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June 29th, 2012

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  1. Matthew
    June 29th, 2012 at 01:43 | #1

    It will take a few days to digest the ruling and what it means….but Luis, come on. You are living in Japan. You have real health care now. This ruling only goes to show how far behind the usa is to other countries. I see headlines—- a hundred year battle. Blah blah blah.

    Try explaining USA healthcare to anyone outside of the USA and they give you that blank stare—- what are you talking about?

    The more important question for you and I and other USA passport holders is are they going to come knocking on our doors for the “tax”?

    Time to change nationalities IMHO.

    Starting paperwork on Monday.
    Kanpai!

  2. Troy
    June 29th, 2012 at 01:52 | #2

    The more important question for you and I and other USA passport holders is are they going to come knocking on our doors for the “tax”?

    heh, hadn’t thought of that, that the penalty might punch through the foreign income exclusion and even the tax treaty treatment (Japanese taxes deductible from US taxes).

    Loss of ACA is my biggest driver for going back to Japan. It’s still not safe, as it won’t survive if Romney wins (the Dems losing the Senate wouldn’t help either but I think Romney could just refuse to spend the money or something, kinda like Obama stopping the deportation of some illegal immigrants against Congress’ will).

    You are living in Japan. You have real health care now

    Kinda questionable, no? It is true the Japanese system runs a tight ship, with the per-capita cost roughly 1/3 that of the US, but I had a helluva time finding actual reliably quality service in that system, and I was living in Minato-ku, LOL.

  3. Troy
    June 29th, 2012 at 02:05 | #3

    Roberts did not act as a liberal, but instead took a stand that would be called conservative

    Roberts did hold that Congress indeed has the power to tax (which was my argument all along).

    Roberts did not go along with any Commerce Clause power to mandate heath insurance, and he also kneecapped the ability to mess with Medicaid apparently.

    Pretty sad that the “strict constructionists” can’t read the 16th amendment for what it plainly says:

    The Congress shall have power to lay and collect taxes on incomes

    That’s all the mandate is. Don’t want to buy insurance, fine, pay the f-ing tax.

    this is not the health care plan we should have

    I like it and don’t see any big difference between Japan’s patchwork system.

    The big hurdle was getting nearly everyone on insurance so they stop abusing the charity of the system. The next step is working on the high costs of care, but that’s mostly our high cost of hospitalization, so getting people covered means hospitals won’t have to eat the costs of the uninsured and underinsured like they do.

    Profit margins are no doubt high in the US, but now that Uncle Sam is directly paying for so much healthcare, it will have some power in regulating these too.

    Provided Dems retake the House, LOL. The Republicans will try to destroy ACA by every means available.

    What a sick country this is.

    In other news, Japan looks to be doubling the sales tax — that’s pretty big of course.

    I forget, but it’s about 30% or so of the way towards the fiscal balance Japan needs as the postwar generation retires, 2015-2025.

    Japan doesn’t have the massive surge of retirees that the US does, but if people’s savings are going to be convertible into cash, taxes are going to have to go up a lot (since 80%+ of these savings are *in* Japanese government bonds).

  4. Troy
    June 29th, 2012 at 02:05 | #4

    (I hate when I do that)

    Fixed. Editor

  5. Luis
    June 29th, 2012 at 02:10 | #5

    The more important question for you and I and other USA passport holders is are they going to come knocking on our doors for the “tax”?

    heh, hadn’t thought of that, that the penalty might punch through the foreign income exclusion and even the tax treaty treatment (Japanese taxes deductible from US taxes).
    Assuming that you guys are not just kidding here–IIRC, the ACA requires that you buy health insurance, that it is not an actual tax you pay on income earned or of any other sort, Roberts’ reading notwithstanding.

    In any case, I am pretty sure that they would not insist that Americans abroad purchase insurance from America for treatment in America, or even American insurance which will cover one abroad when one is already covered abroad. I don’t know if it says that specifically within the law, but I would have a hard time believing that they would try to force Americans abroad to do that, even if belonging to some insurance plan already did not satisfy a prerequisite.

    On an off-topic side note, one thing has occurred to me about taxes and double taxation: what if I wrote and app or a book and sold it on the iTunes store? Despite living in Japan, the U.S. would treat it as income earned in the U.S. and therefore not subject to the FEIE–and Japan would see it as taxable in Japan as well. Would the foreign tax credit cover it, or would a person in that situation simply be screwed?

