NPR piece about retirement

harriethomeownerJuly 27, 2007

I heard this this morning; I thought it was an excellent short piece about how much money you need to retire. She really brought up a lot of issues in 5 minutes.

Here is a link that might be useful: Can you afford retirement?

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Absolutely dead on. The stat that really amazes me is that 50% of Boomers expect to receive a pension in addition to their Social Security checks - yet very few of us BB's actually will!

Mind you, if you work for at least 5+ yrs for a company, many of them DO buy annuities for vested former employees. I was surprised to get three letters from former employers, whose combined payments will give me another $1K/monthly at age 65 - I wasn't expecting that at all, thinking my 401k money was all I had from those long-ago employers. It's not much, but will help with inflation as my DH and I work on our retirement budget.

People grossly underestimate medical costs when they've worked for a corporate employer who picks up the majority of the cost. Talk about unrealistic: I've actually had a stay-at-home mom whose husband is a six-figure union worker tell me that "free healthcare is our right!" Uh, I must have missed it when the Founding Fathers put that into the Constitution.....

Hopefully more people will start saving seriously as these articles start to impinge on their consciousness. Interestingly enough, most of the Gen X/Y workers I know are much more serious about saving than Baby Boomers, because they've taken the SS/Medicare scare articles to heart and just figure no help is going to be there at all by the time they get to age 67.

    Bookmark   July 27, 2007 at 2:25PM
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The audio had more info in it than the written piece in the link. Worth listening to.

The interviewee mentioned this Web site, which I thought was also very good. There's a calculator in the "Retirement" links that gives an estimate of how much you will need to save when you enter a few simple numbers.

Here is a link that might be useful: Choose to Save

    Bookmark   July 27, 2007 at 5:13PM
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I respect this reporter. She is clear and has her facts.

Now, children, who do you think is going to pay for all those who have not saved for their "golden years". Uh-huh, it will fall to those of us who have saved and are paying taxes and inflated medical costs (further inflated by the "charity" cases), and inflated credit card charges (to make up for the losses of those who bail or simply die leaving no assets). (See post about 85-yr-old debtor.)

    Bookmark   July 27, 2007 at 5:47PM
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I think it is a disgrace that we do not have universal health care that SAHM is absolutely right regardless of how poor or wealthy she is

Please read this op ed piece from Newsday July 18 written by someone I know, I attended the funeral

At the beginning of the film "Sicko," we see one man giving himself stitches and another explaining he lost two fingers in an accident but could afford to have only one reattached.

Michael Moore tells viewers that his movie isn't about these men or the other 47 million Americans who don't have health insurance. The movie focuses instead on stories about "the rest of us," the 250 million Americans who have insurance, but who are all too often denied proper medical care.

Many Americans were wary of Hillary Rodham Clinton's efforts to reform U.S. health care during her husband's presidency, largely because powerful lobbying interests persuaded them that "socialized" health care would threaten their access to quality medical care. Fifteen years later, Moore deftly demonstrates that we were misled by those who care more about keeping the profits rolling in than about providing health care to all Americans.

But what about those 47 million uninsured and their stories?

While many people assume that not having health insurance is a problem of the poor, the uninsured are likely to be people with incomes above the poverty line - those who make too much to qualify for Medicaid, but too little to pay out hundreds of dollars in monthly premiums.

Such was the case of my sister, Mary Mascioli, who became one of the more than 18,000 Americans who die each year because they don't have insurance.

She was only 44 and a widow caring for her disabled son. Last year she went to a local emergency room complaining of shortness of breath and severe swelling in her legs. For the next five weeks, as she lay in a hospital bed too sick to fight for herself, my family and I desperately fought to get her adequate medical care. But her lack of insurance was a wall that we ran into everywhere we turned.

Although laws prohibit hospitals from denying treatment to those without insurance, there's a limit to what a facility must provide, and most won't make any effort beyond that.

In my sister's case, that meant urgently needed treatment would often be delayed for several days. It took more than four days to get her on dialysis after her kidneys failed. By then she was barely conscious.

When her toes turned black from lack of blood supply, the vascular surgeon didn't come for five days, and, by then, the toes required amputation. Some doctors refused to treat her at all.

We begged hospital personnel to call in other doctors, but, as an uninsured patient, Mary had to wait for the doctors assigned to her. And even after her doctors admitted they could not diagnose what was wrong, administrators refused their repeated requests to have her transferred to an affiliated tertiary care hospital that was better equipped to diagnose and care for such a medically complicated patient.

The transfer was finally approved after her condition became critical, but it was too late. She died two days later.

An autopsy showed the cause of death as sepsis, a common infection that she contracted while in the hospital. But I believe she also died because the inherent conflicts in our profit-driven system of health care resulted in treatment decisions based on economic factors instead of on how best to save my sister's life. This same system drives up costs to the point that most of us could never afford to pay out of pocket for treatment.

Of course, no one expects doctors to work for free, and it costs money to run a hospital. So how do we fix the system? There are viable alternatives.

Some of the proposals being considered as we approach the 2008 presidential election include a federal health insurance program, the expansion of Medicaid, or a national system in which our tax dollars would fund doctors' salaries and hospital operations.

We owe it to ourselves to become better informed about these options and truly consider them before we let another opportunity for reform go by.

Although my family was interviewed for "Sicko," Mary's story didn't make it into the film. But we all need to stop being complacent about the problem of the uninsured and understand how it affects all Americans.

It is all too easy for you or someone you care about to end up without health insurance - whether through job loss, divorce, the death of a spouse or one of the thousands of pre-existing conditions insurance companies use to disqualify applicants for private coverage.

Not having insurance can result in bigger problems than medical bills you can't afford to pay. At the very least, you may compromise your health by delaying needed care. At worst, you may needlessly die. We have to find a better way - for all of us.

    Bookmark   July 28, 2007 at 11:49AM
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As for the whole retirement issue, I find it frustrating. For example, the article said that I need 12 x my last years income before retirement in savings (assuming I do not have a pension). Os sounds great. Lets say I am 45 and have an income of 100k per year (lets pretend). So I need 1.2million. Well great, that is what I need based on my 2008 income, not what I need based on my 2028 income. By then my 1.2m may only be worth half of what it is or we may have a deflationary cycle or who knows. So I do not understand the idea of setting a goal, to me all such goals are merely minimums and mya not be enough depending on what inflation does

    Bookmark   July 28, 2007 at 11:54AM
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Some years ago a local psychiatrist consulted me as to whether he might be able to retire early.

After some discussion relating to his asset base, current income, that he and wife live fairly simply, if so, how come such low level of assets, he had only been earning at that level recently ...

... after some consideration, I told him that not only could he not retire early, that it would keep him busy to manage on the assets that he had, if he continued working till regular retirement time.

He thought that quite strange ...

... and I told him that he had not taken into consideration the impact of inflation on his asset base and future (annually increasing) income needs.

Part of his assets included a somewhat above-average home, which could be expected to increase in value over the years, but he wanted fairly secure invested assets ... which wouldn't.

If you're 20 years from regularly scheduled retirement age, you won't expect to be earning then at your current rate.

And, during the first year of your retirement, you won't want to be earning at a level comparable to this year's income, but at a level comparable to the compensation rate during that last year of work.

Several years ago, on a province-wide phone-in program related to financial planning, I told the consultant that I felt that, as I was age 70 at the time, I felt that I needed to fund my retirement till age 100.

Which worked out, in my mind, to 6 blocks of 5 years each, with each of the unused blocks earning through the periods prior to my need to use them for living.

I judged that I would be very unwise to use the full amount of one of those blocks of funds during the first 5-year period, as it would no longer be able to provide income for me to use in later years.

In fact, I thought that I didn't want to use the full amount of the first of those 6 blocks of funds during the first 10 years, for not only would that money no longer be available to earn, but I needed to remember that I would want to withdraw an increasing amount annually, due to the ravages of inflation.

Plus ... the relative value of each dollar of my invested funds would be reduced annually due to inflation. Which made me unenthused about investing a substantial amount of them in dollar-denominated assets.

Also, many financial advisors suggest that someone use equity-based assets for a substantial portion of the funds that they expect to leave invested for 10 years or more.

Which, in my case, I expected to be 5/6 of my assets, or over 80% of them.

The advisor said that he felt that my plan made a great deal of sense.

Now, as I approach age 80, I am able to live on somewhat less than the amount of my three pensions (one private and two government, two of them having been contributory), and payout from my (rather small) tax-deferred retirement fund, so am able to invest part of them.

And, I have about 80% of my assets in equity-based assets, about 1/5 of that in largely globally based mutual funds.

Something over 10% in more secure (less volatile) mutual funds, and something under 10% in liquid assets (after having wrecked two older vehicles in under two years, receiving a substantial settlement from the insurance company for one and paying in full for the replacements).

One thing that troubles me somewhat is that most of the individual stocks that I own are Canadian, and the Canadian equity market is only about 2% of the world market.

During the first 5-year period, I didn't need to draw on any of my investments, and that's still true as I approach ten years after that discussion.

In fact, I've added to them. Also enjoyed unexpected income and a bequest totalling about 4% of my assets.

But - if/when I enter a residential retirement home, or even more, a nursing home, I'll need a much larger monthly income than I'm using at present ... and the level of fees in those institutions can be expected to grow, annually.

If there may be some left for my kids and charities, fine ...

... if not ...

...tough cookie.

Good wishes to everyone: I hope that you're enjoying a fine summer weekend.

ole joyful

P.S. My highest year's income was when I was just past 50, 27 years ago.

My current assets are about 25 times that amount. Or, rather ... they were ... until the markets dropped during the past couple of weeks!

But, I'm not troubled ... it's been several years since there was a substantial correction, and one has been overdue for a while.

As you may have noted, I have about 8% of assets in cash, in case I feel that there may be some bargains available, after a correction.

And, I have no debt, but if there should be some good bargains available, I could choose to make use of some of my Line of Credit.

o j

    Bookmark   July 29, 2007 at 6:24AM
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I listened to that story, too.

The wild card for us is HEALTH CARE, and this is the "bugaboo" for our entire nation. Make no mistake about that. Look at what it's done to GM, Ford, and several other US companies. No one seems willing to discusss the Medicare crisis that looms large on our horizon, let alone Social Security. I loathe Dick Army, but he's right... this looming crisis has been too much "overlooked". Every time I write to my Congressmen and Senators I raise this question. And every reponse "skirts" it with too much bull-hit.

I'm freaked right out about, frankly. And I am "solvent"! I have retirement savings, a home that is paid for, and the financed portion of the garage is paid by earnings on investment accounts. Hey, if the -hit hits the fan we can pay the outstanding balance. But that is chump change in comparison to health care costs, let alone long term care costs.

My point is that you can "do everything right" and still not be adequately covered. It's no wonder to me that people "give up"!

    Bookmark   July 29, 2007 at 9:24AM
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Though most Americans don't want to or cannot believe it, sometimes, life is better elsewhere. It should give us pause that the United States is the only developed country without a single-payer health plan. And while many defend this policy as the reason why American health care is "the best", the facts are that 15% of this country is completely uninsured; a good percentage of the rest of us are covered for no more than catastrophic care or are discouraged by our insurers from getting the best treatment; and the U.S. lags several other countries in lifestyle metrics like infant mortality rates and average longevity. Health care is headed down the same path toward oligarchy that income has headed. On the present course, someday only the very rich will have health care. You would think companies like GM would be banging the drum loudest in favor of a policy which would save them some serious money and would even be The Right Thing To Do.

I'm "over 45". I am fortunate in that I can save a good chunk of my income and that I don't define myself by buying ever more "stuff". I work at a company which is solvent, though I joke that it's a competition to see which one of us will last longer. I'm not planning on Social Security providing me more than a token payment and an insincere "how could anyone have known this would happen?" In fact, I'm planning for a career after this one -- assuming both this company and I make it to my retirement date in 2025 -- because I'm not sure the money will be there. And I'm one of "the lucky ones".

We will reap what we are sowing. It may not be very soon, but it will happen, and, when it does, the U.S. will be well on our way to becoming an aside to history because those in charge will be too greedy or scared to make changes and the rest of us won't have the wherewithal. What a shame....

    Bookmark   July 29, 2007 at 10:39AM
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Bingo! Steve. I'm with you. I figure I'll work until I can't any longer. I'm OK with that, personally, I LIKE what I do and it isn't terribly physically taxing. It's "brain thing", and if I can't DO it I can TEACH IT.

This household is looking very seriously at "retirement"in an off-shore locale!

The reality is that health care is vastly superior in many places; esp. when you factor in knee/hip replacemements. Factor in the flight and the accomodations and the quality of care. "The Best Care In The World"... yeah, MYASS! IF you can pay for it...

A total "load", believe it or not...


