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Old 08-27-2010, 03:50 PM   #21
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Obviously a 10% per year increase is unsustainable...
Interestingly enough, FIDO's Retirement Income Planner has had a 7% annual increase for the category of health care expenses for many years, separate from the long term inflation rates for all other expenses.

I'm sure that they will be looking at changing it as things progress...
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Old 08-27-2010, 04:03 PM   #22
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Said it before and will say it again....if you can't write the check, then you can't write the check! Those charts show 10-15% increases, but most individual policies my clients have were hit with 20-35% increases the past two years. My personal policy with Anthem went up 35% in one year.

In the health reform bill you have an ever-increasing subsidy since the out of pocket costs are capped based on income. If your income today is $60k and you can't spend more than 9.5% of that on premiums that cost 3 times as much, how big is that subsidy when you're still making $60k a few years later and the rates keep going up 20-30%? Taxpayers making over the subsidy limits will also balk at the subsidies as the disparity gets bigger. Why should someone making $88k with a family of 4 only have to pay $8k/year for insurance while the person making $89k has to pay $25k? Sickening...

Have to agree as that is exactly what I have been able to read. Our increases on a private policy each year have been 12% except last year which was 25%. The nice think is in three years since I am ESR and only work some part time you can bet we will not make over $88K. For us it will be an improvement but I really do not like to get cost decreases that way as it is just passing the buck. I do think and hope that this change will in the short term force some price controls as we have certainly not had any to date and as an individual I really never had a way to bargain for lower rates. The changes for cost control that eventually must happen I am sure we will not like but something has to be done and hopefully this will get the ball rolling.

How is this for the Glass is half full outlook?
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Old 08-27-2010, 04:10 PM   #23
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Said it before and will say it again....if you can't write the check, then you can't write the check! Those charts show 10-15% increases, but most individual policies my clients have were hit with 20-35% increases the past two years. My personal policy with Anthem went up 35% in one year.
Mine went up 25% in June since I turned 55. I expect another increase in Jan.
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Old 08-27-2010, 04:57 PM   #24
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Said it before and will say it again....if you can't write the check, then you can't write the check! Those charts show 10-15% increases, but most individual policies my clients have were hit with 20-35% increases the past two years. My personal policy with Anthem went up 35% in one year.

In the health reform bill you have an ever-increasing subsidy since the out of pocket costs are capped based on income. If your income today is $60k and you can't spend more than 9.5% of that on premiums that cost 3 times as much, how big is that subsidy when you're still making $60k a few years later and the rates keep going up 20-30%? Taxpayers making over the subsidy limits will also balk at the subsidies as the disparity gets bigger. Why should someone making $88k with a family of 4 only have to pay $8k/year for insurance while the person making $89k has to pay $25k? Sickening...
No body is even attempting to answer the question, just reiterating the problem. My point is that the UK is addressing the underlying issue of cost and has the tools to do so. Some US states like Hawaii, Mass and California are starting to do something, but the annual premium increases are still double digit in MA. What do we do?
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Old 08-27-2010, 05:07 PM   #25
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No body is even attempting to answer the question, just reiterating the problem. My point is that the UK is addressing the underlying issue of cost and has the tools to do so. Some US states like Hawaii, Mass and California are starting to do something, but the annual premium increases are still double digit in MA. What do we do?
Is eliminating medical services really addressing the underlying issue of cost? If so, health service costs could be brought to zero by eliminating all medical services at which time everyone could be covered.
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Old 08-27-2010, 05:36 PM   #26
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Is eliminating medical services really addressing the underlying issue of cost? If so, health service costs could be brought to zero by eliminating all medical services at which time everyone could be covered.
Sure, not paying for gastric bands on the NHS would reduce overall cost, whether that should happen is another issue. The UK already bargains with drug companies and doctors (who are often self employed) just as US insurance companies do, so that should hold down costs. I just don't know why the US insurance companies and hospitals are so bad a holding down costs. Is it the demand from the patient for unnecessary tests, the fear of the doctor from being sued so they do unnecessary tests, the near monopoly and easy profits or the way we have become disconnected with our immortality so that a liver transplant might be given to a terminal cancer patient. These are very difficult issues and I don't think the US is facing them like the UK and other European and Asian countries are.

The US spends about 2x as much per capita on health care as European countries, yet we live shorter lives. Obviously the US system isn't working and it hasn't been copied by any other country. The thing that stops us from getting a better system in arrogance. Surely we could learn from other countries and come up with a better system. Some day soon we'll have to.
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Old 08-27-2010, 08:01 PM   #27
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In the US the UK approach to health care is derided as being "socialized medicine". However, the British love it, live longer that Americans, and it costs them far less.

