How would national health plan affect ER?

[FIRE'd@51]

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Originally Posted by Want2retire In answer to your questions, this will not affect my ER planning. I have been delaying ER until I qualify for lifetime medical as a federal employee. Since ER will be in about 22 months, I don't think things will progress fast enough to personally help me to retire sooner. Since I will already have lifetime medical, it won't help my situation in retirement, either. On the other hand, increased taxes would hit me hard after ER! I will have to manage with less than I had planned. I earned (and I am still earning) a lower salary as a federal worker than I could have in industry, for many years. I deliberately chose to do so, because I felt that this job offered the greater total compensation package when considering the small pension and lifetime medical offered to federal employees. If I now have to pay for lifetime medical for everybody else through my taxes as a retiree, that would NOT make me happy. I have no idea what taxes would increase or how much in order to pay for all this, but I am thinking it can't be good for my personal financial position after ER.

I am not criticizing your position, but I think your post illustrates why health care reform is so difficult. I am disappointed that none of the major candidates for President (especially the Dems) are actively promoting the idea of ending employer-based health insurance, along the lines of Ron Wyden's plan. Until we tie the insurance to the individual, there will always be people who will lose their insurance when they are laid off, switch employers, forced into early retirement, etc. If those persons have pre-existing conditions, they will not be able to buy affordable insurance in the private market, assuming they can buy it at all.

Of course, anyone who has "cadillac" insurance provided by an employer doesn't want to give it up for something less (which is what any government provided health care will likely be), and the candidates know this.

[W2R]

Oh, I'm not necessarily AGAINST something being done about health care. Something needs to be done. But I thought the question was how this would impact the timing of exactly when we ER, and our personal situation once we are in ER, wasn't it?

I looked back on what I wrote, and I don't see anywhere where I say that I think nothing should be done. It's not always a good assumption that when someone feels their personal best interest isn't going to be met by a certain change in government or piece of legislation, and that this does not make them happy, that they would make their decision on being for or against it based only on their own self-interest.

Guess I wasn't clear.

[Grizz]

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Originally Posted by David1961 I’d like to throw a question out to the members here, particularly those planning for ER who have not ER’d yet. If and when the US goes to some sort of national health-care system, how will it affect your retirement planning? Would you be more likely to ER early? I know the devil is in the details, but in general how would such a plan affect your planning?

I'm Canadian, and we have a universal gov't health plan for everyone. It's an unruly system that is not efficient in many ways, but from my observation, those who are planning retirement are much more concerned with their proximity to the nearest hospital than personal funding of any sort. That said, during our working lives we pay taxes at a rate that if implemented in the U.S. would cause some serious civil unrest. I guess the idea is that we are pre-paying for our old age health care when we are working. I am absolutely not a socialist by any stretch of the imagination, but after reading of all of the people who can't seem to fund their own insurance for health care in the U.S. I actually (shudder at the thought) feel pretty good about our system.

[Martha]

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Originally Posted by Rustic23 Martha, The 47 Million number is often tossed out. However, a 2003 article How Many People Lack Health Insurance and For How Long? states that between 21M and 31M don't have insurance for the entire year. It also Stated that 240M Americans do have health insurance. Another thing, as pointed out in discussions on this before, what percentage choose not to have insurance, what percentage are non us citizens?

For some reason, I can't make your link work. However, the 46 million number is from Census figures from 2006 (revised down now to about 45 million) and is for people uninsured for at least an entire year. The 2004 Census showed 45.8 million uninsured. I previously linked to a breakdown of the demographics of the uninsured. Yes, you are right, a portion of the uninsured are not US citizens. "The vast majority (79%) of the uninsured are citizens. However, a disproportionate percentage of the uninsured are non-citizens. While non-citizens are 7% of the population, they are 21% of the uninsured." Inotherwords, about 9 million of the uninsured, leaving about 35 million citizens uninsured. Overview of the Uninsured in the United States: An analysis of the 2005 Current Population Survey: Issue Brief IIRC, the census figures do not count illegal aliens in its count of the uninsured, only legal residents.

Let me give you some more numbers:

The Commonwealth Fund has estimated that 16 million Americans are underinsured and in a 2005 study found 71 million non-elderly Americans had trouble paying their medical expenses in 2003, with 27 million working adults carrying medical debt.

