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Uh oh. Its starting to look like a requirement for all Americans to purchase health care may be part of this plan, no mention of expat exemptions:

Washington Post

Obama Signals Willingness to Compromise on Health Reform

By Ceci Connolly

President Obama may be leaving the health reform bill-writing up to Congress, but he is beginning to sketch out the parameters of a deal he could live with.

In a letter today to Democratic leaders, Obama suggests he may be open to a requirement that every American have health insurance, even though he opposed the so-called individual mandate in the presidential campaign. If Congress moves forward with the requirement, as many expect, Obama says he wants a "hardship waiver to exempt Americans who cannot afford it."

You see now, Jingthing, it is not about giving Americans healthcare, it is about controlling American's healthcare. Obama wants to totally change the social-economic dynamic of the U.S. The man made the comment that he doesn't care what happens on Wall Street???? Wall Street, investments, is a sign of how much confidence Americans have inthe U.S. economy, it s the number one indicator proceeded by luxury spending and the man says he doesn't care about it. He thinks he can turn America into a utopian version of Europe, the socialism without all the negative add-ons...he actually believes he is the one to do it.

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You are not understanding Amerian mentality. They want qaulity, affordable heathcare not universal healthcare. You accomplished that by cutting out the litigation powers of attorneys, overblown judicial awards in court cases, lowering the amount of money doctors have to pay for their own insurance to cover their butts because of the constant threat of being sued. That will never happen because of the power of the lobbyists and attorneys in Washington.

More popular misinformation. Malpractice insurance adds 3% to the cost of healthcare. Health insurance companies skim 31% of the healthcare dollar.

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You are not understanding Amerian mentality. They want qaulity, affordable heathcare not universal healthcare. You accomplished that by cutting out the litigation powers of attorneys, overblown judicial awards in court cases, lowering the amount of money doctors have to pay for their own insurance to cover their butts because of the constant threat of being sued. That will never happen because of the power of the lobbyists and attorneys in Washington.

More popular misinformation. Malpractice insurance adds 3% to the cost of healthcare. Health insurance companies skim 31% of the healthcare dollar.

People who think that leaving health care to 'the market' severely misunderstand the nature of markets.

Two things that underlie a well functioning market. Perfect information and the ablility to choose a product. If you don't like it, you go elsewhere to where the price is better. You do so, cause you are FULLY informed about the product you are buying. If it is dodgy, you don't buy it, or you ask for a lower price to compensate.

Equally, in a functioning market the seller has no power over raising the price more than the market can bear. Why? Given there are many sellers, they will go elsewhere - either to the same product offered somewhere else for a better price, or they'll go to an alternative, within their budget.

Health care provision shares none of the characteristics. Why?

1) Doctors as a group, are monopolists. Not anyone can be a doctor, it is a highly skilled profession, made harder to get into by regulations which say you need to be of a certain standard. The cost of going to school puts some off, so there are even fewer potential cantidates. As such, there aren't too many doctors around for consumers to pick and chose from . If don't like this brain surgeon, you can't exactly go next door for a new one, nor in most cases, can you do it yourself....

Result? They charge whatever they want for a proceedure. They can, and they do, and medical inflation in the US has run away out of control.

To protect their interests neverthless, doctors have formed a self preservation society called the AMA. Sounds nice and harmless, but it is one of the biggest unions in the US. Thats right a UNION. I notice people on this thread knock unions. Well, so be it, the AMA deserves a massive knocking. But, because they wear white coats rather than blue overalls, they have a air of respectablilty.

2) Consumers aren't able to 'bargain' against this monoloplist. If a doctor says to a patient, you need X, Y, and Z treatment, and it is going to cost you $40,000. Do you disagree? Unlikely, unless you are a doctor yourself, or someone as equally as powerful. It is not as if you can choose to be sick. buying health services from a doctor isn't like buying a car or an icecream. You can live without the car and icecream, but not without a doctor treating you.

