Why Americans are Flocking to Asia

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gera
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Re: Why Americans are Flocking to Asia

Post by gera » Sun Feb 17, 2019 2:21 am

I have to strongly support firecat:Medicare is a great benefit for American retirees.

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Gaybutton
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Re: Why Americans are Flocking to Asia

Post by Gaybutton » Sun Feb 17, 2019 5:50 am

firecat69 wrote:I have nothing to apologize for.
That's right, you don't. You know who has something to apologize for? ME - for letting personal comments stand instead of deleting the entire post, which is exactly what I should have done and is exactly I'm going to do if there is any more of it.

I've asked that posts stick only to the issues. Getting personal with each other is verboten on this board.

I thought I made that clear under the "Board Rules." If anyone needs clarification, see: viewtopic.php?f=10&t=299

Is that a problem for anyone?

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Bob
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Re: Why Americans are Flocking to Asia

Post by Bob » Sun Feb 17, 2019 8:18 am

firecat69 wrote:,,,My Medicare cost is as close to zero as you can get . The amount is so small that they take out of my SS , that I don't pay any attention to it...
While I'm not complaining about the US Medicare system, I do question the "cost is as close to zero" comment. The monthly cost for Part B this year is $134.00 per month for those earning less than $85,000 per year; however, that cost escalates for those earning more (i.e., the monthly cost for somebody making $165k per year is $433.40 per month). But while that cost isn't all that big for some, one can't ignore the (1) 1.45% deduction one has paid from every paycheck over their working life for Medicare and (2) the cost of supplementary health insurance (often nowadays $200.00 to $400.00 per month for that alone for most people) which many (if not most) people maintain. And for those with drug plans under Part D, that isn't inexpensive at all. In other words, the cost of Medicare isn't anywhere near close to zero (and for those expats permanently living here, any of their "donations" to the Medicare system have returned exactly zero benefit to them).

As for the initial post of Americans "flocking to Asia", I actually don't know if that's occurring but I've seen no evidence of that up here in the boonies (Chiangmai). Perhaps it's happening more in other parts of Thailand or neighboring countries.

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Re: Why Americans are Flocking to Asia

Post by Dodger » Sun Feb 17, 2019 11:10 am

Medicare is great but it only pays 80% of the bills for the average American if they’re lucky and it’s that 20% that’s an absolute killer due to the astronomical costs of U.S. health care. Even with all the supplements they offer you at a cost (including Medigap) you can count on being stuck with some of the costs, and for the elderly who don’t have supplemental insurance to cover their prescriptions they can and sometimes do end up being financially devastated.

All said, my concerns are not directed at Medicare – they’re directed at the Costs of Health Care in America which starting spiraling out-of-control decades ago bolstered by the influence of the Pharmaceutical Industry which is the second largest market in America and together with Canada and Mexico represents the largest continental pharma market in the world.

I’ve watched three presidents try to tackle this problem by making health care more affordable but not one has been able to actually lower the costs of health care. A hospital tossing a $26 dollar charge on a hospital bill for two aspirins and a glass of water is nothing short of a scam and I’ve seen this with my own eyes. And that of course is just one of the very trivial charges that the taxpayers ultimately end up paying for.

Almost all Americans are enrolled in Medicare, starting at age 65, of course. Yet they still face the risk of catastrophic health care expenses; Medicare doesn’t cover many long-term chronic health care needs and services. Economists determined that people incur an average of $122,000 in medical costs between the time they’re 70 and when they die — mostly paid out-of-pocket, except for low-income people covered by Medicaid.

Saying that health care costs in America are astronomically high and totally out of control would be a gross understatement. This is a money making machine that’s tied all the way to the lobby in the White House resulting in people having to work longer to maximize their savings and social security income levels to mitigate the risk of not being able to take care of themselves after they retire. This changing attitude toward work, discovered by a Gallup poll earlier this year, reveals rising concerns about these astronomical health care costs and a cultural shift America has to grapple with as an aging society has become a full-blown reality.

