November 21, 2016

The #1 Problem With Our Health Care Future

No, it is not the massive increase in ACA premiums for those who must buy on the individual market. Nor is it the similar increase in deductibles and copays for the health insurance that the 80% of us who get coverage through our jobs must face. 

No, it is not the consolidation of the industry, where a handful of companies control our options. Nor, is it the immoral increases in life-saving drug costs.

No, it is not the inability of our political "leaders" to arrive at a solution that works for those in need. Heavens, they refuse to even talk with each other, preferring threats and slurs instead. Nor is it the slow acceptance by most of us that our health is primarily dependent on choices we make in diet, exercise, and lifestyle. 

The Number One problem with our health care future is.....uncertainty.

Retirement is a period in our lives when we welcome many changes, new opportunities, new directions, a new sense of the possible. We take back control of the clock, our schedule. But, what we don't want is uncertainty. And, there is a big difference between change and being unsure.

The difference is the source. Change is usually initiated by us. Except for obvious things like a health problem or financial reversal, most of what we do during our retirement is to choose...choose what to do with our time, our talents, our resources. We choose to live closer to family, or farther away! We choose when and where to go on vacation. We choose what makes it on our calendar.

Uncertainty is change without choice. We can't plan very well when we don't know what is around the corner. Obamacare will be repealed. It will be replaced by something that has yet to be defined as workable for those most in need. 

So, will my wife start with her new insurance company in January, only to find the system that supports it taken away shortly thereafter? Do we budget for thousands of dollars a month in coverage? Or do we decide to roll the dice and self insure until 65 (assuming Medicare isn't next on the chopping block)?

Will health insurance companies continue to group together, leaving virtually no real choice for customers? Even now Betty cannot get a referral to a specialist in network that isn't more than 50 miles away, has English listed as a third language, and is booked up for 4 months.

With the stunning election results still reverberating around the world, any hope we had for less uncertainty in our health care situation has been shattered. The only certainty we can count on is things are going to get a whole lot more unsure for as far as we care to gaze into the future. 








24 comments:

  1. Your current health care right now, under Obamacare is this, as you stated:

    "Even now Betty cannot get a referral to a specialist in network that isn't more than 50 miles away, has English listed as a third language, and is booked up for 4 months."
    Sounds like, to me, ACA ain't working to well. So far, in the last 3 years I've been dropped off of Obamacare three times. The first two were because the new insurance companies went out of business. Brilliant, that Obamacare is. This time I was dropped because my income went to high for a subsidy. Triple brilliant.
    Millions of young people today have chosen to pay the fine rather than sign up for Obamacare. How much better, without interference, do you think the current Obamacare was going to get. Financials dictate that ACA was already in a death spiral, expecting to go bankrupt in 2017. So, I have no ide what you are talking about.
    Uncertainty?
    If anything, y'all should be thankful finally something is going to be done about Obamacare. Repeal and replace. With something that will finally make sense. For like everybody. Not just the chosen few.
    Myrtle Briar.

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    1. When they had a chance,Republicans could not come up with a reasonable health care plan for all Americans.Obama's original plan involved a single payor system, quite like Medicare,which works pretty well.WHat's to replace?? I think we need to go back k to the original ACA plan. You got "dropped" from "Obamacare" because HEALTH INSURANCE COMPANIES run the show and decided not to cover you anymore. It's the health insurance lobby which is the problem.Our government has a way to provide health insurance just like it has a way to pay for defense.

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    2. Uncertainty comes from not knowing which parts of the ACA that will remain, the reported 2 year timetable for changes, and how private companies will have to rebuild their business models are unknown. Thus the difficulty in planning.

      As often happens, if Democrats score major gains in Congress in 2 years, then everything is back on the table.

      That is uncertainty.

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  2. The mess of our health insurance industry makes early retirement a real crap shoot. Luckily,Ken and I are close to Medicare age. I am not sure we could have retired a little early if we had not had access to the ACA insurance. I imagine folks with the means to retire early have to think this through, because having to cough up $2000 or more a month for health insurance is just plain crazy. This just doesn't seem right! I pray we get the health care we deserve very soon, in this country.

