Obamacare = early retirement anyone?

[tomfl]

Originally Posted by osirissail

SNIP

Bottom line, there is no shortage of available doctors

SNIP

We may have to agree to disagree about this. I would point out wiki says:

"Globally, the World Health Organization (WHO) estimates a shortage of 4.3 million physicians, nurses and other health workers worldwide".

Wiki goes on to point out that Obamacare will increase the demand for health care services while the supply of these services will remain relatively constant, or perhaps decrease according to some sources:

"With the expansion of Medicaid and a decrease in incentives and reimbursement rates in 2014, the supply of physicians in Medicaid may drop substantially, fluctuating the supply of Medicaid physicians. A study examining variation between states in 2005 showed that average time for Medicaid reimbursements was directly correlated with Medicaid participation"

Here is the wiki link to those quotations:

Physician supply - Wikipedia, the free encyclopedia

While this is far from my area of expertise I do have post graduate training in Urban and Regional Planning (as well as course work for a law degree) and was required to take at least one health care planning course as a grad student. For as long as I can remember there has been agreement among health care planners that there is both a shortage of health care professionals in general and doctors in particular which is made worse by a geographic misallocation of health care professionals. Rural and poor urban areas are under served while middle class and above areas generally have a better supply of health care.

Another factor to consider is that health care workers/doctors are not an undifferentiated commodity; just as some sailors are better than others some doctors are better than others. As a rule the best doctors have more choice in which patients they care for, and often are sought out by patients with resources to pay more for their services.

Almost everyone agrees there are real problems with the health care system and how services are allocated and these issues should be addressed. This does not preclude the fact that there is wide spread agreement there is a doctor shortage.

[Christerart]

Originally Posted by tomfl

I am not sure what point you are trying to make with this post.

Your lists have to do with revenue, not R&D. Not to mention the revenue is not broken out by country. To make matters worse you go to post prices for the same drugs are higher in the US than elsewhere implying foreign drug companies may be making more revenue in the US than outside.

I am not trying to make any points at all. I simply pointed out that your statements are perhaps not quite factual.

Reading the page I linked to seem to verify that. All drug companies today as far as I understand are multi-nationals and *where* they do research and are based are more due to financial and economical circumstances, regulations and laws (and profit incentives) than anything else.

"During the past several decades, the pharmaceutical industry in the US - more than half of which comprises European-based companies - has largely been the most profitable industry in the nation's economy, thanks to mechanisms such as the lack of a government-imposed pricing structure. "Free pricing and fast approval secure rapid access to innovation without rationing," said Daniel Vasella, the former head of (Swiss-based) Novartis, of the advantages of doing business in the US."

From "The great billion dollar drug scam":

The great billion dollar drug scam - Opinion - Al Jazeera English

more:

List of pharmaceutical companies - Wikipedia, the free encyclopedia

HOW MULTINATIONAL CORPORATIONS AVOID PAYING THEIR TAXES

[Pat Ross]

Originally Posted by osirissail

So these numbers are all over the place which leads me to the conclusion that the news releases about access to Medicare doctors is being "spun" as a bargaining tactic and is not actually a problem.

This has been my experience for the last 10 years, never denied service or ever brought up as an issue using medicare. 3 Surgery's different doctors, 4 different specialty uses and multiple doctors in these specialty's with two treatment experiences with Physical Therapy, medicare was a non issue.

[capngeo]

I retired from the Fire Department earlier this year. With that retirement, went my health insurance. I could have COBRA'd coverage at $900/mo, and declined.

I shopped around and found coverage for $200/mo with a $5000 annual deductible. All preventative care is covered at 100% as is EVERYTHING above $5k with no limit. The best thing is the discount I receive on services is the same as the insurance co gets.

