I am from a generation that lived without the need for health insurance. I remember when a doctor’s visit was affordable. I remember when hospitalization did not bankrupt a family. I remember when health care in the US was priced as it is in Panama now. Those memories are distant, because it is no longer that way in the US, and, even in Panama it is changing rapidly.
Years ago, in a land far away, I had a small business. I also had four children, and a wife with a health problem. As a small business owner, I wanted to provide health insurance for my employees; and, as the head of a family, I wanted to provide for my wife and children. Under the laws of the great State of Arizona, our company, at that time, was considered a small business; so small that no insurance company would insure anyone if they had a pre-existing condition. We needed to become part of a larger risk pool. We ended up paying a monthly fee (on top of insurance premiums) to an employee leasing company so that we could be part of their much larger pool. If not for this larger pool, we would have been uninsured in a country that provides healthcare for the poor, the elderly, government employees, and the military, but not for the small businesses and individuals that pay the taxes to cover all of those above.
That has now all changed. If you are an American citizen, or a resident of the United States, you will be affected by the PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010. Whether you agree with the law or not, the US Supreme Court has upheld the law against constructional challenge (surprising many, including myself. I believed, as did the Court, that the individual mandate was a stretch of the Commerce Clause. I never thought of the argument that won the day: it is within the taxing authority of the government. It seems, in retrospect, that if the government can tax for Medicare and Social Security, it can join the rest of the world for health care.
I have read the law, all 974 pages and admit that some of it is cryptic enough that I am sure portions will be back in court over and over. If you want to read the act as passed it is available for download as a PDF file at http://housedocs.house.gov/energycommerce/ppacacon.pdf .
Grab a bottle of rum and prepare to need it. The law is long, tedious, and in parts indecipherable, due to references to other laws on the books.
For those who object to the law, I would like to quote few items, and provoke some thought. This law may upset people because they are being forced to purchase insurance. It will however benefit many who cannot now obtain insurance. By forcing all to have insurance the pool of those insured will include more young healthy people, as well as people who really need insurance because of health issues.
According the the World Health Organization 2000 report the US had not the best healthcare in the world as propaganda might make you believe, but was number thirty-seventh in overall system performance and found to be the most expensive. WHO Report this is a PDF download.
According to a 2009 Article in Business Week, 62% of personal Bankruptcies in the US in 2007 were Health Care related, Business Week . The cost of healthcare and health insurance has grown to be a massive cost for the entire country. When an indigent person goes to a hospital and cannot pay for services the hospital needs to find the money someplace: higher bills for you, more taxes to subsidize the indigent. If you have health insurance in the US, you can read insurance statements and see the difference between what you would have paid and what the insurance company rate was — vastly different numbers.
This law will shift some of that burden. Under this law people pay for insurance based upon ability to pay, the government is subsidizing with some tax credits based on income. Under this law hospitals will get paid by insurance for bills that were un-collectable. Maybe in time this will slow the increasing costs of insurance and healthcare.
For this who think Mitt Romney will remove the law, he cannot unless Congress also votes to rescind it and I hope they do not. It was Mitt’s Medical Reform in Massachusetts that helped to create a model Federal law possible; he understands that affordable healthcare is essential.
“The Massachusetts health care insurance reform law, St. 2006, c.58,[1][2], enacted in 2006, mandates that nearly every resident of Massachusetts obtain a state-government-regulated minimum level of healthcare insurance coverage and provides free health care insurance for residents earning less than 150% of the federal poverty level (FPL).[3] The law was amended significantly in 2008 and twice in 2010 and major revisions related to health care industry price controls were introduced in the Massachusetts legislature in May 2012 with expectation that some version of these controls will pass by July 2012.” http://en.wikipedia.org/wiki/Massachusetts_health_care_reform
Blue Cross of Oregon has posted a good summary of how the new law will impact some areas. LINK . This summary shows how this law will help people. The law itself may not be perfect but most people who are negative about the law, will benefit from the law. Stop believing the thirty second sound bites, read the law.
Under this Federal act many of the same elements are covered.
People who could not buy health insurance before can.
