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David C. Murray

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Everything posted by David C. Murray

  1. If the others are correct, that this "natural" pool would be something through which flows a natural source of water, then I'd advise you to have that water source tested before you commit to construction. Not all the free-flowing streams and rivers in Costa Rica are clean and pure, and some that originate on Volcan Poas (and maybe from sources near other volcanos, too) are very acidic.
  2. I like simple, too. When we go to the States, I buy a prepaid AT&T card from the AT&T Store. It has, of course, a limited number of minutes, but you can add to that online if you wish. They also offer a "voice plus data" prepaid plan that's been useful when we were beyond any Wi-Fi coverage. Trying to sort out the details of the various plans and providers gave me a major headache. Maybe the AT&T deal isn't the best, but it's tolerable and it's a known quantity now.
  3. None of the foregoing has anything to do with ObamaCare or your confused objections to it. Discussion over.
  4. 1) It was the Bush Administration and their supporters in Congress who drafted, amended and enacted Medicare Part D. That law does, indeed, prohibit price negotiation within the Medicare Part D system, but you've asserted that (paraphrasing) it's illegal for a government agency to require price negotiations or volume discounts. Unless and until you can name one (just one) other federal law that contains such a proscription, you will remain wrong. 2) I would never suggest that Republicans are more responsive to human needs than Democrats. What I will say, with respect to Medicare Part D, is that the Bush Administration wanted it and the Republicans (and indeed some Democrats) in Congress were rubber stamping anything and everything the Bush Administration wanted in those years. If you don't believe that, have a cursory look at the enactment of the Patriot Act, the Authorization to use Military Force which "justified" the U.S.' invasion of Iraq, and the Bush tax cuts for the wealthy for prime examples. 3) In my response #25, I quote your own words that ". . . it is ILLEGAL for a [emphasis added] government agency to require Pricing . . or Volume discounting." What you said then, and what I'm saying now, is that you're simply wrong. When you wrote that " . . . a government agency . . ." you cast your net over every agency of government in the United States -- federal, state and local. And you got it wrong, as I pointed out. Not only is the VA permitted to negotiate prices but so are fifty state Medicaid programs, the Medicaid programs in Puerto Rico, Guam, the U.S. Virgin Islands and elsewhere, the States Title V (Children witjh Special Health Care Needs) programs, many or most governmental employee health plans, health systems which the government runs or subsidizes for underserved areas and Native American reservations and elsewhere, the entire U.S. military medical establishment, and in other settings. For you to assert that it is illegal for a governmental agency to negotiate price or volume discounts, you simply don't know what you're talking about. Or prove me wrong. Cite one (just one) other example. ____________ ‚ÄčAnd as for throwing Senator Kennedy under the bus, I did no such thing. If he supported passage of Part D, he's to be thanked for that. I've never said it was a bad thing. But understand, too, that plenty of things passed through Congress in his years there that Senator Kennedy neither favored nor supported. By a very wide margin, he did not get his way every time or things would be very different today. _____________ And, by the way, you have yet to volunteer yourself and your entire extended family to be among the nameless, faceless "them" who go without health care coverage. When will we be hearing about that? Remember, you and they are equally "them". (See Response #2.)
  5. Don Ron, you wrote, " I am a bit confused, and thus delayed in response, by your most recent POST #31 where you state " you have to have your facts right" . I THOUGHT WE WERE TALKING POLITICS, WHAT THE HELL DO FACTS HAVE TO DO WITH POLITICS ????? The facts "have to do with [it]" once the political process is complete. Once the law (ObamaCare, in this case) becomes the law of the land, politics ceases to be relevant. Then (and, sadly, only then) are we confronted with the actual, verifiable truth of the matter.
  6. I'm easy to lick in an argument, but you have to have your facts right. If not, whose fault is that?
  7. Friend Ron, once again you're off base a little. First, it was the Bush Administration, with strong support from Congressional Republicans, who passed Medicare Part D (the prescription drug benefit). It was the Bush Administration and their supporters in Congress (maybe Senator Kennedy but hardly on his initiative alone) who included the "no price negotiation" provision in Medicare Part D. It is not (absolutely NOT) ". . . ILLEGAL for a government agency . . to require Pricing . . or Volume discounting". In fact, every State's Medicaid program does exactly that. They, not the drug companies, set the reimbursement rates for the drugs on their formularies just as the VA does. Too, every federal government employee health plan (and most other governmentally-sponsored health insurance policies) control drug costs by setting maximum prices they will pay. In fact, what most (maybe all) Medicaid plans require is that pharmacies charge the wholesale cost of the drug to the Medicaid program and then add a small fee to cover administrative costs and to permit a modest profit. You and others concentrate one one or just a few of the weaknesses in ObamaCare but ignore its strengths and benefits. I would never suggest that the ObamaCare law is perfect. And I've said before that it's not the design I proposed to anyone who would listen. That aside, it's what we've got, and rather than advocating repealing it in its entirety, we should recognize the best of it and remedy its shortcomings. ObamaCare, like every other law Congress has ever passed, is subject to revision. And while we're at it, what's your complaint with ObamaCare's prohibition of termination of coverage when people actually get sick? What is it you don't like about the mandate for coverage of pre-existing conditions? Tell us how awful it is that children can be covered by their parents' insurance up to age 26. Tell us how expanding Medicaid coverage to those who have never had medical care is such an awful thing. Why is it that reducing excessive payments to Medicare Advantage plans is so bad? Shall I go on . . ?
