Re: Latest Health care Entitlement discussion

[Sprogster]

Krusty and Cat,

I believe that other EU countries reimburse the French government for the health costs incurred by their countries "inactifs" resident in France, without time limitation. This is the crux of the issue and maybe a point on which Brits should be lobbying their own government?

[makfai]

[quote user="cheminot"]Sorry Makfai I'm not sure what you mean. Could you elaborate please? cheminot[/quote]

Sorry I didn't want to duplicate the discussion on that topic here but if it will help. 

The issue being discussed there is that part of the Embassy's reply which says:

However, the French Ministry of Health has assured us that the provision of healthcare to people already resident in France and subscribed through the French system will not be affected.

as compared/contrasted with para 3 of the French statement which says

3) Pour les personnes inactives qui bénéficiaient déjà de la CMU du fait de la réglementation antérieure, il leur est accordé un délai pour 6 mois, pour s'affilier à une assurance privée. Pendant cette période, ils continueront à être couverts par la CMU.

 

The issue here seems to be whether the phrase:  'les personnes inactives qui bénéficiaient déjà de la CMU du fait de la réglementation antérieure,' applies only to 'inactive' existing residents still on an E106 (in which case the Embassy's statement makes sense) or whether it applies to all 'inactive' existing residents (in which case the Embassy's statement seems incompatible).

[KathyF]

[quote user="krusty"] 

The heading of this announcement mentions "britanniques inactifs" are there no german , dutch or other `inactifs` ?

[/quote]

Apparently, according to something quoted on the TF forum, other European govenments pay the health costs of their citizens living elsewhere in the EU.  Only Britain limits health provision to those actually living in Britain, except for the cover provided by the E forms.

 

[makfai]

[quote user="KathyF"][quote user="krusty"] 

The heading of this announcement mentions "britanniques inactifs" are there no german , dutch or other `inactifs` ?

[/quote]

Apparently, according to something quoted on the TF forum, other European govenments pay the health costs of their citizens living elsewhere in the EU.  Only Britain limits health provision to those actually living in Britain, except for the cover provided by the E forms.

 

[/quote]

The post you are referring to is, I think, this http://www.totalfrance.com/france/forum/viewtopic.php?t=33174&postdays=0&postorder=asc&&start=120

I must say that this puts a different slant on things for me as I did not know that Britain had a different arrangement to that of others.  As this seems to be important to the broader issue I have copied the info to here for others to read.

BÉNÉFICIAIRES DE LA COUVERTURE MALADIE UNIVERSELLE

Jean-Yves Cousin, Député du Calvados



La loi de juillet 1999 et ses décrets d’application ont créé une couverture maladie universelle pour toutes les personnes qui résident en France. Celle-ci comporte deux niveaux de prise en charge : l’assurance maladie de base - avec une affiliation au régime de base - et la complémentaire gratuite. La première est ouverte à tout résident en situation stable et régulière ne disposant pas de droits ouverts à l’assurance maladie. Elle concerne les personnes en situation d’exclusion, mais aussi celles qui sont momentanément ou durablement dépourvues de droits.

La complémentaire gratuite est ouverte à tout résident stable dont les ressources sont inférieures à un seuil qui est fixé par décret. Elle s’adresse, au nom de la solidarité nationale, aux personnes les plus défavorisées.

Pourquoi des étrangers qui perçoivent des revenus dans leur pays - je pense aux résidents britanniques, nombreux en Normandie - bénéficient-ils de la couverture maladie universelle ?

Catherine Vautrin, Secrétaire d’Etat aux personnes âgées

L’affiliation à un régime de base d’assurance maladie est obligatoire pour tous les résidents, y compris ceux que vous mentionnez. Les personnes qui n’ont pas d’autre protection sociale ont donc l’obligation de s’affilier à la CMU.

