Health Care

[smoker]

Anyone else hoping Obama hits a home run with his health care speech today and ends this debate so that people can actually have access to medical care?

[WannaGo]

So far, I'm not crazy about the health care legislation that Max Baucus has proposed.

No public option, which I thought was a great thing to include, a requirement that everyone who buys insurance through the exchange first be cleared by Homeland Security to make sure they aren't in the country illegally (meaning that DHS will able to track who has what kind of health care coverage...a little unsettling), and stupidest of all, fines for those who don't buy health care.

Yes, let's take those people who can't afford health care and make them pay even more money they don't already have. Supposedly, the bill contains provisions that will exempt those who can't afford insurance from the fines, but I can already see the exemption process becoming a bureaucratic nightmare. Besides, why should the burden be on the public to prove to the government how poor they are?

The Republicans, with their scare tactics, outright lies and distortions and town hall astroturfing, have just plain hijacked health care reform and gotten it so twisted around that we will not see any meaningful POSITIVE change in the near future. I bet there are a lot of very happy insurance company lobbyists right now -- and some Republica legislators enjoying some nice expensive perks, courtesy of those lobbyists.

Oh, and there's also this little gem in the plan:

To help pay for his bill, Baucus is proposing a series of new excise tax on insurance plans worth more than $8,000 for singles and $21,000 for families, and new fees on insurers, drug makers, device makers and clinical labs.

Is it just me, or are these insurance companies, drug makers, labs, etc. not just going to turn around and pass all these fees right along to all of us, raising premiums and out-of-pocket expenses. That's just the normal course of business -- costs are passed on to the consumer. And nothing I've seen so far indicates that the bill would prohibit them from doing that.

For what it's worth, I don't think we're going to tame our health care costs until we see a fundamental shift in the way we view the entire healthcare profession. We have to stop looking at it as a business and stop encouraging people to become doctors and researchers as a way to make a lot of money. Instead, we have to start shaping healthcare as a calling, so that people go into it for the same reasons they become clerics or firefighters or schoolteachers.

[Thaimo]

Whatever they eventually come up with, I hope you can use it no matter where you are instead of having to be in the USA to use it. I live in Thailand and I paid my taxes all my life too. I still do. I don't understand why I have to return to the USA if I need to use Medicare or other health programs. Why should I be screwed out of those benefits simply because I chose to retire outside of the USA?

[lvdkeyes]

There is so much wrong with the American health care system, I wonder if it can ever be fixed. I also think it isn't fair not to be able to use my Medicare (which I paid into since its inception) simply because I am not in the US.

[Thaimo]

I also think it isn't fair not to be able to use my Medicare (which I paid into since its inception) simply because I am not in the US.

The way things currently work, as a USA citizen you have the right to live and retire wherever you choose, but even though you paid into the system through taxes all your life, if you make the choice to live somewhere other than within the USA you forfeit the benefits you spent a lifetime paying for.

What is the rationale for that? Is it because the USA thinks the health care available there is better than health care elsewhere? Go to a typical hospital in the USA and then go to a typical hospital in Thailand. Then tell me that health care in the USA is better than in Thailand.

Could it be that the policy of the USA is the hospitals, HMOs, pharmaceutical companies, etc. have a right to a monopoly on the money from Medicare? Is it possible that Big Brother USA feels it has a right to decide for you what and where you should go for health care?

[WannaGo]

After I saw what you guys were saying, I did some reading and was a little surprised at what I found.

Of course, you're right. Medicare doesn't cover foreign medical care even in the case of an emergency. The sole exceptions seem to be that if a foreign hospital with the treatment you need is closer to your home than a US hospital (yeah, right) or if you are traveling from Alaska to another state and have to pass through Canada, then Medicare will cover the expense.

You can see Medicare's policies on foreign care here.

This seems pretty outrageous. According to the New York Times, between 4 and 6 million Americans live abroad (civilian and military). At the top of that estimate, that's almost 2 percent of the population. And, as Thaimo pointed out, most of them have been paying into the system for most of their working lives. Yet, they aren't allowed to then use those benefits?

It can't be due to an inability to coordinate medical treatment and payment between the US and foreign countries. There are a whole slew of US insurance companies that will provide coverage for Americans living abroad, including one of the best, Blue Cross/Blue Shield.

