[oVeRdOsE.]

Originally Posted by tranquility

How's the health insurance situation in the US, as I always hear horror stories of ppl getting bankrupt just because they need good medical care. Sure, if one has a job that provides coverage, that's fine, but what if they lose that job, then what?

What few friends telling me , is you need to put money under your bed for retirement and healthcare.

People are crazy about taxes here, but if you're uber sick, you loose your job or get a early retirement, you still can live somewhat well if you play your cards.

You can burn your cash no worries until late in your life. Don't wonder why most people here are running 10yo and less cars, have 4k tv with 13 kind of subscription, restaurant are full, and they can still travel. Because if something happen, gov got your back.
Even bankruptcy is a joke here, you can do 10 in your life and still having a gold retirement.

[e90335e36m3]

Lived all over. Instead of giving the rosy picture, I'll focus on negatives.

Money no object: San Diego area...it's the cheapest metropolitan area in CA and most conservative. As much as I hate CA and its politics, when I lived there, going to the beach after work gave me peace of mind like little else does. Another downside is that the people in all of CA are impatient, rude, entitled for the most part...so if you're a people person you wouldn't fare well there. I lived in CT and traveled to Boston and NYC almost every weekend, doesn't compare to CA. Californians take the rude cake.

Common Sense: Charlotte, NC. Nice clean city, great people. Not as conservative as I'd like, but leaning red. Food scene is terrible, city very poorly planned (I don't think they expected the massive population growth) with one lane country roads everywhere in the metropolitan area. People say hello to each other and it's safe. Cost of living is getting up there.

That said, despite the negatives I've been thinking of relocating back to SD, only way I would do so if I bought a home, at least I can build equity. No way I'd rent again. My 1BR in Chula Vista was $2175 in 2019, today it's $2775. Nuts. Want to get a house in a new suburb that's relatively isolated (e.g. Otay Ranch) and go to the beach after work.

[grocerylist]

Originally Posted by Joekerr

This is what I was referring to:
https://globalnews.ca/news/8477772/p...re-staff-work/

Then there is old Australia there (but from the Guardian, so not sure as to validity of source):
https://www.theguardian.com/australi...fing-shortages

I just personally find this decision to be very odd and not logical.



I'd certainly agree that those vaccinated should be less likely to transmit for the same period of time (but they can still transmit, just should be a shorter time frame correct?), but still - wouldn't you prefer a worker who did NOT have COVID and was unvaccinated, rather than a worker who was vaccinated but ALSO had COVID at that particular time they were attending to you? I know I would...feels like my risk is lessened.



Out of curiosity - would you also not feel sorry for anyone then that needed medical attention but couldn't be seen because there was a shortage of physicians / nurses because the government / hospitals told some doctors and nurses that they couldn't work anymore because they chose bodily autonomy over policy? Because I believe these doctors / nurses are willing to work...can't blame them right? It is policy. So would you get upset at the government / hospitals then?

Interesting about Canada considering allowing sick staff to see patients. Luckily AFAIK, things haven't gotten that bad here but I know staff at clinics are being pulled to work in urgent care for the surge. My wife today was just notified that they'll be having her clinic closed for the time being and she'll be working from home via Teladoc.

I'd like to keep it the way it is. With my limited knowledge, someone unvaccinated is more likely to spread covid than someone that's vaccinated. Also, the virus dose/load that you're exposed to is one likely determinant of ultimate illness severity (regardless of omicron generally being less severe for young people) and I'd have to assume someone that's vaccinated would be spreading a lower dose/load (than someone that's unvaccinated), until they possibly show symptoms and then are removed from work until they're better.

[2000cs]

As an adult I’ve lived in CA, OR, MI, NH, KY and FL. As I kid I also lived in TN, TX, KS and CO. I’ve traveled in all 50 states pretty extensively, mostly in my own car.

Every state has some great areas and wonderful people, and every state has some crap holes. Key factors for us were climate and proximity to some family, along with state income taxes, which put us in either TN or FL. We wanted to be on “big” water, with wide and far water views, which eliminated a lot of places. Warm climate eliminated the Great Lakes, proximity to family eliminated the coast of OR, NorCal and WA. We are about 60 miles south of Jax on the Atlantic, ocean front. Small town, one of the few remaining, so still barely affordable for us. This works for us but would not if I was commuting (I am retired).

It is hot and humid here in late summer, although the ocean breeze helps. I’m adjusted to it, my wife is not. 2022 will be the final year of trying for her; if she doesn’t adapt we will probably sell and move to one of the TN lakes (Cherokee is a favorite).