That is the simple reason why it makes sense for government to be involved in the provision of health care. The government doesn't have to 'run' it, but it does have to provide its weight of power behind patients so that patients get reasonable price outcomes for proceedures, and more importantly, force doctors to treat people who need the treatment, regardless of cost. It can basically call the doctors bluffs on the true costs of health care. And that is where savings will be made from government participation in the system.

The doctors will squeal, through their UNION, the AMA, convincing Americans that the whole world is about to collapse, unless they defeat the evil socialists. Dammit, it will be un-American they will tell you (sound familiar?). All the while, their counterparts in the Canada, Australia, the UK (the ones working under socialist tyranny of a centrally run system) will drive home in their Mercs, BMW's to their nice suburban homes, or to their holiday home if it is a friday evening, shaking their heads of the gaul of the AMA, probably wishing they can do the same. Fortunately though, no patient in these countries is going to go bankrupt cause they can't afford medicl care, as there is someone who will always cover them.

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OK, I have a semi-paranoid thought about this. It is now looking likely that there will be a requirement to have some kind of health insurance. Another poster mentioned that there will be a non-resident exemption. Great! But here is my concern about that. Many of us, in my view, MOST of us maintain US ties in the form of bank/financial accounts and state driver's licenses, etc. The governments are going to have to figure out ways to ENFORCE the health insurance requirement. So perhaps one of those tripwires will be renewing driver's licenses? If not that, I think you can see the kind of thing I am thinking about that could trip us up and potentially put us into the required pool subject to penalties ...

Edited by Jingthing
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OK, I have a semi-paranoid thought about this. It is now looking likely that there will be a requirement to have some kind of health insurance. Another poster mentioned that there will be a non-resident exemption. Great! But here is my concern about that. Many of us, in my view, MOST of us maintain US ties in the form of bank/financial accounts and state driver's licenses, etc. The governments are going to have to figure out ways to ENFORCE the health insurance requirement. So perhaps one of those tripwires will be renewing driver's licenses? If not that, I think you can see the kind of thing I am thinking about that could trip us up and potentially put us into the required pool subject to penalties ...

Why would you want to keep a US driver's license? It would expose you to the risk of liability for state income taxes as an indication of an intention to return. I plan to surrender mine in the same year that I expatriate. Also, getting a Thai driver's license would support a claim to residence there.

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Why would you want to keep a US driver's license? It would expose you to the risk of liability for state income taxes as an indication of an intention to return. I plan to surrender mine in the same year that I expatriate. Also, getting a Thai driver's license would support a claim to residence there

For ID back in the states on occasional trips. Most US expats maintain faux US identities for convenience with their relationships with US financial institutions. It is my impression that MOST US expats here maintain state driver's licenses as well as that supports the faux US identities.

Here is evidence of my assertion:

http://www.thaivisa.com/forum/index.php?s=...t&p=1985743

The truth is that the prevalent attitude in the US is that US citizens that voluntarily expatriate are deviant, because isn't everyone in the world clamoring to get into the US? This bias bleeds into policies of banks, credit cards, etc. ...

Edited by Jingthing
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Why would you want to keep a US driver's license? It would expose you to the risk of liability for state income taxes as an indication of an intention to return. I plan to surrender mine in the same year that I expatriate. Also, getting a Thai driver's license would support a claim to residence there

For ID back in the states on occasional trips. Most US expats maintain faux US identities for convenience with their relationships with US financial institutions. It is my impression that MOST US expats here maintain state driver's licenses as well as that supports the faux US identities.

State ID cards are the same picture ID without the liability

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The health care that is being proposed will not effect those of us living and working in Thailand legally. If you are working in Thailand (not for a US company) chances are you are making less than $80,000 US per year thus you are exempt by agreement between the USA and Thailand and in this case your taxes are paid to Thailand not the USA and you are paying Thai Social Security thus you have health care coverage. The people I would be concerned about are the retired persons over 65 collecting social security I would highly doubt they would have to pay and think it would be free as a retirement benefit but the truth is anything we say is purely speculation and who knows if Obama will even get this past congress. Remember many members of congress have their hands in the health care industry and would stand to lose a lot of money not to mention that Hillary took payoffs from the drug companies to kill her health care plan.

