How can we keep European healthcare systems sustainable? According to the World Bank, healthcare expenditure in the European Union has gone from roughly 8% of GDP in 2000 to almost 10% by 2015. How long can a trend like this continue?

As the demands of an ageing population put increased pressure on public health systems, how can we be sure that standards don’t slip? Maintaining quality will require either greater efficiency (i.e. “do more with less”, probably with the help of e-health and new technologies), focusing more on prevention and public health measures to ensure a healthier population, cutting expenditure in other areas of government spending, increasing government debt, growing the economy, or raising taxes. The solution, in practice, is likely to involve some messy combination of all of the above, with different EU countries relying on different policy mixes.

Exacerbating the problem is the fact that doctors are retiring faster than they are being replaced with new trainees, right at the moment when the average age of patients is going up. In France, for example, the number of practising family doctors has declined by 10% over the last decade, while in Austria roughly 40% of doctors are due to retire over the coming 6-7 years.

What do our readers think? We had a comment sent Edward saying he thinks Europeans would accept higher taxes if it meant better healthcare. Is he right? Do Europeans value public healthcare so much that they would be willing to contribute more in order to maintain standards?

To get a reaction, we put Edward’s comment to Fiona Godfrey, Secretary-General of the European Public Health Alliance, an association of non-profit organisations active in public health. How would she respond to the suggestion that Europeans might be willing to pay higher taxes for better healthcare?

I think, as a European myself, I would be happy if we could see multinationals paying higher taxes, which could be used for better healthcare. I think, if you look at taxation trends over the last ten or fifteen years, the average level of corporate taxation in the EU has gone down; it’s now just over 20%, whereas the average level of personal taxation for a citizen living in the EU has either been stable or it’s gone up, and the average is almost 40%.

So, I think there is a need for higher taxes; I’m not sure that there’s a need for individuals to pay higher taxes, because I think they’re already paying enough. And I think, on top of that, a lot of companies – McDonald’s, for example – who don’t always produce the healthiest food, and whose products contribute to a lot of ill health in children and in adults, and they’re not always paying their fair share, either in general, or in certain countries where they’re making a profit but not paying taxes.

To get another perspective, we put the same comment to Pedro Pita Barros, Professor of Health Economics at the Universidade Nova de Lisboa in Portugal. Did he agree with Edward?

No, not really, on a broad basis. I’ll take that observation by Edward by saying that people in Europe value a lot the government intervention in healthcare, and so they value what the government does in that field.

The point here is that if the economy grows slightly, or grows at a reasonable pace [as it has done in] the past, you’re going to have more tax revenues anyway, that you can use in healthcare more than using in other areas. And I think it’s true that people would like the extra revenue that comes from the natural growth of the economy to be spent on healthcare.

Increasing current tax rates is probably very hard to do, because in some of the countries they are already quite high, so increasing further could actually face resistance. I would take the comment as saying that people would like more emphasis on healthcare expenditure by governments more than saying we want higher taxes to be spent into the healthcare sector.

So, the feasibility [of higher taxes] is probably low, but the willingness of Europeans to have more government money [going] into healthcare instead of other areas is probably true.

Would you pay higher taxes for better healthcare? Should multinational corporations contribute more, rather than individuals? Or is keeping taxes low and growing the economy at a reasonable rate enough to keep healthcare systems sustainable? Let us know your thoughts and comments in the form below and we’ll take them to policymakers and experts for their reactions!

IMAGE CREDITS: (cc) Flickr – Phil Chambers; PORTRAIT CREDITS: Pedro Pita Barros (c) Pedro Pita Barros


75 comments Post a commentcomment

What do YOU think?

  1. avatar
    catherine benning

    Would you pay higher taxes for better healthcare?

    This question is phrased to stop you wanting a full from cradle to grave health service that does not rely on your paying extortionate fees to an insurance company who doesn’t really want to pay out on legitimate claims. And in fact, as in the US, will deny you very real treatment and medication.

    You do not have to pay extra taxes for this kind of health cover. This tells you all about it. It is the USA who is adamantly against a proper health service. Which, if you look at what they are offered under any system they have, is an enigma. This has now gone global. So, you are being pressed into an idea of globalist austerity by a fake inference to you will be impoverished if you dare to believe you can copy the UK.

    https://www.youtube.com/watch?v=-ywP8wjfOx4

    Privatisation is a global policy being used to remove a health service that is free at the point of use.

