Health care/Medicare

[54-46]

Cant charge more for pre-existing conditions any longer

If they could, I'd be fucked and not kissed

[Mazderati]

Fifteen or twenty thousand dollars per year in insurance alone and that social security check may as well be marked return to sender. Premium increases of ten and fifteen percent annually aren't sustainable. Something will break eventually.

[bigdude2468]

Fifteen or twenty thousand dollars per year in insurance alone and that social security check may as well be marked return to sender. Premium increases of ten and fifteen percent annually aren't sustainable. Something will break eventually.

The Medicare part B premium will be $109 per month next year, seems like a bargain. (A higher premium exists if your annual income exceeds $170,000 for married file jointly, $85,000 single) That's it and it includes a level of drug coverage. As far as allowing some privatization of Medicare they already do it. All sorts of insurance companies offer Medicare Advantage plans that wrap Part A & B together. You see ads on TV for United Heath, AARP, Aetna, Blue Cross and others. Medicare gives them a flat fee each month and they provide everything else. You get an insurance card from them, they manage your care, they pay the provider, they do everything, you have zero contact with Medicare. It also possible to pick up the phone and talk to someone easily. As someone that had some issue with premiums and had to contact Medicare directly, good luck. I waited on hold as long as an hour and never less than 20 minutes to talk to someone.

[fastfred]

They'll make it so any policy changes to medcare are years out, that way the baby boomers, who are the "we got ours, fuck the next generation" generation will vote in favor of it, despite the fact that they got to benefit from it during their days.

very well said

can't wait for the boomers to all be in nursing homes and die off so the millennials can take over and right things

[GeezerSteve]

Something will break eventually.

Translation: People will suffer and die.

My financial goals were to get out of debt, save for retirement and have enough money for the kids education, who theoretically will pay it back. Pretty well got all those covered with enough left over for a few trips here and there.

Good work. I'm pretty much there. Whew

[Benny Profane]

very well said

can't wait for the boomers to all be in nursing homes and die off so the millennials can take over and right things

Well, that's going to take over twenty years, so, you'll probably be dead before that happens.

[Yonder_River]

These ^^^^^

Outcome and wellness models sound great and all and can help guide a portion of the payment, but the metrics behind it are not always clear cut. ACO's may show some promise for certain payment schemes, but many areas of medicine are hard to quantify. So an Anesthesiologist shouldn't get reimbursed if the patient takes awhile to wake up, or feels nauseous afterwards? The surgeon who performs an unsuccessful back surgery (which is probably half of them) shouldn't be paid, a GP who's fat ass patients don't take care of themselves and have increased rates of morbidity should take a pay cut? All because the outcome's weren't rainbows and unicorns? I like the idea of rewarding positive outcomes, but there are way to many variables in a lot of areas of medicine to make it fair.

The biggest factor in rising health care costs continues to be overuse of the system by the few, use of medical advancements and technologies which are expensive to develop and questionable in efficacy and end of life care ($50k operation to keep granny around 6 more months, etc.). These need to be addressed before anything else imo.

[Benny Profane]

Wait. That means death panels!

[54-46]

very well said

can't wait for the boomers to all be in nursing homes and die off so the millennials can take over and right things

Aren't the Gen Xers up next? Are they getting skipped over? Or, will the Gen Xers and Millennials work together to create a safety net for themselves?

[54-46]

Outcome and wellness models sound great and all and can help guide a portion of the payment, but the metrics behind it are not always clear cut. ACO's may show some promise for certain payment schemes, but many areas of medicine are hard to quantify. So an Anesthesiologist shouldn't get reimbursed if the patient takes awhile to wake up, or feels nauseous afterwards? The surgeon who performs an unsuccessful back surgery (which is probably half of them) shouldn't be paid, a GP who's fat ass patients don't take care of themselves and have increased rates of morbidity should take a pay cut? All because the outcome's weren't rainbows and unicorns? I like the idea of rewarding positive outcomes, but there are way to many variables in a lot of areas of medicine to make it fair.

The biggest factor in rising health care costs continues to be overuse of the system by the few, use of medical advancements and technologies which are expensive to develop and questionable in efficacy and end of life care ($50k operation to keep granny around 6 more months, etc.). These need to be addressed before anything else imo.

This ^ coming from someone with lots of experience in the health industry. How would we address the issues raised in your last paragraph? (Only so many of us have health care directives/DNRs)

[Yonder_River]

This ^ coming from someone with lots of experience in the health industry. How would we address the issues raised in your last paragraph? (Only so many of us have health care directives/DNRs)

Certainly no clear cut answers, but solve some of it there needs to be more skin in the game for those that are high users. High out of pocket costs plans on some kind of sliding scale for overusers and abusers (however the hell that is determined) to discourage consumption where it is not warranted, proven or helpful. No matter how you slice it, healthcare is expensive to administer and we don't have an endless supply of it. Somewhere along the way, real economics are going to have to be involved. These changes will eventually (and are now) going to be forced on people one way or the other.

[GeezerSteve]

The biggest factor in rising health care costs continues to be overuse of the system by the few, use of medical advancements and technologies which are expensive to develop and questionable in efficacy and end of life care ($50k operation to keep granny around 6 more months, etc.)

Add gouging, e.g, hospitals charging $50 for $2 worth of gauze pads, excessive testing and other manifestations of fee-for-service incentives.

