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Old 03-13-2017, 11:46 PM   #61
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Speaking of survival rates, there is a new study out today that shows diffferent survival rates for cystic fibrosis in Canada and the US. The news story identifies some possible contributory factors.

Cystic fibrosis patients in Canada living more than a decade longer than those in U.S.: study | CTV News
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Old 03-14-2017, 12:26 AM   #62
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Perhaps the US system treats patients with acute conditions better than those with chronic illnesses.

But speaking of Canada and the reputation for long wait times, I just saw this article: Canada's healthcare wait times in 2016 longest-ever recorded: Fraser Institute report | CTV News.

In Ontario, the best province, the GP-to-specialist wait time is 7.2 weeks, and specialist-to-treatment is 8.4 weeks. The worst province is New Brunswick with 21.5 and 17.4 respectively. That is awful.

Earlier, I said I was quite happy with the treatment of a serious life-threatening illness. With my pre-ACA plan in 2013, I could go to any specialist myself without waiting for referral from the GP, so I skipped the GP. Saw this specialist in 4 days.

The diagnosis was positive when the result came back the next day. After calming down, I found myself another specialist, whom I saw in 2 days, who immediately referred me to a surgeon whom I happened to choose already. They turned out to be friends. I saw the surgeon the very next morning. They coordinated the treatment, and referred me to another specialist yet, whom I saw 2 weeks after the positive diagnosis.

The course of treatment started with a surgery in a hospital less than 4 weeks after I thought something was wrong with me. As mentioned earlier, it involved 2 minor surgeries, 2 major ones, and numerous CAT scans, tests and procedures that lasted 2 years.

I don't think any place could do any better than that, unless I were a billionaire. It cost me $20K in deductible over 2 years (not including follow-ups), and my insurance a bit less than $200K.

So, as I mentioned in the earlier post, other than the cost, everything was great. Hospital rooms were nice and clean. I had my own room for both major surgeries. One hospital had an awfully nice menu I could order from, but I recovered so well that just as they allowed me to have solid food, they kicked me out before I could try one interesting dish (forgot what it was). Well, maybe it would not be really that good, but I felt I needed some real food to ease the surgery pain.
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Old 03-14-2017, 01:12 AM   #63
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NW-Bound, I'm glad you received such prompt and excellent treatment. What would the situation have been had you been uninsured?
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Old 03-14-2017, 01:21 AM   #64
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My friend has a nephew with the same illness before I did. I do not know the severity, and all the details. The young guy applied for the state indigent assistance program, got the treatment and surgery, and was still alive when I talked with my friend about my disease. My friend was consoling me that it would be OK when telling me about his nephew.

I did not ask, and my friend probably would not know, about the wait time to get approval for that assistance. Where did the nephew get the treatment and surgeries, I do not know, and my friend most likely would not either.
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Old 03-14-2017, 01:48 AM   #65
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I realize I did not really answer your question about my own situation.

I would not be eligible for indigent assistance. And I have always had insurance. So, I did not find out what I would have to do.

I guess I would try to negotiate with the providers, and if they gave me the same $200K bill, I would have to take it as I valued my life.
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Old 03-14-2017, 03:20 AM   #66
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Right how DH and I have an average Silver Plan through the ACA costing us $22,740/year, no subsidies. For kicks, letís say the new plan goes into effect in 2019. We will both be eligible for Medicare in 2024. Assume our premium jumps to 5x the minimum premium in 2019 and there is no premium decrease. Assume a 5% inflation rate per year, including next year. Assume we get ACA insurance next year but the program phases out starting in 2019. Our health insurance premiums from 2016-2024 will be the following:

2018 $22740 x 105% = $23,877
2019 $23,877 x 5/3 x105%-$8000 = $33,784
2020 $41,784 x 105% - $8000 = $35,874
2021 $43,874 x 105% - $8000 = $38,067
2022 $46,067 x 105% - $8000 = $40,371
2023 $48,371 x 105% - $8000 = $42,789
2024 $50,789 x 105% - $8000 = $43,328

Total: $228,023

I know this is a worst case scenario, but that's what we are in right now.

What do you all think?
1) This is not a worst case scenario. CBO expects Insurance rates will initially rise by 15-20 percent.

2) Do not buy real estate outside of the US.

3) Consider Non-Habitual Residency in Portugal (Tax Heaven). Portugal is safer, with better infrastructure and friendly people.

4) Consider moving to Hawaii or Massachusetts. US States with best healtcare laws/affordability.
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Old 03-14-2017, 04:21 AM   #67
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Not a terrible idea, worth looking into.

PS, if you are serious, start learning Spanish now. I'm sure more folks in Mexico speak English well, than in the US folks speak Spanish, but it will be a handy skill to have especially if you end up in hospital for any period.


The places listed are large expat communities. I also have a second cousin in Los Cabos, we don't know each other well but after my aunt's funeral in February, cousin's blood has grown thick. And I speak some already. I know a bit of the medical terminology from work.

I'm only partly serious. But that part could grow. It's hard to believe this is happening. But our premiums are also unbelievable.
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Old 03-14-2017, 04:42 AM   #68
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1) This is not a worst case scenario. CBO expects Insurance rates will initially rise by 15-20 percent.

2) Do not buy real estate outside of the US.

3) Consider Non-Habitual Residency in Portugal (Tax Heaven). Portugal is safer, with better infrastructure and friendly people.

4) Consider moving to Hawaii or Massachusetts. US States with best healtcare laws/affordability.


Doc Severinson moved to San Miguel de Allende in 2006. That area is safe and retiree friendly, apparently with good medical care. But your ideas are decent too.

