Us Expats And Health Care Reform

[Jingthing]

you are both right and i really appreciate your thoughts/comments. healthcare care coverage is one important step (only 63 additional steps to go) for the Greatest Nation on Earth™ on her way to drop the status of a Third World Nation and become a respected member of the international community.

Well at least we already have the world's best burritos. And pizza.

[Jingthing]

The WHO rates the current American health care system before reform -- 37th.

[Jingthing]

Obviously, I am on Naam's side on this one. For the other side, watch Fox News. However, can we please limit the discussion here to be about the impact on EXPATS of any health care changes that become law? This issue isn't over and there will be some impact for some of us. I want a place for us to discuss it here without getting threads closed for being off topic US politics flame fests. OK?

Edited December 30, 2009 by Jingthing

[Naam]

Obviously, I am on Naam's side on this one. For the other side, watch Fox News. However, can we please limit the discussion here to be about the impact on EXPATS of any health care changes that become law? This issue isn't over and there will be some impact for some of us. I want a place for us to discuss it here without getting threads closed for being off topic US politics flame fests. OK?

it does not matter JT. you can't discuss the colours of a beautiful sunset with a blind man who has no idea what colours are. that especially applies to Yemenis. my Yemeni employees initially refused to wear company overalls.

reason: they wanted to keep on wearing their skirts.

their argument: "if we wear trousers we look like women folks and where shall we keep our daggers? !"

[vagabond48]

And just to return to the original topic of this thread for one brief moment, the Senate health bill, like the House bill, does contain an exception for expatriates based on the "330/365 days foreign presence" or "bona fide foreign resident" tests of the foreign earned income exclusion.

Getting back to how it will effect US expats living in Thailand (and other countries), is the above highlighted statement that was posted earlier correct?

[taxout]

Of course it's correct.

But you're free to read the bills yourself.

H.R. 3962, passed by the House:

http://www.opencongress.org/bill/111-h3962/text

H.R. 3590, passed by the Senate:

http://www.opencongress.org/senate_health_care_bill

[vagabond48]

Of course it's correct.

But you're free to read the bills yourself.

H.R. 3962, passed by the House:

http://www.opencongress.org/bill/111-h3962/text

H.R. 3590, passed by the Senate:

http://www.opencongress.org/senate_health_care_bill

No offense meant. I was just looking for confirmation, that's all.

[Pakboong]

Dr. Benjamin Rush, a signer of the Declaration of Independence, is quoted as warning two centuries ago:

"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an underground dictatorship. . . . The Constitution of this republic should make special privilege for medical freedom as well as religious freedom."

[OriginalPoster]

Dr. Benjamin Rush, a signer of the Declaration of Independence, is quoted as warning two centuries ago:

"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an underground dictatorship. . . . The Constitution of this republic should make special privilege for medical freedom as well as religious freedom."

That's an often repeated quote in these days but its source is hard to track down even in these days of google. It doesn't appear to have been included in any of Rush's writings. Maybe it's something that someone heard him say and then they repeated it to someone else, and they to someone else, for 200 years. It seems like yet another attempt to attribute more wisdom to the founding fathers than they actually possessed. Until health are reform became a hot button item, Rush was actually best known for his efforts to have George Washington removed as commander in chief of the Continental Army rather than for being a Nostadamus-like sage.

Edited December 31, 2009 by OriginalPoster

[Jingthing]

Dr. Rush also pioneered the use of the restraining chair and centrifugal spinning boards to treat mental illness. Lets stay in the modern world please. If you want to talk docs, there is Dr. Howard Dean.

[noot]

since we dont have the details of the final bill yet. realy cant discuss the ramifications of it.

can someone explain why they want to ram a bill down the throats of the american people when the majority dont want it?