What I do know is the health care plan being proposed is going to put a lot of insurance companies out of business and instead of them making billions the USA will have the surplus in the national treasury not the fat cats pocket, as far as the pharmaceutical companies go they will get the same treatment Canada gave them, the government will pay a fair market value not what they want or they will have to find some one else to sell to. In fact if you listened to anything Obama has said we are going to have health care, which we don't now, we have sick care. The average American only goes to the doctor or hospital once they are good and sick in many cases next to death. Obama said we have to go after the companies making unhealthy foods and regulate the tobacco companies but better yet get people to quit smoking and work out.

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Wouldn't a passport suffice as ID? Why maintain any affiliation with a state be it ID or driver license?

A U.S. driver's license or state Id is usually needed for those of us who still want to open new U.S. financial accounts.

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Wouldn't a passport suffice as ID? Why maintain any affiliation with a state be it ID or driver license?

A U.S. driver's license or state Id is usually needed for those of us who still want to open new U.S. financial accounts.

Yes, and if you needed to go in there to do any future business, you will always be asked for ID and if you opened it with a driver's license (required) they are usually going to expect a current driver's license for ID. Policies vary from bank to bank but I expect many would indeed have a problem with a passport only. Again, go back to my poll, most of us find it very useful to maintain faux US residence identities.

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Yes, and if you needed to go in there to do any future business, you will always be asked for ID and if you opened it with a driver's license (required) they are usually going to expect a current driver's license for ID. Policies vary from bank to bank but I expect many would indeed have a problem with a passport only. Again, go back to my poll, most of us find it very useful to maintain faux US residence identities.

Seems too risky to me. In the worst case it could cost you a lot of money. When I move to Thailand I am going to surrender my driver license immediately. The states are desperate for money and may become more agressive in trying to foist tax liabilities onto expats. California and Virginia already do this and I expect others to follow their example. On the other hand, if I lived in a state without an income tax I would probably keep the license.

At the same time I have already opened several bank and credit union accounts now in anticipation of the move abroad and will open additional financial accounts before I leave.

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As an American citizen you are (at least in some states) required to have a US licence to drive from my understanding (and I have seen that confirmed by law enforcement) - seems to be the same as using a US passport for entry if you are an American. But in fact most auto rentals will not check if you present an IDP and foreign licence from most reports I have seen. They did have this listed in there rules years ago so not sure if laws have changed (each state has there own) or if they no longer have an insurance issue (probably in house now). My last state of residence was Florida so have renewed several times from here and plan to continue.

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<< When I move to Thailand I am going to surrender my driver license immediately. The states are desperate for money and may become more agressive in trying to foist tax liabilities onto expats. California and Virginia already do this and I expect others to follow their example. On the other hand, if I lived in a state without an income tax I would probably keep the license.>>

CaptHaddock: I am sorry to report that you got this wrong. If you move to Thailand you are still required to pay federal AND State income tax. Yes State income tax.

Move to Alaska or Texas before you retire here. Get a new license and make sure you register to vote. You do not need to be a homeowner. Your "physical address" can be a cheap motel. But if you keep ties to tour old state like getting your mail sent there or still owning your house there then your old state can come after you claiming you are still a resident. They are bloodsuckers. Sever all ties.

With this new Obama health care plan they will be trying to make us pay even if we live here. If there is some exclusion I am probably never going to set foot in the USA again just so they don't try and say I am still resident in the USA.

Wish I could dump my USA citizenship and get a Thai passport but that is another story...........................

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CaptHaddock: I am sorry to report that you got this wrong. If you move to Thailand you are still required to pay federal AND State income tax. Yes State income tax.

It depends on which state you are talking about regarding the aggressiveness of going after expats for state tax. Obviously if you first move to a no tax state you are golden. It is also true if you maintain a license and bank accounts in a previous resident state, it is possible they may see you as a resident regardless. Another tactic is to never move back to your old state if you do repatriate.

