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Old 09-21-2017, 11:10 AM
 
7,944 posts, read 5,050,887 times
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If we allow ourselves to take this thread in a philosophical direction, well, here’s my speculation on the root cause, the Ur-cause, the cause-of-causes.

It’s about the sanctity of human life. If, in our culture, we regard human life as being absolutely sacrosanct, as being beyond any commercial or material or scientific reckoning, then no cost is too high, no effort too onerous, to keep sustaining and abetting and prolonging life. I don’t just mean care for the elderly; it’s for life overall. Markets work, when something is exchanged for something comparable. If my life and its preservation are declared to be beyond financial reckoning, then there’s no price too high, to be charged for my care. Then there’s no threshold above which healthcare as a portion of GDP becomes excessive. Then no medical test is perfunctory, no procedure overwrought. Life, life, life… at all costs.

Now consider what for many is a nightmare scenario: everyone gets a lifetime budget, say of $100K, or $1M or whatever, for healthcare. Exceed that budget, and your only additional treatment is a bullet between the eyes. Is this unimaginably cruel and callous? Maybe. But by placing a definitive price on human life, a price on which we collectively agree, healthcare becomes a market-good, which can be traded and competitively bid. Healthcare becomes something that can be weighed against building new roads, buying a new car, funding college tuition. Now it is entirely possible that we’ll make a gross mistake in setting the price-level. The point isn’t to argue for one level or another. The point is to argue that SOME level ultimately does exist, and then to codify that level going forward. Until and unless we do that, there’s no equitable way of pricing healthcare, and costs will continue in runaway spiral.
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Old 09-21-2017, 11:24 AM
 
Location: Haiku
4,143 posts, read 2,587,409 times
Reputation: 6099
I agree with ^^^.

We cannot have it both ways - cheap healthcare AND the ability/willingness to cure everything, and everybody, and everyone gets to live to a ripe old age with new hips, new heart, new whatever. The two are just incompatible.
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Old 09-21-2017, 04:30 PM
 
Location: Rosa’s Cantina
177 posts, read 194,373 times
Reputation: 412
I am in year two of aca and it is working well for me. I get a generous subsidy (thank you taxpayers). The law requires me at threat of penalty to purchase insurance and when I enter in my data the subsidy is what it is. But the subsidy can be a double edged sword. I can't do Roth conversions which will likely result in higher taxes at rmd time, so I will pay one way or the other. What sticks out at me in this thread are the people who are offended by people like me getting subsidies. Most in this country get health insurance through work or Medicare and both of those are both highly subsidized. If you work, the portion of your insurance premium your employer pays is untaxed compensation income for which you pay no federal, state or ss taxes on. If the portion of the premium you pay is with pre tax income that is a subsidy and if you have hsa account that is a subsidy too. Our whole system is a disgrace, we pay more per capita for healthcare by far than any other country on earth. We pay Cadillac prices and many of us have to walk or drive a Pinto.

Last edited by Llep; 09-21-2017 at 04:41 PM.. Reason: Spelling
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Old 09-21-2017, 05:26 PM
 
Location: Former LI'er Now Rehoboth Beach, DE
7,885 posts, read 10,577,808 times
Reputation: 7973
One way or another the system is flawed and yo use damned if you do and damned if you don't. The rules regarding no asset testing were done to get the masses covered and this is the consequence. Now the congress will send hours debating this and fighting. I have an idea, make them pay for health benefits and we will see a complete reform of the system.
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Old 09-23-2017, 08:41 AM
 
11,265 posts, read 11,279,851 times
Reputation: 3464
Quote:
Originally Posted by StealthRabbit View Post
1) 1st... you gotta pay..(but it can be MUCH less than USA 'Out-of-pocket'
https://patientsbeyondborders.com/

2) service availability varies with immigration rules for each country, Several avail fairly quickly (Good thing for USA medical exiles)
Malaysia, Thailand, Philippines are all courting for USA medical $$, France, Spain, Portugal, and Italy are offering some new options. We met many USA medical escapees in Ireland. (Not sure of their coverage, but they were there because they couldn't get HC in USA)
Thank you for that lead, Stealth. I check out PWB. Unfortunately I couldn't find anything on it about regular health care coverage similar to Medicare or private insurance coverage here. Everything on PWB is for single procedures like lasik for shortsightedness or dental implants, that sort of thing at great savings. From what I have investigated a person has to have intentions to apply for green card or become a citizen to get health coverage in a particular country. Costa Rica has an excellent affordable plan Americans can get onto but it's like a steambath down there 24/7 so I wouldn't be interested in CR.
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Old 09-23-2017, 04:53 PM
 
