Re: Latest Health care Entitlement discussion

[Cat]

Oh look, the Telegraph are quoting the "However, the French Ministry of Health have assured us that the provision of healthcare to people already resident in France will not be affected." myth again.

http://www.telegraph.co.uk/global/main.jhtml?xml=/global/2007/09/18/healthcare-in-france.xml

[cooperlola]

I have written to the Telegraph journalist, referring him to the French statement, and the contradictions vis a vis the Embassy's version.  Maybe he'll get an answer?[Www]

[ali-cat]

[quote user="Will"]

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 same level as whom - high earners, the low paid, unemployed. Is it not a fundamental of public healthcare systems that the higher earners subsidise lower earners.  I'm pretty sure most of those affected by these changes have a history in the UK of contributing well above the average and thereby 'subsidising' others - without complaint as this is the accepted social pact.

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.

: - If this is so surely it strengthens the argument that the UK health service is amenable to funding transfers.

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.

: - The NHS costs are not met by the government - they are met by taxpayers. UK citizens pay for their healthcare - only the funding mechanism differs.

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.

: - The principle I was referring to was the 'territorial' argument whereby there is something unique about the NHS which makes reciprocal transfers of healthcare funding impossible.  Clearly not the case.  The NHS overriding principle is universal healthcare - the same principle I would imagine as most other EC member states.  The only difference is the mechanism of funding the system - something that has not been above debate regarding the funding of the NHS.

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.

: - Public service pensions result from the terms and conditions of employment so why should they be taxed in the UK if this disadvantages the recipient?

 

[/quote]

[makfai]

[quote user="cooperlola"]I have written to the Telegraph journalist, referring him to the French statement, and the contradictions vis a vis the Embassy's version.  Maybe he'll get an answer?[Www][/quote]

 

I did the same so maybe he will look at it again!

[Clair]

[quote user="Cat"]

Oh look, the Telegraph are quoting the "However, the French Ministry of Health have assured us that the provision of healthcare to people already resident in France will not be affected." myth again.

http://www.telegraph.co.uk/global/main.jhtml?xml=/global/2007/09/18/healthcare-in-france.xml

[/quote]

This is an updated version of the article that appeared in last Saturday's Telegraph (15/09), which I partly quoted in this thread:

http://www.completefrance.com/cs/forums/2/1023751/ShowPost.aspx#1023751

[memb]

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? 

My husband has the E.121 because he is 68 and in receipt of OAP, I am on there as his dependant - fully retired, but not yet with my own pension (which incidentally has been put back by another 1 1/2 years with UK Govt changes to the retirement pension scheme). We are treated the same as a French pensioner, in that we get 70% cover, the remaining 30% has to be covered by private top-up health insurance.     Some months ago I wrote to the UK Health Minister to ask if the E121 was "for life" as was quoted to us by DWP, should the unthinkable happen to my husband before I reach my pension age (which will now be 61 and 5 months).   No it is not.  "I would have to take out full private health insurance or join the C.M.U. after 1 year".     Well, being able to afford full private health insurance would be out of the question, and, so it seems, is his second solution to join the C.M.U.   The 2 of us paid N.I. and tax for a total of 80 years between us prior to coming to live in France.  We are British, but opted to live in an E.U. country.  Individual cases should be looked at and cover given by the UK Govt according to contributions made.   Why should we even have to pay a top-up insurance to cover us for 30% ourselves, its our biggest monthly outlay?    Its unfair and unjust to think that should the unthinkable occur I would have no cover after one year whatsoever.     Some say you opted to live in France therefore you cannot be in a better position than a French pensioner.   We are not claiming anything from France, nor should we.    The E.U. is supposed to be a community of common practices and interests.  Its also unfair and unjust that anyone entering the UK can have instant free healthcare, when we with 80 years contributions paid up in the UK have to pay anything.   We are awaiting replies from 3 M.E.P's.

[Tony F Dordogne]

Edited to be deleted by poster as I ran out of time to delete.

[Magoo]

Well, I've trawled through the forum looking for answers and still the question what if you have a chronic condition that cannot be covered by private health care??

I am a type I diabetic that injects 4/5 times a day, needs constant blood tests, eye screens, kidney function tests etc etc and will not be able to obtain private health care cover. I have no problem having insurance that covers me for anything else but in the 3 years I have been here I have only needed treatment for the diabetes. I am unable to go back to the UK for treatment and trying to find a job in the rural area I live in is impossible for a lot of the locals let alone a non-fluent speaker of the Francais!! I have a small pension alimentaire that I declare on my tax returns so am not a 'drain' on the state.

economically inactive people with sufficient resources to support themselves and insured against sickness; - impossible for some I think

I know that there have been discussions on here that basically say you should have been aware of this before coming to France but the law at the time was E106 for 2 years then onto French Health system and my diabetes, after a medical board judgement, would be awarded 100% rights (the same as the UK).

