Lowering the age for Medicare

[6miths]

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Originally Posted by Bir48die Secondly, it's best not to bring up Canada unless you are very familiar with their system. There are also incredible flaws in their system. Just ask someone who lives there. Lastly those who RE bear a risk or a cost.

First, I apologize for stepping out of character as a polite Canadian.

I'm pretty familiar with 'their' system since it is 'ours'. There is a reason most Canadians are fiercely proud of their health care system. Having worked in the systems in both Canada and the US (as well as a couple of other systems and having been exposed to several more), there is no way I would ever choose the US system either as a consumer or a provider. There are many reasons that the US system will not change but in the end it comes down to money and I think most recognize this. Every system has flaws but it is unlikely that any OECD country's system has more major flaws than that of the US.

At the end of the day no one is spending any significant amount of money promoting universal healthcare in the US while the other side of the argument is supported by countless dollars from many sources. It is instructive reading the threads on the various plans available in the US and the angst that Obamacare caused in some circles.

For a second, imagine if you can, what it is like to not be concerned about how you are going to pay for essential health care services for yourself, spouse and family. And knowing that all of the other people in your country enjoy the same benefits.

[MRG]

Quote:

Originally Posted by 6miths Many health economists would say that the money to pay for universal healthcare in the United States is already in the system. It's just a matter of figuring out a way to modify the system. I am pretty sure that the same group recognize that there is a snowball's chance in hell of this happening anytime soon. The days when such a thing was doable seem very far in the past.

+1

Not an economist but I saw the Megacorp I w*rked for rake in hundreds of millions by doing processing for the healthcare industry. None of that added any value to anyone's healthcare; it simply fed the machinery. Why do we need a machine?

[Midpack]

Quote:

Originally Posted by Bir48die A few things. It's not that I wouldn't like to see a single payer system. It's just not going to happen, in our lifetime. We are not set up to handle this big of an issue without either screwing it up like the current ACA without extreme backlash. Secondly, it's best not to bring up Canada unless you are very familiar with their system. There are also incredible flaws in their system. Just ask someone who lives there. Lastly those who RE bear a risk or a cost. As I said earlier, it's just not that you paid into the system X years. I did all that and more. It's that even if you pay $450/mth or whatever to get Medicare early the lower negotiated pricing will not sustain the system.

Those are the kinds of deliberately vague criticisms uninformed Americans use casually to defend the status quo - for a disjointed “system” that costs us twice as much as all other developed countries, with middling results in the US. If you can’t be specific you have no business throwing out blanket criticisms. Wait times is largely out of date. Canadians engaging in medical tourism to the US are exceptions, often wealthy Canadians and/or in need of leading edge procedures - not the routine stuff that makes up the bulk of health care.

Like they’re aren’t “incredible flaws” in US healthcare. Ask the millions of Americans without healthcare or those who can’t afford the care they need even with very limited HC insurance.

[Midpack]

Quote:

Originally Posted by 6miths Many health economists would say that the money to pay for universal healthcare in the United States is already in the system. It's just a matter of figuring out a way to modify the system. I am pretty sure that the same group recognize that there is a snowball's chance in hell of this happening anytime soon. The days when such a thing was doable seem very far in the past.

Show us one of the “many” health economists studies showing this with their underlying assumptions (specifically regarding medical costs). And please, not a clickbait article from a 10 second Google search.

[Midpack]

Repeated by many, many times. Why so many Americans defend a “system” that costs much more, delivers middling results and leaves out millions is beyond me. Americans are paying much more, but it’s indirect - many naively think their premiums and out pocket costs are all they’re paying.

Quote:

