Retiree Medical - ouch?

[daylatedollarshort]

Since DH left the megacorp job our insurance premiums have varied by plus or minus $2.1K a month between COBRA, COBRA conversion and ACA policies.

I think all you can do is hope for the best and plan for the worst. One change in legislation and we could be back to over $2K a month in premiums alone for less than stellar coverage.

 

[GTFan]

I'll be amazed if there is any meaningful reduction in entitlements given the history of Medicare and SS 'reform'. I don't see the ACA being any different, regardless of the blowharding about repeal. The ship has sailed.

 

[Huston55]

Huston, I'm not sure what your point is. I think ERHoosier is correct in that health insurer profits are not a significant contributing cause to the escalation of health insurance premiums, particularly since medical claims cost ratio limits were put in place a couple years ago. Health care costs, which ultimately become health insurance claims are the major cause for the reasons described in the article and summarized in Table 3-1.

Sorry, maybe I was trying to be too clever. I'll try to be more direct.

It's not just the insurance companies (which I actually never mentioned or inferred), it's not just the hospitals, and it's not just the govt. It's the whole design of our healthcare delivery system. It's broken. It doesn't deliver effectively. It wastes valuable resources.

So where's the disagreement? Overall HC costs are too high but this is not mainly due to HI companies. If you go to the IOM source material, most of the "Excess Administrative Costs" are NOT due to the insurance co's but are spread throughout the system. Much of it is at the provider/hospital level (e.g. too many supervisors per doc/nurse/tech actually delivering care), much is due to gov't mandates/unnec regulations, and much is due to just plain silliness (e.g. spending $25 in billing costs to recoup a $2 payment...duh!). And big insurers are on the front lines in the fight against the 3 of the 4 biggest sources of excess costs-"Unnecessary Services", "Inefficiently Delivered Care", and "Excessively High Prices". It's very hard for individual patients to impact these directly, but big insurance (warts and all) has the clout to push back. BTW- I think IOM's definition of "Excessively High Prices" seriously UNDERestimates this factor- particularly with Big Pharma and the medical device makers.

FWIW- I've followed Reinhardt's work for years. Some is "pony" and some is....well you know . But IMHO this is a good synopsis of factors in excess US HC costs. I would love to see a similar analysis of HC overhead in other developed nations.

Hoosier: As noted above, I didn't mention health insurance companies. So, your defending a group that has not yet been accused of anything. Seems to me, thou protesteth too much. And, honestly, insurance companies on the front lines fighting for more efficiency; really?

On the final point, "excess US HC costs", we do agree. So, we got that goin' for us.

So, my comments are about the inefficiency of our system, as is simply and clearly noted by Totoro below:

All the facts i've seen point to a system that's too expensive for what it delivers.

PS: this is all kind of off point from the OP's post so, I suggest someone start another thread if he desires this discussion to continue.

 

[daylatedollarshort]

I'll be amazed if there is any meaningful reduction in entitlements given the history of Medicare and SS 'reform'. I don't see the ACA being any different, regardless of the blowharding about repeal. The ship has sailed.

I think total repeal is unlikely but asset testing could be added or income limits lowered. Hopefully we would never be back to the $2K+ a month days, but who knows the way health care costs keep rising.

With health care costs rising at a faster rate than SS benefits, there are predictions that health care for retirees will cost more in the future than people receive in SS benefits. I think the peasants will revolt before that happens, but it does make how much to budget for retiree health costs pretty much a wild card.

 

[robertf57]

Do you have a source that marks the USA as outstanding in overall healthcare?

Here is one study of many describing it's not
MMS: Error

I won't dispute that the best healthcare in the world for many ailments can be found in the USA, if you can afford it. Most (99%) of its citizens however, can't. They are getting a bad deal, paying twice as much for poorer outcomes vs. other developed countries. That said, don't underestimate countries like Singapore. I'd much rather have a medical emergency there than in any US city.

In terms of research the USA also have the edge overall, although certainly not in all areas. More importantly however, the total amount spent on research in the US is nowhere near 3.500 USD per person (or >1 Trillion USD, yes with a "T"), which is what you are spending more than the average OECD country (adjusted for purchasing power) annually.

List of countries by total health expenditure (PPP) per capita - Wikipedia, the free encyclopedia

All the facts i've seen point to a system that's too expensive for what it delivers. Would love to find out if my perspective should change though!

I don't want to high jack this thread to any greater extent; but the report you linked refers to a study that has been repeated discussed to be flawed by it's very design. It doesn't compare apples to apples. the American Enterprise review here will give you some insight.
US health care: A reality check on cross-country comparisons - Health - AEI

The US certainly has substantially higher costs and the healthcare system is plagued by those who are uninsured, those who choose life styles that are unhealthy, and those who choose not to receive preventative services. (i.e. our relatively low pertussis immunization rates are commonly cited despite being available for free. People CHOOSE to not receive the all sorts of immunizations).