[noot]

Hey maybe obama know best! sorry but yr experience diesnt convince me socialized medicine is the way to go.

i really need medical people who confirm uk has better system..........any here please chime in.

if you would learn to read properly you'd find out from my posting that i consider the present system in U.K. nearly as shitty as the U.S. one. my judgment is however based on what i read and not based on personal experience. but whatever... only third world countries (such as The Greatest Nation on Earth™) have more than 15% of their citizens without any health insurance because a certain percentage of people are too poor and can't afford it.

flying to the moon... sending probes to Mars and even further... spending every year hundreds of billions for new weaponry... invading countries half way around the globe to promote "human rights" but at home millions of citizens suffer = my àss!

us health care is shit

uk is shittier

so if i can surmise you want to nationalize usa healthcare so it can become as shityy as the uk one

cant we have higher aspirations than to be shit.

Edited January 1, 2010 by noot

[Bagwan]

There are American made cars currently in Europe that cannot be sold in the U.S. due to emission standards and other EPA rules. Now, he wants higher emission standards? The Left and the unions have made the U.S. auto industry impotent and now they want to do the same with Health Care. There is a reason why people the world over come to the U.S. to get the best health care.

Huh? They must be locked up in garages or sit rotting on the docks because nobody would want one. Compare that with the number of Mercedes, BMW's, Mini's, VW's, and the flash Italian jobs that are commonly seen on US roads. Car manufacturers operating in Europe with an American input design and build to European standards and owe little to their parent companies. They are deemed passable rather than sort after; most of the common people (for want of a phrase) prefer to buy Japanese. I assume that the Japanese are governed by the same laws and regulations as US companies so why have they made such inroads into the US market?

Who are these people that come from all over the world to the US to get 'the best health care'? Who could afford to? If the standards of health care so high, why do the doctors have to pay swingeing insurance premiums? The private Thai hospitals seem to follow the American model and there is no shortage of peeps to criticise them on this board and elsewhere. I hold that health care should be made available to everybody regardless of income, race or creed and should be a manifestation of a further advance made by the human race since coming down out of the trees.

Some over sensitive peeps may write this off as a prime example of 'America bashing'. Nothing could be further than the truth. I have made three long term visits to the US and have many American friends, both in the US and here in LoS. When I make what some may regard as an untoward or unflattering comment they at least have the nous to recognise that I am offering an opinion which is not coloured by the usual BS that they are fed, or by the now, ingrained predilection for self

delusion. The opposite of love is not hate, it is indifference. That I make comments, flattering or not, shows that I care about the US, imperfect as it is, as ALL countries are.

[lannarebirth]

I hold that health care should be made available to everybody regardless of income, race or creed and should be a manifestation of a further advance made by the human race since coming down out of the trees.

And what reasonable person wouldn't think similarly?

[Naam]

us health care is shit

uk is shittier

so if i can surmise you want to nationalize usa healthcare so it can become as shityy as the uk one

cant we have higher aspirations than to be shit.

the correct interpretation of "US healthcare is shit" is based

-on my personal experience

and

-that millions of US citizens have no access to health care.

personal experience:

-nov 1991, weightlifting at 06.00 hrs in a gym, suddenly abdominal terrible pain, drove home and two hours later to my internist (a pakistani lady). white bloodcell count through the roof. she suggested emergency transport to the hospital and diagnosed extremely high infection acquired from recent travelling in tropical countires. i refused, got my things from my house and drove to the hospital (a rather huge and "famous" one). her remark "tropical" earned me a bed in the quarantine section. interview by specialist for tropical diseases, x-rays, ultrasound plus the usual tests. two days later consilium of three medics and my internist attending. diagnosis = liver cancer, operation required. my internist dared to voice her input after examining the x-rays and ultrasound pictures and indicated it could be a liver abscess caused by amoebia. "no way!" the experts claimed, operation is a must. estimated cost ~38,000 dollars plus tax, tag, title, service charge and VAT

i refused the operation and (believing in the cancer diagnosis) asked to make me fit to fly to Germany, reason "i want do die in my country" paid 18,000 dollars for a 5 day stay and "treatment". in Germany a medical doctor (friend of mine) had everything arranged in a hospital for my arrival. saw a surgeon first who indicated that at this point an operation was not advisable as the x-rays showed a still closed abscess and since nobody can be sure what tropical buggers dug the cave in my liver an operation could cause a serious sepsis in my whole abdomen. "no cancer?", i asked. "what cancer?" he answered. to shorten a long story. 3 days of blood tests sent to one of the german hospitals specialising in tropical diseases, discharged from the hospital to my house (12 km distance), one week daily to the hospital to get infusions, additionally four weeks taking hard antibiotics... and i was cured.

