Obamacare cost...

[Art Vandelay]

Fish oil is a rare exception. It actually does make a difference and has performed well in clinical trials.

Omega 3s with an EPA+DHA sum equivalent or greater than 1000mg is hugely beneficial to people with chronically dry eyes.

[Topper]

My premium rises by a reasonable 3.6% next year, but then my monthly cost is around $740 (my wife's is slightly lower) so let's not gush. Over the past fifteen years or so I think my premium has risen an average of 12%, compounded annually. We know that the salaries of the care providers and staff (which should comprise the lion's share of medical expenses) have risen at a MUCH smaller pace than that. So that means that other components (drugs, physical facilities and equipment, and executive/administrative expenses) are climbing at a much faster rate than even the 12%. I'd like to learn more about what's causing these increases but I'm too tired to look around, as I'm working hard to pay my premiums.

You should be approaching Medicare age just in time, but Hillary will likely means test it to disqualify you or to increase your out of pocket. The actual data is not favorable and the system can't sustain itself. More rationing will also be implemented.

[Moliere]

premiums for my family are still zero...

That would only be true if you don't have insurance.


Sent from my iPhone using Tapatalk

[Uncle Ted]

My premium rises by a reasonable 3.6% next year, but then my monthly cost is around $740 (my wife's is slightly lower) so let's not gush. Over the past fifteen years or so I think my premium has risen an average of 12%, compounded annually. We know that the salaries of the care providers and staff (which should comprise the lion's share of medical expenses) have risen at a MUCH smaller pace than that. So that means that other components (drugs, physical facilities and equipment, and executive/administrative expenses) are climbing at a much faster rate than even the 12%. I'd like to learn more about what's causing these increases but I'm too tired to look around, as I'm working hard to pay my premiums.

California's obamacare premiums are jumping 13.2% next year...

Covered California's Health Plan Rates To Jump Sharply In 2017

California's Obamacare premiums will jump 13.2 percent on average next year, a sharp increase that is likely to reverberate nationwide in an election year.


The increase, announced by the Covered California exchange Tuesday, ends the state's two-year respite from double-digit rate hikes.
[...]

http://www.npr.org/sections/health-s...harply-in-2017

So I guess it is safe to assume that you don't have Obamacare.

[Bo Diddley]

premiums for my family are still zero...

Me too. We're very fortunate.

[Moliere]

Me too. We're very fortunate.

I don't pay a dime towards my premiums but they certainly aren't free.


Sent from my iPhone using Tapatalk

[cowboy]

My premium rises by a reasonable 3.6% next year, but then my monthly cost is around $740 (my wife's is slightly lower) so let's not gush. Over the past fifteen years or so I think my premium has risen an average of 12%, compounded annually. We know that the salaries of the care providers and staff (which should comprise the lion's share of medical expenses) have risen at a MUCH smaller pace than that. So that means that other components (drugs, physical facilities and equipment, and executive/administrative expenses) are climbing at a much faster rate than even the 12%. I'd like to learn more about what's causing these increases but I'm too tired to look around, as I'm working hard to pay my premiums.

Having served on a hospital board for a decade, I'll chime in. The largest driver of medical expenses overall is the big ticket items. Heart issues, cancer treatments, etc. comprise the lion's share of our total medical expenditures, and these things are becoming more costly because technological advances that save lives don't come cheap. Per capita healthcare spending is around $11,000, but 10% of the population accounts for 66% of the nation's total healthcare expenditures. Also, while I don't have any data on this, end of life care is huge. We spend a phenomenal amount of money to keep people alive for an extra 6 months.

Our hospital costs have risen by 100% in the last 10 years, which is around 8% per annum, and roughly in line with the 40-year average. Proportionally, all costs are going up about the same, but 80% of a hospital's costs are labor. Our docs salaries have increased at a greater rate than inflation, but overall not much higher than other wage growth. The big cost driver for hospitals, schools, and other entities that don't have market competition is added personnel. Every department wants to add another employee. I sit on the school board (don't be impressed, it's a small community) and the school is worse than the hospital in this respect. About 6 years ago, I became the chair of the hospital board and began working with the CEO to curb this trend. Since then, our expenses have moderated, and risen at a much slower pace. We also started watching our fte's, and added personnel based on volume of patients rather than revenue. This has made us extremely profitable, and puts us in a good position to outbid other area facilities if Medicare/Medicaid moves to a contract/bid system for areas with more than one facility within an hour's drive.

[byu71]

Also, while I don't have any data on this, end of life care is huge. We spend a phenomenal amount of money to keep people alive for an extra 6 months.

I can't remember the number or percentage, but I do remember it was mind blowing.

Being the oldest I was the one who had the responsibility of deciding when to cut life support to my parents. My Dad did for my Mom, but I had to for him. It was tough and of course I had a conversation with my siblings. I also knew clearly what my Dad wanted from previous conversations.

I remember walking by an open door in the rest home and seeing a lady just staring and connected to several tubes. I asked the nurse about her and she said she had been on life support for 2 years and really hadn't functioned for two years. Her sons wanted to let her go, but the daughter insisted she be kept alive.

This may sound very harsh, but if that decision is made the family should pay the medical bills not medicare or other government assistance. I am also all in favor of one being able to choose to end their own life.

I know this issue can be a very controversial issue and hope I haven't offended anyone.

