Hello chefwong,

Apart from referring to you having achieved a certain age, you haven't given much indication of your actual need for life insurance.

When insurance companies advertise for agents, they don't like to use the term, "life insurance" ... so they frequently use the term about serving the public by offering "income replacement" products.

Who is/are, and how many, going to be financially inconvenienced should your income stop, due to your death? If there's someone, or several, who'll be unable to fund their own needs for daily living, now and until they can provcide for themselves, you quite likely need some life insurance. If that need will be for a substantial period, e.g. if you have young children, you may need a substantial amount. Possibly including support for post-secondary education.

I have a whole life policy that Dad bought for me when I was 15 years old, a policy for a few thousand that cost about $14.00 per year. Not really necessary then, as no one depended on me for their livelihood till I was double that age and married, and that need was not great, as my ex- was a graduate in hospital food service and could soon have provided for herself, lacking children.

My need increased somewhat a couple of years later when babes appeared. And that need would be operational for something over 20 years, until the young ones were independent - that was over 40 years ago, when Moms mainly stayed home.

I had some other insurance policies over the years, but was somewhat underinsured, as the money wouldn't have funded their needs fully for that period.

My ex- and I parted when the kids were fairly young, shortly after the youngest started school, and became second head (later head) of food service in a major hospital.

I provided some support for the young ones until both were through university.

After that, who needed support from me? No one.

So I suggest that I had no need for life insurance ... having assets enough on hand, after income tax liability, and lacking other liabilities, to pay for my burial.

Those later policies matured and were cashed several years ago, around my age of retirement.

Basically, you, who need alternate financial resources for your family in case you're not here to provide them, are betting that you are going to die ... early ... and the life insurance company is betting that you're going to be around for a long time, to continue paying those beautiful premiums annually.

If you die young, when you've paid few premiums and the insurance company is on the hook for a major death benefit ... the insurance company lost on that deal. But, don't forget ... they're the ones with the actuaries, who have more than educated guesses as to how long, on average, you can be expected to live.

I must declare a certain bias against life insurance agents, and the companies that they represent.

If they are as generous and public-spirited folks as they like to claim, how come they've sold so many whole life policies over the years?

The great preponderance of financial advisors suggest that young folks who need to provide for survivors buy term insurance, and invest the difference between that fee and the one that they'd pay for a whole life policy, which is often about 3 - 4 times as expensive.

They like to refer to the saving benefit with whole life ... but in order to access that, one needs to cancel the policy, thus losing the death benefit. Or, if one keeps the policy in force until death, the survivors receive the death benefit ... but the "cash value" disappears like fog on a sunny morning.

The family whose income provider had bought term insurance for the same face amount ... received the same amount of death benefit as the family with the whole life policy.

As the owner ages, the fee for the term insurance increases, as there becomes a larger possibility, though still not large, that death may occur during the term of years when the insurance company agrees to pay.

But the invested money has been growing over the years, so the policy-holder is partly able to fund his family's needs ... and those needs are for a shorter period.

The only way that I know of to receive both components of the whole life insurance "benefit" ... is to arrange to be alive and dead at the same time.

Though many have life insurance and, in earlier days, few had long-term disability insurance, there's about 4 times the possibility (or was, some years ago) that a citizen may become disabled for an extended period during his/her period of employment.

And in Canada, the disabled person is present to need food, clothing and other services, quite likely including drugs, rehab. services, etc.

In the U.S., there would be those costs, and in addition, quite likely be expensive doctor and hospital services needed, as well, which would be quite small in Canada.

So income needs in case of extended disability could well be larger than in the case of the death of the wage earner.

That seems to be enough for the present.

Hope this helps as you continue your thought process.

ole joyful

There are many types of insurance. You cannot alleviate all risk, and it is up to you to decide how much risk you are comfortable with.