.... the US system costs more and Americans have shorter lives that the British, and other Europeans.

It's interesting that Americans are scared of the UK system ...
Actually, what scares me is right in your own words - I fear that the US system will cost more and have poorer results. Both the US and the UK have 'socialized education', and we pay more and have poorer results. Why should I expect "socialized health care" to be different from "socialized education"?

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Why should someone making $88k with a family of 4 only have to pay $8k/year for insurance while the person making $89k has to pay $25k? Sickening...
Because the family of four probably has two votes, and the single only one vote? I suspect that someone has done that math...

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Old 08-27-2010, 08:24 PM   #28
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Those charts show 10-15% increases, but most individual policies my clients have were hit with 20-35% increases the past two years. My personal policy with Anthem went up 35% in one year.
Here you go. That $5,000/year policy becomes a nice round $100,000/year policy in ten years at a 35% annual increase, and after 30 years will run about $40,640,000/year. Hmm... Might have to adjust the Medicare payroll tax a smidge... Ahh, yeah, and you may have to work some Saturdays.

Annual increase10 years30 years
7% 2.0x 7.6x
10% 2.6x 17.5x
11% 2.8x 22.9x
12% 3.1x 30.0x
13% 3.4x 39.0x
14% 3.7x 50.1x
15% 4.0x 66.2x
20% 6.2x 237x
25% 9.3x 808x
30% 13x 2620x
35% 20x 8128x

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Old 08-27-2010, 08:35 PM   #29
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Is eliminating medical services really addressing the underlying issue of cost? If so, health service costs could be brought to zero by eliminating all medical services at which time everyone could be covered.
Ah, the good old days, when we'd just drop by the barber shop for a shave and a bit of surgery, overseen by the local monk (forbidden by Papal decree from spilling blood, but with the education the barber lacked). Perhaps a nice trephination to treat those nagging headaches? And of course there's the Leech Lady just down the street, should we suffer from plethora as our humours stagnate.

This might also serve to mitigate those annoying Social Security draws on the Government's accounts. I do believe you are onto something!
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Old 08-27-2010, 08:47 PM   #30
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The US spends about 2x as much per capita on health care as European countries, yet we live shorter lives. Obviously the US system isn't working and it hasn't been copied by any other country. The thing that stops us from getting a better system in arrogance. Surely we could learn from other countries and come up with a better system. Some day soon we'll have to.
Yup. I'm pretty sure the current system here is unsustainable. I don't see how institutionalizing the current model will lead to any sort of cost containment or improved cost/benefit ratios, but that is all that any of the mainstream proposals from the various political factions really do. (Note: debate on this should be in a new thread over on FIRE Related Political Topics.) I'm just noting that we don't have a real fix in sight for the health care cost bubble, and unfortunately, any fix would have to come from THAT direction.
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Old 08-27-2010, 10:01 PM   #31
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People in the US won't stand for rationing, I just can't see it happening. It goes against everything the US is built on, regardless of political issues. I have said many times that the single biggest cost driver in the US is THIRD PARTY PAYERS! When the insurance company foots the bill, nobody cares how much the service costs.

Talk to people who have an HSA policy and ask if they have ever called around to get prices on services and you'll almost always get a yes answer. Talk to people with a low-deductible plan with fixed co-payments and you'll almost always get a no. Why should people care when it makes no difference whether an office visit costs $75 or $180? They still only have a co-pay of ~$25 in either case. Who cares if an MRI costs $2500 or $1000? You still may only have a co-pay of $100 in either case. It's just common sense.

There is also almost zero price transparency for services. Call around to 10 doctors offices and ask how much the office visit will cost with your network discount. You'd be lucky to get one person out of the 10 who can tell you, and they'll have to look it up and call you back. The other 9 will tell you "just look on your ID card, your co-pay should be on there." Hey lady, I don't have a co-pay....what's the negotiated charge for my network?! Should not be so difficult to get this info. Just think if a tow truck picked up your car, towed it to the yard, then said "that'll be $2,500 please"....this is how our healthcare system works.
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Old 08-28-2010, 01:14 AM   #32
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Is eliminating medical services really addressing the underlying issue of cost? If so, health service costs could be brought to zero by eliminating all medical services at which time everyone could be covered.
US health companies are constantly changing coverages. They ration coverage already, we just don't acknowledge that.

