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Raddr's Early Retirement and Financial Strategy Board
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KenM
Joined: 23 Jun 2004
Posts: 988
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 Posted: Thu Aug 11, 2005 8:31 am Post subject: |
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hi kramer
.... but for medical insurance you've got to look at an apples/apples situation - I haven't analysed this in great detail because it doesn't affect me, but it appears that most Americans expect that US insurance will cover them for everything - inpatient/long term outpatient/long term medication/extensive tests/latest technology and drugs/long term care and treatment for chronic problems/etc/etc - that's why it's expensive. The equivalent (although probably not so comprehensive with latest tecniques etc etc) in "cheap" SE Asia is US$9000 for a couple in late 50's with $200 excess. Cheapest is catastrophic type insurance - US$3500 with $5000 excess for inpatient treatment only; limited follow up treatment and no chronic disease management. Are those figures really so cheap when compared with medical insurance in low-cost States in the US? (I understand that premiums vary betwen States depending on state regulations etc?).
I may well be wrong but I suggest that wanderer's taxes are not zero ... as a US citizen I think he pays US taxes on worldwide income ... I've heard that for US citizens residing overseas, although perhaps there is a higher allowance for earned income?, taxes on investment income (as a retiree) would be the same as though residing in the US? As an expat Brit living in SE Asia I'm in the same situation as ben ... no home country taxes and, for investment income, no taxes in SE Asian countries .... and that makes a very considerable difference 
But I'd certainly recommend living in other countries ... it shouldn't cost any more than the home country but, living for extended periods of time, may not cost very much less if someone wants a comfortable long-term type of lifestyle .... for example, riding in bemos, jeepneys, tuktuks, trishaws, bullock carts, etc loses its appeal after about the first 6 months or so - at least for me it does 
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Author
Joined: 09 Aug 2005
Posts: 227
Location: World wide
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| Posted: Thu Aug 11, 2005 10:27 am Post subject: |
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kramer said: | Quote: | | A wild card here, though, is health care. If you are in bad health, or locked into bad insurance, things can get very expensive. |
I used to work for a civil engineering firm before my husband and I retired. At that time, it was an employee driven market and the company who could offer the most benefits got the valued employee. My boss put me in charge of employee benefits, researching health care. He wanted top of the line, no brainer, cover everything insurance "like the old days" and about had a heart attack when he saw what that would cost his business.
The employees, on the other hand griped about every little thing they were offered and replied with the standard "it's not enough."
I think the guaranteed payments that insurance offers hospitals only brings the prices higher with no ceiling in sight. Insurance needs to be brought to the open market, and force prices for services to be competitive.
On the other hand, we as the ones being covered, need to learn more about prices being charged, services being rendered, deductibles offered, and get involved in our own care. Going into a doctor's office blindly, without any effort on our part, or knowledge of our conditions or side effects of our medications and then expecting the doctors to "heal" us is naive and no longer works.
In fact, I think employer sponsored health care should simply be phased out altogether, and have the whole issue be brought to the open market.
Akaisha
Author, THE ADVENTURER'S GUIDE TO EARLY RETIREMENT
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raddr
Site Admin
Joined: 22 Jun 2004
Posts: 4735
Location: Texas
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| Posted: Thu Aug 11, 2005 11:46 am Post subject: |
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| Quote: | | In fact, I think employer sponsored health care should simply be phased out altogether, and have the whole issue be brought to the open market. |
I agree. 
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ascenzm
Joined: 14 Feb 2005
Posts: 78
Location: Pittsburgh, PA
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| Posted: Fri Aug 12, 2005 7:58 am Post subject: |
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| Quote: | On the other hand, we as the ones being covered, need to learn more about prices being charged, services being rendered, deductibles offered, and get involved in our own care. Going into a doctor's office blindly, without any effort on our part, or knowledge of our conditions or side effects of our medications and then expecting the doctors to "heal" us is naive and no longer works.
In fact, I think employer sponsored health care should simply be phased out altogether, and have the whole issue be brought to the open market.
