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  • Originally posted by Ghetto View Post

    Join the fight? Who is fighting? People on this thread admit that the US taxes nearly 50% of their income but most everyone here is just fine with that. The battle is over and the taxes will be moving higher with time. Pretty much everyone agrees on that.

    I suggested that one could move to the Bahamas and pay 0%. In response I’ve heard that’s “crazy” and I’m ruining my life.
    I’m nowhere even close to being fine with that.

    Comment


    • this discussion of what country is best is pointless. most of us were born here and this is our "normal." it's like asking people from NYC vs. Alabama which region of the country is best. they are far from objective. everyone has a list of things that they just can't believe other countries tolerate. one of my most memorable experiences from my senior year of residency was stitching up the face of a canadian kid (?19) and trying to explain how healthcare worked here as he looked at me like i was speaking Klingon.

      "will i get a bill for this?
      "probably so"
      "do you know how much it will be?"
      "i would guess well over a thousand dollars."
      "... ... ... excuse me?"

      tried to explain that americans get massive healthcare bills but they don't pay the full amount but they are larger b/c people who have insurance essentially have to subsidize care for those who don't. he looked at me with growing disbelief, i'm still pretty sure he thought i was jerking his chain.

      Comment


      • Originally posted by Ghetto View Post
        I suggested that one could move to the Bahamas and pay 0%. In response I’ve heard that’s “crazy” and I’m ruining my life.
        I don't think you're crazy but, as I attempted to point out in my previous post, I don't think the tax saving are what you are assuming they are.

        From reading your posts, I have the impression that main tax you are seeking to avoid is inheritance tax. As your net worth is over $2 million, you will be a covered expatriate (if you expatriate). Usually gifts/inheritance from non-residents/citizens are reported but not taxed. However, it is not the same from a covered expatriate. From my reading of the tax code (section 2801) if your heirs are US citizens they will have to pay tax on their inheritance from you even if you expatriate. The rate is at the highest gift or estate tax rate.

        So, you pay 0% on gains you make after you leave but your children will also need to expatriate to take advantage of your plan. If they are still citizens how much tax does your plan avoid?

        At least that is my understanding of the tax code. I am not a tax professional so please correct me if I am wrong.

        Comment


        • Originally posted by MPMD View Post
          this discussion of what country is best is pointless. most of us were born here and this is our "normal." it's like asking people from NYC vs. Alabama which region of the country is best. they are far from objective. everyone has a list of things that they just can't believe other countries tolerate. one of my most memorable experiences from my senior year of residency was stitching up the face of a canadian kid (?19) and trying to explain how healthcare worked here as he looked at me like i was speaking Klingon.

          "will i get a bill for this?
          "probably so"
          "do you know how much it will be?"
          "i would guess well over a thousand dollars."
          "... ... ... excuse me?"

          tried to explain that americans get massive healthcare bills but they don't pay the full amount but they are larger b/c people who have insurance essentially have to subsidize care for those who don't. he looked at me with growing disbelief, i'm still pretty sure he thought i was jerking his chain.
          To be fair, plenty of 19-year-old Americans would look at you like you were speaking Klingon after that exchange.

          Comment


          • Originally posted by MPMD View Post
            this discussion of what country is best is pointless. most of us were born here and this is our "normal." it's like asking people from NYC vs. Alabama which region of the country is best. they are far from objective. everyone has a list of things that they just can't believe other countries tolerate. one of my most memorable experiences from my senior year of residency was stitching up the face of a canadian kid (?19) and trying to explain how healthcare worked here as he looked at me like i was speaking Klingon.

            "will i get a bill for this?
            "probably so"
            "do you know how much it will be?"
            "i would guess well over a thousand dollars."
            "... ... ... excuse me?"

            tried to explain that americans get massive healthcare bills but they don't pay the full amount but they are larger b/c people who have insurance essentially have to subsidize care for those who don't. he looked at me with growing disbelief, i'm still pretty sure he thought i was jerking his chain.
            I am going to agree with you here. Unfortunately, I don't know what the answer is. Like many complicated problems it is multifactorial.

