[Snow-i]

When I was in elementary school we took a field trip to meet Dr Carson as he spoke to several young schools. This was before he separated the twins and became nationally recognized. He's always been a role model of mine - a truly remarkable person when you look at where he came from and what he's accomplished.

Some have suggested him as a 2016 presidential candidate, and based on his views and messages, I would vote for him in a second. He hasn't ruled out running - he's not a career politician and IMO might be just what this country needs to break the "business as usual" in washington thats driving our country into the ground.

What's your take on Dr Carson as a whole?

[subego]

I know nothing!

[Chongo]

Enjoy.

Dr. Benjamin Carson Epic Full Speech at National Prayer Breakfast

[subego]

I was hoping for something more textual.

[ebuddy]

Originally Posted by subego 

I was hoping for something more textual.

You too? I hate it when people (not directed at you Chongo) post videos in response to a question or query for information. Of course, there's always this as a starting point.

*edited to include -- okay... then I watched it.

[subego]

I checked that out. It didn't really give me much to go on.

27 minutes is a long time. I could (and would) read a transcript in probably a third of that time.

[The Final Dakar]

Jesus, conservatives didn't even wait for Rubio's watery corpse to get cold before introducing the next guy. Kind of hilarious.

[shifuimam]

Ben Carson's done some really good stuff in the world of medicine, but how does that qualify him to lead a country?

What's his take on foreign policy? Social security? Is he only interested in radical changes that will never make it through Congress?

[ebuddy]

Originally Posted by The Final Dakar 

Jesus, conservatives didn't even wait for Rubio's watery corpse to get cold before introducing the next guy. Kind of hilarious.

Do liberals line them up one by one or something? I don't see what's so humorous about a couple of different people from the right getting face-time.

Watery corpse? Rubio? Nonsense.

[ebuddy]

Originally Posted by shifuimam 

Ben Carson's done some really good stuff in the world of medicine, but how does that qualify him to lead a country?

What's his take on foreign policy? Social security? Is he only interested in radical changes that will never make it through Congress?

This was a prayer breakfast and I'm not sure what his style is in a more secular forum, but you can have radical ideas, campaign on pragmatism, and steadily move the country in the proper direction from your office. You just need buy-in or... sold-in. I think one of Carson's problems is that he's only slightly more interesting to listen to than Al Gore and of course, your first question. I think we overplay the importance of politics, but it is certainly a relevant experience.

[The Final Dakar]

Originally Posted by ebuddy 

Do liberals line them up one by one or something? I don't see what's so humorous about a couple of different people from the right getting face-time.

Carson wouldn't be getting facetime if Rubio's SOTU response had gone well.

Originally Posted by ebuddy 

Watery corpse? Rubio? Nonsense.

[shifuimam]

I'm not sure why he's getting so much attention for what he said. The guy is a very conservative Christian - accdg. to Wikipedia, his family is a member of the Seventh-Day Adventist Church. They're fringe even by mainstream conservative Christian standards. It should be no surprise that he's on the far right politically.

[The Final Dakar]

What did he say anyway? OP didn't even include a link as to what inspired the thread. (And no, a video doesn't count. How about an article on the video or a profile?)

[Snow-i]

Originally Posted by shifuimam 

I'm not sure why he's getting so much attention for what he said. The guy is a very conservative Christian - accdg. to Wikipedia, his family is a member of the Seventh-Day Adventist Church. They're fringe even by mainstream conservative Christian standards. It should be no surprise that he's on the far right politically.

He really isn't all that far-right in politics, nor is he fringe in his religion. He is, however, an internationally recognized pediatric neurosurgeon responsible for great advancement in pediatric medicinal capability. He also oversees the world's best pediatric hospital in John's Hopkins.

Out of his entire wiki page, that's the only line you read/thought was important?

[ebuddy]

Originally Posted by The Final Dakar 

Carson wouldn't be getting facetime if Rubio's SOTU response had gone well.

This must explain the quality of Obama's SOTU and why we're seeing so much more Tiger Woods and Andrew Cuomo.

[shifuimam]

Originally Posted by Snow-i 

He really isn't all that far-right in politics, nor is he fringe in his religion. He is, however, an internationally recognized pediatric neurosurgeon responsible for great advancement in pediatric medicinal capability. He also oversees the world's best pediatric hospital in John's Hopkins.

Out of his entire wiki page, that's the only line you read/thought was important?

No, I also remember learning about him when I was a kid. The guy is pretty well known to be very Christian and religious, and he's used as a teaching point in Sunday School for little kids. You know, follow your dreams, be all you can be, love Jesus, etc.

It also happens to be that the SDA church is pretty fringe, whether you think so or not. My point is that it's funny to me when famous people get ragged on - or put in the spotlight - because of something they say, simply because it's politically conservative. It should be no surprise that a conservative religious man would have conservative political views, regardless of how famous he is. Same goes for the Chick-Fil-A incident.

