The Hidden Cost of Retiring Early

[Fermion]

Well there have been quite a few other trials of Gilead's drug Sovaldi. I think the earlier trials were with other combinations and had 90%+ cure rates but this latest trial in Japan was 100% cure in a shorter time.

NICE has a history of doing this sort of thing. They are not doing it for the benefit or protection of UK patients but instead are doing it to try and engineer a lower cost for the drug. It probably works out better for the overall UK health system but maybe not for the people getting warehoused that actually need the drug now.

[nun]

Quote:

Originally Posted by Fermion Well there have been quite a few other trials of Gilead's drug Sovaldi. I think the earlier trials were with other combinations and had 90%+ cure rates but this latest trial in Japan was 100% cure in a shorter time. NICE has a history of doing this sort of thing. They are not doing it for the benefit or protection of UK patients but instead are doing it to try and engineer a lower cost for the drug. It probably works out better for the overall UK health system but maybe not for the people getting warehoused that actually need the drug now.

That is a good analysis. NICE has a set or criteria that attempt to balance factors to come up with the best solution for the NHS and the majority of patients. It's part of the balancing act that keeps healthcare far less expensive than in the US. The drugs are available in the UK, but not on the NHS. It's the same with US health insurers, they won't cover many treatments either. Unfortunately the difficult ethical/financial/treatment problems are too often politicized or made the fodder for special interests. The US health system tends to neglect the fact that sometimes it's hard to justify extreme treatments and US doctors over proscribe and don't admit that their efforts will at some point be unsuccessful. Americans don't do well with the failure inherent in death. Sometimes failure is an option and might just be for the best.

[Fermion]

Yes but it is one thing to not cover a $100,000 cancer treatment that maybe extends your life 2 months and yet another to publicly say you will not endorse a drug with a 90%+ cure rate because you are not convinced of it's benefit (when the benefit is preventing liver disease, transplants, and eventually death).

If they came out and just said we are not going to cover that because it is too expensive and we want to keep our rating as the lowest cost healthcare in the developed world, then that would be a bit more honest.

[nun]

Quote:

Originally Posted by Fermion Yes but it is one thing to not cover a $100,000 cancer treatment that maybe extends your life 2 months and yet another to publicly say you will not endorse a drug with a 90%+ cure rate because you are not convinced of it's benefit (when the benefit is preventing liver disease, transplants, and eventually death). If they came out and just said we are not going to cover that because it is too expensive and we want to keep our rating as the lowest cost healthcare in the developed world, then that would be a bit more honest.

NICE's approach seems very sensible. The Hep C drug is being evaluated and questions asked about the cost....it is already substantially less expensive in Europe than in the US and maybe the cost will come down even more. Unfortunately, the US health care organizations don't seem to be as aggressive when it comes to cost....which is probably why US healthcare costs twice as much

Sovaldi stumbles as NICE assesses hep C drug's price - PMLiVE

[Alan]

When making comparisons with the NHS you should be comparing it to Medicare and Medicaid (and I've no idea if these expensive drugs mentioned above are available on Medicare and Medicaid).

Many people have private health insurance in the UK which we always had before we moved to the US in 1987, and have when we make these long stays in the UK as my PPO HI from BCBS of Louisiana covers treatment abroad including the UK, and before I travel I look up in-network facilities in the countries and cities we are going to be, just in case a non-emergency medical event happens.

We had friends drop in to see us last weekend on their back to Louisiana from Austin. They have the same coverage as us (retiree from the same company). Last year in Vienna she had a problem (Crohn's disease I think she said it was) and went to see a doctor. (Austria has universal healthcare) Our friends said they paid for the visit and medication and were really surprised how inexpensive it was, and at the end of their trip they put in a claim and got a full refund of their costs.

[Chuckanut]

Quote:

Originally Posted by Alan Many people have private health insurance in the UK which we always had before we moved to the US in 1987, and have when we make these long stays in the UK as my PPO HI from BCBS of Louisiana covers treatment abroad including the UK, and before I travel I look up in-network facilities in the countries and cities we are going to be, just in case a non-emergency medical event happens.

My this thread certainly has wandered about.

There is a website that gives a list of overseas medical providers that have contracted with "The Blues" insurance companies to provide covered services: http://www.bluecardworldwide.com/

When I discuss medical systems with middle class (not rich) Canadians or British citizens, I have yet to find one who would trade their overall system for the American system. Not one.

[ERhoosier]

Quote:

Originally Posted by nun The NHS won't pay for treatments or drugs until they are approved by NICE (National Institute of Healthcare Excellence). So many new treatments are not available because they have not been proven to work well. This might be seen as bad for some individual patients, but it also controls costs and prevents some dubious treatments.

I basically agree with NICE approach-as long as it remains truly independent. Economic resources are not infinite and runaway HC inflation has the potential to bankrupt societies in the not too distant future. There are limits to what 'society' can pay for. Particularly for measures which have not been INDEPENDENTLY shown to improves outcomes over significantly less costly alternatives.

