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Khsog - There are 2 words I hardly ever use - "always" and "never". Except in extreme circumstances (like I know I will *never* win an Olympic medal ).
Mayo JAX actually got an offer it couldn't refuse when it decided to open here. A private donation of 400 acres on which to build its campus:
Also - one of its main areas of growth/income these days is its transplant business (it has become a major transplant center in the US). I don't know why - but - for some reason - our transplant waiting lists are among the shortest (perhaps the shortest) in the country. Maybe it's because we have lots of young motorcycle riders - and don't have mandatory helmet laws. And we're just up the road from Daytona Beach (which has things like Biketoberfest).
I've actually met people who moved to JAX to get on a transplant list (you have to live here to get on the list - because you have to be good to go immediately when an organ "with your name on it" arrives).
I certainly wouldn't be surprised to see changes in Medicare 5-10-20 years down the road. Although I expect the more significant changes to take place after I'm dead. And I don't have a clue what any changes might look like now. Which is one reason I'm not running out and buying a super expensive house today just because I'm going on Medicare - and I'll continue to save money for the unexpected.
I do understand economic realities. Which is why I always try to phrase my advice carefully about how to approach Medicare. Do this "if you can afford it". By which I mean - do it unless it means you can't eat or live properly. And don't not do it just so you can get an unlimited data plan for your iPhone or 10 premium stations on your cable TV. I kind of got the impression you were in the former category - not the latter - but I could be wrong (and won't pry). Also - in case anyone hasn't read my messages before - I don't care to subsidize middle income (or even higher income) people who would rather pay money for iPhones and cable TV than health care. OTOH - I think it would be fair to charge me and my husband (and many other people) more money for our Medicare. I'm not sure we need any subsidy - but 75% on Part B is certainly too much IMO.
As for your statements about children and grandchildren - I am in the Clark Howard camp on that one. Which is take care of yourself first (he usually says this in the context of things like saving for retirement - but there are other contexts). One possible exception might be if they're in bad financial straits as a result of bad luck (as opposed to stupidity). But I would hope kids/grandkids wouldn't love parents less if they spent money taking care of themselves so they will perhaps be around to participate in their lives for more time - not less. As opposed to giving them more expensive presents - a bigger inheritance - etc.
FWIW - I've never been in an HMO (and hope never to be in one).* I have been in a really good national PPO - First Health - for decades. Covers just about every provider my husband and I have ever used - including Mayo in Rochester (except for one primary care dermatologist we used to use - they're kind of a dime a dozen here - so no big deal). Although the PPO discounts vary a lot (from 5% at a place like Mayo to 40% or so at other providers - the discount comes into play when we haven't met our deductibles). Why do MA PPOs get bad ratings? Robyn
*I think the only time I've ever been in a doctor's office that accepted HMO patients was when we first moved here - and one of us had to see an eye doc we hadn't used before. When I went to sign in - every patient had a color coded dot next to his/her name. And I asked the receptionist - what's this? And she said this dot meant HMO - this meant TriCare - this meant Medicaid - this meant MA - etc. We were like the only people with a red dot. And I asked what that meant. And she said "full insurance". Didn't prevent the doctor from keeping us waiting for an hour + in a crowded waiting room full of sneezing and coughing people in the winter. I don't ever want to go back to a doctor like that again. Although I will make some exceptions in terms of waiting (like if I have an afternoon consult with a surgeon - and an unanticipated complication of a morning surgery has put the doctor behind schedule).
Robyn, we've had the same doctor for years. He lives a couple of blocks from us. He is in the Advantage plan with the HMO, so are we. Nothing wrong with that. If he dropped that we'd switch to whatever he switched to. Or Medigap if he only took that. The Advantage plans are big in certain parts of the country. Like it or not thats the way it is. Much more prevalent than Medigap in some places. Medicare changes - ummm. 5 years max IMO.
I retired from a large company. They had the old style defined benefit pension plan, so it turned out well for us. And maxed out on social security also. Our house is worth far more than we paid for it. In short, the bad economy over the past few years hasn't affected us one day. But there are millions and millions in this country who can't say the same. Who are in a real struggle just to make it day-by-day. Life happens and not for the best many times. You really do need to join the real world. At least understand whats going on. And as best I can tell you don't have a clue.
Too bad you weren't in the Army. That snob aspect would've been knocked out of you in short order. I've never seen anything like you described in any doctors office.
As far as companies go, anything can happen. Nothing surprises me anymore. From the corporate world the old saying money talks B-- walks is especially true these days. Best believe Mayo has been approached and will be again (and again, ...). You are naive to think otherwise. Companies are in it to make money, nothing else. And it doesn't matter what their field/specialty is. Mayo is no different than any other. Really though, there is nothing special about Jacksonville. Personally I'd go for Naples if I wanted to live in Florida.
