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Old 01-02-2018, 07:10   #136
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Re: Early retirement and health care for boaters

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What we really need here is tort reform and more competition among the insurers.
Tort reform in health care would be aided by a government or insurance framework that serves patients/victims without respect to cause or fault. Tort reform as preached by most businesses is just a one-sided avoidance of responsibility.

There IS something that would reduce costs further than more competition between private insurers: having NO private for-profit insurers. The numbers don't lie...
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Old 01-02-2018, 11:17   #137
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Re: Early retirement and health care for boaters

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Reading that it is easy to understand why USA healthcare is more expensive than other countries.

What we really need here is tort reform and more competition among the insurers. The latter could be achieved by allowing carriers to sell across state line like other insurance carriers already do.

I pay the monthly fee for Medicare but don't use it as I am able to receive healthcare from the VA. The VA here is great although we have all read about the horror stories in other parts of the country. For me the VA is not free but there is no monthly premium and the co-pays are very low.

FWIW Medicare is far from free because, as has been pointed out, every worker pays into it as long as they work even though they can't use it until they are 65 at which point they continue to pay into it if still working and also pay the monthly premium.

Amazon has just announced they are getting in the healthcare business on a "non-profit" basis. That will be interesting to watch.
Not to get political but look up Tort reform in TX. The results of tort reform there were underwhelming.
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Old 01-02-2018, 11:52   #138
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Re: Early retirement and health care for boaters

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Tort reform in health care would be aided by a government or insurance framework that serves patients/victims without respect to cause or fault. Tort reform as preached by most businesses is just a one-sided avoidance of responsibility.

There IS something that would reduce costs further than more competition between private insurers: having NO private for-profit insurers. The numbers don't lie...
Tort reform is not necessarily one sided avoidance as you state. It seems to work in your country.

Yes, I know that you believe government run health care is the best option and that might be true for Canada and other countries with smaller populations but there are almost 10x more people here and government has a hard time running itself never mind a brand new enormous bureaucracy that would need to be created to administer it.

Amazon is coming out with something "non-profit" and that maybe could become the future. We will see.

For now most everyone here who wants health care has access to it.
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Old 01-02-2018, 12:30   #139
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Re: Early retirement and health care for boaters

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...Yes, I know that you believe government run health care is the best option and that might be true for Canada and other countries with smaller populations but there are almost 10x more people here and government has a hard time running itself never mind a brand new enormous bureaucracy that would need to be created to administer it.
Your federal government already runs national programs such as your medicare and medicaid. By all measures Ive seen, these are run as efficiently as most of other national healthcare systems in the developed world. The evidence suggests, therefore, that your federal government is perfectly capable of running an efficient national healthcare system. And further, that this would save your country upwards of a trillion dollars each year.

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Amazon is coming out with something "non-profit" and that maybe could become the future. We will see.
Amazon, JP Morgan and Berkshire Hathaway team up on health-care plan 'free from profit-making' - Business - CBC News

Yes these financial whizzes have identified the actual problem: profit. Markets are wonderful for a lot of things, but not everything. Healthcare is clearly one of those things.

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For now most everyone here who wants health care has access to it.
Yup might destroy some people financially for life, but at least they can access it.
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Old 01-02-2018, 12:33   #140
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Re: Early retirement and health care for boaters

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For an ACA plan it all depends on your income. Im 57 and wife is 56, for 2018 we will take $22417 out of our 401k as income and they results in our health care costing us $22/mo
Can you expand on this a bit? Your annual spend is higher than this (per your monthly spending posts) . Are you pulling the rest from an after tax savings account?
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Old 01-02-2018, 12:35   #141
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Re: Early retirement and health care for boaters

The Amazon-Chase-Berkshire announcement seems to be intended to raise their stock prices, it really says nothing except, foggily, that the three of them REALLY are only going to form a joint self-insurance company.

That's not news, companies self-insure all the time.

Whether they'll open it up and what the details are, all speculation.

Three big companies decide to open a new self-insurance plan, hey, that says something about how the market su***s. The way that the news was put out though, that says "We're manipulating our stock prices" more than anything else.

Tort reform: A real problem to be true. But when some fool doctor does something like remove the wrong kidney, guaranteeing major problems because the other one needs to be removed anyhow and now the patient has to live without any kidneys at all...Oops? Tort reform doesn't seem the same.

Culling out the doctors who should be stripped of any crucial roles, that seems more important. Lucky for them, they've got the AMA to ensure no progress is taken.

Medicare and Medicaid ARE NOT EFFICIENT. They are ripe with corruption as well and suffer from lobbyist pressures. Case in point, a family member was notified of something like 1/2 million dollars in false claims on their account from a bogus HIV clinic and a bogus limb amputation. They picked up on the false claim in weeks. Found out the "clinic" was literally a mailbox in a strip mall. Called CMS immediately. Also the local PD, the county sheriff, and the FBI. Ergh, gee, it's only a half million in non-violent crime, we can't do anything. Oh, and they have 30 days to respond to any questions. Yeah, the fact that your limb is still attached and you haven't ever been there and they don't really exist is interesting, but we have to keep sending checks for the next 30 days and another half million dollars.

