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Old 29-01-2018, 15:30   #76
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Re: Early retirement and health care for boaters

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We lived in NH when we left to start cruising. For a few months we had a NH expanded medicare program that cost us nothing.It was only good really for major medical as we were out of State. But it was FREE so look into it (do the application early as it takes a month plus to get an answer and we had to pay the taxes on the period we weren't covered).
Good thing your not in NH anymore. It's one of the 10 states requiring Medicaid recipients to work if able, effective 1-1-18. If you were still here you'd be filling out employment applications
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Old 29-01-2018, 15:52   #77
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Re: Early retirement and health care for boaters

It is hard, even unfair and deceptive, to compare the US health systems to any "national health" that is a single-payer system. And that's a real stopper. Even the "member owned" health mutual assurance companies (as opposed to the for-profit insurers) pay huge salaries to executives who often range from inept to outright crooks. But they donate to politicians and have a huge lobby, so getting rid of them in favor of a single-payer system would be political suicide for any elected official.

Doctors often say that 30% of their time, or an equal part of their office $taff, are consumed by paperwork with insurance companies. And most doctors do a mediocre to outright poor job of handling paperwork, or managing their offices, one can only hope they are better at practicing medicine.
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Old 29-01-2018, 16:07   #78
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Re: Early retirement and health care for boaters

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It is hard, even unfair and deceptive, to compare the US health systems to any "national health" that is a single-payer system. And that's a real stopper. Even the "member owned" health mutual assurance companies (as opposed to the for-profit insurers) pay huge salaries to executives who often range from inept to outright crooks. But they donate to politicians and have a huge lobby, so getting rid of them in favor of a single-payer system would be political suicide for any elected official.

Doctors often say that 30% of their time, or an equal part of their office $taff, are consumed by paperwork with insurance companies. And most doctors do a mediocre to outright poor job of handling paperwork, or managing their offices, one can only hope they are better at practicing medicine.
Some interesting thoughts you have, thanks.
I'm always amazed at how gullible the average voter is. I guess people just parrot what they hear and don't do any investigations themselves. The scenario your projecting suggests a couple of things..nothing is ever going to change and politicians are overly successful in making up stories that their voters want to believe. I think Winston Churchill got it right when he suggested 75% of the voters shouldn't be allowed to vote as they never took time to inform themselves.
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Old 29-01-2018, 16:25   #79
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Re: Early retirement and health care for boaters

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Doctors often say that 30% of their time, or an equal part of their office $taff, are consumed by paperwork with insurance companies. And most doctors do a mediocre to outright poor job of handling paperwork, or managing their offices, one can only hope they are better at practicing medicine.
My wife works in a medical office, she would agree with that statement.
The problem with health care in America, it is the third largest industry in the country.
How does one go about reforming this third largest industry without putting us in a depression. Shame on the people that allowed this to happen....
This is an issue for anybody that wants to get off the treadmill not just boaters.
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Old 29-01-2018, 16:37   #80
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Re: Early retirement and health care for boaters

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My wife works in a medical office, she would agree with that statement.
The problem with health care in America, it is the third largest industry in the country.
How does one go about reforming this third largest industry without putting us in a depression. Shame on the people that allowed this to happen....
This is an issue for anybody that wants to get off the treadmill not just boaters.
Viewed in this light, perhaps the American healthcare system is genius in design. Look at the huge amount of employment it supports. Look at the massive profits it generates for all the shareholders of these insurance companies.

If you switched to a single-payer system like we have in Canada youíd need a fraction the workers, and thereíd be zero profits to share with corporate owners* (including pension plans and small investors). The money that flows through your healthcare system would plummet Ö what a disaster.

(*In reality, Canadaís healthcare system is nearly 50% private, which is actually where most of our problems lie).
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Old 29-01-2018, 16:58   #81
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Re: Early retirement and health care for boaters

Well, there are two sides of the problem: The "payers" and the "sellers." Doesn't do much good to fix one without also fixing the other. Nothing is happening to reign in the scams on the supply side. 10,000% price mark-ups on everything are routine. That's not even hyperbole. The primary purpose of the US "health care" system has become siphoning off any assets one may have left at the end of life and diverting them to Wall Street swindlers.
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Old 29-01-2018, 17:24   #82
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Re: Early retirement and health care for boaters

Or we could do like Cuba. Free healthcare for everyone, made possible by paying doctors $20 a month. And for the important cases, just fly them out to...well, somewhere else.

Singapore(?) is one of the nations that only "recently" went to national health. In order to make it work, they said something like "MRIs will be reimbursed $20, period" and the health providers said it was impossible. Government didn't cave in on it, and somehow? Yeah, it happened.