What does the United States have in common with Peru, Zimbabwe, Bangladesh, and Uzbekistan? Answer: none of them have a universal health care system. The US is the only country in the developed world that does not provide health care to all of its citizens. The US federal government actually pays for a lot of health care. If you are old, very poor, or ex-military, the government foots the bill. That’s 37% of the population. But the system is hardly efficient. What the US pays for less than half of its population is more than what every other country pays to look after all their citizens, even after you have adjusted for population size (Norway and the Netherlands are the only exceptions). Size, culture and politics are barriers to reaching universal healthcare in the US - but aren’t enough to explain why the US doesn’t provide health benefits for all. What does? Vested interests, diversity, and a fortunate history. Vested interests. Spending on health care makes up a staggering 17.4% of American GDP. That’s double what Australia or Japan spends, and more than 5% more than its nearest competitor. There are a lot of people making a lot of money from the current health care system in the US. That includes hospitals, doctors, pharmaceutical corporations, and insurance companies. The only way the US could afford universal care would be to cut costs. That would mean confronting some or all of those who benefit from the current state of affairs. That would be very hard. It might even be impossible. Universal health care works best in countries where people feel strong solidarity with one another. They think that everyone else in society is basically the same as them. But that’s never been the case in the US. The sheer size and cultural diversity of the country, and especially the old and painful divisions over race mean that it’s all too easy for Americans to feel that their fellow citizens are not like them at all. So why should they pay taxes for other people to get looked after? Most European countries set up universal health systems after the Second World War. So many had died (tens of millions), so many made homeless (tens of millions), so many bereaved (hundreds of millions) that it was hard to argue against the idea that every citizen deserved the chance of a decent, healthy life. The American experience of the Second World War was very different. 400,000 died, but the country looked better after it than before. The war had brought the US out of the Great Depression and the country was now the leader of the free world. It still had big problems, as the Civil Rights movement would show, but the postwar mood was triumphant, not somber. America was the richest, strongest country ever. It was easy to overlook those who couldn’t afford eyeglasses, let alone surgery.

https://restoftheiceberg.org/posts/2...al-health-care

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Paying more for less Despite the evidence that a single-payer system would be a more efficient and cheaper choice, introducing it in the US is not a serious option. Trying to dismantle the current system would be a mammoth task. For one thing, it would cost a great many jobs: Health- and life-insurance companies employ some 800,000 people, with yet more employed by the medical industry just to deal with insurance companies. Though the savings from eliminating them could be invested in retraining those people for other professions, it would be difficult for any party to convince voters that it’s a necessary step. And with a market worth more than $3 trillion, drug firms, medical providers, and health technology companies have an incentive to maintain a system that lets them set prices instead of negotiating with a single government payer. Both the GOP and the Democratic party are under the influence of the medical-industrial complex: In 2016, hospitals and nursing homes contributed over $95 million to electoral campaigns in the US, and the pharmaceutical sector gave nearly $250 million.

https://qz.com/1022831/why-doesnt-th...l-health-care/

[marko]

Haven't read every post here but why not just increase the ACA income threshold to $100k for those over 50 or 55?

How many people take SS at 62 just to pay for health insurance? One could offset the other.

[6miths]

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Originally Posted by Midpack Show us one of the “many” health economists studies showing this with their underlying assumptions (specifically regarding medical costs). And please, not a clickbait article from a 10 second Google search.

I am not going to quote any articles, academic or otherwise, there are many sources on this and given that you just threw up a graph that shows the US spent twice as much on healthcare as Canada (and we can put up graphs that show many health indicators in the US are not as good - I am not going to do that either). As mentioned, the front end of the US system is deeply flawed and a huge burden, as well vast sums are spent on things that do not improve quality of life while relatively small amounts are not invested in preventative and basic healthcare that could be transformative. This is a retirement forum and I am sure that if you are informed you are already well aware of the issues. At every turn there will be many arguments about why this or that can't be or shouldn't be done. That side of the discussion is very well funded. In the meantime, the system should be a national embarrassment. My apologies.

[6miths]

Quote:

Originally Posted by Midpack Show us one of the “many” health economists studies showing this with their underlying assumptions (specifically regarding medical costs). And please, not a clickbait article from a 10 second Google search.

Again my apologies as it is easy to get worked up about this. I think a starting place could be articles written by Dr. Atul Gawande such as Overkill: America's Epidemic of Unnecessary Care. Or 'An American Sickness: How Healthcare Became Big Business and How You Can Take It Back' by Dr. Elisabeth Rosenthal. Both of these authors are Harvard educated MDs and have been frontline physicians though my understanding is that Dr. Rosenthal has given up active practice. Her book is well referenced, eye opening and somewhat depressing.

[Bir48die]

Well by golly, I certainly ruffled a few feathers. I love Canada. I did business there for twenty years. Many are my best friends. I love and used to play hockey. I've known the anthem since grade school. I love their maple syrup. I'll go there for my next open heart surgery. I promise

[Car-Guy]

In my way of thinning the biggest/best argument for Medicare for all is what has happened to private insurance in the past decade or so. Medicare, even with it's problems, is sooooo much better than private insurance, IMO. Why not at least make it an option for those under 65, at a comparable price to private insurance of course.