[ERhoosier]

Quote:

Originally Posted by Chuckanut ....When I discuss medical systems with middle class (not rich) Canadians or British citizens, I have yet to find one who would trade their overall system for the American system. Not one.

I've run across a few Brits over the years who have not been happy with NHS, but clearly they have been a minority. Most freely admit the issue is larger than just HC but involves national pride ....and its position as Britain's single largest employer by far.
https://en.wikipedia.org/wiki/List_o...gdom_employers
OTOH- In my years living in (now regularly visiting) metro Detroit I have met many, many Canadians from Windsor (sister city across the Detroit River) who have become fed up with their system, mostly due to longer waits vs US. Canadian wait times are generally much longer than even for US Medicaid (poverty) patients. According to a recent independent (non-gov't) survey, ave wait times across Canada run 20-26wks for Ophthy, ENT, Neurosurg, or Ortho specialist treatment.
http://www.fraserinstitute.org/uploa...-turn-2012.pdf
Many Canadians vote with their feet and come to US for some care, even using private companies to negotiate charges.
Canadians Pay Too Much for US Medical Care
Some may recall the controversy over Newfoundland Premier Williams choosing to have his heart surgery in US despite the procedure being available in Canada.
'It's my health, it's my choice,' Danny Williams says - The Globe and Mail
IMHO a majority of Canadians still favor their system, but that number may be changing.
Canada's costly health care wait times - Winnipeg Free Press
Interestingly- with ACA, some Canadians are now viewing US as an attractive retirement location BECAUSE of US health care system (inc lower taxes, HI subsidies).
Health bill opens doors to Canadians seeking U.S. retirement - The Globe and Mail

The world keeps getting curiouser and curiouser

[MichaelB]

Canada does indeed have wait time issues. Despite that a recent analysis by The Commonwealth Fund of 11 developed countries (here) ranks Canadian health care above the US and life expectancy there is still longer, eh. BTW, the UK is ranked #1.

I don't think much has changed for Canadians to retire here in the US. The ACA does a few things for retirement age people age 65 and up, but that's mostly Medicare-land, and there has been no change in Medicare eligibility. It does guarantee insurance will be available for legal immigrants, but subsidies are only available to permanent residents that have a tax household here and meet other eligibility criteria.

[ERhoosier]

Quote:

Originally Posted by MichaelB Canada does indeed have wait time issues. Despite that a recent analysis by The Commonwealth Fund of 11 developed countries (here) ranks Canadian health care above the US and life expectancy there is still longer, eh. BTW, the UK is ranked #1. I don't think much has changed for Canadians to retire here in the US. The ACA does a few things for retirement age people age 65 and up, but that's mostly Medicare-land, and there has been no change in Medicare eligibility. It does guarantee insurance will be available for legal immigrants, but subsidies are only available to permanent residents that have a tax household here and meet other eligibility criteria.

Life expectancy depends mainly on public health, behavioral, environmental, and often genetic factors. LE is a poor measure of the effectiveness of a health care delivery system. Few would argue that Greece's woefully underfunded and inefficient health care system the is equal of NHS or Germany...or US for that matter. Yet according to WHO Greeks enjoy the same 81yr overall LE at birth as Brits, Irish, and Germans, and better than the 79yr LE of Americans.
Life expectancy: Life expectancy - Data by country

BTW- According to HHS web site-While ACA requires Permanent (5 yr) or naturalized status for Medicaid or CHIPS, it does not require permanent resident status for subsidies. Subsidies only require legal resident status.
"Access to subsidized coverage will also expand under the ACA for non-elderly lawfully residing immigrants with incomes below 400 percent of the Federal Poverty Level who have been in the country five years or less. " Non-wealthy Canadians wishing to emigrate to US could find that helpful.

Coverage Implications and Issues for Immigrant Families: ASPE Issue Brief

[nun]

Quote:

Originally Posted by MichaelB Canada does indeed have wait time issues. Despite that a recent analysis by The Commonwealth Fund of 11 developed countries (here) ranks Canadian health care above the US and life expectancy there is still longer, eh. BTW, the UK is ranked #1. I don't think much has changed for Canadians to retire here in the US. The ACA does a few things for retirement age people age 65 and up, but that's mostly Medicare-land, and there has been no change in Medicare eligibility. It does guarantee insurance will be available for legal immigrants, but subsidies are only available to permanent residents that have a tax household here and meet other eligibility criteria.

Yes I read about the Commonwealth Fund's analysis here

NHS is the world's best healthcare system, report says | Society | The Guardian

Its interesting that the UK and US rank at the bottom for "Health lives" and have high infant mortality and death rates for treatable conditions. This must be down to bad diet, alcohol consumption, lack of exercise and maybe still some smoking producing heart conditions, diabetes, high blood pressure, and possible lots of early term births etc.