Surely this transends EU legislation and moves into the realms of human rights . . . whereby the rule to obtain private health care is unobtainable by many who have ALD's or chronic conditions thus preventing them from receiving adequate healthcare.

Sorry to bleat on - worrying about this has played havoc with my blood control and I may not be able to afford to get ill!!!

[cooperlola]

Magoo, I can't imagine how worrying all this must be for you.  I have close friends who are in a similar position - they know nothing about all this yet as they are in Canada on an extended holiday, and I'm hoping that I'll have at least a proper handle on what's going on for people like them and you by the time they return.

One thing which strikes me in all this is that the same thing happened in Spain not long ago and many now find themselves without cover in a similar way.  I wonder what they did/are doing about this.  Yes, I know some return to the UK for medical treatment but this must be impractical for many.  Surely they did not take all this without a fight so it would be very interesting to see what their own take on this kind of situation is.  I must have a look on a Spanish ex-pat forum and see what happens there.  There is surely a case for us joining forces as a lobby group if they are similarly affected?

[Quillan]

[quote user="47AJM"]

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? 

My husband has the E.121 because he is 68 and in receipt of OAP, I am on there as his dependant - fully retired, but not yet with my own pension (which incidentally has been put back by another 1 1/2 years with UK Govt changes to the retirement pension scheme). We are treated the same as a French pensioner, in that we get 70% cover, the remaining 30% has to be covered by private top-up health insurance.     Some months ago I wrote to the UK Health Minister to ask if the E121 was "for life" as was quoted to us by DWP, should the unthinkable happen to my husband before I reach my pension age (which will now be 61 and 5 months).   No it is not.  "I would have to take out full private health insurance or join the C.M.U. after 1 year".     Well, being able to afford full private health insurance would be out of the question, and, so it seems, is his second solution to join the C.M.U.   The 2 of us paid N.I. and tax for a total of 80 years between us prior to coming to live in France.  We are British, but opted to live in an E.U. country.  Individual cases should be looked at and cover given by the UK Govt according to contributions made.   Why should we even have to pay a top-up insurance to cover us for 30% ourselves, its our biggest monthly outlay?    Its unfair and unjust to think that should the unthinkable occur I would have no cover after one year whatsoever.     Some say you opted to live in France therefore you cannot be in a better position than a French pensioner.   We are not claiming anything from France, nor should we.    The E.U. is supposed to be a community of common practices and interests.  Its also unfair and unjust that anyone entering the UK can have instant free healthcare, when we with 80 years contributions paid up in the UK have to pay anything.   We are awaiting replies from 3 M.E.P's.

[/quote]

I know many people hold the same feeling as yourself namely that you and your partner have contribute NI for some 40 years (each) and feel entitled. The truth of the matter is that when set up in 1911 by the Liberal government it was a way for people to contribute to a government run and administered insurance scheme for health and unemployment (you might like to search in google for National Insurance History for more information). It is an insurance but currently with one benefit namely that you are not only insured for one year like any normal insurance policy but for two. So you need to understand that providing you continue to work and pay in you get 2 years worth of cover hence the 2 years E106 entitlement and that people also don't always get the full 2 years. When you retire effectively the government pays your NI contribution for you although in reality it does not although you get 'free' insurance until you die, again hence the perpetual E121 cover. Also, like many commercial policies, there are certain things that are not covered.

I looked at all this about 10 years ago when my father was terminally ill (it took him 2 years to die) and was staggered at what he was not entitled to. My mother being a frail 76 at the time could not cope with my father and managing the house so respite care was recommended one week in four. This cost my parents over £300 per week in cash plus a reduction in pension whilst my father was in care. Home help had to be paid for as were meals on wheels. There were other things which I forget now that were also chargeable. My father was a socialist and believe that the government would look after you from the 'cradle to the grave' especially as he had fought for his country and worked all his life. No such luck.

I know this has drifted away from the subject a bit but what I am trying to get across is that what you believe you are entitled to and what you really are is quite different in real terms. You also need to understand that NI (National Insurance) is a form of insurance and not an entitlement.

To be honest I think its (NI) something the UK can no longer afford in its current form and needs to be completely revamped so that those that are poor or elderly get treated better and those that can afford it pay more and that its use is restricted (in much the same way as France intends) to those that have put in, nothing in, nothing out.

