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Old 09-07-2018, 16:09   #211
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Re: Early retirement and health care for boaters

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Originally Posted by valhalla360 View Post
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.
Some things are definitely cheaper in the USA vs Canada (can’t speak for the rest of the world). A few winters ago I spent seven months travelling around your beautiful country on motorcycle. My unscientific observation was that booze and gas were noticeably cheaper (basic booze … but sadly not good craft beer, which is my weakness). Lodgings (motels) were cheaper. State campgrounds were more expensive. National were cheaper. Food was about the same. Some of the price differences are clearly tax rates (especially on stuff like booze and gas). A lot is simply due to the larger local market (econ 101).

One thing that was clearly more expensive for us was healthcare costs. We were obliged (scared into) buying supplemental travel insurance. Any cursory examination of the price of medical procedures shows the USA has the highest rates compared to almost every other country. I realize it’s a complicated issue, but clearly it has something to do with the private nature of the insurance system. I doubt if the physical input costs of a hip replacement in the USA are any different than in Canada, but when you add all the additional cost layers into the price, the bottom line is quite a bit different.

There’s no doubt the USA has the best medical services on the planet IF you can pay for them. But as a national system, it produces mediocre outcomes at twice the price as the next costliest system: Canada’s. As cruisers we must deal with these costs. American cruisers are at a disadvantage in this regard, which makes early retirement and the cruising life more difficult.
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Old 09-07-2018, 16:44   #212
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Re: Early retirement and health care for boaters

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'Single-payer' means that there is ... just one payer. If the clients of the VA system have all their medical bills picked up by the VA... it's a single-payer system. I don't understand why that would be in dispute.

Advantages:
  • no "pay & claim & wait for reimbursement" cycle for client
  • no coordination/conflict between multiple payers
  • the single-paying entity has fantastic leverage to negotiate lower costs
  • in a universal single payer system (eg Canada) every primary-care provider is in, you can choose your Dr
... net result is a system with lower overhead costs

Why is mentioning that "VA is single-payer" meaningful? I imagine that it's to underscore the fact that single payer is not some unworkable socialist unicorn, but a practical and viable system of delivering health care that's already being applied successfully in the US.

(Anyway, I think we've all made our points. This tangent doesn't really advance the thread about health care for boaters.)
I had not visited this part of the thread for a while. We all seemed to ignore the difference between a single payer system, a single provider system, and one that combines both -such as the VA. After the usual cop out by O'Reilly blaming we for thread drift, I spent a couple of minutes reviewing the posts (not in detail, and not all the way back), and can say that between post 138 and 211, O'Reilly made 8 of them, with six of those involving ad hominem attacks on the US health care system -prices and/or quality. For the life of me (almost literally) I cannot figure out why so many want to come here despite our faults, real or imagined. But if it helps keep people from places with better health care systems (I recall Iran, Canada, and Guatemala as being specifically identified) from flocking here, so much the better. I like the care I have received, and will not and would not trade it for a better "average." But them what I receive is via choice, not via single payer or provider. I will now shut up on this thread, unless I forget myself. Stay healthy all, including O'Reilly, but please avoid US waters.
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Old 09-07-2018, 18:47   #213
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Re: Early retirement and health care for boaters

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I had not visited this part of the thread for a while. We all seemed to ignore the difference between a single payer system, a single provider system, and one that combines both -such as the VA. After the usual cop out by O'Reilly blaming we for thread drift, I spent a couple of minutes reviewing the posts (not in detail, and not all the way back), and can say that between post 138 and 211, O'Reilly made 8 of them, with six of those involving ad hominem attacks on the US health care system -prices and/or quality. For the life of me (almost literally) I cannot figure out why so many want to come here despite our faults, real or imagined. But if it helps keep people from places with better health care systems (I recall Iran, Canada, and Guatemala as being specifically identified) from flocking here, so much the better. I like the care I have received, and will not and would not trade it for a better "average." But them what I receive is via choice, not via single payer or provider. I will now shut up on this thread, unless I forget myself. Stay healthy all, including O'Reilly, but please avoid US waters.
I really have no idea what you’re on about. Your comments seem divorced from fact or reality. Please post the “ad hominem” attacks I have made. I’ve certainly criticized ideas, but you do understand that an ad hominem attack must be levied against an individual, not a concept. By definition, it is impossible to launch an ad hominem attack against the US healthcare system. According to the wikipedia definition an ad hominem attack is:

Quote:
a fallacious argumentative strategy whereby genuine discussion of the topic at hand is avoided by instead attacking the character, motive, or other attribute of the person making the argument…
You seem personally insulted that the US healthcare system produces mediocre results for its population while being the most expensive system in the developed world. Neither of this is news, nor is it new. These are both well established FACTS. This doesn’t mean there is not excellence in your country. Indeed, for those with financial resources it likely offers the BEST healthcare money can buy. But that is not how national healthcare systems and population health are measured.
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Old 09-07-2018, 23:19   #214
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Re: Early retirement and health care for boaters

From what I know Australia has a similar health care system as Canada. I think it's great. Works for all and as far as I know dosent send anyone broke.