BTW, the initial senate health reform bill, still early, requires "all" Americans to get health insurance and also offers the "public option" to put pressure on the thieving lousy insurance companies. So many people with so called good insurance learn they aren't really covered once they get sick, that's why so many Americans are "satisfied" with the current system, they have never tested it!

Edited by Jingthing
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Major health care reform is coming. It will be the biggest change in the system since medicare was established. There is talk now that Americans will be REQUIRED to have some kind of health insurance. Now we will not be getting Canadian/Euro style universal single payer health care. That is completely off the table. In other words, there is going to be a private cost to buy the insurance and probably some tax cost for those now getting it "free" from employers. My concern is that expats are going to be caught up in this and not be exempt from this requirement. With any requirement, there has to be TEETH, so there will be some kind of penalties for not having it. As expats, we should be exempt from this requirement, of course, but that doesn't mean we will be. Stay tuned ...

I wouldn't get tooworked up over this one. You should probably hope you are not forced to enroll in in this plan as it is a watered down version of what could have been. Obama has caved in again and rather than having a single payer universal system he has bowed to the pressures of the lobbyists and will create an overpriced and under delivered plan. The number one reason auto plants like to locate in Canada rather than the U.S. is that the health care costs are substantially less. So rather than deal with the true problem of overpricing and inefficient delivery Obama has opted to include more people into a broken system and tax employers which will further make American business less competitive. I have lived in the U.S. and Canada and I can tell you the Canadian system is much much better for 90 percent of the people (unless you are super loaded and money is no object). I like Obama as a person but as a leader he is proving to be no different than others as he caves into the lobbyists and the sleazy advisers and politicians around him. What can you expect from a Community Organizer turned lawyer hailing from the most corrupt jurisdiction in America? I hope he proves me wrong but I doubt it.

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Obama has caved in again and rather than having a single payer universal system he has bowed to the pressures of the lobbyists and will create an overpriced and under delivered plan.

Yes, I agree the US health system is so broken that the most logical thing would be to do a total reboot and make health insurance companies illegal. However, the fact we are not getting universal health care is not Obama's fault. Yes he could have been a purist and said all or nothing, my way or the highway, but the votes just aren't there. It is just political reality. There is no politician that could have passed that at this point in time and maybe never. Politics is about compromise. Imagine how Obama will be blamed if he manages to pass NOTHING.

Back to the expat issue, yes, I am still concerned how this may impact expats who for convenience maintain faux USA identities. Like I said before, there is evidence that MOST of us do that.

Edited by Jingthing
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Obama has caved in again and rather than having a single payer universal system he has bowed to the pressures of the lobbyists and will create an overpriced and under delivered plan.

Yes, I agree the US health system is so broken that the most logical thing would be to do a total reboot and make health insurance companies illegal. However, the fact we are not getting universal health care is not Obama's fault. Yes he could have been a purist and said all or nothing, my way or the highway, but the votes just aren't there. It is just political reality. There is no politician that could have passed that at this point in time and maybe never. Politics is about compromise. Imagine how Obama will be blamed if he manages to pass NOTHING.

Back to the expat issue, yes, I am still concerned how this may impact expats who for convenience maintain faux USA identities. Like I said before, there is evidence that MOST of us do that.

I respect your opinion but have to disagree. I don't know if you are familiar with Tommy Douglas from Saskatchewan who introduced universal health care to Canada. No one said it could be done. The doctors were against him. The insurance companies were against him. What did he do? He didn't cave in and went to the people for support. He never surrendered. I haven't seen any great speeches from Obama telling people to lobby congress and not give in, how they need one stop health care. Yes it can be done and it has been done but it requires the will to do it and undying commitment. Obama does not fit this bill as much as everyone wants to believe it.

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I respect your opinion but have to disagree.

That is well and good but the cultures of the US and Canada are VERY different. Canada has a much more established tradition of collectively helping your neighbor, the US is more dog eat dog. That's just the way it is.

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Here is the House bill: http://edlabor.house.gov/documents/111/pdf...Text-071409.pdf

The expat exclusion is on page 170.