  2. avatar
    Pedro Maia

    I don’t think so. We do need less corruption and responsible/sustainable money managment

  3. avatar
    Aubrey

    Yes, and maybe introduce a system where people can pay more tax voluntarily in return for swisher rooms and food (not care quality or priority)

  4. avatar
    Victor

    Health care, and education, are the core of any welfare state, civilized state.
    I would pay more taxes to assure and improve them, but I need to know that my taxes are intended to that, not just the pockets of corrupt politicians, as Spanish are for instance, or to cover the losses of the banks.

  5. avatar
    Kristján

    I’m getting sick of paying higher taxes for one thing, only for them to end up in some stupid pet projects that are in turn privatized the minute they show some profit for pennies per the dollar

  6. avatar
    Marios

    EU should make sure that in all the member states a healthcare system exists and then debate about its quality

  7. avatar
    Κωστας

    It depends.In Greece it would be pointless

  8. avatar
    Gene

    Its nothing to do about paying HIGHER taxes…its about the govt you voted for USING YOUR TAXES THE RIGHT WAY.

  9. avatar
    Rick

    Most of Europe pays taxes on their income and spending. In Spain, 19% income tax and 21% sales tax, now do the math. These taxes specifically pay for “free” health care. Entergy taxes are high and even electricity is taxed and you pay sales tax on top. Gas is over $5/gal.

    • avatar
      Montgomery

      Those taxes not only pay for health care (it reprensents 14 cents of every euro you pay in taxes). You also get public education, inexpensive collage fees, the second largest high speed rail network in the world, the 3rd largest expressways network in the world, 40% of the electricity production from renewable sources, 52 airports, extensive and high quality public transportation system, public housing, etc. Things aren’t cheap. While gas prices may seem scary to most Americans, in reality we don’t need to drive as much, and European countries in general aim to get rid of cars in larger cities anyway.

    • avatar
      Rick

      Public education below the age of 16 doesn’t include the fees for books, like public schools in the US.
      Education above the age of 16 is determined by “selectividad” test where students compete for placement in public universities or go to trade schools (formacion profesional). Those students selected for college do a Bachillarto program (which can be described as an associates degree in general studies, basically the first two years of college in the US). Trade school is everything else than academia.
      To undertake the state-supervised Selectivo, the student will take 7–8 examinations over three days that mimic their Bachillerato examinations. Then they will be provided with an aggregate score up to 10. This will be combined with their Bachillerato score to provide the overall university grade – although the Bachillerato exam results will account for 60% of their final aggregate mark and their Selectivo 40% . The final grade will define WHAT they can study at university. This means the state chooses for you what you get to study for free or very little cost.
      You see, one pays taxes for the free education and serives but access is limited. Health care is the same. Many waive the flag of free health care but I personally saw my Spanish father-in-law suffer thru cancer, being sent home each time from the emergency room because there wasn’t an open slot for him in the hospital. It wasn’t until my Spanish mother-in-law’s GP got involved because it was affecting her health trying to care for him.
      Airports? Tell us about the Castellon airport. You know, the airport was officially declared “open” by local authorities in March 2011, shortly before regional elections and as total cost reached €150 million, despite having neither airlines signed up to land there nor government approval to operate. Delayed for several years, commercial flights were due to begin on 1 April 2012, but the first commercial flight to the airport landed on 15 September 2015.
      In February 2012, it was reported that modifications would have to be made to the runway before the airport could be brought into use. It was then later reported that the runway was to be dug up entirely.
      The airport has become a symbol of the wasteful spending that helped sink Spain deep into a recession and a banking crisis. For instance, the company in charge of running the airport, Aerocas, was found to have spent 26 million euros, a sixth of the cost of the airport, on sponsoring various sports teams in its region. Also, a $375,000, 24-metre-tall statue, often interpreted as a representation of Carlos Fabra, the formerly powerful local politician who was the driving force behind its construction, was erected just outside the airport. Fabra has been under judicial investigation in connection with several cases of corruption and tax evasion, and was sentenced to four years in prison for tax fraud in December 2014.