Sorry, you simply don't understand children from a parents point-of-view. You don't understand what I've said, no point in trying to describe it to you.
Health Care Should Not Be A Corporate Concern At All
Thinking Cost Allocation and Employment Benefits and Electronic Medicine available directly from the Executive Department of the USA, it's a brand new access for each individual in the USA based on their own private intelligence.
I think that the Feds could do what they did for Inter-Active Graphics and Personal Computers, which I experienced. For Inter-Active Graphics back in the 1960's, the Navy Department took the lead and divided the field into three separate sub-structures: University, Business and Government Sectors. It was easy for me to talk to a business saying well the universities are doing such and such, we are doing such and such and you can take advantage of all this and develop your own projects. Who am I? I was learning FORTRAN on-the-job because of Sputnik and the cold war with Russia to get the first man on the moon. It was a wonderful "oasis" in the evolution of Inter-Active Graphics.
For Personal Computers, in the 1980's I could depreciate the cost of my PC on my IRS 1040. When PC's became popular, the Feds refined this by demanding a document from my employer to state I use my PC at work. Finally when the PC was under the control of the Corporate Comptroller instead of the Chief Scientist, I could no longer depreciate my PC on my 1040.
Similarly, but in an abusive way, I have been victimized by the fact that the Corporation offers health care as a benefit. I realize that now at the age of 83. Right now it seems to me that the feds could simply use cost allocation to motivate a one time wage increase in the Corporation to rid itself of health care altogether and then let Health care be managed by Health Insurance just like Car Insurance and Home Insurance. In fact, it's effecting me now in a 55plus gated community. We have employees that I have to pay their health insurance costs and we both use the same Health Insurance. I happen to have chosen the same one before I moved into this community. What a surprise that was, realizing this. What's happened to me is now these same employees can effect me and my own health. Health insurance is used politically in the Corporation. I also had problems when I was with this same plan when I was an employee 20 years earlier. They were trying to get rid of me.
Last edited by macnietspingal; 08-07-2012 at 03:44 AM..
Similarly, but in an abusive way, I have been victimized by the fact that the Corporation offers health care as a benefit. I realize that now at the age of 83. Right now it seems to me that the feds could simply use cost allocation to motivate a one time wage increase in the Corporation to rid itself of health care altogether and then let Health care be managed by Health Insurance just like Car Insurance and Home Insurance. In fact, it's effecting me now in a 55plus gated community. We have employees that I have to pay their health insurance costs and we both use the same Health Insurance. I happen to have chosen the same one before I moved into this community. What a surprise that was, realizing this. What's happened to me is now these same employees can effect me and my own health. Health insurance is used politically in the Corporation. I also had problems when I was with this same plan when I was an employee 20 years earlier. They were trying to get rid of me.
What "Corporation" are you talking about which is victimizing you? The 55-plus community in which you reside?
When you say "wage increase," do you mean give people salary increases and then tell them to buy their own insurance? What about preexisting conditions?
You are throwing people with preexisting conditions under the bus if those people are forced to go from group to individual insurance in most states - until 2014 when ACA becomes effective.
What "employees" are you talking about at age 83? Aren't you on a former-employer retiree Supplement Plan or private Medigap, plus Medicare?
Or, are you talking about your Community/Association fees, which cover insurance for the employees who maintain your 55-plus community - and therefore are higher than need be if the Association didn't provide health insurance for its maintenance people?
You chose a policy before you "moved into this community." Assume you mean your health insurance/Medigap is through United Healthcare (or its ilk) - and, coincidentally, the group coverage for your Association's employees is also through the very same United Healthcare (or its ilk).
Of course, you had problems at age 63 when you were working. Your age raised the rates for everyone in your employer's group. That's the way group insurance works. The older the people in the group and/or the higher the claims if you have really sick people, the higher the premiums.
Guess if you don't want to be an "employer," you shouldn't be living in an association which has so many maintenance and other employees that this association needs to provide health insurance for them. Doubt if the Association will want to give $3-$5/hr raises to these people to cover their insurance costs in the open market, unless you're only talking about a few people. Keep in mind, FICA needs to be paid on these salary increases, as well.
Also assume you are reviewing your HOA's financials and have identified this as an expense "you" don't need - just as many employers will do in future as ACA becomes law.
Sounds to me as though "you" want carefree/maintenance-free living, with some concierge services, I'll bet, but are unwilling to compensate people who provide this for "you." In that case, your association should consider outsourcing its employees to a private management/maintenance firm. That way your Association will be billed one lump sum and you won't know that in that lump sum you are still paying for health insurance for those employees - unless, of course, it is a predatory outsourcing firm which makes sure it isn't required to provide benefits and hires part-time people at minimum wage.