The deal is just living outside the USA does not appear to be enough to exclude you (me). You need to be paying taxes to the foreign country in addition to living outside the USA or else your IRS tax rate will increase by 2.5% as a fine for not paying into Obama Care.

because IRS section 911 says: (d) Definitions and special rules

For purposes of this section—

(1) Qualified individual

The term “qualified individual” means an individual whose tax home is in a foreign country and who is—

(A) a citizen of the United States and establishes to the satisfaction of the Secretary that he has been a bona fide resident of a foreign country or countries for an uninterrupted period which includes an entire taxable year, or

(:) a citizen or resident of the United States and who, during any period of 12 consecutive months, is present in a foreign country or countries during at least 330 full days in such period.

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Uh oh. Its starting to look like a requirement for all Americans to purchase health care may be part of this plan, no mention of expat exemptions:

Washington Post

Obama Signals Willingness to Compromise on Health Reform

By Ceci Connolly

President Obama may be leaving the health reform bill-writing up to Congress, but he is beginning to sketch out the parameters of a deal he could live with.

In a letter today to Democratic leaders, Obama suggests he may be open to a requirement that every American have health insurance, even though he opposed the so-called individual mandate in the presidential campaign. If Congress moves forward with the requirement, as many expect, Obama says he wants a "hardship waiver to exempt Americans who cannot afford it."

You see now, Jingthing, it is not about giving Americans healthcare, it is about controlling American's healthcare. Obama wants to totally change the social-economic dynamic of the U.S. The man made the comment that he doesn't care what happens on Wall Street???? Wall Street, investments, is a sign of how much confidence Americans have inthe U.S. economy, it s the number one indicator proceeded by luxury spending and the man says he doesn't care about it. He thinks he can turn America into a utopian version of Europe, the socialism without all the negative add-ons...he actually believes he is the one to do it.

=====================

Here's a good chart that shows the cost per capita for healthcare around the world:

http://facts.kff.org/chart.aspx?ch=359

I think it takes creative minds to fix this issue, and for once we at least are looking at a failed system and how to fix it. We (the US) pay more per capita for healthcare than any industrialized nation. Good healthcare?

Healtcare is dragging down this whole nation; http://www.cfr.org/publication/13325/

Maybe we have good healthcare for those who can afford it, but at what cost? Bankruptcies? Most are not caused by loss of jobs, but by healthcare expenditures that can not be paid. (By individuals and corporations) Credit card problems in the US? Most are caused by medical expenses that people put on credit so they can have care. "Controlling American Healthcare"? It is now controlled by the insurance industry and manipulated by the power of the pharmacudical industry.

Personally, I went in to my doctor in Ohio this March for swelling leg veins and was not able to see the doctor until June, so I went to the emergency at a hospital. They did ultrasound and found no blood clots, but advised I see the specialist. So June comes around, and he prescribes another ultrasound because the insurance requires it.(the first wasn't good enough I suppose) 2nd appointment ($250 a crack) he says I need surgery as I am at risk of blood clots, and prescribed support hose, and said he would see me in October to schedule the operation, probably to be performed in Nov-Dec. He said the insurance company would not pay unless I wore the support hose for 3 months...... Are you getting my drift here? I had to go to emergency $1300.00, see the Dr 3 times (counting this coming oct, but more to come $750) 2 ultrasounds on legs $790, and I haven't been touched, and still risk having a blood clot. It's all crazy here.

Any doctor here will tell you they are burdened with administrative costs, there own insurance malpractice costs, and have to answer to someone in a Hartford Ct insurance office to get permission to do what is needed to get paid for treating a patient.

Now I ask you, who is controlling healthcare here in the US? We are now "controlled" by those who are looking for profits, and the bottom line has taken over for common sense. I suppose the same can be said for our troubles with Wall Street. And all of this is promoted by the Social Darwin mentality of "survival of the richest", without any accountability or regulation. And yes, that is the Republican agenda for the most part. Maybe we can have some trickle down healthcare too?