Cette affiliation est gratuite en-dessous d’un seuil de revenu fixé à 6 849 € par an pour une personne seule. Au-delà, elle donne lieu à cotisation à hauteur de 8 % des revenus.

Pour bénéficier de la CMU, il faut justifier d’au moins trois mois de résidence sur le territoire français.

Pour les citoyens de nos partenaires européens qui viennent résider en France, la couverture maladie est assurée par la CNAMTS pour le compte de leur caisse nationale, à l’exception des Britanniques. En effet, l’assurance maladie en Grande-Bretagne est territoriale. Un Britannique résidant en Angleterre - tout comme un Français résidant en Grande-Bretagne et justifiant de sa citoyenneté européenne - bénéficie d’une couverture maladie de base gratuite. Mais les Britanniques résidant en France ne bénéficient plus de leur couverture nationale, et doivent donc s’affilier à la CMU lorsqu’ils ne disposent pas d’autre protection sociale.

La question qui se pose est celle de la cotisation et du montant des revenus, sachant qu’il peut y avoir des difficultés à vérifier des revenus perçus à l’étranger. Les caisses primaires d’assurance maladie vérifient les déclarations de ressources des demandeurs. Lorsqu’un faisceau d’indices donne à penser que le demandeur pourrait bénéficier de revenus non déclarés hors du territoire national, elles diffèrent l’ouverture des droits et demandent des pièces justificatives.

Jean-Yves Cousin, Député du Calvados

Je vous remercie de cette réponse. Je souhaite que les caisses primaires s’attachent à vérifier soigneusement les revenus des demandeurs.


Groupe UMP de l’Assemblée nationale© 2004 • Mentions légales • Plan du site • Admin

[Jazzer]

Two thoughts strike me this morning

1. A legal challenge is expected-who is going to do this. The British government? I doubt it. If such a chalange is made would we be allowed to stay pending the result?

2. There seems to be an implication that it will be a condition of residence that you are covered by private health insurance. If you are unable to obtain such insurance, will there be an exodus? Has anyone an idea of what  the range ofpre- exisitng health problems may be, over here.

[krusty]

[quote user="Sprogster"]

Krusty and Cat,

I believe that other EU countries reimburse the French government for the health costs incurred by their countries "inactifs" resident in France, without time limitation. This is the crux of the issue and maybe a point on which Brits should be lobbying their own government?

[/quote]

It would be interesting to see this confirmed in b&w ,the fact that other countries reimburse.

But it may not be a valid argument with the British government "they do it ,so we must do it"

What it needed is an EU law.

Just my thoughts [I]

[Cat]

My reading, and translation of the text a few posts above yours is ...

For the citizens of our European partners who come to reside in France, health cover is insured through the CNAMTS by their own national health service, except for the British. In effect, health insurance in Great Britain is territorial. A British person residing in England - just as a French person residing in Great Britain and justifying his/her European citizenship - profits from  basic free health cover. But British people residing in France can no longer profit from their national cover, and must thus affiliate themselves with the CMU when they do not have any other social protection.

You might also like to read this http://www.europarl.europa.eu/hearings/20070124/imco2/bernitz_en.pdf

It could be said that it is not France, or the decision to withdraw health coverage, that is at fault, but rather the British health service.

It's 8 pages, but in a nutshell, discusses the right of all EU citizens to cross-border health care, presented at the European Parliament committee meeting in January this year. For those without Adobe, I have copied some of it, and highlighted the most interesting/relevant parts.

Paper prepared for the European Parliament Committee Meeting on Cross-Boarder

Aspects of the Health Services Jan 24, 2007

 

1. The Right to Health Care in Europe

We are currently witnessing the emergence of a EU-based health policy, in some sense

one could even speak of a Europeanization process. This development has been initiated

by the European Court of Justice, which in several rulings has interpreted health care as

an area subject to the principles of free movement of services within the internal market.1

The practical application of the right to health care in other parts of the Union is primarily

the fruit of the independent and somewhat integrationist interpretation of the provisions

of the EC Treaty by the Court. Without prior authorization, EU citizens are now entitled

to seek non-institutional care, including out-patient care and dental care, both on an

emergency and non-emergency basis, in all Member States and thereafter claim

reimbursement for health care expenses from their home country. The exception to this

rule is so-called unnecessary care, e.g. beauty operations.