    Bookmark   July 29, 2007 at 11:01AM
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I agree that healthcare expense in retirement is a major concern. The system in the US has major flaws. However if you think there are not major flaws in other country's universal healthcare systems you may want to do some more research. Be careful what you wish for as they say.

I work in the healthcare industry and have worked with customers in the US, Canada, UK, Singapore and Australia. I also have had quite a bit of interaction with consumers of healthcare in some of these countries. I also have a background in Public Health so I'm interested enough in this topic to study it a bit. It's not a panacea in these other places. People have to wait months and in some cases years for procedures I was able to have done in the US in a matter of weeks by the best physician I could find. I realize I have the benefit of health insurance that not everyone has.

Besides a lengthy wait, people's choice of healthcare providers is limited - and in some cases limited to providers who do not offer the current standard of care - they are way behind. In Australia for example they do not yet routinely do colonoscopies to screen for colon cancer. In all of these places more and more people are buying private insurance so they can have more timely, better quality healthcare. In some places more private hospitals are being built to serve this population. So there is healthcare for all - but you get better care if you can afford private insurance. Sound familiar?

In the US many people not only feel they have a "right" to free healthcare but a right to the very best healthcare, prescription medications, etc. every day of their entire life no matter how long they live and all that at a low cost. In Japan the amount of care you get if you're old and have cancer is limited - you don't get "the best" possible care if you're too old. Their philosophy is that they have to control healthcare costs and this is one way to do it. Do you think people in the US would accept a universal plan with lower quality or less care? I doubt it - everyone wants the best for less. Well, there's no "free lunch" and theres no "free" healthcare. Someone has to pay for it.

There is currently a shortage of family practice and internal medicine physicians in the US. The amount of work and stress of the job is increasing and the pay is decreasing so people just aren't going into these fields of medicine. Massachussetts recently put a plan in place to provide healthcare to more people at a low cost. Problem is there aren't enough physicians to serve all these newly covered people. Interestingly they had a similar problem in the UK - the universal system (which doesn't pay doctors much) had problems recruiting physicians. They had to start recruiting from other countries - perhaps lowering their standards - and in the process recruited a few physicians who also doubled as terrorists.

Folks, the US system ain't perfect but neither are some of these other systems that I hear many people referring to as the model we should use for the US. I say think again.

    Bookmark   July 29, 2007 at 12:16PM
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People have to wait months and in some cases years for procedures I was able to have done in the US in a matter of weeks by the best physician I could find. I realize I have the benefit of health insurance that not everyone has.

But the person without health insurance in the U.S. either waits years until the condition is critical or never gets procedures like those -- or spends a huge chunk of their own after-tax income (which likely isn't great if they're not being covered by health insurance by their employer).

The irony of it all is that, because people lack health insurance in our for-profit system, they often cannot afford preventive care or medications, but when they suffer the catastrophic results of that lack of care (heart attack, gangrene, whatever), we'll pay to treat that, either /pro bono/ or through major medical.

Besides a lengthy wait, people's choice of healthcare providers is limited

May I introduce you to my health care plan? I'm lucky: I am "strongly encouraged" to choose in-network providers but can go outside the network with much lower coverage. The folks in my company's health care plan who chose the lowest-premium plan have to select one clinic from the network's list of providers and have all other care approved beforehand unless it's determined to be a true medical emergency. I would say our choice of providers already is limited.

Do you think people in the US would accept a universal plan with lower quality or less care? I doubt it - everyone wants the best for less. Well, there's no "free lunch" and theres no "free" healthcare. Someone has to pay for it.

Here is the crux of the matter.

I suspect that anyone who has ended up on the wrong side of the stick for employer-paid health insurance would go for a single-payer plan. Better some coverage than none. I'm still amazed that the CEO of GM can whine about the cost of health insurance without suggesting that spreading out the costs with a single-payer plan might be worth examining. And, frankly, while Americans might like to think they have the best of everything, it's telling to find out how far back the U.S. is in infant mortality rates and hard to explain why a man living in Norway has a longer life expectancy than the man's son living in Minnesota.

In fact, a single-payer plan might not cost anyone any more than it does now. The competing health systems here in town have created three top-tier "heart hospitals" in town. Two of them are within five miles of where I live and less than one mile from each other. Why does it make sense to duplicate all that expensive equipment and talent while poor people are getting scrued for coverage of their blood-pressure medications?

Folks, the US system ain't perfect but neither are some of these other systems that I hear many people referring to as the model we should use for the US. I say think again.

I don't notice people burning up their Medicare or VA cards and going solo. I think if we can get past our soundbite mentality, if we can again experience a federal government that does not screw up everything it touches, and if we ask ourselves the hard questions of who we want to be as a nation, single-payer will work here just as well as it does everywhere else. The U.S. has a lot of hard questions to answer. There have been many "free" lunches over the years. Now we're going to have to pay.

    Bookmark   July 29, 2007 at 1:32PM
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The US has a health care "system" that works wonderfully well -- for the providers. We poor schnooks who can afford it pay tremendous portions of our incomes for insurance for ourselves, and we pay for the uninsured in many ways, but mostly we pay the "health" providers and the insurers.

We do not have the best health CARE in the world, only the best system of extracting dollars from payers.

I first became aware of this many years ago when my mother was dying of leukemia. She was admitted to the hospital for a total of over 200 days in one year. Her body was ready to die. There was NOTHING further to try, yet her doctors kept admitting her and transfusing her to keep her "alive" for a weeek or ten days more.

On another thread (about cancer insurance) a poster has wirtten that her husband died after two years of treatment for cancer. She was happy to report that their insurance paid for everything. The profitable end-stage treatements are well-funded and there are plenty of doctors and techs in those fields, but preventive care???

Today we pay triple what other first world nations pay for health care. What do we get for that? We get lower general health, higher infant deaths...oh, and the right to keep insurance companies' bottom lines very healthy.

The only way I see this country reforming is when Big Business decides to stop paying ANY health insurance costs -- which are currently a huge and growing portion of their bottom line.

Follow the money. Gotta love Free Enterprise.

    Bookmark   July 29, 2007 at 2:41PM
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I'd just like to say as a late baby-boomer that when I was young I never ran into articles or tv or radio programs when I was young. Today's youth have the benefit of the information age, "how-to" "you should" is everywhere.
So of course I didn't even think about till my mid-30s.
And aren't some IRA's, 401K's and everyone in the stock market fairly new options?
Not an excuse mind you, but a reason. Nowdays 20 year olds know far more than I do and are doing something with all that knowledge. Boomer's have been caught in the middle. The old company secured way of life sort of disappeared on us when we were already half way to retirement.

    Bookmark   July 30, 2007 at 11:43AM
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I think we overlook that we pay less in taxes than many of the companies with universal care. I only have a few Canadian friends, but I can't see paying the rate of taxes they pay and then waiting three years for a surgical procedure. And those countries have deadbeats which don't contribute, the same as the US.

We are self-employed, so we pay our own premiums. We know many other self-employed families who say they can't afford the insurance. We don't go on the vacations they go on, nor do we drive the expensive vehicles, etc. We obviously have different priorities.

I don't know the answer, but I don't think having our government be the dictator of our health care is the way to go.


    Bookmark   July 30, 2007 at 8:52PM
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One thing to consider on the topic of healthcare in the US vs. vital statistics such as average life expectancy, infant mortality, etc. You can't assume that universal health coverage is necessarily the cause of better vital stats like this. Japan has one of the lowest infant mortality rates and the highest average life expectancies. I also observed firsthand when I was there that there are very, very few overweight people and I saw thousands of Japanese people. Lifestyle plays a big role in overall health - and the best healthcare in the world probably can't offset the impact of that.

I don't disagree with anyone that the healthcare delivery system in the US needs improvement and it's a very difficult problem with no easy answers. I still prefer having a choice - and I can accept that if I choose to go out of network to see a top specialist in a particular field that it costs me more. At least I have the choice if I'm willing to sacrifice other expenditures for my health. I'd rather not have to be forced to have the lowest level of care that allows us to provide something - no matter how deficient - for all. The time may come when I can't afford the same level of care I can today and then I'll have to accept what I can afford.

    Bookmark   July 31, 2007 at 11:03PM
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I, for one, would be perfectly happy to pay more in taxes to fund healthcare for everyone. The reality is that when the Medicare Crisis washes onto the beach finally that's what will happen.

Right now, as taxpayers, we fun every Federal, State, and local employees healthcare. Interestingly, the Congress has repeatedly refused to make public the benefits their package provides... wonder how much Roberts' wipe out on his dock in Maine cost the good taxpayers? would be very interesting if they provided an in depth bill showing each and every expense for his 24 hr. stay... , how about the price of Dick Cheney's last "procedure" and all the others the taxpayers have paid for?

I have many friends who live in Europe and in Canada and none of them have complained very much about "waiting" and "choice", as with anything, when the insurance lobby wants to protect its turf, the lobby hauls out all the horror stories about universal care systems. But very few of the horror stories caused by lack of care in our own country...

Who pays for your insurance premiums, gibby?

    Bookmark   August 1, 2007 at 5:35AM
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My mother was a resident in Japan for over 50 years. She was covered by their national health care system. When she began to show signs of memory issues, I had a first hand look at their system.

We took her to a large university complex. She was seen the day we showed up (without an appointment). The next day she was given a battery of tests (including MRI). Her out of pocket cost was about $1.85.

I've talked to a number of her Japanese friends about their healthcare system, and none of them ever complained about having to wait. They are astounded that we have no such system.

    Bookmark   August 1, 2007 at 9:37AM
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grandma, in contrast, when my mother suddenly developed mental problems (really ovenight), her HMO dragged their feet for over a week on getting an MRI. I saw her chart later; someone had written "Alzheimer's." It was not Alzheimer's; it turned out to be a malignant brain tumor. We still wonder if she had been treated for this immediately if her last year might have been less traumatic, but we'll never know.

The sad part is that she could have had the best possible care if she had opted for it; she was covered as a federal retiree. But she was used to managed care and had always been healthy, so she stayed with it. When I was talking about it with the surgeon who operated on her, he said she could have had a Cadillac and instead chose a Yugo. I had to wait until open season at the end of the calendar year to switch her to Blue Cross, and we were able to find a wonderful doctor then, but it was really too late to make much difference at that point.

    Bookmark   August 1, 2007 at 11:47AM
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I have been in the healthcare industry for 20 yrs and agree with Gibby3000 on many counts. I've worked with thousands of employees and the general mentality is low premiums and high coverage with unlimited choice and no personal responsibility. Financial priorities are placed elsewhere, even though we know the cost of quality medical care can be high. I am not referencing people with serious medical needs, just the general population.

Insurance companies are (for the most part) for-profit companies, many with stockholders and boards to report to. They are providing a service, not a charity. Insurance premiums are 80%-85% claims cost and the rest is administration and profit. (Federal and state gov't legislation have made administration incredibly expensive, especially for employers who have to outsource just to make sure they're in compliance.) The claims cost is held down by negotiations with drs & other providers, therefore you are encouraged to see PPO/HMO providers through a higher level of coverage. No one is limiting choice unless you're in an HMO. We incur higher claims when we go out of network and when we incur higher claims, the premiums increase. We have control over costs, which will ultimately be reflected in premiums...just like we control the cost of our car & homeowner's insurance. Note you are forced to pay for the latter insurance. Some people willingly forgo health insurance, even when they could afford it.

It's not just what provider we use that causes prices to increase. Michael Moore is a good example of someone who will force the system to increase in cost. He has stated that his documentary has forced him to reexamine his own unhealthy lifestyle.

BTW, Medicare is a single-payer system. The benefits are complicated and not comprehensive. The system is fraught with abuse and poorly run by multiple administrators. And it still costs a lot in premiums! This is what Americans want for all of us?

I think one of the best things we can do in preparation for retirement is plan and save for health insurance like we save for other aspects of retirement. Especially for pre-65 retirement when options are most expensive.

No solutions, just my 2 cents. And my family has had serious medical problems. Our health insurance has paid some & we have paid some and we have been happy with the care received. And I am worried about retiring early.

    Bookmark   August 1, 2007 at 11:56AM
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Insurance companies are (for the most part) for-profit companies, many with stockholders and boards to report to.

And THAT is the gist of the entire problem. Health care should not be a profit making industry. Period.

    Bookmark   August 1, 2007 at 2:07PM
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Some highly-regarded MDs in our area have gone to retainer-based practices. You pay them X dollars annually; they provide medical services. They'e given up trying to figure out what forms each of dozens of different insurance plans requires them to file. Medicare payments are delayed more than a year in many cases.

The MD who replaced my left hip five years ago no longer accepts Medicare assignment. He saves by not coping with the paperwork and waiting ages for payment. He's happier seeing fewer patients, too. (Still doesn't want for trade!)

