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Is the author actually right to live and work in the US, and only fly back to Britain for getting medication subsidised by British taxpayers? And is the fact th

Is the author actually right to live and work in the US, and only fly back to Britain for getting medication subsidised by British taxpayers? And is the fact that he can do this just an indication of US healthcare being screwed? The post doesn't tell too much about facts and I don't know the British rules for eligibility to NHS, but I think it's possible he could be committing fraud. If he were doing the same with my country's national system, it certainly would be fraud (though it would probably not be possible in the first place, because we have a Big Brother that knows more than the British one).

mgkimsal 12y ago
From a moral standpoint, I'd say this person is in the right - they've paid in to the NHS at some point earlier, or their parents had - to cover this sort of thing. Legally, I don't know enough about the NHS to say for sure.
- k-mcgrady 12y ago
  >> "they've paid in to the NHS at some point earlier, or their parents had" Yeh, to cover them for the time they were paying. If you're no longer paying your taxes or seeking employment or unable to work due disability the money you paid in the past should't cover you morally. Edit: There's no doubt the price the writer has to pay in the US is a disgrace and if they couldn't afford it then I think using the NHS is a good temporary solution but the fact that he could afford it but uses that money for a holiday instead is very immoral imo.
  - droope 12y ago
    I know, we should take this person their medicine away, so they can have a wretched and miserable life! Healthcare should not be something you can or cannot afford, we should all be able to access healthcare. It is just common sense.
    - k-mcgrady 12y ago
      Huh? I didn't say that at all. This person CAN afford their medicine. Instead they spend that money on a trip to the UK to see family but also gets their medicine. Medicine they didn't contribute taxes to pay for.
  - mgkimsal 12y ago
    > Yeh, to cover them for the time they were paying So... what if someone is no longer paying anything in, living there, but is a huge net drain? Should people only be covered while they're able to pay premiums/taxes?
  - mgkimsal 12y ago
    He doesn't really indicate that he can afford it. min $500/month for 6 months is $3k. Trip to UK, staying with family, is far less than $3k.
- VLM 12y ago
  From a moral standpoint in the USA the international megacorp will say "Oh, your health is worth anything to you? Hmm. Howabout everything you got minus $1" Like a semi-kind mugger. Its not a free market. Pay up or die, sucka! In the UK the .gov will fight for you instead of the corporation so you pay a fair price. The UK gov is under no life and death pressure to pay up or die, and they have regulators who are educated and understand the market. It is a much free-er market than the USA market. Arguably what he's coughing up in hotel fees and surcharges and taxes and hotel prop tax is Exactly how a visitor should be paying for medical care, so on an individual level he's moral and ethical. Not getting screwed over when someone else gets screwed over does not imply some kind of survivors guilt is ethical.
  - ancap 12y ago
    >From a moral standpoint... From a moral standpoint it is immoral to force person A to pay for person B's misfortune. You and I call that stealing. >they have regulators who are educated and understand the market It is impossible to "understand the market" without market prices. >It is a much free-er market than the USA market The USA is not a free market. Anyone who claims otherwise is lying.
  - refurb 12y ago
    It is a much free-er market than the USA market Umm...no. The UK is a single payer system, that is, the government holds a monopoly over healthcare purchasing (or nearly all healthcare delivered). If a really skilled doctor wanted to charge a higher rate for their services, tough, he/she would get the same as every other doc. It's not a "freer" system.
    - DanBC 12y ago
      This is false. The UK has a national health service and private provision running side by side. Any doctor is free to work outside the NHS to provide private practice. Maybe you're thinking of Canada?
      - refurb 12y ago
- adwf 12y ago
  Not to mention that most young ex-pats do eventually come back to the country and contribute. I'd rather they came back alive and well, even if it is me footing the bill for them in the meantime. That's one of the big missing parts of the US healthcare debate. It's not just about immediate cost, it's about potential future tax revenue and economic value that you're losing when you let people die before their time.
jjoonathan 12y ago
Well the fact that drugs are twice as expensive (or more) in the US* and the fact that the US accounts for a huge chunk of government funding into the relevant sciences are part of the reason why drugs are so cheap overseas. British taxpayers buying drugs in Britain are effectively getting a subsidy from US taxpayers even though they don't pay into the pot, so this all seems like a stroke of cosmic justice where I'm standing. Of course, I doubt the British tax authorities care much about what I think. * Why? Remember how bargaining works: the biggest customer gets the best deal. First imagine Kaiser, Wellpoint, and Aetna sitting down at the bargaining table. Now imagine Canada sitting down at the table. Now imagine the European Union sitting down at the table. But at least our insurance companies are more efficient due to competition, right? Spoiler: not even close, and that's before you take into account the costs they offload onto the rest of the system in the form of incompatible claims policies, paperwork, and exploitation of information asymmetry against consumers.
- giarc 12y ago
  I don't know figures, but I imagine Kaiser represents more than 35 million people (the approx population of Canada). Shouldn't they be able to negotiate the same price?
  - refurb 12y ago
    Bingo! The largest US private insurer (United) cover 40M lives in the US. They pay higher prices than nearly all European countries (even the ones with smaller populations). Drugs aren't cheaper in places like the UK because the gov't negotiates lower prices. Drugs are cheaper because the gov't mandates lower prices. People shouldn't confuse the two.
    - zaroth 12y ago
      So is the UK not concerned about mandating lower prices and squeezing the R&D funnel for new drugs... because Americans are making up the difference?
      - 12y ago
sveiss 12y ago
The rules aren't written in a particularly clear way, but in general the idea is that NHS eligibility is residence-based, and people who aren't ordinarily resident are entitled to urgent treatment only. Flying back just to pick up prescriptions is definitely against the spirit of the rules. Enforcement -- or even understanding -- of the rules on a local level seems spotty. I've helped overseas visitors find their way through the NHS. Some GPs and out of hours services have treated them like a local patient and when asked about payment had no idea, whilst one GP pulled their wallet out in the consulting room and demanded cash there and then. Hospitals are supposed to be more consistent, but I haven't any experience there.
DanBC 12y ago
EDIT: strikeout [In my opinion it's fraud.] /strikeout http://www.nhs.uk/chq/pages/1086.aspx?categoryid=68 http://www.nhs.uk/chq/pages/1086.aspx?categoryid=68 http://www.nhs.uk/chq/pages/1087.aspx?categoryid=68&subcategoryid=162 http://www.nhs.uk/chq/pages/1087.aspx?categoryid=68&subcateg... But the rules are a bit complicated so maybe it's fine. It's weird that he gets a six month drop of medications each time -- that is very unusual behaviour from the prescribing doctor and the prescription-filling pharmacist.
- geographomics 12y ago
  It's not fraud. Such charges for overseas visitors only apply for hospital treatment - prescriptions are explicitly excluded, and are subject to the statutory price that everyone pays (unless they are exempt and get their medicine for free), see: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/210439/Overseas_Visitors_Charging_Review_2012_-_Summary_document.pdf https://www.gov.uk/government/uploads/system/uploads/attachm...
  - soneil 12y ago
    Thank you for finding that - a surprisingly readable source. Para 23+24 spell it out quite clearly, as does "Powers to charge those not ‘ordinarily resident’ were introduced through the NHS (Amendment) Act 1949, but were not enacted through regulations until 1982. These charges were and remain only applicable to hospital treatment." Really doesn't seem that complicated at all.

