The Cost of Retiring Healthy

[retire@40]

"A 65-year-old couple retiring today will need on average a tidy $200,000 set aside to pay for medical costs in retirement, according to an annual Fidelity Investment study released this week."

http://www.marketwatch.com/News/Stor...ll&siteid=mktw

[Zipper]

Why do you put up with that?

[ERD50]

Originally Posted by Zipper

Why do you put up with that?

Is the Canadian system significantly more cost effective (it may be - I do not know)? If not, then you are paying the same amount through your taxes - no free lunch.

Part of the problem of socializing services is people think of them as being 'free'. Usually, that leads to waste. Part of the problem with the US system is that many are covered by insurance, so they also do not see the costs associated with a treatment.

-ERD50

[Rich_in_Tampa]

Originally Posted by ERD50

Is the Canadian system significantly more cost effective (it may be - I do not know)? If not, then you are paying the same amount through your taxes - no free lunch.

Hmm... maybe not quite that simple. A universal system has imperfect but built-in boundaries as to how much care is covered, limits on futile care, and appropriate incentives to minimize the risk of an entrepreneurial provider ordering gray-zone tests because there is a profit involved. It also makes everyone ration their health care costs via taxes, so that the risk of catastrophic illness, etc. does not have to affect decisions about changing jobs, retiring, etc.

Yes, the Canadian system is cheaper per capita (a LOT cheaper) than the USA.* See here http://consumeraffairs.com/news03/health_costs.html for starters - a third the cost. Outcomes are generally as good or better in Canada (notwithstanding the usual anecdotes about dying while waiting 3 months for your coronary bypass surgery). It's the way it is.

[cute fuzzy bunny]

Originally Posted by Rich_in_Tampa

A universal system has imperfect but built-in boundaries as to how much care is covered, limits on futile care, and appropriate incentives to minimize the risk of an entrepreneurial provider ordering gray-zone tests because there is a profit involved.

Ding ding ding...

[db]

ERD50 writes the usual that folks will assume medical care is free and thus waste it.* I think that may be more ideology than fact.

I would argue that utilities, and health care is a form of utility in the sense that you have no alternative, should be removed from the profit system.* The need to pay dividends to stock holders adds to the cost of health care.* But*lobbys for special interests will never let it happen.* Witness the pharmaceutical coverage the Bush administration implemented.

db

[Rich_in_Tampa]

Originally Posted by db

I would argue that utilities, and health care is a form of utility in the sense that you have no alternative, should be removed from the profit system.

Some would argue that health care is even more than a utility: that it is a right, when used appropriately. Throw in some sin taxes to support the burden imposed by tobacco, alcohol, etc. if you have issues there.

[Martha]

I am with you on this Rich. If enough of us decide it is a right, it will be a right.

The move towards a so called consumer driven model, with more of the cost born by the patient so the patient makes better "choices," doesn't make much sense. Taking your kid to the doctor because he has a sniffle is a drop in the bucket.
Most healthcare costs are from expensive conditions and chronic conditions. No matter what choices are made, it costs a lot. And if you are seriously ill you are not shopping based on cost.

[Rich_in_Tampa]

I'm pretty moderate politically, but trust me: market-style capitalism and health care do not work well together. Lots of ethical and moral reasons, but also ..

a) unlike widgets, you can't withhold needed care on the basis of ability to pay (unless you are a psychopath),
b) a sick patient cannot reasonably be expected to shop around for the best deal,
c) all the power is concentrated in the provider given the technical expertise - the dynamic is lethal to good faith negotiation,
d) patient's cannot opt out on the basis of cost without unreasonable consequences,
e) third party costs alone eat up a third of expenditures and only drive wedges between patients and their physicians. I could go on and on.

The "let the market take care of it" system being promoted is great, however, if you are an insurance executive. Oh.. and to keep this thread on topic: it really screws up FIRE plans for alot of people

[. . . Yrs to Go]

Originally Posted by Rich_in_Tampa

I'm pretty moderate politically, but trust me: market-style capitalism and health care do not work well together.

That is certainly true, but medical progress is pushed forward by a profit motive. It's hard to say, which, if any, of the world's break-through drugs and treatments would have been invented without the U.S. consumer footing the bill. The rest of the world can, and does, look down smugly at the U.S. system when, instead, they should simply say "thank you."

[Rich_in_Tampa]

Well, I was referring to health care delivery rather than pharmaceutical research. I agree that private research has brought some great achievements, and that paying for R&D is a necessity. That is indeed a tricky one.

Oops -- gotta go -- there is a beautiful babe in a short dress and low-cut blouse who wants to detail me on her company's new "me-too" designer drug which costs $300 a month, and is almost as good as ibuprofen. And I'll get free dinner tickets at Chez Celebrex, and a $500 honorarium for lecturing on .... oh never mind.

Sarcasm aside (it's been a long day ) - breakthroughs are real, but day-to-day management of getting basic good care to folks with the commoner diseases in an affordable and reliable way is where the payoff is (for patients). There are zillion dollar cancer drugs that extend survival by 2.9 months (much of it under therapy). Never know which one will some day be "the cure" but I hope you can see that with limited resources it is not always clear how to best spread the most fairy dust around.