  10. avatar
    Paul

    I am sceptical that higher taxes would lead to better health care….hypothication doesnt work…more likely would just go into subsidising bloated government spending.
    Better to ensure basic health care to all, and allow people to take out private insurance according to their means if they wish premium cover.
    This is the norm for all other service businesses.

    • avatar
      catherine benning

      @ Paul

      Doesn’t work. They don’t pay out or take you on if you have existing conditions. If you are ill in one year and they find they have to pay out it only lasts for that year. The following year they more than treble the monthly cost to get rid of you. They do not pay for prescriptions. They do not pay for diabetes. They do not pay for child birth. They do not pay for a person who is born with illness.

      The cost to have national insurance is miniscule in comparison to private health insurance. Private insurance dumps you when you are needing them most. And they will spend a fortune going to court over it, whilst you are left untreated, facing death. Plus, even if you are the healthiest of people, it goes up every year and once you reach old age, they dump you and you then have no health cover at all.

      I know, I lived with that kind of cover for ten years when abroad. Friends were bankrupted by their mother and father’s need for surgery in old age. Ending up with them having to sell their house to pay for their care. Not a good deal. Especially when these austerity merchants spend fortunes from our taxes on arms and military coups.

      Additionally, if you are covered by your company, they too dump you from your job if you continue to need treatment via their plan. As it cost them and their other employees.

      https://www.youtube.com/watch?v=_LFltqK12W4

    • avatar
      Ramiro

      What do you mean basic health care? What if you have cancer and no insurance

    • avatar
      Giuseppe

      We, all the people, deserve the best care. I don’t like the idea that rich people can afford better social services than poor people.

    • avatar
      Matija

      That’s why you should get yourself an insurance. You would pay higher tax but not an insurance? I can’t understand that logic… Choosing how much you pay for what you gain is better than when some buirocrat chooses how much you worth.

    • avatar
      Paul

      Giuseppe …for me basic health care is one deemed as treating the sick. ..not enabling lifestyle choices. ..ie botox …liposuction…multiple ivf sessions…etc etc.
      You have to reconsider what it means by “best care” for everyone….just how much is affordable….in the UK, the bill for the NHS has increased from around 75 billion…to 125 billion within the last 2 decades & still is unable to meet the demand..
      With rising demand due to ageing population. ..ever increasing costs due to technological & medicinal innovations, some degree of rationing is inevitable.

    • avatar
      Nikola

      Hmm, not even private insurance provides coverage for aesthetic treatments. So your basic coverage, as per your comment, includes everything.

    • avatar
      Marc

      Basically what Nikola says. What you are asking is something that most “universal” systems don’t even totally cover. I agreet they should cover eny illness, but they simply don’t, and that’s what they ask when they ask if you would like to pay more taxes for better healthcare. Better coverage and more services above all. I would need cheap oculists or dentists for example but nearly no healthcare systems covers them. I would gladly pay more taxes if this allowed me to access those treatments for “free”.

    • avatar
      Paul

      aesthetic issues are not sicknesses and for me are a matter of personal choice & not to be covered by a universal health care.

    • avatar
      Rick

      my niece’s boy had Leukemia. She was separated at the time, working as a farm hand at a goat milk farm, which provided a place for herself and 3 kids and a small amount of cash. Medicaid and other assistance organizations took care of it. He survived. So, when I hear that in the US and have serious medical issues, there is no coverage or help, I always share this story. Oh, it was about 5 years ago that this all happened.

    • avatar
      Paul

      is heartening tale Rick …my wife’s great niece also had ALL….following a year of intensive tests,treatments, BMT, is now recovering but still needs regular monitoring …similarly my mother (92) has Alzheimer’s and has pretty much constant care at her own home…4 times a day, pairs of support workers come to feed/wash/change her…district nurse once a week…regular other visitors…this palliative care will last until she passes (probably not so long, but could be 1-2 years …)….both cases demonstrate that our increasing ability to treat, along with the exponential increase in demand is placing a huge strain on resourcing health care…

  11. avatar
    Eduardo

    No most people don’t have money for private hospitals. The public ones have a taxe that is not expensive but they take long time to see the pacients. We pay 46% of taxes every month. It is enough.

