March 31, 2014

Holding Down Hospital Costs

After last Thursday's post about staying in your home versus making the move to a care facility, you may be worried I have become somewhat fixated on health and death. No, not to worry. It is just that last week's post and today's deal with subjects that readers have asked about. Plus, today's subject is one that drives me crazy. There are fewer things that push me over the edge quicker than the absolutely ludicrous way medical care is priced in our country. There is virtually no way you can comparison shop, or even know what your bill will be until you try to check out. What other area of our economy has the nerve to sell a service without letting the consumer know the cost before committing to that service?

One year ago Time magazine had a cover story about hospitals and their chargemaster system. Entitled, The Bitter Pill, it detailed the complete disconnect between what hospitals charge for their services and reality. The article showed the huge price differences for the same procedure in different parts of the country and for different types of insurance.

The simple fact is that those without insurance or the ability to pay are charged the most for any services. On the other side of the spectrum, hospitals accept a small percentage of that maximum charge from Medicare. There is obvious unfairness of going after those least able to pay with the biggest bills and the very real possibility of bankrupting or financially ruining lives just because they can.

Yes, I know hospitals must treat anyone in the ER, regardless of insurance. A high percentage of those costs are eventually written off. But, to go after the poorest among us with guns blazing to make up for a flawed system is just not right.

Our system is not designed to make us healthier, in fact Americans rank dead last when compared to 16 other developed nations all while spending 250% more per person. True, we lead the world in medical technology and cancer research. But, for the day-to-day health needs of our citizens we perform terribly. Ours is the only country in the civilized world where our health options are controlled by private or publicly traded corporations who sell health services and prescription drugs for a profit first, and good health second.

All of this leads me to a story I saw recently that gives me hope that the shroud of secrecy over what hospitals charge may be finally showing some tears. A new web site is making an attempt to allow us to comparison shop, to have medical professionals and facilities compete for our business. Isn't that how capitalism is supposed to work? Don't we look for the best deal and service before we plunk down our money, particularly for something that may cost six figures? has been around since 2010, but just recently has been getting all sorts of press and mentions. My guess is our increased focus on the actual cost of our  healthcare system because of the ACA (aka Obamacare) has begun to make people more aware of what it really costs to use our system.

Medibid allows the consumer to have doctors and hospitals or clinics bid on the cost of an operation or procedure. No longer must you shop in the dark. You get a guaranteed, in writing bid.

You may be asking yourself, "but why do I care? I have insurance. Whatever they pay, they pay." I'd suggest there are two major flaws with that conclusion. First, your policy is going to cost you more every year in both premiums and a larger deductible with diminished coverage. That trend started over two decades ago, well before the ACA. While you could argue the new healthcare law has made it worse, I would ask, compared to what? Health insurance costs have averaged almost 15% higher every year. If you are part of the 80% of Americans who get health insurance through work you have been largely insulated from the true cost of taking care of you and your family. Only now are you beginning to see what our system really costs. One thing this is absolutely is true is that health costs would not go down.

But, that isn't really where I want to go with this post. For all sorts of reasons Obamacare discussions tend to become filled with emotion and more heat than light.  So, leave that landmine alone for now and consider the second reason services like Medibid are potentially good: by allowing consumers to compare prices, hospitals and providers will be forced to compete for business. In our economic system competition means lower prices. Over time, maybe the absurdity of $15,000 a day hospital rooms will disappear.

One very important disclaimer: I have never used Medibid. I have no connection with the company. I start Medicare coverage in one month so I will be largely insulated from our silly system's costs. Medibid may eventually fail for lack of support or some other reason. But, what it shows me is a movement toward transparency in medical costs.....and that is a good thing for all of us.

March 27, 2014

Staying At Home: Is It Possible As We Age?

When I asked for topics you'd like me to spend a bit more time writing about, home health care versus living in a nursing home was near the top of the list. Most of the folks I talk with would like to stay in their home as long as possible before the move to a full time care facility. There is comfort and peace of mind in being in a familiar place, with your belongings around you.

Of course, there are obvious complications and problems that can arise. As health deteriorates the risk of falls or accidents increases. Becoming forgetful about taking pills and eating properly can have serious consequences. Your spouse, partner, or grown children must take on a more active role in your care. If you wait too long, nursing care facilities may not welcome you. In an odd irony, you may find you are too ill to be admitted to the nursing home of your choice.

If you are able (and willing) to move into a continuing care community at some point, this situation is already taken care of; a nursing home environment is part of what you contracted for. In the meantime, you can remain independent or have some assistance on a daily basis.  But, for many the costs are too great to make this a viable choice. For others, the thought of living among people who are all the same age and social status is not attractive.