mgkimsal 12y ago

From a moral standpoint, I'd say this person is in the right - they've paid in to the NHS at some point earlier, or their parents had - to cover this sort of thing. Legally, I don't know enough about the NHS to say for sure.

k-mcgrady 12y ago
>> "they've paid in to the NHS at some point earlier, or their parents had" Yeh, to cover them for the time they were paying. If you're no longer paying your taxes or seeking employment or unable to work due disability the money you paid in the past should't cover you morally. Edit: There's no doubt the price the writer has to pay in the US is a disgrace and if they couldn't afford it then I think using the NHS is a good temporary solution but the fact that he could afford it but uses that money for a holiday instead is very immoral imo.
- droope 12y ago
  I know, we should take this person their medicine away, so they can have a wretched and miserable life! Healthcare should not be something you can or cannot afford, we should all be able to access healthcare. It is just common sense.
  - k-mcgrady 12y ago
    Huh? I didn't say that at all. This person CAN afford their medicine. Instead they spend that money on a trip to the UK to see family but also gets their medicine. Medicine they didn't contribute taxes to pay for.
- mgkimsal 12y ago
  > Yeh, to cover them for the time they were paying So... what if someone is no longer paying anything in, living there, but is a huge net drain? Should people only be covered while they're able to pay premiums/taxes?
- mgkimsal 12y ago
  He doesn't really indicate that he can afford it. min $500/month for 6 months is $3k. Trip to UK, staying with family, is far less than $3k.
VLM 12y ago
From a moral standpoint in the USA the international megacorp will say "Oh, your health is worth anything to you? Hmm. Howabout everything you got minus $1" Like a semi-kind mugger. Its not a free market. Pay up or die, sucka! In the UK the .gov will fight for you instead of the corporation so you pay a fair price. The UK gov is under no life and death pressure to pay up or die, and they have regulators who are educated and understand the market. It is a much free-er market than the USA market. Arguably what he's coughing up in hotel fees and surcharges and taxes and hotel prop tax is Exactly how a visitor should be paying for medical care, so on an individual level he's moral and ethical. Not getting screwed over when someone else gets screwed over does not imply some kind of survivors guilt is ethical.
- ancap 12y ago
  >From a moral standpoint... From a moral standpoint it is immoral to force person A to pay for person B's misfortune. You and I call that stealing. >they have regulators who are educated and understand the market It is impossible to "understand the market" without market prices. >It is a much free-er market than the USA market The USA is not a free market. Anyone who claims otherwise is lying.
- refurb 12y ago
  It is a much free-er market than the USA market Umm...no. The UK is a single payer system, that is, the government holds a monopoly over healthcare purchasing (or nearly all healthcare delivered). If a really skilled doctor wanted to charge a higher rate for their services, tough, he/she would get the same as every other doc. It's not a "freer" system.
  - DanBC 12y ago
    This is false. The UK has a national health service and private provision running side by side. Any doctor is free to work outside the NHS to provide private practice. Maybe you're thinking of Canada?
    - refurb 12y ago
adwf 12y ago
Not to mention that most young ex-pats do eventually come back to the country and contribute. I'd rather they came back alive and well, even if it is me footing the bill for them in the meantime. That's one of the big missing parts of the US healthcare debate. It's not just about immediate cost, it's about potential future tax revenue and economic value that you're losing when you let people die before their time.

