Longwood50

12 hours ago, shdmn said:

I believe this has been required by the banks for a few years now.

Was not required last year when I opened the SCB account that I have.  Only the passport with long term visa. 

On 11/1/2021 at 3:18 PM, Na Fan said:

Any of you own any portable ones? Are they good? Recommendations?

There is a difference between and air conditioner and an air cooler.  The cooler vents to the inside and is really nothing more than a fan that blows air over water or frozen blocks placed in the water bin.  A portable AC vents to the outside.  They do work but the vent hose has to go through an opening usually a window and that can be problematic. 

2 hours ago, 1FinickyOne said:

I think in the present public health system the docs are on salary here and are not in need of extra work and do not benefit by it... and I doubt there are many Thais seeking unnecessary surgery... 

 

but look, try as you might, you are not going to change the system here or in USA even if you have a brilliant idea..

No the system like most is rigged by those who benefit from it.  The hospitals, doctors and pharmaceutical companies don't want competition and consumers making choices.  They want consumers/patients to use as much healthcare as possible. 

In terms of the Thai doctors yes most that work in the hospital are on some sort of salary.  That does not mean that the hospital does not encourage them to upsell for more treatment and more expensive treatment.  Also all of them have pharmacies that sell prescription drugs and so again, there is a profit motive to prescribing medication.  Lastly, I don't know this as a fact, but given my experience with hospitals here the doctors are pretty insistent on keeping you running back repeatedly.  It would not surprise me if they are on some sort of incentive based on the fees collected from patients. 

It just seems like a hurdle that is unnecessary.  Here the Thai government is doing everything to promote social distancing and obtaining a residence certificate means a trip to immigration.  I already have a residence certificate copy since I needed one to purchase a car.  So I can show them my car registration, my passport, my drivers license all of which demonstrate that I have a residence but yet they want again another unnecessary trip and a couple hours of my time to get a piece of paper that shows that I reside in Thailand which could be established by my 0 visa and extension. 

Just like Thailand is putting hoops for tourists to come to Thailand, Kasikorn obviously is putting hurdles up for foreigners to open accounts at their bank.  Guess which bank, I won't be opening an account with. 

I went yesterday to open a second bank account at Kasikorn bank.  First they told me I had to "make an appointment" and come back the next day.  The woman asked to see my passport and visa.  I have the 0 Visa extended to Feb 2022.  She said I needed a certificate of residency to go along with that and it had to be an original not a copy. 

I have not had this before when I opened my current bank account with SCB.  Has anyone else experienced such a requirement.  And candidly what sense does that make?  If I have a Visa I am obviously approved by immigration to be residing here. 

24 minutes ago, 1FinickyOne said:

of course not, it is free essentially. but I would not expect most Thai to have $10,000 and money for insurance.. 

If you read the original post this was an idea for USA citizens not Thailand.  However the same thing could work here if the government mandated a deduction from peoples wages going into some sort of reimbursement account.   The government is essentially providing the major medical portion right now.  However the 30 baht is hardly enough to get people to shop for health care.  

The bottom line is if you make health care so cheap to the patient, they will misuse it and providers knowing they are getting paid by the government will prescribe too much of it. 

 

12 hours ago, 1FinickyOne said:

Interestingly, the Thai have it figured out pretty well, certainly better than the USA... w/their 30 baht coverage for all.

You have to remember the $10,000 USD was for medical care that the person would cover themselves.  After than a major medical policy to cover catastrophic health care. 

In terms of the 30 baht plan.  Why 30 why not 10 why not zero.  The 30 baht plan does not mean health care costs 30 baht only that the patient is charged 30 baht.  Again, that only encourages people to use healthcare excessively because it is cheap.  

With the 30 baht plan the patient goes in and gets an operation costing 1 million baht and the government pays.  Then everyone paying taxes covers the cost of the 1 million baht operation.  So what about that is "free" 

The system whether here in Thailand or in the USA encourages people to unnecessarily use the healthcare system and intensifies the health care system to provide excess medical care to reap profits.  

Its like an all you can eat buffet versus and ala carte menu.  When you have an all you can eat, you don't care how much of the food you take, and discard anything you don't consume. WASTE.  If it is ala carte and you are paying for each item consumed, you choose wisely.  The same is true for health care.  If the patients were responsible for each health care procedure requested they would shop for it, and choose judiciously. 

The only way I can think of to encourage such shopping is to have each person have a government account using deductions from their money.  They would shop for the small health care expenses and the larger ones covered by either a private major medical policy or government catastrophic health care coverage. 

I can tell you I am guilty.  I had procedures done under Medicare strictly because the government would pay for them.  One a cosmetic procedure to raise my eyelids.  The government policy said if they were "restricting my vision" they would be covered.  You don't think the doctor who did the surgery made sure what was reported to Medicare ensured that the "test" showed I was impaired.  If I had to pay for the surgery, I would not have done it. 

