patrick.net

So I can say socialism now? Socialism, socialism, socialism. I'd stopped posting because of that ;)

danville woman Says:
April 26th, 2009 at 11:33 pm
I am a nurse practitioner and a good percentage of my patients are on mood altering meds due to nonspecific fears, and depression, anorexia, etc

Only certain fields of endeavor require mind numbing memorization, regurgitation, and competition. Medicine is one of them, however, I would say that many of the docs I work with, really regret their career choice. Their life can be hell.

DW, can I get in touch and get some more info on NPs in the US? There's only a handful of NPs in Oz, the British Commonwealth systems have really marginalised alternative providers like NPs, PAs, etc, they don't really exist as yet except as an experiment in rural/remote areas -- it's like a 100 year old system of entrenched privilege for MDs. It's one of the major areas for reform the govt is looking at. Just curious to know about the training time and limits on ability to diagnose, prescribe and order tests etc. my email is housingaffordability at gmail.com. I know there's probably resources on the net about this, just interested to ask a couple of questions comparing and constrasting the role of NPs with primary care MDs, relative salaries, etc from the figurative horse's mouth...

SA in a previous thread opined " people look at healthcare costs and believe insurance is the solution and fail to see insurance is one of the biggest problem."

This may be true. I think there's a lot of agreement here that student loans are a cause of high tuition, not a solution thereof.

Costs can only go up if there's an easy path for the average bloke to temporarily come up with the funds. I think there's a great similarity in the bubbles and their causes: housing and cheap no-doc mortgages; tuition and easy to get student loans; and medical costs and comprehensive medical insurance for 70% of the population.

oh, did I mention university education tuition fees are free too... well, they charge a % now, it used to be free. same in UK -- new £3,000 fees per annum as the welfare state tires of footing the bill... primary care MDs here (GPs) only get paid about $70-90K per annum though, possibly because they don't have to pay huge tuition fees to get trained, and consequently don't have to claw back the money from their patients over a few years. the only reason a student generally needs to get loans in Oz is for lifestyle reasons, although the relatively new fee regime is gradually changing that...

I’m not sure that the AMA can control numbers of graduates, specialisation college places, etc
Why don't come over here and try to practice, DS. An extremely onerous process to become licensed (to protect the patient, of course, not to "limit competition").

"the house always wins statistically, but you may hear of big payouts"

Hey, and that's what keeps me coming back! Hell I figure if I allow myself to slide into a total state of disrepair, I TOO can cash in on one of those big paydays!

( You just have to hope you don't "cash in" altogether? )

Honestly, it is very easy to bring down the medical cost without even changing over to mandated national coverage.

1) Only cover major illness, because that is the part that we cannot afford and people go broke over. When you are slightly ill, you can bargain and shop around. There are lots of illness that won't kill you overnight, and some don't even need treatment.

Americans are spoilt to the point that those that are covered go to doctors for every single little thing (including me of course). Why not? The co-pay is only $10, might as well get the most out of it. Instead, we should all have to pay for medical cost for the first, say, $2500pp each year. Then people will learn to take care of themselves.

2) Let old people die a natural death. The US is the only country in the world with national coverage ONLY for the elderly, and we spare no cost to keep them alive, particularly towards the end of their lives. Americans spend about 40%-60% of lifetime medical cost in the last 6 months of our lives, is that ridiculous or what? Because at that stage of life, no matter how much you spend, you are gonna die, it is just a matter of dying a fast and natural death or dying an agonizing prolonged death.

We should really have a lifetime cap for every single person, and that is just fair. If someone just blows all his lifetime cap at 50, tough luck, or he can spend his own money for the extra years he wants to live. But I am sick of hearing those Medicare dollars spent on installing defibrillator on a 90-year old, or prescribing $100/day pills for an 85-year old cancer patient so that he can live on another 3 months on taxpayer dollars.

Also, why do American doctors have to go through the medical school system beyond college to rack up an average of $200K debt?

Why can't we be like other countries so our doctor can start studying medicine at college level? I know we have pre-meds but the seats are so limited.

For most illness, American doctors are over-trained, and as a result, they usually are stuck in this laser-focus ONLY in the area they know, sometimes losing sight of a big picture. They also see far fewer patients than their counterparts in other countries, which makes them far less intuitive in making diagnosis, because tests only reveal part of the story.

I guess not a lot of people are aware how bad the tiered insurance system is, particularly for the self-employed.

I have both individual and group, so when I use the medical service, my provider sends bill to both policies, all by the same insurance company. For example, I recently did a blood test that cost ~$460 , but my individual allowed them to bill $160, paying for 70% of that leaving me ~$50 bill.