            Here are some of the components:

            1. What we have now (part socialized medicine = medicare ) part private in my opinion seems like a mess.

            2. Socialized medicine is not perfect (ex. My sister in Norway complains about it, she thinks care she receives here is better).

            3. People respond to incentives. I have a small business and I am not sure I would work on it as hard as I do for free. I seriously doubt it. As an Anesthesiologist, who has worked at 8 different hospitals, the most efficient surgeons and ORs that I have seen provide incentives to be efficient.

            4. Incentives can backfire. For example, sometimes care is giving that might be less than perfect in my opinion. Here is an example. I did anesthesia for a 93 year old man with lung CA. He could not get a lung resection until we addressed his aortic stenosis so we put in a percutaneous aortic valve (TAVR). I found out about the case the morning of. As an anesthesiologist I was last on the boat and the boat was going. I frankly don't know the right answer here. It seems a little bit much but who decides? What are the chances he gets through all this and has a meaningful recovery at 93? He has COPD and Lung CA, could his shortness of breath be from that rather than his aortic stenosis? (SOB was his primary symptom). BUT, on the other hand, when I discussed with an anesthesia colleague he said: "that old guy paid his taxes, he wants it, he should be able to decide". While I agree for the most part, it is hard not to worry that the "system" that gets paid a ton of money to put in these percutaneous valves has the incentive to talk him into it. If I was him I do not know what I would do. I am not 93. But I think I would just avoid spending my last months in an ICU.

            5. Insurance is a mess. It is so crazy that we have no idea how much something will cost? Your example covers this perfectly. How does that make any sense?

            I might just be too simple. I don't have any answers but I agree with you. Our healthcare system here is a mess.

            Despite all this, as a person who pays for health insurance and has an HSA I think this is a good place to retire. You have options here. As physicians we are especially fortunate. We get paid a lot to work and live in the USA. I am not aware of many other countries that pay anesthesiologists what we pay here.

            I do not know if it is fair for me to get a huge check as a result of working in USA and then complain about how messed up the system is?

            Anway, I think you bring up a good point, and this is my long winded way of saying so.
            Last edited by Tangler; 04-06-2021, 04:09 AM.

            Comment


            • Originally posted by Tangler View Post



              Anway, I think you bring up a good point, and this is my long winded way of saying so.
              fair, i mostly brought it up as a way of demonstrating how things that are considered fairly normal in one place are viewed as intolerable to the point of criminal in others, i wasn't specifically making a point about healthcare.

              my one other thought is that if someone is going to try to move their tax base as a protest act i think they should be in with both feet and not sneak back in at 66 when they can get Medicare.

              Comment


              • Originally posted by Tangler View Post

                I am going to agree with you here. Unfortunately, I don't know what the answer is. Like many complicated problems it is multifactorial.

                Here are some of the components:

                1. What we have now (part socialized medicine = medicare ) part private in my opinion seems like a mess.

                2. Socialized medicine is not perfect (ex. My sister in Norway complains about it, she thinks care she receives here is better).

                3. People respond to incentives. I have a small business and I am not sure I would work on it as hard as I do for free. I seriously doubt it. As an Anesthesiologist, who has worked at 8 different hospitals, the most efficient surgeons and ORs that I have seen provide incentives to be efficient.

                4. Incentives can backfire. For example, sometimes care is giving that might be less than perfect in my opinion. Here is an example. I did anesthesia for a 93 year old man with lung CA. He could not get a lung resection until we addressed his aortic stenosis so we put in a percutaneous aortic valve (TAVR). I found out about the case the morning of. As an anesthesiologist I was last on the boat and the boat was going. I frankly don't know the right answer here. It seems a little bit much but who decides? What are the chances he gets through all this and has a meaningful recovery at 93? He has COPD and Lung CA, could his shortness of breath be from that rather than his aortic stenosis? (SOB was his primary symptom). BUT, on the other hand, when I discussed with an anesthesia colleague he said: "that old guy paid his taxes, he wants it, he should be able to decide". While I agree for the most part, it is hard not to worry that the "system" that gets paid a ton of money to put in these percutaneous valves has the incentive to talk him into it. If I was him I do not know what I would do. I am not 93. But I think I would just avoid spending my last months in an ICU.