From a cruising perspective Australia is a great place to cruise. Also places like Thailand and Malaysia are great to cruise as their medical systems are very good and cheap.

The below is a email I received from a cruising friend in 2012 (not American). They pulled into Florida and were excited to be in the big smoke, hired a car and went to the movies:

"Heres the thing!!
One moment you are sitting watching a drive in movie eating junk food and pigging out , next you have a serious case of food poisoning, end up with internal bleeding, are rushed off to the emergency department where after asking for $600 before they treat you, they leave you lying there for 8 hours.
then when they discover that the blood is now running out your arse in litres, they suddenly rush you off to the intensive care unit for 3 days and poke so many holes in your arms you look like swiss cheese.
Then after 3 nights in the hospital, 5 litres of antibiotics drip fed through an IV drip they give you a bill for $23000 USD and that does not include the doctors bill.
Next exciting installment will follow."

I also have a friend cruising that is remarkable (cruisers by himself, just crossed the Indian ocean) . He has lost an arm and a leg in a motorcycle accident in the US (he is American). He just survived to have his insurance company sue him into bankruptcy! Lost everything. For the record he his a very happy young guy, living on not much and following his dream.

These two examples regarding the US medical and insurance system cause me fear that I don't have cruising other countries.
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Old 09-07-2018, 23:36   #215
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Re: Early retirement and health care for boaters

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Originally Posted by daletournier View Post

I also have a friend cruising that is remarkable (cruisers by himself, just crossed the Indian ocean) . He has lost an arm and a leg in a motorcycle accident in the US (he is American). He just survived to have his insurance company sue him into bankruptcy! Lost everything. For the record he his a very happy young guy, living on not much and following his dream.
What did he get sued for and buy whom? His automobile insurance or his health insurance?
Seems a strange story.

-Chris
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Old 10-07-2018, 00:02   #216
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Re: Early retirement and health care for boaters

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What did he get sued for and buy whom? His automobile insurance or his health insurance?
Seems a strange story.

-Chris
I will be seeing him next week and will ask details. I believe his own health insurance company. He's a very down to earth and honest guy, he will be factual.
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Old 10-07-2018, 07:51   #217
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Early retirement and health care for boaters

We are really just planning on getting most of our regular checkups and health situations done wherever we are at and keep a a very low cost plan back in the usa for emergencies. Of course... until we reach Medicare eligibility. I don’t really see any other way.

The playbook on how to manage insurance is going to continually change and we are prepared to adjust to whatever insurance models come down the road. What works well today isn’t guaranteed to be available as an option 10 years from now.

Of course, cutting down on alcohol, exercising, and losing weight will all contribute more to our health than any cheap insurance product.
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Old 10-07-2018, 09:54   #218
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Re: Early retirement and health care for boaters

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...Of course, cutting down on alcohol, exercising, and losing weight will all contribute more to our health than any cheap insurance product.
Well… I tend to lose weight and exercise more while on the boat. But I manage to keep up my booze intake. So… two outta three ain’t bad
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Old 10-07-2018, 10:10   #219
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Re: Early retirement and health care for boaters

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That’s funny, I’m Retired Military, and I pay more than that for my “free” health care.

Ditto here and I think it stinks!
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Old 10-07-2018, 11:36   #220
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Re: Early retirement and health care for boaters

I took the time this AM to read this entire thread for the only reason, I have built a career studying healthcare both domestic (US) and International and may have some good advise for the OP. This is my wheel house and although I may be a subpar sailor, healthcare is my expertise.

Typical of CF, the thread turned into a political diatribe rife with anecdotal argument by generalized example. " I know this person, I was told this by a MD, or PBS, COMMONWEALTH,FOX, VOX told me so, therefore it is." The problem with all these claims is in order to rectify a broken healthcare system that I am sure we would all agree upon, we have to use actual peer reviewed data to draw effective and sustainable conclusion.