I've looked into Portugal and I didn't think about Hawaii or Massachusetts. And California is considering their own health care legislation. Moving to California would be moving home.
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Old 03-14-2017, 07:56 AM   #69
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Not as cold, eh?
Well the cold is certainly a factor, and I didn't like needing an ice scrapper for my glasses when I came back home (moisture would condense and then freeze on them). But there's lots of other things to like about the US & San Diego area -- no mosquitos when camping for one thing. I've gotten more mosquito bites in one trip to Algonquin park than I have in my entire time in the US (~20 years).
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Old 03-14-2017, 10:47 AM   #70
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Current law has residence test:

"Americans who are NOT residents of the USA, do NOT have to participate if you meet the requirements of being a resident of another country (or if you are outside the USA for 330 days or more per year). "
https://yucalandia.com/living-in-yuc...living-abroad/

Does the new proposal include something similar?
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Old 03-14-2017, 10:58 AM   #71
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IDK, how about instead of abandoning family and friends where you have spent 95% of your life, just make a plan that includes HI costs as part of your ER planning? But then that wouldn't make a statement....
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Old 03-14-2017, 11:09 AM   #72
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IDK, how about instead of abandoning family and friends where you have spent 95% of your life, just make a plan that includes HI costs as part of your ER planning? But then that wouldn't make a statement....
That could be $50K a year or more with deductibles. Some might rather spend that money on a villa in Spain, make new friends and have extra money to travel and pay to have friends and family visit. Many of us have already moved away from the towns we grew up in so there's no family around. Some posters here or their spouses aren't from the U.S. anyway. The U.S. is a big place. We'd actually be closer to family if we moved to Mexico than if we stayed put.

Some of our friends have already moved away in retirement to lower cost of living areas, even before the ACA repeal popped up. From what I've read LTC costs are also significantly less than $100K a year in every country outside the U.S. There are many compelling reasons to consider a move for some of us.
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Old 03-14-2017, 11:15 AM   #73
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My son lives in Ontario. He was diagnosed with testicular cancer in April 2016. He was admitted to the operation in May and began radiation treatment in June. I think the wait times are because everyone goes to the hospital because it is free. But at least they do triage on life-threatening diseases.
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Old 03-14-2017, 11:19 AM   #74
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That could be $50K a year or more with deductibles. Some might rather spend that money on a villa in Spain, make new friends and have extra money to travel and pay to have friends and family visit. Many of us have already moved away from the towns we grew up in so there's no family around. The U.S. is a big place. We'd actually be closer to family if we moved to Mexico than if we stayed put. Some of our friends have already moved away in retirement to lower cost of living areas, even before the ACA repeal popped up. From what I've read LTC costs are also significantly less than $100K a year in every country outside the U.S.
Each person has to make their own decision about how much it means, or how important it is for them to ER, and what they are willing to give up. Maybe I will get to the point that I will leave the State, Country that I call home so that I don't have to work a few more years. I just haven't gotten there yet....

yet.
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Old 03-14-2017, 11:38 AM   #75
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3) Consider Non-Habitual Residency in Portugal (Tax Heaven). Portugal is safer, with better infrastructure and friendly people.
Do you have any first or second hand experience with this? I have been considering this as a way to have a base to explore Europe from.
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Old 03-14-2017, 01:41 PM   #76
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Current law has residence test:

"Americans who are NOT residents of the USA, do NOT have to participate if you meet the requirements of being a resident of another country (or if you are outside the USA for 330 days or more per year). "
https://yucalandia.com/living-in-yuc...living-abroad/

Does the new proposal include something similar?
Yes, no healthcare mandate!
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Old 03-14-2017, 01:48 PM   #77
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<mod hat on>
Every thread on health care reform has been closed, some because of politics, others because of too many snarky posts. Why not keep both out of this thread, eh? Most members are trying to have thoughtful discussions around a difficult topic.
<mod hat off>
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Old 03-14-2017, 02:07 PM   #78
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Do you have any first or second hand experience with this? I have been considering this as a way to have a base to explore Europe from.


No I do not. I am just aware that Portugal and Malta are tax heavens in Europe.

I would consider Portugal. Malta is too small.

That tax heaven status is for 10 years. Enough to bridge FIRE date and 65.
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Old 03-14-2017, 02:29 PM   #79
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No I do not. I am just aware that Portugal and Malta are tax heavens in Europe.

I would consider Portugal. Malta is too small.

That tax heaven status is for 10 years. Enough to bridge FIRE date and 65.
I've never been to Portugal, but we're considering checking it out because of a relatively large English speaking population and a Mediterranean climate, which we've gotten used to and are not eager to give up.

AARP has this to say, "Another inexpensive country, Portugal also entices retirees with its low cost of living and real estate. A couple can do well on just $1,700 a month in many smaller cities; in Lisbon, the capital, about $2,200 a month or more is needed. Other big draws are the usually mild climate and the country’s superior red and white wines. (The seafood is excellent, too.) The laid-back atmosphere means less stress, and the western coast, lined with beaches, offers plenty of recreational opportunities."

Living costs of $2.2K a month? Pre-ACA I think our health insurance premiums here alone (when we had dependent kids) were more than that for a high deductible and high out of pocket max policy.
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Old 03-14-2017, 03:01 PM   #80
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Portugal has become quite an attractive destination for Europeans trying to escape either high living costs or high taxes in their home country. And the climate is nice too. But do your research. That "laid back atmosphere" can be maddening for those who are used to or value more efficient/convenient ways of doing things.
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