You can't "throw a switch" on this stuff, but you can phase in change, spread the conversion and make it happen. I listened to the arguments about "We can't computerize! They cost too much!" from the medical industry for over a decade. Now, they've been forced to convert, and what a mess they made of the process. Meanwhile, a friend of mine ran his practice on computer from day one, and saved HOURS of paperwork time, every day, from the first day.

Give a farmer a tractor and if he's never used one, he'll never figure out how to hook his oxen up to it. He'll insist it can't plow. Give an MD a computer...Oh hell, if he can't figure it out, pay him $25 a month and send him to Cuba. They'll teach him about plows, too.
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Old 29-01-2018, 17:26   #83
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Re: Early retirement and health care for boaters

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That is a silly comment. I have personally spoken to numerous Canadians who come to the US for healthcare -usually related to long waits in the Canadian system and/or quality of the care for the condition. That said, mine is a silly comment as well. Neither yours nor mine relate to the OP's concern, and in no way help solve his problem.


So you are saying that Canadians are to blame for mucking up the healthcare system here in the usa?!? We need a northern border wall! Keep those Canuck out!
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Old 29-01-2018, 18:09   #84
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Re: Early retirement and health care for boaters

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Itís a good question. Since itís based on taxes (income tax, sales tax, business/corporate taxes, etc..), itís hard to generalize. It would depend on the individual tax rate. According to OECD stats, Canadian healthcare cost (in 2017) $4,753 per capita. Taken as a raw number that is about $400 per month, but like I say, since itís paid through general taxes, the actual amount paid individuals will vary depending on income and home province.

(I could also tell you what I pay, but that would reveal a bit too much private financial information than Iím comfortable sharing on the public Internet.)



Here you can see that the USA is just about twice as high as the average, and even considerably higher than the next highest country: Switzerland. This might be OK if outcomes were much better, but the sad fact is the USA scores pretty low on most health measures in comparison to other OECD countries.

Personally, my healthcare plan is to pay as I go when travelling internationally (except the USA). Healthcare costs outside of the USA are generally pretty modest. I can afford basic stuff and acute care situations. If I got into a chronic care problem I would have to come back to my home province.
Thanks for the $400 number that's what I was wondering about. My wife's mom was from Canada maybe we could get in lol. Or better my mom (Slovenia) that would help across the pond...
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Old 29-01-2018, 18:17   #85
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Re: Early retirement and health care for boaters

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There's a lot of variables for US based folks, which I assume the OP is.

Ultimately it's going to (probably, and for the time being) depend on two things:

1. Income. Not assets. Income. Lower income generally means the more the gov will kick in to cover the cost. You could have a million sitting in a bank account that you're going to use for cruising, but only 20k in actual income and you'll probably pay less than someone with $0 in the bank and a 40k pension. The subsidies are all about income.

2. In what state you are (or will be) a resident (this can make a very big difference or not much of one, depending on your income).

On #2, it's definitely worth doing the research and considering if you should establish residency in another state before and while you cruise (also consider tax ramifications).

We're planning on leaving well before 65 too. Our plan is to establish residency (and buy income property) in a state that:
1. Actually participated in the ACA and medicaid expansion (costs are pretty uniformly lower in these states).
2. Doesn't have an income tax.
3. Has a real estate market in which we're comfortable investing.
4. Is someplace we wouldn't mind living if things go awry and we have to move into the investment home we buy there.

Just some things to get you thinking.

It can be eye opening to shop healthcare.gov and tell it you live in a different state and/or have a different income (then clear your browser cookies and try and different combination).


Uhm... tell me more!
You're running right down my alley!
States without income tax... Nebraska/ Iowa .. they pay you, I think, or is that Alaska?
Good ideas... what have you learned?

Bill
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Old 30-01-2018, 00:11   #86
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Re: Early retirement and health care for boaters