Our insurance provides drug coverage. Ongoing meds must be obtained from a single provider in another state. Our doctor and his whole practice (12 MDs) have decided they will no longer fax prescriptions because the pharmacy mixes up the orders and will not refund to patients when they've received the wrong meds. That means every prescription must be mailed to the provider at least three weeks before we expect to run out of the medication; it can take that long to process an order.

The medical profession is getting VERY angry.

Employers are being stretched too far by exploding health care costs for employees.

Americans think there must be another way, whether they are the uninsured who are unable to fund their care or the insured who are paying for themselves (combination of insurance payements and direct payments) AND for the uncovered expenses of others.

    Bookmark   August 1, 2007 at 3:56PM
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Our young, very hip, family doctor did that very same thing, ChiSue, UNTIL he was informed by a very large, very powerful insurance company that they wouldn't pay out for services if he continued with that pursuit! So, he made the annual "fee" optional.

We HAPPILY pay it ($500/yr.). We received same day appointments if necessary, and the appointment is for 30 minutes, uninterrupted! This guy is great, committed, and absolutely HORRIFIED by the assembly line mentality so pervasive in medical care these days.

I work in a skilled trade, for a very small business. My employer can't afford to offer "paid for" insurance. It's a struggle to pay for ever increasing premiums; at what point do we have to choose between 5K deductible and a 10 or 15K deductible? when we're so old we are automatically bumped up to the "higher price bracket" even though we're fit, careful, and have never had a claim?!

It's simply not right. Health care shouldn't be a luxury item, paid for by those who can afford it, with insurance companies shedding people like sunburned skin when they can no longer keep up with premiums that have spiralled out of their ability to pay.

It's not RIGHT!

And I absolutely agree that there needs to be accountability on the part of the insured. Your life style is risky... YOU get to foot the extra cost! My automotive insurance offers a "good driver" discount... 25%... BCBS has never done that for me. Isn't it funny that Home Economics is no longer offered in public schools... they USED to teach basic nutrition and how to achieve a healthy diet on a minimal budget... .

I want to know about the health insurance benefits available to the legislators who are taken to fat-laden lunches by Health Care Lobbyists. :)

    Bookmark   August 1, 2007 at 4:39PM
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Insurance companies are (for the most part) for-profit companies, many with stockholders and boards to report to.

"And THAT is the gist of the entire problem. Health care should not be a profit making industry. Period."

Then prescription drug mfrs, durable medical equipment companies, medical supply companies, physicians, hospitals, etc. would all need to be non-profit too since their products and services make up health insurance premiums. Take the profit out of costs and you won't find a marked difference in premium as long as our population continues to age, live longer, demand quality services, etc. Insurance companies lose money on companies (claims exceed premium paid) every day. But to stay in business and continue to pay any claims, they need to make money, like any other company you purchase products or services from. When you go to buy life or car insurance, don't you look for the most stable company? It's the one that is has a large financial reserve (so it will be able to pay your claims) and therefore gets rated high by AM Best etc.

Blue Cross/Blue Shields are non-profits and their insurance premiums are not vastly different than the for-profits. If health insurance were taken over by our gov't, I think it would be a nightmare. I don't work for an insurance company and agree there is a crisis for those that truly can't afford healthcare -- not people who don't buy it b/c they don't consider it a necessity or b/c they are currently healthy.

    Bookmark   August 1, 2007 at 5:35PM
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Sorry I've derailed this from retirement in general but I do think this healthcare thing is an interesting dilemma. I was reading an article in the WSJ about someone else's innovative approach to healthcare coverage and reading about the docs above who have taken a new approach reinforces my belief that we need a radical new approach.

I struggle with the "for profit" issue too but "for profit" organizations drive enormous creativity and innovation - which is what we need!! While it would be nice if everyone in healthcare were motivated by purely humanitarian need, that will never be reality. In my experience most people seem to be motivated by creating a better life for themselves and their families. And clearly the government's not for profit approach to Medicare isn't the answer - in my opinion there is NO WAY the US government is the answer to this problem.

And lynnemarie is so right - the amount of money spent on administrative overhead to meet all the billing and regulatory requirements that have been legislated into healthcare is nuts. Imagine how much money is being spent on all the HIPAA privacy paperwork you complete at every healthcare provider you see. And today I got something else to sign at a PT appt - I had to sign another form which was basically a receipt - I signed my receipt!!! to meet some HSA requirements. It's crazy. I think there's enormous waste here and in the $ that funnel into the for profit insurance/managed care companies. In my opinion we'd all be better off if that entire middle layer could somehow be scaled back to the absolute bare minimum. Managed care hasn't reduced costs - it's just shifted payment from the actual healthcare provider (who I'd rather have my $ go to) to the for profit insurance company. And just to go off on one other tangent about wasted $ in healthcare - can you imagine how much money is being spent on advertising pharmaceuticals to consumers - something that never occurred in the past.

I think we do have to face the facts though that if as a population we are going to have an increasingly unhealthy lifestyle, that is going to drive healthcare costs up. I would be fine with whatever the costs are if they were directly related to my choices - my choice of lifestyle, my choice of healthcare providers (cheap, expensive, high quality, average quality) preventive care/not, etc. The fact we have this kind of closed, controlled system that is not consumer/free market driven is a problem - IMHO.

chelone - my insurance coverage is partially paid by my company and partially paid by me - my part dramatically increasing year over year.

    Bookmark   August 1, 2007 at 5:54PM
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Just the way Ford, GM, and Chrysler have? lol. Philosophically, I agree with you, but the practical reality is that innovation doesn't always go hand in hand in with "for profit" organizations; just as often they're too busy consolidating their turf and making sure innovation is squelched (or moving it offshore!).

I share your feelings with respect to billing. It took me 15 MONTHS to get "new" insurance cards when Anthem took over our policy... and a telephone call every month! I am STILL seeing statements from my mother's urostomy surgery in March 2004! yep, they're "right on top of it".

And when it was time for my mammogram last January I called 4 different facilities for prices. NOT ONE OF THEM could give me a concrete price, even when I gave them my insurance number... go figure. The people I spoke to were stunned; "why are you calling for a price?". Because that's what Howard Dean thinks every medical "consumer" should do!

If we really want competition in the market why is it that not one of those places was able to quote me a price without shifting me from one department to another at least once?

WSJ... hehehe

    Bookmark   August 1, 2007 at 6:11PM
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I haven't seen "Sicko" yet, but I am astounded at the idea that someone had to or did make a choice about finger reattachment based on cost. I've worked in hospitals for over 30 years & have NEVER seen such a scenario--it is difficult to believe.
But I do hear stories such as saphire's from people who have transferred to my facility from smaller town hospitals. It happens to well insured patients, too--it is just plain bad medicine & would happen with a national payer system also. (Not saying that in saphire's sister's case the poor care *wasn't* related to her coverage--) Happens in some teaching hospitals also, where too much of the initial evaluation & decision making is left to students & first-years; the priority is their learning experience, not the patients' best care. Over the recent years, most of the horror stories that I've heard in the media or in testimony to congress that are blamed on poor access or poor/no insurance are in fact just plain bad medical decision making.
We often have to deal with patients (&/or their families) with end-stage disease who won't give up & sometimes (much more rarely) it is the MD who won't give up. However, the profit motive really doesn't come into it, in my experience. It is an emotional issue. There was a governor (Colorado?)about 20 years ago who brought up the enormous amounts of money spent on the last 3 months of life, and how should we deal with it & the looming costs to medicare--a very unpopular subject, it ruined his political career, and to this day it is still a question.
Likewise, the often cited infant mortality stats do have more to do with socio-economic factors other than access to care, such as nutrition choices, smoking, drug use, age of the mother, family situation...Scandinavian countries do have quite a different culture in respect to those things, who pays for the care is not the only difference.
Insurance has always been a product for purchase, a profit based business; only in the past decades has it become increasingly available then expected then a "right". I only just got insurance coverage in March for the first time in 15 years, and I am a nurse!
Sorry for the long post, and I could go on & on about the burdens of gov't requirements that add enormous expense but don't improve care at the bedside...this is a subject that our society has to address non-politically cause I think it is going to ruin our economy one way or another.

    Bookmark   August 2, 2007 at 1:06PM
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Insurance has always been a product for purchase, a profit based business

In this country. We are the only industrialized country that does not have a national health care system.

Again, I believe that it's the very fact that health care, in this country is based on profit that is the problem.

    Bookmark   August 2, 2007 at 1:41PM
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Insurance has always been a product for purchase, a profit based business

Johnson and Johnson's CEO received salary and bonuses in 2006 of $28 million
Merck CEO Richard Clark received $10 million in compensation
When former Pfizer CEO Henry McKinnell left the company in 2006, he was given pension, stock and other benefits worth $180 million
CEO William McGuire, of UnitedHealth Group, had an annual salary in 2005 of $124 million, and he has been provided stock options worth more than $1.7 billion. As part of his retirement package, he and his spouse will receive free healthcare for as long as they live

Yes, indeed, it IS about profit. That's what it's all about.

    Bookmark   August 2, 2007 at 5:22PM
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How silly that someone with that sort of wealth would specify lifetime HEALTH CARE... (are the details of that healthcare package available to the public? what's their "deductible"?). Give me a break.

What, exactly, does that tell us?

(that the "finest healthcare in world" is available to those who can "afford" it!).

    Bookmark   August 2, 2007 at 6:09PM
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No question health care is in crises.

One major problem our physicians are facing right now is the incredible amount of litigation in this country. Many fine doctors are closing up shop because they can no longer afford malpractice insurance. This is especially true in fields like OB and neonatal pediatrics where juries are most sympathetic and awards for damages tend to be huge.

    Bookmark   August 2, 2007 at 6:26PM
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Oooohhhh...all kinds of root causes to this healthcare crisis. Our litigious society; executive level arrogance and greed; our increasingly sedentary, unhealthy lifestyle; inablity of large bureaucratic organizations to do anything in an efficient, low cost manner; entitlement mentality combined with lack of personal accountability; bad policy decisions based on political foolishness....

I wish I could figure out the answer. I still don't think it's a universal health plan because I can't see how the large, bureaucratic machinery necessary to adminster that in the US could do it well - which is why I think some kind of innovative, entrepreneurial thinking is needed.

    Bookmark   August 2, 2007 at 7:06PM
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I agree!

I'd start with a public school curriculum espousing exercise, good nutrition (and HOW TO ACHIEVE IT ECONOMICALLY! Home Ec.?!). Beans and rice? "day old vegetables" and how to use 'em?! All the things my 80 yr. old mother learned when she was in school with the last wave of immigrant kids, lol.

How about we begin by insuring children? gradually increasing the age of those covered as we begin to realize the benefits of early intervention/prevention? Just a thought.

If we look at the entirety of the crisis it's ovewhelming. But if we look at it in managealbe increments it's not that frightening. Everyone here has an either/or point of view...

what are YOUR SUGGESTIONS to deal with what we all agree is the catastrophe about to overwhelm us?

Time for a new thread? or what?

    Bookmark   August 2, 2007 at 7:40PM
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gibby -- what we need is a *single payer* system, not a *single bureaucracy* system. Get rid of the whole employment-based system of paying for health care and the gate-keeping function performed by the insurance companies, and there you are. That is, what would be administered is the money -- not the medicine.

Other countries have this type of system, and it seems to work. (Not that I'm an expert or have studied this -- just have heard things about it.)

In fact, Medicare works this way. Yes, you have the vested interests trotting out the "socialized medicine" scare tactics (e.g., this week in the debate in Congress over extending the bill that offers health care to uninsured children), but that's just obfuscation.

    Bookmark   August 2, 2007 at 7:43PM
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One suggeston:

1) Caps on malpractice suits.

    Bookmark   August 2, 2007 at 8:48PM
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According to a GAO study, malpractice suits do not appear to significantly limit access to health care.

And, according to the Dallas Morning News, Texas enacted damage caps last year and the number of lawsuits filed has been declining. But more than half the state's doctors have yet to see a decrease in their liability insurance.

Malpractice suits are a red herring, imho.

As harriet said, we need a single payer system. The whole point of Sicko is that we can take the best of other systems and make it our own. Healthcare should be a nonprofit industry. At the very least, healthcare insurance should be regulated.

    Bookmark   August 3, 2007 at 11:08AM
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No, please. No new regs for insurance companies. Just no more health care insurance companies! Single payer is a must. (Funny, what just came to my mind was when car salesmen wanted Sundays off. It had to become law or some dealers would continue to exploit their workers.)

Some states are starting their own single payer health care systems. Read: Wisconsin. States are generally afraid to do this kind of thing lest their populations surge, but it's a start.

MD's shouldn't have to pay outrageous malpractice insurance. Perhaps if doctors would stop protecting their own bad apples? Hospitals are beginning to publish their success/failure ratios on certain treatments. (Get thee to a Level 4 hospital -- and tell the techs and MDs to WASH before they touch you!)

