Health Care Costs

[Rich_in_Tampa]

Originally Posted by jmm

the HSA is tax free and any moneys you dont spend by 65 are yours tax free.

I know that at age 65 you can draw out HSA funds for any purpose, not just uncovered health expenses, but are you SURE you can draw them tax free? After funding the HSA with pre-tax dollars?

[Martha]

I believe the HSA distributions after 65 for non-medical expenses are taxable, but you don't have to pay the 10% penalty, which would be due if you took the money out before age 65.

[eridanus]

Originally Posted by Martha

I believe the HSA distributions after 65 for non-medical expenses are taxable, but you don't have to pay the 10% penalty, which would be due if you took the money out before age 65.

Yes, they are taxable distributions.

Over age 65 people can also use their funds (tax-free) to pay for Medicare premiums.

http://www.ustreas.gov/press/releases/js1045.htm

"Qualified expenses include prescription drugs, qualified long-term care services and long-term care insurance, COBRA coverage, Medicare expenses (but not Medigap), and retiree health expenses for individuals age 65 and older. "

[Billy]

I seem to have a different view of healthcare insurance costs than most people here -- Since I came from a business family, was self-employed most of my adult working life, I had to pay for my own health care insurance all along (other than for short periods when I worked for others).

It seems to me that those who have employer supplied health care policies feel the most threatened with the idea of having to foot their own health insurance policies once they no longer have a job.

I agree. It is frightening, especially given all the scare talk in the media. That being said, if it is really a concern, and you are looking at retirement, consider also the idea of moving to another state. Just as you would weigh the costs of housing, needs for better weather, cost of living expenses, etc... you could research HICosts offered in different states.

Also -- and not to be taken lightly - is the rising surge in Medical Tourism.
http://www.retireearlylifestyle.com/medicalTourism.htm
http://www.retireearlylifestyle.com/...TourismCBC.htm
http://www.retireearlylifestyle.com/...hilippines.htm

I fully understand that this option would intimidate most 'regular' Americans, however, it is an option, and it feels better to have an option available than to be scared *%#less all the time (which only adds to the stress of your life).

Akaisha
Author, The Adventurer's Guide to Early Retirement

[ESRBob]

Akaisha,
This is really interesting. Though I knew of course about getting medical procedures at great prices overseas, I thought the initiatives were essentially promoted by the hospitals themselves. Seeing your link (Philippines) made me realize this is now at the Government tourism initiative level. That means the scale is such that it has hit the govt's radar -- I hadn't realized this had become so big. So it looks like this is becoming (has become?) more than a blip or a whacked-out left-field option for people needing major procedures.

[Nords]

The PI govt is still trying to catch up to Thailand.

Last fall Don Ho (yeah, the "Tiny Bubbles" guy) was dying of heart failure. It was determined that he could benefit from a procedure not available in the U.S., but that could be performed in Thailand. The publicity from his recovery showered down a lot of money on the country and has made others take notice.

http://starbulletin.com/2005/12/07/news/story02.html
http://starbulletin.com/2006/01/23/news/story02.html

[Billy]

Hi ESRBob!
Thanks for taking the time to view. Yes, it is serious, and HUGE. We were just in Bangkok on the 13th and 14th of May(2006) and I stopped in to Bumrungrad Hospital.

First, it was walking distance from my hotel. I arrive, and there is are several police/valet types directing traffic out in front of the (what looks like a glass, *chrome and marble hotel) front of the hospital. I have never seen it so busy!

Every nationality and language was represented. Every age group. Babies in strollers, Ancients in wheelchairs, Muslims in full dress, Eastern Indians in full garb, Blacks from Egypt, Africa, Saudis, ExPats from Europe, the US, -- it was packed!

I thought I was at a movie premier!

I go up to the 3rd floor (after passing through the 2nd floor restaurants - High class dining - Japanese, French, Italian, fast food, Chinese, McDonalds, and a bakery) and go to the reception desk.

6-8 employees, fluent in several of the represented languages of the countries mentioned above, took my Hospital Number (HN#) and found me in their computer. They then directed me to 'my' doctor...

There are water fountains, plants, Starbucks coffee on the first floor, shopping, florists, - you name it.

I also happened to stop at another government run hospital where I was met at the door by a woman who took my piece of paper and found me in their computer, walked me up a winding marble staircase (Think Gone with the Wind) and to 'my' doctor. Again, plants, terraced gardens outside big picture windows, free herbal tea donated by the fusion restaurant located on the 6th floor (fine fast food) and next door (for slower dining experience.)