2 hours ago, 1FinickyOne said:

Personally I do not see a solution. 

There is no solution.  There are only alternatives.  Everyone seems to think there is a "perfect solution". 

To me, I have concluded that if society decides to mandate and/or provide health insurance, you will have a system that the medical community exploits.  They will charge whatever they can and provide more services than really required to line their pockets. 

Alternatively you can have a market based health care system where patients select what exams, tests, and procedures they want done and they are willing to pay for them.  Unquestionably you will have some patients who make bad decisions to "save money" and it will cost them their health. 

The only middle ground I can see is for the government to "protect" its citizens by mandating a program like social security where each person is forced to put a small percentage of their income away in a health savings account until it reaches a maximum of $10,000.  They would be able to spend any amount from the savings for medical expenses.  Those would include the routine office visits, xrays, lab tests, blood work etc.  When the balance in the account falls below $10,000 the deductions from the persons income resume until such time as the $10,000 threshold is reached.   That would instill some incentive on the part of patients to only seek necessary medical assistance and to shop for the best value. 

The deductions from the persons pay would also cover the premiums for a major medical policy with a $10,000 deductible.  If the person faced catastrophic medical expenses the $10,000 in their account would cover the deductible and then the major medical policy would kick in.  Those major med policies are cheap. 

Is it a perfect solution, no nothing is perfect.  The current system costs a ridiculous amount in bureaucratic overhead for hospitals and doctors to get paid and for insurance companies to cover the expense of monitoring and paying claims.  That expense would be mostly eliminated if the patient was the one doing the monitoring when they selected the doctor or hospital to go to for their treatment and paid directly.  

 

36 minutes ago, 1FinickyOne said:

I have plenty of complaints about the current system.. money and medicine are a toxic mix...

You are absolutely correct.  I believe the best solution for fixing the health insurance mess in the USA is to have a mandatory system like social security where a small portion goes into a separate account in the name of the person.  Those monies are used to pay for small medical expenses and go back to the person once a certain balance is reached.  The person knowing they are using their own money will be careful in terms of what medical services they request and what they pay for them.  

Then each person would have a major medical policy covering catastrophic illness and medical expenses.  Lets say with a 1 million or 3 million dollar cap and a $10,000 deductible.  Those policies are cheap.  

The person would be covered using their own money for less than the $10,000 and covered if they got really terrible hospital expenses.  I know this, this system of trying to limit the reimbursement to doctors and hospitals only causes the medical community to get more deceptive.  Instead of ordering 1 test that they make $100 on, they order 10 tests that they make $10 each on and of course the expense of the 10 tests is more than the 1 test.  Doctors want to keep your running back because they are limited as to how much they can receive in the way of a reimbursement for each visit.  

You do not insure your car for oil changes and tire changes.  You insure it in the event of a serious accident than runs up a large expense.  Health coverage should be the same.  Pay out of pocket for those routine physicals, blood work, x rays and have an insurance policy for those truly catastrophic expenses. 

16 hours ago, 1FinickyOne said:

so, you think this is a good plan - bargaining for medical like you would in a flea market?... call me a dreamer, I would hope for a better plan... 

Do you have a better idea.  Whose to say that irrespective of what the hospital charges that you are getting quality service.  

I see nothing wrong with a patient shopping for services particularly routine services like blood work, x rays, annual physicals, required vaccinations etc. 

This current system where the hospital charges what it wants, the patient does not care because they are insured only leads to more overcharging and higher insurance premiums.  Even the insurance companies really don't care so long as they can pass the cost on to their customers via higher premiums. 

The current system is like having a dinner on the company account.  You don't care what the cost is and you only want the best. 

I see nothing wrong with a patient who needing a procedure shopping with several qualified physicians before selecting one.   The consumer is then making a choice between the perceived quality of the care being received versus the expense and making a value judgement.  

My system of private pay is not without its shortfalls the primary one being that some people will put off medical care because of its costs.  But the alternative of having third party pay does just the opposite.  Its like a medical buffet where the patient selects the most expensive items on the buffet and doesn't care how much they eat.   There is nothing in the world more wasted than something that is "free"  And right now, once the patient reaches their deductible or co-pay they don't care in the least how much the hospital or doctor charges.  

3 hours ago, 1FinickyOne said:

how and when does that bargaining occur... you go to the hospital w/an actively dangerous condition or in tremendous pain - do you want to bargain under those circumstances? 

 

"i'll give you everything I have for one shot of morphine!! Now!!"

Did I say it was a "perfect solution". Using your example the hospital could charge the insurance company an outrageous amount and everyone who purchases insurance pays for it via higher premiums. 

