On taxes, pharmacy benefits, national formularies, common sense vs. regulation, and setting priorities: The US could learn a thing or two


After a hundred and eighty-three days

Taxes I surely would pay

     Unless I’m employed

    Then I’d be annoyed

To start paying, without delay.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, we’re in Wellington, New Zealand.  I’m prepping to work here.

Orientation entered a second day.

Our first speaker came from the Inland Revenue Department.

Independent contractors who stay fewer than 183 days don’t pay income tax here, but employees pay income tax from Day 1.  Two docs intend to stay for a year, and one intends to stay for six months.  At least one will be employed and at least one will be a contractor.  The simple New Zealand income tax structure divides into three tiers, with the highest income bracket at $75,000 paying 37.5%.  The tax year starts on April 1, with returns filed by July 7, and payment made by February 1.  The highest earners pay estimated tax ahead of earnings, in three equal installments per year.

The US tax system is terminally broken.  We could learn a lot from New Zealand.

The second speaker came from the Ministry of Social Development, in charge of disbursing to the sick and disabled.  Pregnant women past twenty-seven weeks gestation become eligible for an income.  By accident of history, full-time work does not diminish the benefit a blind person receives.  Watch out for people trying to scam the system, were warned.  I noted, with alarm, that alcoholism is considered a disabling condition, despite refusal to seek treatment.

Welfare doesn’t pay much here.

We had an excellent speaker, a GP with long experience, from the Medical Protection Society, which defends doctors facing civil or criminal charges.  Settlements here tend to be small because the no-fault Accident Compensation Corporation pays for all accidental injuries.  Watch out for the drug seekers, she warned, and don’t risk personal injury if a patient intimidates you.  New Zealand’s approach to problem solving tends to rely on common sense rather than regulation.  She urged us to call if we thought we were getting into a problem.  And, if we make a mistake, we can apologize without prejudicing our situation.  If, however, we prescribe controlled substances to a patient in return for sexual favors, no defense will do any good.

We had a good discussion about drug seekers.  I have been in clinical situations where failing to treat pain could bring sanctions, and I learned with relief that I don’t have to prescribe anyone anything if I think it against their long- or short-term best interests.

She provided us with some Kiwi slang, and told a clinical story with the final proviso that we need to keep a high index of clinical suspicion any time a farmer comes in.  Which fits with experience from home.

Pharmac, the governmental agency in charge of the national formulary, sent a representative, who gave us the rundown on what the government pays for.  She explained how they decide how to allocate a $700 million budget to get the greatest good for the greatest number.

Unlike the US system, which has refused to set priorities.

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