The Continued Failure of the USA Health Care System and Our Politicians

Providing a health care is extremely costly everywhere. Rich countries nearly universally provide a health care system that allows all citizens to get needed health care. Nowhere is it perfect and nowhere is it cheap. And nowhere is it more of a mess than in the USA.

Sadly those we elect in the USA have continued for the last few decades to keep the USA healthcare system the mess we have now. The Affordable Care Act took a relatively small step in addressing several of the most flawed aspects of the USA system. It left unaddressed many of the major flaws. Instead of taking where we are now and making improvements to address the problems left from decades of Democrat and Republican created and maintained USA health care policy all we have had it demands to “repeal Obamacare.”

This is exactly the type on avoiding improvements to maintain the existing (for the last few decades) broken healthcare system those in the USA must live with. Cutting hundreds of billions from the budget to provide health care to the elderly is not improving the health care system.

Making next to no attempts to actually improve healthcare outcomes in the USA shows how flawed the current process is. It continues the behavior of the Republicans and Democrats for the last few decades. It is sad we continue to elect people behaving so contrary to the interests of the country.

The exceedingly costly health care system in the USA is in need of a great deal of work to improve the government policy that results in the mess we have now. Some of the huge issues we face.

photo of the Capital building in Washington DC

photo of the Capital in Washington DC by John Hunter.

  • Pre-existing conditions – this has long been a huge problem with the USA healthcare system and one of 2 major things ACA dealt with well. ACA greatly improved the USA healthcare system in this area, something that Democrats and Republicans had failed to do for decades. Current attempts by the Republicans are to gut these improvements. This is a completely unacceptable area for all but the most extreme people to even be looking at. That the Republican house members approved this radical removal of health insurance coverage from tens of millions of people and the vast majority of Republican senators has not expressed outrage and such attempts to punish those who have been sick in the past is pitiful. The USA even with the ACA does a much worse job on this measure than any other rich country in the world.
  • Medical bankruptcy – due to the decades of poor leadership by the Republicans and Democrats the USA is the only rich country with this as a macro-economic factor. The ACA made small moves to improve this but much more is needed. Instead of improving the USA healthcare system to deal with this long term problem the current Republican efforts will great increase the number of medical bankruptcies in the USA if they succeed in their efforts.
  • Massive cost-tax on all economic activity due to the costs of the USA healthcare system. The USA healthcare system costs twice as much per person as other rich countries (there are few countries with costs that have costs which the USA “only” 50% or 75%… but overall it is twice as costly) with no better outcomes than other rich countries. ACA did nothing to improve this (certain aspects of the ACA did but other aspects balanced those out), the new plans are not going to do anything to improve this (in a minor way it is possible reducing medical care for the elderly could reduce costs by having people die much sooner but given the mess of the USA healthcare system for many reasons the huge reductions in Medicare and Medicaid are unlikely to actually result in cost savings that are material).
  • Tying health care to the employer – The USA is one of the few rich countries to do this. Combined with refusing or providing only inadequate coverage for those with pre-existing conditions this is a great barrier to small businesses and entrepreneurship. ACA didn’t address this directly by eliminating the pre-existing condition failure it did greatly reduce the harm this causes the USA economy and individuals in the USA. The current proposals don’t address the problem and exacerbate the issue by returning the huge problems the USA system has in dealing with pre-existing conditions (it would be slightly better than before the ACA but much worse than what we currently have with the ACA).
  • A huge burden on individuals of dealing with insurance company paperwork, fighting with the medical system and insurance companies… Neither ACA nor the current plans made any improvements in this area.
  • The USA pays much more for drugs than any other country. This is directly the result of decades of failure by Democrats and Republicans to create sensible healthcare system policies for the USA. Neither ACA or the current plans made any significant improvements in this area.
  • Of interest to the readers of this blog the current USA healthcare system doesn’t deal at all well with the reality that tens of millions of USA citizens travel and live overseas. This is a complicated issue but it has been unaddressed for decades. It is pitiful that ACA didn’t address it and the current plans don’t address it. Even things that would be able to save tens billions of dollars by allowing healthcare to be preformed overseas (at much lower costs) for say Medicare are not addressed. There are complexities in how to craft policy to save tens and hundreds of billions of dollars this way. So it isn’t something you can expect to be addressed in a year or two. But they have had well over a decade since the obvious huge savings potential has been apparent and nothing. When you are going to cut health care benefits of the elderly to save money and don’t bother using wise policy to save money without reducing the care people receive you are failing as policy makers. And we are failing by continuing to elect these people that decade after decade fail to make wise policy decisions and instead force us to suffer with a poor healthcare system.
  • Continue reading

New International Banking Solution for Small Business and Digital Nomads

One of the significant hassles of a the new digital economy is that national borders are largely irrelevant to digital businesses but the banking infrastructure is still stuck in the past. Dealing with international payments is a hassle and can be expensive.

