Obamacare = early retirement anyone?

[Charlie]

Originally Posted by Stumble

Not that I claim to be an expert in this field, but both my brother (hospital administrator) and step mother (head of the masters in medical management at Tulane University) are. Instead of responding off the cuff I asked them a) what the ACA generally is, and b) the major parts of the plan.

From them the boiled down simple answer is that the ACA does not provide insurance for anyone, nor does is regulate the practice of medicin. What it can best be considered is a massive rewrite of the health insurance regulations dealing with what insurance policies must cover, how they have to deal with clients, and the way that risk pools are constructed and maintained.

She then suggested I take a look at Healthcare Management | Healthcare Consulting | Behavioral Health Consulting | Behavioral Health Management that has an expert though uncomplicated review of what the act actually does. From them I am going to post a brief synopsis of what the ACA actually does, and the changes it makes.

- health insurers can no longer refuse or drop coverage based on patients’ medical histories or because of a pre-existing condition
- health insurers cannot charge different rates based on patients’ medical histories or gender
- establishes minimum standards for qualified health benefit plans
- young adults can remain covered under parents until age 26
- most employers must provide coverage for their workers or pay a surtax on the workers wage up to 8%
- an expansion of Medicaid to include more low-income Americans by increasing Medicaid eligibility limits to 150% of the Federal Poverty Level and by covering adults without dependents as long as either or any segment doesn’t fall under the narrow exceptions outlined by various clauses throughout the proposal
- a subsidy to low- and middle-income Americans to help buy insurance
- a central health insurance exchange where the public can compare policies and rates
- requiring most Americans to carry or obtain qualifying health insurance coverage or possibly face a surtax for non-compliance
- a 5.4% surtax on individuals whose adjusted gross income exceeds $500,000 ($1 million for married couples filing joint returns)
- inclusion of language originally proposed in the Tax Equity for Domestic Partner and Health Plan Beneficiaries Act
- inclusion of language originally proposed in the Indian Health Care Improvement Act Amendments of 2009

Thank you for this. I have been reading thru this thread wishing there was a place to get an unbiased report on the ACA.

[belizesailor]

Originally Posted by svHyLyte

...

Folks do not provide for themselves and their needs when they are confident others will pick up their burdens. They suffer no consequences for such an approach. Frankly, it's not the fault of the majority of people at this point as they have been raised with, nearly, every want provided for by someone even before many of these wants become manifest. My own daughter, who I love quite dearly, was a perfect illustration in her time

...

I think the very popular spoiled child comparison is a gross over simplification of the healthcare situation in the USA. It is far more complex.

While there are certainly those in the USA who fit this cliche and have never taken responsibility for anything in their lives -- to the extent they have no concept of it. I also know a number of Americans, who have worked hard all their lives, and taken responsibility for themselves, who now have no health insurance, or who have their options seriously constrained by concerns over healthcare coverage. The excessive costs of the USA system have simply risen to a point they can no longer even afford the insurance premiums, much less pay costs out of pocket. These are not irresponsible deadbeats -- these good people with incomes well above the current poverty line. The few that I know are not just isolated cases, there are millions of Americans who fall into this category.

I am all for changing the system and the culture so that more people take accountability for themselves, but this is not just an issue for people who fall into that category. Many responsible Americans are simply being crushed, or at least seriously constrained, by healthcare related issues. As a result they are limiting their careers, their business ventures, and of course can't even dream of going cruising.

And, I also know quite a few cruisers who are without health insurance for similar reasons, but offshore they can realistically afford to pay for their healthcare.

[thinwater]

Originally Posted by Charlie

Thank you for this. I have been reading thru this thread wishing there was a place to get an unbiased report on the ACA.

Wiki has a write-up. Can't witness to the accuracy, but on those engineering and chemistry topics where I consider myself very knowledgeable, they seem fair if always a bit simplified... but that is the aim. If you need more, the references are there.

[xymotic]

Originally Posted by svHyLyte

I don't see what the point of this debate is.

Maybe step out of the bubble for two minutes and read a post or two and you MIGHT expand your world view a little bit.

Obamacare in its current incarnation is the law of the land and those choosing to reside here (USA) will have no choice but to endure it. One's options then are to simply maximize one's own benefit while minimizing ones own losses in the regime.

Or not.