  12. avatar
    Júlio

    I don’t mind paying taxes for healthcare, education,… but I wouldn’t pay more than I already pay. Portugal is one of the most demanding in taxes. What we already pay is more than enough for premium services.
    All we need is more control and accountability rules and directives from EU to prevent bad spending and corruption. But I don’t see this as a concern for EU, unfortunately.

  13. avatar
    Olivier

    Not your business…. In France we have enough about taxes.. We want less tax

  14. avatar
    Douglas

    Not here in Germany already paying enough, how about cutting profits for Pharma to pay for the better care

  15. avatar
    Manuel

    yes.
    much easyer than any money for defense..

  16. avatar
    Julia

    I got an ad in my facebook newsfeed saying: “Reduce your taxes on global revenue to 1%. Companies have saved billions in tax by relocating to Ireland from high tax EU nations.” So this is how you avoid tax when you own a global corporation. Local businesses just don’t declare most of their revenue. So why doesn’t the EU focus on getting tax from these tax evaders and leave hardworking people alone?

    • avatar
      Ramiro

      Because Brussels is infested with lobbiers

  17. avatar
    Guilherme

    I’d rather not pay those taxes and pay for private healthcare

  18. avatar
    Bella

    I would if we could be sure that thr hospitals dont have to follow austerity paradigm and cut and save all the way.

  19. avatar
    Pedro

    Do you think good money management and less corruption, would lead you to better health care? Hell yeah!

  20. avatar
    EU Reform- Proactive

    Just 7 month ago the DE raised that issue. Once again- why is the alarming Gilles Merritt article by FoE/DE/EU published here- “that doctors are retiring faster than they are being replaced etc. etc. etc.”? I do not deny such reality may exist- but it raises various questions:

    • To what extent are national governments aware to pre-empt any reported shortages, service deterioration and increases in cost? What are THEY doing? What has been done already?

    • I expect to be informed FIRST by my National Health Minister- instead reading responses by private organization- not knowing what their real agendas are. Why is that not done here?

    • Are the shared competences in health being ignored by National governments or overemphasized by the EU propaganda arms to capture another shared competence to make it a sole competence on the way to one EU unity state?

    • One should reject all neo- liberal “think tanks” to propagate privatization of ALL previous public services (eventually) and spreading fear by propagating a United States of Europe as the only saving grace- as if the EU remains the only solution, financed on the back by all EU taxpayers.

    • Tax payers are already highly taxed & should not pay higher taxes out of their pockets! Other pockets need to be picked- instead letting EUnion pickpockets reign supreme & pick more & more!

    • National government should be challenged to think for themselves, engage & pay their own think tanks- not outsource to third parties! Is it national complacency, laziness or surrender? Please, push back on greedy supra national competences!

    • Determine the cost effect due to allowing unlawful & indiscriminate entry of illegal, uncontrolled masses of uneducated, unsuitable asylum-migration seekers on the national fiscus & stresses on the national health system.

    • Once all that has been investigated & answered- let’s return & discuss this problem again. Not every 7 month by stories from questionable fear mongers.

    Isn’t it a process by National Ministers to summarize, share their problems & solutions on a communal ministerial level? Or are they just told by opaque institutions how to act & what to do?

  21. avatar
    Luís Rocha

    In the period 2000 to 2015, public healthcare expenditure in Portugal when up from 5.9% GDP to … 5.9% GDP (that’s right, no increase).
    On the other hand, we had a 30% increase in people over 65 years and a 30% increase in people over 85 years

  22. avatar
    Alexandra

    It is not about higher prices. Raising taxes should not be necessary if the organisation is constructive and not done with the present American system with centralisation and thousands of useless managers !
    We need serious holistic doctors and a system where there is time to listen to the patient ! Bureaucracy has become much too expensive and created big failures!

  23. avatar
    David

    I’d like capital gains tax to match the tax I pay on my salary and the closure of all the loopholes I can’t afford to pay an accountant to exploit.

  24. avatar
    Alex

    Oh ffs! We’re already taxed to death! Italy France and the UK have the best healthcare in the World so it’s OK

  25. avatar
    Ann

    Use the money efficiently instead.

  26. avatar
    Kontogianni

    We already pay high taxes but we don’t have better healthcare. The contrary most of national hospitals face severe problems with types of equipment, staff, and buildings. Some buildings need reconstruction

  27. avatar
    Timothy

    No because higher taxes does not mean better health care. I live in Sweden and pay 33% in tax. Despite that we are faced with apathetic doctors and nurses, waiting lists for everything from cancer screening to open heart surgery and it’s getting worse.