As well, medical underwriting differs by type of insurance. Companies are constantly monitoring their statistical results (claims) and adjusting rates. For instance, it is extremely easy and cheap to buy level term life insurance right now. It is extremely difficult to get disability and health insurance. It is moderately difficult to get long term care insurance.

And all of this depends upon your state of health. Certain medical conditions can either disqualify you from getting any policy, or result in an increased premium to the point you wouldn't be able to afford the policy.

Disability insurance: you first of all need to investigate what your state pays for disability, and how it defines short term and long term disability. Unlike O.J.'s Canadian situation, the situation in the US differs by state. Therefore, you need to know what the laws are in your domicile. My telling you what CA's rules are may not be particularly helpful to you.

I can tell you that disability insurance underwriting is extremely tight right now. I did not even qualify for my small employer's group disability insurance when I started working for them. However, our state covers short-term disability of 2 months to all residents. We also belong to the Kaiser Permanente HMO system. We have NEVER gotten Kaiser to give more than 2 months disability anyway. If you can talk and walk, you're not disabled as far as they are concerned, and it's back to work you go.

My husband suffered a haemorrhagic stroke at age 50 but had to go back to work in 8 weeks when the doctor refused to sign off on additional disability. It didn't even matter that he had 2,000 hours of sick time remaining! The doctor gave him no choice.

So long-term disability insurance for us is pretty worthless. YMMV, of course. You should also note that there are salary limits. The standard is 60% of your annual salary last year. If you are self-employed you can get a slightly higher percentage except for certain job classifications which are limited to 60% (why I don't know, that's just the info I got when I tried to get disability quotes for clients).

My DH and I bought long term care policies before we reached 50, through the PERS retirement system - he's a union employee with the State of CA. The advantage is they negotiate an extremely good package, and if the carrier decides to leave the business, they can't leave until PERS finds another insurer to take their place. LTC policies can be very tricky to compare, there are many "fine print" items to watch out for. Because we did not listen to common wisdom and bought them before we hit 50, our premiums (even after 2 whole-class increases) are very moderate. And of course, after my husband had the stroke, he ISN'T insurable any longer for LTC at an affordable price. We could get it, but it would cost in the area of $6K/yr just for him. Right now we pay $3K for the both of us for very generous policies.

I don't believe in any cash value life policies of any kind. I worked for insurance companies for several decades, and for a Certified Financial Planner for 18 months as well. The only thing he recommended to his clients, and what I've always considered worth buying myself, is level term insurance. It's the cheapest insurance, you pick a 15, 20, 25, or 30 yr term, and the premium stays at that level until it lapses at the end. Mortality has improved so much, even with chronic diseases, that premiums have dropped to rock bottom levels I haven't seen since the early '70's.

I'm not even a Preferred class, I'm Standard class (overweight but w/low BP, no medication for anything). I have $500K of 20-yr level term for $56/month from one of the best companies for low-cost term. They've been in business for many decades and have specialized in this market for the last 50 years.

Why do I have this life insurance? Because in CA, it pretty much takes two incomes to live. And since I've bopped around here and there with different employers, I've never accumulated any sizable retirement portfolio. My DH, OTOH, has worked for 35+ yrs for the same company, and will retire next year with a big monthly pension, retirement health benefits at nominal cost, along with a 401k account worth an additional $400K.

So my life insurance is for two things: (1) to make up for my lack of a retirement portfolio, should I die before my DH does; and (2) to pay off any mortgage or debt (there shouldn't be any by January 2008, but you never know!). It's an unusual situation, but having worked in the business I understand exactly what I can use this for to our greatest advantage, at the least cost.

At the end of 20 years I can let the life insurance lapse if I'm still alive, because it will have served its purpose. By that time we will be moving on to elder care facilities - if not sooner - and the sale of our house, added to the current portfolio, should be sufficient for our needs.

Joyful is on target that it is about replacing income really.