83% of the uninsured are in working families (Employee Benefit Research Institute).

The Kaiser Foundation's 2005 Employee benefits survey has found that employers providing insurance to their workers declined steadily in the prior five year period. In 2000, 69% of companies offered health insurance. In 2005 it was 60%. This may explain in part the fact that the fastest growing group of uninsured Americans are those in families earning between $50,000 and $75,000. (2006 Census).

I don't disagree that a portion of the uninsured in the US are not citizens. I also don't disagree that some of the uninsured could buy insurance. But doesn't that make the problem easier to solve? Because there is a problem as there are plenty of people who can't buy insurance either because of cost or because they are not insurable.

One group that tends to have "voluntarily" uninsured are young people between 18 and 25. They feel invulnerable and sometimes also work in jobs that don't provide benefits or the benefits require an extensive waiting period. Bringing them into the system will be good for everyone as it levels out cost and protects them from catastrophe.

EDIT: Hey Rustic, you and I have done this before. More facts in this thread: http://www.early-retirement.org/foru...tml#post541820

[Rich_by_the_Bay]

The uninsured numbers are felt by many to be understated because they require a full year of no insurance. The sequence seems to be: have a job and be insured; get sick; become unable to work; lose insurance. Then comes the sell-off of personal savings or possessions, and finally (in some cases) personal bankruptcy.

That individual would not be considered uninsured in the year in which the job ended. I have personally seen numerous variations of the above.

[Rustic23]

The link is from the Congressional Budget Office Congressional Budget Office - Home Page. It was a 2003 paper 'How Many People
Lack Health Insurance
and For How Long?May 2003
While the information is 2003 and not 2006, it does not seem to me the numbers of people without insurance for an year, which were 21-31M should have climbed to 46m in three years.

Again, mine is not so much a quibble with the numbers as what people want to do. Is the system broke? If so why. What do you want to do about it.

While requiring people to get Health insurance that don't want it, because they don't think they need it does not seem very democratic to me. I guess you could use the motorcycle helmet reasoning, 'If they do need it we will have to pay for them so lets force them to have it" Of course if this is so, then they really aren't uninsured if 'we' are going to pay for them.

By the way, doesn't the Kaiser Foundation run a large HMO in California? If so how balanced is their survey?

Now the cynic in me. Follow the MONEY! There is a reason we don't have Universal Health Care/Insurance. Politicians bleed the Insurance companies for contributions. When they stop paying they will do something.

On the other side Insurance is a business. So, would you lend your car to a known drunk? The insurance business does not want them as a customer either. Well not at the same price as the non drunk. Likewise if you have a known medical condition, they don't want to insure you. It is the same reason you want insurance. A national high risk pool like FEMA might work. However, it would only have high risk individuals so either it would require government subsidies or sky high prices.

So I guess I am back to square one. What do you think we should do? As you and I have talked before, I am not against or for Universal Health/Insurance. Just tell me:

1. What does it provide
2. What is it going to cost
3. What is the long term effect on research
4. Who is going to pay
5. What is the effect on the health care profession
6. What are the legal aspects i.e. Lawyers, Doctors, Malpractice etc.
7. If put in place what will the health care system look like 5/10/15 years from now.
8. What is the effect on quality and quantity of health care

I am sure there are more questions. Right now, health care is a political football that is being kicked around, and like the Fair TAX/Flat Tax, I doubt it is going anywhere.

[Shawn]

I could afford to retire now, at 48, but I'm waiting until I'm 50 to be eligible for lifetime medical/dental through my employer. If universal health coverage became available today, and it was equivalent to my expected employer-sponsored retirement coverage, then today would be my last day on the job. Why should I be a tax-paying productive member of society when the government (or someone else such as my employer) will provide something for free.

I selected my job many years ago, in part, because of the stability and retirement security that it offered. In addition, like many people here, I've saved my money throughout the years. These were conscious decisions on my part, and there is no reason that most people cannot make equivalent decisions. I made what I consider to be good choices and I don't particularly want to pay for the poor choices other people make. This is neither an argument for or against universal coverage.