As an aside, when house hunting on line we found a neat trick. We look for pizza delivery at the house. If there is pizza within delivery range, there are also doctors, clinics, hospitals, shopping, movies, etc. That turned out to be a good test of whether we were getting too rural for our tastes/needs.

I’m not recommending anyplace specifically to the OP. There is good to be found in many places, the trick is to match to your preferences and needs.

[Germanauto]

Originally Posted by e90335e36m3

Lived all over. Instead of giving the rosy picture, I'll focus on negatives.

Money no object: San Diego area...it's the cheapest metropolitan area in CA and most conservative. As much as I hate CA and its politics, when I lived there, going to the beach after work gave me peace of mind like little else does. Another downside is that the people in all of CA are impatient, rude, entitled for the most part...so if you're a people person you wouldn't fare well there. I lived in CT and traveled to Boston and NYC almost every weekend, doesn't compare to CA. Californians take the rude cake.

Having lived in the Midwest for much of my life, I feel like San Diego is sort of the Midwest of California. Very slow and quiet pace of life, people are more simple and down to earth. None of the craziness and rudeness that people in LA/IE are deservedly known for.

But on the flip side, I find SD to be terribly boring. For people who enjoy a faster pace of life and world-class amenities, it's not a good fit. Small town vibe, it always feels like a lazy Sunday afternoon, which I suppose is what many people love about it.

[e90335e36m3]

Originally Posted by Germanauto

Having lived in the Midwest for much of my life, I feel like San Diego is sort of the Midwest of California. Very slow and quiet pace of life, people are more simple and down to earth. None of the craziness and rudeness that people in LA/IE are deservedly known for.

But on the flip side, I find SD to be terribly boring. For people who enjoy a faster pace of life and world-class amenities, it's not a good fit. Very small town beachy-vibe, which I suppose is what many people love about it.

Funny, I think SD is too big, too busy. Maybe I've just gotten older. That's why I'd opt to live in Otay Ranch or similar area because it's sort of on the outskirts of town but within 25 min of Coronado.

[chassis]

Originally Posted by tranquility

How expensive is it, it is really untenable esp for ppl who just got laid off? Pretty scary situation one needs to think about.

COBRA is a joke, like the entire healthcare system in the U.S. The system is utterly broken, a colossal disaster. This is not me talking, this is from billionaires and literati who are in a position to know and say such things. Physicians will agree with this in the right environment/context.

If you are laid off you don't need to take COBRA, you can choose the "Marketplace". See below. The law was revised a couple of years ago to remove the legal requirement to choose and pay for health insurance. Prior to this, paying for healthcare was legally mandated. It is no longer mandated, you can go without coverage if you choose.

Compare the U.S. on any outcome statistic (life expectancy at birth, prevalence of common diseases, etc.) with other highly developed nations, and the U.S. is no better and in many cases much worse. Then compare the total healthcare expenditure per year as a percentage of GDP and the U.S. is at or near the top. Summary: the U.S. has the highest cost (by far) system for no better outcomes, and in many case the outcomes are worse. A complete disaster of a system.

healthcare.gov is known as the "Marketplace". $500/month for a married couple no kids, for a bare bones plan that provides nearly no "benefits" other than limiting maximum financial liability. The deductible is high enough that if you are a healthy person, the cost of paying full retail for normal preventive services comes no where near the maximum out of pocket. This means the plan delivers nothing to you besides limiting your maximum financial exposure.

It's a garbage institution, the U.S. healthcare system. Germany has a far, far better system than the U.S., and in my view the German system should be adopted in the U.S. to the greatest extent possible over a period of years.

[gary_william]

Florida panhandle, or Texas. Loved Vegas (1st place I bought a house) and would recommend.

[kscarrol]

Originally Posted by ///MPhatic

It sounds like I can stop dreaming of retiring there.

Come an hour south to Greenville SC.

[///MPhatic]

Originally Posted by kscarrol

Come an hour south to Greenville SC.

Metairie was my first choice!

[tranquility]

Originally Posted by chassis

COBRA is a joke, like the entire healthcare system in the U.S. The system is utterly broken, a colossal disaster. This is not me talking, this is from billionaires and literati who are in a position to know and say such things. Physicians will agree with this in the right environment/context.

If you are laid off you don't need to take COBRA, you can choose the "Marketplace". See below. The law was revised a couple of years ago to remove the legal requirement to choose and pay for health insurance. Prior to this, paying for healthcare was legally mandated. It is no longer mandated, you can go without coverage if you choose.