DH and I have a solid long term plan, but being a couple years shy of all that retirement cash flow kicking in, we did opt to purchase some term insurance a couple years ago. I had boldly downsized my career into a "pretirement" phase and realized it'd be a mess if DH exited suddenly. And were I to depart, he would badly need a cook.

The additional term covers that risk. We will likely drop the term insurance once the long range income streams (pensions, 457, TSP annuity, IRAs) are flowing. DH also has an old Universal Whole life policy - now self sustaining, finally! - and we can cash that out if necessary later, but we don't plan to. Funny, that 250k policy seemed like so much money way back in 1983...

Once retirement income streams are in place for life, we will have no need for income replacement, er, life insurance. Until then it serves simply to cover the risk of losing income.

>>Funny, that 250k policy seemed like so much money way back in 1983Actually, it still is. Life insurance passes free of income taxes to the beneficiary. However, it is still counted in the overall estate for estate tax purposes, but then the estate itself bears the burden of paying the taxes before distributing the assets to the heirs.

It remains one of the very few ways you can still pass on substantial assets to heirs free of income tax.

Of course, if you are so wise as to die in the year 2010, there is no estate tax on anybody! For any size estate! But unless Congress acts, in 2011 the estate tax limit drops back down to the old $600K level.

One point to consider relative to disability insurance: as jkom pointed out, some policies will not consider you "disabled" as long as you can walk and talk. However, there is a type of disability insurance (or, at least, it existed when I bought my policy around 20 years ago) called "own occupation". "Own occupation" coverage means that you can be considered disabled if you cannot do what your line of work requires you to do: if you were a brain surgeon before you were disabled and you can no longer do that job, some disability policies will not consider you disabled as long as you can place pencils in a box or stock shelves, nevermind your income or career as a surgeon. "Own occupation" costs more, of course, but if you ever need to claim on it, can make a huge difference.

Re: Long term care insurance. DH and I took out a policy through his large employer. We dropped it after two years. At that point it would still pay 50% of its then-value as a discontinued policy. The premium costs were rising and I began to question our likely need.

I did some research on how long we might actually tap this policy and discovered that it is highly unlikely that either of us would require expensive skilled nursing care for even one year. (Most people in our race and wealth bracket spend a few months in care before dying -- a process neither of us wants to prolong!) I'm also leary of a policy paying out at a meaningful level, given the escalating costs of care. The way companies are pushing this type of coverage gives me a clue that it is very profitable (for them). We're self-insuring.

RE: Life insurance. DH had some paid-up whole life policies taken out by his father when DH was a child. We used two to borrow against at a very low rate when we bought our first home and cashed them in much later when our savings, pension and SS negated need for replacing his income. (The survivor of us will need to downsize, but won't face hardship.)

We could take out additional life policies that could pass to our DS and avoid some taxation. He is in good enough financial condition that we will probably be giving any high-tax-risk holdings to local charities. We might make our GS beneficiary of such a policy, depending on how our net worth declines as we tap it and how tax indexing increases. Anyway, at our stage (past 66), we would only be considering life insurance as a tax dodge.

RE: Home insurance. I suspect some people are over-insured, having "covered" things like the land and fooundation rather than just replacement of the home & furnishings. I just read that fire departments largely service ambulance and paramedic calls; a tiny percentage are actually fire calls. If you live in a non-fire, -flood, -tornado, etc. area, you may not need a huge homeowner policy. I dread the day I have to fight with one of these behemoth insurance companies over a claim!

Buying insurance is like getting a bank loan. You need both the most when you are young, when it's a hardship to pay for them!