I'm sure you'll like the service and work product of those part-time, minimum-wage, no-benefit, semi-literate, possibly non-English speaking people just as well as those of your permanent association employees who, at present, have some sense of loyalty and concern for their workplace/employer and the welfare of its elderly residents(I'm looking at you).
Last edited by Ariadne22; 08-07-2012 at 04:50 PM..
How about the feds simply encourage free market in the good old-fashioned way they have always done in my professional life-time. Simply provide a path by promoting corporations to give a one-time increase in wages based on their contributions to health care as a benefit and get rid of the benefit altogether. It would help the unions too. Then treat health insurance like long term insurance, car insurance, home insurance. That way employees stop being human resources/political slaves and become good old-fashioned PERSONnel, even in the unions.
What "Corporation" are you talking about which is victimizing you? The 55-plus community in which you reside?
When you say "wage increase," do you mean give people salary increases and then tell them to buy their own insurance? What about preexisting conditions?
You are throwing people with preexisting conditions under the bus if those people are forced to go from group to individual insurance in most states - until 2014 when ACA becomes effective.
What "employees" are you talking about at age 83? Aren't you on a former-employer retiree Supplement Plan or private Medigap, plus Medicare?
Or, are you talking about your Community/Association fees, which cover insurance for the employees who maintain your 55-plus community - and therefore are higher than need be if the Association didn't provide health insurance for its maintenance people?
You chose a policy before you "moved into this community." Assume you mean your health insurance/Medigap is through United Healthcare (or its ilk) - and, coincidentally, the group coverage for your Association's employees is also through the very same United Healthcare (or its ilk).
Of course, you had problems at age 63 when you were working. Your age raised the rates for everyone in your employer's group. That's the way group insurance works. The older the people in the group and/or the higher the claims if you have really sick people, the higher the premiums.
Guess if you don't want to be an "employer," you shouldn't be living in an association which has so many maintenance and other employees that this association needs to provide health insurance for them. Doubt if the Association will want to give $3-$5/hr raises to these people to cover their insurance costs in the open market, unless you're only talking about a few people. Keep in mind, FICA needs to be paid on these salary increases, as well.
Also assume you are reviewing your HOA's financials and have identified this as an expense "you" don't need - just as many employers will do in future as ACA becomes law.
Sounds to me as though "you" want carefree/maintenance-free living, with some concierge services, I'll bet, but are unwilling to compensate people who provide this for "you." In that case, your association should consider outsourcing its employees to a private management/maintenance firm. That way your Association will be billed one lump sum and you won't know that in that lump sum you are still paying for health insurance for those employees - unless, of course, it is a predatory outsourcing firm which makes sure it isn't required to provide benefits and hires part-time people at minimum wage.
I'm sure you'll like the service and work product of those part-time, minimum-wage, no-benefit, semi-literate, possibly non-English speaking people just as well as those of your permanent association employees who, at present, have some sense of loyalty and concern for their workplace/employer and the welfare of its elderly residents(I'm looking at you).
I'm sure YOU are looking at me and following me around That's the very point. Personally, I was put on mental disability to get rid of me. They hired a social worker who lied about our interviews. It's a true miracle I got my job back. I was lucky to have a personal lawyer who did it by phone call. The K-P psychiatrist refused to say I was "normal", he said "It's too political". The employees of my gated community can do the same thing through the same company and like YOU "watch me". Rather recently I told my daughter who is a management counselor about my prior work experience. She simply said "Conflict in Management" which means that every one with an MBA knows this goes on.
I don't see why Health Insurance field can't take care of you and all the benefits you are concerned with and the Federal Government will still do its thing. I've now got a K-P health account and a Medicare health account. The secret is that in every single community every one should be on line, have a special USPS email address maintained by the USPS and that's all it does. We all, retired/'disabled people should go forth and make sure every single person is on line. Every single USA CEO should stress this. Even the ones who are headquartered in foreign lands. Certainly during the past 4 years our current President has definitely provided the tools for We the People of the USA to do this and educate ourselves all together: the best way for YOU 2 watch ME. I don't watch any one. I simply watch the Board of Directors on line only.
Robyn, we've had the same doctor for years. He lives a couple of blocks from us. He is in the Advantage plan with the HMO, so are we. Nothing wrong with that. If he dropped that we'd switch to whatever he switched to. Or Medigap if he only took that...