So I'm still waiting for constructive ways we can change the system to make it cost less. Would they be further rationing, cutting doctors salaries, cutting drug company profits, limiting the number of tests per year, making insurance companies and hospitals non-profits. I like the idea of increasing the insurance base by requiring insurance, but that will run into political opposition in the US....so what's to be done?
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Old 08-28-2010, 06:53 AM   #33
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The US spends about 2x as much per capita on health care as European countries, yet we live shorter lives. Obviously the US system isn't working and it hasn't been copied by any other country. The thing that stops us from getting a better system in arrogance. Surely we could learn from other countries and come up with a better system. Some day soon we'll have to.
Actually once you consider the cost of living in an area the 2x figure is way off. The only countries that come close are Spain, Finland, and Greece. None of those are close to our society in terms of food or culture. Those countries spend approx 8-9% of their gross income on health care. Most of the rest of Europe spends approx 10-11% of their gross income while we spend approx 15%. That number sounds like a lot. When you also take into consideration the differences in society it really is not that far off. Which country has the highest rate of elective cosmetic surgery? The US. On the northern border several hospitals routinely take cardiac emergency patients from Canada, to the tune of several million dollars per year. Those expenditures are added to the cost of health care for US citizens. Whereas when we go on medical tourism it typically costs much less.

We live in the suburbs and drive everywhere, while most Europeans live in the city center an walk almost every where. When I used to live in Europe the wife lost 40 lbs just from walking everywhere instead of driving like we do here. Just about every sport you will find in other countries you will find here. In addition to those we have a large football, baseball, BMX racing, X-games, fighting sports, moto-cross, the list goes on. Our society is more violent than almost any other established country. We have the right to possess firearms and in many cases people use them against other people. My point isn't that we are the biggest/baddest country on the block. My point is we have a society that values danger and violence and with that danger and violence comes higher injury rates. Those higher injury rates result in higher medical expenses.

Comparing costs across countries that don't share common societal norms is irrelevant. You are concerned that our system is too expensive. Once you consider the differences in society and the cost of living our system is not that much more expensive than most other countries, like I stated earlier we spend within in hundreds of dollars per year of other industrialized countries. That works out to less than $10 more per month. For that $10 we get unrestricted access to health care. Fast service. We can choose which doctors we want to see or don't see.

Improvements can be made, but none are going to lower the costs of our health care system to lower than European prices, because of our societal differences. One big step would be to have price transparency and don't have insurance cover the day to day health care expenses. I looked at lowering my coverage to a higher deductible one last year. The difference in cost was about $50 per month. It didn't cover anything until we had spent something like $2-3k. So looking at it purely from a financial perspective. I get to save $600 per year in insurance premiums, but I will spend $2-3k more in doctor's bills. That makes no sense, since the DW has medical issues that will easily go through the $2-3k per year. For someone with no health issues it might make more sense, but not for me and my family.
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Old 08-28-2010, 08:28 AM   #34
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Taxpayers making over the subsidy limits will also balk at the subsidies as the disparity gets bigger. Why should someone making $88k with a family of 4 only have to pay $8k/year for insurance while the person making $89k has to pay $25k? Sickening...
I'm pretty sure it doesn't work this way -- the subsidy phases out over an entire income range as I understand it, not all or nothing.

Still, that subsidy and its phaseout does resemble a 15-18% tax in the $50K-$90K income range for a family (more or less) and as such is a highly regressive middle class tax for those buying their own insurance. I do wish they found a different way to pay for it, as this will make the effective tax bracket for a self-employed middle class household feel like over 50% and closer to 60% in some states.
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Old 08-28-2010, 09:59 AM   #35
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Comparing costs across countries that don't share common societal norms is irrelevant. You are concerned that our system is too expensive. Once you consider the differences in society and the cost of living our system is not that much more expensive than most other countries, like I stated earlier we spend within in hundreds of dollars per year of other industrialized countries. That works out to less than $10 more per month. For that $10 we get unrestricted access to health care. Fast service. We can choose which doctors we want to see or don't see.
There are a lot of differences between Europe and the USA to explain the cost differences - number of automobiles, miles driven/year and resulting accidents; USA growth into suburbia, higher USA corporate tax rates - USA/Europe - not a good comparison.
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Old 08-28-2010, 10:28 AM   #36
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I'm pretty sure it doesn't work this way -- the subsidy phases out over an entire income range as I understand it, not all or nothing.

