Medical costs in the USA

But not just for today, but also for in retirement …

In the US between what Social security pays and potential medical costs, it tends to be more than many people realize until it is just about too late (Yes I’m in that group)

-Karen

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That too has to be part of “whats enough”

Indeed. Our European friends and indeed many people living outside the US may not be able to understand or credit that our health “care” system is such that a serious illness or accident is often equivalent to financial ruin.

That’s right, there are certainly too many people in Germany who don’t know your system. Most of the same people who only talk bad about our welfare state though.

Especially the richer people here who don’t understand that

  1. you can fall quickly through no fault of your own
  2. it is part of the basis of the system that higher earners have to contribute proportionally more.

This in turn is not understood by many on the other side of the pond when they talk to us about the comparable higher taxes over here and that we are all “communists”.

In fact, our system has to be financed here too, but distributing the risks across several shoulders is not only fairer, it is ultimately the only guarantee of financial survival of an individual and his family in the event of tragic events.

And since our system is going to hit the wall in the foreseeable future, we should learn the right lessons from bad systems like the American one and, if necessary, also accept even higher contributions and at the same time ensuring more transparency in the expenditures in the health care system.

The constant that unites us is that we need more education and understanding on both sides.

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I grew up in Germany, lived many years in France and now in Switzerland. There are differences in healthcare systems and a huge difference between here and the US system. We get it in the news, newspapers and documentaries and we know that the US systems generates the highest per capita health cost in the world but offers only very limited coverage and many people can’t afford health insurance at all. I personally find it quite shocking that such a basic need of a civilised society fell prey to an industry, with the consent of lawmakers. It is very disturbing that ‘adjustments’ made to healthcare systems here in Europe are mimicking the US system - privatise and draw profit, exclude those who can’t afford it.

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All I can say is, do everything you can to oppose changes in the direction of the US system. It is dystopian on so many levels. My wife and I (in our mid 60s) pay between us well over $1K per month for “just okay” insurance which still, rather than paying the bills, quibbles over and micromanages them. We call them the “claims denial department”. My wife was seeking a pain management procedure for her knees; they approved the painful exploratory shots and then denied the actual procedure, unilaterally decreeing it to be “experimental”. Some insurance companies do this, others don’t. Any of them can change their mind at any time.

Locally here in upstate NY doctors have been retiring early or moving out of the area, such that you can’t see a general practitioner in less than about 8 week’s lead time, even if you have coverage and/or money. Increasingly they are pushing people off on urgent care facilities for most things. Since our family doctor abruptly retired in December, between lead times and cancellations (sorry, the doctor is ‘not available’ today) I have yet to see the new care giver, who is not really even a doctor but a nurse-practitioner.

You do NOT want what we have, trust me.

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You have my fullest attention on this. Recently I read this article about software-supported automated claims denial:

Cynical is a too kind word for what these people do.

And who the hell is coding this kind of software?

The basic problem is that it is a for-profit healthcare system. It’s not profitable to review, much less approve claims, so it tends to degenerate into this sort of thing. The best you can hope for sometimes is that they will routinely deny a claim and then relent on appeal – because they know a certain percentage of people just won’t even try. Not necessarily because they lack assertiveness but because the last thing you need when sick or in pain is to have to argue with the insurance carrier, be on hold for an hour, end up talking to some contractor working from home who makes it clear they don’t give a fig, then have to call back once or twice more until you get an actual human being with some level of functioning empathy and at least vestigial sense of agency.

Absolutely. Here we have insurance companies that have the legal form of a mutual company (Genossenschaft). By their bylaws and i.a.w. law, they can’t make profit and pay out dividends. All proceeds must be given back to the insured people. Does this exist in the US, too?

According to the article, the concerned insurance company got humans out of the claims verification chain as far as possible. Let AI step in and this will become worse.

There are highly qualified software developers who develop this kind of software and put it in the hand of managers. I think the software developer world has a huge ethics problem. This kind of software actually kills people. It is less obvious than in flawed avionics software but the risk is clearly there.

There are “mutual” insurance companies here, for certain kinds of insurance such as life insurance. But not health, so far as I am aware. I would be unsurprised to find that the for-profit industry has somehow made that illegal, to protect their market. The whole system is predatory.

Traditional Medicare (for persons 65 and older and some low-income disabled persons only, in the latter case known as Medicaid) is an exception of sorts. Traditional Medicare is the government health insurance payer, not to be confused with Medicare Advantage, which is bringing for-profit health insurers into the Medicare system; it is very hard to just get straight-up Medicare anymore, or I should say, it is very easy to be duped into Medicare Advantage. For example I was on a health plan through my late wife’s employer as a survivor (a rare situation; she had converted her retirement into an annuity with me as the beneficiary when it was clear that she was dying, and her relatively good health coverage came with the annuity). When I turned 65, if I had continued that coverage, it would have been an “Advantage” plan. “Advantage” carriers even advertise inside the Medicare government web site.

If that all sounds confusing, it’s because it is. By design, really.

It is confusing, indeed. As a system it looks inadequate to cater for people’s needs. All I can do is wishing you good health!