The essential problem is that in this issue, as others, there are more takers than givers

The entire society has been paying for indigent emergency care for 30 years. Obamacare forces everyone to pay *something* towards that. Everyone is giving so what is the problem? You would rather just let people die in the street?

[terminalcitygrl]

This language of the "givers and the takers" is so FOX news. It's oversimplified pablum for people looking for an answer that doesn't involve a whole lot of soul searching, rational thought or the taking of personal responsibility. Obama won because the majority of folks who voted in the US believe he is the best man for the job. We're all gonna get to see how things improve or go to hell in a hand basket under Obamacare over the next four years so you know, grab some popcorn and chill. Maybe things and people are not as horrible as FOX news prognosticates.

[propellanttech]

I love the posts which focus on the expense of the medical field in the US.

None of you know anything about expenses.

Let me explain why medical care is so expensive in the US:

When someone can sue McDonalds for burning themselves with a cup of coffee, this country has a problem. It is known as the legal system.

For every doctor or nurse, there are 4 to 5 people doing paperwork. Services and drugs cost money, but labor is the most expensive thing any business can have.

Then you have the ambulance chasers (Sleezy lawyers) which are just waiting on a human to make a mistake. They get a client, sue, and take most of the money for themselves. This works, because our legal system is broken.

Who pays those bills? Well, when filtered down, it is you, the insurance payer, or medical bill payer. The government wants you to think it is the non-payer that make the rates and costs so high. It isn't true.

Ask a doctor what he makes a year, gross and net. You will be surprised how much difference there is. This is due to liability insurance he must carry. Is a doctor overpaid? That may be so, but he did spend a major part of his life to get the ability to practice medicine. I have to say, I think it is worth it.

American's have been duped into thinking it's the non-payers who have screwed them. It's the lawsuits which have screwed them.

The ACA will not fix the broken legal system.

If you don't believe me, just turn on a TV that is not on cable. I bet within 30 minutes to an hour you will see at least one ambulance chaser commercial.

Keep believing it's the people with no insurance, it is the "smoke and mirror" game. They do it all the time.

Why would the system need 4-5 paper pushers for every doctor and nurse? To keep up with the paper work for lawsuits. The more evidence they have, the better chance they have in court. The system is too complicated.

The ACA does nothing to fix this situation. How long do you think the current stated rates (insurance costs) will remain at this level? Not long......they will go up.

James L

[sailorboy1]

I wish there was more discussion about how Obamacare is going effect cruisers from the US and much less about the problems of US health care etc.

I guess the cost of US health care is a cruiser related topic in general. But we all know the answer far as a cruiser is concerned.

[chrisferro]

James is dead-on.


Obamacare requires all insurance policies to cover anything and everything under the sun - including lots of stuff that many of us don't want or need. Thus will increase costs to the insurance companies who will then raise premiums to cover them. Obamacare also requires insurance companies to cover all sorts of preventive care with no out of pocket costs from the patient at the time of care. This will also cause insurance companies to raise premiums to cover these added costs. Obamacare also raises taxes on insurance companies, which will lead to higher premiums. It also raises taxes on medical devices, which will increase costs and premiums. It also forces businesses to buy policies for their employees, which will increase labor costs, which will in turn increase unemployment and cause general price inflation society-wide. It will also limit the profit margins of insurance companies with the medical loss ratio rule. This will also increase premiums because, if you are only allowed to keep 20% of "X", then your incentive is to increase "X" ("X" being total premium payments collected). All of this will also increase demand for health care services while disincentivizing the expansion of the supply, which will result in shortages and rationing.

Anybody who thinks these idiots in Washington have magically solved our problems is in for a rude awakening.

Too late now, though. What's that old saying: "You get the government you deserve..."

Good luck to us all...

[propellanttech]

Originally Posted by Don Lucas

I wish there was more discussion about how Obamacare is going effect cruisers from the US and much less about the problems of US health care etc.

I guess the cost of US health care is a cruiser related topic in general. But we all know the answer far as a cruiser is concerned.

The problem as I view it.

We have no idea how it will affect the general public. Getting more specific to the life cruisers is just unknown.

I hope it won't affect them at all, as I plan to become one within the next year.

Changes to the ACA are an absolute, but we have no idea what way these will go.

As I understand (which is very limited), if your under the poverty limit, you are safe. If you are not, you will be required to carry insurance or pay the standard rate, even though the standard insurance probably won't cover you outside the US.

