 am:
"A GM employee in Detroit will get paid more than a GM employee in Oshawa, Ontario, and have more purchasing power notwithstanding the fact that consumer goods are cheaper in Oshawa."
You're gonna have to prove that one to me, Stefan. Can purchasing power really be accurately measured like that? Judging from what I've noted in this end of the province and in "my" part of upstate New York, I'd say that our purchasing power is greater here.
One other thing should be noted. While Canadian tax rates can kill the working stiff, depending on the province (Ontario good, Alberta great, Quebec bad, etc.), it isn't nearly as bad for the self-employed. With a good tax accountant/financial planner, you can reduce the tax you pay significantly here if you're self-employed. And legally, too, I might add. ;-) I've never done a direct comparison with the US, but we're definitely not as rigidly controlled here, and I believe that the system is more flexible with writeoffs.
By Fulopke on Tuesday, November 27, 2001 - 04:47 am:
In Hungary (in the middle of Europe) you are in the top income bracket with less than 10K USD and you pay 48% tax (including tax for public healthcare and things like that), plus, we have something like the GST in Canada that is 25% for pretty much everything except basic food and public transport.
And with that 10k USD income you are considered rich. Really.
Another thing: the software prices here are the same as in the US. That means software piracy is a big business here.
By Jason McCullough on Tuesday, November 27, 2001 - 05:36 am:
Man, Hungary grew 20% last year. Not bad.
'And with that 10k USD income you are considered rich. Really.'
Are you rich? What's food and rent cost?
By Desslock on Tuesday, November 27, 2001 - 12:09 pm:
>That's absurd; so pretty much every two worker family in the country is technically in the top bracket?
For a good chunk of their income, yes, since anything above 60K (40K U.S.) was taxed at the highest rate, which was 55% until a few years ago, including provincial income tax in Ontario. Fortunately, that's come down quite a bit, largely because of Provincial tax cuts, to around 45%.
Still high, but the federal govt also announced that for the coming year, the top bracket will be booted up to 100K (around 65K U.S.) -- still a far cry from the 200K+ top bracket in the U.S. (which is still a lower rate), but at least the income between 60-100 is now taxed at a slightly lower rate, the surtaxes of 8% are being phased out over the next five years (unless we decide to build a military again, heh).
Brett: re - tax write offs. What differences are there between Canada/U.S that affect freelancers/self-employed? In the U.S. they pay a punitive self-employed tax, I think - is that what you meant?
The other big tax advantage Americans have generally is the ability to write off the interest charges on house mortgages -- that makes it much, much easier to afford a house. We don't have that ability, and with the average house price in Toronto now going for almost U.S. $300k, ($440k Cdn.), it's pretty difficult to buy a house. Uh, apparently not as hard as in Sydney, however, heh.
By Jason Levine on Tuesday, November 27, 2001 - 01:18 pm:
"In the U.S. they pay a punitive self-employed tax, I think - is that what you meant?"
Yeah, the U.S. self-employment tax is meant to take the place of the Social Security (FICA) tax that employees pay. The difference is that for FICA the employer kicks in some and the employee kicks in some. The self-employed have to pay the whole thing and that's what makes it punitive. You do get to deduct half the self-employment tax from your income tax, but it's still a pretty good kick in the teeth.
One thing I found that helps is that you can put a certain percentage of your self-employment income (I think it's up to 15%, but I always use TurboTax to figure it out so I don't really remember :)) in a tax deductible IRA-type account called an SEP. And you can deduct that contribution from your taxes even if, like me, you have another employer who contributes to a retirement plan.
By Jim Frazer on Tuesday, November 27, 2001 - 01:33 pm:
Being self employed can be a tax boon, depending on your profession. My Mom runs a day care center out of her home. She brings in roughly $40k a year, but last year was able to write it down to $11k.
She is able to write off about anything in the house: electric bills, a new air conditioner, roofing repairs, food bills, carpet cleaning, and, thanks to the new laws, her health and home owners insurance.
FICA still bites her in the ass though. I believe she pays 15.5% towards it.
By Jason McCullough on Tuesday, November 27, 2001 - 01:49 pm:
'Yeah, the U.S. self-employment tax is meant to take the place of the Social Security (FICA) tax that employees pay. The difference is that for FICA the employer kicks in some and the employee kicks in some. The self-employed have to pay the whole thing and that's what makes it punitive. You do get to deduct half the self-employment tax from your income tax, but it's still a pretty good kick in the teeth.'
Technically, you also pay this tax in the form of a lower salary at a regular job; you just don't notice it.
By Fulopke on Wednesday, November 28, 2001 - 04:28 am:
Jason: I'm not considering myself rich but can make both ends meet.
OK, I bought a small car in January (10 years old) and bought an old (around 100 years old)house 35-40 miles from the city, so you can call me rich - I own a car and a house and i'm only 26 years old! Most hungarians just dream of an own house. (And half of my salary goes to the banks paying back the loans).
For food I spend around 100 USD per month, and renting a 30 square meter flat in the city starts from 140 USD. And my net income is 700 USD per month. But I live with my girlfriend who gets 110 USD per month (minimum wages).
So, what do you think? Am I rich?
By Fong on Wednesday, November 28, 2001 - 02:22 pm:
Give me money, mofo jet-set Eurotrash.
By Jason McCullough on Wednesday, November 28, 2001 - 05:21 pm:
Nah, you're middle-class.