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

whitecoatinvestor.com

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

#151

Post by refurb »

joe_the_user wrote: post #143
WalterBright wrote: post #139

Earlier quoted context omitted.

Is it a coincidence that the industries with the most heavy government involvement - health care, education, and housing - are the most messed up with perverse incentives? Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero.

Most other advanced nations have nationalized health care which works much better. The US health care system is broken because health care is a natural monopoly that US free-market ideology dictates be run with (fake) "free markets" with result being a variety of companies profiting by abusing the system.

> Most other advanced nations have nationalized health care which works much better.

That's not true by the definition of "nationalization" (government ownership)

Switzerland and Netherlands are entirely private insurance. Most European countries have a public system and private system. It's very common for people to purchase supplemental insurance on top of what the government provides.

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

#152

Post by SilverElfin »

qwerpy wrote: post #91
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.

It’s a stealth income tax. Most high income people saw through it and opted out by buying their own LTC (which isn’t indexed to income) and then canceling it once their exemption was recorded.

I don’t understand. How is it an income tax? It’s a requirement to get a particular kind of insurance right?

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

#153

Post by refurb »

elgenie wrote: post #95
lvl155 wrote: post #12

Healthcare in the US is broken and they won’t let you fix it because the money is too good. Think about the fact that PBMs, which is there to save and manage on pharma is incentivized to promote drug price inflation. That’s just one “small” piece of this clusterf*k. It’s layers and layers of these convoluted system of incentives. As to OP, the simplest solution is to move out of the US early enough or become “poor” e…

Like 5-10% of the US's total GDP gets wasted annually on the layers and layers and layers of healthcare middlemen… for worse outcomes.

Where did you get that number from? It doesn't even pass the sniff test.

17% of GDP is spent on healthcare. Claiming 60% of that is just "middleman overhead" makes no sense when the highest European countries spend 70% of what the US spends on healthcare.

If you want an actual analysis of why US healthcare costs are higher, I'd recommend the McKinsey study that compared category spending vs OECD countries. Exhibit 2 on page 4.

https://www.mckinsey.com/~/media/mckinsey/dotcom/client_serv...

Administrative costs are way higher in the US, but it only accounts for 15% of the higher cost.

The biggest driver is outpatient care - Americans get way more healthcare and it costs more (quantity * price).

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

#154

Post by refurb »

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.…

> all free capitalism and no public intervention

Who is going to tell them?

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

#155

Post by WalterBright »

joe_the_user wrote: post #143
WalterBright wrote: post #139

Earlier quoted context omitted.

Is it a coincidence that the industries with the most heavy government involvement - health care, education, and housing - are the most messed up with perverse incentives? Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero.

Most other advanced nations have nationalized health care which works much better. The US health care system is broken because health care is a natural monopoly that US free-market ideology dictates be run with (fake) "free markets" with result being a variety of companies profiting by abusing the system.

If they're fake free markets then free market ideology doesn't apply.

> health care is a natural monopoly

It obviously isn't, because it wasn't a monopoly before the 1960s when the government got involved in it.

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

#156

Post by qwerpy »

SilverElfin wrote: post #152
qwerpy wrote: post #91

Earlier quoted context omitted.

It’s a stealth income tax. Most high income people saw through it and opted out by buying their own LTC (which isn’t indexed to income) and then canceling it once their exemption was recorded.

I don’t understand. How is it an income tax? It’s a requirement to get a particular kind of insurance right?

It's an income tax in all but name because your income is taxed a certain percentage in order to fund the benefit.

There was a brief window where you could get LTC insurance from any provider and use it to opt out of the tax. High income earners did that because it was cheaper than paying the tax and also because receiving the benefit required you to stay in WA. The opt-out window has since closed, and if you haven't opted out by now, you will forever pay that tax if you work in WA.

https://wacaresfund.wa.gov/how-it-works

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

#157

Post by bruce511 »

apwell23 wrote: post #147
joe_the_user wrote: post #143

Earlier quoted context omitted.