A million dollars in obvious fraud, and no one can stop sending checks?

That's a big part of the problem, fraud was and is still rampant, and the system is built to encourage it.
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Old 01-02-2018, 12:46   #142
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Re: Early retirement and health care for boaters

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Yes, I know that you believe government run health care is the best option and that might be true for Canada and other countries with smaller populations but there are almost 10x more people here and government has a hard time running itself never mind a brand new enormous bureaucracy that would need to be created to administer it.
Just some small quibbles: I'm for universal healthcare, and the Canadian government single-payer system is one way to implement that. But there are other ways, involving the private sector, to achieve that too. I mentioned France before.

I don't think a country's size is relevant; i bet China has single-payer .
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Old 01-02-2018, 12:56   #143
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Re: Early retirement and health care for boaters

China has some, ah, quirks. Like taking kidneys from prisoners?

In the US we supposedly tried to rationalize the health insurance business by heavily regulating it. Capping profits and such. But there are always folks who will game the system.

Same thing for the VA, where there was such an outcry about incompetence and forged waiting list records and other failures and frauds last year. That same problem gets raised every few years, people forget it continues time and again.
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Old 01-02-2018, 13:38   #144
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Re: Early retirement and health care for boaters

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Your federal government already runs national programs such as your medicare and medicaid. By all measures Ive seen, these are run as efficiently as most of other national healthcare systems in the developed world. The evidence suggests, therefore, that your federal government is perfectly capable of running an efficient national healthcare system. And further, that this would save your country upwards of a trillion dollars each year.



Amazon, JP Morgan and Berkshire Hathaway team up on health-care plan 'free from profit-making' - Business - CBC News

Yes these financial whizzes have identified the actual problem: profit. Markets are wonderful for a lot of things, but not everything. Healthcare is clearly one of those things.



Yup might destroy some people financially for life, but at least they can access it.

I don't know what "measures" you have seen re Medicare/Medicaid being well run and efficient. Perhaps you have a source?

Running a healthcare system for 350m people is a whole lot more complicated than one for 35m people.

You should swing by some ER's here and observe the people being treated many of whom will ignore the bill. That cost eventually gets passed on to those who do pay or the taxpayers but the sick get their treatment. There certainly are people who take a big hit but that is what catastrophic insurance is for. Now that the ACA is on its last legs and the tax penalty is going away I imagine many more people will now go that route.

There is nothing wrong with business making a profit. It's the engine that runs the machine. And, yes, those certainly are financial genius's but you say it like that is a bad thing. Profit is not a four letter word.

There are improvements to be made here without changing over to a single payer system. You dismiss them too readily.

Look, you like big government. I get it. I prefer government get out of the way whenever possible. Different strokes. Different countries. Vive la difference as the French would say. Maybe even the Canadian version?

One thing is for sure, the business climate here is changing favorably and rapidly and that should have a positive effect on health care among other things.
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Old 01-02-2018, 14:15   #145
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Re: Early retirement and health care for boaters

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I don't know what "measures" you have seen re Medicare/Medicaid being well run and efficient. Perhaps you have a source?

Running a healthcare system for 350m people is a whole lot more complicated than one for 35m people.

You should swing by some ER's here and observe the people being treated many of whom will ignore the bill. That cost eventually gets passed on to those who do pay or the taxpayers but the sick get their treatment. There certainly are people who take a big hit but that is what catastrophic insurance is for. Now that the ACA is on its last legs and the tax penalty is going away I imagine many more people will now go that route.

There is nothing wrong with business making a profit. It's the engine that runs the machine. And, yes, those certainly are financial genius's but you say it like that is a bad thing. Profit is not a four letter word.

There are improvements to be made here without changing over to a single payer system. You dismiss them too readily.

Look, you like big government. I get it. I prefer government get out of the way whenever possible. Different strokes. Different countries. Vive la difference as the French would say. Maybe even the Canadian version?

One thing is for sure, the business climate here is changing favorably and rapidly and that should have a positive effect on health care among other things.
Canadians on average don't like big government but certain things are more efficient when funded by Government although I'm chocking a bit even saying those words. Canadians and most western countries just think different than Americans when it comes to healthcare. The concept that every step of your health care will be a profit center is not something we like. The times we travel to your country we usually buy travel insurance because of the horror stories we hear from friends and family. Canadians are very well traveled and insurance is not on the radar in other countries.When we look at what you folks pay for your health care compared to ours and we can only imagine what benefits you might have if that money was left to average American to spend on their family or save for retirement or whatever. Having said all that we also know that you are a wonderful bunch of people and some of the world's finest hosts so we only wish you the best.
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Old 01-02-2018, 14:33   #146
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Re: Early retirement and health care for boaters

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I don't know what "measures" you have seen re Medicare/Medicaid being well run and efficient. Perhaps you have a source?
I could Google it for you Try medicare efficiency. Lots of sources pop up. Plenty of sources also saying there are lots of problems AND there are lots of problems with the Canadian healthcare system. No system is perfect, especially one run by large organizations, be they public or private.