1 Please see the following cases in particular: Case C-120/95 (Decker v Caisse de Maladie des Employes

Prives), Case C-158/96 (Kohll v Union des Caisses de Maladie), Case C-157/99 (Smits and Peerboms),

Case C-385/99 (Müller- Fauré and van Riet), Case C-372/04 (Watts).

2

When it comes to treatment of patients admitted to hospital, the issue is somewhat more

complicated. Generally speaking, patients must obtain prior authorisation from their

insurance scheme to be entitled to reimbursement for hospital treatment in other Member

States. However, according to the case law of the European Court of Justice, treatment in

another Member State may only be refused if the same or equally effective treatment can

be obtained in the patient´s own country without undue delay. The concept “undue delay”

is a legal concept interpreted by the Court, as has been done in, e.g., the Watts case. The

concept is related to the seriousness of the illness and the urgency of the treatment, i.e., as

underlined by the European Court in the Watts case, it is interpreted in the light of the

needs of the individual patient, not timetables or waiting lists drawn up by national health

authorities.

This development has been opposed by the U.K. and some other Member States, among

them, until recently, Sweden. They have argued before the European Court that crossnational

health care (particularly hospital care) would make financial control impossible

and lead to an impairment of national control, planning and organisation, which in turn

could cause a threat to the basis of universal health care access. The UK Government has

argued that the NHS would not be covered by the EC Treaty provisions on services at all,

since the NHS is a non-profit-making body (i.a., in the Müller-Fauré case, decided in

2003 and the Watts case, decided in 2006). However, according to the Court´s

understanding of European law, medical care is a service by definition and a right for the

individual. Exemptions from the fundamental EU principle of free movement should be

admitted only if objectively necessary and only to the extent the same result cannot be

achieved by less restrictive rules. The European Court has not accepted broadly

formulated arguments brought forward by the British Government about detrimental

effects on the management of the NHS and, in particular, the risk that payment for

medical treatment in other Member States would threaten the financial balance of the

NHS system. The decision by the European Court in the Watts case should have put an

end to this line of reasoning.

(.....snip......)

So far, there seems to have been too much focus on the particular issue of reimbursement

of costs and we have seen different efforts and proposals to curtail the right to health care

in other Member States as laid down by the European Court. It should be underlined that

the right to health care in other Member States is based directly on the EC Treaty, thus it

is primary law. It cannot be legally restricted either by secondary EC legislation

(regulations or directives) or by national legislation in the Member States. On this point,

there seems to exist much misunderstanding of the legal position under Community law.

If further clarification of the application of the law in borderline cases is considered

needed, the best way to get such clarification would be to refer additional cases from the

national courts to the European Court for preliminary ruling. However, what seems

important is not primarily detailed legislation but clarifying and easily accessible

information about patients´ rights to health care in other Member States.

 

 

[cooperlola]

[quote user="KathyF"][quote user="krusty"] 

The heading of this announcement mentions "britanniques inactifs" are there no german , dutch or other `inactifs` ?

[/quote]

Apparently, according to something quoted on the TF forum, other European govenments pay the health costs of their citizens living elsewhere in the EU.  Only Britain limits health provision to those actually living in Britain, except for the cover provided by the E forms.

 

[/quote]I have made this point before, elsewhere.  I can accept the French government's reluctance to continue to cover the costs of the healthcare of those who can afford to stop work before many of their compatriates.

