Usa Expats, Universal Health Care Coming?

[Jingthing]

I am betting Hillary Rodham Clinton will soon be our next president and she will have a democratic congress and senate to work with. So with that, the chances are we will be getting some variation on the newly proposed Clinton health reform plan.

Well, all and good, I am all for universal health care for Americans, but what about expats? Her plan requires that all Americans purchase health care plans if they don't get it through an employer or medicare, etc. Living abroad, I will not want to!

Should we be concerned?

[PeaceBlondie]

Trying to keep it focused on expatriates in Thailand, will it be okay if we, the UAW retirees, and a few other lucky folks have our medical ins. covered by our pension funds? Any chance that the expatriate recipients of Social Security might be able to receive Medicare benefits overseas?

I wouldn't count our chickens before they're conceived or hatched.

[Jingthing]

Trying to keep it focused on expatriates in Thailand, will it be okay if we, the UAW retirees, and a few other lucky folks have our medical ins. covered by our pension funds? Any chance that the expatriate recipients of Social Security might be able to receive Medicare benefits overseas?

I wouldn't count our chickens before they're conceived or hatched.

I agree it is half baked, more like raw dough right now.

But some changes are almost definitely coming and you can bet they won't be thinking about expats.

You make a good point about medicare, if the idea is to make things universal, that makes it logical that medicare should be extended to expats.

[gbt71fa]

Trying to keep it focused on expatriates in Thailand, will it be okay if we, the UAW retirees, and a few other lucky folks have our medical ins. covered by our pension funds? Any chance that the expatriate recipients of Social Security might be able to receive Medicare benefits overseas?

I wouldn't count our chickens before they're conceived or hatched.

I agree it is half baked, more like raw dough right now.

But some changes are almost definitely coming and you can bet they won't be thinking about expats.

You make a good point about medicare, if the idea is to make things universal, that makes it logical that medicare should be extended to expats.

If you are middle-class or higher, income-wise (your level in the u.s.), it is expected that your taxes will rise. She has already said that the tax-cuts will be killed and that wealtheir Americans (she has not said what she considers wealthier) would be expected to pay more.

[keemapoot]

Trying to keep it focused on expatriates in Thailand, will it be okay if we, the UAW retirees, and a few other lucky folks have our medical ins. covered by our pension funds? Any chance that the expatriate recipients of Social Security might be able to receive Medicare benefits overseas?

I wouldn't count our chickens before they're conceived or hatched.

Or...elected into office....

[jumnien]

I refuse health insurance, much prefer to take responsibility for my own medical condition and expenses.

[Jingthing]

I refuse health insurance, much prefer to take responsibility for my own medical condition and expenses.

Thats kind of my point. The rough outline of her new plan requires ALL Americans to have health insurance, even if they have to purchase it. This is nothing like the Canadian, French, or British systems. I don't like the idea of being mandated to purchase anything.

Look folks, she is the odds on favorite now and if not her, it will probably be a democrat who will also reform US health care access.

[samran]

I refuse health insurance, much prefer to take responsibility for my own medical condition and expenses.

Thats kind of my point. The rough outline of her new plan requires ALL Americans to have health insurance, even if they have to purchase it. This is nothing like the Canadian, French, or British systems. I don't like the idea of being mandated to purchase anything.

Look folks, she is the odds on favorite now and if not her, it will probably be a democrat who will also reform US health care access.

The basic economics of it all is that if the insurance pool is larger, then premiums are cheaper for everyone as the average risk decreases across all categories. It forces the young and healthy to take out insurance when they otherwise feel they wouldn't need to, so it can cross subsidise older patients who tend to dip into the insurance pool more.

The other thing to remember is that it is no bad thing to have certain elements of the health system centralised - within a market environment. One is the bulk purchase of medicines. One reason (apart from subsidies) why the same medicines on average are cheaper on Canada/UK/Australia than in the US is that these governments are the only organisations which purchase medicines in bulk from the drug companies.....giving them huge negotiating power to counterbalance the huge market power of drug companies. The drug companies hate it, but the truth is they hate being at a disadvantage.

One final thing to change is the powers doctors have for pricing their services. If you think about it, given the barriers to entry to become a doctor, by any economic definition, unless you are to the right of Ghengis Khan, then the proper term for a doctor is a monopolist. Most monopolies have their prices controlled by an independent regulator, so they can't overcharge. There is no reason why a visit to a private doctor in Australia can cost $40 all up and why it should cost $300 in the US. The AMA, for all its white coats, it the last unreformed union in the US, one of the most powerful, and for all their shiny teeth, the most miltant.