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    1. Betty and I have seriously considered self insuring for the last year or two before she is Medicare-eligible. Of course, if Paul Ryan has his way, Medicare will be gutted, too. Then, I think we are on our way to Canada, Mexico, or Europe.

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    2. We travel to Mexico each winter from Canada. Where we stay about 80% of the snowbirds there are from Canada, however, most of the expat residents are Americans. Many came down as early retirees for the Mexican public healthcare system, ended up liking Mexico and stayed.

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  3. Medical care should be recognised as a basic human right and not another industry set up to make profits for shareholders. Here in the UK we are looking to preserve our NHS and the fundamental principle of free health care for all as, bit by bit, services are eroded or farmed out to private enterprise. Nasty truth is though that we should all be paying more taxes to meet the cost and politicians don't want to stand for election on that one. So like you, we come into retirement with a growing need for healthcare and a growing uncertainty as to the quality or even long term existence of the service that we have depended on throughout our lives.

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    1. I guess this is a problem that extends well beyond America's borders, but our current system seems woefully out of sync with our needs.

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  4. After saying he won't touch the entitlement programs (calling them an entitlement grinds me, as I paid into them all my working life), DJT is now saying he is open to change, which I assume to be agreeing with Ryan's plan. That means privatizing Medicare. While the insurance companies are surely salivating, the rest of us are left with no idea what to expect. So yes, Bob. Uncertainty on all fronts. Rumor has it he often goes with the opinion of the last person in the room. Guess we'll have to cross our fingers.

    I retired a bit early and am still using COBRA, which has turned out to be a decent option and more affordable than self insurance or Healthcare.gov. But it runs out a year before I can use Medicare (whatever that is by then) so I'll have to purchase my own coverage. Fun times. I am fortunate to be healthy and in good shape, but none of us knows when a health problem will hit. It is causing me great anxiety. My DH is on Medicare and it's been great, although his costs are creeping up every year. Still reasonable and great care in our neck of the woods.
    --Hope

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    1. Medicare has been great for me. I am hard pressed to believe there are politicians stupid enough to try to privatize Medicare. That would be, to quote our president-elect, a disaster. That would instantly mobilize almost 54 million voters to throw the bums out.

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  5. I don't believe that Trump will actually do anything with Medicare. That would affect so many people. It would leave most senior citizens in a very difficult position. It would also leave younger people in a difficult position too...as seniors are wiped out financially, they will have parents depending on them and leaving no inheritances.

    I actually think I may have thought of something that might work and satisfy both the Dems and Rep. Currently when you sign up for Medicare you can choose a Medicare Advantage Plan. These plans get the funds from Medicare that you pay, but the insurance companies offer plans ranging from zero to a couple of hundred a month, depending on what plan you choose. In this case, Medicare is only supplying the funds. If they can make it work for senior citizens, they certainly can make it work if all people were covered! We could eliminate traditional Medicare, and everyone in the US would go on an Advantage Plan. We could raise the medicare payroll deduction a little bit on individuals and considerably more for companies, as they will no longer be paying for insurance for their employees. The government will be collecting the funds and distributing to the insurance companies. This would also replace Medicaid. Each individual will pick their own insurance plan. The insurance companies will compete for our business, we will have a choice of plans, and the government is out of the insurance business. There would be requirements of the insurance companies...no one can be rejected and a zero cost basic program must be available. You can purchase other more expensive options. It would also fix one of the biggest problems with our current system....a fee for service based system puts the financial interest with needing more services. The advantage plan type of system would give the insurance companies a set amount each month. They will receive the same amount whether you are sick or not....so the financial best interest of the insurance companies is to keep you healthy and requiring fewer services! The emphasis would shift to preventive services.

    Many details would have to be worked out, but I do believe this would satisfy both sides. That being said, I would much rather have a single payer system like Canada and other countries have.

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    1. Interesting idea. It is probably much too logical to have a chance in Washington, but with Medicare working (but underfunded), expanding it under an Advantage banner could make many of our problems go away.

