Obamacare = early retirement anyone?

[avb3]

Originally Posted by rebel heart

..........
Until there is price competition in medicine, there is zero incentive for providers to control costs. There is no God-given standard that radiologists should get 400k a year, which is their current median salary. I'm all for folks making money, but I'd prefer it to be inside the confines of a free-ish market system. The American medical system is *far* from that.

That is about what the average radiologist makes in Canada. In fact, here in Alberta, nurses make about $45/hour, and double that for overtime. You need to understand that most nurses here work under a .6 of a FTE scenario, because that is first of all where benefits kick in (like free massages), and that everything after that .6 is overtime.

In other words everything after 4.8 hours assuming an 8 hour day 40 hour week would be doubletime.

It is not unusual for a nurse to make 6 figures.

My point is, it is not the care provider salaries that are the difference it is the huge inefficiencies and profit driven hospitals and insurance companies the determine that the US spends 1/3 more of its GDP on healthcare than Canada.

[sailorchic34]

Originally Posted by Don Lucas

Please quote a part of the bill/law that says this. Because so far we have seen that there is a minimum amont or percentage of your income, whichever is larger.

Gee Don, Look it up yourself. I did look it up months ago so I know its in there... It really varies by state but for me being one of those folks that lives below the poverty line (IE the $500/month cruiser), there is no cost. Those below FPL which is about $900 ish a month last time I looked, get signed up for medicare for free. But it depends on the state, For some states its for those below $5000 a year, Texas for one) Those between 100 % and 400% of the FPL get tax credits for some or most of the cost.

For those families above 400 percent of the FPL (about $3600/ month) its all out of pocket.

I've got a dollar that says I'm right BTW....

[osirissail]

Originally Posted by SunDevil

. . . I will say that I hate the way the billing and cost information is though. I had no idea a CT scan cost $4,000, and that was probably cheap. I found out a few weeks after when a bill came in the mail. Except it wasn't a real bill. The health insurance company paid that, but I got something in the mail asking me to pay $1000 when it was covered by my insurance.

I don't know where you got your CT scan, but it must have been in some swanky, fur lined, gold-plated clinic. I have had a half dozen CT scans in the last 1.5 years here in Central Florida at both hospitals and dedicated imaging clinics. The "retail" price** for the CT scan was US$726 (chest) and US$800 (abdominal). The "wholesale" price** was US$218 and US$154. And with AARP supplemental coverage my out of pocket was US$0 (zero).

** For the last decade or more the U.S. medical system has instituted a dual pricing system. "Retail" is what the medical provider bills for a procedure/process and "Wholesale" is what they will accept as full payment from insurance companies for that procedure/process. With most insurance policies you pay about 20% of "wholesale" (after meeting the deductible) and the rest is paid by the insurance provider. With "Supplemental" insurance the 20% you have to pay is paid by your "Supplemental" carrier.

[Stumble]

According to the experts there are a coupl of drivers of the US health care costs, as to why they are much higher than in other developed countries. Of course it depends to some extent on which study you look at, but the generally agreed drivers fall into just a few categories.

1) extremely high prices for pharmaceuticals - in large part driven by non-negotiated prices between drug manufacturers and Medicare/Medicaid.
2) over payment for specialized services and lack of primary care physicians
3) high overheated related to billing complexities
4) huge quantity of services provided to people who have no possibility of paying (either no insurance, or underinsured).
5) to many non-justified tests, and procedures.

This is not a simple problem, and even trying to discuss it is fraught with difficulty since the issues are very complicated, and there are too many people that are emotionally invested in issues with little to no empirical basis.

To me this is part of the problem with a lot of political issues. The problems and answers are very complicated and cannot reasonably be understood by the average person. But because they are emotional issues poor or misinformation is easily digested by both sides.

[sailorchic34]

BTW the reason that the fine folks that live on LESS then 100% of the federal poverty limit (FPL) get signed up for medicare, is it actually saves the government money to do so. It saves $100 BILLION to sign the folks up for medicaid then to do the tax credit for the Sub FPL people. That's why its set up that way.

Or so I read on the internet. Its got to be true if its on the internet....

I knew I was a cheap date ;-)

[rberrey]

The bottem line is who will pay for Obamacare when I and many others stop working as hard or stop working all together like I plan to do next year? The superintendent on the job I'm on now plans to quit first of the year, I quit running work 5 years ago. I plan on sailing away and sucking up the easy life with everyone else while it last. Rick

[Doodles]

Originally Posted by Stumble

According to the experts there are a coupl of drivers of the US health care costs, as to why they are much higher than in other developed countries. Of course it depends to some extent on which study you look at, but the generally agreed drivers fall into just a few categories.

