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David C. Murray

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Everything posted by David C. Murray

  1. 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?
  2. 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?
  3. 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.
  4. 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
  5. 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.
  6. Yes. And it's not "el Grosso". It's just "Grosso" which is to say, "grosso!".
  7. So your hair ends up bug-free but dog-slobbery, Tiffany? How enchanting an image.
  8. 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.
  9. 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.
  10. 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.
  11. 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
  12. Oddly enough, I just did a Trivago.com search on Fort Lauderdale hotels, !Mark! There appears to be a wide variety of reasonably priced places available through Priceline.com. I don't know how close to the airport them might be.
  13. We have not used this service but we do highly recommend it. A competent attorney/notary's research via the National Registry of any property you're thinking of buying should be your very first step. And, if losing the money might be a setback for you, hire a second attorney/notary to check the work of the first. And always, always have this service performed by an attorney/notary who is working for you and not for either the seller or for some real estate agent. It's my understanding that there is Internet access to the National Registry, so while some law firms may have some sort of direct access, it really isn't necessary.
  14. We've always gone back to Michigan, imposed ourselves on family and friends, and borrowed Marcia's sister's car. We were there in May, so we won't be going back anytime soon. My original inquiry was just for planning for the future. Things in Michigan are changing.
  15. Well, you could hire a qualified Costa Rican and direct him or her to " paint a tree over here and an oxcart over there . . .". That way, you would be directing the work but not performing any physical tasks yourself.
  16. Er . . . ah . . . Paul, I'm not sure how a "humidifier" will help control mold and mildew but I am sure that a dehumidifier will do better. That said, ozone generators and combination ozonators/ionizers work well, too and they're much less expensive to operate than a dehumidifier (less maintenance, too).
  17. Well then, maybe you should rethink all this since it'll take about five years to achieve permanent legal resident status after which time you can apply for a "carry" permit. Wouldn't want you to get a sunburn while you wait.
  18. As with so many things that are posted on the Internet, the article you cite isn't dated, so it's impossible to know if the information is current or not. Best to engage a competent Costa Rican attorney to research the current state of affairs before undertaking this project.
  19. . . . and becoming a permanent legal resident typically takes about five years. It seems that becoming a temporary legal resident is now taking a year or longer. Then, after you've been a legal temporary resident for three years, you can apply to become a permanent legal resident. That'll take another year or so. Only after becoming a permanent legal resident can you commence the process of obtaining a permit to possess a firearm. Non-residents (tourists, mostly) cannot possess a firearm except under a very few and very restrictive conditions. Almost no one would qualify.
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