It's interesting to note how the French see this and in particular with reference to us and other EU nationalities. More than one of my French friends has been of the belief that people are sent over by the NHS to France and get free operations at the expense of the French. Nobody has ever explained to them that it is a deal set up between France and the UK and that the UK pays France (quite well in fact) for these operations. This leaves me to believe that amongst the French community there is either a lot of dis-information floating around or no information at all. .

Mind you have a look on the BBC website about how none EU immigrants are to be treated, DNA testing etc. France is poised (it implies) to send home thousands (30,000 initially) who will become illegal once the new immigration law is passed.

I will be interested to hear the replies you recieve from the MEP's but I wouldn't hold your breath.

[Will]

I may not always agree with Quillan - and would still dispute some of the detail above (for example, if you do as he suggests and look up the history of NI on the Internet it will be plain, from things like the Wikipedia entry, that NI is not an insurance but a taxation regime). But I am with him in principle on this matter.

It is a basic fact that if you opt out of life in Britain, you opt out of automatic entitlement to its benefits as well as opting out of the things that may, more directly, have caused you to leave. Opting out is not selective: some things, like health cover under NI, simply cease to be officially available to those who cease to be resident.

It may seem tough in the present circumstances, and I can sympathise with that, but it is not the fault of the British government, which has not changed any rules, not the fault of Brussels, which has merely reiterated the circumstances under which citizens of one member state can reside in another, not even the fault of the French government, which is trying to control health costs without cutting too severely the services it offers to its own voters (sorry, that should read citizens [;-)] ).

Ironically, the French have always envied Britain for the NHS. Not for the financial state of the service (though that is arguably no worse than that of the French service), neither for the cuts in services and long waiting lists (although, again arguably, such could be to come under the Sarko reforms), and certainly not for issues such as MRSA (though I know of at least one person whose death in a French hospital was attributed to a superbug caught there rather than the heart attack that put him there). No, it is the universal nature of the NHS; and that was, I am sure, the thinking behind the CMU. And it is ironic because it seems to be the excesses of the CMU that is causing France to drive British residents in France back towards seeking help from the British health system if they are to maintain health treatment abroad. Things are, of course, complicated further in that the E form system allows a limited extension of NHS health cover abroad (but how far can this realistically be extended?) and that NI also includes pension contributions. Of course, British abroad can opt to pay voluntary Class 3 NI contributions - but the crunch is that these merely maintain state pension rights, and have no bearing on health cover.

Realistically again, and putting it bluntly, is Britain likely to pay towards the health cover for those of its citizens who have chosen to abandon its shores for sunnier climes? I can't see it, and as an NI payer myself, I don't see why it should.

 

[cooperlola]

I am with you Will and although it seems very tough at the moment - particularly for those with pre-existing conditions - I cannot see that there are likely to be many concessions on this issue.  As said before, this is already the case in Spain and one assumes that they got nowhere as it is now accepted that private health insurance is the only (legal) way forward for some ex-pats there.  Elsewhere, there is the suggestion that we "get off our backsides" and lobby those who may be able to help and although I'm happy to do this, I suspect it is a forlorn hope, unless one is likely to be truly destitute as a result of the "new" measures.

However, I still find it rather tough on those who not only pay NI contributions but also all their taxes, back in the UK (those with public sector pensions).  They must wonder what they are paying for (although it's always seemed an odd anomoly to me in the double taxation rules anyway, as for myself I feel one should pay taxes in the country in which one lives and whose services - police, roads etc - one uses.)

[Quillan]

[quote user="Will"]

I may not always agree with Quillan - and would still dispute some of the detail above (for example, if you do as he suggests and look up the history of NI on the Internet it will be plain, from things like the Wikipedia entry, that NI is not an insurance but a taxation regime). But I am with him in principle on this matter.[/quote]

Unfortunately Wikipedia is not always right and is biased towards the thoughts of the individual typing the entry. NI is not a tax it is an insurance scheme and always has been from day one. I would strongly suggest you look at the Open University entry and the one for school children's revision, both clearly state it is an insurance (not a tax). In fact all the information (except personal information) I put in my post came from both these sources [:D].

[BJSLIV]

Whatever  it may call itself NI is a tax.

From a major firm of accountants......

1. Principles of taxation in the United Kingdom

Tax system

The main taxes in the UK are:

• income tax

• corporation tax

• capital gains tax

• NIC (National Insurance contributions, a payroll levy)

• inheritance tax (on gifts and death transfers)

• VAT (Value Added Tax - the main indirect tax)

• stamp duty (a duty on certain transfers of assets, primarily shares)

• stamp duty land tax (a duty on land transfers).