[The Final Dakar]

Originally Posted by ebuddy 

This must explain the quality of Obama's SOTU and why we're seeing so much more Tiger Woods and Andrew Cuomo.

I imagine this is some type of sarcasm that is supposed to highlight the error in my logic, but the references are completely lost on me.

[besson3c]

He believes in flat tax, which is highly impractical, and he believes that health care should be paid for with health savings accounts, also impractical.

He sounds like he'd be good to have in debates, but like Ron Paul, if his other positions are along these lines he's probably unelectable.

[Snow-i]

Originally Posted by besson3c 

He believes in flat tax, which is highly impractical, and he believes that health care should be paid for with health savings accounts, also impractical.

How so?

A Flat tax would go a long way to solve the mess of a tax system that we have now. It would reduce the power of the establishment politicians, though, so it would be very hard to implement.

HSA's would also give people the option of caring for themselves over their lives, and encourage responsible choices. I like the idea. That's not to say there wouldn't be safety nets for people, as Dr Carson himself is a proponent of. I would like to see some modifications to HSA's though. The only reason I don't have one is any money left in the HSA at the end of the year is forfeited to the government, which IMO is the dumbest thing in the world.

EDIT: sorry, I was referring to FSAs which don't rollover.

He sounds like he'd be good to have in debates, but like Ron Paul, if his other positions are along these lines he's probably unelectable.

There's nothing really in this to address. His positions are common sense and IMO, highly practical. What's clear is that the current system is unsustainable and serves to increase the disparity between government dependent low-income families and the rich. Giving a means for people to care for themselves, vs having the government do it is a much better position to hold.

[besson3c]

Originally Posted by Snow-i 

How so?

A Flat tax would go a long way to solve the mess of a tax system that we have now. It would reduce the power of the establishment politicians, though, so it would be very hard to implement.

It would also be hard to implement because it would be highly impractical if we're interested in reducing our debt and improving our economy.

Increasing the tax rate of the lower/middle class income brackets means they have less money to spend on things. Having hordes and hordes of middle class people spending their money on toke is what drives the economy, you don't pinch them. We're dependent on enabling these hordes and hordes of middle class people spending money on toke by relying on revenue from the wealthy, many of which have made their wealth from these same hordes of people.

I think you'll find that most economists and even wealthy elites like Warren Buffet would say that it makes sense to ask the rich to pay more.

What the flat tax argument does is appeals to emotions and this concept of equality, which sounds great and feels great, but when it comes down to it this is simply math, and the math doesn't support these ideas.

HSA's would also give people the option of caring for themselves over their lives, and encourage responsible choices. I like the idea. That's not to say there wouldn't be safety nets for people, as Dr Carson himself is a proponent of.

You sound like Turtle. People are not responsible, and they never will be. If there are safety nets for people, at least the idea is more realistic, but it can't be built around this principle that people can be encouraged to be responsible.

Moreover, this whole thing is framed erroneously.

The word "responsible" is simply an inappropriate word to use, in many cases. Sometimes unaffordable health care costs are not the result of irresponsibility, but bad luck. The costs of paying for conditions like cancer are simply ridiculous, especially if you get cancer at an early age, and they're especially ridiculous for conditions that require ongoing treatment. There is a certain point where no reasonable person ought to expect somebody who isn't quite wealthy to be able to afford these costs, taking responsibility out of the equation entirely (unless it is irresponsible to not become wealthy).

I would argue that costs are debilitating to both the responsible and irresponsible more often than people being unable to pay for their costs because of irresponsibility. Therefore, I think this whole concept of irresponsibility is just another emotional way of thinking about this that is targeted at those who for whatever reason would prefer not to confront the reality of health care costs being completely out-of-hand.

There's nothing really in this to address. His positions are common sense and IMO, highly practical. What's clear is that the current system is unsustainable and serves to increase the disparity between government dependent low-income families and the rich. Giving a means for people to care for themselves, vs having the government do it is a much better position to hold.

Maybe you could point out a position of his that is common sense and practical, because these two positions certain't aren't.

[besson3c]

You know what I've never understood about this "encourage people to be responsible" argument? This argument often comes up around encouraging economic responsibility, but many of these same people detest the government doing things to discourage obesity, smoking, not wearing seat belts, whatever else. They say that they don't want the government to be a nanny government.

Why is it that encouraging financial responsibility is not a nanny government? If you believe that the government has it in them to encourage and produce responsibility, at what point does a government become a nanny government in doing this?

[Snow-i]

Originally Posted by besson3c 

It would also be hard to implement because it would be highly impractical if we're interested in reducing our debt and improving our economy.