Compare the U.S. on any outcome statistic (life expectancy at birth, prevalence of common diseases, etc.) with other highly developed nations, and the U.S. is no better and in many cases much worse. Then compare the total healthcare expenditure per year as a percentage of GDP and the U.S. is at or near the top. Summary: the U.S. has the highest cost (by far) system for no better outcomes, and in many case the outcomes are worse. A complete disaster of a system.

healthcare.gov is known as the "Marketplace". $500/month for a married couple no kids, for a bare bones plan that provides nearly no "benefits" other than limiting maximum financial liability. The deductible is high enough that if you are a healthy person, the cost of paying full retail for normal preventive services comes no where near the maximum out of pocket. This means the plan delivers nothing to you besides limiting your maximum financial exposure.

It's a garbage institution, the U.S. healthcare system. Germany has a far, far better system than the U.S., and in my view the German system should be adopted in the U.S. to the greatest extent possible over a period of years.

Tx, that's what I was afraid of. So employers have another leverage to hold over ppl for super-reliance upon employment.

[chassis]

Originally Posted by tranquility

Tx, that's what I was afraid of. So employers have another leverage to hold over ppl for super-reliance upon employment.

Sort of. Health insurance is not guaranteed for all, free of charge, by state or Federal government. Assistance programs are available, but for the average able-bodied and able-minded person, assistance is small or zero.

Health insurance is obtainable at a cost to an unemployed or self employed person. Options include COBRA, Marketplace or private insurance.

Health insurance cover is not a legal requirement, althought it was a legal requirement until recently.

[Germanauto]

Originally Posted by chassis

COBRA is a joke, like the entire healthcare system in the U.S. The system is utterly broken, a colossal disaster. This is not me talking, this is from billionaires and literati who are in a position to know and say such things. Physicians will agree with this in the right environment/context.

If you are laid off you don't need to take COBRA, you can choose the "Marketplace". See below. The law was revised a couple of years ago to remove the legal requirement to choose and pay for health insurance. Prior to this, paying for healthcare was legally mandated. It is no longer mandated, you can go without coverage if you choose.

Compare the U.S. on any outcome statistic (life expectancy at birth, prevalence of common diseases, etc.) with other highly developed nations, and the U.S. is no better and in many cases much worse. Then compare the total healthcare expenditure per year as a percentage of GDP and the U.S. is at or near the top. Summary: the U.S. has the highest cost (by far) system for no better outcomes, and in many case the outcomes are worse. A complete disaster of a system.

healthcare.gov is known as the "Marketplace". $500/month for a married couple no kids, for a bare bones plan that provides nearly no "benefits" other than limiting maximum financial liability. The deductible is high enough that if you are a healthy person, the cost of paying full retail for normal preventive services comes no where near the maximum out of pocket. This means the plan delivers nothing to you besides limiting your maximum financial exposure.

It's a garbage institution, the U.S. healthcare system. Germany has a far, far better system than the U.S., and in my view the German system should be adopted in the U.S. to the greatest extent possible over a period of years.

A lot of fair points, and I agree Healthcare system in this country is terribly convoluted and often impossible to navigate. But as a Physician who is certainly not living the high life yet thanks to my massive loans, I refuse to be a government employee and get paid like a government employee. Physician salaries only make up about 7% of total U.S. healthcare expenditures yet we are often blamed by the public for being overpaid. We are a cog in the system whose practice is dictated entirely by greedy Insurance companies and self-serving hospital administrations and politicians. After all the years of shit, sacrificing my entire 20s and the opportunity cost that comes with it, I'm looking out for my self-interest too.

[dreamingat30fps]

Originally Posted by RickFLM4

My wife and I own a condo in Asheville. Great place to visit but I couldn't live there permanently. OP wants red and Asheville is as blue as blue gets.

I’ve only been to Asheville maybe 2-3 times in the 7 months we have had the house in NC and usually only the outskirts. Shit we hardly even go to Boone anymore and that’s only like 30min away. I guess I’m just not a city guys, don’t like cities, don’t like people! I’m fine having 4 restaurants to choose from in our little downtown.

Originally Posted by tranquility

How expensive is it, it is really untenable esp for ppl who just got laid off? Pretty scary situation one needs to think about.