jjoonathan 12y ago

Well the fact that drugs are twice as expensive (or more) in the US* and the fact that the US accounts for a huge chunk of government funding into the relevant sciences are part of the reason why drugs are so cheap overseas. British taxpayers buying drugs in Britain are effectively getting a subsidy from US taxpayers even though they don't pay into the pot, so this all seems like a stroke of cosmic justice where I'm standing. Of course, I doubt the British tax authorities care much about what I think. * Why? Remember how bargaining works: the biggest customer gets the best deal. First imagine Kaiser, Wellpoint, and Aetna sitting down at the bargaining table. Now imagine Canada sitting down at the table. Now imagine the European Union sitting down at the table. But at least our insurance companies are more efficient due to competition, right? Spoiler: not even close, and that's before you take into account the costs they offload onto the rest of the system in the form of incompatible claims policies, paperwork, and exploitation of information asymmetry against consumers.

giarc 12y ago
I don't know figures, but I imagine Kaiser represents more than 35 million people (the approx population of Canada). Shouldn't they be able to negotiate the same price?
- refurb 12y ago
  Bingo! The largest US private insurer (United) cover 40M lives in the US. They pay higher prices than nearly all European countries (even the ones with smaller populations). Drugs aren't cheaper in places like the UK because the gov't negotiates lower prices. Drugs are cheaper because the gov't mandates lower prices. People shouldn't confuse the two.
  - zaroth 12y ago
    So is the UK not concerned about mandating lower prices and squeezing the R&D funnel for new drugs... because Americans are making up the difference?
    - 12y ago

sveiss 12y ago

The rules aren't written in a particularly clear way, but in general the idea is that NHS eligibility is residence-based, and people who aren't ordinarily resident are entitled to urgent treatment only. Flying back just to pick up prescriptions is definitely against the spirit of the rules. Enforcement -- or even understanding -- of the rules on a local level seems spotty. I've helped overseas visitors find their way through the NHS. Some GPs and out of hours services have treated them like a local patient and when asked about payment had no idea, whilst one GP pulled their wallet out in the consulting room and demanded cash there and then. Hospitals are supposed to be more consistent, but I haven't any experience there.

DanBC 12y ago

EDIT: strikeout [In my opinion it's fraud.] /strikeout http://www.nhs.uk/chq/pages/1086.aspx?categoryid=68 http://www.nhs.uk/chq/pages/1086.aspx?categoryid=68 http://www.nhs.uk/chq/pages/1087.aspx?categoryid=68&subcategoryid=162 http://www.nhs.uk/chq/pages/1087.aspx?categoryid=68&subcateg... But the rules are a bit complicated so maybe it's fine. It's weird that he gets a six month drop of medications each time -- that is very unusual behaviour from the prescribing doctor and the prescription-filling pharmacist.

geographomics 12y ago
It's not fraud. Such charges for overseas visitors only apply for hospital treatment - prescriptions are explicitly excluded, and are subject to the statutory price that everyone pays (unless they are exempt and get their medicine for free), see: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/210439/Overseas_Visitors_Charging_Review_2012_-_Summary_document.pdf https://www.gov.uk/government/uploads/system/uploads/attachm...
- soneil 12y ago
  Thank you for finding that - a surprisingly readable source. Para 23+24 spell it out quite clearly, as does "Powers to charge those not ‘ordinarily resident’ were introduced through the NHS (Amendment) Act 1949, but were not enacted through regulations until 1982. These charges were and remain only applicable to hospital treatment." Really doesn't seem that complicated at all.