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Old 03-07-2008, 08:19 AM   #41
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I hear so much about people going without insurance or at least being underinsured in the states but I've never heard what happens when an American who has no insurance desperately needs medical attention. I doubt that they throw you out onto the sidewalk. Do you get the necessary care and then have debt collectors calling? Do they make you sign away your material assets before treatment? What if you have no insurance and you die after being in the hospital for a couple of months? Do your kids pay?
In an emergency in the US a hospital has to treat you to the point of stabilization. You still owe the money and many hospitals are not shy about trying to collect--garnishing wages and the like. If the person has nothing, no job or any assets, they most often write it off as charity care.

If you die owing money the hospital has a claim against your estate and in most states, a claim against your spouse.

"Welfare" in the US is not available to people who are simply poor. Same with medical care. States administer these programs and set eligibility. Most often you have to be poor and disabled, or poor and aged, or poor with young children, to get any benefits and unless you are fully and completely disabled or aged you will be limited in the time period for which you can get benefits.
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Old 03-07-2008, 08:29 AM   #42
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I was just in a big argument with my friend who was pro universal healthcare. His point was free insurance for everyone seems like the "right" thing to do. My point was, you will pay for it somehow and nothing is free. I went on a tirade about universal gas seems nifty too. Matter of fact how about we say anything free is always a plus. Problem is, there are no free lunches. To make a real decision people need to see it in black and white. I know that Canada's 40% tax rate is going to cost me a helluva lot more than the best healthcare plan in the US system.
If you look at your high premiums (my insurance is around $15,000 a year including the employer share) as a tax, you are already at the 40% level I bet. I do not know that taxes would actually have to rise to pay Univ Care, we are already paying a fortune for health care. The money could possibly just change from a Ins Premium to a Tax. Those of us paying for healthcare are already paying for the needy "indirectly" so that doesn't change.

At least that is one possible view of this. It's not that my taxes will go up and I'll still be paying the high premiums. There are some scare tactics going on.

P.S. The real qestion is: can the government manage the healthcare system cheaper that a profit motivated private insurance system. That is a debate.
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Old 03-07-2008, 01:03 PM   #43
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Those of us paying for healthcare are already paying for the needy "indirectly" so that doesn't change.
This is the part that most people miss. We are paying anyway.

Might as well formalize it so working folks are not pushed into bankruptcy (working poor and people who lose their job).
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Old 03-07-2008, 05:01 PM   #44
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I agree nothing is free, BUT universal healthcare would solve the issue of availability. I do not believe one should (ever) be denied coverage due to their health status, nor I believe that one should be paying $20k/month to get the coverage!
I doubt anyone would disagree that it would be nice if no one had to worry about availability. But one (not the only) of the reasons health care costs have risen faster than inflation, is people don't take care of themselves and therefore have more health issues. Unless participants have to pay some significant portion themselves, universal health care alone will only make that worse, and therefore more costly. Maybe I'm uncaring, but I don't like the idea that we all pay more for those who don't even try.
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Old 03-07-2008, 05:20 PM   #45
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I doubt anyone would disagree that it would be nice if no one had to worry about availability. But one (not the only) of the reasons health care costs have risen faster than inflation, is people don't take care of themselves and therefore have more health issues. Unless participants have to pay some significant portion themselves, universal health care alone will only make that worse, and therefore more costly. Maybe I'm uncaring, but I don't like the idea that we all pay more for those who don't even try.
I could be corrected, but I think that is a small contributor to the health care costs in the US. Disease is usually going to happen or not. Much of it is beyond a persons control.

Maybe this is true: if you don't take care of yourself and die early, you don't need those expensive bypasses and knee and hip replacements. Maybe the healthy minded people end up costing more because they live longer and suck the last dime out of the system. At least that is a possibility of reality.
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Old 03-07-2008, 05:37 PM   #46
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Maybe this is true: if you don't take care of yourself and die early, you don't need those expensive bypasses and knee and hip replacements. Maybe the healthy minded people end up costing more because they live longer and suck the last dime out of the system. At least that is a possibility of reality.
Non-smokers use more health care than smokers. Smokers die earlier, avoiding the end-of-life care costs.
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Old 03-07-2008, 05:39 PM   #47
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Smokers die earlier, avoiding the end-of-life care costs.
I'd argue that smokers also have end-of-life care costs, regardless of when they die...
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Old 03-07-2008, 06:08 PM   #48
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I could be corrected, but I think that is a small contributor to the health care costs in the US. Disease is usually going to happen or not. Much of it is beyond a persons control.

Maybe this is true: if you don't take care of yourself and die early, you don't need those expensive bypasses and knee and hip replacements. Maybe the healthy minded people end up costing more because they live longer and suck the last dime out of the system. At least that is a possibility of reality.
Health Care Expenditures
  • Preventable illness makes up approximately 80% of the burden of illness and 90% of all healthcare costs.
  • Preventable illnesses account for eight of the nine leading categories of death.
  • The United States spends more on health care than any other industrialized nation in the world and yet, in many respects, it's citizens are not the healthiest. (2)
Don't take my word for it, Google around for yourself...
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Old 03-07-2008, 06:58 PM   #49
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Currently get 100% of Healthcare Insurance paid by my wifes employer, which is great. When I FIRE in 2 years, I will still be covered until she retires in 8 years. I am trying to budget what that expense will look like for us. Where can I see rates?