  8. You're right, Ron, I'm not going to leave this alone. So, did you go home and take your pill? And did it help? Is this the improved version?? If yes, what were you like before? <set shudder = off>
  9. Ron, harking back to the 1970s, it's been an established fact that about a quarter of one's lifetime medical expenses (in the U.S., that is), on average, are incurred during the last month of life. That is easily attributable to physciians' heroic attempts to prolong patients' lives and to patients' and families' reluctance to acknowledge the obvious. The costs associated with intensive hospital care, the absurd costs of cancer and other drugs which appear to have limited long-term benefits, etc all add to those costs. What I still want to know is when and where President Obama said that "Patients should go home, take a pill, and go to sleep" or words to that effect which you attributed to him. Where did you get this?
  10. And were it mine to do, I'd scrap the VA Medical System altogether and give veterans access to the care they need in the civilian medical community. For better or worse, smart or stupid, people generally want to receive their care close to home. Too many veterans must either travel unnecessarily long distances past equally good care, endure long waits while civilian resources are more readily available, or go without. Where's the logic?
  11. Ron, ObamaCare made revisions to Medicare, so in fact those over 65 and covered by Medicare are affected by ObamaCare. Government exists, in large measure, to address needs and problems which we cannot address as individuals. Imagine using exclusively your own resources to protect your home, evaluate the medications you use, build the operating suite you're likely to need one day, train the surgeon, and pave the streets you drive on. ObamaCare addresses needs which we, as individuals, cannot address entirely on our own. Hark back to the days when you had private health insurance. How much excess profit was included in your premiums? What exclusions were included in your coverage? And where did you turn when coverage was denied? And to address these and many other problems, the Republicans proposed . . . what? Yup, hospitals and insurance companies are smiling all the way to the bank. What's your point? Then-Governor Romney could have vetoed RomneyCare just to make a political statement, but he didn't. Why not? Because until it took on the stench of Democratic support, he understood that it would be good public policy. And it has been. Remember, it came out of the Heritage Foundation. With the federal government paying 95 - 100% of the cost of expanding Medicaid, the states are in little jeopardy of bankruptcy. And even if the federal government did default, Congress could easily change the law. In the meantime, even some Republican governors have recognized what a sweet deal Medicaid expansion is. Imagine that . . . Republicans! And finally, we are, indeed, a democracy, as you rightly point out. But at the federal level, we are a REPRESENTATIVE democracy, not an absolute one. We have the founding fathers to thank for that. Absent a constitutional amendment, there is no provision for any national referendum on ObamaCare or anything else.
  12. ron, you've bought into several misconceptions about both the U.S. and the Canadian situations. In Canada, patients who need hospital services are often scheduled an a number of hospitals in order to get the first available appointment. So if your doctor gets you on the list at (say) three hospitals, that makes it appear that three times as many people need that care and that the waits are three times as long. Instead, you need to analyze an unduplicated list. That's not to say that sometimes care isn't delayed, but the Canadian picture isn't nearly as bleak is it's sometimes portrayed. Please tell us who says that Canada took twenty years to recover from the national health system that's still operating today. Note that Canada did not suffer the economic meltdown earlier this century that the U.S. did. In the U.S., the law states that those who present at a hospital in need of medical care must be evaluated and stabilized but nothing more. So if you think, for example, that someone with a fracture who needs surgical reduction will get it for free, you just don't understand. What they'll get is a x-ray, a splint, and the recommendation that they consult their own orthopedic surgeon. Same for the uninsured who need a cardiac stent, cancer care, or whatever definitive care is called for. Evaluate . . . stabilize . . . refer. That's it and nothing more. ObamaCare puts a cap on the profits that insurance companies can make. In fact, they must return about 80% of premiums to customers in the form of care reimbursement. Already, several billion dollars in excess premiums have been returned to policyholders. More's to come. (Interesting aside . . . Whereas ObamaCare requires that commercial insurance companies return 80% of premiums in payments and limits administrative costs to 20%, Medicare and Medicaid operate on administrative costs of 1% to 2% and they pay lower reimbursement rates.) The money "diverted" from Medicare actually hasn't been diverted at all. It's been reallocated within Medicare. In a clumsy attempt to privatize Medicare, Congress came up with "Medicare Advantage" plans which may offer somewhat broader coverage and for which Medicare pays commercial insurance plans much, much higher rates. Medicare Advantage plans are very profitable for insurance companies. What ObamaCare does is reduce the excess payments under the Medicare Advantage plans and