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Financial lessons from my family's experience with long-term care insurance

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Re: Financial lessons from my family's experience with long-term care insurance

#111

Post by llbbdd »

A_D_E_P_T wrote: post #109
Avicebron wrote: post #79

Earlier quoted context omitted.

> Really fixing it would put a double digit percentage of people out of work. I'm all for it, but I can see why politicians are hesitant. I'd love to hear what you think "really fixing it" is, please share. I can report that all (almost all?) of the hospitals and their networks both big and small in the area I am in have had layoffs this year of admin staff and healthcare professionals (nurses, doctors, etc). They ha…

> I'd love to hear what you think "really fixing it" is, please share. I'm not that poster, but there's a really easy fix: Just model the system after Hong Kong's. There's a tax-funded public system available to every citizen, so that everybody gets treatment. In practice, this is mostly utilized by the poor, and for emergencies like broken bones. You can see specialists via the public system, but there can be a wait…

Aside from the prescription part, this is exactly 1:1 how it works in the US. I say this having myself and my family utilize all of it extensively, public tax-funded emergency treatment, inpatient coverage, private doctors and specialists.

Re: Financial lessons from my family's experience with long-term care insurance

#112

Post by victorbjorklund »

silisili wrote: post #98
wahern wrote: post #93

Earlier quoted context omitted.

> I believe it is the largest industry by employment in every single state now. This made be curious, so I looked around. FWIW, healthcare constitutes ~11% of the workforce in the US. It's ~16% in Germany, ~10% in the UK, and ~5% in France. As a percentage of GDP healthcare is far higher in the US, of course.

It's actually a really hard thing to track, and BLS does a poor job of it in my opinion. That 11% covers most but not even all people at a clinic or hospital. It counts people from doctors to records specialist, but not say, janitors or IT, and nothing outside of that like insurance. And that's not necessarily wrong to do, but makes it hard to grasp the whole size. If you add in everyone in insurance, pharma, devices…

Doubt european numbers count insurance (public or private) pharmacy etc or all the jobs that support healhcare in general (powerplants, construction workers, restaurants, etc)

Re: Financial lessons from my family's experience with long-term care insurance

#113

Post by mjevans »

silisili wrote: post #98
wahern wrote: post #93

Earlier quoted context omitted.

> I believe it is the largest industry by employment in every single state now. This made be curious, so I looked around. FWIW, healthcare constitutes ~11% of the workforce in the US. It's ~16% in Germany, ~10% in the UK, and ~5% in France. As a percentage of GDP healthcare is far higher in the US, of course.

It's actually a really hard thing to track, and BLS does a poor job of it in my opinion. That 11% covers most but not even all people at a clinic or hospital. It counts people from doctors to records specialist, but not say, janitors or IT, and nothing outside of that like insurance. And that's not necessarily wrong to do, but makes it hard to grasp the whole size. If you add in everyone in insurance, pharma, devices…

It also doesn't count family members providing care for loved ones 'unpaid'.

Nor does it count any of the people who really should have more or better care but don't get it.

Re: Financial lessons from my family's experience with long-term care insurance

#114

Post by mjevans »

pyuser583 wrote: post #6
wwweston wrote: post #5

Earlier quoted context omitted.

The crucial understanding is that incentives are cross aligned because the product is risk coverage. The more immediate/pressing your need for risk coverage, the worse it is for them to sell it to you. The less you need it, the better it is for them to sell it to you and the worse for you to buy it. Pretty different than ice cream or cars or housing. Too many people just think “oh corporate greed” without thinking ab…

This is why state's have insurance commissions. In the past, insurance companies (think: liability, fire, life, shipping) responded to a claim by hiring a lawyer and negotiating down. Like most contracts. So states began creating insurance commissions, which serve as law firms that defend consumers from insurance companies. In practice, their existence forces insurance companies to pay what they are owed. We need ins…

We need to just nationalize these things as basic civic infrastructure that everyone funds as part of the social contract.

Re: Financial lessons from my family's experience with long-term care insurance

#115

Post by nothrabannosir »

vondur wrote: post #63
gruez wrote: post #8

Earlier quoted context omitted.

>The government’s gotta run it But there are plenty of countries with functioning healthcare systems that are private? The Swiss, for instance. Moreover depending on what counts as "government’s gotta run it" (paying for it? administering it? actually providing care?) you can argue that the German or even Canadian systems aren't government run, at least to some degree.

I've heard good things about the Dutch system of healthcare and that it may be adoptable to the US. I'd totally agree that healthcare corporations become non profit like Kaiser here in the US. They aren't perfect, but they seem to be better than the their for profit competitors.

Dutch system and original Romney care (and early versions of Obama care) had a lot in common. Health care providers are private, insurance companies private, gov dictates a basic list of treatments which count as "basic care" and must be covered by insurance, sets max deductible / copay etc, insurance companies are not allowed to refuse any customers, everyone must have insurance, if you can't afford it gov will pay for your insurance.

