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Old 11-03-2009, 03:00 PM   #101
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But big factors are also the good benefits like pensions and health care we have from our emplyers that younger workers no longer get.... With the death of these benefits will anyone be able to FIRE in the future?
Most people no longer enjoy pensions. I certainly don't ... but it will not preclude me from FIREing.

I don't see any reason to expect that healthcare will change substantially in Canada. Costs keep going up as new treatments and procedures are developed, but at worst a lack of resources may cause the quality of care to plateau.
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Old 11-03-2009, 06:51 PM   #102
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But it doesn't say anything about the Health bills cutting reimburesments. Maybe you can give me a link?
Here's where the White House says it will be saving $309 billion from Medicare and Medicaid (exactly how is not specified. Buying fewer paper gowns?)

This CNN piece has more. The White House says they'd like to cut $110 billion from scheduled increases in Medicare payments. This will "encourage health care providers to increase productivity."

Okay, but what about the proposed legislation from the Senate and the House? Medicare cuts are there, too. The House plan calls for $472.8 bilion in Medicare cuts over the next 10 years. The Senate finance committee ("Baucus bill") calls for $377 billion in Medicare cuts. (A source for more info).

There are three potential things a person can believe regarding this issue:
A) Medicare is a wasteful program and can easily absorb these cuts. We know that low medicare reimbursement rates are already impacting the quality of care for some people. But, to those who believe that Medicare is loaded with fat and able to absorb these giant cuts, I would ask why we are considering handing over more responsibility for US health care to the federal government if they can't fix the waste and insure adequate delivery of services in the government-run health care program that is already in place. If these cuts are possible and prudent now, then the administration should be making them regardless of the other health care reform issues.
B) Medicare is not wasteful, but these cuts will be made anyway. Seems to me that this would give anyone destined to be a Medicare recipient (e.g. almost any US citizen who will ever be older than 65) real reason to oppose this legislation.
C) These cuts are just being included as window dressing to lower the sticker shock of the proposed legislation, the cuts will never be made. History supports this view. The Senate leadership is trying to stop Medicare reimbursement cuts scheduled for this year, why should anyone believe cuts will be made for many successive years as called for in the legislation? Medical care costs are escalating, there's no way these cuts will occur. So, let's be realistic and put the true price tag on this legislation--it won't be paid for by cuts in Medicare. Let's see the real cost without the phony Medicare cuts and with the true (giant) costs of the federal subsidies to individuals once employers stop providing insurance. Then we can have an honest national discussion on health care and health care costs.
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Old 11-03-2009, 07:03 PM   #103
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Well put Sam!
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Old 11-03-2009, 08:13 PM   #104
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If this forum became extinct it might kick me off my behind out into the world a little more, especially on rainy days.

Ha
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Old 11-03-2009, 08:21 PM   #105
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If this forum became extinct it might kick me off my behind out into the world a little more, especially on rainy days.

Ha
Oh well Sir haha. These boards give you a chance to relax and recharge your batteries. We all know how full go vroom vroom you are
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Old 11-03-2009, 09:53 PM   #106
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Most people no longer enjoy pensions.
If I had one, I'd enjoy it...
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Old 11-04-2009, 02:11 PM   #107
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Here's where the White House says it will be saving $309 billion from Medicare and Medicaid (exactly how is not specified. Buying fewer paper gowns?)

This CNN piece has more. The White House says they'd like to cut $110 billion from scheduled increases in Medicare payments. This will "encourage health care providers to increase productivity."

Okay, but what about the proposed legislation from the Senate and the House? Medicare cuts are there, too. The House plan calls for $472.8 bilion in Medicare cuts over the next 10 years. The Senate finance committee ("Baucus bill") calls for $377 billion in Medicare cuts. (A source for more info).

There are three potential things a person can believe regarding this issue:
A) Medicare is a wasteful program and can easily absorb these cuts. We know that low medicare reimbursement rates are already impacting the quality of care for some people. But, to those who believe that Medicare is loaded with fat and able to absorb these giant cuts, I would ask why we are considering handing over more responsibility for US health care to the federal government if they can't fix the waste and insure adequate delivery of services in the government-run health care program that is already in place. If these cuts are possible and prudent now, then the administration should be making them regardless of the other health care reform issues.
B) Medicare is not wasteful, but these cuts will be made anyway. Seems to me that this would give anyone destined to be a Medicare recipient (e.g. almost any US citizen who will ever be older than 65) real reason to oppose this legislation.
C) These cuts are just being included as window dressing to lower the sticker shock of the proposed legislation, the cuts will never be made. History supports this view. The Senate leadership is trying to stop Medicare reimbursement cuts scheduled for this year, why should anyone believe cuts will be made for many successive years as called for in the legislation? Medical care costs are escalating, there's no way these cuts will occur. So, let's be realistic and put the true price tag on this legislation--it won't be paid for by cuts in Medicare. Let's see the real cost without the phony Medicare cuts and with the true (giant) costs of the federal subsidies to individuals once employers stop providing insurance. Then we can have an honest national discussion on health care and health care costs.
I was looking for something like "The house bill mandates a cut of X% in physician's services, and the Senate has Y%". The headlines really don't give that type of information.

via Mankiw, I found this CBO analysis of the House bill: http://www.cbo.gov/ftpdocs/106xx/doc...3962Rangel.pdf
See Table 3 beginning on page 18.