The States could learn something of the service, the quality, the options given here... People are friendly, the place is gorgeous, one feels relaxed. Magazines and current newspapers are offered while you wait for your appointment or prescriptions... *If they would have allowed me to take photos, I would *have..

sigh...

Akaisha
Author, The Adventurer's Guide to Early Retirement

[retire@40]

Originally Posted by Billy

Bumrungrad Hospital....If they would have allowed me to take photos, I would *have..

Here are a couple of pictures.* Where does the money come from to pay for all this stuff and the healthcare?

[Nords]

Originally Posted by retire@40

Where does the money come from to pay for all this stuff and the healthcare?

From:
a. Illegal immigrant construction/maintenance labor.
b. "Rich" (by Thai prices) ex-pats.
c. McDonald's franchise fees.
d. The savings from not having to carry U.S.-style liability or malpractice insurance.
e. A brisk business in prescription medication research funded by pharma companies.
f. A brisk business in medical technologies/procedures (not yet approved in the U.S.) sponsored by medical companies.
g. All of the above.

[Billy]

Did you get these photos from their catalog? or were you able to take them yourself? The last time I tried to take pictures, I was politely 'warned' -- you know, international kings, heads of state, their wives/girlfriends/babies, etc...* *8)

But they did have a very nice glossy catalog...

BTW, Taksin implemented a 30baht fee for Thai citizens to have medical care in government-run hospitals. I was told by locals that this fee included surgery, but I don't know if it included meds (?)

Ex-Pats and other foreigners pay full prices (which are outrageous to the Thais) but help fund the operations of the hospitals. Doctors were not happy with Taksin for obvious reasons,* :P* but the local poor were, also for obvious reasons.*

Akaisha
Author, The Adventurer's Guide to Early Retirement

[mark500]

Yeah, looks nice. If one cares about such things when you get your colon removed.

[Rich_in_Tampa]

Originally Posted by Billy

But they did have a very nice glossy catalog...

This is really interesting. My instinct (as opposed to real evidence, I must admit) is that for technical procedures such as coronary artery bypass, aneurysm repairs, and other serious but at least semielective surgery, this is a good option. I have helped train many, many foreign medical graduates over the decades, and found them to be technically equivalent to their American-trained colleagues. Their scientific background may have been less consistent by American standars (not always right, but the default here) but after a year or two their technical skills were just as good.

The fancy hospital doesn't guarantee the best care, but that is true here, as well. As to primary care and sorting out the complex diagnoses, emotional versus physiologic illness, and so on it is difficult to judge.

As in software engineering, we (USA) no longer have a monopoly on the gold standard. Maybe I should dust off some of those old offers to come teach and practice at an overseas hospital...

Thanks for sharing this information.

[Lancelot]

Originally Posted by Billy

BTW, Taksin implemented a 30baht fee for Thai citizens to have medical care in government-run hospitals. I was told by locals that this fee included surgery, but I don't know if it included meds (?)

My buddy's Thai MIL had heart bypass surgery 30 Baht (about 80 cents US at current exchange rates) Not sure if that included meds, but I think it probably did. It was a public Thai government hospital and the 30 Baht "Health Scheme" is hugely popular. The government docs earn around $263 USD per month (10,000 THB) and moonlight to make ends meet. They are mostly younger docs that accept the lower salaries to gain experience. At 30 baht a pop, you'll get to operate 'till you drop.

Of course the 30 baht program doesn't cover it's costs and some hospitals are facing huge cash shortfalls (and running out of supplies and meds.)

But, when the minimum wage is around $4.74 per day in Bangkok; the program is not going away anytime soon.

Lance

[Lancelot]

Originally Posted by Billy

Hi ESRBob!
Thanks for taking the time to view. Yes, it is serious, and HUGE. We were just in Bangkok on the 13th and 14th of May(2006) and I stopped in to Bumrungrad Hospital.

First, it was walking distance from my hotel. I arrive, and there is are several police/valet types directing traffic out in front of the (what looks like a glass, *chrome and marble hotel) front of the hospital. I have never seen it so busy!

Every nationality and language was represented. Every age group. Babies in strollers, Ancients in wheelchairs, Muslims in full dress, Eastern Indians in full garb, Blacks from Egypt, Africa, Saudis, ExPats from Europe, the US, -- it was packed!

I thought I was at a movie premier!

I go up to the 3rd floor (after passing through the 2nd floor restaurants - High class dining - Japanese, French, Italian, fast food, Chinese, McDonalds, and a bakery) and go to the reception desk.