>>I'm also leary of a policy paying out at a meaningful level, given the escalating costs of care. The way companies are pushing this type of coverage gives me a clue that it is very profitable (for them). We're self-insuring. The independent CFP I worked for did not recommend LTC insurance for most clients with assets over $3M cash. Some wanted it anyway, they just felt more comfortable having it. Quite a few could not afford it because their health was such that the annual premium quote came back so high the LTC policies were basically unattainable. Actually, there aren't that many good, long-established companies in this market. And those are certainly the only ones anybody should do business with. (Read the article in the NYTimes a couple of months ago about the LTC horror stories of some insurers who indeed, don't pay claims as advertised)

As I mentioned, there are many "fine print" details on LTC policies. Ours is inflation indexed and the benefits go up 5% per year. This may not sound like much, but the benefits have risen from $125/day when we got it to $190/day now. That's $5790/month for each of us. It might not cover all the costs of a good facility, but it will cover a decent percentage of it. We don't have a large portfolio, so for us it makes a lot of sense to invest in a policy that pays both nursing home, convalescent, and home health care.

Our experience has been personal - in watching our parents and relatives grow old, especially in the last ten years, some of them have been spending considerable time in nursing facilities. By that I mean from 6-18 months.

In fact, my husband's uncle is currently dying at home. He's been in and out of ICU, and has two full-time home nurses the family has been paying for since early March. Fortunately they're quite wealthy so they can afford $12K/month for this, but let's face it, most people aren't in any kind of position to come up with this kind of money for elder care.

Just for math sake, If you have $1,000,000 assets in total, at 8% earnings, it gives 80k a year income without touching the principle. If your wife/husband can work and if the house is paid off, that is a good income. Remember your total assets include all your retirement, savings etc. You should be able to do this kind of number-crunching with your financial planner etc.

Both my husband and I have disability insurance through our work. The insurance pays when we are disabled so we cannot do our current occupation that we are trained to do. This type of insurance is extremely expensive if you pay for it yourself. Many large companies will pay the insurance for their professional employees as a benefit. (I am not sure about non-professional employees.) In this type of insurance, whether you qualify or not is rather complicated and is more than a primary care physician signing off a piece of paper. Often you need a lawyer to handle the process. This type of insurance can make a huge difference in maintaining our income for the rest of our lives if we are disabled in any way.

We currently have life insurance through work but no more. If something happens to one of us, there is enough assets and life insurance through work that we can still maintain a reasonable standard of living. So we chose not to buy additional life insurance. If we both die, there is enough assets and insurance to get my kids through college.

LTC: So far, the insurances are rather unpredictable. Currently, my employer pays for it.

Home insurance: We had a fire in a rental house we own many years ago. Sure needed it!

Just for math sake, If you have $1,000,000 assets in total, at 8% earnings, it gives 80k a year income without touching the principle. If your wife/husband can work and if the house is paid off, that is a good income

I certainly would not want to have to go back to work at the age of 70+.....

The problem is that you can't count on 8%/year. Some years the income might be 20%, other years, it might not even be 4%. If you have to start drawing down the principle, the return will be less and less.

And as one ages, health costs can become very large. My late MIL was paying over $800/mo for her prescription medications (and she had a good Medigap policy).

In our situation, there's no need for life insurance (although we both have small policies through our employer). We don't have disability (I'm already retired) but DH is eligible for a disability pension, if he did become disabled before he retires (next year).

We have large deductibles on both homeowner's and auto policies.

The big issue, for us, is LTC ins. My mother is 82 and in perfect physical health. But she's in a facility because of Alzheimer's. She could easily live another 10-15 years... If my sister and I had to pay for her care, we'd be in a world of hurt. Her care costs over $6000/mo. She's on Medicaid, so all of us taxpayers are paying for her care.

I've decided that LTC ins is warranted for DH and I - still mulling policies, but am near a decision.

As usual, zone8_grandma, I agree with you! 8% is a very aggressive drawdown percentage. Not a bad thing, if you want to risk it, but definitely way above what is recommended nowadays (4-5% max) by most advisors.

RE: LTC Insurance. Everybody knows someone who has spent years in a skilled nursing home, but...odds are YOU won't.

