Month eight for a middle-aged couple on a modest boat.

[Mike OReilly]

Originally Posted by a64pilot

A large issue with comparing one system to another is to determine the percentage of people who pay into the system as opposed to the number that collect from it.
Simply put, a lot of the European countries have a higher percentage in the work force paying into the system, so it works and works well.
If however the payees are outnumbered it’s not going to work as well.

A single-payer system is funded through taxes. All that is required is to tax at the appropriate rate.

Originally Posted by a64pilot

That and big business getting into the Medical system has been what has changed from many years ago, in my opinion.
When I was a kid, many if not most Dr’s pretty much were small business owners, they owned and operated their practice, that’s not the case anymore, they are employees for rather large Corporations now.

Interesting dichotomy. In Canada most doctors are small businesses. Some might operate within group practices, but the vast majority are independent small businesses. In fact, virtually all healthcare in Canada is delivered by the private sector. It’s only the insurance that is government-run. The rest is private.

[robert sailor]

I screwed up, your actual 2018 percentage of GDP on health care in the USA was 18% and growing. The average percentage of GDP for OECD countries health care system is 8.9% so pretty strong message here. I know the word "socialized" in your country causes some people to have panic attacks but it simply means that it's coming from your tax system, so you also have socialized roads,bridges,military,schools,police,fire dept.court system, home land security, border protection, mail, etc. The list is a long one and most if not all make sense.

[sailorboy1]

The thread has driiiiiiifted

I share responsibility, but wouldn't this stuff be better on another thread (a political/government/health care one)?

I could be wrong but I bet CTHoops posts this stuff as just “it cost us this for example”

I’ll go back to my ribeye steak prep now.

[a64pilot]

Originally Posted by sailorboy1

The thread has driiiiiiifted

I share responsibility, but wouldn't this stuff be better on another thread (a political/government/health care one)?

I could be wrong but I bet CTHoops posts this stuff as just “it cost us this for example”

I’ll go back to my ribeye steak prep now.

It would but drift often is what keeps a thread alive, often if they don’t drift, no new posts are made and they fall off of the first page and die.
So long as it’s kept civil.

[a64pilot]

Originally Posted by Tetepare

I’m struggling to think of something, anything, that government does “world class”. In theory you are correct but in practice it won’t happen, as funds are drained off for other purposes and “the system” becomes an employment scheme for the politically connected and their partisan supporters who are otherwise unemployable.

I concede your point, but I actually think the early NASA and the TVA, were well run and well done.
I’d bet Hoover dam and a few others were as well, but all that’s history.

[robert sailor]

Originally Posted by Tetepare

I’m struggling to think of something, anything, that government does “world class”. In theory you are correct but in practice it won’t happen, as funds are drained off for other purposes and “the system” becomes an employment scheme for the politically connected and their partisan supporters who are otherwise unemployable.

In Canada it's called Revenue Canada and my experience is that they are too efficient on collecting taxes.

[Paul L]

Originally Posted by a64pilot

They don’t like to admit it, but they do as most lower income people in the US do, they are uninsured.
They go to the Emergency room and the law says they have to be treated, so they are. I’m sure they leave with a monstrous bill that they will never pay, because they can’t. But somehow the Hospital has to be able to keep its doors open, so the unpaid costs get paid by those who have Insurence and or the means to do so.
That is a major reason the costs are so high, that so few actually pay.

That is an unpopular statement and I’m sure instant death to say on the political world, but I believe it to be true.

The law says that you must be stabilized at the ER. There is no requirement for follow on treatment. So get cancer and you will be treated in an ER for immediate symptoms, not for the cancer, as an example.

The point of the original ACA law requiring everyone to have health insurance was to avoid this unecessary treatment at the ER, as well as to fund the insurance with a diverse population. This requirement has since been removed in an attempt to kill the ACA.

[Paul L]

Originally Posted by robert sailor

I screwed up, your actual 2018 percentage of GDP on health care in the USA was 18% and growing. The average percentage of GDP for OECD countries health care system is 8.9% so pretty strong message here. I know the word "socialized" in your country causes some people to have panic attacks but it simply means that it's coming from your tax system, so you also have socialized roads,bridges,military,schools,police,fire dept.court system, home land security, border protection, mail, etc. The list is a long one and most if not all make sense.

Yep, we already pay far more per person for health care than any other industrialized country, while still not covering everyone and getting worse outcomes in many areas. Finding the money to pay for a full coverage system is not the issue. Fixing a broken system that has astronomical costs that no other nation has.
To keep this on cruising, I have a prescription drug that is expensive in the US. My US med policy will not pay for more than 90 days at a time and that 90 days is not paid for because of an an annual deductible. So tne drug is all out of pocket for me. I need to carry 9 to 12 months worth while cruising.
In the US the best deal I can find is usd$450 per month. I just bought 6 months worth in Australia of exactly the same drug without any insurance coverage for usd$375. That's 375 for 6 months compared to 450 for 1 month.
The US health care system is broken.

[robert sailor]

Originally Posted by Paul L

Yep, we already pay far more per person for health care than any other industrialized country, while still not covering everyone and getting worse outcomes in many areas. Finding the money to pay for a full coverage system is not the issue. Fixing a broken system that has astronomical costs that no other nation has.
To keep this on cruising, I have a prescription drug that is expensive in the US. My US med policy will not pay for more than 90 days at a time and that 90 days is not paid for because of an an annual deductible. So tne drug is all out of pocket for me. I need to carry 9 to 12 months worth while cruising.
In the US the best deal I can find is usd$450 per month. I just bought 6 months worth in Australia of exactly the same drug without any insurance coverage for usd$375. That's 375 for 6 months compared to 450 for 1 month.
The US health care system is broken.