Still, that subsidy and its phaseout does resemble a 15-18% tax in the $50K-$90K income range for a family (more or less) and as such is a highly regressive middle class tax for those buying their own insurance. I do wish they found a different way to pay for it, as this will make the effective tax bracket for a self-employed middle class household feel like over 50% and closer to 60% in some states.
Nope, it definitely works the way I described. Here's a link to a subsidy calculator from the Kaiser Foundation:

Health Reform Subsidy Calculator

Try plugging in $93,000 in "2014 dollars" for a family of 4, age 55, in a high cost area. Subsidy is $14,865 and cost of coverage to the family is $8,835 (9.5% of income). Then try plugging in $94,000 as the income (equal to 401% of poverty level, just over the limit) and there is $0 subsidy and cost of coverage to the family is $23,700, or 25.21% of income. Where will these numbers be in 2020 when the cost of insurance has tripled and the limit on out-of-pocket for subsidized people is 9.5%? Family A still paying $8800 and Family B paying $60k? Not only is family B paying $52k more, they're also footing the bill for Family A's $52k subsidy! That'll go over well...

I'll bet you just got a whole lot angrier, didn't you?
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Old 08-28-2010, 10:47 AM   #37
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Do you know if in line 2 - Enter annual income (Dollars)- is that is earned income (wages) only or can it be investment income. Also, is that adjusted gross income or just gross income.

In 2014 I will only have investment income.
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Old 08-28-2010, 11:15 AM   #38
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I think the tipping point happens when about 60% of people start having issues with the system. Before then its all just political propaganda.

People have small issues with the system now, whether w*rking, retired, unemployed or similar. But the type of issues are more inconvenient or "oh well" type things, when the type of issues which are bigger start happening to most of the people using the system, then the system will change.

The reason the system cannot be fixed is people are trying to modify the current system instead of designing a new one. Two or three examples of designs for a new one:

1) make health insurance like life insurance and car insurance. Purchase a 20 year term health policy, pay in $X per month, and as long as premiums are current, you lock in today's rates and today's costs for every service you need over next 20 years. The people which buy next year get higher rates than me, that's their problem and the general consenus will be to buy health care young... "permanent" health insurance policies could also be created and work similar to HSA's do now- heath care for life with underlying investments. If you "use" more insurance over a 20 year period, then that means your premiums the next 20 are higher than someone of same age which used less health care than you (similar to car insurance premiums).

2) Eliminate all insurance and make people pay cash, or something almost this severe. Routine doctor visits do not covered by insurance, only overnight hospital visits or surgeries type. This at minimum drives cost of primary care down.

3) force price disclosure on all procedures ahead of time.
a) for same procedure, the cost is the same, regardless of medicare, private insurance or paying cash.
b) within a given "geography" the cost of out of hospital procedures must also be the same within reason (meaning if one location had higher real estate/rental costs, that can be factored in, but no reason MRIs should cost different if its the same machine doing MRI at both locations).
c) People no longer pay for health care they do not receive- meaning the cost of me going to get a procedure done should not be higher because I have insurance to make up for the gap when the previous patient was on medicare and therefore paid less- remove this inefficiency.
d) in general focus on the price at point of service, and make that FAIR so all people pay the same cost regardless of insurance, then let business dictate how people pay. For example if I pay $300 for a test or procedure, and medicare will only pay $200, then tell the patient they pay the other $100. If not, they do not get the procedure, period. If they die, sucks to be them (this is the rationing aspect of it). The pressure is then on medicare to increase their reimbursement.
e) let people sue their insurance providers if they fail to make consistent decisions. For example my 2.5 yo is not talking yet, the insurance company confirmed verbally over phone he qualifies for speech therapy. The hospital submitted it, and it was rejected. I should be able sue the insurance company and make them liable for the payments we incurred because they lied.
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Old 08-29-2010, 07:59 AM   #39
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I think the tipping point happens when about 60% of people start having issues with the system. Before then its all just political propaganda.

People have small issues with the system now, whether w*rking, retired, unemployed or similar. But the type of issues are more inconvenient or "oh well" type things, when the type of issues which are bigger start happening to most of the people using the system, then the system will change.

The reason the system cannot be fixed is people are trying to modify the current system instead of designing a new one. Two or three examples of designs for a new one:
Thanks, at last an answer that offers some ideas, rather than either defending the US system or attacking foreign systems.

When Thailand was designing a new insurance system it looked at those from around the world and came up with a Universal Coverage system that had both public and private elements. I contend that there are ideas that have been implemented abroad and why don't we use some of those and adapt them.
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Old 08-29-2010, 09:10 AM   #40
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I contend that there are ideas that have been implemented abroad and why don't we use some of those and adapt them.
Because if we wanted to be like those countries we would have joined those countries or patterned our government after those countries. From the very beginning of this country we have had a desire to forge our own destiny and make something entirely our own. Some still believe in those principles and will do just about anything to keep our country it's own independent idea and not join the idea of other countries. Objectively, it doesn't make our country any better or worse than other countries, just different. Personally, I don't think any other country has done any better than this one. If I did, I would move there in a heartbeat.
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