6-8 employees, fluent in several of the represented languages of the countries mentioned above, took my Hospital Number (HN#) and found me in their computer. They then directed me to 'my' doctor...

There are water fountains, plants, Starbucks coffee on the first floor, shopping, florists, - you name it.

I also happened to stop at another government run hospital where I was met at the door by a woman who took my piece of paper and found me in their computer, walked me up a winding marble staircase (Think Gone with the Wind) and to 'my' doctor. Again, plants, terraced gardens outside big picture windows, free herbal tea donated by the fusion restaurant located on the 6th floor (fine fast food) and next door (for slower dining experience.)

The States could learn something of the service, the quality, the options given here... People are friendly, the place is gorgeous, one feels relaxed. Magazines and current newspapers are offered while you wait for your appointment or prescriptions... *If they would have allowed me to take photos, I would *have..

sigh...

Akaisha
Author, The Adventurer's Guide to Early Retirement

Hi Akaisha!

I've been to Bumrungrad before, but recently I went to Bangkok Nursing Home (it's reall a hospital) near Silom. http://www.bnhhospital.com

My Thai doc had practiced medicine in Pittsburg, PA, spoke excellent english, and was extremely affable. We discussed my options, agreed on a med (which I bought at a drug store for almost nothing) and I was outa there. If I want to schedule an appointment, I can do so online.

Another hospital -a five minute walk from my condo- is Phaya Thai 2 http://www.phyathai.com/ Two months ago I had a physical, complete with blood work, chest exray, etc for $58. Phaya Thai is much cheaper than Bumrungrad and BNH, but still provides quality service.

Lance

[ESRBob]

Nords' list, as usual, is thought provoking. While low-cost labor and lack of malpractice-type liability issues are obvious cost-savers, what about the experimental procedures and the payola from pharmaceutical companies?

If you were simply going to get a well-understood but expensive procedure (e.g. coronary bypass), would you need to worry about these other more insidious 'extras'?

[Billy]

Mark500

Yeah, looks nice. If one cares about such things when you get your colon removed.

I can appreciate your cynicism, Mark.

However, in my experience having lived in the very expensive Bay Area of California for decades, (and I still have family and friends there so I visit regularly) - the absolutely sterile, drab, and cheerless hospitals and clinics I went to when I accompanied friends and family did nothing to uplift anyone.

It was hard to generate any hope for my friend who was visiting the Chronic Pain Clinic. Her mood was already bruised. She could* have used a bit of support from a soothing environment: Something that spoke of life and vitality. I cannot tell you how dreary this place was. There wasn't even a plastic plant, and no smiles from any of the staff.* A hideous experience.* :P

Rich

As in software engineering, we (USA) no longer have a monopoly on the gold standard. Maybe I should dust off some of those old offers to come teach and practice at an overseas hospital... Thanks for sharing this information.

You are quite welcome, Rich. You would* be doing these overseas hospitals a service, with your qualifications. - Please* know, however, that it wouldn't be a one-way street. The gifts they have to offer you would enrich your life as well. It could be a win-win situation.*

Thanks, Lance, for your hospital links! I'm checking them out. I trust your experience in BKK since you know your way around so well... Your knowledge and skill there far surpasses mine!* 8)

ESRBob

...what about the experimental procedures and the payola from pharmaceutical companies?

If you were simply going to get a well-understood but expensive procedure (e.g. coronary bypass), would you need to worry about these other more insidious 'extras'?

I'm not entirely clear on what you mean here -- there doesn't seem to be any problem in dispensing a drug that a person might need, and I believe Nords put a link up on the stell cell operation that Don Ho went through... That was fairly experimental, I think.. ??*

I have been prescribed drugs that were not yet* available in the states, but* were readily available in Japan, for instance. I'm not one much for taking drugs if I can do without them, however, I also subscribe to the philosophy of better living through chemistry if I need something.* Lance? Nords? what do you guys think?

Akaisha
Author, The Adventurer's Guide to Early Retirement

[Nords]

Originally Posted by Billy

Nords?* what do you guys think?

I think it's a lot cheaper to run a double-blind phase III clinical trial in Bangkok than at the Mayo Clinic.* Sort of the medical version of outsourcing, although it's probably difficult to adjust for the demographics.

Maybe it's a starting point for the FDA, or maybe it's a completely separate market.* I don't think that the pharmas are necessarily doing anything illegal, I think that they're just seeking approval in as many areas of the world as they estimate that they can sell medications.*

Hey, Lance?* Ben?* Are farangs ever asked to volunteer for reimbursement by participating in a Bangkok medical trial?* I'm not looking for a job but...