  28. avatar
    João

    Of course I would! With Public health care the all society benefits with your cure. With private health care the businessmen profits with your illness.

  29. avatar
    Mirko

    I guess that who answers “no” to this smart questions would prefer to die instead.

  30. avatar
    Matt

    No, I wouldn’t. But still believe public healthcare is best option so I’m quite happy paying higher taxes already to keep it going. Wouldn’t be able to afford to pay more though. Big companies can :)

  31. avatar
    Maria

    We already pay higher taxes for better healthcare !!!

  32. avatar
    Martti

    Healthcare is simply a must. If you cut expenses there you will get higher expenses,when this patient finally gets the treatment. Sure everything doesn’t have to be 100%free either.

  33. avatar
    Keith

    What kind of question is this? Of course.

  34. avatar
    João

    No!!First improve what exists!!

  35. avatar
    Любомир

    Higher taxes won’t lead to better healthcare.

  36. avatar
    Chris

    No, please perform better with current.

  37. avatar
    João

    Of course as long as that were their use

  38. avatar
    Riccardo

    Higher taxes for rich people. but, like, A LOT higher.

  39. avatar
    Jan

    Oh social healthcare doesn’t work? Who could see that one coming. 🙄

  40. avatar
    Παυλος

    Stupid question without public health care we will reverse back to 19th century

  41. avatar
    Teresa

    only close UE put Drunken and the friend of “putero” Berlusconi, Tajani i jail as exemple for the rest of criminal triad of this organization and its national Governments. Close the off shore and put all this ilegal money for Health, Education and Pensión. Easy

  42. avatar
    Мохамед

    Rising the price will not automatically rises the quality. More likely will fill the bank account of pharmaceutical companies.

  43. avatar
    Róbert

    No. I’d like a mostly privatized, and unregulated healthcare system.

    • avatar
      Matt

      where do you exactly live in Europe? What would, in your opinion, most Europeans who can’t afford private healthcare do? Die?

    • avatar
      Róbert

      maybe they should try working? You know, like for money. Horrible idea, right? That’s instead of just feeling entitled and expecting government to solve all their needs. And then, private businesses will compete for the people’s hard earned money, offering them a variety of options and quality services. But if you think government bureaucrats are the ones who really know best, how to run the economy…

    • avatar
      Jules

      😳🤯🤑😡

    • avatar
      Alexander

      oh yeah cuz that works really great in the biggest market for private health insurance (US)..
      Government = focus on cost-effectiveness
      Private health insurance = focus on profit for stock holders
      The ones who invented insulin sold the patent for 1$ to make it universally available to all, but insulin prices are now higher than ever and people are dying because they can’t afford their medication. And these people might be working 2-3 jobs just make ends meet.
      Is that really the world you want to live in?

    • avatar
      Róbert

      People should stick to their freedom in choosing what services they need and from whom, and which product to acquire and which not. Adults have to make decisions for their own, it comes with responsibility but it’s worth it. Don’t let a government official decide what’s best for you. When government meddles in business, that’s when monopolies are formed, when there’s influence to buy. That’s what keeps prices high.

    • avatar
      Róbert

      We don’t live in a post-scarcity world yet, where everybody’s needs are equally and fully met. We still need to make financial decisions, and prioritize our expenses. And the best democracy is when you vote with your wallet.

    • avatar
      Johan

      No.
      If a drug manufacturer produces a drug I need to survive I will have no choice but to pay their asking price. A government, on the other hand, has collective bargaining power.
      When I am acutely dying I have neither the time nor the physical ability to “shop around”.
      Healthcare is not like other products for these and other reasons. Literally all your comparisions with other products is wrong. Everyone needs healthcare too. It’s not one of thoae things you can elect not to get if you don’t like the market offerings.
      You’re really stuck on a simplistic, baseline idea of idealized perfect freedom and competition. Meanwhile, we live in the real world where perfect freedom doesn’t (and cannot) exist and is often not even desireable.

