The first thought that comes to mind regarding health care in France and the UK as portrayed in Sicko is "oh my God their income taxes must be outrageous!"
Michael Moore artfully dodges this in the movie, focusing instead on the standard of living, disposable income, and the like.
He might as well have laid it all out, though, because it's not nearly as bad as you might imagine. In fact, it's a pretty good deal.
Here's what I was able to figure out.
First of all, some examples of income taxes paid in the respective countries (all converted to US dollars):
| Income tax on $50,000 | |||
| US | Canada | UK | France |
| $6945 | $8144 | $8156 | $7915 |
| Income tax on $100,000 | |||
| US | Canada | UK | France |
| $19,965 | $20,347 | $22,773 | $23,899 |
So there's not that much difference, in the relative scheme of things.
Ironically, corporate tax rates are actually lower in France (33%) and the UK (28%) v. up to 39% but generally around 34% in the US. The capital gains tax in France is higher at 26% v. 15% in the U.S. Capital gains in the UK are taxed the same as income for individuals, with the first £8,800 exempt.
One thing that isn't made very clear in the movie is that the French system is a single-payer "universal health insurance" plan (as opposed to "socialized medicine"), much like if we opened up Medicare to everyone. Employers pay about 12% and employees pay about 1% for mandatory enrollment in "social security", which includes a retirement benefit plus universal health insurance that covers up to 70% of most medical costs (100% for maternity related costs). Supplemental insurance is available for another 8% to get virtually 100% coverage. Most of us pay about 15% for a retirement benefit (the wealthy only pay about 3% on much of their income) and limited medical coverage for those over the age of 65 and the disabled and the poor.
The UK has "universal health care", which means health care is provided and paid for by the government. It is funded by combination of employer/employee payroll taxes in a complicated calculation that, best I can figure, works out to about 13% of earnings over a certain amount. This provides retirement benefits and free universal health care for all.
So, our hypothetical employee who earns $50,000 per year would pay the following in income tax and "social security" payroll deductions (employee and employer combined).
| $50,000 income (USD) | |||
| US | France | UK | |
| Payroll Tax | $7500 | $10,500 | $5760 |
| Income Tax | $6945 | $7915 | $8156 |
| Total Taxes | $14,445 | $18,415 | $13,916 |
In this example, the French employee is paying the extra 8% in supplemental insurance so 100% of their medical care is covered. With the basic plan that covers 70% of their health care costs, the payroll tax would only be $6500, and their total taxes would be $14,415. And keep in mind that the US employee (and/or his/her employer) still has to pay for health insurance.
But then there's the Value Added Tax (VAT), similar to sales tax but not exactly. The VAT in France is 19.6% and 5.5% on groceries. In the UK it's 17.5% and zero on groceries (books, children's clothing, and several other categories are also exempt in the UK, and others are taxed at a reduced rate).
So, some example VAT/sales taxes would be:
| VAT, $200 worth of groceries | ||
| Tennessee | France | UK |
| $18.50 | $11 | $0 |
| VAT, $300 worth of children's clothing | ||
| Tennessee | France | UK |
| $27.75 | $58.80 | $0 |
| VAT, $500 TV | ||
| Tennessee | France | UK |
| $46.25 | $98 | $87.50 |
It's more complicated than this because VAT is included in the price and it's hard to understand how it's all calculated from manufacturer to consumer. Sales taxes in Canada range from 6% (Alberta) to 16.6% (Prince Edward Island) depending on the province. It's 14% in Ontario.
Going back to the previous example of combined employer and employee income and "social security" taxes, here's the same example with only the employee's portion, i.e. take-home pay after payroll deductions:
| Take-home pay, $50,000 income (USD) | |||
| US | France | UK | |
| Payroll Tax | $3750 | $4500 | $4352 |
| Income Tax | $6945 | $7915 | $8156 |
| Take-home | $39,305 | $37,585 | $37,492 |
So the British and the French take home a little less and pay a little more in VAT, but their health care is fully covered (the French employee is still paying the 8% for 100% coverage). The American employee still has to pay for health insurance (anywhere from $600 to $3000 per year in payroll deductions depending on the type of policy and company size), and most also pay additional state and local income taxes (for example, approx. $2500 in Georgia, $3000 in North Carolina, or $3900 in NYC).
So, yes, providing universal insurance coverage or universal health care for everyone would cost a little more in taxes, but not that much more. And think of the savings, not to mention peace of mind and security. It seems pretty clear that it would be a better deal than the $2 trillion we spend now that leaves nearly 50 million people behind and gives false hope to the other 250 million who think they are insured until they file a claim.
NOTE: Feel free to factcheck and correct any of this. It's all pretty complicated and this is the simplified version. It's hard to dig up some of this info, so any help is appreciated. It seems like this is a "myth" that needs to be debunked.
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Very interesting! I
Very interesting!
I pay:
3.5% for insurance (not including dental, eye care, prescription drugs)
15.3% for Social Security and Medicare
----
18.8%
6.25% for deductible and co-pay (if got sick)
----
25.05%
This doesn't include income taxes (state and federal) or sales taxes.
This is an excellent
This is an excellent comparison, Randy; I just thought of a couple of (minor) points to add:
In the UK, the NHS system isn't the only health care provider; private hospitals, private doctors, and private health insurance also exist, but they represent a much smaller slice of the total pie compared to NHS. Private hospitals have become more common in recent years to take on some of the overflow from NHS.
Other taxes exist in Europe which either don't exist here at all (like France's "wealth tax") or which are much lower here (like the gas tax). However, these taxes don't amount to very much either as a percentage of total government revenue or as a part of the average Joe's overall tax burden.