Transferwise has been providing good service for years in helping people move money between currencies at transparent and reasonable rates and with good service. They have a very interesting new service: Borderless banking. They allow you to create an account based on many countries in Europe as well as in the USA (about 30 states so far).

This is a great service, as I have written: finding an international business bank as a digital nomad is challenging.

You may hold funds in your Borderless account in 15 different currencies at the this time. You may send money to someone else using 50 different currencies via Transferwise. With a Borderless account you will be able to accept payments as a local company from Europe, UK and the USA – those paying you can send electronic payments as they normally do using their bank (the process is seamless to them, they treat your bank account just like any other they make payments to).

image showing the currencies Transferwise allows

Transferwise allows you to hold Borderless balances in these 15 currencies.

The fees are mainly a fee to change currencies (often between .5 and 1%) which is very reasonable. So if you hold money in USD and want to pay someone in Mexican Pesos you pay 1% (reduced to .7% over $10,000). USD to Indian Rupee is .9% (reduced .7% over $10,000).

Importantly currency conversion takes place at the real mid-market rate for the currencies (many banks hide fees by giving you bad conversion rates).

In checking costs on their site I have noticed changing from USD to another currency is often higher than from another currency to USD. For example, Euro to USD is 1%, USD to Euro is .5%. USD to Singapore dollar is 1% (reduced to .5% at $5,000) while the reverse is .5%.

Continue reading

Proof of Onward Travel

One of the annoying worries is the possibility of an airline asking for “proof of onward travel” before checking you into your flight. Airlines do this theoretically because they may be liable for getting you back out of the country. Airlines also check that you have a visa for the new country for this reason (which also confirms you have a passport).

It makes sense that they check that you have a passport with a visa for the destination. Still you could be rejected from entering even with the visa. If that happened I don’t see what good it would do to have a plan reservation in 50 days going somewhere. I suppose the country might push the responsibility for getting you out of the country to your departing airline but I seriously doubt it. If you claim you can pay to leave I would have to imagine if some other party gets stuck with the bill it is likely the airline that delivered you.

photo of Air Asia airplane at Yogyakarta, Indonesia airport

Air Asia airplane at Yogyakarta, Indonesia airport

I suppose it could also be the airline only gets stuck if you don’t have proof of onward travel. And if you have that proof they are still responsible for getting you back but someone else pays until someone can collect the money from you (and gets stuck with it if you never pay). This seems pretty unlikely for most “normal” travelers from rich countries that have credit cards which would just be billed for whatever cost there is.

It sure seems to me that credit cards should add a perk to “gold cards” (or even less fancy card types) that promise to bill whatever costs accrue due to you being forced out of the country to you (and just like other costs the credit card issuer is stuck paying the cost if you don’t pay them back).

Continue reading

Making Money as a Nomad in the USA

There are many posts about how to make money online as a nomad. Some ideas work pretty well for some people (freelance work – especially as a digital nomad, writer, bookkeeper, etc.). The biggest problem isn’t learning about these options (they are repeated all the time in many different places online) but actually making them work for you. It can be done and is actually easy for some people, for others it is a very hard (the biggest challenges are having the right skills, marketing and establishing a base of clients).

I have been paying much more attention lately to nomads in the USA which opens up income possibilities in addition to online income. More than I ever saw in digital nomads there are some people making a decent amount from YouTube (documenting the vanlife/RV-life and their travels) – still this is likely a crowded market and being successful will be hard (but aiming at providing a small bit of additional income may be an option for a larger group of people).

In this video Kev provides a good recap of some of the nomadic and location dependant options: getting day jobs through craigslist and temp agencies. Another popular idea is workcamping. These are essentially temp jobs specifically targeted at nomads (campgrounds, farming help often at harvest time) and some that get lots of interest from workcapers Amazon… seasonal hiring, etc. These often don’t pay a large amount of money but for people that have very low fixed expenses (no “sticks and bricks” to pay for as they travel and live in the RV/van) it can work.