Akaisha
Author, THE ADVENTURER'S GUIDE TO EARLY RETIREMENT
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I agree with both you and raddr on this issue. Prior to WWII, I don't think that most American employers offered health insurance. People need to know what health care costs and having employer provided health coverage shields them from this knowledge. I remember my mother, who grew up the depression, telling me that even though her large family was poor, they still could afford to see a doctor when necessary.
Another advantage to not having employee provided health care is that this would make the decision to FIRE a much easier decision.
Mike |
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Author
Joined: 09 Aug 2005
Posts: 227
Location: World wide
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| Posted: Fri Aug 12, 2005 11:34 am Post subject: |
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Mike, I couldn't agree with you more. My understanding is that sometime in the 1950's labor unions decided that instead of getting taxable pay increases, they would forego them and in their place accept benefits (which are still untaxed).
This changed the whole face of employee/employer relations, as well as the health care issue. Also I believe it was Pres. Johnson who instituted the Medicare program with no cap on pricing... dumb.... so the prices continue to rise without an end in sight -- in the current system.
Since we are not in charge of paying, we are taken out of the driver's seat that the consumer is normally in. We have become "victims" of these price increases instead of the ones who should benefit because we can hire and fire according to the service and care we receive.
Also,... imagine what would happen if all of a sudden employees got taxed for these benefits of healthcare (sick days off, paid vacations, etc.)! We would have a riot on our hands, I think...  Actually what would happen after the initial upset, is that people would want to have choice in what "benefits" they would choose to accept.
We have 2 chapters in our book RE: health care issues and options.. It's a subject that really gets us riles up!
I believe it's a toxic administrative system, and it needs to be challenged. Bring health care to the market place, and we will see prices drop like a rock.
Akaisha
Author, THE ADVENTURER'S GUIDE TO EARLY RETIREMENT
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raddr
Site Admin
Joined: 22 Jun 2004
Posts: 4735
Location: Texas
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| Posted: Fri Aug 12, 2005 11:43 am Post subject: |
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| Quote: | | I believe it's a toxic administrative system, and it needs to be challenged. Bring health care to the market place, and we will see prices drop like a rock. |
Yes, but IMO only if there is meaningful tort reform to go along with it. As a radiologist I'm sure that more than half of what I did was the direct result of defensive medicine. Just a simple "loser pays" rule in the courts like most of the world's civilized countries have would lower medical costs here quite a bit.
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Author
Joined: 09 Aug 2005
Posts: 227
Location: World wide
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| Posted: Fri Aug 12, 2005 12:00 pm Post subject: |
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Hey Raddr!
I also believe that much of the services and tests that are performed are due to defensive medicine. Since so many patients don't know a whit about their condition, their medicines, or how they became ill, they go to the doc's looking for all the answers. If the doc doesn't catch something then the patient wants to sue. Since the doc's malpractice insurance is affected by these potential or real law suits... the doc is covering his bun by doing all these tests. - which of course, raises all the prices of insurance.
Could you explain (simply please, for my simple mind  ) how you would see tort reform if you could "be in charge"? in other words.. how would you like to see it implemented? Thanks
Akaisha
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raddr
Site Admin
Joined: 22 Jun 2004
Posts: 4735
Location: Texas
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| Posted: Fri Aug 12, 2005 12:35 pm Post subject: |
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Hi Akaisha,
| Quote: | | Could you explain (simply please, for my simple mind Rolling Eyes ) how you would see tort reform if you could "be in charge"? in other words.. how would you like to see it implemented? Thanks |
I really think that the loser pays rule would be a great start. Lawyers know that they don't have to pay your court costs but that you have to pay to defend a lawsuit regardless of merit. So they have little incentive not to sue and at least try to extort a settlement because they know you will have to pay to defend the suit if you don't settle. "Loser pays" would stop that kind of nonsense pretty quick. I really don't think that payment caps would be necessary if we could just level the playing field a bit with a common sense loser pays rule.
