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Well, I knew my medical insurance was expensive, and now it's official

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I'll echo what others have said about how interesting and engaging this thread is. And thanks to many of you for personalizing your experiences and the truly shocking costs of healthcare in America today. I'm blessed--60 years old and never with a major health challenge for either me or my DW. I'll offer my two cents on how to get this runaway train under control:
  1. This is an industry that is inherently immune to the laws of supply and demand. Good old-fashioned competition just doesn't work--and here's why: right now DW and I are shopping for a new refrigerator. Since it's a major purchase, I've checked Consumer Reports to see which are the best-rated. We've shopped online, gone on the message boards and review sites to see what others who own the brand and model we're looking at say about it, and are now checking various retailers to see what their delivery costs and service capabilities are. But when I have a medical emergency--whatever it may be--I not only have no time to do my due diligence, but time is of the essence, especially if it's a life or death kind of issue. Literally the only factor keeping my healthcare provider(s) from charging whatever they darn well please is the pre-negotiated rates for products/services by my insurer. If it was just me, the doctor/hospital/specialists/drug and medical supply companies could and most likely would hang me out to dry. Competition is out the window because my insurer directs me to which provider and hospital I'm allowed to see. The invisible hand of Adam Smith is not just invisible in the healthcare industry in America, it's non-existent.
  2. The tort attorneys are killing us. I'm old enough to remember when attorneys were not allowed to advertise--until a Supreme Court ruling in 1977 changed all that. Even forty years later, that ruling is controversial because it allows so-called "ambulance chasers" to pre-dispose people to sue doctors and medical companies for so much as a hangnail. One organization has estimated that the passage of federal tort reform would lower healthcare premiums by about 3.5%. It's doesn't sound like a lot, but every little bit helps.
  3. There is no doubt in anyone's mind that greed runs rampant in the healthcare industry. This particularly egregious example comes from an article published just today in Bloomberg BusinessWeek about a drug company--Alexion--which charges an almost unbelievable $500,000-$700,000 per year for a drug called Soliris. The drug companies will often trot out the old saw that they need this kind of pricing flexibility to offset massive R&D costs, especially for drugs that help a relatively few patients, like Soliris does. But the BusinessWeek article contends that so-called "orphan disease" drugs are in fact highly profitable for the drug companies. The article itself is pretty damning.
  4. Thanks to the overly-extensive lobbying strength of the AMA in Washington, bad doctors are not only able to continue to practice despite substance abuse issues, questionable training, and other things, but their patients have no way of knowing they have been disciplined. This is yet another example where the patients are hampered from being able to conduct simple due diligence. Bad doctors should be exposed and then at least let the free market determine their eligibility to continue to practice. But free market principles don't apply since these doctors are shielded by laws advocated by the AMA.
  5. Greg's earlier comments about the effects of a single-payer system ring true. By its very definition, healthcare gets allocated and healthcare availability decisions get made by government bureaucrats and not healthcare providers.
So what's the solution? Of course, there is no easy answer and this issue is incredibly complex. But I would offer a few suggestions that would at least have a positive effect on the outrageous costs in the American system:
  • Pass federal tort reform that limits jury awards.
  • Repeal the ability of tort lawyers to advertise their "services" in a way that encourages frivolous and costly lawsuits that we all end up paying for. Ultimately, the only winners in the current system are the tort lawyers themselves.
  • Substantially shorten the time period for drug patents, allowing generic imitators to come on to the market much sooner. The drug companies will tell us that this would completely undercut their incentives to conduct the R&D necessary to develop drugs, but I think that theory ought to be tested by allowing the free market to have a greater hand in controlling drug costs.
  • Remove the veil from bad doctors and bad hospitals. Expose the bad ones, and allow the free market to laud the exceptional ones.
  • Require doctors and hospitals to post their fee schedule for routine medical procedures and make these fees available online such that online consolidators such as esurance.com can immediately show consumers what those costs are. Yes, some will say that this is impossible because every patient is different and every situation is different. Fair enough. But that doesn't mean something like this could not be done to at least provide some level of price comparison to see the light of day.
  • Substantially shorten the inordinately long and costly drug testing and approval process by FDA. Many will say that this process protects us, but the recent experience of the expedited process for approval of Zmapp to respond to the Ebola crisis shows it can be done--and should be done much more often and with greater dexterity.
Not being in the medical field, I am sure some of my prescriptions (pun intended) for fixing our broken system are short-sighted. But we've got to start somewhere, because what we've got is not only unconscionable, but unsustainable in the extreme.

