So basically you have a taxpayer who has already programmed money to come out of his account to go to the IRS automatically on say April 18 getting a letter telling him to pay the same amount by check by April 15.

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Pay by debit or credit card, or write a check directly to the charity.

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Richer beneficiaries should pay more of their share of Medicare, while the generosity of the system should be kept in check by the independent panel set up under Mr Obama's health reform to monitor services and payments.

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