Early retirement and health care for boaters

[sailorboy1]

Doesn’t it seem like health care is like people’s puppies. You know, don’t call them ugly or something.

I think health care costs are the same in all first world countries. All that’s different is how it gets paid for. It other words how the payments get structured and spread around.

[hpeer]

Originally Posted by Bill Seal

Unfortunately, several million illegals do not "share", and Canadians are about to find out what it costs to care for a few milliion refugees from the mid east. (and Germans too)

Citizenship should be a defended classification. It’s what defines a country.

We agree, let’s not go off topic needlessly.

[sailpower]

Originally Posted by Mike OReilly

Canadian healthcare is far more sustainable than the US model. You pay nearly twice as much as the next highest country (Canada), yet you produce mediocre results. How is this smart, or sustainable?

What do you mean by mediocre results?

[hellosailor]

"BTW, the 8 vs. 12 hour shift issue is mostly a union thing. They tend to want fewer work day"
Nope. Totally wrong. First off, the doctors and nurses usually are not union members, so there's no "union thing" involved. Housekeeping might be union, janitors might be union, but not the medical staff.
And, ask any nurse how they feel about working 14 hour days. Shorter week is nice, sure, but when you are exhausted and need to spend an extra day just sleeping to recover from it? Ah, no, that's not the personnel asking for long shifts, that's management. Longer shifts make easier scheduling and the rationalization is that it supposedly provides superior "continuity of care" around the clock. The effect if fatigue is pretty much like saying "Keep the babysitter drunk, they'll stay all night". The quality of the care counts for more than the rationalization. Drunk, fatigued, whatever, the care suffers. We've only recently (8? years ago?) put in caps on 80-hour work weeks for residents? And you still can't get the admissions triage staff to use disposable (or freshly sterilized) bp cuffs and stethoscopes on incoming patients, much less get the floor nurses to use them. Again, despite all the studies showing incredibly effectiveness from such simple steps.
Can't blame this stuff on the unions, they're in the cafeterias and hall closets, not providing medical care.

[valhalla360]

Originally Posted by hellosailor

"BTW, the 8 vs. 12 hour shift issue is mostly a union thing. They tend to want fewer work day"
Nope. Totally wrong. First off, the doctors and nurses usually are not union members, so there's no "union thing" involved. Housekeeping might be union, janitors might be union, but not the medical staff.

Yes and no. It's not a traditional union...how about calling it a guild that viciously defends and limits the number of doctors. The AMA or whoever rules the MD world does some crazy stuff.

Seriously, who needs a study to know that a sleep deprived half trained intern isn't going to do as well as one that is well rested and alert. It's really more of an old school hazing ritual rather than a training process.

But this is at best peripheral to the insurance issue.

PS: Several years back, we tried to get approval to do 4-10hr days...I was in management but the union was having none of it because you had to agree that if there was a friday meeting, the individual employee had to adjust their schedule to make the meeting (non medical field).

[Paul L]

Originally Posted by sailorboy1

Doesn’t it seem like health care is like people’s puppies. You know, don’t call them ugly or something.

I think health care costs are the same in all first world countries. All that’s different is how it gets paid for. It other words how the payments get structured and spread around.

You couldn't be more wrong. The US spends at least twice per person on medical costs with no better, and often worse outcomes, than other industrialized countries.

[Mike OReilly]

Originally Posted by valhalla360

Unless you pay the national average in taxes, you are either subsidizing or being subsidized.

This is different from a private insurance plan where individuals have a choice to participate or not.

Not saying we should or should not provide it as a social service but to claim it's not some people subsidizing other people is false. If you can't admit that and still defend it, then there must be an issue.

For many years I paid far more than the average. For the past few I’ve been less. That tends to be the pattern for people moving from full time work to retirement. Sorry if this offends anyone.

I never made any claim about some people subsidizing others. Others are pushing this line … not me. We could get into a discussion about how functioning civil society actually works, but none of us pay for everything that we use in our modern countries. Unless you live on a desert island, and produce everything you use, then you too are living off subsidized services or infrastructure.

Originally Posted by buzzstar

You completely avoid the question, and you dare call the medical care in the US mediocre. Wow! [Expensive yes, unless you are illegal, homeless, or penniless, but mediocre, no.] That is real mouthful for someone who implicitly admits to living off the largess of his fellow citizens (albeit in the form of taxes taken under threat of imprisonment). BTW, I have US Medicare, and I do have foreign coverage via a supplement (admittedly not great) but that coupled with my own resources would have gotten me repaired or home when I was able to travel on the wind.

Try reading my answer once again.