At the present time with third party pay the hospitals have no reason to provide healthcare at reasonable prices.  The consumer who is the insured doesn't care what it costs.  Once the deductible or copay is reached not only doesn't the patient shop for services the patient demands only the best.   

In the instance you are talking about, hospitals should be forced to have an established price list for services.  They can barter down if they wish but in no case can they charge the patient more than the "list" price filed with the government. 

What you describe is no different than the person who is on a trip and their car breaks down.  The mechanic has them at a disadvantage.  That does not mean that all car owners should have insurance to cover them in case their car breaks down and negate their ability to barter for car services when back home. 

Consumers shop for food, cars, appliances, vacations, prescription drugs, hotel rooms, jewelry, and almost every aspect of life and yet somehow healthcare is sacrosanct where it is expected not only does the consumer not have to shop but the provider does not have to compete.  When lasik eye surgery first came out it was approximately $5,000 USD per eye.  It is now down to less than $500 per eye and all with better technology.  Why?  Because lasik was not covered by insurance, consumers shopped and doctors responded by lowering prices. 

Recently a friend of mine who is Thai badly broke her leg and chose to go to a prestigious private hospital.  They told her it would be 350,000 baht for her "emergency"  surgery.  She said she could not afford that and offered 200,000 baht.  They responded no but would do it for 250,000 baht.  

Emergencies as said can be handled with an established price list.  However for routine procedures, health check ups, blood work, etc. very simple if you want them pay for them, otherwise don't get service. 

17 hours ago, Fat is a type of crazy said:

I'll start by acknowledging a limited knowledge of US tax compared to Australian tax. You say that the proposal is to tax them to the point they are not rewarded for effort

First as the graph shows the top 1% use to pay only 20% of the total income tax bill while the bottom 90% paid 50%.  The top 1% now pay 40% of the total tax bill and the bottom 90% pay approximately 30%.  So at what point is "it enough" when the top 1% pay 50%, 60% 70%. You can see the creeping socialism where you take from those who produce and give to those who don't. 

As previously mentioned you tax something you want less of and subsidize something you want more of.  Taking from those who produce creates less of them and subsidizing those who live off others gets more of them. 

You say a couple of percent doesn't make a difference.  Consider a lottery with a prize of $10 million, isn't that enough?  How many tickets do you sell.  If you make the prize $100 million, how many tickets do you sell?   The greater the reward the more people who sill strive to obtain it. 

Finally the majority of the wealthy come from business successes.  They certainly don't come from failures.  The more profitable the business is, the more they want to expand.  That is good for the economy, and good for working class people.  Business expands from using retained profits.  The less money they have to expand, the less expansion there is. 

It is like the adage of the cup of water and the pump.  You can drink the water but then the pump will not prime and you don't get more water.   Like it or not, successful people become wealthy from providing something of value.  That should be something encouraged, not discouraged.  The fact that they become wealthy is a "so what"  Would the world be wealthier and the population better off if Bill Gates when he was worth $1 billion had a larger percentage of his wealth confiscated and hence Microsoft didn't expand.   Would the 3 million people who have jobs at Walmart be better off if Sam Walton as the company was successful had his money confiscated and there were only 500 Walmart stores instead of 5,000.  

It would seem far more logical to look for ways to help the bottom 90% improve their skills so they could earn more rather than confiscate the fruits of others labors who are successful just "because they can afford it"  

Look at Thailand where there is this dual pricing for locals and farangs.  They use the pretext  well they can afford it.  The basic tenet of communism is "from each according to their ability, and to each according to their need"  

This idea that somehow the wealthy benefited from what was provided by society in general is ludicrous.  Everyone has the benefit of what society has provided.  The difference is some people use what society has provided to create value and hence become wealthy and others either to lack of ability or lack of initiative do not.  

On 10/29/2021 at 4:37 PM, Fat is a type of crazy said:

It's an unusual way to tax but if the result of the tax system as it is, is that billionaires are getting richer and richer and paying no tax, it seems a good outcome.

 

Democrats wanted to increase the marginal rate of tax in the normal way for the rich but  Manchin and Sinema weren't having it.

 

Some point out that the most wealthy pay a fair share of tax but my opinion is that at some point you have benefited so much from American capitalism, and have so much power, that it's not unreasonable to pay a bit more tax.  

I am reminded when I see posts like this of the quote by Joseph Goebbels the Minister of Propaganda for the Nazi's.  He said, tell a lie, make sure it is a big lie, and keep constantly repeating it and people will eventually believe it. 