If you get it through an employer it’s not much, depends on the plan, but I never gave it second thought when I was employed. If you are unemployed you can get COBRA as mentioned, typically something you do just in between jobs. If you are self employed or just don’t want to work you can buy your own insurance and depending on your income you can qualify for a “discount” on that insurance and that’s what a lot of people call Obama care. When I was laid off like 5-6 years ago and decided to start my business I bought my own insurance and because I wasn’t making much money at the start I got a decent discount. Maybe I paid like $200-300ish per month for a decent plan. Now that I no longer qualify for any discounts I pay like $600 for a decent low deductible plan. I could probably get away with a cheaper plan, but I can afford it and I don’t want to think about it.

We also have Medicare for people 65+ I believe. While I have no personal experience with it, both my grandmothers were on it and they seemed to be at the doctors every other day. All their stuff seemed to be covered and I never heard of them having issues with that. We also have Medicaid which is for low income people… not sure how that works vs Obama care but I know we have both those things.

So the people that say you are going to die in the streets because you can’t afford health insurance in the US are full of shit. Plus if you are in such a bad place that you cannot afford ANYTHING and somehow don’t qualify for ANY of the programs you can still go to a hospital for emergency stuff and be treated even without insurance. You might get a big ol bill later, but if you are that bad off what are they going to do? There is no debtors prison. I personally know people who go bankrupt every decade or so for fun… people with homes and nice cars and jobs….

[Alfisti]

Where the US system amazes me is the money spent on healthcare is higher than most other places, including europe, Canada, Australia etc where it is primarily public. This circles back to what I said before, they find a way to complicate the simple and tie it up in all these rules and loopholes with a LOT of layers who all take their cut. There's this allergy to centralising services that leads to this brutal inefficiency.


How you spend more per capita than near anyone else and still have such a disparity in care is beyond me, that takes some effort to fuck up in such a way.

[fiveohwblow]

Originally Posted by Alfisti

Where the US system amazes me is the money spent on healthcare is higher than most other places, including europe, Canada, Australia etc where it is primarily public. This circles back to what I said before, they find a way to complicate the simple and tie it up in all these rules and loopholes with a LOT of layers who all take their cut. There's this allergy to centralising services that leads to this brutal inefficiency.


How you spend more per capita than near anyone else and still have such a disparity in care is beyond me, that takes some effort to fuck up in such a way.

I haven’t seen a disparity of care at all. I of course have heard if you need healthcare services in Canada you wait for weeks or months. Is this always true? I doubt it. Don’t believe everything you’ve heard about this on the internet.

Note: I’m not calling it efficient or even giving it a status of good or bad.

[Joekerr]

Originally Posted by fiveohwblow

I haven’t seen a disparity of care at all. I of course have heard if you need healthcare services in Canada you wait for weeks or months. Is this always true? I doubt it. Don’t believe everything you’ve heard about this on the internet.

Note: I’m not calling it efficient or even giving it a status of good or bad.

Actually, it is true to some degree. For example, my wife has people who have been waiting for 2 years to get some elective services done and she just can't get them in because she has to prioritize cancer and other more urgent things. Whereas in the States, if they are willing to pay, I bet these people wouldn't wait very long at all?

That said, what I've heard about the states, and would like grocerylist and Germanauto to chime in on to see if there is any truth to this:

Is it true that the insurance companies and hospitals in some degree dictate the care that the patient will receive? For example, lets say you want to order a CT and a few other tests because you believe it will be in the best interests of the patient and will dictate the course of care. Does the CT and all other tests first have to be approved by the insurer /(hospital)? Can you be blocked from ordering something? It is something my wife has heard that makes her nervous as she feels like it is a different way of doing medicine down there.

[RickFLM4]

Originally Posted by Alfisti

Where the US system amazes me is the money spent on healthcare is higher than most other places, including europe, Canada, Australia etc where it is primarily public. This circles back to what I said before, they find a way to complicate the simple and tie it up in all these rules and loopholes with a LOT of layers who all take their cut. There's this allergy to centralising services that leads to this brutal inefficiency.


How you spend more per capita than near anyone else and still have such a disparity in care is beyond me, that takes some effort to fuck up in such a way.

A lot of people don't even try to take care of themselves in the U.S. and many have terrible dietary and exercise habits that lead to various health conditions, which then leads to consumption of prescription drugs that we manage to pay more for than other places. I haven't seen comparisons to other countries, but I have to believe these are major factors in the phenomenon you mention. Different citizen health starting points and dollars spent on pills.

Also, I don't know how the spending numbers are compiled - using actual spending or using ridiculous "list prices" before insurance "discounts" which no one really pays but healthcare entities like to use because they inflate numbers to their benefit. For example, insurance statements show how much money they "saved" me by comparing my out of pocket cost to this ridiculous pricing that I would be required to pay without insurance. That part of the system is nonsensical and designed to confuse consumers.