CF users love to have political arguments with having very little knowledge of actual healthcare funding and delivery models. I am speaking both to the Canadians who love to hold their nose to the US healthcare system while having very little comparitive analysis of healthcare delivery cost to U.S, coupled with the blinding fact that provincial average cost as weighted to GDP and household income is raising faster than the US. But don't think individuals who think that universal medicine is somehow a tax Ponzi scheme or that greed "profit motive" is the reason for our problem. Only 22% of health insurers and 18% of all hospitals are FOR PROFIT ENTITIES with shareholders. All but 2 countries (first world) have private hospitals, doctors, insurance (primary, secondary or sup) and all are focused on revenue positive operations (making money off the sick and vulnerable) even with a state level pricing model.

All of these arguments reek of politically charged ideology and confirmation bias with very little factual merit and the factual equivalent of bringing a banana to a gun fight.

To the OP:

If "early retiring" and planning on being outside of the country for more than 273 calendar days per year, no US healthcare is needed or required (through 2018). As many have stated, if your MAGI (modified adjusted gross income) qualifies you for ACA TAX CREDITS, you are eligible for significantly less premium per month. YOUR FIRST STEP, IS NOT TO LISTEN TO ANYONE ON THIS FORUM AND GET A GOOD CPA, TAX ATTORNEY THAT CAN ADVISE YOU ON HOW TO LOWER YOUR MAGI TO POTENTIALLY BE ELIGIBLE FOR CREDITS. They are literally worth their weight in gold and if moving into a fixed income and have yet to consult with a tax attorney, you are doing your retirement wrong. Sole 401K, Irrevocable Trust are just a few examples of how to lower your MAGI through contributions. If your CPA or Tax Attorney comes back and informs you that irregardless of legal tax efficient strategies, your MAGI is above the ACA limit (Family of 2 is $68,665) there are several "alternative options" that are more cost effective compared to standard comprehensive health insurance.
1) Get a High Deductible HSA plan. This will allow you to contribute $7,900 (includes catchup) into a HSA account per year. This is your money and will roll over any unused balance. You can contribute into your HSA until MEDICARE eligible and still use the HSA through Medicare to pay health cost. Your health plan will only cover preventative treatment prior to meeting deductible and will not cover most testing/treatment until you have met the deductible
2) Medishare plans are a good option to look at IF you are a faith based individual and fairly healthy. Premiums are 40-50% of standard health insurance and most plans cover you nationwide. Make sure you read the fine print as most plans have exclusions and waiting periods for certain procedures.
3) Self Fund is always an option if you are traveling most of the year in other countries. Of course you take the risk of catastrophic loss but you also eliminate the upfront financial loss. Also, to understand the risk is to understand the cost. The actuarial analysis at your age and current health conditions (without knowing more health information) is a 88/12 1500. This means you have a 12% chance of needing to spend more the $1500 per year or more on healthcare. As you can imagine, this number changes as you increase in age and health conditions change. Is it prudent to go without health insurance, probably not, is it cost effective compared to the risk, absolutely.

I would encourage irregardless of what path you choose, make sure you purchase a emergency evacuation plan (fairly cheap) as if you are in Panama and have a stroke, I will assure you that you would rather be in a US hospital. ALSO, don't listen to anyone on this forum when it comes to healthcare including me, go talk to a tax attorney and a local health broker.


Hope that helps and feel free to DM with more questions, I am happy to help.
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Old 10-07-2018, 12:51   #221
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Re: Early retirement and health care for boaters

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......

To the OP:

If "early retiring" and planning on being outside of the country for more than 273 calendar days per year, no US healthcare is needed or required (through 2018). As many have stated, if your MAGI (modified adjusted gross income) qualifies you for ACA TAX CREDITS, you are eligible for significantly less premium per month. YOUR FIRST STEP, IS NOT TO LISTEN TO ANYONE ON THIS FORUM AND GET A GOOD CPA, TAX ATTORNEY THAT CAN ADVISE YOU ON HOW TO LOWER YOUR MAGI TO POTENTIALLY BE ELIGIBLE FOR CREDITS. They are literally worth their weight in gold and if moving into a fixed income and have yet to consult with a tax attorney, you are doing your retirement wrong. Sole 401K, Irrevocable Trust are just a few examples of how to lower your MAGI through contributions. If your CPA or Tax Attorney comes back and informs you that irregardless of legal tax efficient strategies, your MAGI is above the ACA limit (Family of 2 is $68,665) there are several "alternative options" that are more cost effective compared to standard comprehensive health insurance.
1) Get a High Deductible HSA plan. This will allow you to contribute $7,900 (includes catchup) into a HSA account per year. This is your money and will roll over any unused balance. You can contribute into your HSA until MEDICARE eligible and still use the HSA through Medicare to pay health cost. Your health plan will only cover preventative treatment prior to meeting deductible and will not cover most testing/treatment until you have met the deductible
2) Medishare plans are a good option to look at IF you are a faith based individual and fairly healthy. Premiums are 40-50% of standard health insurance and most plans cover you nationwide. Make sure you read the fine print as most plans have exclusions and waiting periods for certain procedures.
3) Self Fund is always an option if you are traveling most of the year in other countries. Of course you take the risk of catastrophic loss but you also eliminate the upfront financial loss. Also, to understand the risk is to understand the cost. The actuarial analysis at your age and current health conditions (without knowing more health information) is a 88/12 1500. This means you have a 12% chance of needing to spend more the $1500 per year or more on healthcare. As you can imagine, this number changes as you increase in age and health conditions change. Is it prudent to go without health insurance, probably not, is it cost effective compared to the risk, absolutely.