1) extremely high prices for pharmaceuticals - in large part driven by non-negotiated prices between drug manufacturers and Medicare/Medicaid.
2) over payment for specialized services and lack of primary care physicians
3) high overheated related to billing complexities
4) huge quantity of services provided to people who have no possibility of paying (either no insurance, or underinsured).
5) to many non-justified tests, and procedures.

This is not a simple problem, and even trying to discuss it is fraught with difficulty since the issues are very complicated, and there are too many people that are emotionally invested in issues with little to no empirical basis.

To me this is part of the problem with a lot of political issues. The problems and answers are very complicated and cannot reasonably be understood by the average person. But because they are emotional issues poor or misinformation is easily digested by both sides.

Thanks! A very intelligent observation .... and I was being to believe Obama did it all to us!

[dochueb]

Originally Posted by Pete7

Dave, thank god for the NHS (National Health Service). It would worry me cruising the US if something went wrong.

What happens in the US if you don't have insurance and something serious goes wrong like a badly broken leg?

Pete

You get it fixed in the hospital of your choice by the doctor of your choice as neither is legally allowed to turn you away based on your ability to pay.

The hospital & doctor may or (more likely) may not get paid.

[onestepcsy37]

not true, dochueb.

states, (usually at the county level), have 'county' hospitals. years ago they were dubbed 'charity' hospitals but that seems to be politically incorrect today. in any case, an indigent or uninsured patient will be transported to the county hospital where they will get cared for - but not the hospital or doctor of their choice.

the taxpayer then picks up the tab - but not the whole tab. states maintain funds to reimburse hospitals/doctors for a portion of their unpaid services, usually at about the same level that insurance companies reimburse them - about 30 to 50% of their 'usual and customary fee' (the retail price).

before being state reimbursed, hospitals/doctors are REQUIRED to pursue the patient for payment, right up to using collection agencies. only when they demonstrate to the state that there is no possibility of being paid by the patient can they apply to the state.

so in effect we already have 'social' medicine for the indigent. but only for emergencies. getting regular checkups and other forms of non-essential care is not paid for by the state, leading to ill health for americans at the lower income levels.

so, do i think that americans are grossly overcharged for medical care? of course i do, for the very simple reason that hospitals/doctors are perfectly willing to accept 30 to 50% of their 'usual and customary' fees from insurance companies.

[Aussiesuede]

Originally Posted by dochueb

You get it fixed in the hospital of your choice by the doctor of your choice as neither is legally allowed to turn you away based on your ability to pay.

The hospital & doctor may or (more likely) may not get paid.

Actually when you present at the emergency room, you do not get to choose your doctor. You are attended to by whatever random doctor on rotation at the time. And hospitals CAN and DO turn away patients who present at an emergency room if it's determined that the patient is sufficiently stabilised enough to be transferred to the mandatory county facility of record. Present at an emergecy room at a private hospital with a broken arm and either insufficient, or no insurance coverage, and you'll get a quick exam- often in the waiting are- to determine that you are sufficiently stable; then you'll be given directions to the nearest facility in the county that is mandated to fix ya up.

[dana-tenacity]

I started reading at page 1 and got as far as page 8 before giving up.

One thing became glaringly obviouseople in the USA need to get over their irrational fear of anything vaguely "socialist", sack the insurance companies and hospitals for profit and institute a sensible taxpayer funded health system. For advice look to your neighbours to the north (or just about any other OECD country). People - you are all getting screwed.

[Scofvb]

This is an excellent discussion for those of us who are (1) retired and (2) dreaming of casting off from our big mortgages and taking up the cruising life. It's something I never considered in my cruising life fantasy planning. I won't go into a political rant that will cause the moderators to close this thread, but I do have to agree with roverhi: "Are you saying thank you for us paying so that you can go cruising?" The lesson I take from all the excellent posts on this thread is that those of us who DO have pre-existing conditions really need to plan for health care costs. Thanks for all the excellent posts from those who are dealing with this issue.

[osirissail]

Originally Posted by Stumble

. . . To me this is part of the problem with a lot of political issues. The problems and answers are very complicated and cannot reasonably be understood by the average person. But because they are emotional issues poor or misinformation is easily digested by both sides.