[Bir48die]

Just as a disclaimer, I have spent hours and hours speaking with my friends on this subject for Canada. My guy that ran the business there and worked for me asked me to bonus him with money going to supplemental insurance to cover the gaps.

The U.S. system is flawed. I admitted That and it is the largest expenditure I have by 2x and that’s just for me. I’ve never wanted to be 65 so badly. It’s sad

[ziggy29]

Quote:

Originally Posted by Car-Guy In my way of thinning the biggest/best argument for Medicare for all is what has happened to private insurance in the past decade or so. Medicare, even with it's problems, is sooooo much better than private insurance, IMO. Why not at least make it an option for those under 65, at a comparable price to private insurance of course.

I want to agree but some things need to be fixed. I don't know how many providers will stay afloat or continue to see Medicare patients if every patient brought in Medicare reimbursement rates. As it is, folks with private insurance (or uninsured, if they can pay) are subsidizing Medicare patients because of the difference in reimbursement rates.

So if M4A, or even an opt-in to purchase Medicare (even if only 50+ or 55+), is enabled something might have to give with Medicare reimbursement rates, which would of course mean more money (taxes and/or buy-in cost) to pay for it.

If you would have told me 20-30 years ago that Medicare would be considered a "good standard" for health insurance, I would have laughed in your face. I'm not laughing any more.

[Midpack]

Quote:

Originally Posted by 6miths I am not going to quote any articles, academic or otherwise, there are many sources on this and given that you just threw up a graph that shows the US spent twice as much on healthcare as Canada (and we can put up graphs that show many health indicators in the US are not as good - I am not going to do that either). As mentioned, the front end of the US system is deeply flawed and a huge burden, as well vast sums are spent on things that do not improve quality of life while relatively small amounts are not invested in preventative and basic healthcare that could be transformative. This is a retirement forum and I am sure that if you are informed you are already well aware of the issues. At every turn there will be many arguments about why this or that can't be or shouldn't be done. That side of the discussion is very well funded. In the meantime, the system should be a national embarrassment. My apologies.

Quote:

Originally Posted by 6miths Again my apologies as it is easy to get worked up about this. I think a starting place could be articles written by Dr. Atul Gawande such as Overkill: America's Epidemic of Unnecessary Care. Or 'An American Sickness: How Healthcare Became Big Business and How You Can Take It Back' by Dr. Elisabeth Rosenthal. Both of these authors are Harvard educated MDs and have been frontline physicians though my understanding is that Dr. Rosenthal has given up active practice. Her book is well referenced, eye opening and somewhat depressing.

These are answers to a question I didn’t ask.

Now you’re talking about what’s wrong with US healthcare system, where I clearly agree.

What I challenged, now clearly highlighted in red was your statement “Many health economists would say that the money to pay for universal healthcare in the United States is already in the system.” You said “many” - share one that credibly shows that. It’s not a simple as replace the US system with Canada’s (or any other country)...

Quote:

Originally Posted by 6miths Many health economists would say that the money to pay for universal healthcare in the United States is already in the system. It's just a matter of figuring out a way to modify the system. I am pretty sure that the same group recognize that there is a snowball's chance in hell of this happening anytime soon. The days when such a thing was doable seem very far in the past. Quote: Originally Posted by Midpack Show us one of the “many” health economists studies showing this with their underlying assumptions (specifically regarding medical costs). And please, not a clickbait article from a 10 second Google search.

[ckelly78z]

I would be all for lowering the Medicare age to say 60. I have plans of retiring at 63.5, and paying for COBRA for the 1.5 years until I turn 65. If it could be half the cost of COBRA, I could possibly retire at 62.

I haven't really priced out having ACA instead of COBRA...still 8 years to go before I turn 62, and can start drawing SS. Alot of political posturing/promises, and failings will happen over that time period, so waiting to see what is available closer to my F.I.R.E date.

[ncbill]

ACA is a bargain compared to Medicare if you are RE and can "manage" your MAGI for the maximum premium subsidies & cost-sharing reductions (i.e. stay just over 100% of FPL, 138% in Medicaid expansion states)

Not so much if you're over the "cliff" (MAGI over 400% FPL)

I doubt Medicare will be so generous once I get there (~15 years)

Most likely every supplement plan with be some form of Advantage, with only a fixed amount (capitation) allowed annually based on one's age & health (e.g. is the patient compliant with doctor's orders?)