Increasing the tax rate of the lower/middle class income brackets means they have less money to spend on things. Having hordes and hordes of middle class people spending their money on toke is what drives the economy, you don't pinch them. We're dependent on enabling these hordes and hordes of middle class people spending money on toke by relying on revenue from the wealthy, many of which have made their wealth from these same hordes of people.

I think you'll find that most economists and even wealthy elites like Warren Buffet would say that it makes sense to ask the rich to pay more.

What the flat tax argument does is appeals to emotions and this concept of equality, which sounds great and feels great, but when it comes down to it this is simply math, and the math doesn't support these ideas.

How would it increase the tax burden of low-middle income families? I think it would actually decrease their burden, as deductions for low and middle income families could allow them to avoid high effective tax rates during times of financial stress. I'm actually far more enamored with the fair tax, but thats just me. Can you cite your claim that "the math doesn't work"?

You sound like Turtle. People are not responsible, and they never will be. If there are safety nets for people, at least the idea is more realistic, but it can't be built around this principle that people can be encouraged to be responsible.

Thats defeatist bullshit, besson. People are responsible when they need to be responsible. When you remove the need, the motivation isn't there.

Moreover, this whole thing is framed erroneously.

The word "responsible" is simply an inappropriate word to use, in many cases. Sometimes unaffordable health care costs are not the result of irresponsibility, but bad luck. The costs of paying for conditions like cancer are simply ridiculous, especially if you get cancer at an early age, and they're especially ridiculous for conditions that require ongoing treatment. There is a certain point where no reasonable person ought to expect somebody who isn't quite wealthy to be able to afford these costs, taking responsibility out of the equation entirely (unless it is irresponsible to not become wealthy).

We can't regulate bad luck, besson. No one is suggesting removing the safety nets for people in these situations. What we're suggesting is creating a solvent system that removes the taxpayers burden on paying for everyone and using the safety nets on the people who really need it.

I would argue that costs are debilitating to both the responsible and irresponsible more often than people being unable to pay for their costs because of irresponsibility. Therefore, I think this whole concept of irresponsibility is just another emotional way of thinking about this that is targeted at those who for whatever reason would prefer not to confront the reality of health care costs being completely out-of-hand.

Strawman much? No one has suggested removing safety nets for these people. The safety net should be the exception not the rule, however.

Maybe you could point out a position of his that is common sense and practical, because these two positions certain't aren't.

You haven't really shown why these two points aren't practical, you've just given definitions against a strawman argument about people who can't afford the treatment they need. That's exactly what his proposal is designed to address. Considering his tenure as a neurosurgeon and hospital administrator, I believe he is one of the most qualified people in the country to weigh in on the healthcare debate.

[besson3c]

Originally Posted by Snow-i 

How would it increase the tax burden of low-middle income families? I think it would actually decrease their burden, as deductions for low and middle income families could allow them to avoid high effective tax rates during times of financial stress. I'm actually far more enamored with the fair tax, but thats just me. Can you cite your claim that "the math doesn't work"?

Low-middle income families have very low tax rates because of how the current tax system is designed. If you impose a flat tax, that means that you need to set the tax rate at whatever amount is necessary to produce the revenue you need. As the name implies, this means reducing the tax bracket on the wealthy, and increasing it on the poor. You can't just set the tax rate to be what the poor are paying now across the board.

Isn't this common sense?

Thats defeatist bullshit, besson. People are responsible when they need to be responsible. When you remove the need, the motivation isn't there.

Incentives can help, but nobody is going to set aside a gazillion dollars in their 20s in the off-chance they'll get Chinese Monkey Pox in their 60s. This is not a matter of responsibility, this is a matter of health care costs being completely unpredictable, with the potential for them to be extremely high. In other words, incentives work when there is an immediate, clear payoff.

On top of this, costs have been increasing, so even if you could predict the future and knew you were going to get cancer in your 60s, you still wouldn't know what it would cost to treat cancer 40 years in the future.

We can't regulate bad luck, besson. No one is suggesting removing the safety nets for people in these situations. What we're suggesting is creating a solvent system that removes the taxpayers burden on paying for everyone and using the safety nets on the people who really need it.

Strawman much? No one has suggested removing safety nets for these people. The safety net should be the exception not the rule, however.

I'm glad we agree that the safety nets are necessary, but they better be very resilient, and we better count on them being hammered.

I'm far more interested in cost controls to prevent health care costs from going bananas, and the only way I can see that is with a single payer system.

You haven't really shown why these two points aren't practical, you've just given definitions against a strawman argument about people who can't afford the treatment they need. That's exactly what his proposal is designed to address. Considering his tenure as a neurosurgeon and hospital administrator, I believe he is one of the most qualified people in the country to weigh in on the healthcare debate.