[FlogBlogger]

$108 per month.

What? Oh, yeah. That's the cost of catastrophic health coverage for a 50-year-old to retire healthfully.

Delaying retirement only increases the likelihood medical care will be necessary. And the incremental increase in earnings by delaying retirement seems a poor trade-off for the incremental loss of time value, all other things being equal.

[MJ]

I'm 58, healthy and drug free as I have been most of my life. I hope my lifestyle will keep me that way for years to come and keep my health costs down. Of course that asumes that a drunken driver won't run me over while riding my bicycle or an exotic disease won't overwhelms my immune system and kill me.

[Billy]

Rich In Tampa

Yes, the Canadian system is cheaper per capita (a LOT cheaper) than the USA.* See here http://consumeraffairs.com/news03/health_costs.html for starters

That article is 3 years old... why not read NYTimes As Canada's Slow-Motion Public Health System Falters, Private Medical Care Is Surging By CLIFFORD KRAUSS Published: February 26, 2006
http://select.nytimes.com/gst/abstra...AB0894DE404482 ?
Rich

Some would argue that health care is even more than a utility: that it is a right,

Martha

I am with you on this Rich.* If enough of us decide it is a right, it will be a right.

Well... we can't live without food, water, air... Are these rights too? Isn't this getting a bit out of hand here? I thought health care is a responsibility, not a right..
Maybe I should look for "food, water and air insurance"

3 yrs to go

That is certainly true, but medical progress is pushed forward by a profit motive. It's hard to say, which, if any, of the world's break-through drugs and treatments would have been invented without the U.S. consumer footing the bill.* The rest of the world can, and does, look down smugly at the U.S. system when, instead, they should simply say "thank you."* *

I agree with you there, 3Yrs...*

Akaisha
Author, The Adventurer's Guide to Early Retirement

[samclem]

I agree that the way we pay for health care in the US isn't rational and leads to big inefficiencies. Linking health insurance to employment isn't working anymore for the employees or the employers. Got it.

I just wonder where the "right" to health care comes from, philosophically. None of the traditional rights (e.g. in the constitution) involve forcibly taking one person's assets (time/money/etc) and giving it to someone else.

Here's a Libertarian perspective on this thang:
http://www.objectivistcenter.org/ct-...alth_Care.aspx


Or, maybe we'll choose "from each according to his abilities, to each according to his needs." Others have.

[ERD50]

Interesting comments. My original post was in response to 'zipper' from Canada. That was just to point out that Canadians pay for health care too, it comes out of their taxes.

All the systems have faults and (hopefully) good points.

I must say, I don't get the idea of medical services as a 'utility'. Utilities were put in place (in theory) when the government decides that competition would be too disruptive (running multiple power, gas, sewer, water lines through public easements). It may be for the common good, but competitive forces don't keep those utilities innovating and fighting to be efficient and win customers. They don't have to.

But why can't medical services be competitive? Choose your doctor, hospital, prescriptions (where there are alternatives)?

That doesn't mean the government can't supply some kind of catastrophic care, and care for the very poor. Ideally, I'd like to see all those people pay for their own insurance, but that's not going to happen, so having the government do it through taxation may be the only way.

I'm not sure that relying on our employers for health insurance is a good system (remember, we still pay for it one way or the other). Maybe it should work the other way around. For example, when you take out a mortgage, the lender wants proof that you have insurance, but you are free to find the best deal. Maybe employers should ask for proof that you have some form of pro-active health insurance to protect their interests (a healthy employee will be more productive). But, just like home insurance, you would shop around. Of course, your salary would be higher so you can afford the insurance - the company is not paying for your insurance any longer.

OK, it's probably a crazy idea - I'm just brainstorming.

-ERD50

[Rich_in_Tampa]

Originally Posted by Billy

Well... we can't live without food, water, air... Are these rights too? Isn't this getting a bit out of hand here? I thought health care is a responsibility, not a right..
Maybe I should look for "food, water and air insurance"

A "right" in the same sense that reasonabe roads, effective law enforcement, a basic level of infrastructure, fire departments and the like are "rights." We pay for all these somewhat equitably as a society (taxes) because we feel they are basic values and services ("rights" in a sense) we deserve as Americans. I would simply put decent health care at least as high on my priority list. (I doubt many would like to buy firefighter insurance, police insurance, etc.)

Isn't this getting a bit out of hand here? I thought health care is a responsibility, not a right..

That feels pretty harsh, but I respect your opinion. I would hate to tell my cancer patients tomorrow that their leukemia or breast cancer was their "responsibility." Alas, I may have to tell some of them that paying for the care is.

Hope you can see a reasonableness to the viewpoint, even if you don't happen to agree. Maybe at least a catastrophic coverage plan would help some (e.g. expenses over $10K/citizen/yr). I see a badly broken system that has gone wild with millions of Americans paying very deeply in terms of suffering, finances, and disrupted life plans -- and getting worse very moment. Time to address it as a nation.

Just my $.02.

[Martha]

Shopping around for the best health insurance deal only works at all well if you are healthy. People with health conditions have no bargaining power.