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Many also do not know that some of your insurance companies (if not all?) have a maximum spent per patient / family. I had to experience this with an employee who was in his 50s and his wife was very ill for over a decade. She was finally cured, but the “remaining sum” available for future illnesses was just a joke. That would be considered unethical here.

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Thanks.

One of the “arguments” used here against a humane health care system or the concept of healthcare as a human right is based on old-fashioned American exceptionalism. We are a big, populous, diverse country. What works in, say, Germany or Sweden or Norway, they say, would never work here. Yes there are differences and different challenges but the notion that somehow if we went to a single-payer system we would all be waiting in line for life-saving procedures and paying ridiculous taxes and getting nothing in exchange for them is, weirdly, based on everyone’s exasperation with the current system. It’s just assumed that a better system wouldn’t be better, but because the government rather than the almighty private enterprise system is in the mix, it would be even worse.

These idiotic arguments sell, somehow. People are used to whatever patchwork health care they have put together, think they have self-determination in it (American rugged individualism in play there) and therefore any sort of fundamental change is threatening.

If I were 20 years younger I would move to a more sane country but it’s too late for that ship to sail, I think, especially given all the problems in the world; in different ways, nowhere is really safer anymore.

Yes but the grass is not necessarily greener over here either, only a tiny bit. Our system has some issues too. But those are mainly related to exploding cost, as people are getting older and medical progress is causing higher expenses. A lack of skilled workers is also a problem here.

Plus we have the common insurance systems, but richer people who can opt for private insurance, civil servants have their own system. One system for everyone would be needed urgently, who wants to get an even better insurance could still privately pay for extra options.

But overall our system seems to belong to the better ones. And still we have morons saying that people should pay the bills themselves after a skiing incident for instance. Usually the same people are fat smokers, who will change their mind instantly once they need medical care.

The biggest failure of our system is in my opinion that the health insurance pays the costs immediately and many don’t see what has been spent on you. That’s bad too, doesn’t help on transparency, and doesn’t help that people might oppose to treatments which don’t help them but at very high cost. A sack of ice cubes should then no longer cost a 2-digit sum post surgery :wink:

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Why hard? It’s just a choice to make…

I’m still working and hope to for continue at until I reach at least 70… but I know that can change at any time… and if it does I’ll have to immediately get on medicare…

Lots of people seem to think Advantage is a good deal… and it is financially IF you don’t need to use the insurance much…

With traditional medicare (A&B) along with a comprehensive medigap plan and Part D drug plan, it looks like the cost for myself and spouse would be about $1000/Month or more…

I would rather not go Advantage when the time comes, but finances may dictate otherwise.

-Karen

We had friends that moved to Costa Rica after the 2016 election (you can guess the reasons). They did so knowing they’d be without health insurance because they’re not citizens but they felt the risk was worth it because they were both healthy.

Fast forward to this year and one of them had to have a heart procedure done and they couldn’t get it done in Costa Rica and had to go to (Panama maybe? I forget what country). Anyway, without personal or government insurance they ended having to do a Go Fund Me to raise well over $100k USD. If they had been in the US without health insurance that cost may have been well over $500k (or more). They gambled on staying healthy and lost.

Many people in the US, even with insurance, can’t afford the copay. One ER visit can run $10k or even more depending on if, or how much, insurance will agree to pay. Medical emergencies are the number 1 source for bankruptcy in the US.

I’m not unhappy having to work for someone that has a good health insurance plan. It’s way better than we could afford as our own company. Health insurance was always our #1 cost after payroll and every year it was a roll of the dice to move to a different company/plan for about the same money or just take the 20% rate hike.

It seems a shame that medicine (in the US) has to be a profit driven system. I think it was in the mid '70’s when President Nixon signed a medical deregulation bill that allowed the medical community to ‘maximize profits’ and they promised it would lower costs and generate more competition. It certainly generated more competition but only in those area that they could maximize their profits.

In the area of Kansas City we used to live in there were 4 really good quality hospitals within a 10 minute drive. Move 1 county over and there was a single hospital for the entire county only because it was a much poorer community.

Everything is pushing people towards Advantage plans without clearly describing the tradeoffs, unless your sole criteria is premium costs, perhaps.

I want to be done with private, for-profit insurance one way or the other, and their constant second-guessing of the joint health care decisions of me and my doctors.

Traditional Medicare does have some lifetime caps in hospital payouts, and it still has deductibles, but at least for the most part it pays for whatever you need within those bounds. The only private insurance you then need is for prescriptions, and mine runs about $12 a month.

I still pay through the nose for traditional medicare itself because of my income level, but that’s a good problem to have, and will self-correct when I quit working. Then it will be something north of $300 a month for each of us, which here in 'Murica, isn’t bad.

My wife isn’t 65 yet and is on her last year of private insurance at about $575 a month. Those “affordable” health care act (ACA) plans are all about the same, you either pay less premium and more deductibles or less deductibles and more premiums … it all amounts to the same thing in the end. And they oppose you at every turn anyway.

HOLY SHIT !
1K a month ???

It’s not cheaper here in Switzerland, which has a healthcare system not much different from the US, minus the denials.