    Bookmark   August 3, 2007 at 1:21PM
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Forgot to add that I'm hearing of health plans where the insured is charged an extra fee every two weeks that s/he fails to attain health standards on weight, smoking, alcohol, whatever. (I like the every two weeks reminder!)

The plan I heard discussed was charging $35 additional every two weeks for its insured workers. I remember I quit smoking when the cost of a pack of Marlboroughs went to a dollar a pack. (Of course not everyone has Scots ancestors, but it's a start! LOL)

    Bookmark   August 3, 2007 at 1:27PM
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Chisue - That health plan you are referencing with the penalties for smoking etc. could not be an employer sponsored insurance plan. Against federal law (HIPAA wellness regs) for employers to charge more based on health status, including smoking & weight. Employers can only offer carrot. More on new finalized regs (cut and paste so long):

"Although HIPAA nondiscrimination rules prohibit charging similarly-situated individuals different premiums or
contributions based on health factors, the proposed regulations allowed employers to offer rewards (such as
discounts, rebates or modified plan provisions) if an employee participated in health promotion or disease
prevention programs that qualified as a "bona fide wellness program".

The final regulations no longer use the term "bona fide wellness program" and instead treat all health promotion
and disease prevention programs as wellness programs. To comply with nondiscrimination rules, wellness programs fall into one of two categories and must meet the listed requirements, as follows:

A. Wellness programs that provide a reward based on satisfying a standard related to a health factor have
to meet the following conditions:
1. Limit on Reward - The total reward for all the plans wellness programs cannot exceed 20% of the cost
of employee-only coverage. If dependents can participate in the program, the reward cannot exceed
20% of the cost of the dependent coverage.
2. Reasonable Design - The program must be reasonably designed to promote health and prevent disease.
3. Annual Opportunity to Qualify - The program must give eligible individuals the opportunity to qualify
for the reward at least once per year.
4. Uniform Availability - The reward must be available to all similarly-situated individuals. The program
must allow a reasonable alternative standard (or waiver of initial standard) for obtaining the reward to
any individual for whom it is unreasonably difficult due to a medical condition, or if medically
unadvisable, to satisfy the initial standard.
5. Disclosure Regarding Reasonable Alternative Methods - All materials describing the terms of the
program must include the availability of a reasonable alternative (or possibility of waiver of the initial

B. Wellness programs that do not offer a reward or if an individual does not have to satisfy a standard to
obtain a reward comply with HIPAA nondiscrimination requirements without meeting the above five
conditions, as long as they are offered to all similarly-situated individuals. Examples of these types of
wellness programs include reimbursement for gym membership fees, waived co-pays for preventive care,
and reimbursement for smoking cessation programs (without regard to whether the employee quits)."

A mere sampling of HIPAA, which has good intentions (portability, privacy) but the regs for employers and insurance companies and your health care providers are thousands of pages and have costs billions of dollars to YOU and me.

I still don't get the rationale that federal government, which has completely botched Medicare (which costs its users a handsome sum of money and has much worse coverage than anything you have through an insurance company), can operate a single-payer system. There is no excellence in a gov't run "non-profit" system.

Get CLAIM costs down via tort reform, reduce admin burden on our employers & health providers, reward healthy lifestyles, whatever will work. Our gov't or a universal health care plan will not fix anything, and especially not at the current tax rates. Check out the medicare website and just look at the new prescription drug coverage or any aspect of Medicare...that's your universal healthcare when you turn 65.

    Bookmark   August 3, 2007 at 8:54PM
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Zone8grandma - Make no mistake about it. When doctors can't afford malpractice insurance we are all affected. I'm not familiar with the GAO study, I'll have to look into that. But that is good news about Texas. I think its telling that the caps were enacted only last year and they are already seeing a decline in malpractice lawsuits. Kind of like what happened to bankruptcy filings when standards were toughened up a bit. Maybe if other states followed suit, rates would drop and our docs would be able to better afford liability insurance. And, as a result, be better able to provide us with more affordable care.

Chisue - I agree that physicians should not be protecting the bad apples amongst them. Perhaps we should consider stricter *criminal* charges for negligance and coverups?

    Bookmark   August 3, 2007 at 9:09PM
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Forgot to add that I'm hearing of health plans where the insured is charged an extra fee every two weeks that s/he fails to attain health standards on weight, smoking, alcohol, whatever

That is so wrong on so many levels I am not sure where to start. How about BIG BROTHER is watching and checking to make sure you did not have a drink at your cousin's wedding last week! I absolutely agree about smoking, there is no benefit to it or justification for it. However something does not sit well with me to think an employer, the government or an insurance company will smell my breath to see if I have smoked

As for weight, sure pick on the fat person, the last form of legal descrimination left. Maybe they are not fat because of lack of diet and excercise. There was a whole series done about Plus size excercise instructors! They are naturally heavier than other people but are perfectly healthy. They have even found that identical twins raised apart weigh about the same. Nature v nurture? Or sometimes childbirth throws hormones out of whack. What about people who are anorexic. They have health problems too. So some outsider is going to regulate our weight

    Bookmark   August 4, 2007 at 1:22AM
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I don't know where the "unhealthy lifestyles" insurance surcharge was in effect. I only heard it discussed on WGN radio one morning last week.

If risky drivers have to pay more for auto insurance and smokers have to pay more for life insurance, why shouldn't individuals who are higher health risks *due to lifestyle choices* pay more for their health insurance?

We have an obesity epidemic in this country, and it isn't due to genes. We have more women choosing to smoke. Should the insured who live healthy lifestyles be expected to fund additional care for others who choose to put themselves at risk?

I'd exempting Public Health funding because that benefits all of society.

It seemed to me that a twice-monthly reminder in the form of an insurance surcharge could motivate some people to make healthier choices, and it could recover some of the health costs they are likely to incur.

On the "bad doctors" topic, hospitals are in a good position to report this, but they have to motivate their good doctors to step up to the issue. (Goes for all health care workers, not just MDs.) The looming health care worker shortfall doesn't make me think this is going to happen anytime soon -- just as the need for it escalates!

    Bookmark   August 4, 2007 at 11:20AM
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If the insurance companies did a surcharge for "unhealthy lifestyles", why not do a surcharge for "genetic risk?" Those that have a strong family history of costly diseases like cancer and alzheimers pay the most? While we're at it, lets also heap a surcharge onto "risk takers" - those that mountain climb, surf, sky dive, and otherwise risk life and limb pay more.

And as far as "good" doctors vs. "bad" doctors goes - if hospitals were sued for unlimited, huge amounts every time they reported an error, how long would hospitals be around? Right now, the risk of reporting "bad" medicine outweighs the benefit of not reporting it.

And, yes, obese smokers who never exercise and fail to take advantage of preventive medicine are, indeed, issues. But is it fair to call them the *cause* of our current health care crises? And is it fair to expect them to shoulder the costs?

    Bookmark   August 4, 2007 at 12:15PM
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Just back from a round with the nursing home and was appalled at the level of obesity of RNs (the one in charge of Mum's area smokes, too!). Sorry! fat people are at risk for the very things so injurious to long term health. It's not about "discrimination", it's about REALITY. And probability; the cornerstones of the actuarial tables and the insurance industry. Give me a break!

    Bookmark   August 4, 2007 at 2:25PM
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Okay, I'm statistically "overweight" (depends how you measure it) but have no health problems, don't look fat, don't overeat, and no doctor has ever mentioned my weight one way or the other. I just look like your average, well-nourished but not portly middle-aged woman. My blood pressure, glucose levels, and other numbers are always normal (I'm almost 50 y/o). Some of the amount of fat one carries on one's body is genetic. The whole issue of what numbers to use when measuring whether someone is overweight is rather controversial. A few years ago, some official body -- can't remember which one -- changed the way obesity is estimated. The new measuring system made almost everyone overweight.

Smoking, I feel, is a much more black and white issue. It's bad for you, period, and you don't need to do it (vs. the fact that you do need to eat).

Many skinny people have terrible health habits and/or are sick more often than fat people. There just seems to be an irrational, aesthetically based prejudice against fat people. Many actually avoid doctors because they are treated so poorly, and anything that's wrong with them is blamed on their weight.

The fact is that the older you get, the more health problems you have, most completely beyond your control (e.g., cataracts, arthritis, diseases like Parkinson's and Alzheimer's). How these are treated and who should pay for them is the real question. Trying to parse out whether some people are "to blame" because of their diet or their habits is more smoke (ha) and mirrors and avoids the real issues.

    Bookmark   August 4, 2007 at 2:54PM
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busymom -- Let's limit this to things people CAN control, not get into wild scenarios about inherited diseases, nor those normal to the aged. And, yes, I think people who put themselves at risk must bear the responsibility. (The hikers, mountain climbers, etc. who ignore safety/weather issues and must be rescued are an excellent example, in my book.)

harriet -- I'm not talking about overweight, I'm talking about "obese"; there's a vast difference. Doctors don't tell people they must lose weight if they know they cannot due to some contributing factor OTHER than over-eating. (Quite rare, that.) Look at the rising number of diabetics in our population -- worst, the child diabetics!

No, this isn't a panacea, but it is something that could be implemented. It could encourage people to take responsibility for their actions while shaving health care costs.

    Bookmark   August 4, 2007 at 3:36PM
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Here, hear! ChiSue.

Grossly overweight people DO cost insurance companies more long term. It's pretty simple. Enough to this "discrimination" crap... if you're FAT and inactive your CHOICE tips the actuarial scales against you. SIMPLE.

Fat people have options. Pick one. But why must I shoulder the responsibility/COST of YOUR choice to live an unhealthy life? There's a big difference between overweight and "obese". Read the guidelines and place yourselves...

Deal with it and lay off the "excuses". Fat, unfit people cost more to insure!

    Bookmark   August 4, 2007 at 5:09PM
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But what about thin, unfit people? I once worked with a woman who was rail thin and couldn't walk a block without getting worn out. She never exercised at all. I was talking with her once and she said, "I hate walking!" I can't imagine that she didn't have health problems. Someone I work with now is extremely thin -- looks like a fashion model -- and has back problems, high cholesterol, and all the rest. She's always going to the doctor. (She doesn't smoke doesn't starve herself -- she's just naturally thin.)

I'd really like to see some hard statistics about how much more fat people do cost insurance companies -- or is it that health providers blame all of their health problems on the weight?

I was reading somewhere recently -- sorry, can't remember where it was, probably a Web forum -- about a woman who went to the doctor with terrible cramps and pain, and he/she wasn't even going to do a proper exam; just told her to lose weight. She said, "Pretend I'm not fat and do what you would normally do to diagnose this problem." Turned out it was a cyst.

    Bookmark   August 4, 2007 at 6:16PM
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Lots of good commentary here, by everyone.

Back to the for-profit issue--the vast majority of hospitals are non-profit. Few doctors are hospital employees --hospitals live in fear of losing a doctor's business. And any insurance company with "mutual" in its name is in fact owned by its policyholders.

Exorbitant executive pay is crazy in this country (and others). I will never understand how they justify it in there own minds. But that isn't the cause or the source of a solution.

I remember the days when the hospital had to wait to have new rates approved by Blue Cross (the major, maybe only, player in our area then) before we would get a raise. One year our raise was 3 cents/hour. RNs were paid just above minimum wage then; clerks and such were minimum wage. My husband who was an unskilled laborer in the local steel mill was paid $8/hr compared to my $2.74. But when hopital staff wages started to rise in order to get & keep nurses--in the late 70s--that is when folks started complaining about the increases in hopital costs. Ironically led by the unions. Well, I am paid well now, I think, but even just a few years ago a college educated RN's starting pay was the same as a city bus driver.

I work in intensive ("expensive") care. by far most of the patients in there on any day are there from obesity (and I mean obese, not a bit overweight; By the way, assessing percentage of body fat is a fairly easy measure), smoking, drugs or alcohol.
People are dying from obesity and are in denial that they are obese. The local university hospital has a floor full of people with tracheostomys because they are so obese they can't breathe. The morbidly obese patient used to be a rarity; now it is commonplace. and these folks are suffering with all kinds of problems. Emphasis on suffering.

Certainly, I bet every one of us can come up with multiple exceptions ( the healthy obese person or the sick thin one ) but the link between obesity and major health issues is rock solid.

We also have to be wary of saying that systems in other countries are a success--because we should consider how their overall economy is functioning under the social welfare burdens they have assumed--and it's the the rare European country that hasn't been struggling for a decade or more with high unemployment, inflation etc much worse than we have. It's not just a fear of "socialism". Some of those countries are now starting to look at dialing it back. We could certainly live less large than we do (as a nation on the whole), in order to pay for some changes, though.
We need to not let either party make a political football about this(I remember during the Clinton admin, when Hilary suddenly started making speeches about access to immunization -- which already existed--as an example).

