Us Expats And Health Care Reform

[flying]

there is something on snopes that they irs is trying to get us citizens to list all their guns on their returns and pay a fee for having them, scary

Actually that was debunked email.

The rumor is false.

[endure]

we as expats get screwed by paying taxes here as if we still lived in the US

a vat tax would be great and then it all would be equal but they will never do it. aside from putting lawyers and accountants out of business they cant keep there eye on us. its a big brother thing, they know where we go, we live, we travel etc due to deductions and credit cards etc. vat tax they will lose their info on us, cant let that happen

How will the imposition of VAT make any difference to your credit card usage? VAT (Value Added Tax) is simply a form of sales tax.

[BEENTHEREDONETHAT]

Adding a VAT tax will be a con of the people convincing them that other taxes will drop to make up for it. In the end you will pay more. Probably easier for them to collect as I imagine a lot of people are not paying the IRS as they believe the money if being pissed away by the pollys.

[NovaBlue05]

I am disappointed that Obama, who promised to get rid of insurance companies, is not now doing so.

What the hel_l have insurance companies got to do with deciding who should get treatment? Why are they even there?

The insurance companies and the providers have a partnership. The providers agree to charge 5-10 times what a service should cost thereby keeping people in constant fear of financial ruin if they don't buy insurance.......which is not cheap in the US. Fortunately, we are insured through work.

My wife needed a test done this last March. We got a quote in the US OF $4200. At the time, we were one week from our vacation to Thailand during April so we decided to have the test done at Bumrungrad....which is probably one of the most expensive hospitals in Bangkok.

The cost.... $275. This included a consultation with the doctor a week ahead, the test itself and all follow-up labwork. I'm sure we could have gotten it done even cheaper at another facility.

[Jingthing]

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."

[PeaceBlondie]

Congress have staffs of bright experts who contrive complex solutions. They might exclude folks with pensions that give medical benefits, or have filed foreign-address tax returns, the Amish, etc. They know we're here.

[tutsiwarrior]

if US insurance companies can improve profits from health care reform that includes providing benefits to expats we may be in for a pleasant surprise...their PACs (lobbying groups) are right up there with the Israel and gun lobbies...

[CaptHaddock]

if US insurance companies can improve profits from health care reform that includes providing benefits to expats we may be in for a pleasant surprise...their PACs (lobbying groups) are right up there with the Israel and gun lobbies...

Zero chance of that. Why would the insurers want to pay out more? And to foreign providers whom they can't monitor effectively?

[Texpat]

Why does anyone think the government can do health care better than health care professionals?

I have little confidence in the US government and strive to make as many aspects of my life divorced from such ridiculous institutions as possible. Obama is merely the latest buffoon at the wheel. How the government is going to take over health care and make it better ... I can only imagine.

Be careful what you wish for, Jing.

Edited June 6, 2009 by Texpat

[Jingthing]

How the government is going to take over health care and make it better ...

Not wishing for a debate about the wisdom of any changes, only to monitor the potential impact on expats, when something happens. Obama won the election on the clear platform of massive reform and massive increase of coverage for the uninsured and his political future depends on him delivering a lot of that. However, I do need to correct you on something. Universal health care, similar to Canada and France, run by the government is NOT on the table for negotiation, so you are getting your knickers in a twist about something that is not only not going to happen, it isn't even going to be talked about!

Edited June 6, 2009 by Jingthing

[Chunkton]

Maybe the following article will be of interest to Americans:

A Different Perspective on Healthcare

Or even maybe this one:

Cost of Healthcare Plan Soars

Edited June 8, 2009 by Chunkton

[flying]

Perhaps we should become Canadians?

http://www.latimes.com/business/la-fi-laza...,2252325.column

[BEENTHEREDONETHAT]

Health insurance is one of the reasons I live in LOS, I'm from the US but have never been covered under medicare (haven't lived in the US since 1982). If you move out of the country and refuse the medicare coverage, should you decide to go back. The cost will increase by 10% for every year you are not covered. Since I have been collecting SS for over 10 years my cost would be double.

But thankfully I would rather live in LOS anyhow. I'm self insured here as once you reach 70 insurance companies do not want to touch you, which I can understand. But here I am comfortable with the self insurance as the cost is not that prohibitive. In most other places the cost could break you. Particularly in the US, my wife is hesitant on us taking a holiday of any length to the US in case one of us were to get sick.

There are other reasons I do not choose to live in the US but that is one of the biggies .