If you're wedded to your PCP (and I would be wedded to a good PCP if I had one - which I do) - then I think you have to ask yourself a couple of questions. For example - if your doctor has a full practice - do you think it more likely that he or she might drop either MA or Medigap patients in the future. I would think usually the former - but I suppose the latter is possible. In that case - you have to consider the following guaranteed issue rules when it comes to switching from a MA plan to a Medigap plan:
Also - there's the possibility that your doctor may retire while you're still alive and kicking. I've already had 2 PCPs retire since I moved where I live now (one on account of age - one on account of illness). My father just lost his PCP when his PCP moved (and my father would have had a heck of a time finding a new PCP if our PCP didn't accept new Medicare patients who are relatives of existing patients). What's the story with other good PCPs where you live?
Also - I guess you've been lucky in not needing a lot of specialist care (or any). There are a lot of excellent specialists who won't accept MA patients - at least where I live.
Anyway - I'm not looking for you to answer these questions here. They're simply questions you have to answer for yourself. Robyn
And that is how the free market operates. With freedom for the participants or at least freedom for now. That was my point in starting the thread. Government can plan and try all the behavior motivations it wants but trying to fight the free market or not take it into account can be unwise and create many unintended consequences.
I agree. Different strokes for different folks. In all kinds of ways. And all I ask for is the ability to make my own choices. For example - my father's old PCP was at a UF primary care center here. When that doctor left - the doctor who took his place was about 15 years older - not born or trained in the US - and he doesn't speak very good English (note that my father's old PCP was born outside the US and did most of his training outside the US too - but - because he was younger and had spent a lot more time in the US - his English was a lot better). I didn't think my 94 year old father was out of line in wanting a doctor whose English he could understand (especially not after he spent a ton of money on zippy digital hearing aids a few years back ).
FWIW - it is surprising to me how many people I've run across both on chat boards and in real life who think they have great cheap coverage because they've never paid more than X out of pocket in health care costs WHEN THEY'VE NEVER HAD A SERIOUS MEDICAL PROBLEM. They don't seem to realize that the primary purpose of insurance is not to save us $30 here or $50 there - but to give us the best choices when we're dealing with serious stuff. I guess my husband and I have - over the decades - been lucky (or unlucky) enough to deal with both very serious stuff (when it came to our parents) and some stuff that might have been very serious when it came to us. I guess we could call my husband's MS serious - but not compared to someone who winds up with a diagnosis of pancreatic cancer.
Also - we are lucky enough to have practiced in legal/medical specialties. So we have some general understanding of much really bad stuff can be lurking out there - especially as we get older. And how specialized the treatment for that really bad stuff can be. For example - had I been lucky enough to get Steve Jobs' very early diagnosis of pancreatic cancer (pancreatic cancer is of course awful - but he was very lucky to have it diagnosed early - that isn't usually the case) - I wouldn't have used herbal remedies. I'd be on the next plane to MD Anderson.
In any event - you get my point. You really don't know how good your insurance is until you get really sick (or - less likely as we age - have a serious trauma). Robyn
It depends entirely where you live. In many areas MA is the plan of choice. And in other areas (especially rural) it isn't. Almost all the doctors and all the major hospitals where I live take the MA plans. If, on the other hand, I lived in an area where they weren't popular I wouldn't be in one. And it is possible that we may switch next year.
MedPac (the CBO equivalent for Medicare) has studied the payment modes of Medicare and have concluded (as well as have many others) that the current payment mode of Medicare is waaay out of date (1970ish). With Medigap the total cost is 33% more than original Medicare. Their proposed mode is something that looks very, very much like the typical MA plan (including a co-payment cap). I don't know how the necessary HMO cost control aspects would be incorporated (they'd likely look/use the current MA plan companies and administration IMO). The high deduct Medigap F and plans M and N are a step in that direction.
The MedPac Mar 2011 Baseline report (which I have not read but have seen others refer to it) stated that the Advantage plans had 25% of Medicare eligibles (at that time) enrolled, yet the cost to Medicare was 23% of the total budget. A much better alternative than "some" politicians would lead one to believe. Another proposal is to add a $500 deductible to all Medigap plans.
In short, they are looking at ways to better control the costs of Medicare. Something is going to give. I surely don't know where that direction will take us. But I do suspect eventually (and sooner than later) that it will be more in the MA mode than Medigap.
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Health Care Should Not Be A Corporate Concern At All
That's the very point. Personally, I was put on mental disability to get rid of me. They hired a social worker who lied about our interviews. It's a true miracle I got my job back. I was lucky to have a personal lawyer who did it by phone call. The K-P psychiatrist refused to say I was "normal", he said "It's too political". The employees of my gated community can do the same thing through the same company and like YOU "watch me". Rather recently I told my daughter who is a management counselor about my prior work experience. She simply said "Conflict in Management" which means that every one with an MBA knows this goes on.