Like Mitt Romney was on of the most qualified people to be in charge of our national economy, but Warren Buffet's ideas are rubbish? I'm not saying that this is your viewpoint, but my point is that there are lots of experts with lots of different opinions.

[Snow-i]

Originally Posted by besson3c 

Low-middle income families have very low tax rates because of how the current tax system is designed. If you impose a flat tax, that means that you need to set the tax rate at whatever amount is necessary to produce the revenue you need. As the name implies, this means reducing the tax bracket on the wealthy, and increasing it on the poor. You can't just set the tax rate to be what the poor are paying now across the board.

Isn't this common sense?

Well, no. The idea of a flat tax inherently means deductions for those less fortunate. Meaning we set the poverty rate at say $25,000 per year. The low-middle income earners wouldn't pay taxes on that 25k a year, meaning their effecting tax rate would be small compared to top earners.

Incentives can help, but nobody is going to set aside a gazillion dollars in their 20s in the off-chance they'll get Chinese Monkey Pox in their 60s. This is not a matter of responsibility, this is a matter of health care costs being completely unpredictable, with the potential for them to be extremely high. In other words, incentives work when there is an immediate, clear payoff.

Dr Carson's plan specifically encourages an HSA at birth which would allow parents to contribute early and like an IRA, by the time the child is 60 the account would be enormous thanks to compounding interest and investment.

On top of this, costs have been increasing, so even if you could predict the future and knew you were going to get cancer in your 60s, you still wouldn't know what it would cost to treat cancer 40 years in the future.

Costs are increasing because the buyer is removed from the process. This would encourage people to shop around allowing the free market principle to drive costs down considerably. There's no reason a toilet seat should cost $600 now like the gov't pays for.

I'm glad we agree that the safety nets are necessary, but they better be very resilient, and we better count on them being hammered.

The only way to ensure their resiliency is with a solvent system - something we lack now.

I'm far more interested in cost controls to prevent health care costs from going bananas, and the only way I can see that is with a single payer system.

The opposite. The only way to ensure cost control is encouraging people to be smart with their money. As doctor Carson put it, 80% of ER visits which cost $1000 dollars could be handled by outpatient clinics which cost 15% of that. If the patient isn't paying for them, why not take the ambulance? Around here there are several 24 hour clinics which are about $80 per visit. I don't have healthcare aside from catastrophic, so I make use of that. I pay $40 a month for health insurance and another 4-500 or so in visits. That's a far cry from the 5-600 a month I'd need for a healthcare plan that covers my needs. Should something catastrophic happen to me, I'd have a $12k deductible then all the care I'd need. Its insurance, not a healthcare plan.

Like Mitt Romney was on of the most qualified people to be in charge of our national economy, but Warren Buffet's ideas are rubbish? I'm not saying that this is your viewpoint, but my point is that there are lots of experts with lots of different opinions.

Yes, but that point isn't in dispute nor does it counter any of my arguments for Dr Carson. I.e. a strawman.

[besson3c]

Originally Posted by Snow-i 

Well, no. The idea of a flat tax inherently means deductions for those less fortunate. Meaning we set the poverty rate at say $25,000 per year. The low-middle income earners wouldn't pay taxes on that 25k a year, meaning their effecting tax rate would be small compared to top earners.

So for low income people, their first $25,000 is tax free, but for everybody else they pay tax on that first $25,000?

Dr Carson's plan specifically encourages an HSA at birth which would allow parents to contribute early and like an IRA, by the time the child is 60 the account would be enormous thanks to compounding interest and investment.

I'm not against this, but I just don't think that it alone will be anywhere near sufficient. There has been nothing stopping people from investing their own money this same way today, and if you mean "encourage" people as in not force, what would this provide that somebody couldn't do today, beside marketing and perhaps not paying tax on these contributions?

By the name the child is 60 this account would only be enormous if the child was lucky and didn't have health problems. A single chronic, ongoing condition in with today's costs could virtually deplete these savings for many families in a heartbeat.

Costs are increasing because the buyer is removed from the process. This would encourage people to shop around allowing the free market principle to drive costs down considerably. There's no reason a toilet seat should cost $600 now like the gov't pays for.

This whole idea of shopping around is silly.

You shop around when you know what you need. The whole point of insurance is that it protects you from the unknown. You can shop around for a giant policy if you think you'll be coming into heavy expenses, many people do, but you're still just rolling the dice.

If you mean shopping around as in moving beyond insurance policies, there is no time to shop around when you have just had a car accident and you are headed off to the ER. It's also a horrible time to be shopping around from an emotional/stress position.