I would encourage irregardless of what path you choose, make sure you purchase a emergency evacuation plan (fairly cheap) as if you are in Panama and have a stroke, I will assure you that you would rather be in a US hospital. ALSO, don't listen to anyone on this forum when it comes to healthcare including me, go talk to a tax attorney and a local health broker.


Hope that helps and feel free to DM with more questions, I am happy to help.
That's some conflicting advice. You don't need health insurance if you are out of the country, but you should have repatriation insurance back to the US in case you get sick. Who's gonna pay for your med care then?
Have you ever had health care or been in a hospital in Panama City. My experience was you get high end care from specialists who spend far more time with you than in the US. Many are US board certified, all for very reasonable costs.

Your greater than $1,500 annual is a pretty meaningless number. You are insuring against not leaving your partner broke or bankrupt after a major medical care, not trying to beat the annual premium.
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Old 10-07-2018, 14:04   #222
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Re: Early retirement and health care for boaters

"1) Get a High Deductible HSA plan."
Ah, there's something about maybe a $38,000 income limit (probably the wrong number) but once you hit a very attainable income level, you're not allowed to have one.

I like the first advice better: Don't listen to any of us on this forum.
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Old 10-07-2018, 17:41   #223
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Re: Early retirement and health care for boaters

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That's some conflicting advice. You don't need health insurance if you are out of the country, but you should have repatriation insurance back to the US in case you get sick. Who's gonna pay for your med care then?
Have you ever had health care or been in a hospital in Panama City. My experience was you get high end care from specialists who spend far more time with you than in the US. Many are US board certified, all for very reasonable costs.

Your greater than $1,500 annual is a pretty meaningless number. You are insuring against not leaving your partner broke or bankrupt after a major medical care, not trying to beat the annual premium.
AND TIME! Yep, it took a whole 64 minutes for another Anecdotal reference as if fact. Thanks for supplying us with endless information that has no relevence in reality. OECD and WHO rank countries based on a wide spectrum of analysis from morbidity, mortality and equity to comparative treatment outcomes. The U.S. is ranked #2 for emergency medicine, Panama is 78th. Where would you rather be with stroke or heat attack.

Lastly, that meaningless $1,500 is an actuarial value based on actuarial tables. Im gonna let you in on a little secret, Actuaries use this information to price insurance based on risk. If you know the risk, you can understand the price. To understand the likelihood of loss.

Full report: http://apps.who.int/iris/bitstream/h...5-eng.pdf?ua=1

Thanks for playing the game.
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Old 10-07-2018, 18:10   #224
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Re: Early retirement and health care for boaters

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AND TIME! Yep, it took a whole 64 minutes for another Anecdotal reference as if fact. Thanks for supplying us with endless information that has no relevence in reality. OECD and WHO rank countries based on a wide spectrum of analysis from morbidity, mortality and equity to comparative treatment outcomes. The U.S. is ranked #2 for emergency medicine, Panama is 78th. Where would you rather be with stroke or heat attack.

Lastly, that meaningless $1,500 is an actuarial value based on actuarial tables. Im gonna let you in on a little secret, Actuaries use this information to price insurance based on risk. If you know the risk, you can understand the price. To understand the likelihood of loss.

Full report: http://apps.who.int/iris/bitstream/h...5-eng.pdf?ua=1

Thanks for playing the game.
Statistics are only as good as how the question is asked. For instance; Let's say that statistically 5% of people die in an auto accident. You might want to imply that 1 in 20 will die in an auto accident. But what if you dont drive at all? Are your chances still 1 in 20? NO
The same can be said for healthcare in third world countries. Many of these countries have systems that allow their poor people to not get proper care at all. These same ones have doctors that treat the well-to-do or foreigners.... people that can pay well and those doctors make much more money than the guy at the public welfare hospital. So it's just as likely as not your statistics are BUNK!
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Old 10-07-2018, 18:15   #225
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