We will be paying our own healthcare from age 50 forward. This is one expense I have absolutly no clue about how to budget. Is it $500 a month or $1000?
Depends on which state you live in and your current health.
Try Health Insurance, Medical Insurance, Individual Health Insurance Quotes for a quote.

I'm reading a book "Get a Good Deal on Your Health Insurance without getting ripped off" So far, very sound advice. I got it from amazon.com and it had good reader reviews.

NJ, where I live, is a "community rating" state, so prices are high, but you can't be denied insurance and everyone pays the same rate. That works well when you are looking for insurance and have a pre-existing condition, but sucks for those of us who are healthy.
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Old 03-07-2008, 07:41 PM   #50
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Health Care Expenditures



  • Preventable illness makes up approximately 80% of the burden of illness and 90% of all healthcare costs.
  • Preventable illnesses account for eight of the nine leading categories of death.
  • The United States spends more on health care than any other industrialized nation in the world and yet, in many respects, it's citizens are not the healthiest. (2)
Don't take my word for it, Google around for yourself...
I have a hard time believing that. What is the source?

It also hugely depends on how preventable is defined. If someone chokes on a hot dog and has to go to any emergency room, was that preventable?

If someone is injured in a car accident was that preventable?

If someone gets diabetis or colon cancer? Was that preventable?

If a kid falls out of a tree and breaks his arm, Was that preventable?

Everything in life is preventable to some degree, I think one has to be careful.

Is being somewhat overweight preventable? Even that can be questioned.

Give me some examples of what those stats consider as preventable.

We could all sit in our houses, not eat meat, only eat veges, never smoke or drink, never do anything risky like driving or walking cross the street, execise every day, and not have any history of family disease. We don't, and I think that is normal.
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Old 03-07-2008, 08:39 PM   #51
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Health Care Expenditures
  • Preventable illness makes up approximately 80% of the burden of illness and 90% of all healthcare costs.
  • Preventable illnesses account for eight of the nine leading categories of death.
Don't take my word for it, Google around for yourself...
I'm with you as to the importance of lifestyle choices on outcomes, but the above figures are misleading in this context. A healthy life is a long life with life-threatening and ultimately fatal illnesses compressed into the final years. There seems to be a biologic clock that runs out sooner or later. So-called preventable illness can often be avoided so the human organism can live to its natural finale.

Failure to prevent many of these illnesses may lead to premature death, but not prevention of death. In the end, such preventable illnesses probably have less net cost to society than commonly assumed. A preventable heart attack at age 50 is fatal before the patient gets to the hospital 50% of the time. Doesn't cost a penny to society. Sure would be great to have prevented it but its tragedy is more personal than financial. It's hard to know.
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Old 03-08-2008, 01:25 AM   #52
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I'd argue that smokers also have end-of-life care costs, regardless of when they die...
Of course but the costs are lower. At least according to this study in a peer-reviewed journal:

NEJM -- The Health Care Costs of Smoking

"Conclusions If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs."
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Old 03-08-2008, 01:30 AM   #53
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We could all sit in our houses, not eat meat, only eat veges, never smoke or drink, never do anything risky like driving or walking cross the street, execise every day, and not have any history of family disease. We don't, and I think that is normal.
"You take a chance waking up, crossing the street, sticking your face in a fan."
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Old 03-08-2008, 05:31 AM   #54
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Can anyone point to studies about unhealthy lifestyle placing an extra burden?

It appears to be a common sense conclusion. But is it correct (I thought it was).

One thing I know for sure. Here are a few things that I have noticed about friends and coworkers who are overweight (obese). This is not a criticism it is merely an observation. I know that many people really try to battle weight gain.
  • Many seem to have problem walking as they hit 50 or 55. Mobility problems. I suspect the knees are giving out in many cases.
  • They tend to become diabetic (which can play into mobility problems and other problems).
  • Many have heart attacks which seems to be attributed to the weight. Usually requiring angioplasty and a stent. Sometimes these procedures are required again.
  • They tend to have high Cholesterol (But so do I)... not sure if this is a factor or just adds to the risk.
  • Seem to have high blood pressure.
The factors above have many of them on an expensive regime of prescription drugs, many office visits to specialist throughout the year, more expensive tests to monitor their status, etc...

The trend I keep reading about is that Americans (on average) are overweight compared to other developed nations.

This would seem to add a fair amount of cost to the system and continue to do so.
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Old 03-08-2008, 10:41 AM   #55
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[quote=chinaco;625741]Can anyone point to studies about unhealthy lifestyle placing an extra burden?

It appears to be a common sense conclusion. But is it correct (I thought it was).

I don't know about any studies, but I look at my parents. At around 80 both had partial colon removals, one a knee relacement, one some heart work. They did not need transplants, those really rack up the bill. If they had not lived a pretty healthy lifestyle they might have died at the normal rate of 78 and those costs could have been saved. I know that sounds terrible.

