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Old 10-11-2012, 14:55   #241
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Re: Obamacare = early retirement anyone?

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Originally Posted by osirissail View Post
...* * * * * * Unfortunately "mbianca" post #212 is one of the myths perpetuated by the "opposition" to ACA. It is not true. You can research it and such search results can be found at: http://www.ciab.com/workarea/downloadasset.aspx?id=2102

And from ACA – Obamacare’s Effects on American Expats Living Abroad | Surviving Yucatan
"After 2013, there are the penalties ( “taxes” assessed by the IRS) for not enrolling in an US approved plan. Americans who are NOT residents of the USA, do NOT have to participate. More will be described below on how to qualify as a Non-Resident US citizen."

Thanks for the links. Good objective information which gee...actually references sections of the Act.

A couple more to add to the collection:

The actual law in searchable PDF format

http://www.gpo.gov/fdsys/pkg/PLAW-11...111publ148.pdf

Kaiser foundation site re ACA: Kaiser Health Reform Gateway: Health Care Reform and Health Insurance Reform Analysis, Data and Information

Something I find interesting as an American living abroad, is that if I want real unbiased information regarding what is going on the USA then I am better off tuning in to good quality non-USA sources like the BBC. The rabid misinformation being spewed 24x7 in the USA now is disturbing -- especially concerning "ObamaCare". Maybe this will subside somewhat now that it is post-election.

As we have seen form the discussion on this forum, getting at the facts requires some effort.
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Old 10-11-2012, 14:59   #242
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Re: Obamacare = early retirement anyone?

Raku, jongleur is right!! Try reading Nobel prize winning biochemist author of the Zone diet. Health saving diets are not about cutting calories but changing what you eat especially getting off highly processed and high glycemic and onto low glycemic food.
16 years after racking on the weight after having children my wife knocked 20% of her weight no problem after reading the Zone book- 15 years later its still off. Obamacare might turn out a winner but will never help as much as changing what you eat.
Always be mindful that its not in the financial interests of the present healthcare industry that you should be well. They cannot spend money promoting solutions that undermine shareholders profit.
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Old 10-11-2012, 15:16   #243
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Re: Obamacare = early retirement anyone?

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Raku, jongleur is right!! Try reading Nobel prize winning biochemist author of the Zone diet. Health saving diets are not about cutting calories but changing what you eat especially getting off highly processed and high glycemic and onto low glycemic food.
16 years after racking on the weight after having children my wife knocked 20% of her weight no problem after reading the Zone book- 15 years later its still off. Obamacare might turn out a winner but will never help as much as changing what you eat.
Always be mindful that its not in the financial interests of the present healthcare industry that you should be well. They cannot spend money promoting solutions that undermine shareholders profit.
I agree. Read Wheat Belly. I have changed my diet in an easy fashion and have less weight, more energy and less medical problems.
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Old 10-11-2012, 15:47   #244
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Re: Obamacare = early retirement anyone?

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Always be mindful that its not in the financial interests of the present healthcare industry that you should be well. They cannot spend money promoting solutions that undermine shareholders profit.
That is what I worry about. And I think the banks are getting paid the unused FSA money, and they charge 3% fees on HSA money if you aren't adding to it...

There are too many vested interests willing to spend lots on ads and blogs misleading the people. I will admit that I don't know everything with regard to the healthcare system, but I shouldn't have to. I just don't want to get screwed, yet receive good care when I need it.

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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
And that is a big issue. Why is it not brought up? What solution is there? You can give the insurance companies more power to only pay $X amount, the government more power to set prices, or the doctors need to have incentives to pick the best facility for care at the least expense. And I wouldn't be surprised if the opposite is true today. Is it the local government's job to have a price list on-line for people to compare? Should the media be investigating this? Or is there a difference in the level of care for that extra money? Can you get in within an hour if you pay $200 compared to waiting a week for the $40 treatment?

I'm sorry, but asking a person in pain to 'shop around' for the lowest cost option isn't going to work very well, even though from a macroeconomic view it would help lower costs. I will say that I hate the way the billing and cost information is though. I had no idea a CT scan cost $4,000, and that was probably cheap. I found out a few weeks after when a bill came in the mail. Except it wasn't a real bill. The health insurance company paid that, but I got something in the mail asking me to pay $1000 when it was covered by my insurance.
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Old 10-11-2012, 15:57   #245
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Re: Obamacare = early retirement anyone?

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I heard a great story about a practice who's rates were cut and cut. So he gave up direct coverage. This means you can apply to your insurance for some coverage but the office won't. Fair enough if you want this doctor you will deal with the paper work and pay. Hard to feel bad when this practice has offices in the highest value property in the USA. Try getting an appointment.
That is basic supply and demand. The USA needs more medical care practitioners. Less at fault lawyers and more small towns.
I
Can't get more doc's not enough room in med schools. Who controls who can be a med school? Doc's!!!
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Old 10-11-2012, 16:21   #246
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Re: Obamacare = early retirement anyone?