    Bookmark   August 4, 2007 at 9:33PM
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Chisue - genetics are not "wild scenarios", they are facts of life. From an insurance standpoint (or if I were placing bets in Vegas) a *strong* family history of cancer would trump a "fat" person any day - with regards to risk of having huge medical payouts.

And people who "die from obesity" cost us nothing once they are dead. Its the people who live (through painful treatments and against all odds) who cost us. Which is why I really don't like to get into this argument.

    Bookmark   August 4, 2007 at 10:59PM
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We also have to be wary of saying that systems in other countries are a success--because we should consider how their overall economy is functioning under the social welfare burdens they have assumed--and it's the the rare European country that hasn't been struggling for a decade or more with high unemployment, inflation etc much worse than we have

I guess you have not done any investing of late, most economies of the world are booming. Except ours! Canada and Austrailia have seen phenomenal growth over the last few years, just to pick other English speaking countries

As for the whole obesity issues I do believe that it is the last legal form of discrimination. As for the studies, as they say lies, damn lies and statistics. I personally think the nursing study may not be a big enough and varied enoungh group to be truly representative.

Here is an interesting study that says in the absence of diabetes, an obese person has not greater risk of dying young that an average person

Before you say well obesity causes diabetes, yes it can but so can family history and so can a virus. I know several normal weight excercisers who develped diabetes because of family history not fat

    Bookmark   August 4, 2007 at 11:35PM
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Oddly enough there was a piece on the radio this morning interviewing some "experts" on healthcare delivery - one person from the US and one from Germany. It was very interesting - hearing about the system in Germany.

He said they have universal coverage for all and here are a few things about how it works. If I understood it correctly everyone is required to purchase insurance from one of six private, non-profit companies that are closely regulated by the government. He didn't explain how it works for low/no income people.

People are also required to pay 10% for their healthcare - it is not "free". In response to the interviewers questions he said no one would be denied healthcare in a life or death situation. When asked about freedom to choose the "best" treatment options available (as you can do in the US if you have good insurance or enough cash) he said people receive "adequate care that is reasonable in cost". He was also asked about freedom to choose who provides the care but I didn't hear a real answer to that question.

He also went on to talk about some program in Germany - 3000 steps or something like that - to address the impacts of the increasingly sedentary lifestyle of their people. His belief was that this is having an impact on the cost of healthcare in Germany. He also said he was over here to learn more about managed care as they somehow think that having more of a managed care option among their insurance choices could be beneficial.

From what I've read recently Germany's economy is improving with unemployment now down to 8.8% from 12% in 2006. I have no idea if their healthcare situation has anything to do with that - I've read more about other cultural things related to that like their generous vacation practices.

Anyway, just another piece of info for others who are pondering this dilemma as I am.

    Bookmark   August 5, 2007 at 11:37AM
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I read Saphire's link, focusing on obese people *without* diabetes. I don't know how many obese people do not have or will not develop diabetes, but...a LOT of obese people do or will. The obesity epidemic in children is running nearly parallel with the increase in diabetes in children. Obesity is NOT what one would choose were one to desire the best health, is it? Let's not focus on exceptions, but on the real problem obesity creates for most people, given time. (Mr. So-and-so smoked three packs a day and lived to be 90 -- spending his final years coughing his lungs out.)

harriet -- Look around. How many anorexics do you see? How many obese people? Let's focus on the bigger problem. (Not LOL)

busymom -- I'm not advocating charging people for their inherited problems. Inherited proclivities are not on the table here. Lifestyles are. (Although I do question the "against all odds" treatments MDs urge on patients with cancer, having witnessed that with my own mother's leukemia.) We can't KNOW, and ethically don't WANT to know, who is at risk due to inherited proclivities. We can know who smokes, is obese, does drugs, (other lifestyle choices).

raee -- Thanks for the input on your obese in-patients. As a former board member of a community VNA, I'm all for paying nurses more and hiring more of them! (Ah, the VNA, now taken into the hospital's "fold" as a part of the continium of cash, er care.) Thanks for pointing out who is running American health care: Insurance companies.

So...I'm still for charging people for the risks they deliberately take, and for getting INSURANCE out of the driver's seat in the health care business. I'm afraid health care has to be a business; that's how our society works. There is no real difference today between for-profits and non-profits either.

gibby -- It's always been hard to make comparisons between a largely homogeneous society like that of most European states, and America's very different population. That's changing somewhat as more European states absorb populations from former colonies and immigrants from war-torn nations. All very well to say the Dutch are the tallest, healthiest, whatever -- not even sure who they are counting, but I'd bet it is only their "own".

    Bookmark   August 5, 2007 at 1:18PM
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How did they define dying young? Age 30, 40, 50, 60...? In our medical system, people are not so much dying young as they are suffering with chronic illness, often leading to disability for years before they die. Again, what I see in the hospital every day is rampant type 2 diabetes in obese people. Excluding diabetics is interesting research but maybe not that appicable to real life in the USA. This discussion has been focusing on obesity, but as I mentioned above, smoking is also a huge player, as well as drugs and alcohol. And chronic illness is what we should all hopefully be each doing our best to avoid, instead of only focusing on who will pay for it.

Back in 1992, right after Pres. Clinton had been elected, I was talking to two sisters whose mother was on a ventilator due to her emphysema (smoking her only risk factor). They both smoked, so we were talking about why they should try to quit so they didn't end up the same. But one said, "We don't have to worry about it now, Mr. Clinton is going to take care of us." True story!!!
And pretty typical of a frequently encountered mind set.

    Bookmark   August 5, 2007 at 4:25PM
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Obesity is NOT what one would choose were one to desire the best health, is it?

harriet -- Look around. How many anorexics do you see? How many obese people? Let's focus on the bigger problem. (Not LOL)

I think it is not aesthetically pleasing so we feel free to make jokes and pick on the fat person. Even in our comments

In fact, there were other societies such as that of Rubens or many groups of Native Americans where women and men who were larger were revered. In one case it meant you were wealthy enough to afford food in plentiful supply and in the other you might survive a famine better

Now, do you really think some Native Americans in 1750 were fatter than others because they did not excercise enough hunting and taming mustangs and eat too many snickers bars? Or do you think it was because they were genetically better at storing fat?

Fast forward a couple hundred years, the descendents of the revered ones are now made to pay a premium on their health insurance because their bodies are more efficient at storing fat, the same as their ancestors

I think too many assumptions are made about fat people. Yes some people eat too much crap but so do many thin people. And many many thin people have diabetes. Many obese people do excercise and try to control their eating but it is not always as easy as people make it seem. What is known as the thrifty gene is mighty powerful. Plus there is a whole school of thought that people who are prediabetic are much more attracted to Carbs than a more average person, making it more difficult for them to stop and moderate their eating

As for the smoking story, some people are just idiots, what can I say

    Bookmark   August 6, 2007 at 12:47AM
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I guess my main question is..... How many freedoms that you enjoy now are you willing to give up for this "universal" health care?

Doctors who are not in their field for altruistic reasons, but there for the money.... many of which are danged good, will choose a different field. Doctors certainly won't be paid as well as they are now under any of these "plans". Nurses as well. What does this mean to you, who have no plans of attending medical school? Just that there are a whole lot more folks who will choose not to go either. The "cream of the crop" will not settle for middle of the road pay. And the guy who graduates at the bottom of his class is still called "doctor".

You will give up your choice of doctor. You will have to go to who you are assigned to and if they are one of those who suck, well.... that's too bad. If you don't get along, have different beliefs, or just plain don't like each other..... too bad. He's got a hundred other patients, and after all, what are you going to do? Can't go elsewhere.

Yes, I'm sure that last ditch efforts will no longer be such a drain on the medical costs.... of course those last ditch efforts are the ones that end up being standard treatment when they work.... but I guess we're all happy with where things stand now.

Folks on this board are already saying that it's ok to charge someone based on whether or not they smoke or have an extra doughnut. I still think that daycare causes more childhood illnesses to more individuals than smoking..... Let's charge a premium on those whose children are in daycare or attend public school. They will need more medical care than those that do not. And alcohol too.... it causes many deaths per year (besides all the alcohol related illnesses, there's drunk drivers as well)....many of those deaths, of folks who never had a drink in their life. So that would have to have a charge too... and since we can't know when someone who doesn't drink might choose to have one, we'll have to put it on everyone of drinking age and an additional special premium on those that admit they drink. Oh yes!! How much more pollution is there in those cities who have "smog" alerts?!?! That can't be healthy..... so another premium on city dwellers. Then there are those folks who choose high pressure jobs.... I'm sure there are more heart attacks in those kinds of businesses.... so a premium on those. Those are all "choices". Individual decisions that may have an impact on the cost of their health care. (Not to mention the need of health care.)

Every single decision you make on a daily basis could have an impact on your health care costs. Do you really want someone looking over your shoulder in the morning to see what your scale says? Have to buy your alcohol at a government run store? Not be able to buy a car because you live in the city?

One more question that has been bothering me..... What have you done within the current system to ensure that "everyone has care"? Does your MD.... the one that gets all your (and your insurance company's) money.... do they do pro-bono work? Do they work on the un/under insured? What about the pharmacy you get your medicine at? Do they have a program that helps out the elderly? Those without insurance? What about the hospital? The company that makes your medication? Do you know? Does your doctor's office have someone who ONLY handles insurance papers? Can you do that yourself? Has your doctor been paid for all the care he has given you? Or is he still waiting on your insurance company to pay your bill?

Everybody seems ready to have "someone" fix the problem. How about YOU be "someone"? Volunteer at the local free clinic. You could be a nurse (of some kind) in a couple of years. If you don't want to go to that extreme, then check out your doctor and change to one who supports your ideals. Same with all those other questions. How about if everyone just did one thing.... just one of those. But then again, it's probably too much trouble. Big Brother has a nice comfy bosom, until he starts looking at YOUR lifestyle and deciding that it's not quite what he thinks is "right". Didn't our ancestors fight against something very similar?

Every country mentioned has less freedoms than we do. So how many freedoms are you willing to give away so that the government can take care of you? How many decisions do you want them to make for you?

Sadly, I have to agree with saphire..... some people are idiots.

    Bookmark   August 6, 2007 at 7:51AM
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Let me echo what momto6 said.

Recently I saw a story about a fellow in England who had macular degeneration. In case that name isn't familiar, it's an eye disease that causes progressive blindness.

The reason it made the news is that he was informed that because of lack of resources, the National Health Service would not treat him until he became totally blind in the eye that had started showing symptoms. At that point they would be willing to treat the other eye.

Economics 101: Everything has a natural price, which is the price that balances supply and demand. If the government forces the price to be lower than the natural price, some other barrier has to take the place of price in order to balance supply and demand. If the government does not impose the barrier, then someone else will, for instance by increasing waiting times.

So despite politicians' claims to the contrary, there is no such thing as free health care, because there is a finite supply of medical people, expertise, and supplies. Which means that health care has to be rationed somehow.

The question is not whether to ration health care by price; the question is whether to ration it by price or by some other means. Anyone who argues that it should not be rationed by price without proposing a workable alternative is being intellectually dishonest, because there *will* be an alternative--the only question is what it should be.

    Bookmark   August 6, 2007 at 10:15AM
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According to the report that I just received from my insurance company, the biggest drain on their resources is preemies. Do you want to pick on them too? Maybe you think they should just be smothered. These postings are just mean - in both senses of the word.

    Bookmark   August 6, 2007 at 5:50PM
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In March of 2005, Sun Hudson was a six month old baby with serious health issues. His parents had no insurance. Texas Children's Hospital removed him from life support over his parents' objections. It was completely legal under Texas' Futile Care law.

Perhaps other states should follow Texas' example to save money???

Not legal, but hospitals are doing it - dumping patients who have no insurance. There are documented cases of patients being loaded into taxi cabs (wearing only their hospital gowns), driven into slum areas and left there. They are old, confused, sick and poor.

The US spends more money on healthcare than any other industrialized nation. And we have 46 million Americans with no insurance at all. Over 8 million of them are children like Sun Hudson.

    Bookmark   August 6, 2007 at 7:01PM
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Sun Hudson had an invariably fatal and untreatable and uncurable birth defect. He was dying despite the maximum life support. He was kept sedated to prevent him from suffering. The hospital could have overridden the mother's (not the father, he was unknown although the Mother stated that the sun --yes, the one in the sky-- was the father) wishes under Texas law, but instead sent the case to court for a judge to decide--and paid for the mother's lawyer. Just so that the motives would not be questioned. That lawyer, by the way, argued vigourously against the hospital's position. The court appointed an outside guardian. Insurance had nothing to do with it. TCH provides free care to many, as do most hospitals.

Also there is the state children's health insurance program, which provides FREE health care &/or very low cost insurance to poor children (it is targeted to the working poor & financed by the states & federal gov't) and is available in every state for children up to age 19. Medicaid covers the very poorest for free. Either people don't know about the coverage already available for their children or don't take advantage of it.