When I looked at the stats, the very people who can best afford to buy this are least likely to benefit over and above what they paid in premiums. If you have a history of poor health care, poor diet, are high-risk for illness due to genetics or lifestyle and are living in an insecure situation -- you'll be sicker earlier and longer. If you are at the opposite end of the scale it's unlikely you'll spend more than a month in a nursing home (the most expensive option, which has meaningful Medicare coverage).

Insurance companies have figured the odds. The people who can afford these policies are the least likely to make claims that equal what they've paid in premiums. If one runs into a catastrophic situation, the policy benefits are not going to make much difference.

sue,
Why pick on LTC ins? The odds of having a house fire are one in 1200, so why bother having fire insurance?

I'll be the first to agree that LTC ins isn't for everyone, but, after some long hard due diligence, I've decided that it is appropriate for me.

Sue,
It's a question of overall risk assessment. I know you don't feel you need LTC insurance, and I respect that.

But we feel we do. We have no children, no convenient family to live with if anything happens to us. And because I have worked in insurance, I understand the whole actuarial process as well. The insurance companies are using stats for insurance that are based mostly on my grandparents and parents' generation. I happen to believe the stats for Boomers will be extremely different, and that there will be much more demand for convalescent and home healthcare services. Because this is only an opinion, this is where the different individual risk assessment comes into play.

Out of my and DH grandparents, only one went into a nursing home. But that was an era when:
-- many families would not put parents into nursing facilities; it was the "somebody has to take in Mom" thinking.
-- most people who had cancer or heart attacks, died immediately or very soon. Improved morbidity did not happen until the '60's. Life expectancy has jumped dramatically since then, DESPITE chronic diseases affecting more and more folks.

The basic truth is, modern medicine can keep you alive, albeit in increasingly declining condition, for much longer than before.

My stepfather died instantly in 1968 from a massive coronary. My husband's father and stepfather, however, lived 8 and 12 years, respectively, after suffering similar CI. Quadruple bypasses and angioplasties weren't available in '68 but by the 1990's it was commonplace.

Both men were fully disabled but basically functional. The decline in the quality of their lives was extremely gradual but noticeable over time. When both got to the point where they fainted when they bent over to tie their shoelaces, I told my DH to get ready for their deaths in the next couple of years. The decline in heart function means the entire body is starting to slowly shut down.

My own father suffered from Parkinson's. Had a widowed aunt not taken him in, he would have been in a Medicaid facility for twenty years.

My experiences may not be typical, but they have been enough to make me feel we need some type of LTC insurance. But no, it isn't for everyone. And even those who buy it, have a lot of conflicting info to wade through!

And even those who buy it, have a lot of conflicting info to wade through!

Boy, if that isn't the truth!! I've discovered that we can get LTC ins at group rates through my former employer (currently DH's employer). The company is John Hancock (one of the big ones I was considering anyway). I've sent the info to our CFA for him to look over and plan to go in and talk to him in a week or two. Of all the companies and plans I've looked at so far, this seems to be the best match for us (at reasonable rates).

Although I have two sons, one is not responsible; the other is married and has a disabled child. The last thing he needs is a parent needing care.... I don't wish to become another burden on the taxpayers, and I don't wish DH to become nearly impoverished paying for my care should I develop Alz..

I also respect sue's position - each of us has to figure out what the best approach is for us. It's not a "one size fits all" kind of situation.

Folks, that's why I posted. All the other posts have been pro-LTC insurance. I've just seen an orthopod prior to having a second hip replacement. I asked him about LTC. His opinion is that very, very few people in our socioeconomic grouping will spend any meaningful time in care. (Not so much whether a family member is going to take care of us...just that endstage will most likely be short.)

Then again, I recall finding a family member for someone once. Located the man in a nursing home. Hitch was, he'd been dead for a couple years, yet the home was still collecting on him!

I'll be interested to hear what zone8's CFA has to say on the matter. All ears!

chisue,
I've already discussed it with our CFA. He says that for some, self insurance is appropirate. He also said that, for us he thought it was a good idea.

