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Old 30-01-2018, 11:19   #106
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Re: Early retirement and health care for boaters

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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.
It's absolutely not true that Canadian doctors "spend a ton of time documenting why a treatment was needed". They spend far less time than US drs on such paperwork.

Part of the efficiency of single-payer comes from the fact that the relationship is not adversarial. There's less effort spent fighting or trying to game the system.

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If you really want costs to drop, a pure capitalist system with only catastrophic insurance is the way to go.
... which is essentially saying that healthcare costs drop by not having much of a healthcare system. Not much to argue with there... except it ignores the fact that a system with only catastrophic care is actually more expensive per capita than a system of regular preventative care, because you end up having to provide acute care for many preventable conditions.

Not to mention that regular preventative care produces a population that's healthier and lives longer.

The central question is... do we support universal healthcare as a worthy goal for a rich nation, or not? If yes, then what is the most efficient way to deliver it?

[ok now I'm only 1 page behind ]
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Old 30-01-2018, 11:31   #107
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Re: Early retirement and health care for boaters

Among the other quirks, in the US Medicare (and possibly some private plans using the same guidelines) will at times pay a flat fee for an "office visit" and whatever procedures were performed during that visit. So a doctor performing two procedures on the same day, gets paid once. If he has the patient come back on a second day for the second procedure? Same amount of work, double the pay. All perfectly legal, although some patients might balk at being made to come and go twice.

Single-payer or not, there's still a lot of room for improvement.
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Old 30-01-2018, 12:30   #108
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Re: Early retirement and health care for boaters

My health insurance is subsidized by my teacher's pension system - and I pay $200 per month. The governor just eliminated this from the budget - and I will now pay over $600 per month.

On a related note, a relative is an MD in general practice, working for a large corporation. He says he spends closer to 50% of his time doing computer "paperwork."

He also says he is periodically graded by the corporation, not by successful diagnosis and treatment, but instead by how much "extra" he bills, particularly more expensive tests. There are various bonuses paid for better achievement in this area.

My opinion is that the majority of the overpriced health care problems we have in the USA are caused by Congress being funded by big money concerns. The 2010 Citizens United decision didn't help this any.
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Old 30-01-2018, 13:16   #109
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Re: Early retirement and health care for boaters

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Hang in there though, once you reach the magic age for Medicare, it's far less likely that any significant medical incident will scuttle your dreams of cruising!
Sounds good except for the reality that there are many MD's who will not take on Medicare patients due to the low compensation from the government.

We have a lot to be thankful for here in the USA but cost of health care isn't necessarily one of them.

I am curious what the tort laws are in countries like Canada? Do medical care providers get sued there like they do here? How expensive is malpractice insurance compared to here?
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Old 30-01-2018, 13:27   #110
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Re: Early retirement and health care for boaters

"65+ have to be astronomically more expensive to insure than those under 65, so why not everyone?"
Simple math, really. If you TAX everyone, and don't spend any money on the healthier ones, you have that much more money to spend on the sick elderly. And the young ones are less likely to complain, because it is just their taxes and they're not looking at where or how that is divvied up.
If you give everyone the same benefits, you have to increase the taxes. Contrary to popular belief, there's no "budget fairy".
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Old 30-01-2018, 14:09   #111
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Re: Early retirement and health care for boaters

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I am curious what the tort laws are in countries like Canada? Do medical care providers get sued there like they do here? How expensive is malpractice insurance compared to here?
For when there is clearly malpractice or error, yes one can still sue a doctor or a hospital in Canada.

I'm going out on a limb here, but it seems to me that in Canada there's more trust between patient and doctor, and medical services aren't being stipulated in contracts or HMOs; if a treatment is indicated, the patient gets it, usually without a fight. So in general, there's less to sue about. Consequently, malpractice insurance costs less.

This link has some comparisons between the US and Canada, including malpractice costs.
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Old 30-01-2018, 14:58   #112
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Re: Early retirement and health care for boaters

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For when there is clearly malpractice or error, yes one can still sue a doctor or a hospital in Canada.

I'm going out on a limb here, but it seems to me that in Canada there's more trust between patient and doctor, and medical services aren't being stipulated in contracts or HMOs; if a treatment is indicated, the patient gets it, usually without a fight. So in general, there's less to sue about. Consequently, malpractice insurance costs less.

This link has some comparisons between the US and Canada, including malpractice costs.
Last I looked at this question there was definitely a lower rate of malpractice suits in Canada vs the USA. This Globe & Mail story cites some stats, and points out how unlikely it is for malpractice suits to go in favour of the plaintiff.