[REWahoo]

Although I was aware that some uninsureds were that way voluntarily (worked at an employer who provided health insurance but chose not to take it), the reality of this never really hit home until I saw a bit on the ABC evening news last night. It was a short piece on the Emergency Room at Parkland Hospital in Dallas :

24 Harrowing Hours Inside the ER: An Inside Look at One of America's Busiest Trauma Centers

On some level I suppose I knew that just because someone had a job where health benefits were available, that didn't mean they were affordable. But the severity of the problem never really dawned on me until I heard the ER nurse say this:

One in four Texans are uninsured and of them, 80 percent have jobs. "Most of them are working people," says nurse Lisa Mack as she walks through the packed room. "It's just 'do I put food on the table for my family or do I pay for a health care plan?'"

Martha and Rich have spent a couple of years setting me up for it, and this news program caused the light bulb to go on in my head. Any Presidential candidate who advocates strongly for sensible health care reform, regardless of party affiliation, has a very good chance to get my vote.

[Notmuchlonger]

How would the plan on funding the plans? Raise taxes?

[Rustic23]

ReWahoo,
At what cost?

Medicare not SS is the government program in trouble. (I base that on hearsay not any given fact I can quote) However, if true we can't pay for the program we have.

I have seen the number that 27% of those working in Texas do not have insurance. It does not address how many of these are US Citizens. The Harris County Emergency Rooms are over run by non US citizens. Take out this portion of their clientèle and Harris County does not have a health crisis in the county hospital. That is the problem with numbers. Statistics don't lie, however people that use them may/do/will!

By the way, ABC, now how about some fair and balanced station..... like CNN.

[cute fuzzy bunny]

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Originally Posted by Martha More facts in this thread:

Silly Martha...dont go trying to confuse people with the facts when their minds are already made up. Its all the fault of the illegal aliens, we'll have to double taxes, and gosh darn it, its a citizens right to not have to have health care!

But if you do want some facts...

- Illegal aliens health care costs are a smaller piece of the health care cost pie than the copier/printer paper used in hospitals. The health care costs for illegal aliens is a percentage small enough to be statistical noise against the trillions spent overall on health care. Some specific hospitals in border areas seem to have financing problems due to caring for patients that dont pay their bills. Yet if you took away those "customers", the hospitals would probably have to close down due to lack of business. And nobody is forcing them to operate the hospital under those conditions, yet they continue to stay in business.

- We spend more per capita than any country and get among the worst care. So "where does the money come from?" seems to be pretty simple. Squeeze out the insurance companies, get rid of the bureaucracy, and provide better care at a lower cost than we're all currently paying. No need for tax increases. Everyone wants to point at the tax rates in countries with socialized medicine. How about this fact: in the past 3 years the combined employer/employee costs for health care for my family has been 3x the amount we've paid in income taxes?

- I'm fine with people electing to not have health care when they can afford it, providing they dont show up at the emergency room the next time they get the flu, and they pay their doctor bills when they do go in for care. I'm not fine with people wanting their families covered but they cant afford it. This is a civilized country. We educate our children, pave our streets, jail criminals and defend our nation. How about we make sure mom doesnt have to choose between feeding the family or taking little Suzy to the doctor?

[Rich_by_the_Bay]

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Originally Posted by Notmuchlonger How would the plan on funding the plans? Raise taxes?

It has been estimated that about 30% of every health care dollar goes to administrative overhead. From other countries' experience and from modelling it appears that this can be decreased to about 20% or less under a system that reduces underwriting costs, staggering complex and difficult to follow policies and forms, perplexing discounting and contract vagaries, etc.

In addition, so many uninsured get their primary care from emergency rooms which, being set up for the worst, charge grossly inflated rates to give minor care. We (the insured) pay these costs now through medicaid, health insurance premiums which support reimbursements distored by cost-shifting ($70 aspirin tablet to compensate for the unreimbursed CT scan). Doctors need to do their part too, and restrain themselves from marginally helpful high tech testing which rarely changes treatment plans (not every mild knee pain or headache needs an MRI).

Out of control. Doesn't matter if your personal politics are liberal or conservative - we are in a mess and it ain't getting better.

[Martha]

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Originally Posted by Rustic23 Again, mine is not so much a quibble with the numbers as what people want to do. Is the system broke? If so why. What do you want to do about it.