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Running a healthcare system for 350m people is a whole lot more complicated than one for 35m people.
Why? Have some source for this assertion?

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You should swing by some ER's here and observe the people being treated many of whom will ignore the bill. That cost eventually gets passed on to those who do pay or the taxpayers but the sick get their treatment.
Yes This is part of the reason a publicly funded single-payer is more efficient. It avoids this whole expensive problem.

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There is nothing wrong with business making a profit. It's the engine that runs the machine. And, yes, those certainly are financial genius's but you say it like that is a bad thing. Profit is not a four letter word.
Markets are wonderful things for many products and services, but they are not the ONLY way. And evidence from around the world shows they are not the best way to deliver healthcare assuming a country wants all its citizens to have healthcare at the most affordable cost.

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There are improvements to be made here without changing over to a single payer system. You dismiss them too readily.
Perhaps but it seems to me the rest of the world has gone over this question many times, and have all come to similar answers: publicly funded (in various forms) is the most efficient method to deliver healthcare IF the goal is provide quality healthcare to all.

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Look, you like big government. I get it. I prefer government get out of the way whenever possible.
Please quote where Ive ever said (in ANY discussion) that I like big government. I am predisposed to dislike and distrust ALL large powerful organizations, be they public or private. But I recognize the need, and indeed the value, of both. Im not dogmatic, Im pragmatic.
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Old 01-02-2018, 15:13   #147
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Re: Early retirement and health care for boaters

One evaluation of Medicare efficiency
Quote:
Medicare Has Lower Administrative Costs Than Private Plans. According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.Sep 20, 2011
https://www.healthaffairs.org/do/10....0.013390/full/
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Old 01-02-2018, 15:16   #148
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Re: Early retirement and health care for boaters

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.
......
I don't think a country's size is relevant; i bet China has single-payer .
It doesn't have health coverage for all.
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Old 01-02-2018, 19:09   #149
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Re: Early retirement and health care for boaters

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I am 61 and live overseas. I got health insurance through Allianz for Expats. I also considered Cigna for Expats. I went with $20K deductable per year with annual max of $3MM for Latin America only. It cost $212 per month. I am a USA citizen and my country of domicile is Guatemala. Health is good and dirt cheap in Gautemala if the procedure is available for what the problem is. Most things can be done in Guatemala. I prefer being treated in Guatemala versus the USA. Had I included the USA the cost would have been $280 a month. I did not got coverage in the USA because Obama Care by laws covers all citizens regardless of pre-existing conditions. Therefore, I can get covered in the USA if I get sick and want to get treated in the USA. All I have to do is establish a residence(rent a cheap apartment), and I will have health insurance and by the 1rst of the following month. The maximum out of pocket per Obama care is aprox. $7K. Allianz covers for emergencies while traveling any where in the world so worst case I would be covered by Allianz until by USA health insurance covered me within a few weeks.

The Alliance policy includes $400 towards physical exam and related tests annually.

Cigna expat you have a choice of the whole world or the whole world excluding the USA. For me the 20K deductible with 1MM annual max for the whole world was $278 per month. Excluding the USA the cost is $230 per month but there is not $400 per year for physical exams, etc. The $1MM max per year is not enough for some things.

My approach is to be covered for the big hit and since health care is dirt cheap and quite good for most things in Guatemala, I don't mind paying for everything until $20K out of pocket.

You can play around with the annual deductible and annual max to suit your needs with Cigna and Allianz Expat.

With Cigna and Allianz Expat the cost of health care in your country of domicile determines what the premium is. Cigna and Allianz don't cover pre-existing conditions.

So when you retire in a year if you move and make your Country of Domicile a country with good but inexpensive health care you will be all set.

My wife and I spend about 6 months year in Guatemala and travel / sail the rest of the time.

I think there are companies that offer insurance to people the travel constantly. I am not sure if Allianz or Cigna offer that kind of coverage. I suggest you ask them. Both are good companies.
Similar situation, lived in Guatemala for many years (now in Panama). Excellent healthcare available. Several friends had major medical events and none spent over $10K total. Because of that I finally dropped insurance. I dont care about the small stuff and even the major stuff is affordable in Guate.

Good healthcare and insurance are avaible here in Panama, but we dont like the system or quality of care as much as Guate.

Medical is a bit more expensive in Panama, but still very reasonable. We pay $160/month for a PPO type plan with low deductables (high deductable plans are not common in Central America...because healthcare & health insurance is so affordable).
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Old 01-02-2018, 19:19   #150
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Re: Early retirement and health care for boaters

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I am 59 and self employed. I plan on working 1 more year but health care cost are just astronomical here in IL. I am 5 years away from Medicare and my wife is 6 years. Our monthly premium is $2100.00 for the 2 of us. There really aren't any options. We have no medical conditions and the deductible is $6K or combined $9K. This cost alone is really putting a real drain on retirement plans. I have even considered going without coverage once I retire. I need $150K just to make it to Medicare for insurance. Any ideas?
Thats just insane...quit letting a screwed up healthcare system ruin your life...get outta the USA!
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