We all know that government-run functions tend to be less efficient than private companies, but still, if BCBS can do it, surely the US government can figure out a way to provide its citizens living abroad with the health coverage they have paid for!

I can see that the US government would have some serious concerns about the potential for scams. By some estimates, Medicare fraud costs US taxpayers about $60 billion a year. Presumably, it would be even easier to pull these con games in a foreign country than in the States. But just because a situation is difficult doesn't mean the country doesn't still have an obligation to its citizens.

It would be different if that money hadn't been coming out of your paychecks for all of your adult lives. Those expats who have retired to Thailand or other places have probably paid tens of thousands of dollars into the system over about 30 working years. Far as I'm concerned, that buys you a sizable interest in the Medicare system -- just as much of an interest as anyone living on American soil.

However, bureaucracy being what it is, the situation doesn't seem likely to change any time soon. And Thaimo had it right when he said that US medical interests stand to lose too much if some of those Medicare dollars started going outside the country.

In the meantime, for those of you living overseas, the only thing you can do seems to be to buy some form of international health insurance, if you don't already have it. This website seems to have a pretty comprehensive list of companies that sell insurance. The US State Department site also has some info on private medical insurance and medical transport companies here (scroll down).

[Thaimo]

I can see that the US government would have some serious concerns about the potential for scams.

Being retired and living outside the USA, as an American citizen I am still expected to pay IRS income tax. If I am still paying taxes even under retirement, then I feel I have a right to the same benefits every retiree living within the USA gets. But all I can do is feel that way. I don't have the kind of money it would take to try to sue the US government, which I see as the only possible recourse. If I had the kind of money it would take to try that, then I wouldn't need Medicare.

I am sure you are right about scam concerns, but I still fail to see the justification in depriving me of Medicare benefits on the basis that I, or others, might try to defraud the system. What it truly amounts to, as it stands now, despite the fact the you paid into the system all your life, if you choose to live outside of the USA, then you're on your own.

[smoker]

You do get a 79k IRS tax break if you live outside the US.

[WannaGo]

Thaimo: Please don't misunderstand me. I definitely wasn't saying that the potential for scams justifies denying American expats the health care they have paid for already. Just acknowledging that it could be an issue. I definitely support what you're saying. You know, given the political atmosphere right now, I bet you could generate some media interest in a story about American citizens abroad are being denied health coverage from a system they've been paying into for years.

[lvdkeyes]

You do get a 79k IRS tax break if you live outside the US.

Would you explain this please?

[lvdkeyes]

You know, given the political atmosphere right now, I bet you could generate some media interest in a story about American citizens abroad are being denied health coverage from a system they've been paying into for years.

How do you think we could do this?

[smoker]

If you live outside of the United States for 11 months of the year or more the IRS gives you an automatic 79k tax write off.

[lvdkeyes]

If you live outside of the United States for 11 months of the year or more the IRS gives you an automatic 79k tax write off.

I didn't know that. It's good news. Thank you. Is that why I never got the second stimulus money?

[Bob]

If you live outside of the United States for 11 months of the year or more the IRS gives you an automatic 79k tax write off.

Are you referring to the foreign income exclusion act? If so, you're number is wrong (it's actually higher now as it's annually adjusted by inflation) and it wouldn't apply to 95% of the expats in Thailand. And, while everybody can google that act and read for themselves, it doesn't apply to income you earn in the US or to passive income earned anywhere (it's a device where you possibly can shield some of your employment earnings overseas if you can meet certain requirements).

[WannaGo]

How do you think we could do this?

I would start by putting out messages to all the expats that you know, asking if any have contacts in the media. Also, start looking at the bylines of the health care-related stories that you see. Try to identify reporters/producers/editors who are assigned to those beats and begin putting together a list of names and email addresses.

You're looking for people in one of the cable networks, or a medium to large newspaper in an urban market, especially one with a lot of policymaker-type readers.

Obviously, CNN or MSNBC would be good ones for TV media...especially someone like Keith Olbermann, who seems to look for these "little-guy-getting screwed" kind of stories.