Basically we are in a position where we can afford the premiums, but if one of us needed care for any length of time, it could seriously affect the financial well being of the other (he knows about my family history - and that is also a factor).

In other words, we aren't wealthy enough to self insure and we aren't poor enough for Medicaid (which is likely going to go through some major overhaul), but we are fortunate enough that we can pay the premiums without greatly affecting our quality of life.

chisue--- "His opinion is that very, very few people in our socioeconomic grouping will spend any meaningful time in care. (Not so much whether a family member is going to take care of us...just that endstage will most likely be short.)"

Can you elaborate? I'm really curious about this, as the reasons I would think are most likely to result in the need for really long-term care (MS, Parkinsons, Alzheimer's, severe osteoporosis) I would expect have little to no correlation to socioeconomic factors. Significant disability from stroke, maybe (cardiovascular health related to lifestyle factors), but that's the only one I'm coming up with off the top of my head. What am I missing?

zone_8 -- Thanks for the update.

Some might be interested in what my orthopedic guy had to say about health insurance. He is "the" hip replacement surgeon in Chicagoland; has his own dedicated wing at one hospital; is a "rainmaker" for the hospital. He's also a nice guy without the "kiss my ring" attitude some doctors have. It's interesting to hear his perspective because his "business" is largely Boomers and older.

In January 2007 he opted out of Medicare. Under their rules, he has to stay "out" for three years. In 2006 he began to lose money because Medicare dropped its reimbursement amounts. I'm still going to use him because he is the best, but his fee is my responsibility -- no Medicare, no private insurance reimbursement.

He is bitter about insurance companies, which are only interested in what their shares are selling for in the Market. Their CEOs brag about their enormous salaries and how they've improved the company bottom line. That's accomplished by lowering their negotiated payments to health care workers and raising patient premiums. Yes, there have been inovative and expensive new specialty treatments, but the majority of profits are garnered the old fashioned way: lower costs; raise prices. In his view, the escalating cost of health insurance is traceable back to arbitrary premium increases and are not backed up by increased payments to health workers or hospitals for the bulk of procedures (not the rare fancy-schmancy innovations).

I don't know any of this. It's one doctor's opinion. But it makes sense when I see how profitable and powerful insurance companies have become. (So polictically powerful that it's a rare politician who dares try cut them out.)

It's one doctor's opinion. But it makes sense when I see how profitable and powerful insurance companies have become. (So polictically powerful that it's a rare politician who dares try cut them out.)

Not just one doctor's opinion. The same thing happened with the physician that hubby had been going to for over 25 years. He got tired of the hassle with insurance companies and left the group to establish a practice with several other physicians. We couldn't afford it because it was strictly cash only, so we had to change physicians. I was really sorry to see him go; he was a dedicated physician who wanted to practice medicine, not dance with insurance companies.

Quite honestly, the sheer political power of the insurance companies scares the heck out of me. They are the reason we don't have universal health care.

Two thoughts. The first is that while I'm no big fan of Michael Moore, sounds like we should all go see Sicko. One friend got so agitated after seeing it she just couldn't stop talking about it and wrote a bunch of letters to her Congressmen about the insurance industry.

My second thought re LTC is to be sure the policy is flexible and not limited to nursing homes as we know them today. My work exposes me to truly remarkable developments in community placement. I'm seeing more dementia, incontinence, wandering, swallow problems, diabetes, mobility limitations etc managed outside of the nursing home - all deal breakers for community placement in the not too distant past. My (admittedly progressive) county has a nursing home diversion program that will problem- solve any and everything to get someone out of a nursing home once they qualify for the funds. EX: they just placed a quadraplegic in an independent apartment with some pretty creative physical planning and staffing solutions. Not the kind of thing easily funded out of pocket.

