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Old 10-11-2012, 10:38   #226
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Re: Obamacare = early retirement anyone?

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Originally Posted by propellanttech View Post
How far will you let the system test your Hippocratic oath? What about when the standards tell you, that the treatment is not allowed on a patient, even if they have the money?

....
There has been much political rant over this subject. So, to try and get at the facts, I spent some time searching the bill this AM to find such a provision. No luck.

The bill does provide for the creation of a number of "advisory boards" in subject areas such as Medicare and Elderly Care etc. The legislated purpose of these boards is mostly to advise on high-level policy and budget matters -- not approving or disapproving specific patient care cases. I have yet to find a board which has the mission stated or implied by the post above.

In the interest of determining the facts, can some provide me with a reference to the section of the bill that establish such a board?
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Old 10-11-2012, 11:16   #227
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Re: Obamacare = early retirement anyone?

The U.S. VIRGIN islands have medicare coverage. Can you get prescriptions there?
Do they have pharmacies there? Does anyone know?

My concern is what will the coverage be like on Obamacare and also from previous comments regarding minimum income, etc. what the cost will be. For retirees, Medicare part a A might be free, but another part is going up to $300 per month in a year or two (used to be $95, $110 now to $195 then $300) in something that was passed last year, then you still need the supplemental so for a couple the insurance cost of Medicare and supplemental will be $900 to $1000 a month by 2015, regardless of low income. Yet Obamacare is supposed to be only $500 if you make $50,000 for a couple. That doesn't make any sense to me, so I don't buy anything I am hearing on this topic. I think we are just going to learn the hard way.

Time will tell.



I think there will be many plans to choose from and the plan with the least coverage and highest deductible will be the cheap one that everyone gets and that will be tied to your income. I don't think you will get the cadillac plan people are used to from work from the government for free.
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Old 10-11-2012, 11:19   #228
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Re: Obamacare = early retirement anyone?

I've not read the entire thread so forgive me if these points have been covered.

First, most if not all US insurance doesn't cover claims from offshore and I've seen nothing in Obamacare that this has changed. Medicare works in PR and USVI.

Most countries you'll be visiting have socilized heath care. I did a 7 days stay with an exstensive operation in Panama for $360 dollars total, and a 3 day hospital stay with operation in Trinidad for $5200- which my offshre insurance paid $1800 while their premium was $4000 a year.

At 72 I'm on Medicare - types A, B, and D and my montly deduction from SS is $99.50 per month.

I dropped the supplement from those AARP approved folks when they wanted to raise their montly premiem to $165 a month. My current Blue Cross supplemental is $67 a month, and due to Obamacare, will be reduced by $17 a month next year with expanded coverage.

I urge everyone to enlist the services of healthcare consulants before making your choices.
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Old 10-11-2012, 11:20   #229
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Re: Obamacare = early retirement anyone?

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Funny, I was wondering the same thing but too lazy to read the whole thread. Maybe it all just ranting.


Mostly.
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Old 10-11-2012, 13:26   #230
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Re: Obamacare = early retirement anyone?

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Oddly enough the $500 a month cruiser will not have to pay for obamacare. We fall under the minimum income requirements. Boy do I feel lucky Actually I'm pretty sure the $1000 a month cruiser is good too...

Please quote a part of the bill/law that says this. Because so far we have seen that there is a minimum amont or percentage of your income, whichever is larger.
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Old 10-11-2012, 13:34   #231
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Re: Obamacare = early retirement anyone?

What I always find a puzzle is that a country known (IMO rightly) for it's "can do" attitude can't seem to sort out universal Healthcare for it's people. It ain't rocket science, nor does it require "the rich" to give up having better treatment - nor even to remove "profit" from healthcare.

FFS yer put a man on the moon .

Obamacare - one small step for mankind, one giant step for the USA .
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Old 10-11-2012, 13:44   #232
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Re: Obamacare = early retirement anyone?

I do think that both sides need to work on improving the system we have now. Cost reductions, preventative care, health education, and improved health care options that are cheaper should be encouraged.

I went to my routine health exams every year or two, but they missed that I wasn't drinking enough water and producing enough urine. A $2 solution would be to measure the amount of urine you produce in a day or two to see if it is over 2L/24 hours. I was at under .5L and had to work hard to get it up to .9L. But, I got a dozen kidney stones and had the CT scans to make sure they weren't too big, or to make sure my kidneys wouldn't fail (which would be a much bigger problem). Doctor visits, medicine, lab tests, sick time and missed work all add up. Avoiding this condition doesn't cost much, and is much advised.

