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Old 10-16-2013, 07:32 PM   #61
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On the whole wealth tax issue, to see what forms might look like look at form 706 the estate tax form, and imagine filling that out every year. (it is on the IRS web site). Now I will admit with software it would be easier.
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Old 10-16-2013, 07:39 PM   #62
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On the whole wealth tax issue, to see what forms might look like look at form 706 the estate tax form, and imagine filling that out every year. (it is on the IRS web site). Now I will admit with software it would be easier.
NWB: "Can I not fill out the form, if I am not trying to get any subsidy?"

IRS: "What subsidy? We want to know so that we can levy the new Medicare tax on your assets. Actually, we already know, but want to catch you lying."

A fantasy? I dunno. As I said, I'd rather see the hospitalization cost gets lowered than get excited about "free money".
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Old 10-16-2013, 07:52 PM   #63
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What if your assets are physical in nature? Do you think there will be a house to house search for hidden stash of gold, silver, artwork, etc.?

Nobody has offered a good explanation of how you do means testing on someone with a paid off $600,000 house and low or no income vs someone with $600,000 invested in stocks who rents.

I predict although there will be small pockets of protest over early retirees who manage their income getting subsidies, the end result will be the subsidies stay income based. Anything else just adds cost and complexity.
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Old 10-16-2013, 07:54 PM   #64
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There are so many things that can be done, no matter which other country's system we may wind up with.

But the biggest elephant in the room is the Cost of Healthcare. The ACA improves the access to healthcare, and to some small degree may help in the long term to cut some costs, if we are successful in making everyone purchase insurance.

First and paramount in delivering and maintaining quality health care is taking the profit out of health care. When I first envisioned this my immediate reaction was:
"yeh, I can just see closing down all those insurance companies out there"
But then I realized. No that's not the way it's done. Insurance companies don't deliver health care (though they may deny it) They are just the middle man who collects the money, creates a lot of paperwork that's expensive for everyone involved, then lops off about 20% of it to spend on huge salaries, very big advertising budgets, etc., and shareholder profits. I wasn't considering that insurance companies could still operate, only not in the same manner. You just take out the "for profit" part of health care.

For Profit doesn't benefit the consumer at all, as it puts profits and large overhead in between the doctor and the patient. Pitting patients needs against shareholder needs and executive compensations tied to stock share prices, is a losing game for the patient.

This is still not the most cost effective method, but a major improvement over what we have. Medicare is much more cost effective, in that due to large size it has much better cost controls by it's sheer size and number. With cost containment paramount in the imploding US health care market, having one big player doing the bargaining, will by itself reduce costs.

Medicare actually could have much greater cost savings, but Congress has pretty much cut off the legs of every cost savings measure that has been introduced, as they will not risk hurting the money flow from the health care industry, who has continued to lobby very aggressively forever to prevent these cost saving measures. I'll include a link to this below

We have lots of issues to correct as well, as to how to increase the number of physicians in the US. I can see lots of solutions there.

Then when it's all done, we tackle Tort Reform

Video on over inflated health care costs in US

Charlie Rose 1 of 2 w/ Stephen Brill Interview Time Magazine - YouTube

http://youtu.be/fdO8reLFk5A
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Old 10-16-2013, 08:03 PM   #65
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What if your assets are physical in nature? Do you think there will be a house to house search for hidden stash of gold, silver, artwork, etc.?
Wealth tax would be indeed difficult to levy and to enforce except for the top 0.01%. They've got so much money it's difficult for them to hide in their backyard. Heck, Forbes publishes a frequently updated list. I do not want to sock them however.

However, impractical laws have been passed in the past in order to appease the public. And these ER's with fat 401k and Fidelity, Schwab, Scottrade, and Vanguard accounts and I bonds, how are they going to hide?

Perhaps you can hide gold in your backyard, but you would then need to run FIRECalc with 100% gold portfolio. And then when you are selling an ounce here and there to get cash for food, I am going to catch you, dig up your yard and confiscate it all.

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Nobody has offered a good explanation of how you do means testing on someone with a paid off $600,000 house and low or no income vs someone with $600,000 invested in stocks who rents.
The local RE taxes levied by the state, county, or city are already value-based. We can just use that valuation. It's not perfect, but if things were perfect, we would not have all kinds of "cliffs" in ACA subsidy calculations.

Yeah, $600K is $600K, whether in your house or at your broker. Tax them just the same.
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Old 10-16-2013, 08:49 PM   #66
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I predict although there will be small pockets of protest over early retirees who manage their income getting subsidies, the end result will be the subsidies stay income based. Anything else just adds cost and complexity.
early retirement is a passing fad for other than truly rich people, most of whom would never wish to live as we do here.