--Socialist With A Gold Card
"I'm a socialist with a gold card. I firmly believe we need a revolution; I'm just concerned that I won't be able to get good moisturizer afterwards." -- Brett Butler
health care
This is a great explanation. Its too bad that the politicians can't lay it out this way instead of talking in sound bites. I'd like to see what the Canadians do. I've heard people complain about waits on surgery in Canada, but then they seemed shocked that in the U.S. the surgery might not be possible or might bankrupt you. You hear alot that the U.S. spends more than any industrialized nation on health care but we have the worst health. I figure its because that money goes to emergency care for people who haven't had preventative care. I've also read that vitamins and herbs over big pharma are more heavily promoted in Europe than here.
Thanks
for taking the time to work this out.
SC
Thanks for the diligence in
Thanks for the diligence in working the figures. The numbers represent a huge chunk of income for those who only work in order to have the 3 BMWs and a flat screen TV in every room of his/her 8 bedroom home. If we can bring the American mentality to be happy with the 1 Audi and $1 million dollar home we might be able to work health care for everyone. How do we encourage our government and doctors to do the "right thing?"
Thanks so much for the treat
Thanks so much for the treat of going out to a movie!
Thanks even more for the information breakdown/lay-out.
Even if there are inadvertent mistakes the fact is other countries are doing a better job of caring for their most valuable resource, people. We hear tales of how over burdened other countries are in taxes, but we never take a real look at how we are taxed.
Perhaps the biggest difference in the value of the tax monies spent.
Trying to not make matters worse.
This may be a stupid question
This may be a stupid question but are health insurance premiums included in the cost of health care?
Excellent analysis
This is a great presentation of the facts and figures. When thinking about govt.-funded healthcare, some folks forget to deduct their present healthcare costs since many of these are hidden in payroll deductions. So I think it's important to always remind them that the govt. program they will fund in taxes are more than negated by not having any more premiums, deductibles, or those huge monthly deductions that happen even before they get their paycheck.
Great analysis, Randy.
Great analysis, Randy. "Eleanor" and I were just discussing this. Some things the numbers you provided don't reflect:
1. These numbers don't even take into account that the "higher" European tax rates don't cover medical coverage alone in Europe, but also cover things such as college tuition. The "bang-for-the-buck" is much greater.
2. Considering that almost no American employer now pays the full cost of medical insurance for American workers, the average out-of-pocket expense (as Bizzgirl notes) makes the American cost much higher than the European model. Add into this the fact that most American medical plans charge extra for dental and vision care whereas the European systems make no distinction between these items. While their erectile dysfunction pills may be covered under the basic plan, their teeth and eyes are still luxury items for the American worker.
3. The peace of mind factor, as "Eleanor" states, is a huge variable. What is the financial value of peace of mind for workers who don't have to worry they can't manage an elderly parents medical expenses or afford to take their child to a doctor until it's time for an emergency room visit. I would include the peace of mind of the removal of a great amount of debt worry from the average American's mind.
Keeping in mind that the above systems seem to tax proportionately to the wealth (attained or earned) of the taxpayer, I think we can see who is most likely to oppose this plan.
The information you have charted out above can go a long way toward emphasizing one of Moore's points to the "average" American: We are paying a butt-load of a money now into a system that offers little or no guarantees of coverage or care or only offers some sort of deferred payout (coverage after the age of 65, etc.). In short, we're paying almost all of our investments into a service we may never see or use. Whereas smaller, less wealthy nations have figured out how to better invest their money into a system that provides guarantees for immediate use and deferred needs.
Americans have learned to expect less for more. They have come to somehow feel it is their "right" and "privilege" as an American citizen to receive less care and coverage than their European counterparts.
Researching continues
Since seeing the movie and attending the discussion afterward, I have been trying to sort it all out. Here is my original posting several weeks ago . I get very bogged down by the details because I see so many sides to the issues including my personal healthcare tribulations and that of my mother before she died.
While I continue to research and compose something more elaborate, I want to mention some nuances with the current Medicare program. IMO it is a very cumbersome program that would need a major overhaul before expanding it.
For a senior using Medicare, they currently have money deducted from their Social Security (around $100/mo I think)to pay for Part B (physician services). If they are on the "original" plan, they pay a $131 annual deductible and 20% of physician charges. For a hospital stay, their copay is $992 for each admission. If they stay over 60 days it gets real expensive ($248-496/day!!). Many have opted to the Medicare HMO, and that costs them roughly $100/mo, plus a $10-30 copay for MD visits, and $500+ for a hospital admission (these are heavily managed to limit admissions and hospital days).
I still am working on the numbers for the prescription drug package. I went through the analysis for my mother-in-law last year and will have to refresh my memory. She is not on many drugs (3-4 only) and has already hit the "hole" this year and is not covered anymore. Her plan was better with the HMO pharmacy benefit than with the new one that Bush gave us.
Another point I want to emphasize is that it will be the employers that want to compete more effectively in the global market that will have to drive a change in healthcare financing. Whether it is the pessimist or pragmatist in me, I do not think the vast majority of Americans will accept a change must less insist and fight for one. The lobbies for the pharmaceutical companies, hospitals, insurance carriers, and physicians are too strong with rented politicians and advertising money they can use to scare the public in order to keep the status quo.
At least Michael Moore has opened the door for discussion and has inspired me to at least try to dissect the pieces of the current system and consider how to affect change.
(My numbers were from the Medicare and Humana websites and may not be exact.)