                5. Insurance is a mess. It is so crazy that we have no idea how much something will cost? Your example covers this perfectly. How does that make any sense?

                I might just be too simple. I don't have any answers but I agree with you. Our healthcare system here is a mess.

                Despite all this, as a person who pays for health insurance and has an HSA I think this is a good place to retire. You have options here. As physicians we are especially fortunate. We get paid a lot to work and live in the USA. I am not aware of many other countries that pay anesthesiologists what we pay here.

                I do not know if it is fair for me to get a huge check as a result of working in USA and then complain about how messed up the system is?

                Anway, I think you bring up a good point, and this is my long winded way of saying so.
                TAVRs kill me for this reason. Feel like no one explains these things to the patients and its all just a money game for procedures

                Comment


                • Originally posted by Panscan View Post

                  TAVRs kill me for this reason. Feel like no one explains these things to the patients and its all just a money game for procedures
                  It is not always a money grab, and that is where it gets complicated. Some people really benefit. Some don’t. Many are in a gray area. My example could have been for any number of procedures.
                  My point was, for a 93 year old with lung CA I don’t know that a TAVR is a great help, but i could be wrong. Also, how do you decide?

                  More relevant to the original post: As a doc who lives in USA you have as good an understanding as is possible of the system and can get good care here, so not a reason to leave.

                  Comment


                  • Originally posted by AR View Post

                    Well, yeah. But that's not the question.

                    The question is "If for some reason you decided you wanted to leave (it doesn't even have to be for tax reasons), where might you go and what might you do?"

                    It would seem that someone who has already lived and worked outside the US would have some insight into that. Even if he is very unlikely to actually do it.
                    Here are the issues.

                    1. I have become a naturalized US citizen. Even if the taxes become higher and higher, I will just have to pay it unless I renounce my US citizenship and pay the exit taxes. So moving for another country for tax reasons is not worthwhile for me.

                    2. If I have to move for some other reason and have to renounce my US citizenship I automatically become an Indian citizen, the country of my birth. Not the end of the world since there are plenty of happy Indian citizens living in India. With my saved money I can live a comfortable life far from the polluted cities. I hopefully won't stand out like a sore thumb. Funny story about it from the distant past

                    Place: Taj Mahal entry ticket counter.

                    Persons: my future in-laws, fiancee, and her uncle and aunt and me. I was at the counter with the uncle.

                    Cost: Rs. 25 per person (35 cents) for Indians and Rs. 750 ($10) for foreigners.

                    Conversation exchange

                    Uncle: Six Rs. 25 tickets.
                    Ticket counter person: Five tickets for Rs. 25 and one for Rs. 750
                    What do you mean one ticket for Rs. 750.
                    Sir, the person standing next to you is a foreigner.
                    Are you blind. Can't you look at his face and skin color. He is an Indian.
                    Sir, he may be of Indian origin but he is not living in India right now and hence he is a foreigner.
                    How can you say that after looking at him.
                    Sir, his appearance is what has given him away. He is wearing an old T-Shirt, worn jeans and dusty old sneakers. The Indians here as you can see are well dressed with ironed pants and shirts and clean sneakers or shoes. Only the NRI ( non resident Indians) dress like your friend. And they have to pay the foreigner fee, not the fee meant for Indians.
                    OK. I don't like it but one ticket for Rs. 750.

                    At the Qutub Minar in Delhi : Uncle - Kamban, do not come near the ticket window,. I will buy the tickets and you join me near the entrance gate. And put away the camera and look like an Indian :-)


                    3. I am not too keen on going back to England. I have looked at the expat communities in Ecuador and Costa Rica and have no desire to be living amongst them, not interacting much with locals and doing it just to save money.

                    4. Earlier in my life I could have been a nomad, living for a month or two in a country and then moving to the next. Now I just want to have a base in USA and visit the other countries for a week or two or three, max.