However, if I and my o/h had taken early retirement and remained in the UK (which was perfectly possible) we would have benefitted from free NHS care - from the time we stopped working until our deaths - with no gap between the 2 years after we retired and the reaching of state retirement age.  We have also paid the full 30 years of NI contributions now required for all UK citizens. It seems to me that an extension by our own government (whom we still vote for, by right) of the E106s, is what is required.  We may not live there but most of us have paid contributions which we expected would last us a lifetime.

The fact that our Embassy is incapable of giving us consise and unconflicting information about what is going on, only rubs salt into an already open wound.

[Quillan]

I was under the impression that there is EU legislation about this and that France has sort of 'ignored' it for a while and have now got round to implementing it. France first discussed it and created draught directives last year and it is being implemented this year. It's not exactly been sneaked in without people knowing.

I think you will find that 'technically' the UK already has made the legislation law and I quote from the Home Office website.:

Do I have a right to live in the United Kingdom?

European Community law gives EEA nationals a right to live and work in the United Kingdom. This is known as a right of residence and you have a right of residence if you are exercising Treaty rights in the United Kingdom. Treaty rights include: employment, self-employment, study or economic self-sufficiency, i.e. you have sufficient funds to support yourself without recourse to public funds (including Income Support, Housing Benefit and Council Tax benefit).

Do I need to show my passport or national identity card when I enter the United Kingdom?

Yes, you need to show your passport or national identity card when you enter the United Kingdom. When you arrive at major ports and airports you should use the separate channel marked 'EEA/EU' where it is available. Immigration officers will check your passport or national identity card to make sure that it is valid and belongs to you.

Can be found at ( http://www.ind.homeoffice.gov.uk/applying/eeaeunationals )

This begs two questions.

Firstly does the UK actually implement this law?

Secondly, and for this thread, you can see that there is no mention of health.

I phone these people and asked about health cover. I was told, after quoting the above, that it was an interesting point and was placed on hold for 10 minutes (nice music by the way) while the lady went to check and the answer was "Its up to the local health authority but you might want to check with Dept of Pensions and Works".

So phoned the DPW who can only give answers if the person has a European health card, E106 or E121. I told them that my imaginary person had none of these but was French so they gave me the number of the National Health payment centre who could answer my question. Obviously nobody ever phones up about paying for health services in the UK as I got through in under 30 seconds and this is what I was told "There is no waiting period (I asked if there was one before they could register), they should register with a GP straight away and they would received free treatment if they were from an EU country".

So it would appear if you are an EU national and turn up in the UK with just a passport (or national ID card) you are treated the same way as a UK national. Us Brits living in France are dealt with quite differently it would seem.

I seem to remember that there are around 800,000 French people living and working in the south of England and in total there are around 1.2M of them in the UK. Personally I only ever met one when I lived and worked there but there you go. Two of my neighbours children now work in the UK (Brighton) because they can't get work in France, this is factual information.

The reason I have said the above is because it seems to back up my personal theory that most French go to the UK (and other EU states) for work and then return to France after 5 or 10 years and are not a burden on the system. The English (British if you prefer) are, in general, at the other end of the age group being that they come here to 'retire', many taking early retirement and are under state pension age hence no E121 or E106 (or the latter runs out after 2 years). The people doing the latter often put little or nothing in to the French system (in comparison to French workers) but expect support (typically in the form of health care) from it.

The French immigrants being younger and wanting to work, save money, then return to France are paying as they go via the tax and NI that are levied on their wages so the meet the criteria stated in the above quote which is probably why nobody ever says anything about them.

I keep seeing the mention of 30th September as if it were some magical date specifically. It is usually the same date every year when CPAM offices send out letters telling people if they are going to get cover for the forthcoming year. This has happened every year we have been here, we fill in the forms from CPAM and attach copies of the requested information, return it typically by the end of the first two weeks of September then wait for the letter to come back saying yes or no. For us it has always said yes in the past, what it will say this year I don't know, we will see.

