The Cost of Retiring Healthy

[Billy]

Martha:

If we keep the insurance model, it seems the choices of what to do are limited.  We could let the market dictate who is covered and at what cost.  That would result in many people not being insured.  Currently there is 18 million uninsured in the United States.  And this is with some significant regulation of insurance companies.  For example, insurance companies have to cover everyone in a group if they offer a group plan....Another  option is to subsidize cost for ill people and poor people, those who insurance companies ordinarily would not cover or not cover at an affordable price.  The problem with this solution is that insurance companies will end up wanting a subsidy for anyone who is not perfectly healthy.

Every model will inherentlly have limitations. You are right, many people are now uninsured. Some of those people are self-insured, some are illegal aliens, some are the poor, some are healthy young people who will choose to insure when they reach their 30's perhaps, and some are self-employed people.

http://www.ahip.org/content/pressrelease.aspx?docid=15301

March 9, 2006 HSA Growth Accelerating Among Employers and Consumers
• In the individual market, 31 percent of new enrollees in HSA/HDHP plans were previously uninsured.
• In the small-group market, 33 percent of policies were purchased by companies that previously did not offer coverage.
• The group market now comprises 58 percent of the enrollment in HSA/HDHP plans, up from 21 percent in September 2004.

"An HSA is an account to which individuals and employers can contribute funds for future medical expenses.  By law, HSAs must be accompanied by a qualifying HDHP.  Preventive care services are generally covered by HDHPs and typically do not count against an individual’s deductible.  Earnings on HSA funds accumulate tax-free, balances can be rolled over year-to-year, and withdrawals made for qualified medical expenses are tax-free."

HSAs, A Model of Healthcare (Part I)  - HealthDecisions.org, Opinion, Tom Cochrane
January 09, 2006

"HSAs simply represent an alternative form of health care funding."

http://www.healthdecisions.org/HSA/News/default.aspx?doc_id=39968

"There has been a massive amount of investment and activity among health insurers, financial services companies and information technology providers who are focused on creating innovative products and services for the consumer directed health care market. "

Martha:

...If we have national healthcare, we are spreading around the risk to everyone.  ...I see national healthcare much like providing education, defense, and infrastructure like roads. 

I see national healthcare as enlarging the welfare state. we must have personal accountabiltiy. As Mr. Murray, the W.H. Brady Scholar at the American Enterprise Institute, and author of "In Our Hands: A Plan to Replace the Welfare State," says:

"The welfare state is pernicious ultimately because it drains too much of the life from life...Aristotle was right. Virtue is a habit. Virtue does not flourish in the next generation because we tell our children to be honest, compassionate and generous in the abstract. It flourishes because our children practice honesty, compassion and generosity in the same way that they practice a musical instrument or a sport. That happens best when children grow up in a society in which human needs are not consigned to bureaucracies downtown but are part of life around us, met by people around us. "

Rich_in_Tampa:

One comment: insurance companies are indeed more efficient than our woeful government bureaucracy. The problem is that the fruits of that efficiency do not get churned back in to benefits and lower premiums, they get taken out as profits or share price. A national program of some sort would have that slack to play with (and admittendly squander in some cases).

Press Release, FOR IMMEDIATE RELEASE, January 30, 2006, Contact:  Mohit Ghose

"Health insurance plan profits comprise three cents of the premium dollar.  "

http://www.ahip.org/content/pressrelease.aspx?docid=14702

Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[Eagle43]

[
I see national healthcare as enlarging the welfare state. we must have personal accountabiltiy. As Mr. Murray, the W.H. Brady Scholar at the American Enterprise Institute, and author of "In Our Hands: A Plan to Replace the Welfare State," says:

"The welfare state is pernicious ultimately because it drains too much of the life from life...Aristotle was right. Virtue is a habit. Virtue does not flourish in the next generation because we tell our children to be honest, compassionate and generous in the abstract. It flourishes because our children practice honesty, compassion and generosity in the same way that they practice a musical instrument or a sport. That happens best when children grow up in a society in which human needs are not consigned to bureaucracies downtown but are part of life around us, met by people around us. "
Akaisha
Author, The Adventurer's Guide to Early Retirement

Amen, Billy

Here's a GOOD essay regarding such.


And if you want to talk MONEY:

quote
If the European Union were a state in the USA it would belong to the poorest group of states. France, Italy, Great Britain and Germany have lower GDP per capita than all but four of the states in the United States. In fact, GDP per capita is lower in the vast majority of the EU-countries (EU 15) than in most of the individual American states. This puts Europeans at a level of prosperity on par with states such as Arkansas, Mississippi and West Virginia.
unquote
Can this be true?  I thought Europe competed with us, at least as the European Union entity.  And if it is true, is not the welfare state the reason?