Soooo, Z8G, you are very wise to appreciate "we aren't wealthy enough to self insure and we aren't poor enough for Medicaid (which is likely going to go through some major overhaul). There is much change underway and you will want optimal flexibility in your LTC policy if you are in the middle tier.

celticmoon,
The flexibility point you raise is huge. Before retiring (really retiring), I worked part time for an agency who provided in home (non medical) assistance for elderly clients. The aides made the difference between living in their own homes vs institutionalization for many of our clients. A number of them were early stage Alzheimer's. By having an aide go into the home and assist them with meal prep, housework, driving them to the dr, etc, they were able to remain in their homes longer than they would have otherwise. The aides also served as "eyes and ears" for concerned children because the parents would always tell them that everything is fine (when in fact, it wasn't). Without that option of in-home assistance, the clients would have refused to move to a facility anyway and would just struggle along until a crisis developed.

The policy I'm looking at does cover both.

Maybe some of the problem with health care is that we've gotten away from community-based care services. For several years I served on the board of a VNA (Visiting Nurses Association) in our town. It was established to care for the indigent, but over the years became the home health care system for many residents. When I came on the board I was aghast to discover that the wealthy were paying the same rate as the poor and put a stop to that, instituting a sliding fee scale. Clients didn't object; the top rate standard of care continued. We did so much, so well that the local hospital saw an opportunity to take our services "in house" and make a profit on them. Home health care and hospice were born of that.

My hip surgeon recalled spending a half day per week doing consults and surgery gratis to community residents who qualified by showing their tax returns. No more.

One thing I don't understand: why are premiums paid through an employer plan deductible (pre-tax - same thing), while those paid solely by an individual must meet a 7% threshold?

You've probably heard of the recent fuss in Iowa made by folks who want to run for the presidency ... and what kind of costs were quoted as being required.

Then it's on to a quick campaign in ... New Hampshire?

And that's just to take a run at seeking the nomination!

Who bears those costs of running? Only a very few candidates can afford to pay a major portion themselves ...

... which leaves almost all of them depending on contributions from many sources.

Since money doesn't grow on trees, guess where those multiplied millions mainly come from?

One of the major lobbying agencies is the insurance industry.

I agree with zone 8 grandma that the major roadblock along the road to universal health care is placed by those hugely wealthy and powerful insurance companies.

And their support for the political campaigns of many of the lawmakers means that their desires receive a major hearing in the legislative bodies.

Unfortunately.

Good wishes for continuing to be in good health, all of you U.S. residents.

ole joyful

P.S. When one of our provinces wanted to institute universal health care, over 50 years ago, many U.S.-based agencies came up here conducting a lot of fear-mongering to try to block it.

They didn't want to see any such nonsense going on ...even in one small corner of the neighbour's backyard!

I guess they feared that the disease might be catching!

o j

One thing I don't understand: why are premiums paid through an employer plan deductible (pre-tax - same thing), while those paid solely by an individual must meet a 7% threshold?

Good question! I'd sure like to know the answer to that one too. For that matter, those funds they put into a pretax account can be used for premiums, to meet deductibles, eyeglasses and exams, dental, etc...like all of their health care is tax deductible.
Oj

For the most part are people satisfied with the health care system in Canada? I doubt if any system is really perfect for everyone. What are some of the good and not so good points?

Sue

Hi again, Sue,

Our system is far from perfect.

It's a multi-billion dollar enterprise ... and if you have a pot of honey sitting in the yard, don't be surprised if you attract a bunch of bees to go buzzing around!

The system is a national one, largely ruled by the national government, and partly funded by them (but on a drastically reduced basis in recent years) - but administered provincially. The government-related agency is the only payer allowed, and I understand that in most provinces a doctor can choose to practise outside of that system, but if he does so, he must practise entirely that way, that he can't be billing the provincial system for part of the service that he offers (to avoid having him bill the lucrative stuff directly).