In 2009 I was charged U.S $670 for a hernia operation performed at Bangkok-Pattaya Hospital. According to my ex wife who works in the medical field this same operation would have cost somewhere between $14,000 - $22,000 in the U.S depending on the hospital. Last year I had varicose vein surgery performed on both legs at Queen Sirikit Hospital in Rayong and the total bill was 22,000 THB (U.S. $710) which included a two night stay in a private room, ultrasound exam, anesthesiologist, surgeon fee, pre and post op exams and prescription meds. My ex wife, sounding equally astonished, said that for both legs this would have cost somewhere between $28,000 - $38,000 in the U.S. Last March my next door neighbor in my condo building (also an American) had major heart surgery (bypass/valve replacement) at Queen Sirikit and his total bill was 77,000 THB (U.S. $2,480). Only you can guess how much this would have cost in the U.S.

My plan for retirement was simple: Keep a pile of money in the bank to cover my ass and use the services of a Thai hospital when needed, most of which are low cost with a reasonable level of quality care. I’ve recently been contemplating picking up another insurance policy here in Thailand especially if that becomes a requirement for maintaining my visa. Court is still out on that decision.

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Re: Why Americans are Flocking to Asia

Post by Gaybutton » Sun Feb 17, 2019 11:26 am

Dodger wrote:I’ve recently been contemplating picking up another insurance policy here in Thailand especially if that becomes a requirement for maintaining my visa. Court is still out on that decision.
I don't understand what you mean. Don't you currently have medical insurance that covers you in Thailand?

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Re: Why Americans are Flocking to Asia

Post by Dodger » Sun Feb 17, 2019 1:32 pm

Gaybutton wrote:I don't understand what you mean. Don't you currently have medical insurance that covers you in Thailand?
Sorry...poorly stated.

I had a policy in Thailand with Liberty Mutual but opted to cancel it last year after testing the waters at Queen Sirikit Hospital for myself and then decided to go the "self-insured" route.

I've been contemplating picking this policy up again, especially if immigration says it's mandatory. The fee structure at Queen Sirikit could always change at some juncture as well. Right now a farang pays exactly the same medical fees as Thai naval personnel and their family members and the hospital is geared to service some of Thailand's highest ranking officers so the quality of care is pretty good. Not up to U.S. standards in my opinion...just pretty good.

I have Medicare in the States as well but can't see myself ever using it. Assuming I would be experiencing some level of pain for something that would cause me to return to the States for health care flying coach would be out of the picture. For the cost of a Business Class ticket I could pay for a brain transplant at Queen Sirikit, thus the reason I was never interested in the supplemental Medicare programs being offered in the States.

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Re: Why Americans are Flocking to Asia

Post by Dodger » Sun Feb 17, 2019 3:24 pm

Just another tid bit on Medicare:

Medicare works only in the U.S., with limited exceptions. (none of these exceptions apply to retirees in Thailand) A retiree living overseas would need to consider other options, such as buying private insurance before moving, or enrolling (if possible) in health coverage abroad.

Some might decide they still want to keep — and pay for — Medicare coverage, thus preserving the option of U.S.-based medical care even as they continue to be based abroad. In that case, Medicare Part A, which covers hospital bills, is free for most individuals age 65-plus. But Medicare Part B, which covers doctors’ services, costs between $104.90 and $389.80 a month, depending on one’s income. If a retiree plans to settle overseas, it might make sense to drop (or not enroll in) Part B.

If a retiree returns to the U.S. and wishes to start Part B coverage, the premium could be 10% higher for each 12-month period that person could have been enrolled but wasn’t

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Re: Why Americans are Flocking to Asia

Post by fountainhall » Sun Feb 17, 2019 3:41 pm

Healthcare for all seems already to be one of the campaign slogans for 2020. I lost track of the number of times Bernie Sanders mentioned the free healthcare offered in the rest of the world during the last campaign. Of course, that was not true. In most countries, healthcare costs are paid for out of taxes plus additional contributions from patients. But it is certainly true that it is vastly cheaper for individuals who require healthcare than it is in the USA.

But . . . the points that have been made on this Board before are perfectly valid. In the USA you can get immediate treatment and elect your own carers - if you can afford it. In the UK, in Norway, in Sweden, in Australia and I'm sure in other countries, you have to join a queue for many procedures. Sweden claims the maximum wait time is 90 days. Many Swedes say they have waited longer. Some Norwegians say they hop over to Germany to avoid waiting lines at home. In the UK where waiting times can be longer, I recall reading that some administrators in the National Health Service wanted to send patients to India where the British taxpayer would actually save money and procedures could be undertaken much faster at a fraction of the cost. How true that was I don't know.