It does seem a little unfair that French (and other EU) nationals appear to get free health care in the UK yet in other EU countries the Brits are expected to pay in before they get something out. We need an even playing field one way or the other, either we all pay or we all don't. The French probably think we are stupid and that we should do the same as them and make people pay.

Sorry it's a bit disjointed but I'm in a hurry.

[cooperlola]

Ergo, as I am a UK citizen and by default an EU citizen, I can quite legitimately nip back to the UK if I need medical treatment. Which seems to be what most people who live in Spain, and were similarly affected, do.

[Quillan]

[quote user="cooperlola"]Ergo, as I am a UK citizen and by default an EU citizen, I can quite legitimately nip back to the UK if I need medical treatment. Which seems to be what most people who live in Spain, and were similarly affected, do.[/quote]

Ah but then we hear stories (was it not in the UK news a couple of years back) about Ex-pats doing this and getting charged £35 just to see a doctor in the UK. I guess, like normal, we Brits just lay on our back, put our arms and legs in the air, pay up (smiling at the same time) just like normal [:D] .

[cooperlola]

[quote user="Quillan"]

[quote user="cooperlola"]Ergo, as I am a UK citizen and by default an EU citizen, I can quite legitimately nip back to the UK if I need medical treatment. Which seems to be what most people who live in Spain, and were similarly affected, do.[/quote]

Ah but then we hear stories (was it not in the UK news a couple of years back) about Ex-pats doing this and getting charged £35 just to see a doctor in the UK.

[/quote]And based on the statement which you got, Q, I hope they're demanding a refund.[Www]

[Will]

So it would appear if you are an EU national and turn up in the UK with just a passport (or national ID card) you are treated the same way as a UK national.

Ergo, as I am a UK citizen and by default an EU citizen, I can quite legitimately nip back to the UK if I need medical treatment.

Not so. Both the above are popular misconceptions, and it is true that a lot of hospitals and practices will treat you anyway if you fall ill or have an accident (but may apply the rules more strictly for non-urgent cases).

The right to free treatment under the NHS applies only to those who are ordinarily resident in Britain - regardless of their country of origin or whether they have paid NI contributions in their previous life. With a few exceptions, those who normally reside in other European countries can get the same treatment if they have an EHIC or equivalent issued by their own health provider. The 'voluntary' class 3 NI contributions do not count - they are to maintain retirement pension rights, not to give health cover.

[cooperlola]

Yes, I know this really Will, but that was not made clear to Quillan in his conversation, above, was it?  What he seems to have been told is that were he French, he would get treatment, no questions asked, which is clearly not right.  The EHIC is the clincher.  So, in effect, as I said before on another thread, coverage for treatment in other EU countries must come from your private healthcare provider, or travel insurance, if in the near or distant future, one is denied state health care.

[Jazzer]

I can't see that travel to the Uk for medical treatment is even worth discussing. We are hardly going to fly across for a regular prescription and as for an operation most of us will be in receipt of an E121 whilst waiting.

 I think we need to be discussing who is likely to take up the icase for us.If only we had our own MP?

[Will]

[quote user="Jazzer"]

I think we need to be discussing who is likely to take up the icase for us.If only we had our own MP?

[/quote]

How about an MEP? You have the right to vote in France in European elections, and many British people living overseas retain the right to a postal vote, so somebody affected by this ruling must be able to find an MEP willing to look into things a bit further.

[Quillan]

[quote user="cooperlola"]Yes, I know this really Will, but that was not made clear to Quillan in his conversation, above, was it?  What he seems to have been told is that were he French, he would get treatment, no questions asked, which is clearly not right.  The EHIC is the clincher.  So, in effect, as I said before on another thread, coverage for treatment in other EU countries must come from your private healthcare provider, or travel insurance, if in the near or distant future, one is denied state health care.[/quote]

To be honest I don't think being French was an issue. I picked French because when asked what country my 'friend' came from it was the first that came to mind.

