美國醫療儀器將加稅(--Medical device excise tax-2.3%)

[李誠民]

The Medical Device Excise Tax — Over before It Begins?
Daniel B. Kramer, M.D., and Aaron S. Kesselheim, M.D., J.D., M.P.H.
N Engl J Med 2013; 368:1767-1769May 9, 2013DOI: 10.1056/NEJMp1304175
In June 2012, the Supreme Court upheld支持 贊成 critical provisions of the Affordable Care Act (ACA), which aims to expand health insurance to many of the 50 million currently uninsured Americans. With prospects dimming for legislative reversal of the entire law, the various stakeholders in the health care market are now focusing on its implementation. One of the numerous controversial elements to date has been the medical device excise tax, a 2.3% tax on domestic sales of medical devices, paid by the manufacturer, which went into effect in January 2013. Several categories of device sales are exempted, though not purchases by government agencies and nonprofit institutions. Retail零售 purchases for individual use of devices such as blood-glucose–monitoring equipment are excluded from taxation, along with several specific devices such as wheelchairs, hearing aids, eyeglasses, and contact lenses. All told, the excise貨物稅 銷售稅 tax is predicted to raise approximately $2 billion to $3 billion annually, from a medical device industry with estimated annual U.S. sales of more than $100 billion.1 ---美國的醫療儀器稅(2.3%)是增加在製造廠商上,而排除零售購買者,----抽富人稅?!不增加一般(中下人)的稅?!....外國進口廠商!!!
Yet this source of funding for the ACA now faces an uncertain future, even as other key provisions of the law, such as state-run health insurance exchanges, slowly come to fruition. The U.S. Senate voted overwhelmingly on March 21, 2013, to repeal the excise tax in a nonbinding budget resolution, with 79 senators voting in favor of repeal and only 20 voting against. This bipartisan兩黨的(委員會) push followed months of intense lobbying from industry groups, which spent nearly $30 million in 2012 alone.2 This raises several questions. Where did the excise tax come from? Why is it now in danger of repeal? And what would repeal mean for the ACA?.........

美國可負擔的照護法案(Affordable Care Act ACA, 2012年),期中選舉附帶條件是在今年通過,才可實行!---期間歷經舉債上限,財政懸岩等,;最近就是臨界點(保險交換--Insureance Exchange),如果不能通過,就進入”自動減赤”;--美國已經減少18萬聯邦公務員了
反觀台灣健保財務(仍是隱藏的)虧空,影響政府財政,就增加個"補充保費?!",油電雙漲,再想提高營業稅(一般民眾!!!)……,;健保不會垮?!除非政府財政拖垮!!!....歐巴馬總統應該能過關,因為將制裁"敘利亞”,台灣怎麼過關?!

To the Editor: First, the claim that “purchases by government agencies and nonprofit institutions” are exempted from the tax is incorrect
Second, the claim that broadening insurance coverage, “including appropriate use of medical imaging and other diagnostic tools, would translate to enhanced sales for many device companies,” is incorrect
Third, the claim that job reductions cannot be traced to this tax is incorrect…. the math that is laid out by the authors belies their assertion: If 7 to 8% of sales are spent on research and development, as the article states, then the 2.3% tax on sales
Fourth, claims that repealing the medical device tax would have an effect on the health insurance provisions of the ACA are incorrect
finally, recent data highlight that diagnostic errors are the most common, most deadly, and most costly of medical errors.2,3 Yet, the tax discourages accurate diagnosis. In some ways, taxing the very devices that can facilitate discovery is similar to establishing a tax on supercomputers while attempting to sequence the human genome……A. Gregory Sorensen, M.D.
Siemens Healthcare, Malvern, PA
sorensen@siemens.com
Dr. Sorensen reports being an employee of Siemens Healthcare. No other potential conflict of interest relevant to this letter was reported.
The authors reply:
Sorensen and Ubl repeat common rhetoric修辭學 巧言花語 surrounding the medical device excise tax. Despite their references to anecdotal claims and industry reports, we remain skeptical that this tax will have the effects they claim on personnel decisions, the international competitiveness of the U.S. device industry, or innovation Ubl
Advanced Medical Technology Association (AdvaMed), Washington, DC….
…..First, imaging is only one component of the entire medical device sector. Second, other changes in the health care market in Massachusetts and elsewhere during recent years may have influenced the utilization of imaging, including payment reform1 and uptake of strict conflict-of-interest policies at Massachusetts academic medical centers, which insulate physicians from industry-related marketing of services,2 both of which are unrelated either to excise taxes or insurance coverage. Third, regional differences in health care utilization in general and in utilization of high-cost elements in particular challenge extrapolations from Massachusetts alone…….