Or even from the Government's own guide to taxation.

Beginner's guide to tax

Basics of the tax system

Types of tax, how each tax is worked out and collected and what happens to the money

Personal and tax allowances

Find out how much personal tax allowance you are entitled to and make sure you get it

Understanding your tax code

Details of common tax codes including emergency tax, and changes that might affect you

How tax codes are worked out

Information on how tax codes are worked out and whether you have the right one

National Insurance

National Insurance (NI) - who needs to pay it, current rates and how to get an NI number

Income Tax

Income Tax - what it is and how it's applied, including Income Tax bands, rates and allowances, PAYE and Self Assessment

Stamp Duty

Stamp Duty Land Tax on property and Stamp Duty on shares - how they work and how much you pay

VAT - Value Added Tax

Find out what the VAT amount on your receipts means and why you have to pay it

Capital Gains Tax

What happens if you give away or sell an asset that's gone up in value - the basics of Capital Gains Tax (CGT)

Personally I hate the phrase but I suppose its the original "stealth tax".

 

[Will]

Being married to a former Inland Revenue trainer and tax officer, and still having some good friends in the British HMRC, I subscribe to the BJSLIV view on this one. NI may have been originally envisaged as, and subsequently dressed up as, an insurance scheme - certainly in Beveridge's 'welfare state' it was presented as such - but to all intents and purposes it is a tax. In that respect it recalls the CSG, CRDS and PS 'social charge' in France, which has caused all sorts of discussion here about whether or not it is a tax. Though semantics like this could be debated for ever more.

Interestingly, one of the main reasons the original insurance-based proposals in the Beveridge report had to be comprehensively modified is that they were seen as too exclusive - some even accused them of being 'racist' - and did not cater to the needs of minorities. Gypsies/travellers and refugees were one case in point, and the Irish community in Britain, plus the Afro-Caribbean immigrants who were starting to trickle into post-war Britain in greater numbers, were another. For the NHS to be a universal, all-inclusive service, such people, as genuine residents, obviously had to be included. Particularly the latter group, who had been encouraged into Britain to carry out work that not enough British wanted to do. Maybe some interesting parallels can be drawn with the current situation in France, which also seeks to exclude a small but significant minority of true residents?

[cooperlola]

If it comes out of my income and goes direct to the state, then for my money it's a tax, whatever else one might call it.  Fair enough, I've never had much of a problem with the principal of taxation myself, but that's another thing...

What I guess has been the point re this discussion, is that whether by having paid the full 30 years' of required NI contributions, one has any entitlement to healthcare as a result.  Quite clearly, from Will's assertions before, and from BJSLIV's link - one does not.  Pensions, disability and other social security benefits yes, healthcare per se, no.  However, I still wonder if those who continue to pay all their taxes in the UK have a case, as I asked before.  What does the team think?

[BJSLIV]

Whether you have paid the ten years or thirty years contributions, if you are resident outside the UK then you have no entitlement to UK health-care either within or outside the UK other than an e106 or an e121 at retirement age.

Irrespective of contributions anyone who takes up residence in the UK is immediately entitled to full health-care in the UK and EHIC for cover within the EU.

 

[memb]

Realistically again, and putting it bluntly, is Britain likely to pay towards the health cover for those of its citizens who have chosen to abandon its shores for sunnier climes? I can't see it, and as an NI payer myself, I don't see why it should.

So from the above statement we take it you don't mind free healthcare being given to all who enter the UK whether they are from the E.U or elsewhere?        We read a report recently which said most entering the UK have no ambitions or aspirations, however, free healthcare and benefits which can be sent to their family still living in their own homeland was the biggest draw on them wanting to enter the UK.   Yes, we appreciate they take lots of the jobs Brits won't have (or indeed want), because lots of Brits choose the layabout lifestyle which the benefit system allows them to have.    But free healthcare and certain benefits are instant, no dues have been paid in to gain anything back immediately.    To be informed that in the situation as previously posted, my wife would have no cover after one year is completely unfair and unjust when between us we have paid dues totalling 80 years.     We use the phrase "paid dues" because as another poster advised, paying tax and N.I. contributions are one and the same thing under the same umbrella - it is all paid to the state.    Individual's contributions should be checked and cover given accordingly, whether you choose to live in France or not........France, a member of the E.U.  which tells us our rights are  "Free Movement within the E.U. - a fundamental right".

[cooperlola]

Legally, BSJLIV, you are undoubtedly correct.  The DWP website clearly states that the entitlements to healthcare whilst living overseas are entirely a matter for the government of the country in which you reside.  Fine; personally I'll take the rough with the smooth (although I'm not above trying to make a case for continuing state health cover from one source or another, to those with influence, even though I don't think I have much of a legal footing) - but then I am in the happy position of being able to take out private health insurance with a bit of belt-tightening here and there for the next few years.