[PaloAltoCougar]

That was interesting, cowboy. The huge cost of end-of-life care and the sometimes ridiculous amounts spent on extraordinary measures to keep a person alive for a couple of extra, often painful or unconscious, months need to be addressed. My family, btw, knows NOT to do anything extraordinary, an instruction I suspect they'll follow enthusiastically.

[byu71]

That was interesting, cowboy. The huge cost of end-of-life care and the sometimes ridiculous amounts spent on extraordinary measures to keep a person alive for a couple of extra, often painful or unconscious, months need to be addressed. My family, btw, knows NOT to do anything extraordinary, an instruction I suspect they'll follow enthusiastically.

I have 3 boys and two girls. The girls have no say in whether to pull the plug on me or not.

[Mormon Red Death]

Having served on a hospital board for a decade, I'll chime in. The largest driver of medical expenses overall is the big ticket items. Heart issues, cancer treatments, etc. comprise the lion's share of our total medical expenditures, and these things are becoming more costly because technological advances that save lives don't come cheap. Per capita healthcare spending is around $11,000, but 10% of the population accounts for 66% of the nation's total healthcare expenditures. Also, while I don't have any data on this, end of life care is huge. We spend a phenomenal amount of money to keep people alive for an extra 6 months.

Our hospital costs have risen by 100% in the last 10 years, which is around 8% per annum, and roughly in line with the 40-year average. Proportionally, all costs are going up about the same, but 80% of a hospital's costs are labor. Our docs salaries have increased at a greater rate than inflation, but overall not much higher than other wage growth. The big cost driver for hospitals, schools, and other entities that don't have market competition is added personnel. Every department wants to add another employee. I sit on the school board (don't be impressed, it's a small community) and the school is worse than the hospital in this respect. About 6 years ago, I became the chair of the hospital board and began working with the CEO to curb this trend. Since then, our expenses have moderated, and risen at a much slower pace. We also started watching our fte's, and added personnel based on volume of patients rather than revenue. This has made us extremely profitable, and puts us in a good position to outbid other area facilities if Medicare/Medicaid moves to a contract/bid system for areas with more than one facility within an hour's drive.

The old adage in the health insurance arena is

80% of your claims expense will be met by 20% of the people. The problems lies in the fact that the who the people are in the 20% change every year

[Mormon Red Death]

I can't remember the number or percentage, but I do remember it was mind blowing.

Being the oldest I was the one who had the responsibility of deciding when to cut life support to my parents. My Dad did for my Mom, but I had to for him. It was tough and of course I had a conversation with my siblings. I also knew clearly what my Dad wanted from previous conversations.

I remember walking by an open door in the rest home and seeing a lady just staring and connected to several tubes. I asked the nurse about her and she said she had been on life support for 2 years and really hadn't functioned for two years. Her sons wanted to let her go, but the daughter insisted she be kept alive.

This may sound very harsh, but if that decision is made the family should pay the medical bills not medicare or other government assistance. I am also all in favor of one being able to choose to end their own life.

I know this issue can be a very controversial issue and hope I haven't offended anyone.

Freakonomics had a good thought provoking episdode about end of life care. http://www.wnyc.org/story/are-you-re...t-rebroadcast/

[CardiacCoug]

The problem is that to reduce health care spending at the end of life you have to define "end of life" spending prospectively, not just retrospectively.

I know dozens of patients who I felt at the time were almost certainly getting expensive "end of life" care and here they are doing great 5+ years later, beating the odds by making a full recovery.

And pessimistic withholding of care becomes a self-fulfilling prophecy -- that makes me uncomfortable because a small but measurable number of people can make a full recovery from cardiac arrest, for example, but if care is withheld because the odds are unfavorable then nobody will survive.

There is so much uncertainty in medicine, every case is different. I'm totally in favor of aggressive hospice care and not doing expensive, futile surgeries but these are much more difficult to define prospectively than retrospectively.

[Northwestcoug]

Freakonomics had a good thought provoking episdode about end of life care. http://www.wnyc.org/story/are-you-re...t-rebroadcast/

I'm not a huge fan of freakonomics, but I agree, this is a really good one.

[hostile]

The problem is that to reduce health care spending at the end of life you have to define "end of life" spending prospectively, not just retrospectively.

I know dozens of patients who I felt at the time were almost certainly getting expensive "end of life" care and here they are doing great 5+ years later, beating the odds by making a full recovery.

And pessimistic withholding of care becomes a self-fulfilling prophecy -- that makes me uncomfortable because a small but measurable number of people can make a full recovery from cardiac arrest, for example, but if care is withheld because the odds are unfavorable then nobody will survive.

There is so much uncertainty in medicine, every case is different. I'm totally in favor of aggressive hospice care and not doing expensive, futile surgeries but these are much more difficult to define prospectively than retrospectively.

There was a report a few years ago about Michael DeBakey, one of the pioneers of cardiac surgery. One of the operations he innovated was for treating aortic aneurysms. In reviewing his outcomes it became evident that patients over a certain age didn't do well after the surgery and therefore the recommendation was that these patients shouldn't undergo the surgery - too expensive and resource intensive with unpredictable benefit.

Ironically, at the age of 90, Dr DeBakey was diagnosed with an aortic aneurysm. The size of the aneurysm would normally indicate surgery but his age would indicate no intervention. He knew the data better than anybody but still chose surgery. Even with the best info available it is hard to prospectively say who gets what treatment.