 

[tomz]

I've been reading this thread from the sidelines and decided it was time to put my 2 cents in.  (Why not, that's what forums are for  ).  Here is a long, but very informative article comparing how healthcare is delivered by other countries.  http://ezraklein.typepad.com/blog/health_of_nations/index.html

Reading this will give anyone interested some good info on different approaches to healthcare.  Canada's system is not the only approach.  For the record, I favor some sort of national health insurance.  Call it socialized insurance.  It's different from socialized medicine.    Very different.

 

[Martha]

I'll make just one last comment. I see the trend as being more and more choices and options for those who are perfectly healthy, have a decent income, or who are employed. HSAs work great for healthy people with a decent income. They are next to useless for those with chronic conditions or are poor. I am concerned that at a point "fixes" such as HSAs and Medicare prescription drug benefits will be considered good enough. Leaving many shut out of the system.

For example, the state and federal governments are getting more and more stingy with medicaid. You can't get medicaid just because you are poor or sick. S

Akaisha, you quoted the following:

"The welfare state is pernicious ultimately because it drains too much of the life from life...Aristotle was right. Virtue is a habit. Virtue does not flourish in the next generation because we tell our children to be honest, compassionate and generous in the abstract. It flourishes because our children practice honesty, compassion and generosity in the same way that they practice a musical instrument or a sport. That happens best when children grow up in a society in which human needs are not consigned to bureaucracies downtown but are part of life around us, met by people around us. "

I think I cannot properly respond to this position in a sound bite on a retirement board. Personally, I believe that a society that takes care of its weakest makes for a strong society and enobles us all. But we can't run an experiment to see which philosophy is right.

 

[bamsphd]

To stir this up a bit 

Consider any disease/condition X.  If you are a profit maximizing
entity, are you better off finding a CURE for X, (which can be sold once
per disease/condition), or a treatment which only suppresses the
symptoms of X, (which can be sold repeatedly until such time as
the patient dies, or recovers on their own)?

I'm starting to think we should make a distinction between treatments.
Something like:
1) Treatments which protect third parties (eg vacination).
2) Treatments which cure the patient (eg setting a broken bone).
3) Treatments expected to extend the patient's life. (cancer drugs).
4) All other treatments.

I would like to see 1 universally available, 2 universally available
with a very high lifetime cost cap, 3 universally available but
with some kind of cost per month/life cap, and 4 available but not
subsidised by anyone.

I would probably offer 1 with no deductable, 2 and 3 with a high
deductable, but cover the deductable for anyone with an income
lower than around five times the duductable.

P.S.
I believe that if you were the only person in the universe, none of
your rights could ever be violated.   Though not rights, some
universal "entitlements" do seem to be in the best interest of society.

 

[Billy]

So glad someone else got involved in this discussion! whew. I started to feel lonely out here...

It's good to have a lively debate. I am all for having the best idea(s) 'win'.

Martha:

Personally,  I believe that a society that takes care of its weakest makes for a strong society and enobles us all.  But we can't run an experiment to see which philosophy is right. 

Martha, I don't disagree with you on this statement as a whole. However, I believe that 'society' is made up of individuals. Having a bureaucratic system to provide the personal touches somehow leaves me cold. 

The socialist 'experiment' has failed... (IMO) 

It is entirely possible that the twain shall never meet on this issue.

Akaisha
Author, The Adventurer's Guide to Early Retirement

 

[haha]

I just noticed this thread. It is a topic that I have been interested in for years. First, I agree with Martha, Rich, TomZ and others who are able to see that the "health care market” is no free market at all; it is a perfect market from the point of view of the oligarchic sellers of "medial services". What does any business crave- large well financed, information rich providers dealing with atomized, needy, information poor consumers.

In the 1870s Germany under Kaiser Wilhelm 2nd, and Chancellor Otto von Bismarck realized that some nationally mandated important social services would help unite the young German state which had been created out of fragmented small political and geographic entities. Health care was one of the things they provided, as well as education and others.

Most Americans today realize that some things cannot be well done personally or on a mass scale, privately. Oddly, most approve of publicly provided and very expensive education, but not of publicly provided or at least publicly supervised health care. Interestingly, it is likely that competition among education providers would work better than it does in the realm of health care.

We will get some form of universal or near universal care. The surest sign of that is an editorial in last Monday's Barron's, advocating it. The reason? Our system of employer provided care is wrecking certain large old but very necessary employers. Both Ford and GM have closed more plants in USA than they have in Canada because in Canada they are not burdened by employee and even worse, retiree health costs.

As we transition to another way of doing things, we will likely get a more rational system if people are able to look beyond their reflex categorizations of socialism, etc, to see the underlying on-the-ground reality.

Ha

 

[tomz]

Oddly, most approve of publicly provided and very expensive education, but not of publicly provided or at least publicly supervised health care. Interestingly, it is likely that competition among education providers would work better than it does in the realm of health care.