sounds like you're putting most of blame in health care costs on lawyers and lobbyists
I'll check back in when you turn 65 and go on Medicare, it's possible you could change your mind about all those "government bureaucrats" and the single payer system!
 
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I bave some opinions on our healthcare systems and insurance. While the affordable care act was beneficial for some people, it was not for all. How can we reduce costs? My very first thought is to change the hospitals themselves. There is no reason I can think of to have to pay $10.00 at the minimum for a $.01 aspirin. http://www.rd.com/health/wellness/wildly-overinflated-hospital-costs/
I worked for 2 contracts with the government, medicare and ACA. I have seen the cost rise on both!

The best advise I can give my friends and family... If you plan on down sizing and selling your house, do it 3 years before you go on Medicare. Otherwise you end up paying even more for part b and d.
 

pagosajim

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The best advise I can give my friends and family... If you plan on down sizing and selling your house, do it 3 years before you go on Medicare. Otherwise you end up paying even more for part b and d.

Can you elaborate on this? Fits my situation well and I'm curious as to why there's a timing issue here.
 

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3rd Note: It is really cheap to live healthy to old age. The list of what to do is really short. 1) Eat 1200-1600 calories a day, depending on your height, and no more, about half those calories need to come from veggies 2) get enough sleep 3) eat a good amount of fish (about 4oz twice a week). Notice exercise doesnt even make it to the list. What is not easy is having an environment where most people adhere to those three things. Imagine how many fast food restaurants would go out of business, and how many customers would balk at paying $8 for a meal with 300 calories.

Since obesity creates significant health costs that are born by the taxpayers, does anyone have a problem with barring food stamp users from buying soda and other sugary drinks with food stamps? Mayor Bloomberg tried to get USDA approval to do that in 2011 and 2013 and the USDA denied his requests.
 

rapmarks

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Can you elaborate on this? Fits my situation well and I'm curious as to why there's a timing issue here.

Medicare is income based, when your income crosses a certain threshold, you pay two, three, or four times as much per month for Medicare, as well as a surcharge for part D. Selling your house may course large capital gains, resulting in an increase in Medicare premiums.


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bogey21

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It is really cheap to live healthy to old age. The list of what to do is really short. 1) Eat 1200-1600 calories a day, depending on your height, and no more, about half those calories need to come from veggies 2) get enough sleep 3) eat a good amount of fish (about 4oz twice a week). Notice exercise doesn't even make it to the list. What is not easy is having an environment where most people adhere to those three things. Imagine how many fast food restaurants would go out of business, and how many customers would balk at paying $8 for a meal with 300 calories.

There is some truth here. In my late 70s (I'm now 82 gong on 83 and all is well) I saw the light and took my weight down from 205 to 155 by eating pretty much as described above. In addition I focused on reducing stress. I agree that formal exercise is not necessary. I do avoid elevators and climb stairs when I can, take long walks with my dog and park as far away from the entrance when going to Kroger, Walmart, etc. IMO fast food and drinks with sugar are dangerous.

George
 
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Can you elaborate on this? Fits my situation well and I'm curious as to why there's a timing issue here.