As for the US healthcare system producing mediocre outcomes (at twice the cost, or more, of everyone else — I see you completely avoided that one ), it’s a basic fact. You know … one of those things some people like to ignore. Just look up any measure, from life expectancy and infant mortality to treatment outcomes for diabetes, heart disease, asthma… the USA tends to fall near the middle of the OECD pack. You know … mediocre.

[valhalla360]

Originally Posted by Mike OReilly

For many years I paid far more than the average. For the past few I’ve been less. That tends to be the pattern for people moving from full time work to retirement. Sorry if this offends anyone.

I never made any claim about some people subsidizing others. Others are pushing this line … not me. We could get into a discussion about how functioning civil society actually works, but none of us pay for everything that we use in our modern countries. Unless you live on a desert island, and produce everything you use, then you too are living off subsidized services or infrastructure.
.

No offended just trying to get to an agreement on a baseline of how the system is funded.

You said you paid your own way via taxes (ie: you were not being subsidized and in your follow up implied that you were not subsidizing others as it all averaged out over your lifetime). If it makes it easier for you to follow, we can say lifetime average taxes rather than go into the complications of income changes over your lifetime. But that really doesn't change the underlying point.

Most people don't average out over their lifetime. Half are above and half are below. Someone who can't hold down a job doesn't pay much tax during their career or during retirement. Likewise, a successful entrepreneur pays a lot of tax during their career and during retirement. There is the rare individual who starts out rich and winds up poor (and vice versa) but they are statistical outliers and the lifetime average sorts that issue anyway. Technically since this is a discussion of early retirement a good chance you are looking at a lot of low tax years dragging down your average tax bill pushing you into the subsidized ranks.

So unless you happen to average out over your life dead on at the average, you are either subsidizing or being subsidized. Can you agree with that? No implication if that's good or bad just how the system works.

This is a discussion about how society should work and until we can agree how it currently works (including who is subsidizing who and to what degree), it's hard to have a meaningful discussion of where to set the limits of govt intervention. Some is acceptable and necessary but when we hear people claiming how great "free" stuff is...automatically it's a pointless discussion as the people claiming "free" stuff have no idea what is happening or how it will be paid for.

So back to the question: Can you admit that over your life are you subsidizing or being subsidized? If you can admit that's how the system works, we can have a meaningful discussion. If you are just going to insist that the govt magically finds "free" money it's hard to take your points seriously.

PS: A large portion of the population is by definition paying for all the govt services they receive (and many are paying far more). If they weren't the govt would be spending more than the people pay in and the govt would quickly go broke.

[Mike OReilly]

Originally Posted by valhalla360

…This is a discussion about how society should work and until we can agree how it currently works (including who is subsidizing who and to what degree), it's hard to have a meaningful discussion of where to set the limits of govt intervention. Some is acceptable and necessary but when we hear people claiming how great "free" stuff is...automatically it's a pointless discussion as the people claiming "free" stuff have no idea what is happening or how it will be paid for.

So back to the question: Can you admit that over your life are you subsidizing or being subsidized? If you can admit that's how the system works, we can have a meaningful discussion. If you are just going to insist that the govt magically finds "free" money it's hard to take your points seriously.

PS: A large portion of the population is by definition paying for all the govt services they receive (and many are paying far more). If they weren't the govt would be spending more than the people pay in and the govt would quickly go broke.

Val, this is categorically NOT a discussion about who is subsidizing and who is not. That NOT what this discussion was, and only just recently got off on this strange tangent by someone (Buzz?) taking it there — certainly not me. If I died today I’ve paid far more in that I’ve taken out of the CND healthcare system. If I live to 100 the balance will likely swing the other way. It’s just like most insurance programs.

But this is all irrelevant. This discussion is about early retirement and how cruisers afford healthcare. All I have said is that I could not afford to live as I do if I was faced with the costs most of my Americans friends need to expend. And this quickly follows into the corollary that the US healthcare system is, by far, the most expensive in the developed world (with mediocre results … but that is beside the point).

If you want to have some deeper philosophical discussion about how societies should be organized, I’m happy to do so. But that’s not what this thread is about, nor what I’ve tried to contribute.

[Cyrus Safdari]

Originally Posted by valhalla360

Reality it's not half as bad as the media would have you believe. The USA is still a great place to live. For every exorbitant expense in the USA, every other country has a similar cost for something else (not always measured in dollars)

no, not really, certainly nothing like basic healthcare

[Cyrus Safdari]

Originally Posted by buzzstar

I am fascinated by how many think health care is "free" in most of the developed world, with the US being the exception. Econ 101 lesson one: TANSTAAFL. If you do not know what it means, look it up.