So I donít think itís only due to the level of trust Canadians have in institutions vs our American cousins, but that also appears to be a factor. Those who attempt to measure national trust levels always show Canadians society is more trusting than American (for good, and for ill). But itís not dramatically more, at least according to some research.



This other graph shows the decline in trust towards government in the USA:
https://ourworldindata.org/grapher/p...-in-government

And even more telling, the dramatics decline in inter-personal trust. From the report:

"In the US, people trust each other less now than 40 years ago.

In the US, the General Social Survey (GSS) has been gathering information about trust attitudes since 1972. To our knowledge, this is the longest available time-series on interpersonal trust estimates in the world. The following visualization uses this source to show the evolution of trust in the US. Specifically, this plot shows the share of respondents agreeing with the statement "most people can be trusted" in the surveys 1972-2014.7 As we can see, there are short-term fluctuations, but people in the US seem to trust each other less today than 40 years ago."

https://ourworldindata.org/grapher/t...udes-in-the-us
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Old 30-01-2018, 15:48   #113
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Re: Early retirement and health care for boaters

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Originally Posted by hellosailor View Post
"65+ have to be astronomically more expensive to insure than those under 65, so why not everyone?"
Simple math, really. If you TAX everyone, and don't spend any money on the healthier ones, you have that much more money to spend on the sick elderly. And the young ones are less likely to complain, because it is just their taxes and they're not looking at where or how that is divvied up.
If you give everyone the same benefits, you have to increase the taxes. Contrary to popular belief, there's no "budget fairy".
This is exactly the premise of the Affordable Heath Care Plan, and the financial model that health care companies use to set prices.
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Old 30-01-2018, 15:52   #114
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Re: Early retirement and health care for boaters

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OK, I was about to post a tirade in response to certain “alternative facts” being presented here. But Don’s post shamed me into stepping away from the keyboard. Thanks Don. You are completely correct.

From all I’ve read here, outside of actually just paying as you go, or moving to another country with normal healthcare, Don’s approach seems incredibly innovative.
I am truly sorry that Canadians are so sensitive about their healthcare system. If it works for them that is good. I have met quite a few who moved to Canada for various reasons (not just from the USA), but I can say with absolute honesty, I have never even heard of someone moving to or even going to Canada for healthcare.

Odd bit: I have known several people who had serious emergency health situations while in Mexico. All but one lived, and the brag about the quality of care and the cost. Even the family of the one who died were very pleased with the quality of the medical care (and the cost too, when asked much later).

Much of this discussion reminds me of the Veterans Administration in the USA, although my dual citizenship(British/USA) brother says he likes the American VA better than the Brits' National Health. My younger son claims he and his family receive great care in southeast Asia for just a few pennies on the dollar.

These tidbits make me sort of wonder if some entrepreneurs in the cruising crowd might put together an world insurance plan for cruisers. It might actually be feasible, particularly if regionally based. Could DAN, and the people who insure expats, provide the basic models?
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Old 30-01-2018, 16:00   #115
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Re: Early retirement and health care for boaters

It's hard to debate health care with an American because Americans have 2 completely separate systems. If your younger than 65 then you are in the private system and if your 65 or older your in the the Medicare system which is similar to Canada and other Western countries. It's a single payer system that is Government funded. This site is heavily weighted to older sailors so it really depends on the age of the American your talking with when they express how they feel about their health care system. Often they like to put down the Canadian system all the while enjoying the same system in America.
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Old 30-01-2018, 16:18   #116
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Re: Early retirement and health care for boaters

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I am truly sorry that Canadians are so sensitive about their healthcare system. If it works for them that is good. I have met quite a few who moved to Canada for various reasons (not just from the USA), but I can say with absolute honesty, I have never even heard of someone moving to or even going to Canada for healthcare.
It's no secret that some immigrants target Canada for our health care. We don't have private hospitals or for-fee primary care for non-citizens, so there's no stream of foreigners flying in to use them. Like the US and other countries, there are of course exceptions or mercy cases where specialized treatment is provided.

We're mainly sensitive to misinformation about our system, propagated often by American opponents of single-payer. It has flaws, but it is a good model for a high standard of universal care at reasonable cost. If you don't think that universal care is a reasonable goal, then of course the Canadian single-payer model offers no advantages.