Sure,
If your yearly income in 2015 (for what you pay in 2017) was You pay each month (in 2017)
File individual tax return
File joint tax return File married & separate tax return
$85,000 or less $170,000 or less $85,000 or less $134
above $85,000 up to $107,000 above $170,000 up to $214,000 Not applicable $187.50
above $107,000 up to $160,000 above $214,000 up to $320,000 Not applicable $267.90
above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 and up to $129,000 $348.30
above $214,000 above $428,000 above $129,000 $428.60


I saw one beneficiary paying about 535 bucks a month, they still had to buy marketplace insurance for his wife. Needless to say, it ended up costing them 5 times what they had been paying threw his former employer.. to go back, to my reason why..So they sold their on of their houses, it ended was taxable and received a Form 1099-S . My grandparents have run into it twice now.

Most home sellers don’t even have to report the transaction to the IRS. But if you’re one of the exceptions, knowing the rules will help you hold down your tax bill. There
are three tests you must meet in order to treat the gain from the sale of your main home as tax-free:

  • Ownership: You must have owned the home for at least two years (730 days or 24 full months) during the five years prior to the date of your sale. It doesn't have to be continuous, nor does it have to be the two years immediately preceding the sale. If you lived in a house for a decade as your primary residence, then rented it out for two years prior to the sale, for example, you would still qualify under this test.
  • Use: You must have used the home you are selling as your principal residence for at least two of the five years prior to the date of sale.
  • Timing: You have not excluded the gain on the sale of another home within two years prior to this sale.

I don't know your situation exactly, but if it is like my parents and grandparents, you won't want to get stuck paying extra everywhere.
 

WinniWoman

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Medicare is income based, when your income crosses a certain threshold, you pay two, three, or four times as much per month for Medicare, as well as a surcharge for part D. Selling your house may course large capital gains, resulting in an increase in Medicare premiums.


Sent from my iPad using Tapatalk

Even if you buy another house? Even downsizing, for many people the downsized house can cost the same or more than the old house.
 

VacationForever

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Medicare is income based, when your income crosses a certain threshold, you pay two, three, or four times as much per month for Medicare, as well as a surcharge for part D. Selling your house may course large capital gains, resulting in an increase in Medicare premiums.


Sent from my iPad using Tapatalk
High income penalty hit only afects that one year as Medicare uses 2 year old data to calculate the penalty and because there is a lag, you may be able to get the income penalty removed. Downsizing home also does not mean an increase in income. My large home is listed for sale, at 200K less than I paid for. It won't affect our income level for rhe year.

Even when/if your income is much higher before you turn 65 and then "normal" or low at 65, you simply need to write to Medicare to indicate that your current year income is not what they have used from 2 years prior. We did that for my husband and I want to almost say "easy peasy"... they revised his rate down from $504 to $134 effective first of the year.
 
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ace2000

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I saw one beneficiary paying about 535 bucks a month, they still had to buy marketplace insurance for his wife. Needless to say, it ended up costing them 5 times what they had been paying threw his former employer.. to go back, to my reason why..So they sold their on of their houses, it ended was taxable and received a Form 1099-S . My grandparents have run into it twice now.

Most home sellers don’t even have to report the transaction to the IRS. But if you’re one of the exceptions, knowing the rules will help you hold down your tax bill.

As you mentioned, mostly everyone reading this will not have to worry about what you've described above. But, it is good to know!
 

wilma

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Since obesity creates significant health costs that are born by the taxpayers, does anyone have a problem with barring food stamp users from buying soda and other sugary drinks with food stamps? Mayor Bloomberg tried to get USDA approval to do that in 2011 and 2013 and the USDA denied his requests.

Why single out food stamp recipients? Why not charge higher insurance/medicare rates for people who smoke and/or are obese?o_O:rolleyes:
 
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ace2000

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Why single out food stamp recipients? Why not charge higher insurance/medicare rates for people who smoke and/or are obese?

I've got mixed feelings about this. There are plenty of higher risk behaviors and dietary choices that impact health. It's a slippery slope.
 