Afaik that's the gist of it. The ACA has been maimed on various fronts (e.g. the mandate "everyone must have health insurance" is no longer practically in effect), but it originally started out very similar. Far more than to, e.g., the UK's NHS which is fundamentally quite different.

Re: Financial lessons from my family's experience with long-term care insurance

#116

Post by seanmcdirmid »

lazyasciiart wrote: post #75
SilverElfin wrote: post #69

Earlier quoted context omitted.

Some states are forcing you to buy LTC insurance. I’ve heard Washington does this through some convoluted laws.

Yea, just like the country forces you to buy Medicare, except convoluted because people hate social safety nets.

Medicare provides a long term benefit as well, anyways the LTC is insolvent and is mostly a ploy to get everyone to pay for expensive unhoused neighbor care (well, the homeless industrial complex gets most of the money, it probably isn’t being used to help many). It doesn’t transfer if you ever leave the state, and doesn’t pay out very much if you ever need it.

Re: Financial lessons from my family's experience with long-term care insurance

#117

Post by mixmastamyk »

esseph wrote: post #103
mixmastamyk wrote: post #35

Earlier quoted context omitted.

Yes indeed. Part of the problem is having “insurance” draining part of the resources. Long term care means it isn’t an “accident,” but a constant recurring cost. Saving the money up front, producing income, and paying directly for what you need is often a better strategy.

I think this underestimates the "cost" of LTC. And also doesn't consider when the LTC starts. It could start at any time, even before working age.

Companies are not in business to lose money, and you have to fight them to collect. That there are some low probability exceptions is not enough in their favor imho.

Re: Financial lessons from my family's experience with long-term care insurance

#118

Post by AngryData »

kasey_junk wrote: post #89
wredcoll wrote: post #49

Earlier quoted context omitted.

Something I've run into in similar situations is the "moral necessity of punishment", sort of a reverse just-world fallacy. "There are people not good enough for health care and helping them would violate this natural order".

It’s absolutely the case that public health coverage will benefit some people who make bad health decisions at the cost to some of those who make good decisions (or the decisions themselves must be made by a central authority). That doesn’t make it the wrong policy decision. Lots of systems we happily manage with similar dynamics. But I don’t think denying that basic fact is the right path forward. The moral hazard i…

Ironically the people who make bad health decisions are often benefiting the medical system by dieing more often around retirement age rather than going on to live 20+ years past retirement with age-related healthcare problems that cost WAY more than any other health conditions they could encounter when they are younger.

Smokers for example have more lung disease and cancer which cost money to treat, but usually not until they are in their 60s so they still spend their entire life paying into the system, but then they die soon after, saving on age related healthcare costs. And that is on top of smoking disqualifying someone from many treatments and surgeries, making smokers a net-win for healthcare costs to society.

Being really fat also seems to have similar effects, although the the finances are much closer so perhaps the second order effects from being fat cancel them out. But on paper they are still a bit cheaper than the average person.

Many people will argue against it because it "feels wrong" and they think unhealthy people should be punished (for example with higher insurance fees) and don't want to admit that unhealthy people are subsidizing their own healthcare, doubly so if you add in the sin taxes they have been paying their whole life that often result in more state income than their entire life-time medical costs add up to. But there has been numerous studies across the decades in Europe and the US showing how much cheaper unhealthy people that die earlier are to care for compared to the 90 year old granny walking everyday and risking broken hips and taking 30 different medications a day.

Re: Financial lessons from my family's experience with long-term care insurance

#119

Post by EvanAnderson »

2OEH8eoCRo0 wrote: post #80
silisili wrote: post #74

Earlier quoted context omitted.

Healthcare is little more than a jobs program at this point. I believe it is the largest industry by employment in every single state now. That compounds the problem even further. Really fixing it would put a double digit percentage of people out of work. I'm all for it, but I can see why politicians are hesitant.

My father's doctor says she doesn't want healthcare reform or more doctors because then their salaries will tank.

This was the reason behind the AMA lobbying for the freeze on federally-funded residency slots back in the mid-90s (which is still being felt today, even after AMA has changed their tune).

Re: Financial lessons from my family's experience with long-term care insurance

#120

Post by Spooky23 »

gosub100 wrote: post #47
Spooky23 wrote: post #43

Earlier quoted context omitted.

Because your congressman gets lots of donations from doctors and hospitals. Doctors like to drive fancy cars. In places with Catholics, you usually get the bishops advocating for the local Catholic hospital system.

So government (my congressman) IS the problem! Thanks for reinforcing what Reagan said 40 years ago.

Ironically, your guy Reagan was paid and supported by the AMA to fight “socialized medicine” and increasing the number of doctors in the 1960s.
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