The 10 year reduction in physician's services is $42 billion, mostly in the second 5 years. From other sources, I can estimate the baseline for physician's charges and get a ratio. It's about 2.5% for the first 5 years and 4.5% for the second 5 years. (I wish I could find a more authoritative source than my own calculations. I'm using 19% of total Medicare expenses from the Kaiser foundation, applied to this projection of total medicare http://www.cms.hhs.gov/NationalHealt...s/proj2008.pdf

But, where's all the other money? Well, $170 billion is in reduced payments to Medicare Advantage plans. That's because the gov't gives MA plans more for their enrollees than it actually spends on similar people in the traditional Medicare program. This is an example of getting rid of "waste", but the waste is in the private MA plans, not in the gov't run program. Certainly, this is something that could be done without all the other provisions of the bill. But, I'd guess it's more politically feasible to bundle it other things that are popular.

$42 billion is in "elimination of coverage gap" in Medicare part D. I don't know about that.

Most of the rest looks like "hoped for efficiencies in hospitals and other places from stuff like electronic records". I think they are looking for those savings for all patients, not just Medicare. Like the physician's services, it seems to be back-loaded.

Now maybe physicians will leave the Medicare system in droves because their fees won't grow as fast as they would have, and they'll come up short 2.5% over the next 5 years. Maybe they won't. I wonder how many of the seniors who are very scared are thinking in terms of 2.5%.
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Old 11-04-2009, 05:18 PM   #108
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If I had one, I'd enjoy it...
Me too!

Oh well. At least with no pension, one is not tied down to an arbitrary fixed retirement date (yep, those grapes are sooo sour!).
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Old 11-04-2009, 06:46 PM   #109
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But, where's all the other money?
I don't know, either. Thanks for tracking down more info, it looks like you found from where slightly less than half of the "savings" in the House bill will come. I can see why those on Medicare are nervous.
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Old 11-04-2009, 07:16 PM   #110
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If this forum became extinct it might kick me off my behind out into the world a little more, especially on rainy days.

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But...but...bbbamI and I would become so bored and start becoming archeologists or something (my apologies to any archeologists who may belong here )
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Old 11-05-2009, 09:07 AM   #111
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I don't know, either. Thanks for tracking down more info, it looks like you found from where slightly less than half of the "savings" in the House bill will come. I can see why those on Medicare are nervous.
I found 100% of the savings. They are all in the CBO analysis that I linked, I just didn't copy them. Look at Table 3.

The bulk of the money is in trying to keep charges from hospitals and doctors from going up faster than everything else in the economy. That doesn't seem like an outrageous idea to me. The impact will come in very slowly. I expect that if doctors are dropping out of Medicare in great numbers, Congress will change the rules again.

Thinking a little further about this, I remembered this story:
Quote:
The nation's hospitals agreed last night to contribute $155 billion over 10 years toward the cost of insuring the 47 million Americans without health coverage, according to two industry sources. ...

Most of the savings -- about $100 billion -- would come through lower-than-expected Medicare and Medicaid payments to hospitals, said the two industry sources. About $40 billion would be saved by slowly reducing what hospitals get to care for the uninsured, they added. The reductions would probably not begin for several years, after a significant number of people have enrolled in the new insurance programs.
The concept here is that hospitals (and doctors) have bad debt losses on uninsured people. Those losses have to be charged to someone, so they end up going to everybody else. If the new bill decreases the number of uninsured people, then it reduces bad debt losses, meaning they don't have to raise rates as quickly.

(There's at least two pieces here. The federal gov't currently has a program of directly reimbursing some hospitals who have large numbers of poor emergency patients, who they have to treat because of federal laws. Separately, there's all the other bad debts for other hospitals and non-emergency. IIRC, the $40 billion is in the first category.)

The important point is that these "savings" (really cost shifting to new taxes) happen without any negative consequences to seniors on Medicare. They actually lower the hospitals' costs.
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Old 11-07-2009, 02:21 PM   #112
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I am from the pre baby boom "lost generation." I think we had the
advantage of being able to move up the ladder faster and make
more money relativelly speaking than those that that followed. We
were also on the tail end of the "defined benefit" pension era. Personally,
I would never have been able to retire early without the generous lump
sum payout that I received. Even at that, I would have been hard
pressed without my sideline laundromat business and substantial
inheritances from my parents and DW's.

Bottom line, I think earlly retirement will be much harder for today's
wannabees.

Cheers,

charlie
I pretty much agree with that and personally, I have given up on the idea of "early" and replaced it will "comfortable" retirement.

I would really need some major headwinds in the equity markets or some large lump sum along the way.

I probably won't be making big money anytime soon. I can only save so much. I won't have a pension. I may get some form of SS but I am not counting on it.

Either way, I will quit at some point and if I end up being the old guy in the pic I am ok with that so long as I have my pup with me.
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Old 11-07-2009, 07:02 PM   #113
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But...but...bbbamI and I would become so bored and start becoming archeologists or something (my apologies to any archeologists who may belong here )
Oooooohhhhhh....how did I miss this one?

Archeologist...sure. Yet another reason to buy a pair of boots.
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