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Greg, I really like your post, it seems honest.
I'll tell you what is wrong with the system in our great country and how to fix it in a much shorter posts than yours.
The current US system rewards cures such as those provided by your company, but it does not do anywhere near enough to prevent people from needing those cures in the first place.
Imagine a world in which fire prevention officials didn't exist, and in which you and I had to pay every time a fire truck came to the front of our house.
The more fires, the more loses; the more loses, the bigger the insurance premiums; the bigger the premiums, the higher the profits from insurers; the higher the profits from insurers, the higher the incentive to put out those fires quickly if expensively (see the pattern).
So, to conclude, while I do not necessarily agree that a single payer system would be the end of all problems health related, a single payer system does have strong incentives to prevent disease in the first place, something that our current system desperately needs. If there is a substantial reduction in disease, sorry to say, your company would not need to exist in the first place.
 

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TOTALLY agree with this! Having worked in the wellness arena, I was continually amused at how employees would complain to no end about participating in healthy eating or exercise programs, then want to complain even more about how much they had to pay! There is a direct correlation here people! Keeping yourself healthy and getting some exerciser will go a LONG WAY towards better health! Too many employees feel it is an employers obligation to provide them with health insurance, and then want nothing to do with controlling those costs! Not picking on lower income people, but lets start by restricting food stamp use for healthy foods instead of potato chips and junk foods! I would rather the difference be spent on gym memberships![/QUOTE]
 

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Not picking on lower income people, but lets start by restricting food stamp use for healthy foods instead of potato chips and junk foods! I would rather the difference be spent on gym memberships!

Ahem...you just contradicted yourself. :) And where do you draw the line on junk food vs non junk food? It goes a lot further than chips and soda. It gets complicated.

I would think the only way to make inroads down this path, is to somehow make the food companies financially accountable for the health care issues they are indirectly responsible for. That seems more fair. It would be similar to what has been happening to the tobacco companies.
 
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vacationhopeful

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... users from buying soda and other sugary drinks .....

In the city of Philadelphia, Pa ... the city government enacted a 'Sugary Drink Tax' earlier this year. It basicly about doubles the cost of that beverage (per ounce)... whether from a fast food place to the supermarket to the corner store. The tax money goes to the school district.

And yes, LOTS of people complained and swore they would NOT buy sodas in the city ... and the wholesalers & stores forecasted closed businesses and fired employees ... but generally, the people just paid a bit more AND MAYBE, they drank less sugary drinks.
 

rapmarks

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Even if you buy another house? Even downsizing, for many people the downsized house can cost the same or more than the old house.

If married, you get five hundred thousand off the profit, so wouldn't affect most, but certain areas have really high housing. My friend, single, sold house on cape cod she had lived in over thirty years, and made more than $250,000 profit, had to pay capital gains tax, and Medicare went up for a year. She did buy a replacement house, but that had no effect on taxes



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"
He needs a knee replacement and has difficulty walking and kneeling but he has to wait six to eight months before it is his turn (her words)."

You do not mention where your friends live in Canada, but I have to totally disagree with that comment. My DH had 2 hip replacements. The first one could have been scheduled within 3 weeks of visiting the surgeon, but DH put if off because of a trip we had already planned. After this first replacement, we had a physiotherapist visit our home for 8 weeks, to evaluate his recovery and add exercises for him to do. The second hip replacement took place within 4 weeks of visiting the surgeon, and the same process happened with the physiotherapist. In our province we have designated hospitals that do only hip and knee replacements, some specialize in oncology, and others in cardiology. They have found that this works more efficiently in caring for the patients.

I am sure we probably pay more taxes than in the US, but our taxes are based on income, and of course people with low incomes pay less etc, etc. Now that we are retired, we pay even less taxes, and the younger generation pays the taxes to cover the retiring generation. I have truly never heard of any Canadian having to sell their home or mortgage their home to cover medical expenses.
 

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In the city of Philadelphia, Pa ... the city government enacted a 'Sugary Drink Tax' earlier this year. It basicly about doubles the cost of that beverage (per ounce)... whether from a fast food place to the supermarket to the corner store. The tax money goes to the school district.