It is very easy to blame the need for very hard decisions about futile medical intervention on insurance or race or citizenship or whatever. Easier sometimes than accepting that sometimes the doctors and nurses can't --or shouldn't-- do anything to prevent death. Even when we have literally exhausted ourselves, and the hospitals' resources (such as emptying out the blood bank)..., but the patient died, we have been accused of "killing" him , or "letting him die" because he's black, or poor, or ...fill in the blank. People that have been victimized or discriminated against can sometimes too easily believe it's happened again, even when it hasn't.

And the story you saw about the patients being dropped in front of the homeless shelter -- Remember that this was about 2 incidents involving one hopital and one shelter in the same "slum". Hospitals actually do usually provide clothes, (but I can easily believe some individual employees not bothering.) They weren't "dumped" because they had no insurance--remember, they had already received treatment for free & were being discharged. No one accused the hospital of not having treated the person, if I remember correctly, but of not caring what happened after discharge. Is the hospital also supposed to provide an apartment and an income? Or keep the person indefinitely? The shelter is where the person lived. Once you are discharged, the hospital is not even responsible for getting you out the door, much less paying for the taxi (which hospitals do all the time for indigent patients anyway). The thought of leaving the hospital and having no place or no one except a homeless shelter is horrible--and a real social problem--but is that caused by a lack of insurance? We spend a lot of time trying to persuade homeless folks to NOT leave AMA before they have finished treatment, also. But you will never see that on 20/20.

    Bookmark   August 7, 2007 at 12:38AM
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Well I did attend my friends sisters funeral in the last year. I posted her story above. She did not have insurance and received substandard care in one of the richest counties in the country. That she died as a result is without question. I remember when my friend called me to say her sisters toes were turning purple and no one from vascular was even available to come see her. I thought the next phone call would be about gangrene, not to let me know she died. The hospital she was at for most of the time simply did not care because there might not be any money in it for them. If she had a top insurance company she would have gotten the blood tests that could have easily and cheaply diagnosed the sepsis

    Bookmark   August 7, 2007 at 12:55AM
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BTW she was not even overweight, did not drink and did not use illegal drugs or smoke

    Bookmark   August 7, 2007 at 12:56AM
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Well I originally wanted to mention the booming Canadian & Australian economies vs. the USA's not booming one: 2006 stats:

USA unemployment rate 4.8%, growth in GDP 3.2%, inflation rate 2.5%

Canada: 6.4%, 2.7%, 2%

Australia: 4.9%, 2.7%, 3.8%

France: 8.7% (the lowest in 10 years), 2.1%, 1.5% Germany, Netherlands, Spain are similar. Spain has higher inflation

Sweden: 5.6%, 4.7%, 1.4% (well I was wrong here, I thought I read way worse numbers for them) Norway and Denmark have less unemployment.

Let's see, India is a hot place to invest: 7.8%, 9.2%, 5.3%

Venezuela: 8.9%, 10.3%, 15.8% and 37% of the population below the poverty line.

Korea is among the best: 3.3% , 4.2% , 2.2%

Azerbaijan: 1.2%. 34%, 8% ; 50% of the pop. below the poverty line in the fastest growing economy. A demonstration of how good growth can look when you are starting near the bottom.

I've made a fabulous return on my eastern european stock fund, but everyday life there still doesn't sound too enticing. You know, the US stock funds haven't been doing too badly either...

    Bookmark   August 7, 2007 at 2:23AM
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It's not clear what the point of this last post is, BUT, if you are going to tout US unemployment figures, you do need to realize that the way the gov't measures unemployment was changed by the current administration. If you work as much as one hour a month, you are considered "employed".

Now, maybe we can get back to the original topic, retirement and the issue of health care as it affects retirement.

    Bookmark   August 7, 2007 at 11:04AM
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jkom51 has a fairly comprehensive financial planning and retirement section on their website, for those who are interested - all kinds of separate topics nice organized, such as Budgeting, Investing, Creating a Plan, Insurance, Who Can Help You?, etc.

    Bookmark   August 7, 2007 at 11:21AM
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Smokers already pay way more for life insurance. Also, don't they already pay those healthcare "premiums" with that hefty tax that was levied on cigarettes? Until tobacco use becomes illegal, I don't see how smokers or chewers could be forced to pay more for health insurance.

    Bookmark   August 7, 2007 at 4:37PM
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Thank you raee for the numbers. It is unfortunate that our media touts Canadian great economic growth (2.7%) while at the same time telling us how bad our (US) economy is (growth 3.2%);)
My mom lives in Estonia and they have now national health care. Everyone, who works, has amount deducted from their salary that goes to centralized health department that pays the doctors and hospitals. The pay is not very high for medical personnel and good doctors and nurses are leaving to other European Union countries were pay is higher. If you need tests done to find out what is wrong with you, it can take months if not years. My mom told me that in order to have a test done, she needs to see her primary doctor who gives referral to the specialist. The waiting time to see the specialist is month or more. Then the specialist sends her to do a test where the waiting time is again a month or more to get the test done. Then she needed another test done and again to primary doctor first then wait a month then test then wait a month. So it goes until she is done with all her tests and gets back to the primary doctor more than 6 months has past and the earlier results might not be valid anymore. So I hope that we here in US will never have such a system.
As for here, I think we need to have price lists available for every service, so we know how much it costs before we decide to have the procedure. How can we contain cost if no one knows how much it is?

    Bookmark   August 7, 2007 at 5:27PM
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How can we contain cost if no one knows how much it is

The cost isn't the same for everyone. When my husband had his hernia surgery, he asked the surgeon, "So what do you charge for the procedure?"
The surgeon said, "I charge one price if the person has insurance. If they have no insurance I charge less. If I know they can afford it, I charge more. And I've done it for free when I knew the person simply could not pay for it."

I believe that is typical.

    Bookmark   August 7, 2007 at 7:51PM
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Grandma, read the article attached and you will see that "The uninsured can pay three times more for procedures, says Nora Johnson, the senior director of Medical Billing Advocates of America." :(

    Bookmark   August 7, 2007 at 9:22PM
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punamytsike, that happens in the U.S., too, for people who are enrolled in HMOs. You are required to see your primary doctor before you do anything.

Back when I was dealing with Kaiser, the decent doctors were all leaving. The only ones they could get must have graduated at the bottom of their class.

I still think there is a big difference between managed care (such as in a national health system like Estonia's) and a single payer system.

(btw, totally OT, I have an Estonia piano!)

    Bookmark   August 7, 2007 at 9:23PM
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I suspect the issue of health care for everyone could be resolved rather easily if we quit being inefficient about it.

It is inefficient to indirectly load the cost of health care onto employers. It puts them into a business that, for most employers, is alien. It is a "regressive tax", if you will, striking smaller employers harder than larger employers. And it puts us at risk if we ever lose a job or, as is far more frequent today, that job is taken away.

It is inefficient to award huge salaries to doctors and then take it away in the form of punitive malpractice-insurance fees. I'm guessing most doctors would be happy making less if so much didn't have to go out the door to service insurance companies in premiums paid directly and in staff to handle paperwork.

It is inefficient to refuse to cover medications which can prevent serious problems later on. We won't pay for antibiotics or blood-pressure medications for poor people, but we will pay for the eventual hospitalization when the infection runs amok or when untreated blood pressure (however it was acquired) causes a heart attack, stroke, or kidney failure.

It is inefficient to subsidize farmers who grow tobacco when there is no positive health benefit to it at all -- and then to pay for treatment of the diseases that tobacco use can cause. The same argument can be made for alcohol, but it's harder to define when a wheat field will become loaves of bread and when it will become vodka. :-p

No system will be 100% friction-free. There will be sad anecdotal stories regardless of how we choose to fund health care. But if we could get past the powerful money interests lobbying for the status quo, and once we get back to a government by people who actually don't hate government, we might be able to make some progress. It's hard for me to believe that "the greatest country on earth" -- one he11-bent on imposing its great way of life on the rest of the world -- does not consider timely health care a basic human right. We could do it if we stopped being inefficient and stupid about it.

    Bookmark   August 8, 2007 at 7:02AM
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Well said, steve_0 We have always been a "can do" country. I don't believe that we can't fix this broken system.

    Bookmark   August 8, 2007 at 9:46AM
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Harriet, I hope you are enjoying your piano:)

    Bookmark   August 8, 2007 at 10:55AM
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Watch to see what the Presidential candidates are coming up with on the health care front. Some may have thoughtful ideas and some will forward some gobbledygook just to say they "have a plan". It does seem they all realize the present system is not working.

Watch out for the candidates who bring up the same weird and unusual situations we've read in some posts here to distract from the large overall problems.

Al Gore is saying that Exxon and others are spending lotsa bucks to get people to publish articles that question global warming, just as the tobacco industry used to do to question tobacco's entirely detrimental effects.

We will see candidates put out guff about how awful single-payer health insurance would be. Look for catch phrases like "pull the plug" and "limited care" and "government waste", as well as misdirected spotlights on the weird and unusual to distract your attention from how the vast majority would benefit from change.

Most Medicare patients are very satisfied with their care. (So much for the anti-government rant.)

Obese, smoking, drug abusing people DO cost more to care for. Why shouldn't they pay their fair share for their lifestyle choices in a democracy?

Let's all gather around Harriet's piano. Who's got the "American Health Care Solution" lyrics?

    Bookmark   August 8, 2007 at 11:21AM
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Richardson has offered a plan

The age limit for medicare lowered to 55,
Children could stay under parents insurance coverage up to age of 25,
and the part I like the best
Require that insurance companies not deny coverage due to pre-existing conditions, and mandating that they spend at least 85 percent of their premiums on health services.

The article also mentions some other candidates' plans, or plans to have a plan.....

    Bookmark   August 8, 2007 at 11:52AM
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Saphire, I can TOTALLY believe that your friend's sister received substandard care. I see it happen too frequently. I just want to convey that lack of insurance is usually NOT the reason, and we can't draw that conclusion unless someone flat out said so. Even the fact that she was there for over 5 weeks--cost much more to the hospital than the "tests for sepsis" that you mention. It sounds like she should have been transferred--administrators normally would have no role in that decision & we get patients almost every day in such transfers, often at family request.(The only exception I can think of would be an HMO system like Kaiser, with its own hospitals: they sent their heart surgery cases to us to perform & we often felt they would wait too long --this was in the 80's).

The reason I respond to these stories is just that I don't want people to be making decisions on how we change health care delivery and payment based on horror stories which tend to be exceptions to the rule or attributed to the wrong cause. Unfortunately our media often fails us here.

Medicare is a system which has been working well (for the patient), but it also often forces the hospital to deliver care at a loss--and requires us to have upteen staff people to make sure the doctor has used exactly the right words in the chart to describe the patient's condition to be sure all the care given is reimbursed. That is an example of why you get different prices, different payors treat the place like a bazaar where they bargain for the service & what it actually costs is ignored. With lots of hospitals in a town, the competition is fierce--

which leads me to Steve-O's post. Right on the nailhead. There are SO many ineffiencies, starting with how we still train doctors (learning on the patient). So much money supports bureaucratic demands on time, not patient care. We need to be sure that any system doesn't just change the burden of payment from individuals, but remakes the way the whole system works.

    Bookmark   August 8, 2007 at 3:24PM
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Warning: what follows is tongue in cheek. But the stats are real, taken from the site.

What am I getting at? I do think we need a serious overhaul of our (lack of) health system. Too many people falling through the cracks; and anything so confusing that even lawyers and insurers have a hard time figuring it out, is clearly inadequate and wasteful.

But lines WILL have to be drawn. It won't be possible to cover every single person no matter what kind of health problems they have. We will, either as voters or consumers, have to make choices. Let us hope we will make the best choices amongst some very hard decisions to make.

>>Obese, smoking, drug abusing people DO cost more to care for. Why shouldn't they pay their fair share for their lifestyle choices in a democracy? Absolutely, let's charge everyone who drives up costs. Let's see: how about these stats on premature babies! Look at how much they are costing us, compared to normal deliveries. And the percentage of them is increasing every year - so obviously we can't keep sustaining this kind of thing. So parents of preemies should count on getting maybe 2x average, and the rest they can pay themselves. No free rides here for anybody, folks!

(Excerpted from the WebMD site)
Estimated Costs of Premature Babies 15 Times Greater

Employers pay nearly $42,000 in average health care costs in a premature baby's first year of life, says the March of Dimes. That compares to about $2,800 for a full-term baby with no complications.

The figures include hospitalization, drugs, doctor visits, and time off from work needed by the mothers of premature babies. The numbers came from a database of millions of U.S. employees and their dependents.

Across the board, premature babies needed more medical attention, bringing higher costs.