Now, my group only allowed them to bill $80 (!!), and I pay 10%, so my share of the same service is $8.

Got the picture? The uninsured in this case will have to pay $460, or just ignore. Those on individual insurance pay $50, so the self-employed need to pay $50. Then the group insured only need to pay $8. All for the same darn blood test. It is a wonder indeed how the lab could inflate a service that they happily settled for at $80 to $460.

Those who are not in perfect health should really not become self-employed just because of the very discriminating medical policy alone.

I am American but left the USA after my employer went out of business in 2002. I was denied insurance by every company licensed in my state. So I sold most everything, put the rest in storage and left on a one-way ticket. I now have insurance for my wife and I for $200/mo valid everywhere in the world except the USA.

I have hired foreigners and run my business from the UAE and other places. I'd like to live in my own country again, but I don't think I'll ever be able to go home now.

When I was in college during the Cold War, I met two medical students who the Navy was putting through medical school.
Both of them were not in the Navy nor in the reserves when they were premed majors. They both applied and got accepted to medical schools, one was somewhere in the midwest, I forgot whether the other one was going to med school. Then they signed some kind of contract that made them reserve officers, their job being to go to med school, Navy picking up the expense and paying them living expenses as officers or reservists or some such. Then they were going to owe the Navy 5 or 7 years or something like that.

Well looking bad it seemed like a way to get started with some hands on clinical practice and no worries for beginning doctor about malpractice insurance nor student loans.

I wonder if the Navy still has that kind of a program.

I have a feeling the government would screw this up. Look at social security, our education system, the inabiltiy to count votes in FL and MN...

"Insurance invites waste. That's a reason health care costs so much, and is often so consumer-unfriendly. In the few areas where there are free markets in health care -- such as cosmetic medicine and Lasik eye surgery -- customer service is great, and prices continue to drop."

"Suppose you had grocery insurance. With your employer paying 80 percent of the bill, you would fill the cart with lobster and filet mignon. Everything would cost more because supermarkets would stop running sales. Why should they, when their customers barely care about the price? "

John Stossel

http://abcnews.go.com/print?id=2574980

>> Americans spend about 40%-60% of lifetime medical cost in the last 6 months of our lives

I was looking for a source for that number, and came upon the number for Canada, which In Canada, the number is 30-50%., per the following article.

http://findarticles.com/p/articles/mi_m0LVZ/is_8_17/ai_84895863/

OO,

>>Why can’t we be like other countries so our doctor can start studying medicine at college level?

Indeed. This works well in other countries, and saves cost both for society and for medical students. The MDs are done at a young age and do not need a gigantic initial salary to pay off student loans. They can more ease into their career, as it were.

One problem seems to be that US teenagers at least appear to be more irresponsible and less "mature" (I hate that word, sensibility and morals really have nothing to do with age).

I hate it when I start rewriting a sentence, and then do not quite finish. It makes for odd sentences.

EBGuy Says:
April 28th, 2009 at 5:15 pm
I’m not sure that the AMA can control numbers of graduates, specialisation college places, etc
Why don’t come over here and try to practice, DS. An extremely onerous process to become licensed (to protect the patient, of course, not to “limit competition”).

Does the AMA set those conditions? Or another licensing body? I thought there was one licensing body per state. One Dr Patel aka 'Dr Death' was barred from practising in NY and Oregon (only) recently after killing a few patients in Oz...

Apparently Oz graduates 2,000 drs a year, and has to import another 4,000 from overseas! Every year. Go figure...

sybrib Says:
April 28th, 2009 at 10:39 pm
When I was in college during the Cold War, I met two medical students who the Navy was putting through medical school.

I wonder if the Navy still has that kind of a program.

The Australian Defence Force has a tri-service scholarship scheme like this, where they will pay for n-1 years of an undergrad med course or all 4 years of a graduate one -- salary, textbooks, fees, and maybe a few other perks. Nice gig to get. Your ROSO is n+1 years of their assistance, plus 2 years internship in the civilian system as an officer after graduation. So can vary from 7-13 years all up depending. Army, Navy or Air Force.

About the Medical Board of California

The mission of the Medical Board of California is to protect health care consumers through the proper licensing and regulation of physicians and surgeons and certain allied health care professions and through the vigorous, objective enforcement of the Medical Practice Act, and, to promote access to quality medical care through the Board's licensing and regulatory functions.

http://www.medbd.ca.gov/board/Index.html

Just sos youse all know - yes, I'm looking at you, EBGuy.

I am a doctor, and I don't play one on TV.

American medicine has become schizophrenic. It is a rigidly controlled and regulated and yet no one can truly regulate or control it. Cash "customers" pay the highest rates(!) Insurance adjusters with a high-school education (or less) determine medical care using a preprinted algorithm. I could go on and on.