And yes, LOTS of people complained and swore they would NOT buy sodas in the city ... and the wholesalers & stores forecasted closed businesses and fired employees ... but generally, the people just paid a bit more AND MAYBE, they drank less sugary drinks.



I agree with the tax idea when it is clear that the product has no benefit, but the proceeds need to go to better health initiatives!!!! Not against better schools, but putting the money back into schools doesn't solve the base problem!
 

vacationhopeful

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I agree with the tax idea when it is clear that the product has no benefit, but the proceeds need to go to better health initiatives!!!! Not against better schools, but putting the money back into schools doesn't solve the base problem!

Actually, it does help. Many families in the city did cut back on those sugary drinks. Yes, many families do shop and buy cheaper soda products across the city limits .. just like some people pick up way cheaper smokes in the Carolinas. But that daily soda at lunch or at the movies ... the "walk by, pick up, then buy and slam down" soda purchase becomes ... so the bottle water is CHEAPER and gets brought MORE.

I think RETRAINING the population .. via PASSIVE negative reinforcement training .. does work. Less soda consumption is a BETTER HEALTH INITIATIVE with the government NOT being the watch dog, no Public Health lectures/directives and it happens in the home, work, fast food and schools every day.
 

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Actually, it does help. Many families in the city did cut back on those sugary drinks. Yes, many families do shop and buy cheaper soda products across the city limits .. just like some people pick up way cheaper smokes in the Carolinas. But that daily soda at lunch or at the movies ... the "walk by, pick up, then buy and slam down" soda purchase becomes ... so the bottle water is CHEAPER and gets brought MORE.

I think RETRAINING the population .. via PASSIVE negative reinforcement training .. does work. Less soda consumption is a BETTER HEALTH INITIATIVE with the government NOT being the watch dog, no Public Health lectures/directives and it happens in the home, work, fast food and schools every day.

I'm thinking the extra tax on sugary drinks IS the GOVERNMENT watch dog but hey, if it's PASSIVE NEGATIVE and it works it's all good
 

WinniWoman

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I personally think government should stay out of our lives as much as possible.And I am against most taxes. But- hey- who cares what I think. Doesn't matter.

(As for sugary drinks- I have a 82 year old friend in great health that has drank a sugary soda every day of her life as well as sugar in her tea and a piece of cake at night after dinner. She is slender and very youngish. Not one single health issue)
 

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I got a good laugh reading this thread talking about MedicaidMedicare recipients and what they should and should not be allowed to purchase!

Having spent a lot of time in the hospital lately I cannot tell you how many overweight medical professionals I have seen! If you cannot get them to eat healthy how can you possibly expect the rest of the people to?
 

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I personally think government should stay out of our lives as much as possible.And I am against most taxes. But- hey- who cares what I think. Doesn't matter.

(As for sugary drinks- I have a 82 year old friend in great health that has drank a sugary soda every day of her life as well as sugar in her tea and a piece of cake at night after dinner. She is slender and very youngish. Not one single health issue)
I know someone who was successfully treated for fatty liver with a low-carb diet. In his case the culprit was orange juice, not pop. The doctor said orange juice is frequently a problem since rarely is it served in those little shot glasses like back in the '60s, and it's perceived by patients to be a healthy alternative to pop.
 

Patri

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I got a good laugh reading this thread talking about MedicaidMedicare recipients and what they should and should not be allowed to purchase!
Having spent a lot of time in the hospital lately I cannot tell you how many overweight medical professionals I have seen! If you cannot get them to eat healthy how can you possibly expect the rest of the people to?
And they are out back puffing away during smoke breaks.
 

Talent312

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Having spent a lot of time in the hospital lately I cannot tell you how many overweight medical professionals I have seen!

The nurses I've seen have been thin + boney, which I ascribed to the quality of hospital food.
Considering the $$ they rake in, they should be able to set up a Longhorn Steakhouse.

.
 
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