The chief problem is that for many elective procedures, there is a long waiting list. When one has a painful hip, the prospect of waiting for more than a year to have replacement is not a pleasant experience.

But I don't think that we use our operating rooms on a 24 hour basis, either.

And they have beds (or O.R.s) shut down, sometimes - shortage of staff ... or shortage of money.

Some people travel to the U.S. for care, at far higher cost, and some travel to such as India, where quality care is available, and at much lower cost, for people who can't wait in the line-up here (or whose service isn't covered, e.g. facial tucks - but they can be done here: private-pay). Sometimes (usually a rather small) part of their costs are recoverable from the provincial plan when they've gone elsewhere for service.

While there are a good deal of tears shed over the shortage of staff, no one seems to get much out of breath running hard to get some trained people from other parts of the world to become licensed here: quite a few Ph.D.'s from various third world countries are driving cabs, here.

Though a large number of Canadians can't find a family doctor, quite a few of us figure that the government isn't enthused about empowering a lot more doctors - which means more bullet holes in the rain barrel, depleting the water even more rapidly.

And many of us feel that quite a few procedures currently restricted to doctors could well be carried out by nurses ... but no way are the medical associations going to stand still for any kind of nonsense like that being put into place!

Plus - there's a shortage of nurses, as they cut back on training a while ago, and many of our grads move to the U.S. Same with our doctors. Seems to me that such people should reimburse for much of their training. But - we're just as bad - we seduce many such trained people from various less developed parts of the world, where such trained people are scarce and precious, and losing them something of a disaster.

Also, many nurses work short hours per week per institution, in order to avoid the need to pay benefits to full-time workers.

And any fool knows that a patient needs to be seen successively, day by day, by the same nurses - a lot of incipient problems can be forestalled by an observant nurse ... provided that s/he deals with the patient daily.

Also - the medical system, in whatever country, is a bottomless pit.

My old step-uncle, who died in his mid-80's a few years ago, had had three hip replacements. Such things were unheard of 50 years ago.

And many patients undergo heart by-pass procedures in recent years: it's routine, these days. And we replace hearts, lungs, liver, kidneys, etc. (everything except heads?). I think that I heard a while ago that when a heart transplant takes place, something like 25 people are in the operating room.

We old farts never heard of having MRI tests, CAT scans, etc. - but now they are reasonably commonplace (but still expensive).

And they are learning of more complex (read "expensive") procedures day by day.

Many Canadians are pleased with the system that we have.

And there is quite a large number who complain about it. The main complaint is that people should be allowed to pay for their care, outside of the system, should they choose.

To which some reply that it is possible, now - just convince some doctors that they should practise on a private basis, with all of their patients paying them directly.

One of the major problems is ...

... that if a doctor sends in a request for payment for a visit, the payer must pay him ... or prove fraud.

Many docs put patients through pretty quickly.

And over-prescribe drugs ... partly to get the gal/guy off his/her back ... quickly?

Many European countries have, generally speaking, quality health care, at much lower costs per capita than the costs under our system.

And your sustem costs a lot more than ours, per capita ... and a substantial number of your people aren't covered, and do get some care, but many say that it's not first class.

I'm thankful that on my occasional visits to my doc, for regular (if somehat infrequent) physical exam, he doesn't give me any indication that he's under time pressure.

But we patients are aware that most of us sat for an hour or so after the time assigned to us, as well.

I am mightily thankful that I've had almost no contact with the medical system for many years - haven't taken a pill in 30 years at least, I think.

When my ex- (named Sue, by the way) was suffering on a downward trail with cancer a few years ago, our adult children felt that they had no complaint whatever with the care that she received.

She'd been head of food service in a major local psychiatric hospital for 20 years (and ironically ... it was her gut that did her in!) and whether that enabled her to receive special treatment I have no idea, but I didn't hear any whisper of such a thing from the offspring.

Good wishes to you and yours - and I hope that the New Year brings many pleasant surprises.

ole joyful