There are EU countries that this does not apply to and those are the more recent ones that require work permits to enter the UK. If you look through the government websites there appears to be loads of information which it would seem mean nothing as the lady from immigration said that at the end of the day treatment and cost would be down to the local area health authority. This means that without written law/regulations etc the whole thing really is open to local 'interpretation'.

The only thing I can think of to bring this to peoples attention is to contact the press. I emailed the BBC news line with some basic facts and said I would provide them with links to where they can find out more information (This and another forum where it's also being discussed). No reply I am afraid. Perhaps if they were inundated with people going on about the same issue they might take more interest. I used this link if you want to have a go.

http://news.bbc.co.uk/newswatch/ukfs/hi/newsid_3950000/newsid_3958800/3958817.stm

You might also consider Channel 4 news at

http://www.channel4.com/news/dispatches/

There is a place to click at the bottom of the page to suggest a story.

When looking for the BBC link there was a load of stuff about France and immigration in general, compulsory DNA testing on family members was one thing that caught my eye as part of the proposed new laws.

 

[cooperlola]

[quote user="Jazzer"]

I can't see that travel to the Uk for medical treatment is even worth discussing. We are hardly going to fly across for a regular prescription and as for an operation most of us will be in receipt of an E121 whilst waiting.

[/quote]Mmm.  Clearly this is how many who live in Spain are getting around this, though. 

I also know of at least one resident here, who has a property in the UK, who has just had a major op' at the UK NHS's expense, even though she lives here for at least 10 months every year!  Because she has kept her head beneath the parapet, this is what she does - she uses her UK EHIC for medical treatment here (under the guise of its being "urgent" whilst she is staying in her "holiday" cottage over here), and has major treatments in the UK.  Totally illegal of course, and these are just the kinds of people who will remain undetected unless anybody follows her movements in and out of the country, and monitors the time she and her o/h actually live here.

None of the tightening up measures being proposed at the moment, seem to me to address this very real problem of the true cheats.

[ali-cat]

Lets see if I've gotten this straight.  Paraphrasing previous posts on this and other threads :

The right to health care in other member states is based directly on the EC Treaty, is primary law and cannot be restricted by secondary EC legislation or by national legislation;

Inactives are entitled to the same healthcare rights as the economically active;

Without prior authorisation, EU citizens are entitled to seek non-instutional care, including out-patient care and dental care, both on an emergency and non-emergency basis in all member states and thereafter claim reimbursement for health care expenses from their home country;

The right to free treatment under the NHS applies only to those who are ordinarily resident in the UK, regardless of their country or origin or whether they have paid NI contributions;

Other European governments pay the health costs of their citizens living elsewhere in the EU.  Only the UK limits health provision to those actually living in the UK except for the cover provided by the E forms;

For the citizens of our European partners who come to reside in France, health cover in insured through the CNAMTS by their own national health service, except for the British.  In effect, health insurance in the UK is territorial.  A British citizen residing in England - just as a French person residing in the UK and justifying his/her European citizenship - profits from basic free health cover.  But British people residing in France can no longer profit from their national cover, and must thus affiliate themselves with the CMU (sic) when they do not have any other social protection.

Under the proposed changes to the healthcare system in France inactive nationals from some other non-EC countries (e.g USA) can continue affiliation to the French healthcare system;

A recent ECJ case has (at an early stage) ruled against the UK regarding the exportability (read non-territoriality) of DLA benefits.