Fix all these things, and you'll have cheaper healthcare costs all around with no decrease in the level of care provided. You'll also have care available to all those who need it, rather than those who can afford it.

Being a little bit of a student of US politics, I think all you fellas are going to get however is a free band-aid and condom when you leave the country and someone waving goodbye saying "See-ya all later, and don't come back now.."

[Jingthing]

Yes, Samran, I don't expect anything for expats. Many Americans see us as a kind of traitors who defy the propoganda that everyone in the world wants to come the USA, and nobody wants to leave. I am slightly concerned we will be required to participate in the new system and pay for it even though we aren't there to benefit from it. Already the case with medicare.

Edited September 18, 2007 by Jingthing

[Jimjim]

I think it's a stretch to relate this to Thailand, but I don't see how she could make expats purchase medical coverage, or force anyone else to do it for that matter. Out of paychecks like Social Security? I'm not sure.

[Jingthing]

I think it's a stretch to relate this to Thailand, but I don't see how she could make expats purchase medical coverage, or force anyone else to do it for that matter. Out of paychecks like Social Security? I'm not sure.

Really? I think you are wrong. How about if there was a severe penalty if you didn't have it? We are supposed to file federal tax forms as expats, it could be linked to that.

The topic is expat in Thailand related, thus Thailand related. I agree if it gets heavily into US political debate, it isn't relevant.

Edited September 18, 2007 by Jingthing

[retirednavyman]

I am betting Hillary Rodham Clinton will soon be our next president and she will have a democratic congress and senate to work with. So with that, the chances are we will be getting some variation on the newly proposed Clinton health reform plan.

Well, all and good, I am all for universal health care for Americans, but what about expats? Her plan requires that all Americans purchase health care plans if they don't get it through an employer or medicare, etc. Living abroad, I will not want to!

Should we be concerned?

I'm sure she has a senate.gov e-mail address. Perhaps you should e-mail her (I'm sure the e-mail will get routed to the right staffer) and get the answers that way :-)

[sbk]

I suggest you contact her directly with your concerns for expats, rather than on a Thailand related board that her staff will be unlikely to see.

[Carmine6]

I think it's a stretch to relate this to Thailand, but I don't see how she could make expats purchase medical coverage, or force anyone else to do it for that matter. Out of paychecks like Social Security? I'm not sure.

Really? I think you are wrong. How about if there was a severe penalty if you didn't have it? We are supposed to file federal tax forms as expats, it could be linked to that.

The topic is expat in Thailand related, thus Thailand related. I agree if it gets heavily into US political debate, it isn't relevant.

Anyone with a US residence address for financial accounts or tax returns is not going to be able to skate on a requirement that everyone buy insurance. Because other than ex-pats, the category of people who can claim to be a foreign resident and have US tax addresses is wealthy people.

[NovaBlue05]

The only concern that politicians in the US have for Expats is that they continue to be taxed. Expats are a small, but perfect little source of revenue. They give money and require no Govt services.....and their vote really isn't a factor. Go to www.hillaryclinton.com and there is a 12 page summary of her plan. I agree that, 2nd to the war....the primary debates domestically will be healthcare and immigration.

Btw....Hillary is un-electable on a national level .

[PeaceBlondie]

Existing health coverage for American expatriates already discriminate against us. When I turned 65, I went from having several insurance coverages, to one (my pension's). My TriCare extended option that I never use would have required me to join Social Security Medicare Plan B (for $96 per month extra), and as I understood it, Soc. Sec. Medicare also doesn't pay for me when I'm abroad. It's more complex than that, but basically I paid Medicare taxes of 1.45% and my employers matched it, for decades, and now I get no benefit because I had the audacity to leave my homeland.

Even AARP, one of the strongest lobbies in American politics for retirees, may not be concerned about expatriates. In the debates on healthcare, expatriates are seldom mentioned.

[samran]

Not that this should be seen as a plug for anyone, but a number of health insurers of late have opened up their policies for treatment overseas. That is, get sick in the US, and the treatment can be taken in Thailand (eg heart surgery). Bamrungrad is one of the beneficiary hospitals of this, where the US insurer will pay out for coverage taken overseas (cheaper for them!!).

I'm not sure if you can take out this insurance as an expat, but if you come and go to Thailand, it may be worth a look.

[britmaveric]

Universal health care = disaster. We brits can vouch for that.

[samran]

Universal health care = disaster. We brits can vouch for that.

unless you do it like us Australians...

[Jingthing]

Universal health care = disaster. We brits can vouch for that.

The Clinton proposal has almost nothing in common with the British system. It would be a uniquely American system that doesn't abolish the current reliance on insurance companies. A poster mentioend expats are never considered in health care policies. That again is my point. We are likely not to be considered again, as usual.