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Originally Posted by tookish1 View Post
Our $3,000/month cruising budget hinged on health care costs. With pre-existing conditions, we could not have afforded to cruise and pay $1,200+/month for health care. Risking going without was not an option.

With Obamacare now a certainty, a cruising couple making less than $50,000/year from any form of income (no means testing!) will not pay more than 9.5% of income for health insurance ($395/month!)

Whether we like or don't like Obamacare, the economic reality for us, is that retiring and cruising is now possible and I'm wondering if it has had the same effect on anyone else??
Do you know that Obama care won't help you a bit off-shore? You will need to buy insurance and probably ALSO pay into the Obama-crap.
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Old 10-11-2012, 16:25   #247
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Re: Obamacare = early retirement anyone?

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Do you know that Obama care won't help you a bit off-shore? You will need to buy insurance and probably ALSO pay into the Obama-crap.
International health insurance might count as having coverage... And your anger should be directed at health insurance companies that won't cover you outside the US.
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Old 10-11-2012, 16:41   #248
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Re: Obamacare = early retirement anyone?

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And that is a big issue. Why is it not brought up? What solution is there? You can give the insurance companies more power to only pay $X amount, the government more power to set prices, or the doctors need to have incentives to pick the best facility for care at the least expense. And I wouldn't be surprised if the opposite is true today. Is it the local government's job to have a price list on-line for people to compare? Should the media be investigating this? Or is there a difference in the level of care for that extra money? Can you get in within an hour if you pay $200 compared to waiting a week for the $40 treatment?

I'm sorry, but asking a person in pain to 'shop around' for the lowest cost option isn't going to work very well, even though from a macroeconomic view it would help lower costs. I will say that I hate the way the billing and cost information is though. I had no idea a CT scan cost $4,000, and that was probably cheap. I found out a few weeks after when a bill came in the mail. Except it wasn't a real bill. The health insurance company paid that, but I got something in the mail asking me to pay $1000 when it was covered by my insurance.

The solution, as I see it, is already starting in the form of HSA and other vehicles designed to create more incentives for consumers taking more charge of their health care choices.

In my own world, we've got about ~$10k in an HSA fund right now so I really do have a vested interest in picking lower cost providers.

It really just boggles my mind that folks sit around hand wringing about health care costs but do nothing on their own to try to reduce costs. You can literally cut your expenses in half (taking insurance out of the equation for a bit) just by choose different providers.

Until there is price competition in medicine, there is zero incentive for providers to control costs. There is no God-given standard that radiologists should get 400k a year, which is their current median salary. I'm all for folks making money, but I'd prefer it to be inside the confines of a free-ish market system. The American medical system is *far* from that.
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Old 10-11-2012, 17:16   #249
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International health insurance might count as having coverage... And your anger should be directed at health insurance companies that won't cover you outside the US.
Yes that's the issue not Obamacare. In my case ( non us) I have domestic health insurance. It covers me in foreign countries for emergency care and then provides medical repatriation. Note that even countries with socialised medical care can still charge you for emergency. I was charged for 2 nights in Germany yet I blue lighted in. I had to pay and my insurance repaid me.( this was before the introduction of the European wide E111 system ) I can see cruisers would actively want keep Obamacare if cruising abroad because if you are really sick most people want to go home. Particularly if the lower costs of Obamacare are the case.

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Old 10-11-2012, 17:38   #250
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Re: Obamacare = early retirement anyone?

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Politics schmolitics, whatever...

The conclusion is valid. This is why the French are good sailors (just compare the crowds at the Vendee Globe village that started TWO weeks before the start to the Volvo Ocean Race stop in Miami last year).

Pursuing lifestyle choices other than work is less risky now.

Or you can go cruise the world and pay out of pocket even less than Obamacare premium.
Anyone who owns a Dragonfly is on the informed side. I have also found it is much cheaper to just pay for any needed medical procedure in any country you cruise to outside the USA. Cost factors are 10 and 20 to 1 compared to the US costs. How about the fixing of a compound fracture running $700 in Mexico about 20 years ago.
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Old 10-11-2012, 17:38   #251
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Re: Obamacare = early retirement anyone?

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Boy, you hit a sore nerve on that one - - My cruising life was brutally ended when I collapsed in St Thomas and had to be Med-evac'd back to the USA and immediately put into a top-notch cancer center.

For the lack of taking a US$10 annual screening test I am now a "walking dead-man" being kept alive by an experimental new drug treatment. Jimmy Buffet has a song that is one of my favorite cruising songs titled "One Particular Harbor." And after a decade of Caribbean cruising there are indeed some harbors that fit that song title.

However, now I have had to change the title a bit to fit my circumstances and it is "One Particular Truck" - The 24/7/xx continuous moderate to severe pain even with copious amounts of Opium derivatives gets to you so much I pray for that "One Particular Truck" that I can step in front of and end the pain and agony.