*******

Ergo :

All EU citizens, active and inactive, are entitled in principle to access to basic healthcare provision in any EC member state (possibly exluding recent accession countries);

The UK system differs in that it is 'territorial' i.e. applies to only those resident in the UK, but applies to all residents originating from within the EC (and without the EC) and is funded from general taxation rather than contributions.  The argument has been made that this difference precludes the type of reciprocal arrangements e.g. between France and other member states whereby other member states continue to pay (indefinitely?) for their citizens living in France (or in other member states - except presumably the UK).  It has also been argued that transfers between national health systems would make health budgeting impossible.  These arguments are arguments of mechanism rather than principle and are moreover invalid as in the latter case transfers already take place between member states;  the UK also already makes transfers (of a notional health cost) through the E forms system and of actual health costs where NHS patients have operations carried out outside the UK;

It could be argued that the UK has been a good European (or world) citizen by extending healthcare access to all residents regardless of origin.  On the other hand the UK government has been happy to let the French government pick up the tab for the healthcare of UK citizens in France in contrast to other member states and to deny the 'exportability' of other benefits such as DLA;

The above begs the questions : Is Spain also out of step with other member states regarding reciprocal arrangements or again does the fault appear to lie with the UK?;  do UK citizens in other members states have the same problem?;  does the USA have some reciprocal agreement with France?

Why do I continue to pay UK tax if I cannot access the NHS (not very practical anyway) and once the E form expires the UK will not contribute to my healthcare costs in France?

One solution would be for the UK to align with other members states whereby member states effectively cover the healthcare costs (indefinitely) of its citizens regardless of where they are resident.  The UK may or may not ultimately benefit from such an arrangement depending on the active/inactive ratio of its immigres v emigres however it wont happen in my lifetime.

A simpler solution might be to extend cover to UK citizens in other member states through the indefinite extension of the E forms - either on the basis of notional costs or on an actual/refund basis.  Without the reciprocal agreements the UK would find itself the net loser.

Or - the French allow us to affliate to CMU on a more realistic 'flat rate' basis rather than assessed on income below a certain level.  This would be more expensive to many than at present but likely to be less expensive than private insurance,  would not exclude existing conditions, plus I would much prefer paying into CMU rather than to private insurers - much more in keeping with the spirit of the system.  UK government might even consider a modest contribution on our behalf.Real costs to the French might however well exceed any notional fee. 

Sorry to ramble on.  I'm just trying to get this straight in my own head.  Having written it out I don't see an easy solution or one that anyone is likely to take up on our behalf.[:(]

Ali's OH 

 

 

 

 

[Ron Avery]

If the other halves of people who are entitled to E121's get them irrespective of individual income, why cannot the UK pick up the healthcare tab for all other halves that live in France?  If we moved back to the UK we would get free healthcare.  Strikes me from those that I know who pay no CMU contributions because their O/H has an E 121 that the way to paying naff all in France for Healthcare was to play the stress card and get IB, go each year without make up and quiver in front of the doctor and then go back and relax by the pool with new car in the drive paid for from not paying any CMU. This comment is not in any way aimed at those with genuine and serious conditions, just those who play the system.

As Cooperlola says this new legislation does nothing to catch existing lead swingers, tax dodgers or those who keep under the radar, it only penalises those who have followed the rules and affiliated to the CMU.

[Quillan]

The only thing I can see wrong with that is the implication (unless I have misunderstood) that the UK are the only people using E forms. That is not true, its a European form. Our neighbours who are Dutch are entering the system on a E106 (it has that written on it) and the only difference I can see is that its in Dutch. I know a German couple and next time I see them I will ask them if they know what a E106 is. I rather suspect they will.

[cooperlola]

I cannot confirm this, Q, but my understanding is that for many Europeans, though (non Brits), their E106's do not expire after two years.  This may be why we are the ones yelling so loudly!

[Will]

If we moved back to the UK we would get free healthcare. 

Yes, but you choose to live in France, and your home state specifically excludes non-residents from its health cover.

If the other halves of people who are entitled to E121's get them irrespective of individual income...

Not so, you have to be truly dependant on your other half, and not in receipt of income that would, up to now at least, incur cotisations in its own right.

Inactives are entitled to the same healthcare rights as the economically active

Maybe, but perhaps they should also be expected to pay the same level of contributions?