Everyone is well aware that taxes finance healthcare, the point is that the US has the lowest quality of care and yet also is the most expensive healthcare system among advanced industrial companies. http://www.newsweek.com/united-state...d-worst-637114


Heck even Iran is showing the US how to take better medical care of the poor:
https://www.aarp.org/health/doctors-...tas_blues.html

[buzzstar]

Originally Posted by hellosailor

"BTW, the 8 vs. 12 hour shift issue is mostly a union thing. They tend to want fewer work day"
Nope. Totally wrong. First off, the doctors and nurses usually are not union members, so there's no "union thing" involved. Housekeeping might be union, janitors might be union, but not the medical staff.
And, ask any nurse how they feel about working 14 hour days. Shorter week is nice, sure, but when you are exhausted and need to spend an extra day just sleeping to recover from it? Ah, no, that's not the personnel asking for long shifts, that's management. Longer shifts make easier scheduling and the rationalization is that it supposedly provides superior "continuity of care" around the clock. The effect if fatigue is pretty much like saying "Keep the babysitter drunk, they'll stay all night". The quality of the care counts for more than the rationalization. Drunk, fatigued, whatever, the care suffers. We've only recently (8? years ago?) put in caps on 80-hour work weeks for residents? And you still can't get the admissions triage staff to use disposable (or freshly sterilized) bp cuffs and stethoscopes on incoming patients, much less get the floor nurses to use them. Again, despite all the studies showing incredibly effectiveness from such simple steps.
Can't blame this stuff on the unions, they're in the cafeterias and hall closets, not providing medical care.

As silly as it sounds, you don't get around much do you, at least in the US? The nurses union(s) tend toward the very militant in this state (Kaliphonia), but not so much the physicians, although they are moving in that direction as their profession becomes more rote and less art, even if it is not much more than at a snail's pace. Remember the administrators usually follow the accounting types, with money, not safety, being the bottom line. Thus $100 catheters (labor often calculated at least twice -something they learned from aerospace industry). There are few heroes in the medical professions, although they reportedly exist. BTW, do you really think those studies do not add to the costs and prices?

[valhalla360]

Originally Posted by Cyrus Safdari

no, not really, certainly nothing like basic healthcare

Yes, really. There are other costs that balance things out assuming the same general standard of living.

Some people can save money if they have particular needs/wants or lack there of but for an average person, it all averages out.

If you move to a 3rd world country, you can save money but to do so typically means living like the locals. The closer you stick to your original 1st world lifestyle, the closer you will be to 1st world costs.

[Cyrus Safdari]

Originally Posted by valhalla360

Yes, really. There are other costs that balance things out assuming the same general standard of living.

Some people can save money if they have particular needs/wants or lack there of but for an average person, it all averages out.

If you move to a 3rd world country, you can save money but to do so typically means living like the locals. The closer you stick to your original 1st world lifestyle, the closer you will be to 1st world costs.

Lots of countries with standards of living matching or surpassing the US, have national medical care. The US has the most expensive healthcare system, and the worst quality of care among industrialized nations:

Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%). U.S. spending per person was equivalent to $9,086 (not adjusted for inflation)...

The average price of bypass surgery was $75,345 in the U.S. This is more than $30,000 higher than in the second-highest country, Australia, where the procedure costs $42,130.
https://www.commonwealthfund.org/pub...al-perspective

Heck lots of cruisers go to Caribbean islands that belong to 1st world countries and still get better medical care.

Like I said, even the Iranians are showing the US how to take better medical care of the poor. https://www.aarp.org/health/doctors-...tas_blues.html

[valhalla360]

Originally Posted by Cyrus Safdari

Lots of countries with standards of living matching or surpassing the US, have national medical care. The US has the most expensive healthcare system, and the worst quality of care among industrialized nations:

Data from the OECD show that the U.S. spent 17.1 percent of its gross domestic product (GDP) on health care in 2013. This was almost 50 percent more than the next-highest spender (France, 11.6% of GDP) and almost double what was spent in the U.K. (8.8%). U.S. spending per person was equivalent to $9,086 (not adjusted for inflation)...

The average price of bypass surgery was $75,345 in the U.S. This is more than $30,000 higher than in the second-highest country, Australia, where the procedure costs $42,130.
https://www.commonwealthfund.org/pub...al-perspective

Heck lots of cruisers go to Caribbean islands that belong to 1st world countries and still get better medical care.

Like I said, even the Iranians are showing the US how to take better medical care of the poor. https://www.aarp.org/health/doctors-...tas_blues.html

Like I said, it all balances out. Health care might be a bit more but other things are cheaper. Not all are dollar denominated.

This is where people dreaming of moving to some 3rd world country and living like a king on $200/month fail. They get there and find out some things are really cheap but other things are much more expensive or such a huge pain to get done, they would rather pay the US price.