On a recent trip to the dermatologist (a necessary evil for we tropical sailors), the doc sprayed a dozen "spots" that she didn't like. The "retail" price was........$42 per two second spray! I mean c'mon a squirt of liquid nitrogen for $42!!! The rate the insurance company allows (and the rate I pay by default), is $6... SIX DOLLARS! Had I not been "insured" my out of pocket would have been over $500, but as an insured I paid $72 out of pocket WITH ZERO CONTRIBUTED BY INSURANCE!

I'll stop here, as I feel a very non-moderator-like political rant coming on about health care reform.

[Captain Bill]

Originally Posted by Christerart

Actually, of the top 10 drug companies (by revenue, 2008), only 4 are American.

This is of course a technicality as they are all world companies.

Pharmaceutical industry - Wikipedia, the free encyclopedia


1 Pfizer USA
2 Novartis Switzerland
3 Merck & Co. USA
4 Bayer Germany
5 GlaxoSmithKline United Kingdom
6 Johnson and Johnson USA
7 Sanofi France
8 Hoffmann–La Roche Switzerland
9 AstraZeneca United Kingdom
10 Abbott Laboratories USA


And terms of sales, of the top 5, only one is American:


1 Pfizer United States
2 GlaxoSmithKline United Kingdom
3 Novartis Switzerland
4 Sanofi-Aventis France
5 AstraZeneca United Kingdom

And as some have reported in this thread, the exact same drugs are much cheaper outside the US - bad for American residents but good for cruisers.

I used to work for one of these "big Pharma" companies and can tell you that the reason that US drug costs are so high is not because the US fails to negotiate drug prices. It is because the US is the only industrialized country that does not limit drug prices by law. The other countries do not allow drug companies to recoup losses on their drug research in the prices of their drugs, so they make up for it by charging high prices in the US. Drug research is very expensive and most drugs do not actually make it to market for a number of reasons. One popular drug my company made cost $80/month in the US and $8 per month in Denmark. If the rest of the first world countries would allow the recovery of reserarch expenses then everyone in the first world would have to pay something like $12-$15 a month for the drug. The problem is a fair trade issue, not a health care issue. The other option is that the US adopts the same standard as the rest of the world and then all drug research by private companies would stop. While governments do sponsor university type research that results in discovery of promising compounds, none of then conducts, or has the ability to conduct, the clinical trials needed to bring the drugs to the masses.

Now put this post back on the sailing track.... I've noted that "Obamacare" raises the income levels regarding eligibility for Medicaid. Some people seem to think that people would be able to bring their boats back to the US and be eligible for Medicaid. What I have not seen is any wording in the act that changes the asset tests for medicaid eligibility. Recently we had to look into this for an elderly relative. Essentially even if you had no income you still had to have no assets you owned. A family was allowed to "own" one car. You could not own a house with any equity. If you could not qualify for a mortgage you had to sell the house and use up all that money before becoming eligible. Now this is the key item for this forum, you could not own a boat. Now this may vary a bit from state to state, but the eligibility requirements for medicaid are that you essentially have exhausted all of your assets, not just your income level. Maybe I'm missing something but the only thing I see the act changing is the income limitation.

[svHyLyte]

Some interesting developments.

1. We just received an invitation to attend a Reception at our family doctor's office/practice. Since she lives a few doors away, I ran into her when I went to collect the mail last evening and asked her what's up with the "Reception". It seems she's converting her practice to a "Concierge" service because of the new "rules". Now, unless you're a member of the service, you will only be able to get an appointment on a very limited basis and if on Medicare, not at all. Membership is expected to cost $2500 to $3000 per annum, payable in advance. Even to your best friends/neighbors? Yep.

2. In the course of discussing the foregoing, I mentioned that I had looked into signing up for Social Security, which I have not tho' could have for some time. Doing so, however, requires one to also sign up for Medicare whether one needs it or not--we don't as we have an excellant health care plan albeit with a high deductable although we have built up a well funded Health Savings Account for that. It seems, however, that if I am forced to sign up for Medicare, our physician is disallowed to accept payment for any treatment save by Medicare, regardless of my/our willingness to pay out of pocket which we have always done in the past. Now, think about this. When I shattered my arm a couple of years ago, I had to have an MRI. Since we paid cash, in advance for the procedure, the charge was a bit over $600. It seems that via medicare, the same procedure is billed at over $4,000, of which we must pay 20% out of pocket. About $800 or 1/3rd more than the cash up-front payment cost. Well heck, I'll just pay cash up front! Nope. Can't do it if one is on Medicare. Against the rules.