There will be a nice crash, that does not respond well to being doused with Bernanke fluid, and early retirement will once again be the exclusive domain of government pensioners, most of whom have income that cannot be disguised well. And don't forget the VAT. Those mobile home owners will pay handsomely to keep these things rolling along.

Ha
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Old 10-16-2013, 09:02 PM   #67
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No, although I am sure those blogs are there. Or perhaps the poor people may not even have the means or the time to make a blog.

But the above was not the point.

I think a system that allows people to buy additional insurance so that they get a better treatment than a 2-hr wait for blood draw would be good. Some people want to pay more for cars, or houses than their neighbors, even if they have the same income. Some narcissistic people want to pamper themselves with more expensive care than my frugal self would. Why do I deny them their choice? It appears the 4 nations that I listed allow that.

PS. Umm, in case one says that the big-and-fancy car and McMansion lovers are also narcissistic and should be reined in, I will come to their defense (I am not one of them), and say that they may simply have better taste than this cheap guy. They also stimulate the economy like crazy! And I love that it would boost the stock price of my companies. I am not just frugal, but also selfish and want to see my portfolio going up and up.
There are lots of countries that do this. You can buy a supplemental policy that gives you all kinds of perks if you can afford it and chose to have it, while still providing basic necessary care for all. Evan the NHS has private doctors and hospitals that you can go to if you chose not to use the NHS, but I understand that still 95% of the people chose the NHS>

Also, my experience at MD Anderson. I had the fancy menu with the choices of an actual restaurant. In fact I could pick up the phone at any time and call down for a milk shake, a cup or coffee or anything I wanted at any time. But something else that I did notice, especially since they kept me there 30 days and really didn't administer any real treatment except some minimal physical therapy at the gym for a couple of hours over a ten day period, and a shot in my belly twice a day (that I gave myself) But I had LOTS of doctors dropping in my room to say Hi, How are you doing, at a charge of god knows what per doctor, (I must have had at least six drop in a day, and had no clue who they were or what they were there for) and the nurses coming in every couple of hours to try and push pain pills (which I did not want or need) or anything else they could push on me to take (that I did not need) Even so, that 4 week hiatus came to $129,000, and this is not including any cancer treatment or radiation, which I got out patient back home. I am not casting any aspersions on MD Anderson. I think it is a fine hospital. I am just saying, I think that things are pushed in the hospital to rack up the big bills. I did not have to be there for 30 days, I could have easily been out of there in two weeks.

I'm one of the nut jobs who cares about what Medicare is being charged. I can remember going to a Neurologist sometime after my treatment, and him suggesting to me I take an expensive test. When I asked him, what good would taking the test be? Would it improve my condition at all? He answered no, it wouldn't. So I said, then why take the test? His answer to me, and this is 100% true. "What do you care, your not paying the cost, Medicare is." It's stuff like that, that is costing us dearly.
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Old 10-16-2013, 09:08 PM   #68
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Oh Ha, I do not like it when someone talks like the economist Dr. Doom (but I do have a motorhome, which I can camp out in New Mexico with a state camping license for less than $300/year if it comes to that).

I try to restrict my imagination to something less severe, for example the 2 following polls.

I would ask in this forum:
"Do you think healthcare subsidy should be based on income or assets? A - income, B - asset".
Wait a minute. Why should I bother, if I already know the answer from forum members?

Here's a 2nd poll a news media can ask the public at large:
"Given the recent headline that rich early retirees with $500K in assets, and even in the millions in many cases, are getting ACA subsidy, do you think that these should be disallowed any subsidy and instead should contribute more to the national health care? A - Yes, B - No".
Knowing that the median networth of persons in the age bracket 55-64 is only $142K, I fear to see the poll result.
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Old 10-16-2013, 09:20 PM   #69
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New Health Rankings: Of 17 Nations, U.S. Is Dead Last - Grace Rubenstein - The Atlantic


This article is focused on public health issues rather than the health insurance system per se. It is no secret that Americans tend to engage in more self-destructive behaviors than most of the developed world (inc non-compliance with recommend medical therapies whether funded or not).
Is a single payer system really going to solve the higher US mortality from traffic accidents, homicide, drug abuse, obesity, etc.? The article provides a big argument that it may not since better access to care (the main touted advantage of single-payer) was NOT related to better health in US:

"The authors took pains to counteract the possible assumption that U.S. numbers must be negatively skewed by poor and underserved populations. In fact, the report cites data suggesting that even white, well-off Americans live sicker and die sooner than similarly situated people elsewhere. "

The need for better funding of US public health initiatives is great whether US HI remains market-based or becomes single-payer.
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Old 10-16-2013, 09:22 PM   #70
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Modhatter, the general hospital with the nice meals (that I did not get to sample due to being kicked out just as my surgeon upgraded me to full normal diet) was not Anderson, but now I know that the fancy meal deal is getting more popular.