 

Using figures by the Internal Revenue Service the top 1% of taxpayers pay more than the bottom 90% combined.  So exactly what is "their fair share"  

Have they become wealthy - Yes.  Using just 1 example I am from a midwestern city where a small grocer grew to a chain of now over 300 super centers like Walmart.  That person is a billionaire.   Now is that fair.  Consider, the company employs over 60,000 people directly.  The company stores worth millions pay millions in property taxes that support the municipalities they serve.  The sales tax generated by those stores pays untold millions to the state coffers.  The 60,000 employees pale in comparison to the truckers, food vendors, merchandise vendors, sales people, electricians, plumbers, etc that all provide products and services to this one supermarket chain. 

Would the world be better off if people like this were taxed to the point where they can't expand their businesses and hire more people?  You tax things like cigarettes, alcohol, and gas guzzling cars you want to have less of.  You give tax breaks to things like electric vehicles that you want to encourage more of. 


So what has tax policy done.  It has progressed  to a policy to tax those who are productive and subsidize those who are not.  It has successfully done so to the point that 47% of the tax returns filed in the USA pay ZERO.  That is why it is so disingenuous when the liberals say all the tax cuts go to the wealthy. First, the wealthy pay the bulk of the tax so any cut will benefit them disproportionately.  Secondly how in H do you give a tax cut to 47% of the tax returns that already don't pay anything?  

There seems to be this growing socialist thought process that views "successful" people as somehow the enemy when in fact they are the ones who invent products, provide services, and employ people.  Do they get wealthy doing so - Yes  SO WHAT  Without them would society be really better off if no one had the desire to be a capitalist and invest their money in the hopes of becoming a success?  I am not wealthy but do I have jealousy for the wealthy, no.  I have admiration for them.  I look at the productivity that Bill Gates gave the world and he has been underpaid for the wealth he brought the world. 

Remember those who really want the world as better for everyone wants to make everyone millionaires.  Those that are misguided want to make this "fairer" by having no millionaires.  Be careful what you ask for as it might come true and seeing no reward for their investment and efforts the entrepreneurs just might say, gee taking the chance on running a business just isn't worth the risk.  If I fail, I lose my investment.  If I am a success my reward is that my wealth is confiscated. 




There

https://taxfoundation.org/top-1-percent-pays-more-taxes-bottom-90-percent/

Big Spending and Chinese isn't that like Giant Shrimp, government intelligence, and constant variables.  An oxymoron. 

40 minutes ago, gearbox said:

Last year I was stuck in Goa

Two years ago I took a cruise and one of the ports was GOA.  We almost did not get off the ship because at first India was charging $100 USD for a visa and I didn't think the $200 for both of us was worth it added to the cost of a shore excursion.  The price for online dropped to $25 and we purchased the visa's.  Should have stayed on the ship.  I don't know what other parts of GOA look like but I can tell you the port area is a slum.  Closest tourist thing was about a 1 hour tuk tuk ride to some place where they made spices.  If I wanted to look at how spices are made I would have taken a tour of the McCormick factory back in the USA.  

Looking to go on a holiday in 2022 and have not picked out when or where yet.  However if you travel to multiple countries how does that work on re-entry?  Do all of them have to be on the approved list otherwise a quarantine?  With countries constantly shifting from low to high infection does that not mean it is a roulette wheel when a person is traveling not knowing if the country they are visiting will not be on the approved list for re-entry while their itinerary takes them there? 

8 hours ago, JensenZ said:

They reported a 448 million baht loss, but it meaningless without a figure for total revenue from tourism.

You are correct it is peanuts however they are using it as a pretext for making every tourist have a minimum $50,000 health insurance policy covering care in Thailand.  IF and I repeat IF they were really that concerned over the hospitals losing money they would charge each arriving tourist 100 baht and that would be far for money to be awarded to the hospitals for non paying foreigners than is currently being incurred.  

Of course the figure also doesn't include the millions of baht the hospitals made on tourists who went to them for care and paid their bills either.  

The ludicrous part is that having insurance does not guarantee that the hospital will get paid.  Perhaps the hospital performed some service not covered or more likely the bureaucratic nightmare of trying to collect from a foreign insurance company just isn't worth the expense and hassle to the hospital. 

8 minutes ago, sandyf said:

airly obvious you haven't arrived in Thailand during the quarantine regime. Passengers leave the airport in a covid secure vehicle, I was alone in mine.

You are correct I have not arrived since Covid.  OK instead of the secure covid vehicle, they will first meet those in Thailand with Covid either from the hotel staff upon checking into their Non quarantine hotel, or from one of the first 10 street vendors they come into contact with. 

18 minutes ago, sandyf said:

Those that had the virus for a couple of days would pass the pre departure test but not the one on arrival.

And of course a large percentage of the taxi drivers picking the tourists up at the airport would not pass the test either, but Thailand seems only to direct its attention at foreign travelers, fully vaccinated and tested.