SEC. 1101 ø42 U.S.C. 18001. IMMEDIATE ACCESS TO INSURANCE FOR UNINSURED INDIVIDUALS WITH A PREEXISTING CONDITION.
(a) IN GENERAL.—Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014.
Pre-exisitng conditions are no longer a bar for obtaining coverage.
‘‘SEC. 2704 ø42 U.S.C. 300gg–3¿. PROHIBITION OF PREEXISTING CONDI- TION EXCLUSIONS OR OTHER DISCRIMINATION BASED ON HEALTH STATUS.
‘‘(a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage may not impose any preexisting condition exclusion with respect to such plan or coverage.’’; and …
The law does not require you to leave your current insurer.
SEC. 1251 ø42 U.S.C. 18011¿. PRESERVATION OF RIGHT TO MAINTAIN EXISTING COVERAGE.
(a) NO CHANGES TO EXISTING COVERAGE.—
(1) IN GENERAL.—Nothing in this Act (or an amendment made by this Act) shall be construed to require that an indi- vidual terminate coverage under a group health plan or health insurance coverage in which such individual was enrolled on the date of enactment of this Act.
An insurance company can no longer cancel a customer when they have a claim.
‘‘SEC. 2712 ø42 U.S.C. 300gg–12¿. PROHIBITION ON RESCISSIONS.
‘‘A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not rescind such plan or coverage with respect to an enrollee once the enrollee is covered under such plan or coverage involved, except that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. Such plan or coverage may not be cancelled except with prior notice to the enrollee, and only as permitted under section 2702(c) or 2742(b).
So what does Obama care do? It makes health care affordable to those who could not afford it but were not so poor that they already received it free. In the past the poor had Medicaid or some State equivalent. The working might have had insurance from their job and those who were not part of a large group, or healthy had to pay the increasingly unaffordable costs of medical care in the US. The US has now joined the rest of the developed world in providing a path for it’s citizens to have affordable healthcare.
For Expats, this is how you will be affected.
Section 1501
‘‘(f) MINIMUM ESSENTIAL COVERAGE.—For purposes of this section—
‘‘(1) IN GENERAL.—The term ‘minimum essential coverage’ means any of the following:
‘‘(A) GOVERNMENT SPONSORED PROGRAMS.—Coverage under—
‘‘(i) the Medicare program under part A of title XVIII of the Social Security Act,
‘‘(ii) the Medicaid program under title XIX of the Social Security Act,
‘‘(iii) the CHIP program under title XXI of the Social Security Act,
‘‘(iv) the TRICARE for Life program,
‘‘(v) the veteran’s health care program under chap- ter 17 of title 38, United States Code, or
‘‘(vi) a health plan under section 2504(e) of title 22, United States Code (relating to Peace Corps volunteers).
‘‘(B) EMPLOYER-SPONSORED PLAN.—Coverage under an eligible employer-sponsored plan.
‘‘(C) PLANS IN THE INDIVIDUAL MARKET.—Coverage under a health plan offered in the individual market within a State.
‘‘(D) GRANDFATHERED HEALTH PLAN.—Coverage under a grandfathered health plan.
‘‘(E) OTHER COVERAGE.—Such other health benefits coverage, such as a State health benefits risk pool, as the Secretary of Health and Human Services, in coordination with the Secretary, recognizes for purposes of this sub- section.
and this section relevant to those who live out of the Uniied States.
Section 1501
‘‘(4) INDIVIDUALS RESIDING OUTSIDE UNITED STATES OR RESIDENTS OF TERRITORIES.—Any applicable individual shall be treated as having minimum essential coverage for any month—
‘‘(A) if such month occurs during any period described in subparagraph (A) or (B) of section 911(d)(1) which is applicable to the individual, or
‘‘(B) if such individual is a bona fide resident of any possession of the United States (as determined under sec- tion 937(a)) for such month.
Section 911(d)(1) is part of the Internal Revenue Code
“(d) Definitions and special rules
You are absolutely correct. The law is not perfect but it is a very good first step. The next step: Allowing everyone who wishes to do so to buy into Medicare. This will do two things: (1) provide a “public option” that will compete very advantageously with the profit taking paper pushers (insurance companies); and (2) make short work of the anticipated future Medicare financial shortfall, by pumping Medicare full of money, paid by people who will use the medicare benefits less and in less expensive ways, since many will be young and healthy. This would result in lower health care costs for everyone. Its a WIN-WIN.