Luckily, new technology and options are making it much more viable to remain in your home for a longer period of time. If you would prefer to stay in your present home as long as possible, there are choices you can consider. Something as basic as an emergency button that summons help can provide a much needed level of security and safety. Other new products provide monitors and computer links to family members or care professionals. Pills not taken or daily activities not performed as required trigger an alert to allow for quick follow up.

New options for in-person caregiving are also more readily available. Professional help or volunteer visitations are just two of the possibilities.

Because this is an area I have no direct experience in handling, I really can't offer specific suggestions. My dad (and mom before her death) lives in a three level community with constant supervision and care so I am not faced with the toughest choices. At the moment he is in the assisted living section, but is guaranteed a place in the nursing facility when the time comes.

What I can offer is the following list of links to sites that discuss this topic in greater detail or offer options that may make your decision easier.

Of course, the decision to stay in one's home affects both the individual or couple in the home, as well as other family members who find themselves in a position to take on extra visits, care, or responsibilities. Any decision with this level of seriousness should be discussed with all those who are involved, and that includes doctors and other caregivers.

That being said, here are some sites for you to check out if this subject is one that is important to you:

Nursing Care Alternatives

Visiting Angels

Skilled Nursing Options

Alternatives for Care for Aging or Ailing Parents

Community Care In Your own Home

How Seniors Manage to Adapt to Disability

Options for aging in place

Technological tools that may help:

Alert 1

As the saying goes, "Getting old is not for sissies." At some point Betty and I will face these decisions. Frankly, at this point I have no idea what we will decide. But, just researching the information for this post has helped.

March 24, 2014

Old Time Radio (Really Old !)

No, not the Top 40 style of radio I played and you grew up listening to on that tinny AM radio (or even the progressive rock on FM)....this is about radio shows from the 40's and 50's when radio was still king. This was the era when families gathered around the large console radio in the living room to listen to Sam Spade mysteries, Bing Crosby singing. Arthur Godfrey variety shows, or big band orchestras performing live in a radio studio somewhere.

Yes, I know this type of entertainment is likely before your time. Being born in 1949 most of it is before mine. For folks used to the visual stimulus of television, simply listening to a murder mystery or comedy without pictures takes some getting used to. The quality is not what we are used to either; shows from that long ago were recorded on equipment that is crude and almost prehistoric-seeming in today's world.

But, with all that said, I hope you will just try an old radio show or two. There are tens of thousands of them available on the Internet. While some of the better known sites charge to listen, many are completely free. If you try those and find you enjoy using your imagination and mind's eye to recreate the scenes being described, then you can go ahead and invest the rather minimal amount for a lifetime's worth of choices. In fact, collecting old time radio broadcasts is a hobby that attracts thousands. You might find an interest, too.

One thing you will quickly notice is how different humor was 60 years ago. Besides being "clean," it was rather hokey. The jokes sound silly to our ears. But, that is part of the fun of listening: you can hear what made your parents and grandparents laugh You will get a better understanding why they struggle with today's brand of comedy and what is appropriate conversation.

There was no such thing as "political correctness" so jokes at the expense of women and the roles of the sexes, labels such as "doll baby" and "honey" were used for most female characters. Again, this is an excellent way of appreciating how far we have come (with a lot farther to go) in being more sensitive to these issues.

OK, enough set up. I have provided several links for you to explore. They are clearly labeled as free or requiring a membership. This list barely scratches the surface of the resources available on-line, but there is plenty here to get you started.

I must mention that one site listed, RUSC,  provided me with a free guest membership to evaluate their offerings. I was favorably impressed and at $60 for a year I very well might invest in a regular subscription.

Free Choices:

Pay Sites:

I will be interested in your feedback. These shows aren't for everyone, but you might find using your imagination instead of your eyes is an interesting experience.

March 20, 2014

Which is Best: Financial Advisors or DIY (Do It Yourself)?

Ah, if only life's important questions were so simple. Wouldn't we all like a simple, Door A or Door B, pick? Does the blog title hint at a clear cut answer? Has my almost 14 years of retirement provided me with insight on this perplexing issue?

Well, yes, and no. I do have some insight I will share. But, that insight doesn't come with an either-or choice. There are too many variables. Let me explain.

A qualified financial advisor can be a tremendous resource for you. That person should have the training and experience to understand all the choices you have to maximize your investments. He or she should understand your specific short and long term goals and your tolerance for risk.

While there may be an argument made for using a service that is not based on a fixed fee, personally I wouldn't feel comfortable knowing that the advisor's income is dependent on the commissions generated by what I end up buying. For me better is consulting with someone who charges a fee for his time and suggestions but not for everything you decide to purchase or do.

It would also be important for me to arrange for a situation where regular follow ups to check on the performance of my investments was part of the package. No one, no matter how good they may be, will always suggest things that work out exactly as planned. The world of money doesn't operate with precision. Something that seems perfect today may be wrong six months or a few years later. Having the ability to make adjustments is critical.