Hospital charges alone cost businesses and private insurers $7.4 billion annually, says the report. Other findings include:

Average hospital time: 2.3 days for full-term babies; 16.8 days for premature infants
First-year doctor visits: six for full-term babies; nine for premature babies
Mother's short-term disability leave in the six months after birth: 10 extra days for premature babies (29 days, compared with 19 for full-term babies).

Growing Numbers of Premature Babies:
More and more babies are being born early in America. The numbers have notched upwards for more than 20 years.

The reasons why aren't totally clear. Increases in older mothers and multiple births (such as twins) could have something to do with it. Premature babies are also more common among African-American women and women younger than 17 or older than 35. About half a million premature babies were born in 2003, the journal Pediatrics reported earlier this month. That's 12.3% of all babies, a slight increase from 2002.

The number is up 16% since 1990, says the Pediatrics study. Since 1981, the number has skyrocketed by 29%, says the March of Dimes.

    Bookmark   August 8, 2007 at 5:31PM
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Obese, smoking, drug abusing people DO cost more to care for. Why shouldn't they pay their fair share for their lifestyle choices in a democracy?

I find your categorization offensive. Do you honestly think that most people would CHOOSE to be obese in the same way they choose smoking or drugs. You can quit smoking, you cannot quit eating.

You obviously do not have a weight problem. I know several plus sized people that make every effort and it just does not work. In every way they are responsible citzens

Let us not forget people who ride motorcycles, ski, scuba dive, like to take walks alone at night near parks, people who like to tan, people who do not use proper food safety precautions or carry their lunch to work and do not properly refrigerate it, people who are clumsy or accident prone. Let us not forget people who are left handed, apparently they have a higher risk of accidental death, people who use cell phones constantly, you never know what that can do, people with anger management issues, people who travel to third world countries. Yes big brother could really be watching

    Bookmark   August 9, 2007 at 3:12AM
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"You can quit smoking, you cannot quit eating."

You can quit overeating. Food should not fill an emotional void. I am really sick of people making excuses for their weight. I have maintained my 5'3 110 lb. figure since high school, even after pregnancies. The key word is maintain. I try to do some form of exercise every single day. I go to the gym 5 times a week. I don't overeat. I don't deny myself any foods, but I do watch the portion sizes - that is key. I also choose healthier versions of food when presented with a choice. I never eat to the point of feeling stuffed. I drink plenty of water, etc. It is called willpower. It irritates me when people say "oh you are so lucky to not have to watch your weight". Ha! I do. I make health and fitness a priority. It IS hard work. It is a shame that more people can't take personal responsibility.


    Bookmark   August 9, 2007 at 9:01AM
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I think people love to be sanctimonious about weight. Just because I can do it you can too! Maybe your metabolism is different? Ever think of that? Maybe you would have starved in the famines of our ancestors, maybe my obese friend survived because of her thrifty gene. Maybe carbohydrates trigger something in many obese people that they do not in others. I have a friend who is plus sized she plays golf several times a week (withhout a cart she is too cheap), tennis and swims nearly every day, and she is still plus sized. She has been seeing a diet counselor, a professional one not Nutrisystem for over a year. She is happily married with 2 children, has a beautiful home and enjoys her job.

Think about this. In the 1970s and 80s thousands of people successfully quit smoking once the Surgeon General put those warnings out. Even more quit when it became socially unacceptable in the 90s. What are the statistics about successful weight loss, something like 95% of people who lose weight from a diet (as opposed to gastric bypass) gain it back within a couple of years? Those people made a sincere effort, they took personal responsibility. Maybe something else is going on, maybe they are programmed to gain more weight than the average person. I do not think you have walked in my friends shoes

Maybe you should not judge so harshly and discriminate based on asethetics. We are superficial enough as a society

More people vote for American Idol than do for President

    Bookmark   August 9, 2007 at 10:40AM
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saphire: I agree with you.

BTW, interesting piece in the New York Times this week RE body fat (the purpose it serves physiologically).

    Bookmark   August 9, 2007 at 11:10AM
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I don't see any scientific studies supporting the idea that people cannot lose weight by eating less and exercising more. This is NOT about "aesthetics", it's about health. It's not "judgemental" it's science: too many calories + little exercise = obesity.

A friend from childhood fought her weight for years until seeing a new MD whose first words to her were: Why are you so fat? He meant exactly that: Why? With her, as with many people, over-eating was a family lifestyle. That shared quart of ice cream, divided between her and her morose father while watching TV together was the only "bonding" available to her. It can be learned behavoir. It can begin as a stress reliever. It can substitute for or be a buffer against intimacy. There are countless ways people get programed to over-eat, and they need to get help to answer their own individual "Why?"

When the public becomes as conscious of the dangers of obesity as they became about the dangers of tobacco use (took decades, still slow), maybe people will stop getting obese in the first place. Would anyone seriously tell children that obesity is OK or unavoidable?

Premature births are on the upswing for two reasons that I can see. Poor prenatal care and a medical field that wants to "help" women 20 years past their best child-bearing years to acheive parenthood by implanting multiple embryos. (I read recently that the OB field is censoring the latter now and the former is "fixable" with more preventive medicine.) A third reason for rising perinatal costs is because we now can "save" more babies -- save them to live with what kind health deficits is debateable, but if we are going to create life that has unclear chances of optimum survival... All three of these causes require "before the fact" cures.

    Bookmark   August 9, 2007 at 11:48AM
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Here's a possible solution...... How about a welfare type subsidy? For those that can not afford their own insurance? We could set up government hospitals, and everyone who can't afford insurance could go to those for free. Better yet, have co-pays based on what you can afford. Just have to register and prove that you could not afford your own insurance. They could give you a little ID card or something. Then we could pay for doctors and nurses schooling and they would have to serve 5 years or so in one of these hospitals, for substandard pay. After that, they could go out into the world where folks actually pay for their own insurance and medical care, and make money to make the years of schooling worth it.

It solves the problem of folks who can't afford it not having care. It solves the problem of folks who do have care currently, not losing the quality of care and choice that they have now. It solves the problem of losing doctors and nurses who do not want to be overworked for very little pay. It solves the problem of what to do about all the insurance companies and their employees who would be out of jobs under a universal care plan. It doesn't solve the problem of getting care to those who are not located in a city getting care.... perhaps a "traveling clinic" like the blood banks. I'm sure there are other problems as well.... Let's hear them.

I do not have a problem paying for health care in such a manner for those who can not afford it. I, however, have no desire to see a doctor of someone else's choosing. I choose who I trust to work on myself or my children. I want someone who doesn't prescribe an antibiotic for a cold. I want someone who's medical beliefs closely follow my own. I don't want to be seen by a bigot or someone who thinks that fat people should pay more for care (even though that's the same thing).

If I could not afford to take care of myself or my family, then I would not have such a choice. Beggars can't be choosers.

Has anyone stopped to think that every one of those countries mentioned above also have mandatory military service? That's part of the "cost" of their free healthcare. Are we going to do that too? BAHAHAHAHA!!!! That's funny!! Gimme, gimme, gimme, but don't expect me to give back. No worries, it'll never happen. I just couldn't resist when folks are saying how wonderful these countries are because of their health care, that there is a whole lot more involved than just health care. Many things that you would never accept.

OK, I've given one possible solution. (not just a vague someone should do something) Anyone out there have another? Prove me wrong. Prove grandma right. Let's see some of that American initiative. Let's hear from folks who have some kind of plan. Good plans and bad plans we'll have to go through them all, before we get to one that works. Shoot holes in this plan. Let's hear some talk about something concrete. Please keep in mind though, this is not a plan to benefit the majority. You would get further by acknowledging that fact. The majority of Americans have health insurance. This plan is only for the poor unfortunates that we have to save from themselves. Everyone else will see their current health care options diminished under any universal plan. And that, folks, is the hard sell. That is the real reason that those who can and do, are not going to buy a universal plan.

No one has said yet, that they are willing to give up their choice in doctor, or hospital, for this program. No one has said that they, in their day to day life, are doing all they can to ensure that the uninsured have coverage now. I can tell you my doctor, dentist and pharmacy all have programs to help those without insurance. It may not be much. It may only help 2-3 of those uninsured. But it DOES help those 2-3 folks, and all the other patients who use those services may help 1-2 more each (I'm 8 people total, so that's why the difference in numbers). The same number of patients at a doctor who doesn't have such a program - helps 0. I also give to charities who help folks within the US. Many of those are medically related. I give to my church that also helps folks in my community with hospital bills and medical care. I'm doing what I can. How about you? Or is this just a purely intellectual discussion, with no one willing to put their money where their mouth is?

    Bookmark   August 9, 2007 at 5:12PM
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YEAH! I am not going to fussy about who I see for "primary care"... I haven't been thusfar! I go to the local Family Planning clinic every year; guess what?! I don't even see a DOCTOR, I see a Nurse Practitioner.

I go for a mammogram at the local hospital's place. We have a local GP, but only see him for routine visits (bad 'flu., etc.) and because we have to have him for a referral (how dumb is THAT?).

More people need to see skilled Nurse Practioners and take more responsibility for their lifestyles. Sorry! fat people cost more, in actuarial terms.

    Bookmark   August 9, 2007 at 7:01PM
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I don't want to be seen by a bigot or someone who thinks that fat people should pay more for care (even though that's the same thing) Very well said

Would anyone seriously tell children that obesity is OK or unavoidable? Yet by the same token how many teenage and preteen girls feel they are worthless if they are not a size 2? Have low self image even if they are not aneorexic

Maybe Chisues friend had emotional issues but I would not assume all do. I know of several cases where thin and fat people have adopted children and also have biological children. The biological children mirror their parents, the adopted ones do not, whether fat or thin. I even know of one case of identical twins that were separated and one twin was replaced by another child without anyone realizing (it was on 20/20). All 4 biological children were thin like their parents, the misplaced child was obese at 18. Same habits, different outcome.

Do you really believe people are fat because that is what they want? you can educte them all you want, until there is an effective weight loss solution other than simply telling people go excercise and eat right (so easier said than done), nothing will change because people cannot change. If they do change they end up reverting back as happens to 95% of dieters. For some reason it does not happen to 95% of ex smokers

a medical field that wants to "help" women 20 years past their best child-bearing years to acheive parenthood by implanting multiple embryos Now I know you do not know what you are talking about. Triplets and so forth are a result of too many embryos forming in young women who have fertility problems. Non identical Twins in women over age 41 occur rarely. I can find the SART statistics if you are interested. IVF with their own eggs barely works in women over 42. So the odds of having one is slim. The odds of two are almost none. Plus in states with mandatory IVF coverage, as opposed to places where patients are taking a desperate gamble because they only have one shot, the rate of multiple birth above Twins is actually pretty low even in younger women.

Here is my solution. If you really think people get fat from eating too many bonbons, then tax them. Tax regular sodas, it rots your teeth and really does have a redeeming value. Tax anything with a high fat content that does not have an equal amount of protein, anything with more than x grams of sugar. Put the money into a fund for the uninsured. Hey for the bigots out there, maybe only have the tax apply to people with a BMI above 30! That should make the self righteous happy

    Bookmark   August 9, 2007 at 10:17PM
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Should say sugar soda has no redeeming value

    Bookmark   August 9, 2007 at 10:26PM
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Has anyone stopped to think that every one of those countries mentioned above also have mandatory military service? That's part of the "cost" of their free healthcare. Are we going to do that too? BAHAHAHAHA!!!! That's funny!! Gimme, gimme, gimme, but don't expect me to give back. No worries, it'll never happen. I just couldn't resist when folks are saying how wonderful these countries are because of their health care, that there is a whole lot more involved than just health care. Many things that you would never accept.

There was a military draft in the U.S. not that long ago. Some sort of required service, be it military or National Guard or even AmeriCorps, wouldn't be a bad idea if it weren't for the misadventures being directed by the cowards who were too "busy" to serve themselves (talk about "gimme and no give back"!).

For that matter, those countries requiring their citizens to serve often have tax rates significantly higher than the U.S. does. And yet, with all of those "punitive" measures, people are not leaving those countries in droves and no one in those governments has to put up signs that read "Last one to leave (fill-in-name-of-country), turn out the lights."

By several measures, the quality of life in other countries is superior to the quality of life in the U.S. You are right -- it does not come "free". I'm not sure where USians glommed onto that concept, but, if they're honest with themselves, people know it's a fallacy. Now if we could only find statesmen and women who could come clean about that....

No one has said yet, that they are willing to give up their choice in doctor, or hospital, for this program. No one has said that they, in their day to day life, are doing all they can to ensure that the uninsured have coverage now.

Many of us with insurance effectively have given up our choices in doctors and hospitals. Many health plans stipulate which clinic you can use (in non-emergency situations), more require a referral for specialists, and every doctor I can think of is associated with some hospitals but not others. So that restriction of choice already is a reality -- for people who have insurance.