[Car-Guy]

Quote:

Originally Posted by ziggy29 If you would have told me 20-30 years ago that Medicare would be considered a "good standard" for health insurance, I would have laughed in your face. I'm not laughing any more.

I wouldn't have said that 20-30 years ago either. I never thought I'd say a US government program was better than anything offered by private enterprise. IMO, private medical insurance (including drugs) is very likely the most &%^$#* and *&$)%up industry in the US today.

I can't believe we so easily pay outrageous premiums for years and years (sometimes decades) only to beg/fight for coverage when we have a claim. Between the ever changing in-network doctors and facilities, the use of generic drugs that are often less effective that the "originals" and that are rationed, pre-approvals for more and more procedures, and the continuing change of covered services, the customer/subscriber doesn't stand much of a chance.

IMO, the main value of having any health insurance, is getting the benefit of their negotiated discount rates with the doctors, hospitals and drug providers under their plans. And then only if you follow all their rules, use their doctors/facilities, etc. Maybe.


I seriously considered self insuring before I was covered by Medicare.

[jimbee]

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Originally Posted by Midpack These are answers to a question I didn’t ask. Now you’re talking about what’s wrong with US healthcare system, where I clearly agree. What I challenged, now clearly highlighted in red was your statement “Many health economists would say that the money to pay for universal healthcare in the United States is already in the system.” You said “many” - share one that credibly shows that. It’s not a simple as replace the US system with Canada’s (or any other country)...

Your're previous links show the money is there. 6miths stated "It's just a matter of figuring out a way to modify the system.", not that modifying the system would be simple.

You either throw more money at the system, make the system more efficient, or some variation in between. Take your pick.

[harllee]

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Originally Posted by ncbill ACA is a bargain compared to Medicare if you are RE and can "manage" your MAGI for the maximum premium subsidies & cost-sharing reductions (i.e. stay just over 100% of FPL, 138% in Medicaid expansion states) Not so much if you're over the "cliff" (MAGI over 400% FPL) I doubt Medicare will be so generous once I get there (~15 years) Most likely every supplement plan with be some form of Advantage, with only a fixed amount (capitation) allowed annually based on one's age & health (e.g. is the patient compliant with doctor's orders?)

ACA may be cheaper than Medicare for some people BUT in my experience ACA is not better then Medicare. In my state the best ACA policy I could get had a $6000 per person annual deductible and a limited network. Now that I am on Medicare with a Medigap policy G my deductible is $185 and I have a very large network of Medicare providers. To me Medicare is superior to ACA. Most people I know are glad to hit age 65 and finally get on Medicare.

[ncbill]

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Originally Posted by harllee ACA may be cheaper than Medicare for some people BUT in my experience ACA is not better then Medicare. In my state the best ACA policy I could get had a $6000 per person annual deductible and a limited network. Now that I am on Medicare with a Medigap policy G my deductible is $185 and I have a very large network of Medicare providers. To me Medicare is superior to ACA. Most people I know are glad to hit age 65 and finally get on Medicare.

So you were over the cliff?

If I plug in our 2018 household income and family size into KFF's 2020 calculator, here's what I get:

Estimated financial help: $1,710 per month ($20,517 per year)
as a premium tax credit.

This covers 97% of the monthly costs. Your cost for a silver plan: $46 per month ($556 per year) in premiums (which equals 2.06% of your household income).

Maximum out of pocket for the above family plan: $5400.

And if the government goes to all Advantage plans (no more F, G, etc. supplements) as I suspect to save costs there will be networks for that as well so not every doctor/hospital will take your particular Advantage plan.

[aja8888]

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Originally Posted by ncbill And if the government goes to all Advantage plans (no more F, G, etc. supplements) as I suspect to save costs there will be networks for that as well so not every doctor/hospital will take your particular Advantage plan.

Supplemental plans (F, G, N, etc) are paid by insurance companies, not the government. If the Gov eliminates Medicare as we know it and goes to MA plans, you can bet that many specialists and hospitals won't take it. Right now, MD Anderson Cancer Centers in Texas won't take MA plan patients.