Well, I think I have made clear what I want to do about it.

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By the way, doesn't the Kaiser Foundation run a large HMO in California? If so how balanced is their survey?

Common and reasonable misunderstanding. No, there is absolutely no relationship between the two organizations. The Kaiser Family Foundation has an impeccable reputation.

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Now the cynic in me. Follow the MONEY! There is a reason we don't have Universal Health Care/Insurance. Politicians bleed the Insurance companies for contributions. When they stop paying they will do something.

I absolutely agree. This is why I do not support Clinton.

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On the other side Insurance is a business. So, would you lend your car to a known drunk? The insurance business does not want them as a customer either. Well not at the same price as the non drunk. Likewise if you have a known medical condition, they don't want to insure you. It is the same reason you want insurance. A national high risk pool like FEMA might work. However, it would only have high risk individuals so either it would require government subsidies or sky high prices.

The other option would be to bar underwriting and require everyone to get insurance, much like Senator Wyden's plan. But yes, a risk pool doesn't work without subsidies from someplace.

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So I guess I am back to square one. What do you think we should do? As you and I have talked before, I am not against or for Universal Health/Insurance. Just tell me: 1. What does it provide 2. What is it going to cost 3. What is the long term effect on research 4. Who is going to pay 5. What is the effect on the health care profession 6. What are the legal aspects i.e. Lawyers, Doctors, Malpractice etc. 7. If put in place what will the health care system look like 5/10/15 years from now. 8. What is the effect on quality and quantity of health care I am sure there are more questions. Right now, health care is a political football that is being kicked around, and like the Fair TAX/Flat Tax, I doubt it is going anywhere.

So many questions, all of which are reasonable, but can't be answered in the soundbite system of an internet message board. I will say that there are many who are looking at these issues and I have some hope that policy makers will pay attention. The paper Rich linked to is an example.

Because there are so many issues in the health care sector it makes it hard to have a global solution. So, we attack piece by piece. My piece is health coverage for the poor and for the uninsurable. Whether through a public plan or subsidized insurance. Of all the plans, I like either medicare for all (single payer but not single provider) or Wyden's plan where insurance companies stay in the mix, where everyone gets insured, the insurance companies can't underwrite but must compete on cost, and payments are collected through the income tax system. Not perfect, but a lot better.

Other people can work on the delivery end of the system, which needs a lot of work as well.

[Notmuchlonger]

Thanks Rich

Does anyone know if Dr's and nurses in other countries make the same wage as their United States colleagues? I wonder if they would start putting a cap on how much a nurse or Dr could make in a universal health care system. I know there is a nursing shortage. I have no idea if there is a Dr shortage in the US.

[DallasGuy]

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Originally Posted by Notmuchlonger How would the plan on funding the plans? Raise taxes?

How does the US fund the war in Iraq? By running huge deficits, of course. I always find it interesting that people don't want to fund universal health care but don't say anything about all of the money that the US spends all over the rest of the world...on wars and military bases and "bribes" to other countries to "do it our way". I'm guessing that health care would still be more expensive than a war in Iraq, but the idea is still the same...why not take care of the people in our own country first instead of blowing the money everywhere else but here?

[cute fuzzy bunny]

Hitler!

[W2R]

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Originally Posted by cute fuzzy bunny Hitler!

Hey, that didn't work the last time I used it. Nice try.

[cute fuzzy bunny]

ummm....

Godzilla Hitler?!?

[Notmuchlonger]

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Originally Posted by DallasGuy How does the US fund the war in Iraq? By running huge deficits, of course. I always find it interesting that people don't want to fund universal health care but don't say anything about all of the money that the US spends all over the rest of the world...on wars and military bases and "bribes" to other countries to "do it our way". I'm guessing that health care would still be more expensive than a war in Iraq, but the idea is still the same...why not take care of the people in our own country first instead of blowing the money everywhere else but here?

I just asked how it was proposed to be paid for.

[DallasGuy]

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Originally Posted by Notmuchlonger I just asked how it was proposed to be paid for.

And my implied answer was....stop spending our money everywhere else in the world and spend it on universal health care (or something simliar) instead.