The wealthy will always seek out and travel to get what they believe is superior care, and I will be the first to state that the US offers world-leading health care... to those who can pay for it. I am even aware of cases where the Canadian government will pay for a Canadian to travel to the US for life-saving treatment, if it's not yet available in Canada, or there's some other urgent reason.

btw there are other countries who have achieved a high standard of universal care through the private sector. Check out France.
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Old 30-01-2018, 16:46   #117
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Re: Early retirement and health care for boaters

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Hi Everyone,

My wife and I are hoping to retire soon..both just turned 60. We are shocked at the costs for healthcare if you are not 65. I am hoping there are knowledgeable people in the forum who have traveled this road and can shed some light and hopefully share some info on a good strategy to maintain health care at an affordable rate. I understand affordable is subjective. I have found healthcare ranges from $2k to $4k depending on what options are selected...any thoughts? Words of wisdom?
I am 55, and retired last May. I live on my boat, and maintain residency in Florida ( thank you St. Brendan's Ilse!). I enrolled in a Blue Cross HMO plan last year (while I was still working due to the enrollment deadlines) and my income precluded me from any subsidies. My premiums started out at $475 per month, and increased to $550 at the first of the year. My plan has a $5k deductible, if I recall correctly - I went with the highest deductible I could get, anyway. Its premiums, deductible, and co-pays my total out of pocket in any one year would be less than $15k even if something serious happens.

I am pretty healthy, and th first time I had to use the insurance was last weekend when I did something klutzy and had to go to the ER for a few stitches. I haven the gotten the bill yet, but I would guess that one visit may have justified an entire year's premiums.

In my retirement planning I factored in th potential cost for health insurance, and budgeted $1k per month. Didn't like having to do it, but that's the world we live in today and I'd rather have it and not need it than the other way around. And, I am happy that so far my costs have been below what I budgeted.

Hope this info is pertinent and helpful to the OP.
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Old 30-01-2018, 17:20   #118
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Re: Early retirement and health care for boaters

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Originally Posted by buzzstar View Post
I am truly sorry that Canadians are so sensitive about their healthcare system. If it works for them that is good. I have met quite a few who moved to Canada for various reasons (not just from the USA), but I can say with absolute honesty, I have never even heard of someone moving to or even going to Canada for healthcare.

Odd bit: I have known several people who had serious emergency health situations while in Mexico. All but one lived, and the brag about the quality of care and the cost. Even the family of the one who died were very pleased with the quality of the medical care (and the cost too, when asked much later).

Much of this discussion reminds me of the Veterans Administration in the USA, although my dual citizenship(British/USA) brother says he likes the American VA better than the Brits' National Health. My younger son claims he and his family receive great care in southeast Asia for just a few pennies on the dollar.

These tidbits make me sort of wonder if some entrepreneurs in the cruising crowd might put together an world insurance plan for cruisers. It might actually be feasible, particularly if regionally based. Could DAN, and the people who insure expats, provide the basic models?
I hope you are aware that the VA system is a single-payer system. It applies to a certain set of government workers, aka the military.
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Old 30-01-2018, 17:25   #119
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Re: Early retirement and health care for boaters

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[derail alert]

Beg pardon? As with the US, we don't get much of a lifestyle in Canada if we have low or no income. We do get decent healthcare, regardless of income.

It is indeed true that Canada has a fairly mobile workforce, and few are trapped in a job simply out of fear of losing health benefits.

[ok, I'm about 5 pages late with this. Ignore if no longer timely]
I was trying to say that Canadians don't have to pretend to be 'poor' to get healthcare. They can still afford to enjoy other things like 'Cruising'.

Americans have to have a strategy of having assets but low annual income. This entitles you to a lot of benefits.

Let's be blunt. Wealthy people see American healthcare different than most people. Healthcare for the high earners are heavily subsidized from their employers AND the benefits are tax free.

Rich people will seek treatment where they think it is best. Middle class will seek places with best value. I hear a lot of dental work is getting done in Northern Mexico as an example.

I've been buying ACA insurance for years. No direct subsidy.

As far as on topic, Healthcare is a huge issue. I don't want to be without income (spending down assets) when I start cruising. Therefore, healthcare will be a risk.

I'm about to turn 46 and in good health. I keep pushing up my cruising timeline. Currently 2 years away.
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Old 30-01-2018, 17:32   #120
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Re: Early retirement and health care for boaters

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I hope you are aware that the VA system is a single-payer system. It applies to a certain set of government workers, aka the military.
No, you have it wrong. The US military has a separate health system. The VA system is for US veterans no longer in military service. Are you from the USA?
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