I would suggest using the word "regurgitated" instead of "digested" - seems to have a closer "smell & taste" to the issue at hand. . .

[dochueb]

Originally Posted by onestepcsy37

not true, dochueb.

states, (usually at the county level), have 'county' hospitals. years ago they were dubbed 'charity' hospitals but that seems to be politically incorrect today. in any case, an indigent or uninsured patient will be transported to the county hospital where they will get cared for - but not the hospital or doctor of their choice.

the taxpayer then picks up the tab - but not the whole tab. states maintain funds to reimburse hospitals/doctors for a portion of their unpaid services, usually at about the same level that insurance companies reimburse them - about 30 to 50% of their 'usual and customary fee' (the retail price).

before being state reimbursed, hospitals/doctors are REQUIRED to pursue the patient for payment, right up to using collection agencies. only when they demonstrate to the state that there is no possibility of being paid by the patient can they apply to the state.

so in effect we already have 'social' medicine for the indigent. but only for emergencies. getting regular checkups and other forms of non-essential care is not paid for by the state, leading to ill health for americans at the lower income levels.

so, do i think that americans are grossly overcharged for medical care? of course i do, for the very simple reason that hospitals/doctors are perfectly willing to accept 30 to 50% of their 'usual and customary' fees from insurance companies.

Also not quite true.

The last time I worked in such a setting was in St. Louis. Since then, (17 years & 4 cities ago...), I haven't seen the county / charity system. Patients come to ER and are treated. One can only be transferred to a higher level of care (eg. Trauma center) if medically necessary. Otherwise, the hospital & physician are dealing with an EMTALA violation.

I've never worked in a state were physicians were reimbursed for indigent care. I also don't believe that's true for hospitals in my state.

As for preventive care, I agree. I wasn't proposing that our system as A-OK, just answering the broken leg hypothetical.

DH

[svHyLyte]

I don't see what the point of this debate is. Obamacare in its current incarnation is the law of the land and those choosing to reside here (USA) will have no choice but to endure it. One's options then are to simply maximize one's own benefit while minimizing ones own losses in the regime.

The essential problem is that in this issue, as others, there are more takers than givers and, as made clear hereinbefore (earlier posts), because if its implementation, there will be even fewer givers as many, such as we, finally say "The heck with it. If I can't make a reasonable return on my investment and labor, why bother?" Do not put one's money at risk in a business (when "government" never share the losses but greadily steps up for a share of the profits) and skip the 60-70 hour work weeks.

Folks do not provide for themselves and their needs when they are confident others will pick up their burdens. They suffer no consequences for such an approach. Frankly, it's not the fault of the majority of people at this point as they have been raised with, nearly, every want provided for by someone even before many of these wants become manifest. My own daughter, who I love quite dearly, was a perfect illustration in her time. As she approached the age when she would be permitted to obtain a driver's license, she came into the garage one day to ask me what kind of car Mommy and I planned to buy for her and to let me know which ones she didn't want. She was quite stunned to hear that we had no plans to buy her a car at all. "But why not?" she protested, "..all the other kids' moms and dads are getting cars for them!" Having had virtually every wish/need/demand fulfilled for her entire 15+ years of life (although this despite some rather heated debates between the parents in the events), from her perspective her expectations were entirely reasonable. The idea that if she wanted a car, she would have to earn the money to buy one and pay for its maintenance, upkeep and insurance, never occured to her. And so the body politic. "It's not my fault!" is invariably the cry, closely followed by "There should be a Law!".

N'any case, arguing between ourselves and berating one another and creating ill-will for one or another's choices serves no useful purpose. The election is over and folks have made their choices. If the consequences are painful enough, they will make different choices next time around, or not--because, of course, there a more now that will not suffer the consequences then will. The only way to change that calculus is to reverse the balances--one person at a time. So, for those of you that have the resources to say the heck with it and go cruising, do so, please. There are many places that one can cruise within the limits of the USA that are quite lovely and often unvisited and yet still avail one of all of the free advantages of Obamacare (e.g. Puerto Rico, the USVI, Hawaii, American Samoa et al.) And maybe, at some point, when folks realize that there simply aren't enough givers at any tax rate, that they have gutted the Golden Goose and there are no more golden eggs to be had, and foreign investors will no long buy US debt then things will change. Or not. In the mean time, I shall go sailing as I will in a few minutes (here it will be in the 80's today with 10-15 knt winds from the NNE which will make for a nice reach out to Egmont Key for lunch, a nap and a good book to read for an hour or so).

Here Home Nods...