The NHS is first in almost every other category, but the UK could certainly do with a lot of education about diet, exercise and general health.

[Lancelot]

Quote:

Originally Posted by Senator I get free VA healthcare, all I have to do is wait for it... If I was on welfare, I would get it faster, and still free. It's amazing we treat people that have never contributed a dime to society, to better health care than a veteran.

I use the VA too. I emailed the VA, notifying them that I was abroad and cold not make my annual check up appointment.

Their response was to un-enroll me

[Totoro]

Quote:

Originally Posted by ERhoosier LE is a poor measure of the effectiveness of a health care delivery system.

If a long, healthy and happy life (the big 3?) isn't the ultimate measure of effectiveness, something is really wrong. What else is there?

Influence public health, behavior, diet, environmental and social factors are all part of a good health care delivery system.

From a car analogy: you don't get mad at the garage if your road is full of potholes and the suspension brakes down frequently as a consequence. But your car 'health' system is horribly broken if the roads are in poor condition.

The outcomes are worse, that is a fact. Poor countries indicate fixing them shouldn't be expensive. So why not stop defending the poor outcomes and start fixing whatever needs fixing? We'll all live longer, be healthier and happier too

[brett]

There will always be issues with Government sponsored health insurance programs. Just as there will always be a campaign by private insurers, drug companies, and medical associations to denounce them.

When we travel in the US we often hear how poor our Canadian system is. Our family members have had a great deal of exposure to it, including air evacuations. The system is not perfect but it does work-and work well. Try comparing mortality rates.

Three years ago the study I saw showed that 80 plus percent of Canadians want our universal health insurance program. Last week, the Government announced the results of a poll that was done, in part, to prepare for the 150th anniversary of Confederation. The poll asked for opinions on the top 10 Canadians in history and the 10 things that Canadians are most proud of. Top of the the list for individual was Tommy Douglas, the father of our health insurance program, and Lester Pearson-the Prime Minister whose government implemented medicare. The Canadian health insurance programs was in the top 5 things that Canadians were most proud about their country.

I doubt very much that the insurance companies, the drug companies, or the medical associations will be quoting these numbers! We retired at 58. Medical costs simply were not in our retirement equation-they did not have to be. We do not live in fear of loosing our jobs because of the medical insurance issue nor are sixty percent plus of our personal bankruptcies attributable to health care costs. The system works-even though there are some challenges.

We view health care in the same way that we view the provision of clean water or police and fire services. These are basic services that all citizens are entitled to.

[kcowan]

The Canadian healthcare system has one major drawback. You have to live in the home province for 212 days each year to keep it in force! This means that we are home regularly.

In the US, seniors' medicare has no such restriction. As long as you pay the premiums, you can get by with hospital care and an airvac rider which is much cheaper.

[Alan]

Quote:

Originally Posted by kcowan The Canadian healthcare system has one major drawback. You have to live in the home province for 212 days each year to keep it in force! This means that we are home regularly. In the US, seniors' medicare has no such restriction. As long as you pay the premiums, you can get by with hospital care and an airvac rider which is much cheaper.

Wow, that is a restriction I had not heard of. As far as I'm aware, once we become tax resident in the UK, the 4 or 5 months we will spend out of country does not mean that we will have lost coverage when we return as we will continue to pay UK taxes on the full year.

[brett]

Guess it depends where you live in Canada. In Alberta, we need to log 183 days in the province to remain eligible for Alberta Health Care. We have no health care premiums as such but of course they are simply part of our provincial income tax burden.

[kcowan]

Yes the 212 days is BC and ON. The fee is $68/mo. single. I think they adjusted it when they started to count weekend border visits which is so common in those provinces. If you go to Bellingham for a shopping trip, leave Friday and return Sunday, that counts as 3 days so 10 of those trips is another 30 days...

Another thing that fellow snowbirds do is return home after 3 months for a few days. This lets them health insure for multiple 3 month trips, and the first 30 days are often covered by a cheap credit card coverage.

[mickeyd]

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Originally Posted by marko my friend was travelling in the UK and she got sick and spent a week in the hospital and it didn't cost her a thing!!" I said: "Well, somebody paid for it" She said: "Yes, the government!"

It's good to know that we Americans are not the only ones who consider gumment money someone elses cash.

[mickeyd]

Quote:

Originally Posted by Lancelot I use the VA too. I emailed the VA, notifying them that I was abroad and cold not make my annual check up appointment. Their response was to un-enroll me

As an Agent Orange veteran I learned that I was eligible for VA healthcare @ no cost. I have gone to two appointments and have been pleasantly surprised at the top-notch quality of HC that I have received in those 2 visits. I actually like the VA physician more than I do my regular doctor, who is paid for by Medicare/Tricare. I gotta make sure that I don't do any canceling of appointments lest I get cut out.