My surgeon in fact showed signs that he had some pressures from my insurer about me getting well enough to leave. Just kidding about the steak that I missed. I was in no condition to enjoy a steak, even though I was allowed to have it, and a home meal would be a lot better for me (my wife would bring one in). I was indeed well enough to leave, and I wanted to leave.

About the patients not caring about costs because Medicare pays everything, I have seen that with my elderly relatives. A lot of time, they did not query about the tests, because they thought that if it did not help, it would not hurt (but it could hurt physically even if not financially). But if they had a copay, the patients would pay more attention.

OK, if there's no copay, then someone else will have to oversee the process, not too differently than my insurance company that keeps tabs on things. I should add here that I have not had any tests or procedures denied by my insurance, and I tried to learn about all these tests and surgeries for my own good. Everything was explained to me, and how the test results would affect the treatment, based on what they found. No bogus tests, because they knew that I knew the costs.

In all, I had no complaints, and indeed even feel sorry for my insurer who paid so much for hospital costs. I was very happy with my surgeon, and indeed told everybody that the guy was working so hard for his pay, and knowing only what he made in my treatment, thought that I would not want his job. It's certainly more than what I used to make, a high level few engineers got up to, but I am too lazy for his kind of work (assuming that I had the ability to learn medicine, which I knew I did not even care to), and he spent more time for his training.

Now, back on this hospital charge...


PS. I chose all my doctors and specialists. My choice was based on somewhat flimsy info, but they knew that I was the customer, and I liked to understand what was being done to me. No bogus visits in the hospital from doctors I did not know. The doctors that were assigned by the hospital were anesthesiologists. I did not think of these, and do not know if I could even choose my own (based on what?).
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Old 10-16-2013, 09:38 PM   #71
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The need for better funding of US public health initiatives is great whether US HI remains market-based or becomes single-payer.
Better funding to buy what? Is there anybody that doesn't know already that smoking is bad, being fat is bad, exercising is good, etc. The ACA already mandates provision of many preventative care services/screenings. I'm not sure more public service announcements will work. And more coercive methods, at the hands of our servants in the US government, probably won't sit well.
And yet . . . publicly-funded insurance (subsidies, Medicare, Medicaid, etc) gives every taxpayer a vested interest in the efficient provision of health care to the public in general. If a person won't exercise, watch what they eat, or take their medications, how much resultant expensive medical treatment is he/she owed by other Americans?
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Old 10-16-2013, 09:41 PM   #72
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...The need for better funding of US public health initiatives is great whether US HI remains market-based or becomes single-payer.
WADR funding is not the problem - we spend more than most nations on health care so the problem is not how much we spend but the efficiency and effectiveness of what we spend.
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Old 10-16-2013, 09:50 PM   #73
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New Health Rankings: Of 17 Nations, U.S. Is Dead Last - Grace Rubenstein - The Atlantic


This article is focused on public health issues rather than the health insurance system per se. It is no secret that Americans tend to engage in more self-destructive behaviors than most of the developed world (inc non-compliance with recommend medical therapies whether funded or not).
Is a single payer system really going to solve the higher US mortality from traffic accidents, homicide, drug abuse, obesity, etc.? The article provides a big argument that it may not since better access to care (the main touted advantage of single-payer) was NOT related to better health in US:

"The authors took pains to counteract the possible assumption that U.S. numbers must be negatively skewed by poor and underserved populations. In fact, the report cites data suggesting that even white, well-off Americans live sicker and die sooner than similarly situated people elsewhere. "

The need for better funding of US public health initiatives is great whether US HI remains market-based or becomes single-payer.
I don't disagree with health being above and beyond the medical system, but the first recommendation from the article was affordable health insurance for everyone.

Upfront the authors stated that, "More than other countries, our health care system is fragmented, unaffordable for many people, and short on primary care."

And later on in the article, "Senator Tom Harkin, chairman of the Committee on Health, Education, Labor, and Pensions, said via a spokesperson that the existing Affordable Care Act "addresses many of these primary causes" of our health gap. New support for primary care, free cancer screenings, improved women's care, and other features of the law "will all help address these disadvantages," he said."
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Old 10-16-2013, 10:30 PM   #74
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Ah....the Romney answer...."we have health care for those people.....they can go to the emergency room". Yep....works if you are having a heart attack. What if you just want the skin cancer cut off you body like I did today. The people without health care can't do this......it needs to be deadly before anything would be done. I'm planning on moving back to the UK....and likely dropping my private insurance......the US way needs help. The attitude from some people that the socialist medicine is crap....is only sorta true.
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Old 10-16-2013, 10:35 PM   #75
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I'm not so sure that Americans lead less healthy lifestyles than people in other developed nations.

For one thing, I think Americans smoke a lot less. Not sure about alcohol, one war or another.