The right to free treatment under the NHS applies only to those who are ordinarily resident in the UK, regardless of their country or origin or whether they have paid NI contributions

There is a specific exception for residents of other European states who may have an EHIC equivalent or E form.

Other European governments pay the health costs of their citizens living elsewhere in the EU.  Only the UK limits health provision to those actually living in the UK except for the cover provided by the E forms

Very few, if any, other EU states have a system where health costs are met entirely by the government. Most are based on citizens contributing to an insurance (note that NI, despite its name, is not an insurance in this sense of the word). This may be entirely private, but more commonly there is a combination of private insurance for the better-off with a state-assisted subsidy for certain others, or a system that covers part of the cost of treatment.

These arguments [about transfer of health entitlement] are arguments of mechanism rather than principle and are moreover invalid as in the latter case transfers already take place between member states;  the UK also already makes transfers (of a notional health cost) through the E forms system...

I disagree that the arguments are invalid. The NHS is, as we have already seen built on totally different principles from the systems in most other countries, so it is a matter of principle rather than mechanism in Britain's case. The E-form system is, by its very nature, limited, and nobody is affected by the changes to the way the French system is applied as long as they have an E form. It is only when the E form (including the EHIC) ceases to be in force that problems arise.

Why do I continue to pay UK tax if I cannot access the NHS (not very practical anyway) and once the E form expires the UK will not contribute to my healthcare costs in France?

As a French resident you should only pay UK tax on income arising in the UK, such as, for example, interest on investments held there or property rentals. The fact that public service pensions continue to be taxed in Britain is a part of the double taxation agreement, which could be changed if it ceased to be acceptable to both Britain and France. It could be argued that as a French resident you should not be paying the NI component of any British taxation, though there is an option for some to make voluntary Class 3 contributions, which serve to maintain entitlement to a state pension rather than provide health care.

Or - the French allow us to affliate to CMU on a more realistic... basis rather than assessed on income below a certain level. 

That would appear to offer a potential solution. I am not sure that a 'flat rate' is necessarily the best way, but it is one possibility bearing in mind that at 8% one would need quite a substantial pension to even cover the average per-capita cost of CMU provision, and non-actifs are likely to incur higher than average health costs anyway. The self-employed pay, I think, 12%, and the combined employer and employee contributions for salaried workers are higher still. So it could be argued that non-active people are not really paying their way. Moreover, if contributions are to bear any relation to the true cost of treatment, the French government would need to do a lot more to reduce costs. The amount of bureaucracy involved in the way the health system is run is incredible, with 90-odd regional CPAMs and even more trade and professional caisses, all duplicating much the same job. It cannot be allowed to make the same mistakes as the NHS, for example, where monitoring cost-effectiveness and producing figures,league tables etc., has merely created another tier of even more expensive officials.

I think that will do for now...

 

[Ron Avery]

If the other halves of people who are entitled to E121's get them irrespective of individual income...

Will wrote "Not so, you have to be truly dependant on your other half, and not in receipt of income that would, up to now at least, incur cotisations in its own right"

In the case of an E 121 of a pensioner that may be the case, Will, but we had this debate a while back and it became clear for E121s issued to those on IB the O/H is always made a dependant irrespective of individual income.  This was also confirned to me from Newcastle when I asked why a headmaster with a teacher wife on IB for a stress related illness did not have to join the CMU, they told me that in all such cases they issue the E 121 form with dependency shown on it although the French can in theory refuse to accept it but why would they when the UK are picking up the tab.

[Will]

Thanks Ron. I suppose in that case there may be an assumption that the spouse of somebody on permanent incapacity benefit would be a full-time carer, so is counted as a dependant. It will be interesting to see how cases like this are regarded under what is certainly going to be a rather tougher regime. Do you know if the NHS pick up the entire cost of treating such E121 holders in Europe, or is a flat rate per capita payment made? If the former, then as you say, why should the French bother, but if the latter then they may not be so willing.