Good point re public education.  As a society, we have decided that providing education to all children is worth paying for.  We have decided that building and maintaining roads is worth paying for.  The market doesn't always provide the best solution.

There are over 45 million people without insurance in this country.  And doctors are providing less charity care - http://www.miami.com/mld/miamiherald/business/national/14164086.htm

We are losing jobs to other countries that provide national healthcare.  Our health care costs are the highest per capita and, by most standard outcome measures (lifespan, infant mortality), we are near the middle to the bottom of the heap of industrialized nations.  Health care in the US is sick.

It's too bad, we can't agree on a cure....

 

[donheff]

We will get some form of universal or near universal care. The surest sign of that is an editorial in last Monday's Barron's, advocating it. The reason? Our system of employer provided care is wrecking certain large old but very necessary employers. Both Ford and GM have closed more plants in USA than they have in Canada because in Canada they are not burdened by employee and even worse, retiree health costs.

I have often wondered why more CEOs don't push for some sort of nationalized health program for just this reason. It seems strange to push this on companies making them less competetive in global markets. One big problem is that the massive deficits from the recent round of tax cuts will make it much more difficult to do something like this. Of course, making national programs harder to implement was one of the real reason the neocons pushed the cut through in the first place. Looks like they have suceeded.

 

[Rich_by_the_Bay]

In the 1870s Germany under Kaiser Wilhelm 2nd, and Chancellor Otto von Bismarck realized that some nationally mandated important social services would help unite the young German state which had been created out of fragmented small political and geographic entities. Health care was one of the things they provided, as well as education and others.

Most Americans today realize that some things cannot be well done personally or on a mass scale, privately. Oddly, most approve of publicly provided and very expensive education, but not of publicly provided or at least publicly supervised health care. Interestingly, it is likely that competition among education providers would work better than it does in the realm of health care.

Thanks for the historic perspective, Ha. Didn't know that. It is interesting that identifying this need as a national priority spans the social and political spectrum all the way from the left (e.g. modern day Cuba) to the right (examples you gave).

In our typical way, America will fix it. After it reaches crisis proportions. Meantime, let's all take great care of ourselves.

 

[bosco]

The socialist 'experiment' has failed... (IMO)

what exactly do you mean by this statement?

In the context of other statements you have made on this thread, it seems you are referring to Canada and European countries with socialized medicine.

I can't speak about Europe, and I will be the first to agree that there are problems with the Canadian medical system. Also that there is a demand for privately available services in Canada to alleviate long waiting lists for certain procedures.

Neverthless, there are certain facts that need to be considered:

Canada spends 1/3 per capita on healthcare as the U.S.
The life expectancy in Canada is about 3 years longer than the U.S.
infant mortality in Canada is lower
everyone is covered in Canada
according to a recent study in the US, healthcare for the more affluent is not measurably better than for the poor--it's not good for anyone.

so which experiment has failed? Let's face it--there's room for improvement everywhere, but personally I find the Canadian model much more humane.

 

[Caroline]

Did y'all see this in your newspaper? 

http://www.latimes.com/news/local/la-032206dump_lat,0,5616475.story?coll=la-home-headlines

Excerpt: 

"Authorities released a videotape this afternoon of what they say is the dumping of a 63-year-old woman on the streets of skid row.

The videotape, recorded by security cameras outside the Union Rescue Mission entrance on San Pedro Street on Monday afternoon, shows a taxicab pulling a U-turn and then driving out of view. A few seconds later, a woman wearing a hospital gown and no shoes walks from the same direction, wandering in the street and on the sidewalk for about three minutes before a Union Rescue Mission staff person escorts her inside the mission.

LAPD Capt. Andrew Smith said he believes the taxi took the woman, a 63-year-old Gardena resident, downtown against her will after she was discharged from Kaiser Permanente Bellflower on Monday."

Question:  Anybody heard of this type of thing happening in Canada?

 

[Rich_by_the_Bay]

Did y'all see this in your newspaper? 

That is a sad story.

BTW, the untold side of such events is something I have seen numerous times: the impaired homeless patient admitted, treated, and cured or stable. Now what to do? If you discharge them, they will surely get sick again - violence, abuse, substances, the elements. So you look to social workers to find them an alternative. Nursing home? Nope, not needy enough medically (generally you need IVs or some other medical ongoing need). Assisted living? No, not competent enough for the independence. Family? Friends? Hah.

So, they sit in the acute hospital at $1500 bucks a day not receiving any real medical care, under Medicaid (tax) support. Hospitals eventually fill up, and truly urgent patients can't get a bed, etc.

It can be hard balancing your ethical responsibilities to the individual patient against those you owe to society at large. Obviously dumping them on the street is never the right solution but sooner or later they need to leave the hospital.

Seems to me we are all paying for this one way or another. Under the current system it seems we don't get a lot back for our money. I reckon it doesn't need to be a politcal issue, liberal, progressive, conservative, whatever. It's just bad business and bad results.