The best way to reduce costs in US health care is tort reform…..that will make health care affordable.
and the paper pushing is not going to be less with this new system ,expect it to get worse, maybe not for the patients , but for the doctors…they already are spending waaay to much of their valuable time on paper pushing , not patients IMO
having lived in a country (Sweden) with socialized health care , I do not look forward to it here in the states….and having had a few surgeries in my life , here(Houston ) and there (Sweden), if I have a choice , i would go with the old US system.
and to susan , the medicare solution sounds good ,the only problem is you cannot find almost any doctor that will take mediare patients anymore
To me, the USA have lost their way on this.
1. Medicare (and soon Social Security) are increasingly in the red. So doing more of the same, as this new law requires, seems unlikely to solve the financial problem.
2. Insurance intended to cover anything more than catastrophic loss is doomed to fail in the end. Thinking about the circular payments and the frictional losses from administration makes that outcome seem inevitable, to me.
3. The huge costs of malpractice claims and litigation have been a key element in making health care “unaffordable” (The new law is called the Affordable Care Act!). That has yet to come to Panama, thankfully.
Bjorn: you are absolutely correct, tort reform would cut out the ambulance chasing lawyers and awards of millions of dollars to stupid people who spill coffee on themselves in McDonalds. Guess who pays for these awards, INSURANCE COMPANIES.
Guess who pays the Insurance Companies, YOU.
Insurance Companies are only a small part of the problem and they are REGULATED by the Government as to how much profit they are allowed to make. The real culprits of GREED are the Medical professions, Doctors/Dentists and the Pharmaceutical Companies. And the government shows no inclination in regulating them, after all, the AMA, Pharmaceutical Companies, and Lawyers are BIG contributors to the political parties. Insurance Companies are owned by stock holders, not so the others. Very easy to target the Insurance Companies. Why doesn’t the government pass a law requiring ALL doctors to accept Medicare. I’ll tell you why, Political Contributions.
Lee: you stated that “Under this law hospitals will get paid by insurance for bills that were un-collectable. Maybe in time this will slow the increasing costs of insurance and healthcare.” My questions is: since hospital bill are un-collectable how will this law slow the increasing costs of insurance, it would appear that if some homeless guy gets drunk and gets hit by a car and has two broken legs and a broken arm and does not have the means to afford insurance that insurance will increase for the insurance payers (the people), not slow the costs.
Lee, you also stated: “…a country that provides healthcare for the poor, the elderly, government employees, and the military, but not for the small businesses and individuals that pay the taxes to cover all of those above.” and what makes you think that the elderly do not pay taxes for healthcare. I am elderly and I paid taxes all my working life into Medicare Part ‘A’. I contain to pay over $1,000. each year for Medicare Part ‘B’ and if I get sick enough to have to go back to the States for an operation how to I go about finding a Doctor who will accept Medicare?
For Susan: I think the next best step would be for the government to drill-baby-drill and start sending our excess oil to Cuba so that they can send 20,000 doctors to the U.S. like they do for Venezuela. That would really be a win-win situation as there would be more Doctors dedicated to helping people and could possibly lower the costs of doctor fees.
Thank you Lee for you insight into this complicated law. I agree, something needs to be done but blaming the Insurance Companies for all the healthcare ills without addressing the other parties who play a part only complicates matters.
I just hope that this law doesn’t create another BIG BUREAUCRACY which will costs more in the end like so many other BIG government institutions.
Patrick, yes Tort is one thing needed….and you are so correct about Medicare…i`m not using it yet ,even If I could as I still work and use my company policy first…but my Mother in Law just moved 10 months ago from Tucson to Houston…and she has had THE HARDEST time to find doctors who take medicare…
but I think ,this new law WILL createbig bureacracy…unfortunately…
I am going to agree with some points and take exception with some. Before leaving Tucson I had a great doctor, he and his wife were partners, both Internists and shortly before I left he sold his practice. He told me he could not survive with the combined costs of Malpractice insurance and the staff necessary to process all the paper the insurance companies wanted to collect his fees. That is one anecdotal story but from what I hear it is echoed many times.