The opposite. The only way to ensure cost control is encouraging people to be smart with their money. As doctor Carson put it, 80% of ER visits which cost $1000 dollars could be handled by outpatient clinics which cost 15% of that. If the patient isn't paying for them, why not take the ambulance? Around here there are several 24 hour clinics which are about $80 per visit. I don't have healthcare aside from catastrophic, so I make use of that. I pay $40 a month for health insurance and another 4-500 or so in visits. That's a far cry from the 5-600 a month I'd need for a healthcare plan that covers my needs. Should something catastrophic happen to me, I'd have a $12k deductible then all the care I'd need. Its insurance, not a healthcare plan.

We are in the same boat then, although you are lucky if you are paying $40 a month for basic insurance, I'm paying $225/month. I don't remember exactly what my deductible is, but it's probably close to yours.

What does "being smart" have to do with unpredictable catastrophes and controlling costs?

[Snow-i]

Originally Posted by besson3c 

So for low income people, their first $25,000 is tax free, but for everybody else they pay tax on that first $25,000?

Everyone would get the deduction for their first 25k (i just used this number, btw). High earners would pay a higher tax because more of their income would be tax eligible. There could also be deductions for education, HSAs, etc.

I'm not against this, but I just don't think that it alone will be anywhere near sufficient. There has been nothing stopping people from investing their own money this same way today, and if you mean "encourage" people as in not force, what would this provide that somebody couldn't do today, beside marketing and perhaps not paying tax on these contributions?

I would not be opposed to setting this account up automatically upon birth, and requiring hospitals and doctors to make the parents aware.

By the name the child is 60 this account would only be enormous if the child was lucky and didn't have health problems. A single chronic, ongoing condition in with today's costs could virtually deplete these savings for many families in a heartbeat.

So this person could qualify for the safety net.

This whole idea of shopping around is silly.

You shop around when you know what you need. The whole point of insurance is that it protects you from the unknown. You can shop around for a giant policy if you think you'll be coming into heavy expenses, many people do, but you're still just rolling the dice.

As opposed to what we have today, where you shop around without regard to cost?

If you mean shopping around as in moving beyond insurance policies, there is no time to shop around when you have just had a car accident and you are headed off to the ER. It's also a horrible time to be shopping around from an emotional/stress position.

You generally don't shop around for an ER visit, but this is the point of insurance. Outpatient care is another story. We need to make that distinction. Insurance should not cover outpatient care, only emergencies and catastrophic health issues. Requiring a high deductible (say 500) for the ER visit could go a long way towards reducing unnecessary costs.

We are in the same boat then, although you are lucky if you are paying $40 a month for basic insurance, I'm paying $225/month. I don't remember exactly what my deductible is, but it's probably close to yours.

Yes, and the center I go to charges twice as much to insurance companies as they do to the uninsured. Do you think thats reasonable? Two different prices as to whether I'm paying out of pocket or my insurance co. is covering the bill. Under a healthcare planI'm still paying them the higher prices via insurance premiums - its just financed over the long term.

What does "being smart" have to do with unpredictable catastrophes and controlling costs?

Everything.

[besson3c]

Originally Posted by Snow-i 

Everyone would get the deduction for their first 25k (i just used this number, btw). High earners would pay a higher tax because more of their income would be tax eligible. There could also be deductions for education, HSAs, etc.

So then we would still be asking lower/middle income earners to pay more because the first income bracket in our current tax system is also currently tax free.

I would not be opposed to setting this account up automatically upon birth, and requiring hospitals and doctors to make the parents aware.

Nor I, so long as these safety nets are robust and not just an afterthought.

As opposed to what we have today, where you shop around without regard to cost? :brick

The point is that we can't really shop around, because we don't know what we need, and we won't know until we need it. Insurance helps with catastrophes, and having some is smart, but having one particular plan rather than another is not "smart", it is just guesswork.

You generally don't shop around for an ER visit, but this is the point of insurance. Outpatient care is another story. We need to make that distinction. Insurance should not cover outpatient care, only emergencies and catastrophic health issues. Requiring a high deductible (say 500) for the ER visit could go a long way towards reducing unnecessary costs.

I'm not sure we are understanding each other here.

Do you think thats reasonable? Two different prices as to whether I'm paying out of pocket or my insurance co. is covering the bill. Under a healthcare planI'm still paying them the higher prices via insurance premiums - its just financed over the long term.

I don't know, to be honest I'm pretty much numb to this whole racket and tired of it. This will definitely be what I miss least about my move to Canada.

Everything.

Explain then? I maintain that the only "smart" is having some insurance to soften the blow, but beyond this it is just guesswork, and it is literally impossible to plan for future health care costs in a "smart" way. How much should one set aside? What is smart, exactly? Just some random wad of money?