[samran]

It always amuses me when Americans cry 'socialism' when you talk about universal health care.

great article in (subscriber only) crikey dot.com. Read on....

Rundle: 1st item on Obama's health reform agenda -- get rid of the fax machines

Guy Rundle writes:

Barely drawing breath after his ground-breaking Cairo speech, Barack Obama is charging into what will be one of the biggest stoushes in American politics, his plan to reform the hopeless US health system.

Obama launched his campaign in a speech in Wisconsin, urging people who supported him to get behind the plan and lobby their Congress members, because "this may be our one chance to get health care reform through." It would be difficult to over-estimate the risks associated with trying to make even the most basic changes to US health-care. It was after all the failure of Hillary Clinton’s complex plan in 1993 that did more than anything to hole the Clinton Presidency below the waterline, at least as far as being a liberal regime went.

Clinton’s plan wasn’t even the dreaded "single-payer" system, the term the US Right uses as some sort of North-Korean image for what Australians would know of as Medicare -- baseline state-run universal coverage supplemented by private options.

Instead it was an attempt to continue to run health insurance through private providers, while explicitly mandating how much they would charge, how much they would pay out, limiting their ability to exclude people with pre-existing conditions, and so on.

It was a scheme designed to please no-one -- Big Health were always going to be against it, and the liberal-left wouldn’t get behind it because they were still holding out for a single-payer system, which would not -- as would have the Clinton plan -- flood rivers of gold into the insurance companies for stuff that could be done at knock-down prices by the state.

Since then, the organized left have been pretty much beaten down in Congress, and health care in the US has become much worse. This has given Obama a great political opportunity to get real reform through -- but only at the price of proposing a scheme so unthreatening to Big Health, that it will see the wisdom of acquiescing to it.

Why did American health get so much worse than it was at the time of the Clinton plan, when it was already pretty dead? Deregulation between 2000-2006 was one factor -- a release of the (fairly-worn) brakes that were on the insurers in terms of denying continuing care to the chronically ill, excluding pre-existing illnesses and aggressively using the bankruptcy laws to recover costs.

Another has been the open-ended nature of private medical care -- as new techniques and tests are introduced year-on-year, open-ended health plans are faced with spiralling costs, created by the increasing demands of patients, and the desire of GPs to bill for endless additional (and often unnecessary) services.

With no qualitative and triage-based control of health-care spending, the more consumerist options will crowd out necessity. The ideal health insurance client is a member of the "worried well", paying top-hole premiums for routine services, the lions’ share of the service fees going to the insurers. The worst client is the one for whom any rational health system should be designed -- the chronically ill, the suddenly desperately ill, the seriously injured etc, and health insurers spend most of their energy throwing these people off their lists.

The coup de grace has been the sharp rise in unemployment in the US, which has deprived many people of their employer-based health insurance--– the auto manufacturers bail-out deal alone cuts by 50% the health care available to up to a million former car workers and their families, just as many of them are ageing.

The core of Obama’s plan is what’s known as a National Health Insurance Exchange, which is a sneaky way of offering public health insurance to the 45 million Americans who don’t have any insurance whatsoever (and aren’t eligible for the below-poverty-line Medicare scheme) -- and simultaneously providing subsidised matching fixed-prices schemes offered by private providers, so that no-one can scream socialism.

Surrounding this are various measures such as $10 billion in grants to get nationwide electronic record-keeping up and running -- US hospitals are the last places in the developed word where the faxes run hot day and night with paper records being transferred -- and some real battles, such as prohibiting the exclusion of pre-existing conditions.

The advantages of the scheme are all political -- people are so angry with health insurers (average premiums have doubled in the last six years), terrified of bankruptcy (half of the million bankruptcies a year in the US are due to medical costs), and worried for their children’s health, that Congress members who simply roll over for their Big Health campaign donors will find themselves the target of grassroots attack in upcoming party primaries for the 2010 elections.

The disadvantage is that it’s a monstrously expensive way to achieve what single-payer cover does for half the cost, and twice the result -- provide universal optimum health. But if Obama can get this, and if the 2010 Senate vote gives an enhanced Democratic majority, then there is a bridgehead from which non-pauper public health cover can be expanded, thus denying the Right the chance to make a huge fight over it, and gradually converting the American people to the idea that public health provision is not socialism.

And also, if if if it succeeds, proving once again that the road of recent American political history is littered with the bones of those who underestimated Barack Hussein Obama.

If it fails? We may find out -- health insurers here are starting to make noises about unaffordable Medicare and transitioning to a US health system. So remember to choose which leg you’d like to save if they both get infected, because your plan may not cover both.