  6. Troy
    June 29th, 2012 at 02:45 | #6

    the ACA requires that you buy health insurance

    No, people are free to not buy insurance, but are incented because if they don’t they get hit with a penalty tax:

    Penalties will start in 2014 and by 2016 will be $695, or 2.5% of income, whichever is greater.

    People making under 130% of the federal poverty level (~$15,000) will be enrolled in medicaid (this is a big change) so the penalties don’t apply to them.

    People under 400% of federal poverty level will have some sort of premium subsidy — the median household earning $50,000 will be expected to pay $3,385 and have $8,800 paid for by Uncle Sam.

  7. Luis
    June 29th, 2012 at 02:54 | #7

    No, people are free to not buy insurance, but are incented because if they don’t they get hit with a penalty tax…
    Same difference. The seat belt laws require you to wear a seat belt, but you could say that they don’t require it but incentivize via a penalty tax if a cop catches you.

    My point is that if you live in Japan, then you have to (technically) be enrolled in some sort of insurance, and that this should satisfy the US requirement, even if they do apply it to people living outside the US.

    A different question is, will it be required of non-US citizens in the US? Seems likely. A whole new area for conservatives to whine about how illegal aliens are sucking us dry or whatever, and it likely won’t be true.

  8. Tim Kane
    June 29th, 2012 at 03:29 | #8

    I think it says that you have to ‘buy’ insurance, if you don’t have it. If I work at Boeing, and Boeing ‘buys’ my health insurance, then, I have it. They are not going to take a hundred million Americans who are lucky enough to have insurance and force them to buy insurance.

    So, if you have insurance in Japan, you obviously have insurance, and thus, don’t need to buy it. In Korea, which I believe has the same basic system as Japan, I carried around a Health Card that I displayed when I went to a clinic or hospital. I assume you have one in Japan, just xerox a copy of it and attach it to your tax statement.

    On the other hand, if they require you “buy” insurance, then I would also assume that you are doing that already in Japan. My insurance in Korea cost me $42 a month (and over all, it was fantastic).

    If you have the time I HIGHLY recommend watching this Frontline Documentary, “Sick Around the World” at:
    http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

    It is really informative. There take is, there are only a few different basic models for healthcare, and they take a look at a sample of each. Japan is one arch type. Then they ask which system is the best – and the answer, is, Taiwan’s. Taiwan did a “best practice” review of the world’s systems, decided that Japan’s was the best, then they did a re-engineering model on Japan’s to make it more efficient. The result is the best health care for the lowest cost, as I recall, $23 per month per capita or something like that.

    Given that Insurance is running the average American $600 to $1000 a month, it’s easy to see that the system is a disaster. On top of that, our Government pays out more per capita than any country in the world, except Norway, for health care. Despite ALL of that money being spent, over 50 million are uninsured (and if ACA wasn’t implemented, that number would shortly rise to 100 million inside of five years – thanks to the Great Recession) and 40,000 to 120,000 a year die for lack of insurance (a form of genocide, not a form of health care).

    It seems likely that had Health Care been denied by the court, we would have a socialized system in very short order.

    Suddenly then, Roberts vote makes sense. Indeed, I predicted that he and Alito, as both are avowed Fascist, would vote in favor of the ACA. But in only took one – someone was going to have to protect corporations. As they both hate Obama, seems like they flipped a coin and Roberts lost.

    Mussolini said “Fascism is a merger of corporate and state power.” Once Roberts and Alito were installed in the court, the court, in short order, went way out of it’s way and against precedent to find for Citizen’s United. They did the same thing again in protecting the ‘fascist effect’ of Citizen’s United, by going way out of their way and way against precedent in their finding for Arizona Free Enterprise Club, in which Robert’s used contortionist arguments against the trajectory of precedent.

    I don’t think there’s that big of a difference between Japan’s system and the ACA.

    The big innovation will come when a commission is set up by the government to control cost, as they have in Japan (perhaps the first step would be to control the cost of a doctor’s education, and provide him with a way out of debt through several years of national service, say in rural areas, then control transaction cost). The next big innovation will be consolidation of all the health care companies, as was done in Taiwan. The third step is to make health care not for profit (which this bill comes close to by limiting profits to 20%). A fourth step would be public ownership, like the Post Office or there are tons of other models.