Do It Yourself

The flip side of this financial coin is the Do-It-Yourself approach. You know your goals and risk tolerance. By now you have the experience that tells you what investments and approaches have worked for you in the past, and which haven't. You may not know about the latest financial products and esoteric products, but that may be a good thing. Bernie Madoff proved that even seasoned professionals don't understand the ramifications of everything designed to separate you from your money.

The Internet is an amazing tool for staying educated about financial planning and investments. Of course, there is a lot of bad information available there, too. You will need to determine if what you are reading is legitimate. How? Check at least three or four completely separate sources. If all confirm each other, you probably are on safe ground.

Using the DIY approach could save you a lot of money that you can invest instead of giving it to a professional to tell you what to do. Fee-only planners usually charge a percentage of your total invested assets, or an hourly fee for their time.

So What have I done? I have chosen a mixture of the two. For almost twenty years I have teamed up with a financial advisor. Over those two decades he helped me build the financial foundation that allowed for early retirement and is keeping me feeling good about my future. In a slight departure from the caution I noted above, my planner is really a mixture of fee-based with some commissions involved. But, I trust him to not bring anything to me that is not a strong fit for my goals and personality. Because I am not an active trader he probably doesn't make much money having me as a client. At this point our relationship is closer to one of friendship and mutual trust.

At the same time I am actively involved in staying educated about the world of finance, adjusting my goals, and feeling comfortable about what appears on my balance sheet. I determine what percentage of my account I want to withdraw each year (presently less than 3%).

There are certainly a lot of people who are not comfortable in the financial world. The thought of making important decisions without guidance would be terrifying. That is completely understandable and that is where a good fee-only advisor can become your lifeline to a satisfying retirement.

But, the absolutely worst decision is turning over everything to someone else and simply trusting they have your best interests at heart. Almost as bad is to  figure what you put your money in all those years ago is still doing the job for you and ignore everything.

Note: The February/March AARP magazine has an article on Do it Yourself investing that provides an excellent overview of the DIY approach and the various tools that exist on the Internet. The article begins on page 50, or click here.

March 13, 2014

Simple Downsizing: Grabbing a Ready-Made Opportunity

One of the topics you have requested I re-visit on a regular basis is that of downsizing and simplified living. This is a subject that resonates strongly with me. For whatever reason, I have always been more comfortable when surrounded by less stuff. I probably would be quite happy in a small cabin in the woods or a cottage by the sea with just a few important possessions and a lot of peace of mind.

One of the bookshelves in my blogging office has several dozens books on simplicity, voluntary simplicity, downsizing, and the like. When I begin to feel as though life's clutter is closing in on me a bit, I'll grab one and scan it to refocus my determination to "keep it simple."

A recent event in our home reminded me that simplifying and reassessing what is part of your daily life can sometimes be stimulated by something else. After putting it off for at least five years, we finally had the downstairs carpeting replaced in part of the living and dining areas.

I had put it off for so long because of the hassle of the whole process of shopping for carpeting that both Betty and I would like, of moving all the furniture out, being trapped upstairs for 4 or 5 hours while the installers did their job, and then moving everything back.

Our project was complicated by the fact that a rather substantial crack had occurred right through the center of the living room. We knew it was there because we could feel it under the old rug. The 20 foot long split had also risen about 1/2 inch for part of the distance, giving our living room a definitely unwanted two level effect. So, before the rug could be replaced, men with large grinders had to come in and level the concrete before filling the crack with cement.

In any case, all went as well as could be expected; everything was actually under budget. And, this is where the ready-made opportunity to simplify happened. As we began to move everything back, both Betty and I decided to only return the basics right away. The books, knickknacks, candles, photos and paintings, coffee cups collected on various trips,  a dozen or so fancy tea pots, even two large CD  players that held 500 music CDs, all stayed in the garage.....for now.
gone from the living room!
much smaller

This was the perfect opportunity to decide what we wanted to look at everyday and what just added clutter to our home. It has been almost 4 weeks and only some of the stuff has come back in through the garage door. One easy decision was to get rid of the 30 pound CD players, burn the music we wanted to listen to onto an iPod, and put the players on Craigslist.

Betty has a great collection of pewter items that have been in storage for several years. She thought it was time to bring them back for awhile; they will take up residence in the dining room in place of the tea pots that neither of us really see anymore.

Coffee cups are staying in storage, candles are going into a newly found space in the laundry room, and even some of Betty's photos are going into the RV instead of the living room walls. When she has the time we will pick a few new photos to have printed on canvas or metal and mount them.