The current US healthcare system is run by insurance companies, I stand by the statement. They dictate what they will pay, what they will pay for and also how much a doctor needs to pay to stay in practice. They bleed both sides of the equation and they are in it for profit.
Bjorn, we have discussed socialized medicine many times, I can only say it is better than no medicine. Under the pre Obamacare reality Medicaid provided for the poor. People who could afford and be qualified for private insurance had it and a large number of people went at risk. The dilemma has caused a huge number of families into bankruptcy.
The ideal system on paper only is Panama. Social Security covers healthcare for people who work and for their families. It is not the greatest system, people wait for ever for services but it and subsidized Health Clinics make for affordable or free care for all people in Panama. Parallel to the government system is both private insurance and private care. If you can get private insurance it is good. If you can afford private healthcare it is excellent.
The US mess is because doctors can only do what insurance companies permit, malpractice is a problem. Many cases are frivolous but not all. The Tort law system in the US is flawed but because of it there is accountability, there is none here. If a doctor here screws up the patient loses.
I have no experience with healthcare in France but it is rated number one by the WHO. Perhaps it should be looked at for lessons.
OH and that frivolous McDonalds Coffee suit was not all that frivolous.
Probably the most famous “frivolous lawsuit” example of all time. No doubt you’ve heard of the lady that sued McDonald’s because she spilled some hot coffee in her lap while driving. What a moron! you might have thought. How stupid do you have to be to not know coffee is hot? Americans these days! Blaming everyone but themselves for their mistakes!
It turns out there’s a lot more to the story. First of all, the hot coffee wasn’t just uncomfortable and embarrassing, it gave her third degree burns over six percent of her body, which required skin grafts.
Secondly, coffee served at that temperature (180 to 190 degrees Fahrenheit) will give a person third-degree burns in two to seven seconds, while home-coffee brewers normally serve coffee at much lower temperatures (130 two 140 degrees) which won’t immediately burn you. Yes, Starbucks and other joints do serve coffee at the hotter temperatures — because some customers prefer it — but then again, they get sued for it also. Thirdly, she attempted to settle for $20,000 at one point, and McDonald’s refused, which is when she started getting cranky.
You may have heard that she got millions of dollars, when the final award was $640,000. Then from that you take out the medical bills (hint: skin grafts aren’t cheap).
But she has to take some responsibility, right? She may not have been driving, but she was trying to open the lid in her lap so she could add cream and sugar. That’s kind of careless, isn’t it? Why couldn’t the jury see that?
Well, they did. That’s why the compensatory damages portion ($200,000) was reduced by 20 percent, because they ruled it was 20 percent her fault.
From Wikipedia, perhaps food for thought?
The French health care system is one of universal health care largely financed by government national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the “best overall health care” in the world.[1] In 2005, France spent 11.2% of GDP on health care, or US$3,926 per capita, a figure much higher than the average spent by countries in Europe but less than in the US. Approximately 77% of health expenditures are covered by government funded agencies.[2]
Most general physicians are in private practice but draw their income from the public insurance funds. These funds, unlike their German counterparts, have never gained self-management responsibility. Instead, the government has taken responsibility for the financial and operational management of health insurance (by setting premium levels related to income and determining the prices of goods and services refunded).[1] The French National Health Service generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until recently, coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place “universal health coverage” and extended the coverage to all those legally resident in France. Only about 3.7% of hospital treatment costs are reimbursed through private insurance, but a much higher share of the cost of spectacles and prostheses (21.9%), drugs (18.6%) and dental care (35.9%) (Figures from the year 2000). There are public hospitals, non-profit independent hospitals (which are linked to the public system), as well as private for-profit hospitals.
Average life expectancy in France at birth is 81 years.[3][4
OK Lee, you’ve got me convinced. Lets all move to France and apply for our Jubliado discount. Of course, the Venezuelan option with 20,000 Cuban doctors for FREE medical care sounds even better. Glad that you stipulated that the Panamanian plan, ON PAPER, etc… in reality is a disaster and I have family members (Panamanian) who can attest to that.