3. While looking into the Social Security matter at the Agency's local office a pleasent middle aged woman outlined all my "entitlements". She also pointed out that if my wife chose to, she could stop working and go on disability (as she's not yet entitled to her full benefits). When I pointed out that my wife's not disabled, the lady kindly pointed out that it didn't matter. If I went to a certain law firm here abouts, they could arrange it for us as "depression" is adaquate cause for disability (and every middle aged woman is depressed about something or another)! Then, when she reached full entitlement age, she could switch over to Social Security!

What a scam--our combined benefits under the above model would be almost $6,000 per month! (Cruising here we come!)

4. My "helpful" Social Security lady also asked me if I had applied for..."Food Stamps"! Ah, no, I don't think we would qualify for that. Well it seems, another law firm specializes in setting up Trusts into which one transfers one's assets. With this and only Social Security/Disability Income, Bingo! One is entitled to Food Stamps with the double benefit that one's assets can be transferred to ones' children without any tax consequences when that time comes. Are you sure about this I asked. Oh yes, why we "help" people all the time with this. And best of all, the Food Stamps now come in the form of a "Credit Card" that you just run through a scanner at the grocery store like a debit card so there's no "embarrasment" (i.e. having to peel off stamps in front of fidiging, disapproving, cash buyers in line behind you). It seems that even if one lives in Florida, the "credit card" can be used anywhere for anything other than booze and tobacco.

Bingo! Provisioning!!! (Cruising here we come!)

While I have a hard time believing some, if not all of 3 and 4, above, this nice lady had no reason to BS me (as she patiently explained, "Our job is to help people and the more we help the better for our office.")

Interesting, eh?

[LauderBoy]

Originally Posted by Paul L

Not sure what items you plan to pay with the built up reserves in your HSA after 20 years. Many people seem to treat insurance as pre-paid health care, as opposed to insurance. You need the insurance to cover the unlikely event that you get hit with a serious illness that might easily cost $500k to $2mil US. So an HSA isn't likely to cover this. You still need catastrophic health insurance if you wish to ensure that you don't become one of the health care bankruptcies.

A HSA comes tied with a high deductable health plan. The ones I looked at have you paying either 3 or 5k yourself, then they cover 100% after that.

I'd still keep something of a high deductable critical care plan(until I hit the age for medicare). But the saved up HSA would be useful for prescriptions, usual care and paying any deductibles.

[Greenhand]

Originally Posted by svHyLyte

I mentioned that I had looked into signing up for Social Security, which I have not tho' could have for some time. Doing so, however, requires one to also sign up for Medicare whether one needs it or not.

I don't know how these rumors get started. My in-laws firmly believed it to be the other way around - they could only get Medicare if they signed up for SS. Neither one is true. Both programs are designed to be security networks, to help those who need them; no one is forced to sign up for either, not even to receive one.

Furthermore, if you had some idiot pointing out every loophole possible, that is not better for her office. It isn't like they receive commission and she was guilty of inciting to fraud.

[muskoka]

You don't meet citizens from any western country (US aside) offering universal health care who think it's a bad idea. There are certainly national health plans which are better executed than others, but most seem pretty well suited to serve the purpose for which the were designed.

I only weigh in because I've read a few trollish posts which imply that the national healthcare programs in Canada and the UK, etc. are dysfunctional messes. Examples to be avoided even.

Having had to deal with elderly parents and relatives in both countries, I'd say that national health care systems have been indispensable in caring for, and treating ailing and elderly family members. Perfect, no. Essential, very much so.