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caseynshan
Joined: 25 Jun 2004
Posts: 266
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| Posted: Fri Aug 12, 2005 1:21 pm Post subject: |
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I agree with both of you, however, i think many don't take into account the amazing pace of advancement in medicine when figuring the increasing health care costs of the past few decades...
raddr... i agree with your "loser pays".. the phrase "it couldn't hurt to try" comes to mind when describing todays system....
Author said....
I believe it's a toxic administrative system, and it needs to be challenged. Bring health care to the market place, and we will see prices drop like a rock.
Except if you have some type of medical condition... then for you.. prices would likely skyrocket.. or you would simply be "uninsurable"..... |
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Author
Joined: 09 Aug 2005
Posts: 227
Location: World wide
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| Posted: Fri Aug 12, 2005 4:26 pm Post subject: |
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caseynshan said: | Quote: | | Except if you have some type of medical condition... then for you.. prices would likely skyrocket.. or you would simply be "uninsurable"..... |
Except that "everyone" has a medical condition. That's the point. The insurance companies "insure" against themselves having to pay, by pretty much flagging most people and saying they have a pre-existing condition. This is part of what causes the fear surrounding health issues. Plus if you use your health insurance, you are about to acquire some health issue label. If you don't use your insurance, then you are basically paying but getting no benefit.
I knew of someone who had migraines for years, undiagnosed as such. Since it went undiagnosed for years as the simple condition of having migraines, on her insurance forms she was forced to list mysterious symptoms like vertigo, which was a high flag. "ohmigod, it could be brain cancer!!" or epiliepsy or some other unknown and equally feared condition.
When she finally found herself in Mexico and having an attack, her doctor at the time asked a few simple questions, diagnosed her with classic migraines with neurological symptoms, and prescribed some medicine. (she did have other tests to verify his diagnosis, but cost was minimal - $100 USD + medicine) She hadn't had an attack since, and that was a decade ago.
The reason why some people are "uninsurable" is because the insurance companies don't want to be liable for mysterious and unaffordable conditions.
On the other hand, I have known people that, while having a discussion on medical insurance, proudly list all the supposed "conditions" they have. It seems to me to be a series of labels that give them an indentity, something they can point to to explain certain pains that they have.
Look, I also know people who have diabetes, cancer, heart conditions and so on. There are some medical issues that require the shorthand of a label, but then again, it can work against someone also.
If, in the spring you get some sneezes and teary eyes, you are automatically labeled as having allergies, soon to become sinusitis, and thats baaad. Wham! pre-existing condition.
We as a culture are way too drug oriented, and our docs (6 out of 10 last I read) haven't had any training in prescription medicines at all. Some havent had any training in how to prescribe them since the time they graduated from medical school. And of course, prescriptions drugs change constantly. Not to mention that there are side effects from the prescription drugs... and then you might find yourself on the merry go round of treating the symptoms caused by the drugs..
ooops.. I gotta get off the soap box, and give someone else a chance.
Akaisha
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Author
Joined: 09 Aug 2005
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Location: World wide
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| Posted: Fri Aug 12, 2005 4:30 pm Post subject: |
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raddr said: | Quote: | | "Loser pays" would stop that kind of nonsense pretty quick. |
oops, sorry raddr. forgot to mention - I agree completely. Personal responsibility needs a stronger place in the system for sure.
Akaisha
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caseynshan
Joined: 25 Jun 2004
Posts: 266
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| Posted: Fri Aug 12, 2005 5:13 pm Post subject: |
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| Author wrote: | caseynshan said: | Quote: | | Except if you have some type of medical condition... then for you.. prices would likely skyrocket.. or you would simply be "uninsurable"..... |
Except that "everyone" has a medical condition.
Akaisha |
I think life insurance is your best comparison...
It is very market driven.
Someone who has had the fun privilege of having open heart surgery gets either deemed "untouchable" or given ridiculous prices....Even if they exercise, eat healthy, and do all the right things now. There is nothing they can do.
To request a complete open market system without this consideration means you are dooming some people to live without health insurance.
Just a thought.
I'm picturing a meeting with the Doctor.... I've got good news and bad news... The good news is you've got cancer and it is curable... the bad news is your insurance will drop you next year so you are doomed financially for the rest of your life.