FSA accounts are bad because they go away at the end of the year. If they went away at the end of your life to pay for or to loan money to other people, that would improve the situation. I would like to be able to save money tax free during my career to be able to cover medical expenses anywhere in the world for whatever care I need. Plus a person with $100,000 FSA account will look a lot better to an insurance company as a safe bet and should lower premiums.
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Old 10-11-2012, 13:53   #233
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Re: Obamacare = early retirement anyone?

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Originally Posted by Don Lucas View Post
Please quote a part of the bill/law that says this. Because so far we have seen that there is a minimum amont or percentage of your income, whichever is larger.
It looks like the current definition of poverty for a single person is $11,170 and if that is correct then according to this chart...




and this...

Quote:
Low income individuals and families above 100% and up to 400% of the federal poverty level will receive federal subsidies[21] on a sliding scale if they choose to purchase insurance via an exchange (those at 150% of the poverty level would be subsidized such that their premium cost would be 2% of income, or $50 per month for a family of four).
...a person would pay 2% of income. I got the above info here...

Patient Protection and Affordable Care Act - Wikipedia, the free encyclopedia

...at a link someone posted earlier in the thread.

One thing I haven't seen mentioned is that there will now be a lot of people paying something at least into the system where before they were paying nothing into the system and using it.

We won't be cruising outside the U.S. but if we were I'd have no problem paying in our fair share so that if something major happened to one of us we could come back to the U.S. and get health care. Seems only fair to me. Now we have medicare and if something major happen we would be coming home and using it.

Also as one who lost health insurance, our group was cancelled and they only let people back in with no pre-existing, and then going 10 years before going on medicare I say it is about time something happened to keep this from happening. Also now people can change jobs and not fear that they won't be able to get insurance coverage even if they can pay for it.

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Old 10-11-2012, 13:55   #234
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Re: Obamacare = early retirement anyone?

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Originally Posted by Don Lucas View Post
Please quote a part of the bill/law that says this. Because so far we have seen that there is a minimum amont or percentage of your income, whichever is larger.
Some good summary level info regarding this, and other aspects of ObamaCare, at the Kaiser foundation. The link below is to a flow chart regarding purchase/penalty requirements. It does include income limits, but not expat exemptions.

The Requirement to Buy Coverage Under the Affordable Care Act - Kaiser Health Reform
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Old 10-11-2012, 13:57   #235
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Re: Obamacare = early retirement anyone?

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First, most if not all US insurance doesn't cover claims from offshore and I've seen nothing in Obamacare that this has changed. Medicare works in PR and USVI.
Anthem Blue Cross (a huge provider in the western US) covers out of country care. You're charged out-of-network rates and you need to pay out of pocket, but provided you can show receipts they'll treat it like a normal claim. Additionally, HSA funds can be used internationally without issue.
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Old 10-11-2012, 14:06   #236
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Re: Obamacare = early retirement anyone?

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Originally Posted by David_Old_Jersey View Post
What I always find a puzzle is that a country known (IMO rightly) for it's "can do" attitude can't seem to sort out universal Healthcare for it's people. It ain't rocket science, nor does it require "the rich" to give up having better treatment - nor even to remove "profit" from healthcare.

FFS yer put a man on the moon .

Obamacare - one small step for mankind, one giant step for the USA .
The moon thing was over 40 years ago. They figured out how to do it 9 years. Mind you, there was virtually no lobby against it.

The healthcare thing? Well, suffice it to say that a very effective health insurance lobby has convinced a huge number of citizens that somehow by having a single payer healthcare system that all sorts of bad things will happen.

That is ingrained in the mindset now, facts be damned. Facts that countries like Canada can spend 1/3 less on healthcare as a percentage of GDP and get a better result... citizens live longer.

When I listen to friends of mine in the States describing their co-pays, their limits, their needing to make appointments months in advance because of HMO restrictions, the restricted procedures that are covered, the need to get pre-approval from the insurance companies for procedures, and the withdrawal of approvals after the fact, makes me wonder where the hype the insurance lobby promulgates is reflected in real life experiences.

I really can't fathom the premiums that need to be paid, where many people are not shocked that they pay in excess of $500/month in premiums.

All I can say is 'wow' and shake my head. I just don't get the resistance, especially having been the recipient of superb healthcare when I needed it, being in hospital for 3.5 months, and not being denied the same coverage I had before, not being surcharged, nor losing everything I own because of the costs.

I really don't get it.
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Old 10-11-2012, 14:07   #237
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Re: Obamacare = early retirement anyone?

I work in insurance and finance, and thought you guys might find this interesting. This is looking at one particular treatment (a steroid injection into the bursa of the right knee) across multiple providers (hospital, doctor's office, clinic, whatever). This is just for the procedure itself; there's not a lot of variance and the diagnoses itself would have happened before and be covered by another code (and cost). Additionally, this is over a nine month period in the same zip code. Many of these providers are actually within walking distance of each other.



