Wouldn't it be ironic if this sort of thing happens in high numbers, thereby throwing a kink in Obama's stated "spread the wealth" agenda?
"For any kind of 'all-in' group health insurance scheme to work financially, there has to be subsidization of the poor from the wealthy. The system needs the high earners to contribute more than they consume, especially if they are relatively healthy and thus not consuming expensive services.
However, these high income professionals who are NOT utilizing health benefits to an excessive degree would be ABSOLUTELY the ones most likely to look for alternatives to avoid being a captive individual subsidizing the system. This Panama article, while it does not focus on health care exclusively, is pointing out exactly those most likely to leave.
As for the tax impact, at a high level if you are self-employed you can deduct your health insurance premiums against your gross income (which reduces it effectively by your overall tax rate, say 30%) but if you are not self employed then you can only deduct it to the extent that it exceeds 7.5% of your adjusted gross income.
Thus estimates that show the US health care costs (and revenues) and neglect to take into account that the most mobile and wealthy citizens have CHOICES of where to live will not predict accurately what will in fact happen.
While US citizens may not typically migrate overseas, this is an established solution to high taxes in other countries. The UK, for instance, has always had a large population outflow of retirees, especially to Spain. Much of this is due to the fact that UK taxes are punishing (and the weather isn’t so great) and UK citizens are adventurous enough to leave the country of their birth in order to improve their standard of living.
Countries outside the US also will respond to these opportunities. Panama and Costa Rica are attempting to be more friendly to US retirees because they know that they represent an opportunity for their economy. If health care can be brought up somewhere close to US standards (basically by walling off poorer locals or migrants) for at least preventative and maintenance care (if not for high tech procedures) then they will be able to draw in those individuals who can bring their wealth overseas and also bask in the beautiful weather and scenery.
I remember when I was traveling in Australia once and sitting on a plane next to an elderly gentleman and he looked over at me and asked me if I was emigrating. I honestly was taken aback - I had never thought about moving overseas. Perhaps the US citizenry will start taking a wider view of living outside of the USA if taxes and regulations become too punishing."
The middle class would not be amused though. It's obviously clear that in the above instance, the huge tax burden would fall upon them, thereby reducing the middle class and the nation to the economic status of banana republic, assuming Obama can't make the Imperium idea hold up.