Morally, however, I can see that somebody who has moved here recently, who has made themselves fully aware of the regulations as they stood at the time - whereby they were legally obliged to join the CMU - might feel rightly agrieved and in some cases, downright terrified, by what may happen to them.  And although residency in the UK is the qualification for enjoying free NHS healthcare, they may find this rule even harder to stomach if they continue to pay into the UK tax coffers, rather than those here, often at greater expense. 

[Will]

[quote user="47AJM"]

Realistically again, and putting it bluntly, is Britain likely to pay towards the health cover for those of its citizens who have chosen to abandon its shores for sunnier climes? I can't see it, and as an NI payer myself, I don't see why it should.

So from the above statement we take it you don't mind free healthcare being given to all who enter the UK whether they are from the E.U or elsewhere?       

[/quote]

No, I don't. As legal residents that is their entitlement. Despite what the right-wing tabloids say becoming a legal resident is not as easy for other Europeans in Britain as it has been up to now for British in France.

I don't doubt what some reports say about the motivation of immigrants to Britain; others point out their keenness to work, and Britain offers such opportunities. I speak from experience; I have recently worked alongside Serbs and Poles (or to be more exact worked for Serbs and alongside Poles) and have no problem with that, or with their work ethic.

Free movement within the EU is all very well in theory, but Europeans (including British) who have come to France to work rather than to retire know that, at least in France, the practice is somewhat different from the theory.

Many people willingly turn their backs on Britain (and the tone of many posts on this forum suggests that they do this very willingly) and thus abandon their NHS entitlement, at least until they resume British residence, so if Britain turns its back on them that may be tough but I don't think it unreasonable.

That's no help in the present circumstances - so I urge you to take your situation up with your MEP, the British Embassy, your local CPAM and anybody else who may be able to help rather than crying 'poor us' and arguing the toss with those like me with whom you will never see eye to eye politically. I wish you all the best, I may not agree with your views but that doesn't mean I don't feel for your situation.

[Tony F Dordogne]

And can we also get rid of this urban myth that 'everybody in the EU' gets healthcare and benefits when they go to the UK - when the last EU enlargement took place, some countries were specifcally excluded for a specific length of time and some people from outside the UK, like many asylum seekers, aren't entitled to benefit or housing.

We chose to come here and surely, before coming 47AJM, you and your husband worked out whether you could afford to live here with your age, circumstances and income, the fact that your biggest monthly outlay is health insurance means nothing, it's part of being here for all of us.

Surely, though he may be over retirement age, there is no reason why you couldn't go to work unless you have an incapacity which prevents you from doing so, in which case you'd have your own E121.  You're under statutory retirement age and have been here for some time, you must know your way around French employment by now and then your financial pressures would be eased.

There is no reason why people who have E121s can't look for or perhaps, even find, work one does not preclude the other for the holder of the E121 or their dependant - the arguments about French unemployment levels and access to work in France accepted of course.

And if Poles, Lithuanians, Turks, whatever with limited English can find legitimate work in the UK, it seems to me that people here may have the answers to their problems in their own hands, they just choose not to exercise them.

Even with my E121, if I was offered a job here I'd probably take it, not because I need the money, just because I want to work even though I, like 47AJM and her husband 'have paid into the system for 40 years'.  Sort of reminds me of 'I fought in the war for you, young man' comments! 

[memb]

Will - there was no crying "poor us", or arguing the toss, however thankyou for your final comment. We'll agree to disagree.

[memb]

We chose to come here and surely, before coming 47AJM, you and your husband worked out whether you could afford to live here with your age, circumstances and income, the fact that your biggest monthly outlay is health insurance means nothing, it's part of being here for all of us.

Worked out precisely!    This whole subject is about the goalposts being moved!     Good on you for wanting to take a job.   Everyone has different reasons for wanting to choose a new life here, but part of those reasons was to fully retire after working non-stop for 43/37 years respectively.

[makfai]

[quote user="Tony F Dordogne"]

And can we also get rid of this urban myth that 'everybody in the EU' gets healthcare and benefits when they go to the UK

[/quote]

Healthcare provision is not a myth...if you are resident you get it.

[Will]

And to become a resident, there are plenty of things you have to comply with - not just a matter of moving in and signing up at CPAM.

See http://www.opsi.gov.uk/si/si2006/20061003.htm#13 

Funny, some of those look like very close relations of the requirements being brought in by the French.