The net result is the living room and dining area feel fresher and less cluttered. The TV stand and bookcases now have room for our DVD collection. The huge CD jukeboxes are gone, replaced by a small speaker system and iPod that sound fantastic, and can be easily put in the RV for our extended trips. This project has prompted us to decide to tackle a thinning out of all the stuff in the outside storage shed and garage. Even the 200 old VHS tapes have found their way into a dumpster.

What began as a carpet replacement project has given us new impetus to cut back, freshen, and thin out. Who knew?

March 6, 2014

The Week That Was....Fun!

First, a disclaimer: the week I am about to describe is not typical for my satisfying retirement. Most weeks have the normal mix of enjoyable and frustrating activities and occurrences. Retirement is still life and stuff still happens.

Two weeks ago Betty and I managed to put together seven days that were stimulating, entertaining, different from the norm, and, well, fun. It was her birthday week. Turning 60 felt like a major milestone to her (and not necessarily a good one!). So, we tried to make the whole week feel like a celebration of the good things in our life.

First was the RV trip to Cottonwood that I wrote about in the post, A Funny Name, A Beautiful Getaway. Just a two night break from routine put smiles on our faces and allowed her to spend her birthday/Valentine's Day free from the normal concern of our life. A full moon one night added to the magic.

Upon our return home we took an afternoon to attend the Scottsdale Arabian Horse Show. Tens of thousands of folks come to town for this annual event held just 15 minutes from our home. Hundreds of horses, worth untold millions of dollars, are groomed and then compete in front of appreciate horse lovers and  judges. As a former horse owner Betty loves being around them and watching them perform.

Two days later we took a glass fusing class. Looking for something we had never done before, one of our daughters gave us vouchers for this artistic adventure as a Christmas present. What fun! For a little over an hour, Betty and I put small pieces of colored glass on a mold. We had dozens of colors, shapes, and sizes to choose and no "rules" about how the finished projects should look. Here is a photo of the finished efforts.

Finally, we attended one of our favorite Broadway shows, Spamalot, at a local theater. Being Monty Python fans and seeing the show before in a large venue with a national touring company we weren't sure what to expect. Well, not to worry. The cast of fourteen, on a stage not much bigger than our back porch, captured the humor, absurdness, and slightly raunchy character of the show perfectly. We shouting out "Tim" and "killer rabbit with pointy teeth" at the appropriate times. We laughed at the Black Knight and whistled along with "Always look on the bright side of life." It was a splendid two hours.

To cap off a tremendous seven days we gave a gift of three Kindle Fire HD devices: one to each of our two daughters and one for our three grandkids to share. The smiles and excitement when they opened the packages was priceless. The entertainment and learning opportunities made the money spent worth every penny.

The week that Sometimes things just align perfectly and the results are memorable. Those seven days certainly qualified.

March 3, 2014

On The Road But Not Out Of Touch

With plans for lots of RV trips over the next few years Betty and I have been discussing how we will travel and still stay connected with those at home. Also, how do we get involved in the communities where we find ourselves camped for a week or two? Just sightseeing or sitting in a chair in front of the RV for days on end is not what a satisfying retirement means to us. 

With three young grandkids, our first thought is our travels could be used as  a tremendous educational tool for them. With all the ways of staying in touch at our disposal, we will have the ability to send pictures of where we have been and provide links to web sites that detail the history and importance of various historical sites.

Betty thought we should give the kids state maps or an atlas with our route highlighted. Then, as we update everyone on our position they will learn some geography and get an early understanding of the locations and differences between the states we drive through.

 Skype video will enable us to check in on a regular basis and answer any questions they may have.

My dad is used to a lunch time visit from Betty and me every 10 days or so; 75 days is a long time for us to be gone. Regular phone calls will assure him we are fine and enjoying the trip. Of course, he can call us at any time if he has a problem or a concern. Our daughters live not far from his retirement community so they can visit occasionally or do some of the shopping that he certainly will need over such a long period.

What about becoming more than just strangers passing through? We won't be in any one location long enough to become a part of any community, but there must be a way we can interact with locals, or at least leave the place a little nicer than when we arrived. After brainstorming, here are a few of our ideas - I hope you will add more:

  • Pick up trash at a local park or town area
  • Attend a local church each Sunday, share fellowship with others
  • Pay the bill for the person behind us in the drive-through lane
  • Donate books we have read to the local library
  • Make a donation to a local food bank
  • Eat and shop at local merchants instead of national chains whenever possible
  • Leave some extra quarters on top of the washer or dryer at the Laundromat
  • Leave an extra-generous tip for a particularly hardworking waitress/waiter

What would you suggest we can do to make our trips more meaningful and productive?

A road trip is chance to relax and explore, deepen our relationship, help educate the grandkids, and make the places we stay just a little better.  To just pass through, take a few pictures, and add another state to our "been there" list isn't satisfying enough.