Patrick, you are so right. The system here in Panama would be great if it worked; it does not. As to Cuba, they do export doctors all over the world including Panama. They work in places no one else would.
As a healthcare provider in the US, dealing with insurance companies was a nightmare. I was forced into seeing more patients, overbooking and giving them less time, just to pay the personnel to file and collect on the claims. Claims were often >90 days after the visit. Claims denied for silly reasons. How do you run a business like that?
I went to a cash practice and kept Medicare for a small percentage of my patients.
Every doctor I know in the United States is shutting down their practice because of this terrible ACT. They are making 60% less now than they did 3 years ago. And it will only get worse.
Everyone loses.
Please explain why this act that will force people to have insurance will hurt doctors any more than they are already hurting from needing to work for insurance companies? If anything it will increase the patient load because more insured people will be able to go to a doctor.
To All,
Tort reform is the key but most in congress are lawyers and live off suing people. The congress is not about to do a thing about frivilous lawsuits they would lose all their business…..
Bill
Most lawyers are not PI lawyers. I want to point out if not for the Common law tort system the US would look a lot more like a third world country. There is a big cost to being responsible for your own actions but here in Panama if you fall into a hole in the sidewalk it is your problem. If you reach into an open electrical box on a building, sorry you should have known better. There is a balance but tort law is important, reform is necessary but it is only part of the problem.
Tort reform is a convenient excuse. Health care providers in the US have been hurting for years because the insurance companies pay significantly less than 50% on the billed dollar for many services rendered, AFTER obligating providers to navigate bureaucratic labyrinths to get treatment and diagnostics pre-approved. If providers didn’t need to hire an entire medical billing staff to collect payment from insurance companies, they could pocket more of the limited payment dollars. Medicare and medicaid programs in general have been less hostile to the patient and provider, and more transparent regarding what is actually paid. In my experience, providers who refuse medicare and medicaid patients often do so for multiple reasons other than just rate of reimbursement. This law may provide a more equitable provider base for many insureds, as well. Although the legislation isn’t perfect, I am thrilled with the Supreme Court decision and with what has been accomplished thus far. I agree that those opposed should become better informed before protesting so much.
We have tort reform now, it’s called packing the courts with ultra conservitive hacks who rule only in favor of corportions. The rightwing macine has pumped millions of dollars into judical elections all over the country until it is almost impossible to get any kind of regress for any kind of injury. If by chance an injured person wins an award it is overtuned in a higher court. Check out the movie Hot Coffee.
Lee:says:
Bjorn, we have discussed socialized medicine many times, I can only say it is better than no medicine. Under the pre Obamacare reality Medicaid provided for the poor. People who could afford and be qualified for private insurance had it and a large number of people went at risk. The dilemma has caused a huge number of families into bankruptcy.
Yes I agree , its better than no insurance….BUT I do have insurance now , and socialized medicine is worse for me.
Now. one of my sisters live in France, she says care is great there, but she`s k=just like all the others there , ‘everything in france is better than anything anywhere else”…lol And i know my brother in law had a recent surgery there, he did get good care….now , should we talk about how much it costs? tax rates?
as all this stuff is always paid for by taxes…there will always be a huge difference on opinions as most have different views on whats acceptable to be paid for by taxes, who values what.
I for one like taxes to pay for certain things other dont care for…as we for instance have a veery high tax rate in Sweden, or had. We have things very well done , like undergroud electric power lines…I think thats well spent money…look at the heat wave in the NE right now, had power been underground, they wuold have power…same goes for us in Houston , after hurricanes…its a way of ‘insure’ yourslef for problems….just as health care , BUT heatlth care here is not as many portary it , people die from no insurance …they DO get service ,care , and its paid for by govt pools anyway ,which we pay for.
Tort may be ‘good’ but its waaay overdone….the insurance for doctors are then raised quite a bit , premium of several hundreds of thousands of dollars, got to be paid for by someone ,and it boecomes the patient and or his ins company.
its not just the doctors Mercedes that has to be paid for….insurance fraud also bring up costs.
as for the “cash” payment, I recently spoke to a doctor friend of mine ,who will not take cash , because once you set the patient up on cash , he pays the first time, then he “forgot his wallet”, or wife has the check book, or the GF took his money….and no pmt is made.