[ebuddy]

This is where I think people go wrong in their thinking. You don't need insurance, you need health care. As you know, there is no guarantee of coverage no matter where you're getting the insurance be it the government or the private market. The average bankruptcy filing due to health care expenditures for example is $11k and yet the US consumer spends this in two years of dining out and entertainment. The answer IMO is an HSA and compatible catastrophic and/or gap-plan that the government can contribute to if necessary, an employer, or a parent... because money will always talk. You are the consumer of the health care provider; not the government and not an insurance company.

[besson3c]

Originally Posted by ebuddy 

This is where I think people go wrong in their thinking. You don't need insurance, you need health care. As you know, there is no guarantee of coverage no matter where you're getting the insurance be it the government or the private market. The average bankruptcy filing due to health care expenditures for example is $11k and yet the US consumer spends this in two years of dining out and entertainment. The answer IMO is an HSA and compatible catastrophic and/or gap-plan that the government can contribute to if necessary, an employer, or a parent... because money will always talk. You are the consumer of the health care provider; not the government and not an insurance company.

How does one get health care without tacking the insurance thing, and how does one budget for health care costs when these are by nature unpredictable and constantly inflating?

Also, your numbers are off. According to this, in 2011 consumers spent an average of $2600/year on entertainment:

CONSUMER EXPENDITURES--2011

[Shaddim]

Originally Posted by besson3c 

How does one get health care without tacking the insurance thing, and how does one budget for health care costs when these are by nature unpredictable and constantly inflating?

Also, your numbers are off. According to this, in 2011 consumers spent an average of $2600/year on entertainment:

CONSUMER EXPENDITURES--2011

According to your link, eating out and entertainment, which is what ebuddy was pointing out, is >$10k for 2 years. Looks clear to me.

[besson3c]

You're right.

That's a pretty crazy number, how could one spend $2600/year on average in eating out and nearly $4000 for groceries? I guess it adds up if you have kids.

[ebuddy]

Originally Posted by besson3c 

How does one get health care without tacking the insurance thing, and how does one budget for health care costs when these are by nature unpredictable and constantly inflating?

How can anyone? There's no magic formula here just because you're a registered insurance company. The reason they have actuaries that crunch complicated math is because they do not know you. You pay a premium into the insurer and they use your money in various investment strategies that earn them money to help keep the premiums down. The whole purpose of this is greater cost controls to begin reversing the trend of skyrocketing health care costs in charging you what they do simply because they can. Obamacare isn't health care reform, it's health care insurance reform and doesn't do a thing for controlling the costs of health care. Unpredictable expenses are exactly what savings accounts are for.

[besson3c]

Originally Posted by ebuddy 

How can anyone? There's no magic formula here just because you're a registered insurance company. The reason they have actuaries that crunch complicated math is because they do not know you. You pay a premium into the insurer and they use your money in various investment strategies that earn them money to help keep the premiums down. The whole purpose of this is greater cost controls to begin reversing the trend of skyrocketing health care costs in charging you what they do simply because they can. Obamacare isn't health care reform, it's health care insurance reform and doesn't do a thing for controlling the costs of health care. Unpredictable expenses are exactly what savings accounts are for.

I agree, that is why I'm not a fan of health insurance. Insurance works best for accidents with remotely predictable damage.

Snow-i, your posting offended me a little bit, but I realize that was not your intent, and that you may not have had the experiences that I've had.

We've had several family members die in the last few years. My wife's grandma's death was a very slow and money-draining process. She was a very responsible lady and worked at a steady job making a middle class income for many years. She had no debt, owned a house, did not smoke, nor had any other red flags or aspects to her life that one would find particularly unusual. The nature of her death was not unusual or involving a rare condition other than severe arthritis and old age, and earlier heart failure. However, by the end of her life in addition to her old age home we were paying several thousand dollars a month for her health care alone. She was unable to do many things on her own towards the end of her life, and although her family lived close by, she needed 24/7 care particularly towards the end.

The other deaths in our family were quick and therefore inexpensive, but this slow death was absolutely miserable, and has greatly colored why I have such a low, low, low opinion of the health care situation in this country. We drained all of her assets in paying for her care, and my wife's Mom had to use some of her own. Because my wife's grandma was not senile, she was aware that she was using her daughter's money, would leave no inheritance to her kids, and particularly with the pain meds that made her woozy towards the end the whole paying for health care thing was a constant source of stress. It was extremely frustrating for me knowing that if she lived in Canada the end of her life would have been far, far, far more pleasant.

My wife's Grandma was eligible for Medicare, but these payments alone were insufficient. She was even receiving veteran's benefits because her husband who had passed away served. This, her social security, personal savings, sale of her house, and Medicare were still not enough. With these slow deaths, you could be spending over $4-5000/month for stuff towards the end, if not more. Her needs were covered several years ago, but they just kept on building and progressing slowly until they became overwhelming.