Ex-Colorado Gov Dick Lamm used to talk about the duty to die, he realized that living into the 90's was going to cost the country a lot in health care. I think he was taken apart pretty well for those words, but there is truth in it. Older Americans are spending really big bucks on health care through Medicare.

Getting back to the main question, I really think the healthy verses unhealthy lifestyle is nearly a wash when it comes to total dollars spent. Aging happens anyway. It's not a good reason to be against Univ Health Care.
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Old 03-08-2008, 01:48 PM   #56
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I have a hard time believing that. What is the source?
Did you even look for yourself? You don't think there are health consequences stemming from obesity, drug/alcohol abuse, poor diet, smoking, etc.? Again, I am not suggesting life choices are the only cause, but they're certainly a significant contributor, and growing by leaps and bounds - that could be largely avoided. If you go to a hospital, you might be surprised by the patients you see. Here are just a few, there are hundreds of sources...

PreventDisease.com - Health Care Statistics
Poor Diets, Little Exercise Leading Cause of Preventable Illness and Deaths
Heart Screen Health Statistics

from cdc.gov

For the most recent available figures for leading causes of death in
the US, as compiled for the year 2003 by the National Center of Health
Statistics, refer to this page:
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/finaldeaths03/finaldeaths03.htm

The top five are:
1. Diseases of the heart: 685,089 or 28% of all US deaths in that year
2. Malignant neoplasms (cancer): 556,02 or 22.7%
3. Cerebrovascular diseases (strokes): 157,689 or 6.4%
4. Chronic lower respiratory disease: 126,382 or 5.2%
5. Accidents: 109, 277 or 4.55%.

Let's omit accidents (not a health condition, though certainly
preventable) and go to number 6 on the list:
6. Diabetes 74,219 or 3.0%.

How many of these deaths--and the chronic illnesses that led to
them--could have been prevented? Let's go back to that first CDC page
where a second chart lists the "actual" causes of death (that is the
causes of the diseases that led to chronic illness and death)and we
get these top five for the year 1990:
1. Tobacco use: 19% of all US deaths that year
2. Poor diet/exercise: 14
3. Alcohol use: 5%
4. Infectious agents: 4%
5. Pollutants, toxins: 3%

How many of these actual causes could be better controlled and their
resulting diseases prevented? Clearly tobacco use, poor diet/
exercise, and alcohol use are examples of behaviors whose modification
can have a big positive impact: fewer people smoking cessations means
less lung cancer and emphysema; more people eating healthfully and
exercising means fewer heart attacks, fewer strokes, less diabetes,
etc. Causes 4 and 5 are environmental rather than behavioral, but
here too greater efforts to control pollution and greater vigilance
against infectious agents could have a big impact on both morbidity
(illness) and mortality.
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Old 03-08-2008, 03:33 PM   #57
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I just do not subscribe to your premise that Univ Health Care is unfair (as I understood you to say) because you will have to pay for those who don't take care of themselves. In the end we all die, most of us will get some type of disease first. Drinking and smoking for example, does increase treatment costs, but since they die early on average you haven't convinced me their overall care will cost more than yours. Poor behaviors are a factor, I grant you that, but that isn't necessarily why health care costs are skyrocketing. I think is only a modest factor. Seeing your list of the leading causes of deaths and diseases really isn't the same thing as the cost issue. A bigger factor in cost might be that we typically allow older people (mostly under Medicare) to have every expensive procedure they want, isn't it unfair to ask all of us to pay for that also? Life is not always fair.

Nothing is easy when it comes to this problem, I think we should look at Univ Care and other ideas with an open mind. Health Care costs are out of control, something has to be done or none of us will be enjoying retirement. As an example, I've have info from my state showing some health premiums offered to state retirees to be already higher than the entire average pension check. It seems to me to be closed minded to have the attitude that "I'm against Univ Care because I see too many slobs not taking care of themselves and I don't want to pay for that.". That's my opinion. Whether it's Univ Care or something else.
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Old 03-09-2008, 10:28 PM   #58
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Back to the original question or that vein at least... if I retire early, do I worry most about the years before I hit 65? After 65, I qualify for Medicare, right? And then I would buy supplemental insurance to cover waht Medicare doesn't cover. How much does that cost? And do they cover everyone? Or will "pre-existing condition" be an issue because by then, many of us will have pre-existing conditions?! If I have it correct, that would obviously be better than my thinking that I'll need to pay really high premiums from 50 years old until I die.
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Old 03-10-2008, 05:30 AM   #59
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Retiringby50 you need to worry about both. Before Medicare you need to worry about pre-exisiting conditions and costs. At 65 you can get Medicare (there is no pre-existing clause) but... the price is going up fast and there now is means testing. You also will need supplemental insurance. Currently in my state (MI) a couple would pay about $650 ( assuming they don't have too much income.) That will be rising significantly. The Fidelity Retirement planning tool uses a medical cost of living increase of 7% and I think that is conservative.
As the Medicare fund is going to crash much sooner than SS I feel that one should be very conservative on preparing for medical costs.
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