Since the ACA will be an evolving situation, it's just hard to calculate what true effect it will have.

I don't think anyone has any more information at this point.

James L

[micah719]

if your under the poverty limit, you are safe. If you are not, you will be

Sums it up quite nicely.

p.s. Does the aspect that the folks that passed the thing exempted themselves and their buddies from it, not make you at least a little wary?

[propellanttech]

Originally Posted by micah719

Sums it up quite nicely.

p.s. Does the aspect that the folks that passed the thing exempted themselves and their buddies from it, not make you at least a little wary?

Well, this can be taken a few different ways.

If I'm out of the country, then the system is not going to be paying for my routine medical care anyway, so why feel bad about it.

On the other hand, if I do find myself needing major medical services, the ACA is irrelevant in my case anyhow. I'm a Vet. so I can get free medical anyway.

No matter which way I go, I'm not screwing anyone anyhow.

As for the people who are not Vets, I guess it depends on how long they supported the non-payers.

This debate is about morals........and some people believe they paid their debt.

Not for me to judge them,

EDIT:(helps if you read carefully)......

Makes me weary that the people voting on the rules of this plan are not covered by it. /EDIT

James L.

[micah719]

Sry James, couldn't resist....shows what one can do to context with cut & paste.

A few pages ago a poster from France (or, the Euro province formerly known as France...) gave an accurate summary of what socialised medicine has done for us.

For the folks touting Obomney/Robama care (doesn't matter which mascot's name you paste on it...), consider the possibility that your screwed up medical system was deliberately screwed up so that this "solution" could be presented. Research "Cloward/Pivens Strategy".

[Greggegner]

Wow, in skimming all the posts we have lots on opinions with little to know facts associated. Take tort reform to reduce healthcare costs the URL below site no reduction in malpractice in Texas when tort reform was passed. The US is already paying for all the bad habits. In fact because of our system we pay more than anyone else in the modern world. That might be ok except as a whole we are not getting better out comes, see URL below. Hopefully with Obamacare more people will get early and preventative care. This should reduce the cost you are already paying, let me repeat you are already paying.


Tort reform URL:
http://www.utexas.edu/law/magazine/2...s-to-medicare/

US Heathcare ranking 2011:
http://thepatientfactor.com/canadian...ealth-systems/

[Christerart]

Originally Posted by avb3

Being Canadian, I can't even fathom that not getting medical coverage because of a preexisting condition. Different solitudes for sure.

Being Swedish, having lived in the US for a large part of my life and now in the UK, neither can I.

As far as I am concerned it is a human right - and most civilized countries seem to feel the same.

There are much info on the net about this topic; for example the last year the world health care rankings (2000) were produced, the US ended up far down the list:

The World Health Organization's ranking of the world's health systems

I would think most Americans would think it is surprising to find states like San Marino, (#3), Andorra (#4) Malta (#5) Oman (#8) Columbia (#22) are ranked higher than the US (#37).

As I kept my Swedish citizenship I am fully covered for everything here in the UK (being 60+ I do not even pay prescriptions) and a small charge for dental work if I care to use the NHS:

Who is entitled to free NHS dental treatment in England? - Health questions - NHS Choices

In addition, if I travel in the EU I am automatically entitled to the same care as any covered citizen in the country I am visiting:

http://www.nhs.uk/NHSEngland/Healthc...ountries.aspxz

However, no one really knows how long this will last as the Tories (read Republicans) are trying to privatize part of the health care system and have started by selling off hospitals to "Qualified Providers" - some of which are for profit and some are non-profit.

Anyone remember the 70's and 80's in the US when hospitals started to be turned into For Profit and what happened to insurance premiums?:

http://www.nytimes.com/2012/08/25/op...hospitals.html

C

[minaret]

Originally Posted by propellanttech

When someone can sue McDonalds for burning themselves with a cup of coffee, this country has a problem. It is known as the legal system.

This is one of the most classic examples of right wing corporate propaganda out there. Whenever I see someone mention it I know they are a victim of corporate media spin. The original case, the most propagandized example of a "frivolous lawsuit", has been repeated many times. The woman in the first case suffered third degree burns to a substantial (and important) portion of her body. Many others have as well. And then they were attacked in the media for "frivolous" lawsuits. Tell me, would you sue if this was your elderly mother? Tell the truth now...


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