[Murf993]

Originally Posted by fiveohwblow

I haven’t seen a disparity of care at all. I of course have heard if you need healthcare services in Canada you wait for weeks or months. Is this always true? I doubt it. Don’t believe everything you’ve heard about this on the internet.

Note: I’m not calling it efficient or even giving it a status of good or bad.

Canada's healthcare system is a mess. It is top heavy with administration/bureaucrats and under represented in healthcare workers. We pay almost the most per capita and have some of the worst wait times. Hallway medicine has been a problem for 20 years. I can't count how many hospitals have been closed to save money, and then they build large regional healthcare centres but they always take too long to build and often service such a large area that you have a long distance to travel to get to them. Covid has shone a bright light on how fragile our system is, we are locked down again essentially as a precautionary measure incase hospitals get overwhelmed. We have too few ICU beds for the population as the system is designed to run at near full capacity all the time so even a minor crisis can bring it to it's knees. Sure it's free but we are so heavily taxed that it's really quite expensive.

I will say that if you are critically ill you will get excellent care quickly, but if you are in a chronic or non-critical illness be prepared to wait. I needed an MRI on my neck, I waited 3 months and then had to take an appointment 30 miles from home at midnight to get seen.

[Joekerr]

Originally Posted by Murf993

Canada's healthcare system is a mess. It is top heavy with administration/bureaucrats and under represented in healthcare workers. We pay almost the most per capita and have some of the worst wait times. Hallway medicine has been a problem for 20 years. I can't count how many hospitals have been closed to save money, and then they build large regional healthcare centres but they always take too long to build and often service such a large area that you have a long distance to travel to get to them. Covid has shone a bright light on how fragile our system is, we are locked down again essentially as a precautionary measure incase hospitals get overwhelmed. We have too few ICU beds for the population as the system is designed to run at near full capacity all the time so even a minor crisis can bring it to it's knees. Sure it's free but we are so heavily taxed that it's really quite expensive.

I will say that if you are critically ill you will get excellent care quickly, but if you are in a chronic or non-critical illness be prepared to wait. I needed an MRI on my neck, I waited 3 months and then had to take an appointment 30 miles from home at midnight to get seen.

Exactly this. And bloated like any other government service.

[UncleWede]

Originally Posted by Joekerr

Is it true that the insurance companies and hospitals in some degree dictate the care that the patient will receive?

I went to my online pharmacy. I have had battles with them in the past because they want me to use the Dexcom, and I can only wear the Libre.

Recently, I was of the understanding that the Libre 2, being that it included a warning for out of range blood sugars, was now considered a true CGM device. I noticed on the website that the Libre 2 was listed, and had a reasonable price for 90 day supply. I made a request, and the pharmacy was supposed to contact my Dr.

Dr. was never contacted (she says) I had an appointment, and mentioned I wanted the Libre 2. She wrote the script, it was sent to pharmacy. Pharmacy decided I should get the Dexcom, substituted that, and sent me a 90 day supply.

I contacted the Dr. first. Did you send Dexcom? No, we sent Libre 2, but the pharmacy replied back that you wanted the Dexcom. No, I want nothing to do with Dexcom. Please submit the Libre, even if I have to pay non-insurance price.

Yesterday pharmacy notified me that were processing my Libre 2. I'm not holding my breath.

[Joekerr]

Originally Posted by UncleWede

I went to my online pharmacy. I have had battles with them in the past because they want me to use the Dexcom, and I can only wear the Libre.

Recently, I was of the understanding that the Libre 2, being that it included a warning for out of range blood sugars, was now considered a true CGM device. I noticed on the website that the Libre 2 was listed, and had a reasonable price for 90 day supply. I made a request, and the pharmacy was supposed to contact my Dr.

Dr. was never contacted (she says) I had an appointment, and mentioned I wanted the Libre 2. She wrote the script, it was sent to pharmacy. Pharmacy decided I should get the Dexcom, substituted that, and sent me a 90 day supply.

I contacted the Dr. first. Did you send Dexcom? No, we sent Libre 2, but the pharmacy replied back that you wanted the Dexcom. No, I want nothing to do with Dexcom. Please submit the Libre, even if I have to pay non-insurance price.

Yesterday pharmacy notified me that were processing my Libre 2. I'm not holding my breath.

This is precisely the crap I would worry about.