I don't much care how US citizens decide this issue for themselves. I do take umbrage with trolls who suggest that UK / Canadian etc. systems are failures. Nothing is further from the truth.

[Hudson Force]

We expect further posts here to remain on topic without rancor and sarcasm.

[micah719]

You don't meet citizens from any western country (US aside) offering universal health care who think it's a bad idea.

Correction.....me. The non-trollish micah. I worked in aged care here in Teutonia for three years, and have studied the systems in depth. There isn't much positive at all to say about the mess, not even "oh well it's better than nothing". Combine the sickness industry with all the other nanny programs, and it's a wonder we didn't go stony broke a lot sooner. Government never does something cheaper or more efficiently than free-to-compete private enterprise, and they certainly aren't doing it out of the goodness of their hearts, nor are their "benefits" without strings attached. But, you've got the thing now, so have fun with it.

[Greenhand]

Is there an example of free enterprise healthcare anywhere?

[svHyLyte]

Originally Posted by Greenhand

I don't know how these rumors get started. My in-laws firmly believed it to be the other way around - they could only get Medicare if they signed up for SS. Neither one is true. Both programs are designed to be security networks, to help those who need them; no one is forced to sign up for either, not even to receive one.

Ah... Sorry old son, case law is exactly the opposit. In a case decided in March, 2011, Hall v. Sebelius, federal Judge Rosemary Collyer allowed three internal rules of the Social Security Administration that make receipt of Social Security retirement benefits contingent upon enrollment in Medicare to stand. Plus, a person who withdraws from Medicare would not only have to give up Social Security retirement benefits, but repay all benefits previously received.

All the plaintiffs [in the case] had paid into Social Security and Medicare throughout their working lives. They were eligible for both programs, but they didn't want to enroll in Medicare because they had their own savings and health-insurance programs that they preferred.

Three of the plaintiffs had Federal Employee Health Benefits, and two of them had health-savings accounts. Two plaintiffs have ample savings and high-deductible health-insurance policies. None of the plaintiffs sought to get any of their Medicare taxes back; they simply don't want to enroll in Medicare -- but [did] desire their Social Security retirement benefits.

Thanks to Collyer's ruling, though, the plaintiffs [were] forced into Medicare and [had] to give up their private health plans and health savings accounts. [All] seniors now must enroll in Medicare, Part A, whether they want it or not. If they don't, their Social Security retirement benefits will be taken from them.

More on the subject is available at 'Entitled' to chains - NYPOST.com

While I had my doubts about my "helpful" lady at the Social Security office, it seems that her information was correct.

Cruising here we come...

[Christerart]

Originally Posted by muskoka

You don't meet citizens from any western country (US aside) offering universal health care who think it's a bad idea. There are certainly national health plans which are better executed than others, but most seem pretty well suited to serve the purpose for which the were designed.

I only weigh in because I've read a few trollish posts which imply that the national healthcare programs in Canada and the UK, etc. are dysfunctional messes. Examples to be avoided even.

Having had to deal with elderly parents and relatives in both countries, I'd say that national health care systems have been indispensable in caring for, and treating ailing and elderly family members. Perfect, no. Essential, very much so.

I don't much care how US citizens decide this issue for themselves. I do take umbrage with trolls who suggest that UK / Canadian etc. systems are failures. Nothing is further from the truth.

My mother, living in a small town about 30 miles from Gothenburg, had a small stroke at the age of 92. Within 2 weeks she was on her feet and walking around in the hospital. Unfortunately she had a fall walking around - the floor was cleaned and wet and someone did not put up a sign - and she broke her hip..

She had the operation and subsequent physio therapy and now, three years later, at the age of 95 she is still living on her own in her 2 bedroom apartment. She's enjoying daily visits by the "Home Help" who look in on her three times daily and take her for walks when the weather permits.

[Greenhand]

The requirements you are referring to are for part A, not for those parts of Medicare that cover your day to day costs, which is what you were complaining about in the first place.