Wjhat Obamacare has done or is doing for me personally is pushing me more towards a move to Panama .
some added info
Remember what FDR said, “There are no coincidences in politics…”
Click here: The President’s $8 Billion Coincidence | myBrainshark
http://my.brainshark.com/The-President-s-8-Billion-Coincidence-356086344
My mind boggles at the continual focus on what amounts to bits of green-stained linen-stock paper.
The Affordable Care Act (Go ahead — call it “ObamaCare” — as if you can cheapen the intent of the act by applying what you consider a derisive name!) is a flawed compromise which attempts to address what is perhaps the most significant risk facing the citizens of the United States of America. I am personally contemptuous of every fatuous argument about the “expense” of trying to provide affordable health care, for those so quick to bitch and moan and cry about some “crack baby receiving free services” have obviously not had to face critical health-related issues — yet. But we are fragile organisms, and it is a cold, hard world out there, filled with pathogens and a broad litany of other threats to our weak physiology. It is so easy to rail against compassion and empathy, right up until the instant something punctures our own balloon and we begin to screech with pain and suffering and indignation.
I have yet to hear any comprehensive discussion about “expense”. It is too facile to use insurance “industry” data to weigh the costs associated with treating, oh, let’s say cancer. For it is the victim of the illness who always winds-up dropped into the pinball machine of industrialized medicine; the ripples created spread inexorably outward, far and wide. The insurance “industry” has absolutely zero interest in wellness — its focus is exclusively upon those bits of green paper. A whole bunch of little bits of green paper! A great, giant pile of green paper!! But there is one absolute fact which cannot be denied: even the fat cat insurance executive will one day sicken and die, even if it happens on the twelfth fairway….
It is the social and cultural costs that are the greatest challenge. None of us is immune. The Golden Goose of American healthcare needs to be supplanted by the Golden Rule. When I hear these contemptible repugnant-can’t “representatives” whimpering about “costs”, all I can see is the despicable hypocrisy inherent in the fact that they are all eager recipients of that platinum-plated Cadillac health care paid for by — wait for it — the very same “little people” that they consider to be unworthy of basic healthcare … (and all the while stripping funding for education — the single, greatest weapon in the arsenal of PREVENTION of illness.)
Yeah, the Golden Rule. Think about it. What’s the alternative? Soylent Green?
I have a completely different problem with Obamacare, namely, it was written by the health care industry. When Obama pushed for a public option, the sole lobbyist representing the entire healthcare industry began a campaign again the bill.
http://www.pbs.org/wgbh/pages/frontline/obamasdeal/view/
The other problem I have with it doesn’t directly deal with Obamacare but with the pervasive influence the federal government continues to exert. If the administration can dictate healthcare issues, perhaps they will next decide that rum is contraindicated to one’s health and pass a law against it. Then smoking, then mandated motorcycle helmets, then flipflops. What’s to stop them?
jim
Banning 16 oz soft drinks, (like NY) not that i drink any of those, but id like to be able should I want one
All the things this author states are rubbish. This destroys all reality in the US medical system ! You’ll see a natioanl plan and private insurers will fall by the wayside one by one ! Any business who crunches the numbers will surly consider paying the penalty.
Just like the plan I have in Costa Rica is what will will emerge. The so called death panel must be in place to monitor the program and rationing is 100% certain. As in Costa Rica all who can afford to pay drive to Panama and the real rich have US Visa’s and will travel there. This changes nothing ,but, the Republic died and the Commerce Clause is now moot. The Government has become a monarchy !
As a famouse doctor states in his youtube plea… Die before 70 or the Gov will surly kill you. He left the Whitehouse meeting and posted an did radio spots asap. He was told for his patients over 70.. Do nothing ,but,make them comfortable as not even simple procedures will be paid for !
What ever they want the Gov. can now can do and Commerce Clause is just a minor pain ! It’s moot !
Medicare an Medicade are bankrupt. Social Security is too. The lock box has worthless IOUs. As Blackrock CEO L Fink said minutes ago on Bloomberg the US takes in 2 trillion a year an owes 80. Bankrupsy is the best option,but, he is 36 trillion short and OMB #s an assumptions are too.