[jumnien]

Americans will continue to eat, drink and smoke themselves into a state of near comatose lethargy and physical degeneration and then rely on the nanny state to wipe their butts for the last 20 years of their lives. Why can't the rest of the world adopt the great American ideal?

[Jingthing]

Americans will continue to eat, drink and smoke themselves into a state of near comatose lethargy and physical degeneration and then rely on the nanny state to wipe their butts for the last 20 years of their lives. Why can't the rest of the world adopt the great American ideal?

Well, Americans life expectancy is lowering, but gluttony, sloth, and addiction are kind of part of the human condition in general, eh?

[think_too_mut]

I refuse health insurance, much prefer to take responsibility for my own medical condition and expenses.

Thats kind of my point. The rough outline of her new plan requires ALL Americans to have health insurance, even if they have to purchase it. This is nothing like the Canadian, French, or British systems. I don't like the idea of being mandated to purchase anything.

Australian system - you can go with Medicare without purchasing any other insurance.

Until...you earn 75K or more per year. Then you must purchase private insurance.

If you don't, they will tax you extra money for it so better go and get private insurance of your choice.

Edited September 19, 2007 by think_too_mut

[jumnien]

OK, we Americans aren't all bad. If the government wants to provide essential services, medical and otherwise, to its citizens and illegal residents, I think that is a noble effort. If they want to enforce manditory financial collusion with notoriously evil insurance companies, I am against it. Will they imprison those that morally object, the conscientious objectors? I don't hate Hillary, but after our recent bout of Bush, I'd hope for a liberal candidate.

[Jingthing]

OK, we Americans aren't all bad. If the government wants to provide essential services, medical and otherwise, to its citizens and illegal residents, I think that is a noble effort. If they want to enforce manditory financial collusion with notoriously evil insurance companies, I am against it. Will they imprison those that morally object, the conscientious objectors? I don't hate Hillary, but after our recent bout of Bush, I'd hope for a liberal candidate.

Fair enough, but this thread is on its way out. No great loss I admit.

The idea wasn't to discuss the campaign, only the expat connection if the front runner wins. Clinton is the front runner by far for the democrats and most political analysts believe that due to the Bush/Iraq meltdown the democrats will win. So logic says Clinton will win and has a good chance of passing her new very moderate health plan. It is obviously moderate (even conservative) because it doesn't differ very much from republican Romney's ideas.

Edited September 19, 2007 by Jingthing

[jumnien]

As a self-insured expat living in Thailand, part of me shudders at paying a large insurance payment every month for services I'd be far happier paying for myself. If it would help a Guatemalan dishwasher in Los Angeles or an elderly Samoan woman living in Merced get the health care they deserve and won't get from their home countries, I guess I'll gladly go along with it out of humanitarian reasons.

[samran]

bringing it back to maybe a bit more 'on topic'.

While I as an Australian am not covered for medical treatment while overseas under Medicare (at least in Thailand), I am able to access if for 5 years after I leave the country from the time I was last resident there. Which is nice. If you come and go regularly, your residency there need no lapese if you make a point of hanging out at home every for a few months couple of years. If you get really sick, you can always go home.

The other propsal that the US can look at is that under the Australian system, people entitled to Medicare (our version of universal health) get reciprocal rights to access the government health system on the same basis as locals do in a variety of European countries, NZ and one or two other spots in the world. Now for me, that is great use of my tax dollar, even though I live here in LOS.

[Jingthing]

More ammunition that the new health plan is intended for ALL Americans and there will be PENALTIES for not complying:

Fairfax, Va.: If participation in Clinton's health-care scheme is going to be mandatory, then what will be the punitive effects of declination? Permanent unemployability, being banned from public education, etc.?

Steven Pearlstein: Being sent to Guantanamo and forced to watch speeches by Bush administration officials for 18 hours a day.

http://www.washingtonpost.com/wp-dyn/conte...id=sec-business

Washington Post business columnist Steven Pearlstein

[sbk]

Off-topic posts have been deleted. Lets see if we can keep this within the bounds of civility and somehow related to those Americans living in Thailand who may or may not be affected by this legislation that is proposed.

Again, I am not really understanding why the need for debate here. Shouldn't you be contacting Sen Clinton yourself and making your concerns heard by her?

[Jingthing]

Again, I am not really understanding why the need for debate here. Shouldn't you be contacting Sen Clinton yourself and making your concerns heard by her?

I intend to do that, but in my experience when contacting famous people, they never get my emails.

I raised the issue to see how other US expats in Thailand feel about the possibility of being forced into a system that does nothing for them.