-week before Christmas 1993. whole weekend terrible abdominal pain. monday morning internist (again the pakistani lady). diagnosis "ruptured appendix". i contradicted her as the pain was in the middle of my belly and knew the appendix is located on the right side (except when you enter a lady, then it's located to the left). same procedure as two years ago. drove to the hospital and checked in. paramount medic chief checked me a couple of hours later. diagnosis "no appendix, extremely high infection. have you bad boy been travelling in Asia again? don't worry, we'll make you fit to spend Christmas in Germany. it will take a few days though".

afternoon 3 p.m., internist arrived, "are you already operated?" of course not i answered, it told you my appendix is located at my right side. she slammed the door. 20 minutes later i had to swallow liters of contrast medium and they pumped up gallons of that contrast sh** up my arse till i thought i will explode. then x-rays, ultrasounds... back to my room.

evening 8 p.m. door opens, chap (height ~ 7ft) introduced himself as surgeon "Dr. R." tells me "just got a call from the radiologist. your appendix is ruptured, the small intestine is blocked and you should have surgery as soon as possible." i replied "done any surgery before?" he nodded "a couple of them". me "then what are you waiting for?" he looked at my file and read "surgeon Dr. D. mandatory!" me "then get me bloody Dr. D". "no can do" he says because Dr. D. comes back tomorrow morning. "then what?" i asked. "sign here and agree that i can cut you up". i signed and by 10.30 p.m. he cut me up. next day he was joking with me. "your belly was such a bloody mess that i had to take everything out, hose it down and rearrange it".

[flying]

Preview of govt health care results?

Mayo Clinic in Arizona to Stop Treating Some Medicare Patients

Dec. 31 (Bloomberg) -- The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S. government pays too little.

More than 3,000 patients eligible for Medicare, the government’s largest health-insurance program, will be forced to pay cash if they want to continue seeing their doctors at a Mayo family clinic in Glendale, northwest of Phoenix, said Michael Yardley, a Mayo spokesman.

full article at link above

[citizen33]

More than in almost any other area of life, our perceptions of health care systems are shaped by where we grew up.

Most Europeans scratch their heads in incomprehension when they hear some of our US friends suggesting that tightening regulation and expanding coverage in a private health insurance market equals some kind of Stalinist takeover. Recently the BBC correctly observed that even MPs on the right wing of the UK Conservative party would find little in Obama's proposals to upset them. There is a kind of natural history of health care reform whereby certain interest groups (read the medical profession) who opposed change come with time to warmly support it. It is fascinating to look back on old pre-reform interviews in which British and Canadian physicians used much the same rhetoric now being deployed in the USA (see the Canadian documentary 'Bitter Medicine: the Birth of Medicare' and the British film 'The New Jerusalem' for good examples).

Given what some of you may consider my views outlandish, you won't be surprised to hear that I also think that Britain's NHS actually represents rather good value for money and delivers outcomes that in most areas compare well with those of other industrialised nations. For a country spending just over 8% of GDP on health care the UK gets a remarkable bang for its buck. If there were a referendum tomorrow on keeping the NHS vs switching to an insurance-based system there would be absolutely no contest.

Edited January 1, 2010 by citizen33

[jazzbo]

Preview of govt health care results? from the referenced above Mayo Clinic article:

While 92 percent of U.S. family doctors participate in Medicare, only 73 percent of those are accepting new patients under the program, said Heim of the national physicians’ group, citing surveys by the Leawood, Kansas-based organization.

Mayo’s Medicare losses in Arizona

may be worse than typical for doctors across the U.S.

, Heim said. Physician costs vary depending on business expenses such as office rent and payroll. “It is very common that we hear that Medicare is below costs or barely covering costs,” Heim said.

Mayo will continue to accept Medicare as payment for laboratory services and specialist care such as cardiology and neurology, (a Mayo spokesman) said.

If it bleeds, it leads.