The one on the left is a orthopedic group that is 4x more expensive than the ones on the right. In insurance business groups we always joke around that medical care is the only place in the US where no one checks or judges cost in advance of buying something. The parallel is made to ordering a deli sandwich and then having the cashier pull a number out of their ass at the end. You can't see it in advance on their website, no one talks about it, and you'll drown yourself in debt to pay it.

In fact, the two procedures that have come down the most in cost over the years are lasik (and other types) of eye surgery and breast augmentation. Because insurance doesn't cover those and it's almost always out of pocket, people shop around and market forces come to bear.

But in "normal" medical care in the US, people are generally completely ignorant about prices in advance.

For everyone out there that loves the free market, exactly how many market forces do you think are being brought to bear when everyone thinks in terms of their copays and premiums for how much things "cost". Market prices are the most important aspect of a free market.

Don't blame the government and don't blame insurance companies. If either one of them tried to steer you towards providers that are lower in cost for identical treatments everyone would scream bloody murder about death panels and people "getting in between" them and their doctors.

It is fittingly American however that we quickly put the blame on someone else. Like consumers carrying too much debt or signing up to loans they could never pay back, the amount of individual responsibility seems quite small compared to the blame that gets assigned to others.

/rant
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Old 10-11-2012, 14:20   #238
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Re: Obamacare = early retirement anyone?

Quote:
Originally Posted by David_Old_Jersey View Post
What I always find a puzzle is that a country known (IMO rightly) for it's "can do" attitude can't seem to sort out universal Healthcare for it's people. It ain't rocket science, nor does it require "the rich" to give up having better treatment - nor even to remove "profit" from healthcare.

FFS yer put a man on the moon .

Obamacare - one small step for mankind, one giant step for the USA .
I think there is something of a competition between the idea of the american workforce as a market for american / international businesses and the american workforce as a source of educated / healthy / secure workers. More and more the middle class seems to be viewed as a target market to be exploited rather than a target resource to be nourished. I am not sure that the ACA changes that equation, but at least it puts a framework in place to improve upon. As a number of posters have pointed out, the taboo against universal healthcare has been broken -- now we can focus on improving it.

.02 (from the cheap seats)
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Old 10-11-2012, 14:40   #239
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Re: Obamacare = early retirement anyone?

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Originally Posted by avb3 View Post
The moon thing was over 40 years ago. They figured out how to do it 9 years. Mind you, there was virtually no lobby against it.

The healthcare thing? Well, suffice it to say that a very effective health insurance lobby has convinced a huge number of citizens that somehow by having a single payer healthcare system that all sorts of bad things will happen.

That is ingrained in the mindset now, facts be damned. Facts that countries like Canada can spend 1/3 less on healthcare as a percentage of GDP and get a better result... citizens live longer.

When I listen to friends of mine in the States describing their co-pays, their limits, their needing to make appointments months in advance because of HMO restrictions, the restricted procedures that are covered, the need to get pre-approval from the insurance companies for procedures, and the withdrawal of approvals after the fact, makes me wonder where the hype the insurance lobby promulgates is reflected in real life experiences.

I really can't fathom the premiums that need to be paid, where many people are not shocked that they pay in excess of $500/month in premiums.

All I can say is 'wow' and shake my head. I just don't get the resistance, especially having been the recipient of superb healthcare when I needed it, being in hospital for 3.5 months, and not being denied the same coverage I had before, not being surcharged, nor losing everything I own because of the costs.

I really don't get it.
MOST people don't really pay all that much... back in the good ole days when I was employed, My medical was about $70 every two weeks, so only $140 a month. However the employer also paid an additional couple hundred.

So like I said most people can't really add and figure out what was ACTUALLY spent in total to provide them with nothing. They figure 'deadbeats' are complaining that they can't spend $140 like I do, not realizing that in fact they are spending more like $540 and only because they are employed and in good health is it even possible.

In 2008 I spent $9000 in premiums and had no health issues. I would much rather pay that money into a system that actually spent it on a fellow citizen's wellness.
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Old 10-11-2012, 14:46   #240
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Re: Obamacare = early retirement anyone?

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House and senate ARE elected by popular vote. Only the President is not. We are not voting for these things ourselfves because we are a republic, not a true democracy. It would take a major revision of the Constitution to do what you suggest. It's not a technological barrier. It's a constitutional one. If we had to hold national elections to pass each law the resulting traffic jam of elections would bring government to a halt.
No, you missed the point. The bills of which the Congress votes on should be popular vote. Like when the Congress gets a raise.....popular vote, Health care, etc.

Now, since the Congress is not involved in the ACA system, why should they worry about our issues. They are exempt from it after 5 years in Congress.

Evidently you don't see the roundabout issue here. How can we get the Congress to vote, their own power to change the rules for themselves, away?

James
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