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You don't have to spend time digging into these comparisons as highly qualified groups have done just that and continue to do itAs I said, they will continue to support thier agenda, the numbers and comparisons are there for all to see. people with deep pockets do travel to certain highly specialized Doctors in the USA for treatment, we know that but the numbers are low. I'm from the Detroit area and have 3 sisters in nursing.
There are a lot of Canadians who come over.
People also travel to India for specialised treatment..the numbers are high And so are the horror stories.
Actually drugs are created all over the world and while the USA has always been a leader other countries are starting to really step up these days. Don't you find it interesting that your bedrock of trade policy is that other countries should not be promoting protectionist policies and yet your Big Pharma is protected by not allowing any other drug companies to compete with American companies further creating a monopoly and driving your costs and their profits sky high. You are confusing protectionist policies with patent law. If you take away the patent protections, expect research to dry up. But as you say, the USA is still by far the leader.
Your country has the highest cost in the world for health care ( almost double its closest rival)and currently of all the studies I have looked at the highest ranking your country has achieved is 10th in the world as far as quality of health care. Rating by country is one of the ways they get the "experts" get the answer they want. It's far easier to cherry pick a handful of small countries with far less diverse issues and say look they do it better.
Norway is a common poster child but always overlooked is if they lost the oil revenue, they would be a poor backwater within a year. It's an apples and oranges comparison.
Not exactly stellar results but quite predictable given the circumstances.
It is quite predictable because the "experts" are paid by those who have an agenda and if the "experts" don't support the agenda pretty soon they are flipping burgers and lose their status as "experts".

I'll give you an example of some of the numbers that they always ignore in these studies because it's hard to pin down the exact amounts that relate to health care. Let' look at per captia gross domestic product:
- EU $36500 (2016)
- USA $52200 (2016)

Now a more in depth study would attempt to determine how much of that difference is due to EU citizens paying higher taxes due to the govt providing health care and other ancillary costs that are not captured in a simple analysis of adding up the doctor and prescription bills. I would agree that it probably isn't 100% but it's certainly more than 0%. I've yet to see one of these analyses attempt to tease that value out. Usually, the news article simply slams the USA for being expensive and never provides a balanced report of why.
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Old 30-01-2018, 00:23   #87
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Re: Early retirement and health care for boaters

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It is hard, even unfair and deceptive, to compare the US health systems to any "national health" that is a single-payer system. And that's a real stopper. Even the "member owned" health mutual assurance companies (as opposed to the for-profit insurers) pay huge salaries to executives who often range from inept to outright crooks. But they donate to politicians and have a huge lobby, so getting rid of them in favor of a single-payer system would be political suicide for any elected official.

Doctors often say that 30% of their time, or an equal part of their office $taff, are consumed by paperwork with insurance companies. And most doctors do a mediocre to outright poor job of handling paperwork, or managing their offices, one can only hope they are better at practicing medicine.
There is a lot of truth to what you say but none of it goes away with a single payer system.

There will still be political lobbying and doctors will still need to spend a ton of time documenting why a treatment was needed.

If you really want costs to drop, a pure capitalist system with only catastrophic insurance is the way to go.

Right now, I bet you couldn't tell me what the last doctor's office treatment cost but if you had to reach into your wallet and hand over $20 bills, I bet you would remember and you likely would shop around. Very quickly you would see prices listed and people shopping around.
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Old 30-01-2018, 01:15   #88
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Re: Early retirement and health care for boaters

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....

I'll give you an example of some of the numbers that they always ignore in these studies because it's hard to pin down the exact amounts that relate to health care. Let' look at per captia gross domestic product:
- EU $36500 (2016)
- USA $52200 (2016)

Now a more in depth study would attempt to determine how much of that difference is due to EU citizens paying higher taxes due to the govt providing health care and other ancillary costs that are not captured in a simple analysis of adding up the doctor and prescription bills. I would agree that it probably isn't 100% but it's certainly more than 0%. I've yet to see one of these analyses attempt to tease that value out. Usually, the news article simply slams the USA for being expensive and never provides a balanced report of why.
Not sure I understand your point. Taxes are not included in GDP.
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Old 30-01-2018, 01:23   #89
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Re: Early retirement and health care for boaters

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.....

If you really want costs to drop, a pure capitalist system with only catastrophic insurance is the way to go.

...
Except that pure capitalistic system, aka free market, can't work for health care. We agree for safety reasons to regulate who can practice medicine, who can issue degrees, who can sell drugs, who can manufacture drugs, etc. It is never going to be a free market. In addition the consumer is under duress when they need care, so rational pricing decisions won't be made.

Every other major industrialized country has been able to deliver advanced health care at per capita costs way less than the US without trying a free market system.
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Old 30-01-2018, 01:27   #90
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Re: Early retirement and health care for boaters

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Not sure I understand your point. Taxes are not included in GDP.
That's the point. These studies only take on the simple analysis as it supports their agenda.

High taxes (associated with govt insurance) discourage business and hiring. With less business and hiring GDP goes down. I readily admit it's a complex and difficult challenge to assign how much of the GDP loss is really a cost of having govt health insurance.

Secondarily, if wages are 30% lower, it makes it look like health care is 30% lower but when considered as a percentage of income, it's really not.

No matter how fair you try to be in the analysis, people will argue over the exact number but there is no doubt it does have an impact.
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