Location: On the road
5,963 posts, read 2,902,204 times
Reputation: 11412
Quote:
Originally Posted by parentologist View Post
The problem is that social welfare programs (and the ACA is just that - if you're getting a subsidy)
Yep and all those people deducting mortgage interest on are on a social welfare program.

Same with the people who claim the exemptions for their kids... that is definitely a social welfare program. How dare someone with high income or net worth pay less taxes because they have kids that they can afford to raise.
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Old 09-23-2017, 04:59 PM
 
Location: On the road
5,963 posts, read 2,902,204 times
Reputation: 11412
Quote:
Originally Posted by Llep View Post
The law requires me at threat of penalty to purchase insurance and when I enter in my data the subsidy is what it is.
That is the funny part about these people with the "gaming the system!" battle cry, all the people are doing is filling in the forms honestly with the correct numbers. Healthcare.gov asks you what your income is, and you answer the question correctly because you're an honest person.

Is someone seriously expected to decide on April 15th that they should owe more that day since they had a higher net worth and voluntary contribute more? I'm not even sure how that is done, what are they supposed to write a random check to the IRS? It's absurd.
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Old 09-24-2017, 04:19 PM
 
Location: -"`-._,-'"`-._, ☀ Sunny Florida ☀ ,-"`-._,-'"`-.
1,352 posts, read 733,194 times
Reputation: 1300
Default Savers vs Spenders

For those who consider "managing" taxable income something bad... Consider let's consider this scenario. There's two couples, couple "A" and "B". Both made the same money over their lifetime.
  • Couple "A" - lived within their means, saved for rainy day and is prepared for their retirement with net worth in excess of $1 million.
  • Couple "B" - spent like there was no tomorrow and has basically no net worth.

From what I read here, most people are OK with giving "B" a subsidy even though they were stupid in managing their finances, but find it deplorable for "A" who lived within their means and now just work within the tax code.

Seems odd that people want to penalize savers but reward spenders.
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Old 09-24-2017, 05:02 PM
 
Location: Chapel Hill, NC, formerly DC and Phila
8,569 posts, read 12,681,399 times
Reputation: 8334
Quote:
Originally Posted by ohio_peasant View Post

Bottom line: I have no moral qualms about “rich” people getting an ACA subsidy; none whatsoever. What I can’t fathom is how this is actually done.
Here is the link to a blog where the guy keeps his income to about $40K and gets ACA subsidies for his family of 5. He is in his 30s and has a net worth of about $1.8M. They live on very little each year, despite having high assets.

His plan for when he has no income (but still high assets) is to convert his 401K little by little, year after year into a Roth IRA (AKA as the Backdoor Roth). He will convert just enough each year to keep him in the lowest tax bracket (or 15% bracket at most) and to also still qualify for the ACA (about $40K, I believe). He cannot use that Roth conversion money for 5 years, but after 5 years, he can withdraw it with no penalties (and without paying taxes since the "taxable" event happened when he converted it).

Climbing The Roth IRA Conversion Ladder To Fund Early Retirement | Root of Good
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Old 09-24-2017, 05:09 PM
 
71,735 posts, read 71,853,273 times
Reputation: 49289
if i planned better using roths we could have had a 100k plus income and got some nice subsidies from 62 to 65 .

you can draw roth income , set a side a few years cash , delay taking ss so you can use the zero capital gains brackets .

just using the standard deduction and exemptions will let you take up to 22k out of retirement money tax free .

i could have over funded my life insurance policy for decades with money i was holding as cash anyway and gotten 4% on it with no fees . i could have borrowed it out tax free at retirement and never paid it back .

all in all for 3 years until medicare you could have drawn a very high income and paid very little tax but it takes planning early onto get all the pieces in place .

early on we tend to only know what we know and we know little about what we don't know so we don't know we don't know . back then i thought i knew about retirement planning . boy if i only knew back then what i know now
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