Another potential source of income for earning money providing services to other nomads (work on vehicles, install solar/electrical, haircuts, etc.).

Another idea that can work is an etsy store such as the one Driving and Vibing have earned most of their income from.

Kev also mentions a digital nomad income source in his video: human intelligence tasks (mechanical turk). Find some of the better options; though these usually don’t pay very little.

Related: Vanlife in the USAHousing Savings When Living as a NomadGolden Rules for Making MoneyNomadic Businesses in the Age of the Internet

Vanlife in the USA

I have been reading about the possibilities of living in a van (customized to be a small RV) for several months. I am getting more interested in this idea. The cost of living in the USA is so high, especially if you want to travel – which I do.

The combination of where I want to travel (National Parks, National Forest and nature largely) and the cost effectiveness for van living works out very well. You can often park for free in US National Forest and BLM land. Also the cost of campgrounds is much less than any form of lodges, motels or hotels; so even in the instances you pay for lodging the costs are greatly reduced.

Another option for free parking are many Wal-Marts across the country actually don’t mind RVs and vans parking overnight. Many other businesses are hostile to just using their parking lot overnight when it isn’t being used. I must say this is something that greatly increases my opinion of Wal-Mart. I am not a huge fan in general but this is a very real positive action they are taking. It definitely encourages me to shop there.

Stealth parking on city streets or parking lots is another option with van living. Often cities seek to stop such living which is why the stealth part is important. Some cities and residents are more apposed to the practice than others. Obviously if there are negative externalities from you parking your van for a long time that will encourage people to seek to stop that. But if you don’t make anyone’s life worse there is much less likely to be an issue.

Even if you don’t it can make residents, police or security guards nervous (which I understand is possible in some instances) and that is something that again makes it more likely you will be bothered and maybe not allowed to park. I am still in the early phase of learning about all this but it does seem a tactic of driving to a sleeping spot at night and leaving early in the morning is a good idea. And moving around so you don’t park in the same spot (that people will notice anyway) for long periods of time.

[removed embedding video that no longer exists]

One of the words I learned recently is boondocking, which is free camping and at least when I have read about it means also off the grid (no electrical connections, water…) for your RV (or a van that is able to plug in to services). I knew that this was somewhat available on USA Federal Government lands (BLM and forests) but I think it is much more available than I thought (I am still learning so…).

Continue reading

Reporting on the Noise Level of Lodging Options

I would love a service that reports on the noise level of hotel rooms, apartments for rent etc.. I am far more sensitive to noise than others. And in my nomadic existence the most annoying thing for me was noisy places. Even in renting out apartments on a regular lease I had serious problems with extreme noise issues.

Reading reviews will provide some level of noise warnings when past travelers complain about noisy conditions. But this is time consuming (reading through lots of reviews to try and see) and not very accurate. Technology could provide a better alternative, even if it still isn’t perfect.

No solution is going to be perfect but it would be nice if there was a device that you could put in rooms and it would measure the decibel level and record loud noises. I would image smart engineers could design it to automatically categorize many noises. The device could then provide a report of how noisy it is and what kind of noises were recorded.

The idea is the device could be placed in empty rooms/apartments and create a record. That record could then be shared with prospective renters. I realize there are issues with making this work. But I think the market is significant.

One big market to consider (likely the biggest by far) for selling such a device and service to would be large hotel chains. They could gather data on noise issues in their rooms. They could make improvement and measure the improvements. They could gather data on what measures work and which don’t. They could use data to guide reservations for those expressing a desire for a very quite room to the rooms that best fit their needs. I also think for apartments there could be a bit market.

I realize the number of people that noise is as big an issue as it is for me is small. But there are a reasonable number of people that are bothered by noise that such a service would be worthwhile I think.

I sure hope someone fills this need. And if someone is already offering such a product and service I hope the market adopts it quickly.

Noisy fans are good for providing white noise to cover distracting noise. That is very helpful in many cases. It isn’t so great at covering up loud hallway noise (though with the right room setup and fan placement it can be ok in some rooms). The integrated units in the walls can be decent but for example are usually not good for dealing with hallway noise. And also some are designed so you can’t run the fan all the time (it only goes on if cooling or heating is needed): if you are creating a hotel (or the heating and AC system) make sure the fan can be set to run at all times.

Related: Gadgets to Mask Noise and Help You Sleep or ConcentrateTurn Windows Into Sound Canceling FiltersDealing with Noise Pollution in Your CondoFinding Places to Stay to Stay with Decent wifi

Continue reading