Doctors don't like it. Patients don't like it. So why not change? Because I think we all fear that if the government took over health care there'd be a trail of dead bodies in the streets. Let's face it, do you really want your health care totally controlled by the same people who run the Post Office?

Let me correct some prior postings. The AMA does not determine how many doctors are graduated. (I'm not and never have been a member of the AMA.) And that New England Journal of Communism (I meant Medicine) article -- pure left-wing BS from a once honored journal. Fact is, their 1995 projection of a surplus of specialists has become, in the real world of 2009, a worsening deficit of specialists. A deficit of doctors all around. So the force that actually DOES controls the number of doctors, the funding of the Federal Government, is now markedly increasing the number of medical students.

The forces that actually DO control the number of specialists, the specialty Boards, probably do limit their numbers to keep reimbursements high -- but who knows, since they are all self-selected and secretive.

One huge misuse of medical spending is on defensive medicine. Of course, all the lawyers are saying: "What? Outrageous! Take that back or I'll sue you. We have studies that show only 1 or 2% of medical spending goes towards defensive medicine." BS. I have ownership in an MRI unit. Probably 40% of the tests ordered are done "just to make sure we don't find anything dangerous". Notice I did not say the tests were "unnecessary". They are very necessary under our present laws -- to protect the doctor. If the doctor didn't do the test, he vastly increases his likelihood of being sued. The entire system is rife with these expenses for defensive tests and procedures. I should know, and I do.

Some of the posters have correctly pointed out that a large portion of expenses are incurred in the last 6 months of life. Then there are posters questioning pacemakers for 90 year olds, and expensive chemotherapy for terminal cancer patients. OK -- so the solution is to have a Federal bureaucracy with an algorithm telling doctors who should live and who should die? I think we've already seen this: was it Nazi Germany or the Soviet Union? I forget. But not places I'd want to live (or die!). When you walk down this road of "economic credentialing" you better watch out for the land mines.

You really want to save money fast? Then change the malpractice laws, stop giving free ER care to anyone who shows up, get rid of Medicare and Medicaid (and let doctors deduct discounted or free care from their taxes -- they'd line up to do it), allow cross-border medication purchases by pharmacies, and (just once in a while) thank your doctor for putting up with all this nonsense.

Wow -- I feel better already.

DesertDoc Says:
April 29th, 2009 at 12:49 am
You really want to save money fast? Then change the malpractice laws, stop giving free ER care to anyone who shows up, get rid of Medicare and Medicaid (and let doctors deduct discounted or free care from their taxes — they’d line up to do it), allow cross-border medication purchases by pharmacies, and (just once in a while) thank your doctor for putting up with all this nonsense.

All the other countries just socialised their medicine at half the cost per capita of the current US system and provide a universal healthcare guarantee to boot... effectively they've extended Medicare and Medicaid to the entire population.

Doctors' salaries in Oz are lower than US, but I believe UK salaries are comparable -- although with an NHS and socialised medicine.

Single payer has much lower admin costs per item and is more efficient.

Cross-border purchases are required simply because big pharma has the US citizenry by the proverbials. Oz manages to negotiate even cheaper drug prices than Canada through the PBS, somehow. They require that a new drug is proven to be more effective than an existing drug to pay any more than the old price. If big pharma want to sell any product into Oz, they have to play by the rules and adjust their prices. Canada also negotiates tougher prices (obviously). The culprits re US pharma pricing are prolly corrupt Congressmen passing laws favouring big pharma with either personal kickbacks or political donations, from what I've heard -- bit hard to address this problem with the current setup...

OO,

Well said across the board. Most doctors -are- over trained! Their reliance on 'tests' borders on maniacal. Dude, make the call, o.k?

Actually one of our long time posters ( SFWoman ) shared that the "end of life" expenditures are even -more- dramatic. I believe those costs are actually compressed into the last 90 days of one's life?

NOW... if they could give us that 90 days at an -earlier- time of our lives, well... then it might be worth it? But when the nurse comes by twice a day to wheel you into the sun like a potted plant..? No f@cking thanks!

If we let the 90 yr olds die, can we also let the 30 yr old lazy, uninsured, good for nothing couch potato's die along with them please???

A note from an Israeli here:

The Israeli system is halfway between the Canadian and the US (not sure how it compares to the UK or Oz):

There is good universal healthcare that covers mostly everything, which is paid for by a 5% income tax (unlike general income tax, which is progressive, "medical insurance tax" is a constant at 5%, and it does cover the unemployed as well even though they don't pay it). Copay toggles between $2 /quarter and nothing depending on a random dice roll made by the minister of health. (that is, if you used services this quarter, you pay $2, otherwise you don't)

The system is NOT single player -- there are 3 big players and possibly one or two smaller ones I'm not aware of. There is active competition between the players, to everyone's benefit. Everyone must register with a player, and they get their money from the state accordingly. (The bureaucracy behind this is surprisingly efficient).