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  6. Don't even get me started. My nephew is a financial genius of sorts and he has said for years that the healthcare system in the US is the top cause by far of our eventual and inevitable economic downfall. All we have to do is compare our system to other first world countries, and even some developing countries to see the contrast.

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    1. It is utterly amazing that we can be so blind in this one area that we are allowing this one problem to eventually consume virtually all of our GNP, while providing substandard care when compared to other countries.

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  7. Here's another concern.... my mother has always lived conservatively and had excellent health insurance from either her own job or as a surviving spouse in my deceased father's plan. She is also on Medicare. "Regular" health care is no problem. Last August, she had a substantial stroke and has been in rehab. Medicare covers part of the cost, but her other insurance doesn't cover the rest. I checked a bunch of other plans, just to see if we just didn't do a good job choosing, but found that, insurance does not typically cover more than Medicare does. So far, charges to her have been close to $10,000. Also, the long term effects of the stroke will likely leave her so impaired, she will need significant care for the rest of her life. The level of care she requires will likely require her to get full time skilled nursing care- a staff of full time care, as it takes two people to help her in many basic daily living tasks. That is likely to cost $8000 per month. She, like most people, cannot afford anything near that amount. Even with what I can afford to supplement her income, we will be way short. It is making me sick worrying about it. I'm not sure what the answer is, just for my family, never mind the whole nation.

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    1. You have raised an important part of the health care dilemma: long term care. Frankly, I am not sure if a Medicare supplemental plan would make much of a difference in this case, particularly if the stoke leaves long term issues of continuing care.

      Thanks for bringing this problem to light, Terri.

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  8. Bob,given the choice between massive increases in premiums, copays, and deductibles versus uncertainty, I will opt for uncertainty without hesitation!! Aren't you missing the point that the uncertainty is a function of the colossal failure of the ACA. In other words, the uncertainty is simply not knowing what will replace the ACA. I will never forget the words of the immortal Nancy Pelosi circa 2009: "we must pass this bill (the ACA) so we can see what's in it." Hence, the real problem, our leadership!

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    1. Certainly the uncertainty is both the law itself, but also the politics surrounding the bill. Whatever the reasons, the net result is those of us who must be part of the system are in a state of uncertain flux.

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  9. We had plenty of uncertainty BEFORE ACA. Every year I cringed as I waited with UNCERTAINTY to see if my health insurance company would even offer a plan.And how HIGH the premiums would be raised..the premiums went up every single year.. we had to buy our own health insurance as we were self employed.None of this is new, and it is STILL a HEALTH INSURANCE COMPANY GREED problem. Also, our patients who were covered by the workplace were given HIHGER AND HIGER deductible sand copays even single year, more money out of paycheck for see coverage.ePLENTY OF UNCERTAINTY.This is a bigger problem than ACA.

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    1. Yes it is. I was in the individual market for 30 years. Things were pretty steady and predictable until the mid 90's. I am not sure what changed but suddenly, the premium increases, doctor changes, and higher deductibles became a yearly shock.

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  10. I'm not trying to downplay the situation, but uncertainty is something we face in many areas of our lives. Future inflation, market returns, tax structures... Instead of fretting, it makes sense to focus on what you can control. For healthcare, it's your lifestyle and diet. Every time a fear of the future takes hold, we could think "What MORE could I do to make myself healthier tomorrow?". Our rates in America for heart disease, diabetes, and obesity are the highest they've ever been, and we can't blame that on our healthcare situation.

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    1. Point taken. A lot of how well we age is in our own hands and lifestyle.

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  11. There will always be uncertainties, things out of our control. However, as I read about how people are being held hostage by the health insurance system in your country, I feel grateful to be Canadian. I am happy that the tax dollars that I pay help fund equitable free basic healthcare for all. Our system isn't perfect. For example we may have to wait months to see a specialist. But we don't have to worry that the specialist's services might not be covered. The Canadian provinces that I have lived in also provide low cost drugs for seniors, and extra support for people with high drug costs or low incomes so that people needing very expensive drugs do not have to go without or go broke. We can choose which physician or specialist to see; it is not dictated by plan coverage.
    Jude

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    1. The Canadian system is so logical and puts people first. Shame on America for building its health care system on profits first, people second.

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