[greenberg]

us health care is shit

uk is shittier

so if i can surmise you want to nationalize usa healthcare so it can become as shityy as the uk one

cant we have higher aspirations than to be shit.

the correct interpretation of "US healthcare is shit" is based

-on my personal experience

and

-that millions of US citizens have no access to health care.

personal experience:

-nov 1991, weightlifting at 06.00 hrs in a gym, suddenly abdominal terrible pain, drove home and two hours later to my internist (a pakistani lady). white bloodcell count through the roof. she suggested emergency transport to the hospital and diagnosed extremely high infection acquired from recent travelling in tropical countires. i refused, got my things from my house and drove to the hospital (a rather huge and "famous" one). her remark "tropical" earned me a bed in the quarantine section. interview by specialist for tropical diseases, x-rays, ultrasound plus the usual tests. two days later consilium of three medics and my internist attending. diagnosis = liver cancer, operation required. my internist dared to voice her input after examining the x-rays and ultrasound pictures and indicated it could be a liver abscess caused by amoebia. "no way!" the experts claimed, operation is a must. estimated cost ~38,000 dollars plus tax, tag, title, service charge and VAT

i refused the operation and (believing in the cancer diagnosis) asked to make me fit to fly to Germany, reason "i want do die in my country" paid 18,000 dollars for a 5 day stay and "treatment". in Germany a medical doctor (friend of mine) had everything arranged in a hospital for my arrival. saw a surgeon first who indicated that at this point an operation was not advisable as the x-rays showed a still closed abscess and since nobody can be sure what tropical buggers dug the cave in my liver an operation could cause a serious sepsis in my whole abdomen. "no cancer?", i asked. "what cancer?" he answered. to shorten a long story. 3 days of blood tests sent to one of the german hospitals specialising in tropical diseases, discharged from the hospital to my house (12 km distance), one week daily to the hospital to get infusions, additionally four weeks taking hard antibiotics... and i was cured.

-week before Christmas 1993. whole weekend terrible abdominal pain. monday morning internist (again the pakistani lady). diagnosis "ruptured appendix". i contradicted her as the pain was in the middle of my belly and knew the appendix is located on the right side (except when you enter a lady, then it's located to the left). same procedure as two years ago. drove to the hospital and checked in. paramount medic chief checked me a couple of hours later. diagnosis "no appendix, extremely high infection. have you bad boy been travelling in Asia again? don't worry, we'll make you fit to spend Christmas in Germany. it will take a few days though".

afternoon 3 p.m., internist arrived, "are you already operated?" of course not i answered, it told you my appendix is located at my right side. she slammed the door. 20 minutes later i had to swallow liters of contrast medium and they pumped up gallons of that contrast sh** up my arse till i thought i will explode. then x-rays, ultrasounds... back to my room.

evening 8 p.m. door opens, chap (height ~ 7ft) introduced himself as surgeon "Dr. R." tells me "just got a call from the radiologist. your appendix is ruptured, the small intestine is blocked and you should have surgery as soon as possible." i replied "done any surgery before?" he nodded "a couple of them". me "then what are you waiting for?" he looked at my file and read "surgeon Dr. D. mandatory!" me "then get me bloody Dr. D". "no can do" he says because Dr. D. comes back tomorrow morning. "then what?" i asked. "sign here and agree that i can cut you up". i signed and by 10.30 p.m. he cut me up. next day he was joking with me. "your belly was such a bloody mess that i had to take everything out, hose it down and rearrange it".

sorry FOR YOUR BAD EXPERIENCES!

thsi is the litmus test. ask any congressman or girl if they going to give up their lusicious health care plan to join the program they forcing on the masses.

ANYONE WHO THINKS GOVT CAN HANDLE medical care is just looney! they sure handled the pig flu thing well!

[chiang mai]

It's become painfully clear to me that our various governments regard their expats with some disdain who are to be subject to a different set of rules than their stay at home counterparts. I've just discovered that the US now taxes at 30% my future US Social Security pension payments because I am a non-resident alien and since I am not required to file a US tax return I cannot recoup that tax - interestingly the SSI will pay the funds gross of tax if I live in the UK AND I report the payment to the UK government so that they can tax the funds! Retired expats in the UK do not receive COLA on their UK state Pension so clearly there is a push to treat expats very differently from the mainstream.