Most other advanced nations have nationalized health care which works much better. The US health care system is broken because health care is a natural monopoly that US free-market ideology dictates be run with (fake) "free markets" with result being a variety of companies profiting by abusing the system.

other nations get benefits from 1. US subsidizing pharma startups and 2. less people with chronic diseases 3. offer lower quality of care at lower price point 4. import doctors vs solely rely on homegrown USA is very very good at complicated, cutting edge medical care but not efficient at delivering routine care.

It's complicated, yes, but simplifying somewhat the "US" does not subsidize pharma startups.

Yes, VCs do put money into pharma, but that's private money very much expecting an (overall) profitable return. (Ironically most of that profit comes from Americans who have little or no way to collectively bargain on pricing.)

And yes, for bigger companies, there are tax breaks etc, but most of those are regular tax breaks that any company gets.

I won't get into the chronic disease stats. Other than to say that good primary Healthcare tends to reduce the incidence of chronic diseases.

Quality of care is hard to gauge on a national basis. It's a highly localized product, so experience can be different in very small geographic areas. Equally "quality of care" is s metric with many axies.

Naturally for-profit medical advertises a lot, and they strongly push the "quality of care" message. So the general perception of that is "private is better". How much of that is true, how much is perception, is up for debate. My personal experience (which counts for nothing) having experienced both, is that the standard of medical care is the same. (Fewer tvs in public care though.)

I'm not sure what importing doctors has to do with anything, or if it's even true. Personally I don't really care where a Dr is from.

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

#158

Post by conception »

apwell23 wrote: post #147
joe_the_user wrote: post #143

Earlier quoted context omitted.

Most other advanced nations have nationalized health care which works much better. The US health care system is broken because health care is a natural monopoly that US free-market ideology dictates be run with (fake) "free markets" with result being a variety of companies profiting by abusing the system.

other nations get benefits from 1. US subsidizing pharma startups and 2. less people with chronic diseases 3. offer lower quality of care at lower price point 4. import doctors vs solely rely on homegrown USA is very very good at complicated, cutting edge medical care but not efficient at delivering routine care.

“USA is very very good at complicated, cutting edge medical care” - i hear this but haven’t seen it in practice or in statistics. Everyone I know that has needed such things has had the same poor quality of care that primary care providers have - long waits, insurance issues and mediocre outcomes.

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

#159

Post by bruce511 »

llbbdd wrote: post #142
jrs235 wrote: post #135

Earlier quoted context omitted.

What free health services are available to me that I am unaware of?

How free do you want it? Emergency healthcare is free at point of service in the US. Most other healthcare is covered partially or entirely if you're employed, which you should be. I've had hundreds of thousands of dollars of inpatient medical care for my family that I paid nothing for. Every other metric just starts to deal with the impact of taxes on the definition of free. I'm sure there are countries with systems…

I agree the US system mostly works for well-employed people.

It is worth recognizing though that not all employed people get medical benefits. Indeed many minimum wage jobs, low income jobs, "casual" jobs etc come with no medical benefits.

It's also worth noting that I some states it's OK to get fired for being sick. At which point you may lose those benefits.

Plus in poor economic times (like being a federal worker right now) losing your medical because you lost your job, seems like a suboptimal outcome.

But I agree with your last statement, this system works just fine, for a large enough group, so there's little political incentive to change it.

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

#160

Post by Dilettante_ »

jancsika wrote: post #148
WalterBright wrote: post #139

Earlier quoted context omitted.

Is it a coincidence that the industries with the most heavy government involvement - health care, education, and housing - are the most messed up with perverse incentives? Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero.

> Whereas the software industry, with near zero government involvement, has had enormous improvements in function and has pushed the cost to literally zero. What's most frustrating about this-- just take the poultry industry. To bring the cost to zero, all it would take is a single hacker to steal one government-regulated chicken and click "Copy" in its elusive little context menu[1]. Try telling that to a young pers…

Sorry, but I'm completely lost on the chicken point. Would you mind expanding on that just a little more? Is the gov't keeping secret vat-grown super-chickens?
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