Processed foods may be worse though, because the agricultural subsidies encourage unhealthy ingredients like fructose corn syrup and more processed foods, though I think in general, poorer people everywhere are more susceptible to bad diets.
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Old 10-16-2013, 10:37 PM   #76
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I've only ever lived with universal health care (Canada) and as such am wholly unqualified to comment on the cost or care effectiveness of the current American system. What I have noticed though is reading thread after thread about the ins and outs of budgeting for American health insurance in retirement. Of course not everything is "free" under our system but I feel fortunate that the healthcare cost variable is largely a non issue in my FIRE plans and even more so since DW has recently been diagnosed with a neurological disease that can easily cost $50K+ per yr in drugs alone.
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Old 10-16-2013, 10:41 PM   #77
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Processed foods may be worse though, because the agricultural subsidies encourage unhealthy ingredients like fructose corn syrup and more processed foods, though I think in general, poorer people everywhere are more susceptible to bad diets.
Note that sugar is 50% glucose and 50% fructose, while High fructose corn syrup is either 55% fructose 43% glucose or 42% fructose and 53% glucose. Chemically they are about all the same (there is a 90% fructose version but it is primarily a blending ingredent to make the 42% fructose version into the 53% version).
So the only reason it is used is it is 3x cheaper than sugar in softdrinks for essentially the same effect. (Facts from Wikipedia on High Fructose Corn Syrup)
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Old 10-16-2013, 10:59 PM   #78
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NW Bound,

Yes, I agree about the co-pay in certain situations. But my point too, was that I all ready had that procedure done in the hospital. The specialist had the report from the test in his hands. Yet he was more than eager to give me the test again in his office. For what purpose?. Would not have done me any good. But would certainly enrich the doctor's pockets. I'm guessing with that big machine and all those needles, we could be looking at a test in excess of $1,000.

This is another argument for electronic records. If that doctor wanted to give me that same test again, then he should be make to enter this test (everything has a code associated with it) in the medicare data base under my social, and it should come back blinking in bright Red flashing warning signs, that this procedure was all ready performed on such and such a date, and would not be paid by medicare unless the doctor could substantiate it's medical need (in which the patient would have to sign off on as well, as well as make at least a $50 co-pay.) Problem solved.
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Old 10-16-2013, 11:05 PM   #79
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This is another argument for electronic records. If that doctor wanted to give me that same test again, then he should be make to enter this test (everything has a code associated with it) in the medicare data base under my social, and it should come back blinking in bright Red flashing warning signs, that this procedure was all ready performed on such and such a date, and would not be paid by medicare unless the doctor could substantiate it's medical need (in which the patient would have to sign off on as well, as well as make at least a $50 co-pay.) Problem solved.
My doctors use electronic records. Well, we seldom see "doctors", but the PAs and NPs are there. Trust me--they don't read them. There's not enough time between patients for them to review the records. And no second-guesser at Medicare, or Humana, or anywhere else will be as effective as a patient (making a co-pay, and with the flexibility to find a new doctor if he/she is dissatisfied) asking "didn't I just pay for this test? Go back and look at my records. If you still want to do it, explain the value to me."
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Old 10-16-2013, 11:12 PM   #80
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Again, I am surprised that ACA healthcare will not be in force until 1/1/2014, and people already want something else. Yes, we will need cost containment, which has not really been addressed, but preexisting conditions are now a no-problem. One is free to chose a plan suitable for his own conditions, and can jump from plan to plan every year. Yet, some people are still not happy. As I said before, they probably believe it should be all free.

Free as in no new taxes to pay for this. And no, high cost of living as in Europe would not work, as we Americans would not like it, and no such things as US$8 per gallon like they pay. What do they know, driving Smartcars, while we drive big SUVs and 2-ton pickups over here? They are skinny, while we need big vehicles because we are, well, big. Lots of time, we want big just because. It's a birthright.

I have always thought that while the European standard of living is not for me, I respect their choices. I am not going to criticize them for what they want. But as an American, I am not sure that some Americans know what we would have to give up to get something.

The other day, my brother, a highly-paid high-tech worker, asked that how poor people (and presumably ignorant) would know to buy the right insurance, then to choose a doctor. The implication is that the government should do all this for these "idiots". I did not have time to ask him what he had in mind. Should the government do all this for everybody too? Or should the government run public hospitals with doctors and nurses being public servants. I know some Canadians want this as they think their system does not go far enough. Then, we should disallow private care providers, because if they exist, doctors would not work in public hospitals. These doggone doctors, who think they can chose where they work, just like engineers, programmers, book keepers, or auto mechanics do. Damned doctors and nurses! Lock them up, throw in a bone every time they can prove they save somebody.

Oh boy, I can now envision old Soviet-style healthcare! Did my brother know what he was asking for?

It's getting scarier.
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