[tomwct]

Calm down American Expats!!! There is no bill yet, at least in written form. They voted on a bill that was work in process and now has to be combined with the Dummies in the House, who are all up for election in November. I retired here in Thailand at age 51 (2003) and have purchased a Health Insurance policy from BUPA every year, which is the same way I handled my insurance in the states. I am not a Socialist and never plan on wanting anything from the government except a reasonable payout from my social security payments of 15.7% for over 20 years, as a self-employed Consulting Engineer!!! I feel so sorry for my nephews and nieces who will be paying very high taxes in the future for this New Socialist Democratic Parties spending (Formerly DNC). I think the election in 2010 will reflect the countries move towards Socialism last year!!! My personal feeling is that most Americans are fed up with the Union Stimulas, saving of Government Motors (GM), wealth redistribution, and freebies for all including health care. This is not the "Change" they voted for in 2008!!! Everything can be reversed and cancelled in 2012, if Americans Vote for "Change Back" with less government, less spending, and vote lifetime politicians out of office, once and for all!!! I think this will happen in 2010 and 2012!!! God Bless "The Tea Parties" To all my Americans Expats - Have a Happy New Year!!!

[Jingthing]

Most Europeans scratch their heads in incomprehension when they hear some of our US friends suggesting that tightening regulation and expanding coverage in a private health insurance market equals some kind of Stalinist takeover.

Some Americans are scratching too. My explanation is decades of commercial propaganda from the so called health care industry, for profit hospitals, big pharma, and insurance companies. Probably a majority of Americans still actually believe the current pre-reform system is the best in the world. Obama's task dealing with such delusion was near impossible.

[koheesti]

Wouldn't it be cheaper for the taxpayer if they found a way to make health care less expensive THEN find a way to insure the currently uninsured? I wonder if there will be any tort reform included in the new Health Care bill? How much do doctors pay in malpractice insurance just in case some ambulance chasing lawyer hits them with a $10 million lawsuit that of which 30-40% goes into the lawyers pocket? Surely tort reform is one way to bring the costs down.

[flying]

I've just discovered that the US now taxes at 30% my future US Social Security pension payments because I am a non-resident alien and since I am not required to file a US tax return I cannot recoup that tax - interestingly the SSI will pay the funds gross of tax if I live in the UK AND I report the payment to the UK government so that they can tax the funds!

Amazing isn't it?

[Jingthing]

That detail is about resident aliens, not US citizen expats (who are required to file US federal tax forms).

Edited January 2, 2010 by Jingthing

[flying]

That detail is about resident aliens, not US citizen expats (who are required to file US federal tax forms).

Yes I saw that in his post...But I also saw that it was US Social Security pension payments

So I assume he paid into the tax system while working in the US.

It amounts to the same. They tax the tax you paid while returning it to you....It should be enough they were allowed the full use of it interest free all those years while it amassed & had higher buying power to boot.

Wiley Wabbits

[Jingthing]

Social security income is taxable.

[chiang mai]

That detail is about resident aliens, not US citizen expats (who are required to file US federal tax forms).

The common denominator, in case you missed it, is governments approach to increased taxation of expats in a variety of ways, regardless of their nationality and/or citizenship. Anyway, resident aliens in the US are required to file tax returns, non-resident are not.

[Jingthing]

Thanks for the correction. I agree the government isn't interested in us very much. If they did, Medicare would be usable outside of our borders.

[chiang mai]

That detail is about resident aliens, not US citizen expats (who are required to file US federal tax forms).

Yes I saw that in his post...But I also saw that it was US Social Security pension payments

So I assume he paid into the tax system while working in the US.

It amounts to the same. They tax the tax you paid while returning it to you....It should be enough they were allowed the full use of it interest free all those years while it amassed & had higher buying power to boot.

Wiley Wabbits

Your assumption is correct, paid all my US taxes etc for fifteen years. And whilst it's true that SSI is taxable, for citizens and residents that is only so above a certain level, for non-resident aliens it is taxable at the full rate from Dollar 1.