These aren't issues of the quality of our healthcare. Whether the value per unit cost is acceptable is a different story.

 

[youbet]

With health care costs rising at a faster rate than SS benefits, there are predictions that health care for retirees will cost more in the future than people receive in SS benefits.

That's not a future situation. It's happening to some Medicare recipients now. Their entire SS monthly benefit is applied to their Medicare Part B premium and they are then billed for the amount their Medicare premium exceeds their SS benefit.

 

[daylatedollarshort]

the healthcare system is plagued by those who are uninsured

The health care system is plagued by the uninsured? The 47 million are a plague?

 

[Live And Learn]

The law isn't going to change anytime soon especially with the intransigent crowd we have running the place now. You go with what you have, not what might happen in 5-10 years. What if Medicare and SS get whacked? Same deal, you just don't know. But I've got to plan on them being there just like you do.

Medicare plus a supplemental plan plus Part D for prescriptions currently runs approx $4.5k / per person / year. My budget is 7.5k / per person / year.

I only count on 65% of what the SSI calculators says I will get.

How we fudge our numbers is our individual choice. I'm more risk adverse, hence my pessimistic financial data.

 

[youbet]

I won't dispute that the best healthcare in the world for many ailments can be found in the USA, if you can afford it. Most (99%) of its citizens however, can't.

I think your 99% is BS. More than 1% of our citizens can afford (primarily through insurance) access to our "best healthcare in the world for many ailments."

 

[robertf57]

The health care system is plagued by the uninsured? The 47 million are a plague?

Exactly! The decision to not take insurance or to not cover certain classes of people in our communities is a personal decision or a political one. It has NOTHING to do with the quality of our healthcare.

 

[daylatedollarshort]

Exactly! The decision to not take insurance or to not cover certain classes of people in our communities is a personal decision or a political one. It has NOTHING to do with the quality of our healthcare.

If you are saying for those who can afford it or have the right insurance there is no better place to get state of the art care than top ranked hospitals like Stanford in the U.S., that may well be true.

But I think when organizations like WHO use metrics to rate health care systems across countries they do take into account factors like cost and coverage for the general population -

http://www.who.int/healthinfo/health_system_metrics_glion_report.pdf?ua=1

(See the dashboard page)

So by their definition of health care systems the U.S. usually does not rank very favorably compared to other OECD countries with much lower costs and wider coverage.

 

[Live Free]

I am worried about the cost of health care in retirement...AND now while I'm working. It just keeps going up and up and up - much faster than my salary.

We get our insurance through my employer - a Fortune 50 company and they have now moved to two choices - either an HMO that isn't available in our particular area or a high deductible plan (eligible for an HSA) that costs us premiums totaling $7280/yr for family of four and $3000 annual deductible , with max out of pocket of $6700 before 100% coverage kicks in. Because our youngest child has a medical condition, we hit the max every year - so total out of pocket for us is nearly $14K.

I have wondered if it would be cheaper for us on the exchange.

Our costs have gone up every year up anywhere from 7-12%.

 

[ERhoosier]

Hoosier: As noted above, I didn't mention health insurance companies. So, your defending a group that has not yet been accused of anything. Seems to me, thou protesteth too much. And, honestly, insurance companies on the front lines fighting for more efficiency; really?

On the final point, "excess US HC costs", we do agree. So, we got that goin' for us.

So, my comments are about the inefficiency of our system, as is simply and clearly noted by Totoro below:

All the facts i've seen point to a system that's too expensive for what it delivers.

PS: this is all kind of off point from the OP's post so, I suggest someone start another thread if he desires this discussion to continue.

My initial "disagreement" was not with you but with another's notion that it was insurers who are doing the "robbing". I think all here agree that US HC costs are WAY too high for the product delivered.
But who else besides the HI industry, flawed as it is, is currently in a position to push back against these high costs? Legislators avoid the issue 'cause they are far too busy trying to stay elected. And the individual patient has no clout. I don't see providers, Big Pharma, device makers, etc. stepping forward to offer meaningful price cuts. And HC fraud takes no holiday. So where else is the day to day push against overutilization, inefficiency, and overcharging going to come from?

FWIW- IMHO this modest digression is related to OP's post. OP's HI premiums are roughly in line with what many others are paying (unsubsidized). In fact HSA-eligible Bronze Plans in my region are somewhat higher for similar age profiles. These high HI premiums are due to overall high cost of care in US, not due to price gouging by a single HI company. A substantially lower price is not likely to be found without moving to a lower-cost region....or out of the US