This Obama program is right from todays headlines ! Today the Argentina President said “equality is more important then freedom ! ”
I am glad I have nothing left in the US. Not even a penny in any account and it isn’t even worth PAYING to get rid of my Passport. The wife is a tica and I will have a CR Passport soon and blessed to be Jewish I have an Israeli Passport and don’t need a VISA to re-enter the US cesspool ! S.V.
NOTE : I do live in Chiriqui and have a policy with Chiriqui Hospital ! I have great doctors all over David. I do NEED to continue to pay for Costa Rica healthcare as a condition of retaining my residency. So, I get the concept of paying for medical services I NEVER use. The only useful info in this article is the fact I will not need to pay the US TAX as I am a legal resident of Costa Rica and Panama. I wish all Americans could receive the care I get in Panama for the prices I pay and this new plan will explode costs and all but the rich will suffer. Here is the article AMCOSTARICA ran,so, I didn’t need this format for the good news !
( amcostarica)
Most expats need not worry about Obamacare tax
By the A.M. Costa Rica staff
U.S. expats here do not have to worry about the health mandate and its accompanying penalty tax found in the Obamacare legislation.
This is the U.S. law that was upheld in a 5-to-4 U.S. Supreme Court vote. Even if Republicans are not successful in repealing the law, most expats here either are specifically excluded from the penalty or already have health insurance that qualifies.
The advocacy group American Citizens Abroad agrees. In an email, the organization that follows U.S. legislation closely said:
“Americans who are bona-fide residents overseas are not subject to Obamacare tax or penalties. However, the new Medicare tax in the Affordable Care Act (3.8 percent on incomes over $250,000) will be applicable.”
The law officially is called the Patient Protection and Affordable Care Act. Starting after 2013 the law requires most American citizens and residents to maintain what is called minimum essential health coverage.
Specifically Chapter 48 of the Internal Revenue Code says that anyone living outside the United States will be considered to have coverage for the months they are not in the United States. Many really do. The law cites basic Medicare coverage as being in compliance. Also in compliance is the government’s Tricare program for retired military personnel. Many expats here have these types of coverage.
Also approved are U.S.-based private health plans, the health plans extended to Peace Corps volunteers and health plans provided by private employers.
The penalty tax for those who do not maintain coverage is paid with the annual income tax and appears to be capped by a percentage of a taxpayer’s gross income. For the 2014 tax year, the cap is 1 percent. For the 2015 tax year and subsequent years, the percentage rises to 2.5 percent.
The act exempts members of certain religious groups from the penalty. Also exempted are individual in prison and individuals who cannot afford coverage.
The law does not seem to include enforcement teeth. There are no criminal penalties for not paying the extra tax, and the Internal Revenue Service cannot file a lien on a taxpayer’s property to collect the money as agents can do for the regular annual income tax.
For expats in Costa Rica, health plans provided by the Instituto Nacional de Seguros do not seem to meet the requirements of the plan, although there may be additions later. The law is silent on coverage by the Caja Costarricense de Seguros Social, but those legal residents who have that coverage probably also are exempted legitimate overseas residents.
The U.S. Supreme Court decision generated discussion on a number of expat Internet lists all over the world. There are many gray areas in the law that will require clarification. Simply taking an overseas trip for a few months probably will not satisfy the requirement for that tax year. Some expats expect the Internal Revenue Service to enforce the same requirements that are applied for the earned income deduction.
The IRS says to qualify for the earned income exemption, a U.S. citizen must be a bona fide resident of a foreign country or countries for an uninterrupted period that includes an entire tax year or be U.S. citizen or resident alien who is physically present in a foreign country or countries for at least 330 full days during any period of 12 consecutive months.
The IRS is likely to have the same or a similar definition for the health care mandate penalty tax.
And U.S. expats who use Florida addresses for mail courier service are likely to have to explain that somehow to the IRS.
One gray area here is the status of perpetual tourists who really are residents but live here on tourists visas and renew them every 90 days by making foreign trips. The IRS does not discuss this, but on its Web site it says that the agency is not particularly concerned with the status of foreign work permits, although it encourages U.S. citizens to comply with local laws.