    It’s not a perfect system. But, beginning in 2014, more and more people who would have died, will start to live. For each single one of those people, this is a big step forward.

    Meanwhile, I think this decision also means that Vermont’s experiment in universal single payer health care continues to move forward. If that is reasonably successful, then things will become even more interesting.

    I am assuming that this system will be effective at health care cost in the aggregate, and so on, meaning, work, reasonably well. If not, all bets are off the table.

    Oh, by the way Brian Beutler of TalkingPointsMemo did predict Robert’s vote in March: http://tpmdc.talkingpointsmemo.com/2012/03/did-john-roberts-throw-a-wrench-in-major-argument-against-obamacare.php?ref=fpblg

  9. Troy
    June 29th, 2012 at 03:49 | #9

    As for me, this is good news as a 40yo, I can do independent contracting and, starting in 2014, find coverage on a state health exchange (w/o having to move to MA, HI, or other universal coverage state). Maybe I won’t have to leave this country after all (Obama still has to win though, since if Romney wins I think he will effectively dismantle everything).

    What is really bizarre is that this has become a left-right thing. ObamaCare is nothing more than what Romney proposed for MA and is entirely a conservative idea.

    http://www.forbes.com/sites/aroy/2012/02/07/the-tortuous-conservative-history-of-the-individual-mandate/

    The right is simply clinically detached from reality. I don’t know how else to describe it.

    I look forward to Romney’s gymnastics in attacking national health insurance mandates that were directly lifted from his signature plan.

    If “Obamacare” did not exist now, Romney would no doubt be proposing it, no doubt with caps on the subsidies and less redistributive taxation to pay for it.

  10. stevetv
    June 29th, 2012 at 04:14 | #10

    Regarding Roberts, there was another Supreme Court decision handed down today which was totally dwarfed by the Health Care ruling. The Stolen Valor Act – which made it a federal crime to lie about your military service and earned medals – was also struck down today because it violated free speech. This was a 6-3 decision, and both Kennedy and Roberts sided with the majority. This is making Roberts a very interesting Justice in my eyes. No, it probably doesn’t mean he’s jumped the conservative ship and switched sides. I’m sure he’s as conservative as they come and we’d hate most of his decisions. But at least he’s distinguishing himself as a conservative who thinks for himself. (I admit I don’t know if he’s always been like this or if this is a new development.)

    It also gives me encouragement (hopefully not misguided) that any rulings on gay marriage may actually be 6-3 in favor? Hey, we can dream…

  11. Troy
    June 29th, 2012 at 04:21 | #11

    What ObamaCare does do is allow another 30 million people access to the system, and also upgrade access to tens of millions more thanks to the premium support, which is significant for people making under the median income.

    The conservative opposition to ObamaCare cannot be the mandate, for they proposed the damn thing themselves, as Luis mentioned in his post.

    What they don’t like is that they will eventually have to pay for all this, since income taxes are largely paid by the top 10% of the electorate (since they make half the national income).

    And this is going to be very, very expensive, given our $8000 per capita health care expense. ObamaCare’s major insult is to conservatives’ most dearly-held principle, which is of course “Got mine — screw you!”.

  12. Troy
    June 29th, 2012 at 04:27 | #12

    Stolen Valor Act

    that’s weird. I’ve had this very juvenile dream of dressing up in the uniform my alternate-universe self might be wearing now had I joined the army out of high school.

    (I blame Traveller, if you know what that is)

    I didn’t give it a second’s thought back then, but now I kinda wish I had joined the military out of high school. Not terribly hard to cruise through 25 years in the enlisted ranks and be retired for a couple of years already, with a pretty decent pension.

    Surviving 20+ years in the officer corps would have been much harder, given the 1990s cutbacks and more aggressive weeding that goes on at that level.

    At least they can’t offshore our NCOs to India, yet.

  13. Troy
  14. Troy
  15. Troy
    July 1st, 2012 at 05:21 | #15

    Turns out the penalty / tax is just applied against your IRS refund, if any.

    Also, there’s no need to turn-in citizenship to avoid it.

    IN GENERAL.—The term ‘‘qualified individual’’ means, with respect to an Exchange, an individual who— (i) is seeking to enroll in a qualified health plan in the individual market offered through the Exchange; and (ii) resides in the State that established the Exchange

    PL 111–148 Sec 1312 (f) (1) (A)

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