[old goat]

First, eliminate fee for service--everyone is in a prepaid health plan like Kaiser, all docs on salary. Second, sliding scale of copays based on how elective a procedure is--prenatal care you get paid for showing up, appendectomy free, total joint significant copay--depending on indication. Could adjust for income level or give partial tax credit for out of pocket expenses based on income. 3rd--screw the drug companies, 4th Federal government becomes primary source of funds for drug R and D, licenses new drugs to companies and controls price, profits. 5th--I wake up and find out we have the same shitty health care system we always had. Well the dream was nice while it lasted.

As far as paying for outcomes--only works for large systems and hospitals with enough volume to have meaningful statistics and to adjust for risk. Applying to individual docs would be a joke.

[Yonder_River]

Add gouging, e.g, hospitals charging $50 for $2 worth of gauze pads, excessive testing and other manifestations of fee-for-service incentives.

Yes, hospital charge books are a problem for sure. Excessive testing (the definition of that depends on current knowledge, population, individual practicitioner training, etc.) certainly isn't discourage by the hospital, but in general, the overuse of tests and additional procedures is drive by fear of litigation. If a doctor wants to cover all of their bases, they throw the book at it so their asses are covered if(and when) they get sued.

[TG]

so ~2k/month is a common/average premium to expect for a healthy mid 50's guy?

I'm fortunate enough to have a decent insurance plan with my current job, I havent had to think about this for quite some time.
thinking of options re new job and/or partial retirement
wondering where to start with rough estimates of insurance premiums when/if I have to pay for it myself
2k/month is a bit of a shock, is that a reasonable consensus estimate?
how much can a really high deductible offset this?

I am going to do more research and get some quotes, but seems like there's enough experience here in similar age ranges to at least get an overview of what to expect

[wooley12]

very well said

can't wait for the boomers to all be in nursing homes and die off so the millennials can take over and right things

Why would the millennials want to wait to fix it for themselves? And boomers will not all be in nursing homes as we know it today. Can't build them fast enough once the bulge hits.

[mcski]

Winona for president!

[Dantheman]

First, eliminate fee for service--everyone is in a prepaid health plan like Kaiser, all docs on salary. Second, sliding scale of copays based on how elective a procedure is--prenatal care you get paid for showing up, appendectomy free, total joint significant copay--depending on indication. Could adjust for income level or give partial tax credit for out of pocket expenses based on income. 3rd--screw the drug companies, 4th Federal government becomes primary source of funds for drug R and D, licenses new drugs to companies and controls price, profits. 5th--I wake up and find out we have the same shitty health care system we always had. Well the dream was nice while it lasted.

Good list. Though right up front I'd add expanding Medicare to cover the entire population. Private health insurance continues to exist for supplemental coverage only. Private insurance only works if 1) losses are inherently limited; and 2) you can do underwriting. In health insurance, losses can potentially exceed an individual's entire lifetime earnings, and underwriting is morally reprehensible. The only way to effectively cover everyone is to distribute the risk across the entire population.

[BFD]

2000 is for me in Cordova Ak. We have a small pool buying private insurance. My sister 2 years older a smoker in Denver pays $800 something. So price varies greatly by location.

[GeezerSteve]

. . . but in general, the overuse of tests and additional procedures is drive by fear of litigation.

This is the standard insurance lobby propaganda talking point but the evidence suggests that profit motive and bad habits are as big or bigger factors. It's not as bad as it was before laws that limit doc ownership of testing facilities but there there is are strong financial incentives to order a test and have the patient return after the test re$$$ults, test again, wa$$$h rinse repeat.

A similar set of problematic incentives is in play re end of life care. Lot$$$ of money to be made by that $50,000 surgery on a 95 y.o. patient.

I am well aware of the effectiveness of talking points against moving away from a fee-for-service model, but it is beyond debate that the incentives manifested from a fee-for-service model represent a huge contributor to soaring HC costs.

[assman]

Who knows what will be happening when I reach wooley's age but for now I think both parties know that you fuck with SS and medicare at your peril. The biggest single voting block is older folks. I don't know the breakdown between R & D but i guarantee this...whatever party fucks with their bennies loses them for good. Every politician knows this

[Yonder_River]

Steve, you are evidentally a lawyer so have a certain perspective. One of the biggest reasons for the over abundance of running tests is absolutely due to fear of not covering all bases. Believe it or not, most docs are more level headed than money hungry, but your lobby would tell you otherwise.

[mcski]

Who knows what will be happening when I reach wooley's age but for now I think both parties know that you fuck with SS and medicare at your peril. The biggest single voting block is older folks. I don't know the breakdown between R & D but i guarantee this...whatever party fucks with their bennies loses them for good. Every politician knows this

I hope they understand the peril and there is a lot of info put out to counter the bullshit sure to come pushing privatization

[Yonder_River]

2000 is for me in Cordova Ak. We have a small pool buying private insurance. My sister 2 years older a smoker in Denver pays $800 something. So price varies greatly by location.

That sounds about right. HC costs in AK are almost double on average than the lower 48. Limited networks, a hard living population and not enough providers.

[Ted Striker]

...I think both parties know that you fuck with SS and medicare at your peril.

Paul Ryan doesn't seem to know this. And I agree that if he touches that third rail, he's in for a shock.