Kind of a cute headline the other day of an American caravan coming across our borders. I guess it's a common thing as folks from the border states come up to Canada to purchase drugs at deep discounts that our country has negotiated thru our single payer system...the real art of the deal, lol. Anyways the last news storey was about insulin which was 10 times higher in the USA.
Because your medical costs are already double most other countries and growing it simply can't be kept going as it is. Your Government is going to have to change things or limit the health care in your country. Health care is a huge business in your country and politicians get heavy money from these companies to not allow a single payer system or competition on drugs from any other country. It's going to be a really big deal going forward as the current government wants to cut spending on health care and that's understandable but they also don't want to talk about a single payer system to reduce costs. Going to be interesting.

[Cthoops]

While thread drift is inevitable, be careful everyone so the thread doesn’t get shut down. As Sailorboy said, the whole point of my original post was to show what we spent in our eighth month of cruising, and it would be too bad if it disappeared.

Originally Posted by Exile

Wow! That's remarkably inexpensive (premium-wise that is), and also encouraging to hear. Part of a retirement package? Medicare? Under 40 years old? Limited to a statewide HMO?

I’m 50 and Mr. cthoops is 59. No Medicare or retirement package. This was a standard plan purchased on Connecticut’s health exchange and it’s based on annual earned income. It’s a statewide plan but it covers out of network care with higher co-pays and deductibles. When I researched a few other states, the premiums varied wildly but CT was among the cheapest so we decided to maintain our CT residency. Even with having to pay CT income taxes, it was well worth it for us.

[Exile]

Originally Posted by Cthoops

While thread drift is inevitable, be careful everyone so the thread doesn’t get shut down. As Sailorboy said, the whole point of my original post was to show what we spent in our eighth month of cruising, and it would be too bad if it disappeared.



I’m 50 and Mr. cthoops is 59. No Medicare or retirement package. This was a standard plan purchased on Connecticut’s health exchange and it’s based on annual earned income. It’s a statewide plan but it covers out of network care with higher co-pays and deductibles. When I researched a few other states, the premiums varied wildly but CT was among the cheapest so we decided to maintain our CT residency. Even with having to pay CT income taxes, it was well worth it for us.

I didn't realize there was so much variance state-to-state. Thanks for the useful info. One problem in my state is that all the major ins. cos. offering PPO's bailed not long after the ACA was enacted. Many people, including myself, lost their docs and their long-time insurance. Many other primary care docs are packing their bags and leaving the state. Seems to be from a combination of high admin costs, low Medicare & Medicaid reimbursement, and loss of patient control due to the advent of large HMO's.

[sailorboy1]

OK

Another thing to be aware of when looking at ACA is whether "your" State did the expanded Medicare. If it did you need a higher income to get an ACA subsidy.

I'm a Florida resident and it doesn't have the expanded medicare and there were LOTS of plan available the last 2 years I've been on it.

[Pete7]

Originally Posted by sailorboy1

A note:
Went to an Urgent Care a month ago ($10 copay) and they had POSTED prices for common type stuff, and even some semi advanced stuff, and I felt they were very reasonable!!!

Think Ireland operates a similar system of drop in clinics and pay on your way out in addition to the normal hospitals etc. Great for minor injuries and illnesses.

The UK it's all free* although there are private hospitals if you want. Drugs issued in hospitals are free even for treatment after you leave.

*Prescription drugs from the Doc however, are £8 a pop, regardless of the actual cost of the drug.

I have been to the US a few times whilst serving but now I would be looking very closely at the cost of travel insurance to visit. One serious accident even if its not your fault could be ruinous. Out of curiosity I googled a quote for a visit to the USA for 30 days holiday. Price £161. The same quote for Italy is £55.

The idea of individuals paying $450 a month for medical cover is just astonishing.

[Otium]

Cthoops;
Thanks so much for your reports. They are super helpful to someone like me planning my get-away retirement to my sailboat!

[GILow]

Well I’m glad this thread drifted into medical costs because it’s something I had not considered.

Here in Oz when I was earning around AU$165K I paid an extra tax penalty for NOT having private health insurance. Once the accountants had done their thing I think that translated to around an extra AU$3-4K tax bill each year for a a family of three.

But that was a choice we made on the wisdom of my ex wife who was a senior nurse of great experience who strongly believed that the quality of care was better in our public system than our private system. And private health cover of any worth would have cost the same or more.

Now I am a student again my income is below the taxable threshold anyway so no penalty for not having private health insurance and in my new profession I will never reach the threshold that slaps the extra tax on.

But as I set off next year I will be covered by the Australian public health system automatically. So there is no line in my budget for health costs other than a few vitamins and healthy food.

For comparison, I know someone who had an ablation recently who elected to skip the probable 3 month delay in the public system (the condition was not life threatening and was discovered only by chance.) and went fully private with just two days notice. The total cost including hospital, surgeon etc was only AU$22K.

So my point is, a combination of public cover and a moderate cash reserve is my health insurance strategy for the next few years while I am cruising. This may be one of the bigger cost savings that are helping me to understand why the figures I was seeing from North American cruisers did not line up at all with my estimates.

But I stIll feel like a lot of our day to day costs are higher in Oz, certainly if you are at any kind of a goods consumer stage.