Hey, it’s going to get better. The HSS an IRS are estimating they will add 18,000 new pages to the Health Care Act and the writing is currently underway.. I guess the author will need to read some more horrific stuff and spin it for us ! SV
Health care in the Us has been out of control for decades, like most other things the gov’t is involved with.
Decades ago, there were city, county and state hospitals funded by cities, counties and states. They were well equipped and staffed by good doctors/nurses, etc making good wages. Privatization ruined that.
Everyone keeps blaming the insurance companies. Not good. You have to go to the source of the inflated medical costs to find your culprit. And, until the prices are brought under control at “the source” (never gonna happen), health will continue to be big business.
At least that’s my opinion.
Charlie, If the Federal Reserve prints 9 trillion dollars and floods the world with the reserve currency there is no way to control costs ala inflation ! You might remember like me buying 3 slices of pizza and a large ( ok 16 oz) drink for 45 cents and keeping the 55 cents from the buck I got to use for the day. Then paying 11 cents a gallon for gas to run my scooter ..
What does 3 slices a large drink and a gallon of gas cost today ? 15 bucks !
Medical costs are no different and I was a Med tech in NY and volenteer paramedic for the fire department.
So, it’s simple to me ! The dollar is becoming worthless and when all the fear in EU comes down the clock it ticking on the “reserve” status on the dollar. Then the US becomes Greece and Panama takes it in the butt overnight. Lets hope were too old to see it happen !
Too many exaggerations and half-truths!!!! The Affordable Health Care act is a start, and a good one, considering the formidable opposition that it had to overcome. Like any other complex legislative fix, there is room for future adjustments or amendments. However, it is interesting that among the naysayers are many people who conveniently forget that Medicare, VA care and Tricare are government programs. Obviously, they work reasonably well since there is no groundswell of opposition to them. Opposition to the AHCA is largely the result of political party polarization, gullibility to right-wing TV soundbites and misinformation. How many of the critics can list three of the benefits of the AHCA? Not many, and they have no inquisitive interest in expanding their knowledge base. Please remember, that there are some elements who, from day one of the current administration, declared that their duty was to make Obama a one-term President!!! This contributes significantly to the patent irrationality of the opposition to the AHCA.
Incidentally, it is a canard that there is a rush of doctors away from Medicare. In fact, if Medicare disappeared tomorrow many hospitals, doctors’ offices and hospitals would have to close because Medicare provides a reliable central core of their income. Excellent U.S. medical institutions like the Cleveland Clinic, University of Miami Hospitals and Kaiser Permanente provide services to Medicare patients. I am sure there are many others but I and my family members, who have Medicare, have received excellent care at these places.
The ideal situation would have been ‘Medicare-for-all’ but I guess the special interests were not ready for that. AHCA was therefore a compromise plan. Please do not forget that to a large extent it is the step-child of Romney’s Health Care plan in Massachusetts! For some people, if Obama says the sky is blue it must be some other color. If you are anti-government, anti-compassionate care for all and anti-healthcare access for all, the AHCA is a convenient whipping boy. However, twenty years downwind, history will absolve the introduction of the AHCA. I then will proudly call it Obamacare,
This is the best! Everybody has great arguments, and only time will tell how it all works out. Lee, you’ve put together some great stuff. Don’t know yet whether I agree with it all, but then again you definitely know more about the situation than I. I currently have Tricare, and am hopefull that I can keep it. If I have to have some other insurance for whatever country my wife and choose to live in, hopefully at that time I’ll be able to afford it. Who knows, they may just price us out of Tricare as well. This has been very enlightening, and informative, from both sides. It is hard for me to disagree with either side completely, they both have merit. Keep up the great work.
Norman says :Incidentally, it is a canard that there is a rush of doctors away from Medicare. In fact, if Medicare disappeared tomorrow many hospitals, doctors’ offices and hospitals would have to close because Medicare provides a reliable central core of their income
My question…Are you on Medicare? My mother in law recently (8 months ago) moved from Tucson to Houston ,she has had the HARDEST time to find doctors who will take patients on medicare…lucky for me even though i`m at medicare age , I`m still working so i have private insurance that the doctors I have take….