[taxout]

The so-called "House bill" on health care reform introduced yesterday (June 19), does have an expat exclusion tied to the eligibility rules under the earned income exclusion. That is, if you meet either the "bona fide resident test" or the "physical presence test" then you won't be subject to the penalty tax to be paid by those without insurance.

Of course the details will no doubt change before -- and if -- any legislation is actually passed. But the point is, expats have not been completely forgotten by the bill's drafters.

[JimGant]

Another aspect to consider...... (from the June 20th Washington Post):

As the debate on overhauling the nation's health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system.....Washington has also been training a microscope on the groundbreaking effort in Massachusetts to provide everyone in the state with health insurance: Adding 340,000 people to the rolls of the insured there since 2006 has underscored a shortage of doctors. It takes 63 days on average to get an appointment with a family doctor in Boston, more than twice the wait in Washington, and seven times as long as in Philadelphia and Atlanta, according to a Merritt Hawkins survey.

"If Massachusetts is any guide, with increased access you'd see pent-up demand for health care, and you'd see a lot of frustration with the waiting time to access health care," Phillips said. "It'll swamp the emergency rooms, and those people will be seeking health care in the most expensive settings."

The article goes on to explain that med schools are turning out fewer and fewer primary care physicians, and even with incentives, fixing the shortage is decades away. And that's a shortage *without* including today's 46 million uninsured.

Sounds like a train wreck to me.....

[Jingthing]

Yeah, I am not sure this is even really going to happen now. It is starting to look like the early Clinton years all over again. The tragedy I think is that we really need single payer but the health insurance industry is too big to cut them out. This puts the problems of Thailand in perspective. Americans don't seem to be able to fix this and it is kind of pitiful.

Edited June 20, 2009 by Jingthing

[flying]

Yeah, I am not sure this is even really going to happen now. It is starting to look like the early Clinton years all over again. The tragedy I think is that we really need single payer but the health insurance industry is too big to cut them out. This puts the problems of Thailand in perspective. Americans don't seem to be able to fix this and it is kind of pitiful.

Or......Americans don't seem to be able to fix this, like the early Clinton years it is kind of pitiful

Hang on its only a little more than we are getting use to

[EndofDays]

we as expats get screwed by paying taxes here as if we still lived in the US

a vat tax would be great and then it all would be equal but they will never do it. aside from putting lawyers and accountants out of business they cant keep there eye on us. its a big brother thing, they know where we go, we live, we travel etc due to deductions and credit cards etc. vat tax they will lose their info on us, cant let that happen

there is something on snopes that they irs is trying to get us citizens to list all their guns on their returns and pay a fee for having them, scary

Did you know that Obama has more lawyers working for his administration that in any other administration in U.S. history? So, no more lawyers, eh?

[EndofDays]

Major expansion of health care access is DEFINITELY coming. People who don't realize that are completely out of touch with today's political realities. It is true Euro/Canadian style single payer universal health care is off the table, probably out of realpolitik and the fact that the insurance industry is just too powerful to kill (and that is a shame). I didn't start this thread to argue about health care reform, of course I am for it as are most Americans. I started it to consider the impact of these changes on expats. However, as we don't yet have info on the actual changes that are going to happen, this is probably premature.

Are you sure most Americans want it, Jingthing?

POLL: Less support for rebuilding health care system than during Clinton...

As health care reform legislation moves forward in Washington, the political environment is somewhat different than the last time a major overhaul of the health care system was attempted sixteen years ago. In early 1993 the sense of a health care crisis was far more widespread than it is today – a 55% majority in 1993 said they felt the health care system needed to be “completely rebuilt” compared with 41% today. Health care costs were also a broader problem in 1993 – 63% of Americans said paying for the cost of a major illness was a “major problem” for them, compared with 48% currently.

[farmerjo]

If you look up australia network,they have been doing a series called ten trillion and counting.

It seems that the promised medicare for older people cannot support itself.

Interesting viewing

[Jingthing]

Are you sure most Americans want it, Jingthing?

No, I am not but they voted in Obama and coverage for all Americans was at the top of his agenda. Elections have consequences. I expect him to push hard for this to fulfill his election promise. I am not so optimistic the result will be pretty though.

[CaptHaddock]

Are you sure most Americans want it, Jingthing?

No, I am not but they voted in Obama and coverage for all Americans was at the top of his agenda. Elections have consequences. I expect him to push hard for this to fulfill his election promise. I am not so optimistic the result will be pretty though.