In print, obviously you should look at the Washington Post, New York Times, or LA Times, but don't ignore papers that are smaller, but still influential, like the Philadelphia Inquirer, the Boston Globe, the Detroit Free Press, or the Miami Herald...in fact, those are good choices. Phillie, Boston, and Detroit are all working-man friendly papers, so they should have some interest about guys getting screwed on their retirement. Miami has a wide international audience and gets a lot of attention in Central and South America, where many expats live.

Also, look for some of the political bloggers, especially those of a more liberal or progressive persuasion, as they'll be sensitive to these issues. See what the DailyKos, HuffingtonPost, and TalkingPointsMemo are saying about health care issues.

And, check out the Associated Press, too. You're probably more likely to find AP reporters in overseas locations than just about any other media.

Once you have a good list of possible media contacts, you need to start a quiet campaign to get their attention.

Send the list to every expat you know and post it to message boards like this one. Ask the expats to contact the reporters on the list. Caution everyone to keep their tones civil and rational. They should not harangue these people in the media, but rather politely and passionately explain the problem and ask for help. Keep those emails coming...eventually, they will reach a tipping point, after which they can't be ignored.

At the same time, get some expats together to form a group. Give yourselves a name that clearly expresses your purpose..."Expats for Fair Medicare Policy." If you've got someone who can put together a nice website, even better. Pick someone to be the point of contact for the media...someone articulate and with a good grasp of the issue. Put that person's name, email and phone number on the website. Make sure the site has a blog where you can post articles related to expats and health care.

Then, really start ratcheting things up. Find out who in Congress sits on the appropriations and oversight committees for Medicare. Write those politicans a letter in the name of the group...better yet, put up a petition on the website and collect signatures. Send the letter and all the expat signatures you collected to those members of Congress. Then, put out a press release...use PRWeb or PRNewswire...and start it something like, "Today, the 10,000 members of Expats for Fair Medicare Policy called on Congress to..."

Find a foreign city with plenty of expats and AP and CNN bureaus...somewhere like Bangkok, probably. Have a group of expats hold a press conference and announce the problem expats have getting Medicare coverage.

Have some of the better writers among you write letters-to-the-editor and op-ed pieces to the newspapers I mentioned above.

It might take a while...months even...but I bet you would start to get some attention.

Make sure all the expats, especially those who might be dealing with the media, are prepared with an answer to this question: "You choose to live outside the US, so why should the government have to spend extra money to provide you with healthcare?" You can bet you'll get that one a lot, so sit down, put together a good solid answer, and be sure to share it in the expat community so that everyone is ready for it when it comes.

Hope this helps.

[smoker]

I work over the Internet as a freelance writer and have never had a problem qualifying for the write off. I didn't realize they had raised the amount because I have an accountant fill out the forms and I just sign them and I've never even gotten close to earning 79k.

It's been nine years and I've always been told I qualify.

[Wino]

Seems some Democrats are refusing to support the idea of goverment insurance. Not sure if they will be able to put something together before the end of the year.

[Thaifan]

I watched a really interesting programme on Australia Network last week which compared the Health systems of UK, Germany, Japan, China and a few others and all were found to be far superior to America.

[lvdkeyes]

I worked within the health care system for nearly 40 years in the US and the stories I could tell what make you say, "WTF?"

[smoker]

Yes. Unless you are wealthy health care in America often comes down to the emergency room and/or bankruptcy.

[lvdkeyes]

A visit to the emergency room can bankrupt you in itself.

[Beer Chang]

It can't be due to an inability to coordinate medical treatment and payment between the US and foreign countries. There are a whole slew of US insurance companies that will provide coverage for Americans living abroad, including one of the best, Blue Cross/Blue Shield.

Not all Blue plans will cover those living abroad.

And some won't reimburse at the same percentage they would back home.

[Beer Chang]

Being retired and living outside the USA, as an American citizen I am still expected to pay IRS income tax. If I am still paying taxes even under retirement, then I feel I have a right to the same benefits every retiree living within the USA gets.

Sort of like taxation without representation since none of the Congressional clowns care about us.

[Wino]

A visit to the emergency room can bankrupt you in itself.

A vist to the emergency room can certainly cost a small fortune. Many hospitals have opened urgent care facilities in my community. Although they are cheaper than the emergency room, they are still expensive.

[smoker]

What amazes me the most is that the people who would benefit the most from universal coverage - the poor and the middle class - are the people most opposed to universal health coverage.