                    Comment


                    • Originally posted by Ghetto View Post
                      Ok, I’m gonna get real here. I’d never discuss specifics of my finances with someone I know but I’m anonymous here so here goes.

                      I’m around 50 and practicing full time. My net worth is around $10 million but is at this time around 2/3 is illiquid. It’s wrapped up in commercial real estate and another medically related businesses I run. Thank God my parents paid for my college and med school so I had no debt and could just borrow money to start my practice when I finished fellowship. Can’t move now because of medical practice and because I’m caring for aging parents and a father in law. My parents (in their 80s) have an estate worth maybe $3 million and father in law (in his 80s) has an estate of $7 million. My wife and I are only children. When they pass we will likely have a combined estate of around $20 million. I have two college age kids that I’m currently putting through school.

                      I’m the kind of person who loves travel and foreign languages are a hobby. My wife and I have done many medical missions to Mexico and Honduras. I’d love to do some travel and immerse in different cultures. Wouldn’t mind doing some work for Doctors Without Borders or spending time volunteering on one of the African Mercy ships.

                      So let’s say our parents pass away by the time I’m 55. I sell everything and have $20 million in cash. I buy a house in St Kitts or the Bahamas (both zero income tax countries with zero inheritance tax). US exit tax is 23.8% on capital gains but what the heck for discussion purposes I’ll apply that to the entire portfolio. I sell everything in the US and pay $4,760,000 exit tax and renounce my citizenship. That leaves me $15,240,000 to live off of and invest with.

                      I’ll live on one of these islands during winter months and invest $10 million. The rest of the money I’ll use to maybe buy a modest house in Ireland and establish residency there and live there during the summer. Ireland is a safe and stable place with decent healthcare. I pay sales taxes there but my investment income is taxed at 0% in my Caribbean home country.

                      Uh oh....in a decade I come down with a rare but treatable disease but Ireland can’t handle it and the world expert practices at the Mayo Clinic. I get a visa to the US (remember I paid my exit tax and can travel to the US). I seem to remember lots of Mayo patients are from foreign countries so that can’t be too much of a problem, right?

                      So part time in Caribbean as a citizen, part time in Ireland (legal resident), and part time practicing with Doctors Without Borders. Imagine what a $10 million investment portfolio can do with no income taxes and no inheritance taxes when my kids inherit it after 30 years? Surely it would make up for the exit tax I paid to the US after 30 years?
                      Wow, you really have given this serious consideration. I have a feeling if you actually go through with it, you will regret it, maybe not at first, but eventually.

                      You are financially independent: you can afford to live anywhere you want in the US. If you only care about avoiding taxes, then a low-tax state in the South (if you like warm weather) or the Pacific Northwest like WA (if you like cold weather/mountains) are good options.

                      You have also lived through the period of historically low marginal tax rates in the US, along with the longest bull market in history. I would thank your lucky stars that you had the fortune to be able to invest and become very successful during this period. Taxes will definitely go up in the future, given historical trends, but you are already set for life, and will be subject to LTCG for the most part anyways... It's not worth leaving your entire life just to save some taxes, that won't affect your life in any meaningful manner anyways...

                      Comment


                      • There is also always Puerto Rico, if you live off cap gains and structure things appropriately (see Peter Schiff).

                        You can renounce your US citizenship, particularly if you already have another one in place or lined up. Then if you need to be in the US longer term, you can get a green card by investment by putting in a big chunk of money (north of 500K) into real estate. Attractive places with little to no taxes include the usual suspects: Monaco, Dubai, but also low tax states like Andorra (10% all in) or if you have 7-8 figures coming in then consider flat-tax Switzerland (100K income tax per year).

                        Comment


                        • Agree, in reality PR is top bet. Trade offs yes, but least probably and easiest return (ie, nbd). Belize is always talked about as its like a colony, easy passport, etc...nice.

                          But again, I agree with everyone that you just arent going to find a place without significant tradeoffs that is cheaper, the developed countries are more expensive if anything. If those tradeoffs agree with you fine, but most would not for me. Not giving up safety, security, and health for slightly less taxes. Now I would pay more to experience a great place, but taxes wouldnt be a primary driver.