Oh, we want health care reform all right. Make no mistake about it. Here's a quote from an article in today's NY Times:

The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65...

http://www.nytimes.com/2009/06/21/health/p.../21poll.html?hp

But that's not surprising. Americans have repeatedly polled in favor of health care reform over the years, but the politicians have been in the grip of the health care lobby. Obama and the others are playing catch up here, following the will of the electorate. Let's hope he succeeds. Notice that even though a large majority of Americans want a single payer system that option will not even be discussed. However, if Obama succeeds in getting a govt insurance option in, that will be the camel's nose in the tent. The private insurer's days of skimming 31% of every health care dollar will be numbered.

Edited June 21, 2009 by CaptHaddock

[EndofDays]

Are you sure most Americans want it, Jingthing?

No, I am not but they voted in Obama and coverage for all Americans was at the top of his agenda. Elections have consequences. I expect him to push hard for this to fulfill his election promise. I am not so optimistic the result will be pretty though.

Oh, we want health care reform all right. Make no mistake about it. Here's a quote from an article in today's NY Times:

The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65...

http://www.nytimes.com/2009/06/21/health/p.../21poll.html?hp

But that's not surprising. Americans have repeatedly polled in favor of health care reform over the years, but the politicians have been in the grip of the health care lobby. Obama and the others are playing catch up here, following the will of the electorate. Let's hope he succeeds. Notice that even though a large majority of Americans want a single payer system that option will not even be discussed. However, if Obama succeeds in getting a govt insurance option in, that will be the camel's nose in the tent. The private insurer's days of skimming 31% of every health care dollar will be numbered.

A new york times poll....a new york times poll? Are you serious? Why don't you just say an obama administration administered poll. Same bloody thing. Clinton healthcare failed because the public was against it. You think there is a reason that every one seems to go the U.s. for the best healthcare? Some idiot made a post about how Americans think they deserve perfect teeth, ect. Yes, we do because we are better. We work more hours than you, put more time in the office than you, we donate to charity more than you, we volunteer more than you. I want to determine what kind of health care I get, not some political hack. Yes, that is it, lets model our healthcare system after England....

[Jingthing]

The US is not a pure democracy, it is a representative government. We voted in a party for the presidency, the senate, and the house on the platform of health care access reform. Each issue isn't voted on in a poll in real time. That's for the next election. The American people voted for this, now it is the time to deliver, or fail to deliver.

In other words, ELECTIONS are the only poll that matters.

Edited June 21, 2009 by Jingthing

[cloudhopper]

The US is not a pure democracy, it is a representative government. We voted in a party for the presidency, the senate, and the house on the platform of health care access reform. Each issue isn't voted on in a poll in real time. That's for the next election. The American people voted for this, now it is the time to deliver, or fail to deliver.

In other words, ELECTIONS are the only poll that matters.

Only the hopelessly naive believe that writing one's "representative", much less voting, will make any difference whatever. Only the hopelessly naive believe that ANY campaign promise or party platform will be honored. Bread, circus and elections...

[Jingthing]

Only the hopelessly naive believe that ANY campaign promise or party platform will be honored.

That was total B.S.

http://www.politifact.com/truth-o-meter/promises/

[EndofDays]

Only the hopelessly naive believe that ANY campaign promise or party platform will be honored.

That was total B.S.

http://www.politifact.com/truth-o-meter/promises/

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.

[EndofDays]

Only the hopelessly naive believe that ANY campaign promise or party platform will be honored.

That was total B.S.

http://www.politifact.com/truth-o-meter/promises/

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.

It only applies when Republicans are in power I guess:

No. 234: Allow five days of public comment before signing bills

The Promise:

To reduce bills rushed through Congress and to the president before the public has the opportunity to review them, Obama "will not sign any non-emergency bill without giving the American public an opportunity to review and comment on the White House website for five days."

bail out bill that was forced through through both houses in less than 48hrs. They are politicians.

An american indian policy advisor? That has to be the dumbest things since nancy pelosi being allowed to still attend C.I.A. briefs.

[flying]

The US is not a pure democracy, it is a representative government. We voted in a party for the presidency, the senate, and the house on the platform of health care access reform.

Correct because if it was we would have a third choice......

NONE of the above

I bet it would win more times than not.

That is if we actually could vote & our vote was actually counted per vote.

electoral college

In your other post you said

they voted in Obama

Actually they voted in Change. He was smart enough to use that as his slogan.

Funny that if a vote was again taken today I bet most voters have Changed their minds.