My point in all of this is that it is a little offensive to come at this from a responsibility vantage point. Sure there are irresponsible people. Like I said, you can't cure irresponsibility, I might literally be the most cynical person on this board about the responsibility level of people. However, there are also responsible people that can't afford their health care, and there is no system of having extra investment accounts like an HSA that will work in these cases. It is frankly an embarrassment how ill-equipped we are as a country to deal with these sorts of health care needs. I don't know what sort of percentage of deaths come from a long journey like this, but surely this can't be all that uncommon?

[ebuddy]

I remember you having brought this up before besson3c and again, I'm sorry for you and your wife's loss, but you're going to have the same problems with this example that you had when you first brought it up. And invariably, the anecdote is offered and then a little blibbet on how much better the scenario would've been in Canada. I'm going to take a look at that claim, but first -- some perspective;

• $4000-$5000/month: A recent Mt Sinai School of Medicine Study found that out-of-pocket expenses for Medicare recipients during the five years before their death averaged approximately $39,000.00 for individuals. You stated that your grandmother in-law was not facing a rare or exceptional case and yet with Medicare picking up 85% of the tab and Veterans' Care assuming another portion of the cost; you were still shelling out $4000-$5000/month? How on earth did this happen? With both Medicare and Veterans' Care and for a case you claim was not extraordinary; you managed to pay nearly $10k more than the average end-of-life, out-of-pocket expenses for five years of care before death, but in just one year's time? With all due respect, your numbers just don't come close to adding up here.
• Now the claim - "It'd be so much better in Canada": In Canada, only 16 to 30% of those who die receive specialized hospice or end-of-life care. The National Hospice and Palliative Care Organization estimates that 36% of all US individuals who died in 2006 were enrolled in a hospice program.
• Both the US and Canada rank ninth in The Quality of Death Ranking for End-of-Life Care.

I have a huge problem with your math and your conclusion is not based on any substantial evidence. There is absolutely zero basis for the claim that your grandmother-in-law would've fared much, much better and in fact the odds are she would've fared much, much worse.

[besson3c]

Originally Posted by ebuddy 

I remember you having brought this up before besson3c and again, I'm sorry for you and your wife's loss, but you're going to have the same problems with this example that you had when you first brought it up. And invariably, the anecdote is offered and then a little blibbet on how much better the scenario would've been in Canada. I'm going to take a look at that claim, but first -- some perspective;

• $4000-$5000/month: A recent Mt Sinai School of Medicine Study found that out-of-pocket expenses for Medicare recipients during the five years before their death averaged approximately $39,000.00 for individuals. You stated that your grandmother in-law was not facing a rare or exceptional case and yet with Medicare picking up 85% of the tab and Veterans' Care assuming another portion of the cost; you were still shelling out $4000-$5000/month? How on earth did this happen? With both Medicare and Veterans' Care and for a case you claim was not extraordinary; you managed to pay nearly $10k more than the average end-of-life, out-of-pocket expenses for five years of care before death, but in just one year's time? With all due respect, your numbers just don't come close to adding up here.
• Now the claim - "It'd be so much better in Canada": In Canada, only 16 to 30% of those who die receive specialized hospice or end-of-life care. The National Hospice and Palliative Care Organization estimates that 36% of all US individuals who died in 2006 were enrolled in a hospice program.
• Both the US and Canada rank ninth in The Quality of Death Ranking for End-of-Life Care.

I have a huge problem with your math and your conclusion is not based on any substantial evidence. There is absolutely zero basis for the claim that your grandmother-in-law would've fared much, much better and in fact the odds are she would've fared much, much worse.

I would have to check with my wife, but I think it was $4000-5000 total for everything, including her living expenses.

One mustn't overlook that there are other services that are needed that go beyond actual medical care: being in a home where there is somebody around for 24/7 attention, helping somebody get dressed, bathe, help with the meds, etc. Old people need a crapload of services.

My wife's Mom was/is doing fairly well financially now and therefore did what she thought would make her Mom most comfortable, so I was not trying to claim that this was the cheapest possible way to have handled everything, but what I meant by her experience being poor was not the quality of care (and she wasn't in hospice until the last couple/few days, if I recall correctly, so what you wrote about hospice isn't all that relevant here), but:

1) The lack of options available in this area for people in her income bracket, which was somewhere between the poor and rich which were unpleasant in the case of the former and out of her price range in the case of the latter.

2) The stress of all of these costs being wildly unpredictable, with the tendency to balloon particularly towards the end.

3) The stress of having burned through her assets.


It would be one thing if one could set aside $40,000 for their health care (and of course one would need a lot more to cover their other retirement costs), but what if you set aside $40,000 and your costs end up being $60,000. Wouldn't this suck? Setting aside that $40,000 might be deemed as "responsible", but it provides no guarantees.