Casey |
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Nords
Joined: 26 Jul 2004
Posts: 446
Location: Oahu, Hawaii
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| Posted: Fri Aug 12, 2005 6:35 pm Post subject: |
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Back on topic for a second...
Many ERs wonder about a way to spread the word. This is one of the few books worthy of donating to a library, and I'm having my name/e-mail put inside the library's cover. Our Hawaii state library claims that they can catalog the CD without requiring it to have an ISBN.
Sure, there'll be a lot of spam, but it'll be interesting to see what kind of kernels surface from the chaff.
So if you're wondering how to find a kindred ER spirit, spend the $14.95 and deduct it on your tax return...
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Youth may be wasted on the young, but retirement is wasted on the old...
"If you love what you do then you will never work another day in your life." -- Confucius |
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Author
Joined: 09 Aug 2005
Posts: 227
Location: World wide
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| Posted: Fri Aug 12, 2005 8:44 pm Post subject: |
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Nords wrote: | Quote: | Many ERs wonder about a way to spread the word. This is one of the few books worthy of donating to a library, and I'm having my name/e-mail put inside the library's cover. Our Hawaii state library claims that they can catalog the CD without requiring it to have an ISBN.
So if you're wondering how to find a kindred ER spirit, spend the $14.95 and deduct it on your tax return... |
Wow, Nords, I'm humbled by your generosity and I thank you sincerely. The best to you in every way! 
caseynshan wrote: | Quote: | To request a complete open market system without this consideration means you are dooming some people to live without health insurance.
... The good news is you've got cancer and it is curable... the bad news is your insurance will drop you next year so you are doomed financially for the rest of your life. |
That's my point, though, caseynshan. I believe the insurance companies have us by the shorts right now. We at this time already have the "untouchables" or those with too high of a premium to pay. Having it be opened up to the market would allow more options from which to choose. To assume that there would be no options, and the only other choice would be "doomsville" belies the creativity of us as human beings.
Not only that, but I'm sure there would be programs that some could apply for if their particular case warranted it.
I simply do not hold the view that the insurance choices need to stay as they are, or we are "doomed." (Shudder) I have always put my money and support on individual responsibility and creativity.
Akaisha
Author, THE ADVENTURER'S GUIDE TO EARLY RETIREMENT, A Common Sense Approach
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Author
Joined: 09 Aug 2005
Posts: 227
Location: World wide
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| Posted: Sat Aug 13, 2005 2:17 pm Post subject: |
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Hi Raddr.
Perhaps in your location you are able to get those physicals. We tried just a couple of months ago here in our area, and could not. We had to have a referral by a doctor. Without the prescription of a physical, we could not obtain one. We checked perhaps 5 or 6 places.
Each place asked us who was the referral doctor, and what was it that he recommended to be done? We could not simply order that stress test or a couple of other simple blood tests, or a few xrays.
On the other hand, we do take advantage of a service here in our area which offers comprehensive blood testing for a reasonable fee. We get a print out, in both lay terms and medical terms, which we then take to doctors as needed.
raddr said: | Quote: | Like Kramer, I was afraid that I could run out of money since my spouse and/or me could possibly live another 50 years or so after retirement and we still have a child to raise and put through school. Fortunately, my portfolio took off after I quit in 2001 so that is not as much of a concern any more.
Secondly, I wasn't sure if I would be bored or not. |
I know that the fear of running out of money is a very real one for many people, especially if they have children and educational expenses. I respect that. On the other hand, when one no longer needs to make the same amount of income as before, income generating opportunities seem to appear everywhere.
For instance, with Kramer's talents in the computer field - we know of someone here in our area who does maintenance on people's computers like a subscription fee. Monthly, he checks them out for viruses, does restores or recoveries as needed. cleans the keyboards or checks out the software, etc. Sure, it may not be exciting 'career wise' but heck the pressure isn't great either.
Having 20 people a month that he checks out, all on a retainer or subscription like basis, provides him plenty of income on the side...
And regarding boredom - there are lots of places to volunteer your expertise and advice, teach a class or - heck - run a forum like you do!
Akaisha
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