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If I come down with a sore throat in the U.S., it is $55USD (min) to see the doctor, then another $25 at the pharmacist. Total: $80

In Lopburi, Dr's examination including meds about 200 baht, with medication distributed at the Dr's office.

USA $80 (2,725 baht)

Thailand: $5.85 (200 baht)

Same common health problem, same qualified Dr's care, similar or same medication, same treatment, same recovery.

U.S. 13.6 times more expensive in this example. It seems the doctors are not greedy here. In fact, if our doctor does not find a problem, we pay no fee for his exam. Once I felt light-headed and thought maybe my blood pressure was high. Our doctor checked me out. No problem.... and no payment!

My U.S. friends are mind boggled at the low cost of health care here for common, everyday illnesses.

There's a case to made for Medicare coverage to be available here. It's no wonder Medicare is bankrupting America. I've already written my congressman and cited the above example.

(I realize costs are not as low in areas like BKK, Pattaya, Phuket, etc. but you get my drift).

Edited by Lopburi99
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I respect your opinion but have to disagree.

That is well and good but the cultures of the US and Canada are VERY different. Canada has a much more established tradition of collectively helping your neighbor, the US is more dog eat dog. That's just the way it is.

while it is becoming off topic, the only real way of selling this thing is to say that it saves the average joe sixpack $xxx per year in premiums. If they can do that, and I believe the depths of a recession is the best time to do this, then this may have a chance of getting through.

The right will start yelling, they will increase your taxes!! Which may be true, but it is up to the proponents to say that premiums will come down by $yyy, more than any potential tax increases.

From a political perspective, I'm pretty sure that once you have a good system in place, it will be political suicide for any government to ever dismantle it.

Australia, similar to canada, only got universal health care in 1983. Anytime the right wing parties proposed to abolish it, they lost an election.

Edited by samran
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<< When I move to Thailand I am going to surrender my driver license immediately. The states are desperate for money and may become more agressive in trying to foist tax liabilities onto expats. California and Virginia already do this and I expect others to follow their example. On the other hand, if I lived in a state without an income tax I would probably keep the license.>>

CaptHaddock: I am sorry to report that you got this wrong. If you move to Thailand you are still required to pay federal AND State income tax. Yes State income tax.

Move to Alaska or Texas before you retire here. Get a new license and make sure you register to vote. You do not need to be a homeowner. Your "physical address" can be a cheap motel. But if you keep ties to tour old state like getting your mail sent there or still owning your house there then your old state can come after you claiming you are still a resident. They are bloodsuckers. Sever all ties.

With this new Obama health care plan they will be trying to make us pay even if we live here. If there is some exclusion I am probably never going to set foot in the USA again just so they don't try and say I am still resident in the USA.

Wish I could dump my USA citizenship and get a Thai passport but that is another story...........................

It is definitely not the case that US citizens resident abroad are always required to pay state taxes. There is no federal law to that effect. My own state of NY takes that the view that unless you own property in the state, then changing your legal residence to outside of the state is sufficient to establish that you are not subject to NY taxation. Even if you do own property in the state, you are not subject to NY tax unless you spend more than 180 days in the state during one year. I do not own property in the state, will not use a NY state absentee ballot, and will surrender my NY state driver's license prior to leaving. Therefore, I expect to have established legally that I am not a resident of NY and have no intention ever to return.

Now, it is true that some states, notably CA and VA, are more agressive in claiming the right to tax former residents. VA takes the view that you are a VA resident until you have legally established residence in some other state. CA claims taxing authority on the flimsiest grounds that might indication an intention to return to the state at some point in the future. If I were living in either of those states I might decide to establish residence in a no-income-tax state before expatriating. As it is, I think I have protected myself adequately.

I suggest you not express yourself in absolute terms on subjects about which you are not well-informed.

In my view, "dumping" US citizenship would be a singularly imprudent step to take. As far as Pres. Obama's health reform goes, there are many huge issues to be addressed before they get down to the much less important fine details such as obligations, if any, for expatriates. I wouldn't worry about it.

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