                          Comment


                          • Originally posted by Marko-ER View Post
                            There is also always Puerto Rico, if you live off cap gains and structure things appropriately (see Peter Schiff).

                            You can renounce your US citizenship, particularly if you already have another one in place or lined up. Then if you need to be in the US longer term, you can get a green card by investment by putting in a big chunk of money (north of 500K) into real estate. Attractive places with little to no taxes include the usual suspects: Monaco, Dubai, but also low tax states like Andorra (10% all in) or if you have 7-8 figures coming in then consider flat-tax Switzerland (100K income tax per year).
                            Being lazy, does somebody already have a good reference for Puerto Rico? I have heard stuff is a bit different there tax-wise...but it is still the US after all.

                            After my one visit there, I had this recurring fantasy of owning a coffee farm.... It's just that the skiing stinks.

                            Comment


                            • Originally posted by Kamban View Post

                              Here are the issues.

                              1. I have become a naturalized US citizen. Even if the taxes become higher and higher, I will just have to pay it unless I renounce my US citizenship and pay the exit taxes. So moving for another country for tax reasons is not worthwhile for me.

                              2. If I have to move for some other reason and have to renounce my US citizenship I automatically become an Indian citizen, the country of my birth. Not the end of the world since there are plenty of happy Indian citizens living in India. With my saved money I can live a comfortable life far from the polluted cities. I hopefully won't stand out like a sore thumb. Funny story about it from the distant past

                              Place: Taj Mahal entry ticket counter.

                              Persons: my future in-laws, fiancee, and her uncle and aunt and me. I was at the counter with the uncle.

                              Cost: Rs. 25 per person (35 cents) for Indians and Rs. 750 ($10) for foreigners.

                              Conversation exchange

                              Uncle: Six Rs. 25 tickets.
                              Ticket counter person: Five tickets for Rs. 25 and one for Rs. 750
                              What do you mean one ticket for Rs. 750.
                              Sir, the person standing next to you is a foreigner.
                              Are you blind. Can't you look at his face and skin color. He is an Indian.
                              Sir, he may be of Indian origin but he is not living in India right now and hence he is a foreigner.
                              How can you say that after looking at him.
                              Sir, his appearance is what has given him away. He is wearing an old T-Shirt, worn jeans and dusty old sneakers. The Indians here as you can see are well dressed with ironed pants and shirts and clean sneakers or shoes. Only the NRI ( non resident Indians) dress like your friend. And they have to pay the foreigner fee, not the fee meant for Indians.
                              OK. I don't like it but one ticket for Rs. 750.

                              At the Qutub Minar in Delhi : Uncle - Kamban, do not come near the ticket window,. I will buy the tickets and you join me near the entrance gate. And put away the camera and look like an Indian :-)


                              3. I am not too keen on going back to England. I have looked at the expat communities in Ecuador and Costa Rica and have no desire to be living amongst them, not interacting much with locals and doing it just to save money.

                              4. Earlier in my life I could have been a nomad, living for a month or two in a country and then moving to the next. Now I just want to have a base in USA and visit the other countries for a week or two or three, max.





                              I enjoyed reading everything in this post.

                              Comment


                              • Originally posted by G View Post

                                Being lazy, does somebody already have a good reference for Puerto Rico? I have heard stuff is a bit different there tax-wise...but it is still the US after all.

                                After my one visit there, I had this recurring fantasy of owning a coffee farm.... It's just that the skiing stinks.
                                It's been some time since I've read up this, but I think if you google Peter Schiff and Simon Black you can get some details.
                                If I recall correctly, it boils down to this. If you live in PR and start a business which sells a product or service to customers outside of PR, you can structure things such that you pay PR a flat 4% (I think) on the income earned, and pay 0% to the U.S.

                                So, for instance, my understanding is that you could move to PR and practice Telemedicine serving patients on the mainland, and save a bundle on income taxes. (The thought of doing this has crossed my mind more than once.)

                                Comment

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