    • avatar
      Róbert

      I beg to differ, without stating that your reasoning is simplistic. But you’re focusing on terminally ill patients, whereas the vast majority of healthcare expenses are from primary and secondary care, what you are talking about is quaternary care. Special cases should be dealt with special measures. I wouldn’t alter the general approach only to solve the special cases. I’d find special solutions for them, relying primarily on charity organizations, churches, human solidarity. I still believe in humanity, you don’t and that’s why you ask for imposed solidarity through forced seizing of property (taxation).

    • avatar
      catherine benning

      @ Róbert

      Your posts on this are really rather humorous. I am English and live in the UK. I have NHS health care, free at the point of use. There for everything, including pre existing conditions, confinement, diabetes, cancer and so on. I am not left on the street to die. Thank God.. If I want to top my national complete health cover with an additional private insurance, in order to have an extra cup of tea whilst I wait, or, be able to lessen my wait to be seen, I can do so. That plan will of course drop me when I use it, but, that doesn’t matter, it will give me occasional and temporary feelings of superiority when I use it.

      And why you amuse me is, the UK is crawling with thousands of people like you, mostly Americans, who come over here to use our health service as they cannot afford care in the US. An example is, a very dear friend I had, has a brother who was found by his US GP recently to have the first signs of bladder cancer. He lived in the US where they have the best cancer treatment on this planet. In that place they look after astronauts. He works, is a pilot. Has money, own property. But, the cost for his treatment was not covered by his ‘full health care plan.’ So what did he do. Came to the UK and went straight to the top cancer treatment centre in this country, where there they have Proton treatment. Once there, they took him in and treated his condition. When he left, even though not a British born resident he left hospital not owing a penny. I am sure there was some kind of fiddle, but, this is pretty common with thousands of Americans who find their way here, one way or another. Just as they do in Canada. Of course, Americans are not alone, we get that kind of pushy wanton from all over the world. Especially from the third world. These people feel, because there is an unelected International Declaration on Human Rights regarding health care, which doesn’t seem to work in the USA, they have some kind of right to our National Health care. As do the rest of Europe, forced on us by EU ECJ rules. That, no matter they have not a pot to piss in, somehow the British tax payer must foot their health bill when they land on our shore. Including, paying for multiple births when, in their country of origin, they paid for IVF treatment and fill themselves with quads or more to deliver them here, for free of course. First, of course, they fly to the US to give birth, but once rejected on entry, they come on to the UK.

      However, should there be a full National Health Service in their own country, they would not have to bleach the British on a regular basis would they? You may well be happy with your private plan at present, but, your fellow countrymen seemingly are not, as they would not have to wander the world for treatment, if they were, would they? And until you are ready as a country to foot the extortionate costs of health for your fellow man, or, see them dead in your sweet street, lying stiff as your kids go to school. You better begin to care about how your country will deal with the horror before your eyes. Austerity, dear Robert, is going to turn your local into a dump for homeless, disease ridden paupers you hadn’t banked on, as your town or city fills with human flotsam. Are you ready for the explosion? I doubt it. A soupçon, ‘we don’t believe in comoonism, we’d all die rather than that’.. Well there you have it. Die then. But don’t buy a plane ticket to the UK to keep you alive We can’t afford you..

      https://www.dailymail.co.uk/health/article-4176406/Meet-Nigerian-cost-500-000-IVF-triplets.html

      https://www.businessinsider.com/an-american-uses-britain-nhs-2015-1?r=US&IR=T

      https://www.theguardian.com/commentisfree/2018/feb/05/americans-uk-health-system-trump-nhs

  44. avatar
    Renato

    I do think that more taxes could provide better healthcare for populations although there is a tremendous difference among quality healthcare performance between the healthcare resources and governamental institutions. We should try to define quality before we start to pay more money. This reality is not that obvious among european countries and the cost of an ‘unreal innovation’ healthcare is the price that we are paying everyday.

  45. avatar
    Renato

    I do believe that higher taxes could provide better healthcare for populations although there is a tremendous difference among quality healthcare performance between the healthcare resources and governamental institutions. We should try to define quality before we start to pay more money. This reality is not that obvious among european countries and the cost of an ‘unreal innovation’ healthcare is the price that we are paying everyday.

  46. avatar
    Rosa

    As a common citizen… yes, certainly! Priorities for human beings are health and education.

  47. avatar
    Rosa

    Certainly! If health and education are not our priorities, what are they?

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