Having spent no small amount of time on airplanes recently, I saw an ad about St. Patrick’s Day – and immediately started thinking about the connection between the Irish and the ACA. Now, you might not immediately associate Ireland with medicine: the Emerald Isle has four Nobel laureates for Literature and four for Peace, but none for Physiology/Medicine.* Even so, Ireland has influenced health systems around the globe. For example, the Irish inaugurated one of the first medical insurance-type schemes in 1718 with the establishment Charitable Infirmary of Dublin, one of the first voluntary hospitals. Treatment was available by voluntary subscription and the facility provided free services to the poor. Dublin also erected one of the first maternity hospitals during the same period.** And the Irish gifts to medicine are equally notable: the physicist John Tyndall (inventor of spectrophotometry) and physician Whitley Stokes contributed to the development of germ theory in the 19th century – and Robert Graves reportedly discovered “Graves Disease” of the thyroid.*** Further, notable Irish contributions to modern healthcare include the hypodermic needle and syringe, portable defibrillator, and radiotherapy treatment for cancer.****
But what about health care in the Irish Republic today? Well, friends, I’m here to tell you there’s an even more shocking parallel between Ireland’s health system and the ACA.
Much like their American cousins, Irish taxpayers can also claim tax relief for the premiums they pay for private health insurance! Although the context is different, because private health insurance is generally only a supplement to the public health system in Ireland, the tax mechanism is much the same. Irish taxpayers may receive an annual credit equivalent to € 200 per adult and € 100 per child or 20% of their annual premium liability, whichever is less.***** Under a principle known as “Tax Relief at Source” (TRS), taxpayers generally receive this credit as a discount to their premiums – although in some circumstances the credit can be claimed after the fact. Although the dollar (or euro) values are quite different, don’t there seem to be some striking parallels to the ACA’s premium assistance tax credit? We certainly think so.
So there you have it: the connection between shamrocks and health system reform!
Lá Fhéile Pádraig Sona Daoibh! Happy St. Patricks’ Day!
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* Nobelprize.org, “All Nobel Prizes,” available at http://www.nobelprize.org/nobel_prizes/lists/all/, accessed March 1, 2014; Wikipedia, “List of Nobel laureates by country,” available at http://en.wikipedia.org/wiki/List_of_Nobel_laureates_by_country, accessed March 1,2 014. Note that the Irish have linked literature, peaceable society, and medicien: Joyce and other Irish authors provided portraits of the contemporary health system, and a few celebrated Irish physicians were also poets of note. Shanahan F, Quigley EM, “Medicine in the age of ‘Ulysses’: James Joyce's portrait of life, medicine, and disease on a Dublin day a century ago”, Perspect Biol Med. 2006 Spring;49(2):276-85; Lyons JB., “Some Irish contributions to medicine,” Studies, 1975;64(253):35-48.
** Lyons at 35-36.
*** Kingston, W., “Irish Contributions to the Origin of Antiobiotics”, Irish Journal of Medical Science (2008) 177:87-92; Lyons at 39, 43-44.
**** Irish Universities and Medical Schools Consortium, “Three Famed Irishmen Who Have Contributed to Modern Medicine,” webpage available at http://www.iumc.com.my/bitsnbytes12.php, accessed March 1, 2014.
*****Health Insurance Tax Relief is limited on a per person basis to 20% of annual premiums paid, up to a limit of the first € 1,000 of premium per adult and € 500 of premium per child. Premiums paid above the € 1,000 and € 500 limits are not eligible for tax relief. If annual premiums do not exceed these limits, tax relief may only apply to premiums actually paid. See “Tax Relief at Source (TRS) - Changes to Medical Insurance Relief for Policies Renewed or Entered into on or after 16 October 2013”. Accessed March 5, 2014. http://www.revenue.ie/en/tax/it/leaflets/changes-medical-insurance-relief-info-for-employees.pdf