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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

#121

Post by A_D_E_P_T »

llbbdd wrote: post #111
A_D_E_P_T wrote: post #109

Earlier quoted context omitted.

> 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.

The public system in Hong Kong doesn't really cost anything. It's not that you get costs "waived" if you whine hard enough that you ought to be a charity case (which, by the way, is degrading,) and it's not that costs are passed on to a middleman. Medical treatment is transparently priced and simply inexpensive -- so it's simply not a cause of bankruptcy in Hong Kong, whereas, in the US...

> https://worldpopulationreview.com/country-rankings/medical-b...

Also, perhaps because it's a lot more laissez faire, the private system in Hong Kong is almost unimaginably superior to the private system in the US. It's far cheaper because pricing is transparent and most people pay cash! (Cutting out that middleman.) It's higher quality because there's a lot more competition, rather than collusion among a few major providers.

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

#122

Post by casenmgreen »

Avicebron wrote: post #79
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.

> 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…

In the UK, with the NHS, it seems the focus of the NHS became management, rather than clinical care. One example I read of stuck with me; a superb nurse, who ran her ward extremely well, had to leave clinical nursing because as a career path, it was a dead end. She had to move into management, and her former ward descended into chaos.

NHS budget has last I knew increased many times over since 1948, but the bed count went from about 450k down to about 100k - and those numbers were from more than ten years ago.

A theory is presented to explain this, which is that the more money you put in, the more management you get, and the more management you get, the less time clinical staff have for clinical work; more money results in less clinical output - but more managerial output, which theory argues is the primary focus and product of NHS.

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

#123

Post by Seattle3503 »

forrestthewoods wrote: post #66
dehrmann wrote: post #45

> they each paid about $14,000 in annual premiums for 10 years, and the daily benefit started at $200 per day. Insurance companies have to make money, but that's not that good of a deal, and the payout isn't that high ($73k annually) considering you won't be doing much else.

$140,000 in premium and $73,000/year in payout seems like a terrible deal for the insurance company. Two sets of my grandparents have needed daily helpers for years . And that’s just for regular day to day care. Not in response to a particular trauma.

It is a terrible deal. Most don't offer LTC insurance anymore.

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

#124

Post by mhb »

There's another interesting twist to this. The insurance company is willing to pay a certain hourly rate to home health care providers. There is a limited number of health care providers willing to work for this rate. Supplementing the rate is not permitted. Lo and behold, it is sometimes not possible to find a health care provider which the insurance will pay for.

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

#125

Post by pkaye »

mjevans wrote: post #113
silisili wrote: post #98

Earlier quoted context omitted.

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.

Do other countries do it?

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

#126

Post by tsoukase »

From the European POV this is awful and marginally scary. A commenter down the article writes that she is gonna sell her mother's house in order to serve her and even that will not last long.

The way US health care functions is an argument that the nation's principles (all free capitalism and no public intervention) are problematic.

If I were POTUS for a season, I would make a volcanic erruption in the health system. If I needed to care an elder without insurance, I would pay out of pocket a willing friend or even a homeless and not proceed to euthanasia as a commenter suggested.

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

#127

Post by missedthecue »

forrestthewoods wrote: post #66
dehrmann wrote: post #45

> they each paid about $14,000 in annual premiums for 10 years, and the daily benefit started at $200 per day. Insurance companies have to make money, but that's not that good of a deal, and the payout isn't that high ($73k annually) considering you won't be doing much else.

$140,000 in premium and $73,000/year in payout seems like a terrible deal for the insurance company. Two sets of my grandparents have needed daily helpers for years . And that’s just for regular day to day care. Not in response to a particular trauma.

LTC policies are such a bad deal they almost bankrupted General Electric.

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

#128

Post by wat10000 »

tsoukase wrote: post #126

From the European POV this is awful and marginally scary. A commenter down the article writes that she is gonna sell her mother's house in order to serve her and even that will not last long. The way US health care functions is an argument that the nation's principles (all free capitalism and no public intervention) are problematic. If I were POTUS for a season, I would make a volcanic erruption in the health system.…

We have a ton of public intervention in health, it’s just not very well done. The US government spends more per capita on health care than other developed countries, while covering only a fraction of the population. We’ve had universal health care for almost forty years, it’s just bad and nobody wants to call it that. A law called EMTALA says hospital emergency rooms can’t turn people away for being unable to pay, so anyone can get care, just in a very inefficient way. Properly covering everybody is Socialism(tm) and therefore isn’t in the cards.

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

#129

Post by wat10000 »

SoftTalker wrote: post #65
dehrmann wrote: post #45

> they each paid about $14,000 in annual premiums for 10 years, and the daily benefit started at $200 per day. Insurance companies have to make money, but that's not that good of a deal, and the payout isn't that high ($73k annually) considering you won't be doing much else.

Consider also that by the time you need a nursing home or some other form of continual skilled care you are probably going to die within that year. "Long-Term" is sort of a scare tactic that is used to get you imagining that you're going to be needing expensive skilled care for years. That can happen, but isn't normal.

“That can happen but isn’t normal” is exactly the kind of thing that insurance should be for. Unfortunately, US health insurance is more oriented towards covering everything rather than spreading out the risk of rare high-cost events.

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

#130

Post by pkaye »

gosub100 wrote: post #48
aerostable_slug wrote: post #44

Earlier quoted context omitted.

We've done that to some extent via the legal enablement of nurse practitioner and physician assistant led care. Of course, largely speaking all they do is supervise the recording of patient metrics and prescribe drugs in label-consistent ways, but that often works out reasonably well for the patient. When the patient needs specialty care then the NP or PA simply punts them into the winds of referrals and insurance ju…

Why not open more medical schools? And eliminate the matching system? If you want to be an ____-ologist, here is the list of requirements. Meet the requirements and you are the ___ologist. Not whether or not a practice group likes you, or your parents knew which colleague to talk to. Don't allow the supply of MDs to be constrained.

The bigger restriction is number of residency positions which has been limited by government funding constraints. Also you need sufficient skilled doctors to train these residents. There is also the issue of physician burnout and preferences of doctors to be specialist vs being in primary care. So what often happens is foreign medical grads apply for these kind of roles. Also foreign medical doctors have a couple of requirements to work in the US. Get their foreign degree reviews to meet requirements, pass the US medical exams and finally they have to redo their residency even if they have significant experience. Some of this is largely controlled at the state level. Some states are considering loosening the residency part to a shorter period for primary care position for foreign doctors that are willing to work in underserved areas. I know California is also reducing restrictions on foreign dentists.
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