If you want I can confirm some of these numbers with my wife so that you can scrutinize them, but can we first agree upon the concept that growing old in this country really sucks if you aren't comfortably wealthy? Growing old sucks anywhere, but have you thought about how deflating it must feel to have to confront the fact that your savings just weren't good enough and that you aren't going to leave much, if any to your kids in circumstances like hers?

Can we also agree that sometimes this is just about shitty luck more than it is responsibility (although I'm not claiming that my wife's Grandma was a victim of bad luck)? If we can agree upon these two points, I'll be happy with my effort in this thread.

[ebuddy]

Originally Posted by besson3c 

I would have to check with my wife, but I think it was $4000-5000 total for everything, including her living expenses.

So... you're including all manner of out-of-pocket living expenses to health care expenditures?

One mustn't overlook that there are other services that are needed that go beyond actual medical care: being in a home where there is somebody around for 24/7 attention, helping somebody get dressed, bathe, help with the meds, etc. Old people need a crapload of services.

Yes they do which is why the lion's share of Medicare expenditures occur through end-of-life care and why the ACA - health care insurance overhaul not addressing health care costs is an absolute travesty.

My wife's Mom was/is doing fairly well financially now and therefore did what she thought would make her Mom most comfortable, so I was not trying to claim that this was the cheapest possible way to have handled everything, but what I meant by her experience being poor was not the quality of care (and she wasn't in hospice until the last couple/few days, if I recall correctly, so what you wrote about hospice isn't all that relevant here), but:

Wait. First, I can personally guarantee you didn't take the cheapest possible way to handle everything which essentially breaks down the entire crux of your argument. People who have the means to pay more, will, regardless of the quality of care you're supposedly receiving on behalf of the State. This is how people with money, roll.

1) The lack of options available in this area for people in her income bracket, which was somewhere between the poor and rich which were unpleasant in the case of the former and out of her price range in the case of the latter.

Even a modest, lifetime Health Savings Account would've gone a long way toward meeting or exceeding the average cost of end-of-life care (which is substantially bloated on unnecessary curative care based on incentives paid by the government for the number of patients seen and amount of care given without regard for merit) and may have helped save her home. Otherwise, if your wife's grandmother felt it was worth it to sell her home for Cadillac end-of-life care, that was her personal decision and there's nothing you can do that will stop people from making these decisions with their own assets.

2) The stress of all of these costs being wildly unpredictable, with the tendency to balloon particularly towards the end.

This is a natural cost of existence, besson. No matter what's at issue here, the cost is going to be unpredictable. The mechanic, the grocery store... all reasons to save. How much did your wife's grandmother save? The more educated and shrewd the consumer, the less apt to be duped into unnecessary care and the less financially burdensome their situation is on others.

3) The stress of having burned through her assets.

Sounds to me like she chose to burn through her assets.

It would be one thing if one could set aside $40,000 for their health care (and of course one would need a lot more to cover their other retirement costs), but what if you set aside $40,000 and your costs end up being $60,000. Wouldn't this suck? Setting aside that $40,000 might be deemed as "responsible", but it provides no guarantees.

There are no guarantees; not from the government, not from anyone. The sooner you let go of this pipe-dream, the better. Someone has to pay for the provisions made available to your wife's grandmother. The more extravagant the care, the more expensive, and the more burdensome to someone. You all were paying an exceptional amount more than what should have been paid out for a non-exceptional situation. That's no one's fault, but your own I'm afraid. Your wife's mother wanted to do more for her mother and that's perfectly acceptable, but any such scheme to nationalize this level of care will fail and through legislative action will eventually eliminate the options your wife's mother sought for her mother.

If you want I can confirm some of these numbers with my wife so that you can scrutinize them, but can we first agree upon the concept that growing old in this country really sucks if you aren't comfortably wealthy? Growing old sucks anywhere, but have you thought about how deflating it must feel to have to confront the fact that your savings just weren't good enough and that you aren't going to leave much, if any to your kids in circumstances like hers?

The overwhelming majority of seniors receiving care are happy with the quality of it. Who's standards are you trying to satisfy here? There are also pleasant aspects to aging, but the inescapable fact is your body begins to break down as you age. That costs money. You have to want to be happy I suppose. Someone has to pay for those provisions, besson. Who do you suggest should have to pay?

Can we also agree that sometimes this is just about shitty luck more than it is responsibility (although I'm not claiming that my wife's Grandma was a victim of bad luck)? If we can agree upon these two points, I'll be happy with my effort in this thread.

No, we can't agree on any of this. Your anecdote broke down out of the gate. Your wife's grandmother was not unlucky, she merely aged as do we all. It sounds to me like you all wanted Cadillac care for your grandmother and that comes at a cost. I can't think of anyone else that should be expected to pay for a level of care 4 times more costly than it should have been. If you can tell me who should be paying for this and how, we may come to some agreement.