And just because no one is talking about what they may do personally to ensure that the uninsured have coverage does not mean people aren't doing anything. I don't blab in public forums about my charitable contributions or my volunteer work. Hey, we have people running for President who have not articulated a plan for addressing this problem.

    Bookmark   August 10, 2007 at 6:40AM
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Here, here, Steve!

How about Tom's of Maine's effort to privide dental coverage to those most in need? we were delighted to sponsor a child... you wanna talk about prevention, let's start with the mouth.

Don't lay that "gimme gimme" line on me, either. Like Steve, I know what we sponsor and in most cases, to whom it goes. We try to do our good deeds locally.

    Bookmark   August 10, 2007 at 10:14AM
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I should not have limited my criticism of OB/GYNs to just IVF practices. Irresponsible treatment of infertility (amazing costs for little success and some very bad outcomes) is bad regardless of the methods. This is a sad outcome of gimme! and the entrepreneurial side of medicine. BTW, today's news includes warnings that the newborns of obese mothers are at greater risk for neonatal problems.

I do not argue for increased costs for normal human desires to have families, nor for increased costs for any medical condition (heart disease, cancer, whatever) that is not KNOWN to be caused by individual lifestyle choices (obesity, smoking, drug abuse). Yes, it is HARD to resist pressure to over-eat, smoke, take that drink or drug, and harder still to quit -- but people do it every day.

Money can talk. Two states that instituted very high cigarette taxes have seen corresponding drops in the numbers of smokers. When gas prices rise, people realize they don't like their SUVs so much and buy smaller cars. In Europe petrol and electricity cost a LOT; people use less. Maybe taxing empty calories isn't a bad idea! I also like the U-Haul company's idea of paying obese, unfit employees less -- while offering them help to change.

momto6 -- I'm afraid your two-tier system has not worked well for society. (See public health patients waiting days in the ER after failing to recieve preventive care.) I do like the idea of some public service for medicos, and something similar is in place. Medical students can opt for loans that are paid back by terms of service in fields less popular (less lucrative), like family practice. Nurse Practitioners are becoming more accepted, too, to fill some of that same day-to-day need. Proof of need? Drug stores are getting into the clinic business to profit from it!

I'm less skeptical about other countries' health systems. It's only human to complain more than compliment. (Something like the way a customer will tell ten people about the bad meal he had at X restaurant while only two will hear about the good meal.) Bad news! What do surveys say about health care in Canada, the UK, France? (Oh, I would be most interested to see the French survey!)

    Bookmark   August 10, 2007 at 12:04PM
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Here, here! ChiSue!

(the last time I was examined by an OB/GYN physician he told me, " if you want to have kids you'd better 'get busy'!". I was APPALLED and coolly asked him if he'd bothered to read the 10 page "history" I'd filled out? in it was clearly stated my desire to NOT have children, lol.).

And why is it that I am required to pay for "maternity care" when what I'd really rather have is PREVENTIVE care... ummm... birth control?! abortion services if required? NOPE.. not available... not "PC"... how about we start "gettin' real" and leaving the moral judgement out of it?

    Bookmark   August 10, 2007 at 12:28PM
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chelone -- Didn't that doc tell you you could "have it all"? He might have offered to "harvest" your ova to store until you decided to have a baby at age 50, after your career was peaking. (If you decided against motherhood, that would be OK, too. That ova could be fertilized by some anonymous sperm donor and the "result" could be used in stem cell research.)

You may detect a special revulsion I feel for this particular industry.

(I think you mean to say: Hear! Hear! but thanks anyway.)

    Bookmark   August 10, 2007 at 6:05PM
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And I'm right there with you, Chi.!

Pisses me off that I could never get coverage that would cover BIRTH CONTROL or abortion for an unwanted pregnancy resulting from birth control that isn't "fool-proof".

I'm 48 yrs. old. I'm fit, healthy, and have never been pregnant because I've never wanted to be! I've paid attention to details and have paid the price... over the years, in excess several thousand dollars... but the "cost" of my vigilence was to be totally borne by me? even though my CHOICE AND VIGILENCE meant nothing to the premiums I've been forced to pay?! HUH?!

"Well baby"? how about "NO baby"? where's MY discount? After all, my "NO baby" dilutes the "pool" and reduces the price we all must pay for all the f--ked up babies that are delivered to the "uninsured"...

No one wants to talk about that aspect, but how much does it really cost us?... and how many of us are forced to pay for them even though we aren't "given a break" for our assiduous attention to detail over the many years we've NEVER conceived?!

Hot button issue for me, you guys.

    Bookmark   August 10, 2007 at 6:30PM
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This is a crazy thread. I can't believe some of the things I'm reading. It's just not right to say that fat people should pay more for health insurance than skinny people, that smokers should pay more than non-smokers, etc. There are just too many variables to make statements like that.

As far as the high cost of IVF or other fertility treatments, who cares? Insurance doesn't pay for that. People can spend their money however they want. I agree with chelone. Let's keep the moral judgement out of it.

    Bookmark   August 10, 2007 at 6:31PM
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Please, don't start whining about how we are under taxed. How is:

28% of your income taken directly (20% after deductions)
15% taken in your contribution/employer contribution for SS/medicare
Sales taxes that vary from 0% to 10% - let's say average of 4%
if you factor in health insurance premiums being part of taxes - that's another, what, 10%?

I haven't factored in property taxes, local (city) taxes, state income taxes, asset taxes, taxes on fuel (excise taxes), taxes on liquor, tobacco (NEITHER OF WHICH I USE), and I'm sure I could think of more.

Compare this with the European system that tends to have income tax and VAT and nothing else. I would venture to guess that we pay AT LEAST as much as them.

Further many European nations are in the American military umbrella thru NATO. It is we who are funding a significant amount of Europe's defense to this day.

We must find a solution to this healthcare crisis. If our government had a track record of being competent I'd say 'sure!' But I'm not self deluding enough to think that any of this could turn out well, unfortunately.


    Bookmark   August 10, 2007 at 11:25PM
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Hot thread. But I'll throw this article into the fray. Interesting read. Curious what you think.

(BTW, do not confuse the active military hospital system, e.g. Walter Reed, with the VA system. Apples and oranges.)

    Bookmark   August 12, 2007 at 1:24AM
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celticmoon -- WONDERFUL link! Thanks!

(Also looks like I should find the author's book, given my personal "hot button".)

    Bookmark   August 12, 2007 at 11:42AM
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It is unfortunate that so many do not have any health insurance. But it should not be characterized as a "right." A "right" is something every person can exercise without coercing or taxing someone else, such as the right to free speech. We can all engage in it; it does not come at the expense of someone else. Health insurance for all would certainly mean forcing some to subsidize the care of others. The debate should be couched in terms of public policy, not rights. The question is, is it good public policy to subsidize (at least some) peoples' healthcare? Personally, I find the notion of the government overseeing distribution of healthcare/health insurance very disturbing on many levels. No, I am not a doctor nor do I have anyone close to me in the healthcare field. I think change would be good, but not change engineered by the government.

I am interested in the original question about retirement. Geez, if the typical person nearing retirement has saved so little, guess who is going to fund that bailout? Chisue is on the mark raising that question. It is simply not fair that the "ants" among us would have to pay for the living expenses of the "grasshoppers" who just didn't save enough. So, with all this looming, what will one need to retire to an upper middle class standard of living? In recent years, I think the number was $2M. What will it be in 25 years? 4 or 5M, given that we'll have to bail out Social Security and those people who didn't properly fund their retirement?

    Bookmark   August 12, 2007 at 9:08PM
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It is unfortunate that so many do not have any health insurance. But it should not be characterized as a "right." A "right" is something every person can exercise without coercing or taxing someone else, such as the right to free speech. We can all engage in it; it does not come at the expense of someone else.

I disagree. We have many things we consider "rights" which run afoul of your definition. Voting is a "right" but it certainly costs money to buy off Diebo run elections. We consider it a "right" to live peaceably, but I don't notice that police officers and prison guards (or prison builders) work for free.

And we already are subsidizing other peoples' healthcare through our taxes and our own health-insurance premiums should we be lucky enough to have insurance. When a poor person with no medical insurance shows up at the E.R. for treatment of an illness that could have been attended to much easier (not to mention less debilitatingly) early on, we cover those costs as service is rendered in the most inefficient way possible. (I'm not getting down on E.R.s, BTW; it's just that they are designed for the treatment of major trauma, not persistent coughs or mildly-sick babies.) It's not only good public policy, it's just good economics and good medicine to treat problems sooner so they don't become big expensive problems later.

And, coming as I do from the home of "Dollar Bill" McGuire (very rich former United HealthCare CEO), I'm very leery of letting some for-profit corporation run the system. It's strange how so many people think that government organizations like police forces and armies are always well-run and economically-efficient, but they can't see the government organizing a sack race properly. It certainly would help us to get back into government people who actually want to govern and be states(wo)man-like, not just those who pander or want to build empires.

    Bookmark   August 13, 2007 at 9:39PM
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So, with all this looming, what will one need to retire to an upper middle class standard of living? In recent years, I think the number was $2M

I need some clarification here. Does that mean $2M net worth? Or does that mean $2M excluding the value of one's home (which doesn't really contribute to retirement income unless one sells it or uses a reverse mortgage). In addition, does that figure factor in possible income streams such as pension and/or SS? Or does that mean one should have $2M if they expect no other income?

Re the healthcare issue, Steve0 has nailed the issue, again. I consider it simply good public policy to have universal health care. Especially for children.

    Bookmark   August 14, 2007 at 9:16AM
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Other countries have decided that they are each and every one better off providing a basic standard of health care for all. They are doing it (much better than we are) for half of what we are paying. What is wrong here? Calvinism taken to the extreme?

    Bookmark   August 14, 2007 at 11:46AM
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steve o, I am simply talking about exercising the right itself, not the attendant costs that in today's government/society happen to be in place that are related to that right. That is, again, everyone CAN exercise his right to free speech. It doesn't cost anyone anything when someone exercises his free speech right. Same with being "peaceful" -- it doesn't cost me anything for my neighbor to be peaceful, to mind his own business. And voting, in its simplest form, also fits this definition. One can say "yea" or "nay" or raise or not raise his or her hand. The voting per se does not necessarily cost anything.

And oh, gotta love the efficiency of the military other government institutions. Gotta love the $400 hammer and the $200 toilet seat.

As for zone 8 gma, what one "needs" in retirement is certainly dependent on the definition of "comfortable" eh? Let's say someone owns a home free and clear and the home is worth $500K. If that someone gets a typical SS payment in retirement, I am under the impression that for a household used to a salary of say, $100K per year in a medium- to-high-cost-of-living part of the country that SS payment is a small portion of what they will need to sustain their standard of living. Isn't the rough rule of thumb, you want to plan on living on 75 or 80% of your pre-retirement income? If my example household does not have a pension, as MANY will not in future years, then where's the rest of that money coming from? I think at least $1M today could be comfortable for that example household. You have to figure they still pay property taxes, they need medigap insurance, they may need to weather downturns in the market, they may need nursing home care someday, etc. If their $1M earns 8% per year, that's $80K and great, they have their desired stream of income and they do not deplete their nest egg. Most people want to leave their kids something as an inheritance. I know I want to. To really have a solid cushion, though, I do not think $2M is outrageous. What if there's a recession, if there are BIG increases in taxes due to bailout of entitlements, etc? Seems prudent to assume the worst and hope for the best.

    Bookmark   August 14, 2007 at 12:22PM
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Re the $2M 'average' stat: it's generally agreed that is liquid assets, not net worth. With a recommended drawdown of 5% per year (or less; CFPs used to recommend 3-4%) a $2M portfolio gives you $100K/yr or $8K/mo. This would not include Social Security or pensions/company annuities, so one could reduce that figure substantially in some cases.

I agree with Steve too. Prevention is simply cheaper than anything else. Emergency rooms are closing up all around the country because the influx of uninsureds using them for "last ditch" medical care has forced a burden on local counties they can't keep supporting. You live in any county with an emergency room open, and you ARE supporting healthcare for the masses, in the most painful way.

    Bookmark   August 15, 2007 at 10:26AM
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Let's not forget that the portfolio is earning all along the way. If you have $2M invested it is earning -- even in CDs at 5%, there's $100K without withdrawing from the principal.

I would never count on spending LESS after retirement. We don't. At first, because you have the time, you can travel. Later, health care expenses rise. (You "travel" to more MDs.)

We help our DS and his family NOW while they are young and can use the extra funds. (And to whittle down the potentially taxable estate.) Our first concern is seeing that we are funded ourselves, and will not be a burden on him or on society. If it turns out that there's some extra left over when we are gone, that's fine. Some will go to local charities; some to our DS and his family.

    Bookmark   August 15, 2007 at 5:22PM
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