All for the lack of getting that US$10 test every year which would have indicated that I was developing a problem which then could have been treated and my cruising life could have continued.

Every human male on this planet will die from Prostrate cancer unless something else kills them first. It is the curse of being male just like breast cancer and other reproductive cancers in women will "get them."

As I said first, I was put into the best cancer hospital here in central Florida and assigned one of the best oncologists - and - I am financially totally dependent upon Medicare and AARP Supplemental to pay the bills. So don't worry about being able to "pay for" treatment so long as nobody screws with the Medicare system. With virtually** 100% of folks over 65 years old having no choice but to enroll in Medicare, doctors also have no choice (if they want patients) to accept Medicare. (** acknowledging that politicians, military, and the 1% super-rich have their own better medical coverage).

However, as mentioned by others, medical care while you are cruising outside the USA is not covered by US medical insurance and Medicare except for some small short term "travel medical insurance" situations. To avoid having to pay the miniscule "co-pays" charged by the doctors, hospitals, clinics (and even private hospitals) outside the USA, you can buy International Medical Insurance policies. I.M.I.S. offers them at IMIS Online Services

Thanks to A.C.A. (Obamacare) you can now resume your medical coverage for inside the USA without having to pay yearly for medical insurance you cannot use while you are outside the USA. There is some "fine print" attached to that, but in real life, my wife only had to go 6 months "un-covered" after we returned back to inside the USA and she could get covered by PCIP.gov.

* * * * * * Unfortunately "mbianca" post #212 is one of the myths perpetuated by the "opposition" to ACA. It is not true. You can research it and such search results can be found at: http://www.ciab.com/workarea/downloadasset.aspx?id=2102

And from ACA – Obamacare’s Effects on American Expats Living Abroad | Surviving Yucatan
"After 2013, there are the penalties ( “taxes” assessed by the IRS) for not enrolling in an US approved plan. Americans who are NOT residents of the USA, do NOT have to participate. More will be described below on how to qualify as a Non-Resident US citizen."

I am so sorry to hear about your illness. The same thing happened to my father. Very fortunately, my BIL, who had moved to a new city, walked into a doctor's office and asked for a physical, and they did catch it in time.

Prostate cancer (as you know) is a silent killer -- unless you see a doctor once a year or so. In that case your odds are much better.

That said, there's a significant minority who are not eligible for Medicare, including most public school teachers unless they were married to and a survivor or a non-public school teacher. So if my daughter dies before my SIL, my SIL will not be eligible for Medicare under the current rules, just as I have my late husband's SSN on my Medicare card.
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Old 10-11-2012, 18:00   #252
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My problem is there is federal and municipal dollars being spent in healthcare. Access to healthcare is a random act. You may be for given or you may be bankrupted. Even insurance is random on what they cover.
I have premium blue cross coverage I need a lawyer to figure out what they are doing. Funny too I sometimes get checks in the mail from them. No idea why. Guess its covering the expense that they would not cover but because I'm covered they cover it by sending me a check. I'm a mechanical guy not a paper person. My excuse for not giving a **** about how dumb this system is. Really it can't be this convoluted.
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Old 10-11-2012, 18:13   #253
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Re: Obamacare = early retirement anyone?

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..............I had no idea a CT scan cost $4,000, and that was probably cheap. I found out a few weeks after when a bill came in the mail. Except it wasn't a real bill. The health insurance company paid that, but I got something in the mail asking me to pay $1000 when it was covered by my insurance.
Interesting. Here in 'socialist medical care' Canada, an MRI is free, but there may be a wait if it is not a critical situation. One can go get one done in a private clinic, and it costs about $700, with no wait time.

I can't see how a CT is almost 6 times as much. But then, I don't understand the US health system, and I am willing to bet most in it do not either.
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Old 10-11-2012, 18:20   #254
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Re: Obamacare = early retirement anyone?

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The solution, as I see it, is already starting in the form of HSA and other vehicles designed to create more incentives for consumers taking more charge of their health care choices.......
I've had some variation of HSA and high deductible policy for many years. For me, this approach works great, keeps premiums down, and as you point out, makes me more conscious of what I spend for healthcare because the first $5K per year comes directly and totally out of my HSA. Thankfully my annual healthcare cost have always been WAY less.

I think, for those who can afford this approach, this would be a fine way to put competitive pressure on the USA healthcare system. Healthcare delivery costs, and thus insurance premiums, are out of control in the USA. Putting market pressure directly on the providers, and the insurance carriers, could be an effective way to start getting those costs in line.

Why, for example, is the average price for an endoscopy in the USA $2,700? When I can get the same procedure here in Guatemala, at a first class facility (no quality is NOT the difference), for about $650 -- about 75% less??
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Old 10-11-2012, 18:21   #255
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Re: Obamacare = early retirement anyone?

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I can't see how a CT is almost 6 times as much. But then, I don't understand the US health system, and I am willing to bet most in it do not either.
because we pay for the 5 other people that were treated in an ER, and profit for the insurance carrier.
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