allocates those funds to Parts A, B and D (and maybe elsewhere). The effect is to make Medicare buy-in coverage (e.g., Parts B and D) less expensive for those not in a Medicare Advantage plan. Before the implementation of ObamaCare, some fifty million residents of the U.S. were without any medical care coverage whatsoever. And it was estimated that there were some eleven million illegal aliens in the U.S. So we can reasonably state that some 39,000,000 Americans had no health care coverage. ObamaCare sought to remedy that problem and it has done better than expected. If you feel that it's just fine for that many of your fellow citizens to be without health care, I'll agree with you on just one condition. I'll go along as long as we agree that among the thirty-nine million without access to heath care are you and your entire extended family. As long as the shoe is firmly on your foot, I'll go along. Virtually every U.S. state requires that you buy insurance from a private company . . . every one. Just try to register your car or renew your license plates without public liability insurance (bought from a private company). Likewise, private companies impose a virtually identical requirement. Just try to get a mortgage without homeowner's insurance. The point is, indeed, to spread the liability as broadly as possible just as the ObamaCare mandate does. It's a sound public policy first proposed by none other than the Heritage Foundation (that bastion of liberal thinking) and enacted by none other than then-Gov. Mitt Romney. Because the commercial insurance companies now have a much broader base of potential customers, they love ObamaCare. The profit rates are lower but the overall profits are higher. Volume counts. Don't assume; ask 'em. And the hospitals, especially in those States wise enough to have expanded Medicaid enrollment, are pleased because they have far fewer patients who are unable to pay and never will be. Don't assume; ask 'em. If President Obama said that the greatest expense to Medicare comes in the final months of a senior's life, he had it right. That statistic has been available since the 1970s and it's been no secret. If, indeed, he ever said, "Maybe they should go home, take a pill and go to sleep.", please cite the reference. When did he say that? Where? And in what context? Please be very, very specific. If this is something you think you heard somebody say sometime, maybe you should do a little more research. Make no mistake. ObamaCare isn't perfect. It won't solve the entire problem. And it's certainly not the approach I would have taken and which I tried to propose to virtually anybody who would listen. That said, it's better than what we didn't have before and it will get better still as more of our fellow citizens are covered. If that means nothing to you, disenroll in whatever covers you now and go without. And take your own family with you. What's good enough for "them" is good enough for you.* *The Murray Sincerity Test
  13. In my youth, when the streets were still lit by gaslight, we'd drive across the Potomac into DC and buy a six-pack of Budweiser (about $3 even then) and a case of Senator Club (24 for $2.05 plus deposit). After downing the Buds, the Senator Club tasted just fine, otherwise . . . grosso.
  14. Yes. And it's not "el Grosso". It's just "Grosso" which is to say, "grosso!".
  15. So your hair ends up bug-free but dog-slobbery, Tiffany? How enchanting an image.
  16. A word of warning . . . Properties have been "sold" in the past by persons who are not the actual owners, so in addition to verifying whatever's recorded in the National Registry, insist upon seeing the seller's cedula or passport to verify his or her identity. Too, if it were mine to do again, I would have my own surveyor survey the property and mark the corners and boundary lines about every twenty meters. If you end up buying the property, have your surveyor's drawing (plano castrado) recorded in the National Registry as the official plat map. And a second word of warning . . . If the property you're thinking of buying is not recorded in the National Registry, pass on it and find a piece that is. Buying an unrecorded plot can become a nightmare.
  17. I agree, Dana. Current employees of the State of Michigan pay 20% of their BC/BS premium -- about $160 per month. So the total premium is about $800 per month. That, of course, is for a single employee. To cover the family costs more. And then there are the deductibles and co-pays.
  18. Fee-for-service is definitely less expensive here than in the U.S., but with the advent of Obamacare, many more people in the States have or have access to insurance coverage to pay those higher costs. Some expats who originally came to Costa Rica to take advantage of its accessible medical care may be finding that care in the U.S. is equally accessible now. And, at the same time, the range of services, especially at the highest levels of sophistication, is much greater in the north. A population of 4.25 million or so just cannot support the medical infrastructure that a population of 320 million or so can. You can rest assured that as insurance coverage becomes more widespread, providers will accept it or leave the field. Many insurance companies which declined to participate in the exchanges originally are now indicating their intention to participate, and the early evidence is that costs will be less than originally projected.
  19. Attorneys in Costa Rica charge much less than American attorneys. I can't quote you a figure, but I promise it won't break the bank
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