My only claim to any knowledge is that almost my entire family are/were doctors or other medical professionals. Grandfather, father, all uncles, brother, sister, niece, god-daughter . . . All work/worked in the National Health Service and all believe/believed passionately in it. Not one would consider leaving to join a private practice or to emigrate to the USA where they could have earned vastly more in salaries and perks.

But they disliked intensely and constantly criticised the management of the NHS and the shifting sands of its bureaucracy by different governments. Healthcare is always going to face the problem of funding new treatments, new techniques, new drugs, new diagnostic tools, expensive new equipment etc. And finance will always have to be rationed in some way. How that is achieved is a real issue that no government seems to have tackled effectively. All seem to agree that leaving the matter with civil servants without training in medicine and treatments is partly to blame for the recurring crises in the NHS. The cost of drugs is just one piece in a very large jigsaw.

Another issue almost all agree/d on is the responsibility of each of us as individuals. If, in spite of all the health warnings, people continue to smoke, continue to lead unhealthy lifestyles even after repeated warnings, continue to become grossly obese and as a direct result require the services of a health system more frequently and often much more expensively than the average citizen, then in general - and allowing for certain exceptions - there has to be some additional tax or penalty. If individuals do not heed warnings time and again, why should they pay the same as those who do heed them?

Contentious? Certainly. Practical? Possibly! Food for thought? Unquestionably!

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Re: Why Americans are Flocking to Asia

Post by Jun » Sun Feb 17, 2019 6:11 pm

Firstly, thank you to Dodger for publishing some costs of Thai medical procedures.
Somèthing I know very little about, but forms a large unknown in retirement planning.
fountainhall wrote:My only claim to any knowledge is that almost my entire family are/were doctors or other medical professionals. Grandfather, father, all uncles, brother, sister, niece, god-daughter . . . All work/worked in the National Health Service and all believe/believed passionately in it. Not one would consider leaving to join a private practice or to emigrate to the USA where they could have earned vastly more in salaries and perks.
All very well, but the customers should judge the NHS.

Where I live, the doctor sees the first 16 patients. So they queue outside, in the cold for up to an hour before the start. The doctor typically arrives 15 minutes late, despite driving a flash 500hp car. The patients may need to wait 2 or 3 more hours to see the doctor.
If I check the timetable for both practices, the total time each doctor us seeing patients amounts to 16 hours per week.
Of course, they theoretically travel to see sick patients as well, but I only know one person who had such a visit and the doctor completely cocked that up. Another family member decided to take her to hospital the next day, where she remained for 10 days. Lucky to be alive.
I can list at least 3 other major omissions in diagnosis amongst my immediate family members.

Some of the GPS are bloody useless, but very well paid for it. Seems they only pick up malpractice when it reaches Harold Shipman proportions.

Last time I went, doctor A ordered blood tests.
Being a communist state run organisation, they are too inefficient to e-mail the results. So I go back the following week and have to see doctor B. She says she wants to see something additional tested and I have to point out that was one of the items already included on the test sheet. She cannot even properly read the results.

See a good doctor and you are usually OK. The bad ones are dangerous.

In an organisation struggling with costs, some artificial intelligence would be cheaper and way more reliable. Fat chance of getting that innovation from a state controlled organisation.

A state monopoly is not the right model. Too inefficient and they don't even recognise the concept of customers. Citizens need choice and the funding needs to follow the consumer.

Neither is the US model the best one, simply due to the very high cost to the economy and the mediocre results.

I haven't had time to study it, but Singapore seems to get good results for a fraction of the US cost

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Re: Why Americans are Flocking to Asia

Post by gera » Sun Feb 17, 2019 8:56 pm

Jun wrote:Firstly, thank you to Dodger for publishing some costs of Thai medical procedures.
Somèthing I know very little about, but forms a large unknown in retirement planning.

[quote="fountainhall"
I haven't had time to study it, but Singapore seems to get good results for a fraction of the US cost
Financing of health care in Singapore is very complicated . Health care is by no means free for vast majority of citizens and permanent residents in Singapore. As many other things, health care is efficient over there As someone who lived in Singapore for an extended period of time, I can say that in many aspects Singapore is exception rather than the rule and a lot of what is going on over there is not scalable and cannot be extended to larger entities. I got impression that some of the posters here try to make an example out of this city-country to the rest of the world. It simply shows there total lack of understanding of Singapore and the rest of the world. To a natural question whether I would want to live in Singapore permanently, the answer is no ( but I could reconsider if my networth would be 100 times more than my current one).

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