A government committee comprised of 2 politicians and something like 8 doctors (some affiliated, but most unaffiliated with any player) determines what the players MUST cover freely, what they can charge more money for and how much money. Furthermore, this committee determines which non essential treatments and medicine are subsidized (basically, all life saving is subsidized).

The players make their money by offering additional services. E.g., I pay $20/month more to my HMO to get coverage that includes any non-referral 3 specialist visits I choose every year (That is, if my primary care physician doesn't think I should see a specialist but I want to, that's 75% covered up to 3 times a year; Specialists can charge $200/hour). They offer many other additional services.

All emergency room visits with referral are covered. All emergency room visits without referral that were justified in retrospect are covered.

Private medicine is alive and well -- if you want to see a specialist and willing to pay for it, they will be happy to accept you. But everyone gets a good level of medicine for free (as much as you can call 5% tax "free").

I've heard people in the US saying "Oh, I'll only see a doctor if this gets worse because the cost is prohibitive". I've never heard an Israeli say that. Furthermore, when I need to, I prefer to go the $15/visit copay and come at the time I want to (usually 10pm, no waiting lines whatsoever) because I can afford to and waiting an hour in the middle of the day costs me more than that -- but most people use the $2/quarter copay.

Drug companies in Israel do not have the political power they have in the US, and neither do the HMOs; In fact, as far as I know, Teva -- the largest Israeli drug company, and the worlds largest generic drug manufacturer -- has more influence on US policy than it does on Israeli policy.

State managed does not necessarily mean single player, and there are numerous examples around the world in which it actually works.

There could be lot of instances where single payer or some other version of it could work provided the people managing would look out for the little guy and keep the system efficient. I am not that optimistic about it working here, the lobbies are way too powerful and they always get it their way.

"[the insurance bureaucracy] give employees bonuses for how much coverage they [sic] deny to you."

Citation, please. This is the stupidest thing I've read on your blog yet.

For an interview with insurance company employees who get bonuses depending on how much coverage they deny, see the movie "Sicko" by Michael Moore.

The Israeli system sounds pretty good.

Just sos youse all know - yes, I’m looking at you, EBGuy.
DS, Let's put it this way, I was in the room with two female doctors in a social situation. One educated and licensed in California, the other, educated in Europe and trying to become licensed in California. The practicing doctor personally apologized about the US system and how onerous it was for foreigners educated and licensed abroad to become licensed in California.

DesertDoc,

>> Cash “customers” pay the highest rates(!)

This is what I've been saying. The main reason I have insurance is to get the negotiated rates.

>> Get rid of Medicare and Medicaid (and let doctors deduct discounted or free care from their taxes

I see no real difference between getting paid from taxes to provide care, versus avoiding paying taxes on other income by providing discounted/free care.

However, the latter has the negative effect of creating a tax lloophole: Charge high nominal rates and then "discount" them to create tax avoidance for the medical profession. Not a good idea in my book.

>>You really want to save money fast? Then change the malpractice laws, ...

In California there is a 2 year statute of limitations on malpractice suits. Seems more than reasonable to me.

But what is the percentage of healthcare costs that goes towards malpractice costs? And WHY? I could not find a number. There is a good article in Wikipedia, though.

http://en.wikipedia.org/wiki/Medical_malpractice

It appears that lots of cases have merit, from the stats indicated there.

I work as a Lead Sr Financial Analyst at the largest HMO in California. And I can tell you exactly what is raising costs and why a single payer system would be a disaster.

First off Health Care right now is a beauracratic system. It is almost guaranteed continued revenue because everyone needs to go to a hospital. Much like the government where they are guaranteed funding. With this very little desire to make operations efficient exists.

Secondly hospitals are extremely unionized. Most staff never get fired even for gross incompetence and poor performance. The only person that has ever been fired here, in the three years I have worked here, was for a HIPPA violation. Also pretty much everyone who is not a receptionist or a medical asst makes $70k and up. If you have an AA degree in respiratory therapy or radiology technology $100k. And again you will not get fired even for getting into a fist fight infront of patients (this has happened). I constantly hear from the managers I deal with how they can't get rid of their worst performers.

Thirdly my boss, the associate controller at the medical center I work with, has a grandmother in England who has heart problems. He constantly has first hand experience with the single payer system there and its complete ineffeciency. Would he ever suggest going to this system. Heck no!

More competition and less unionization is the way to get health care costs down. Right now Nursing unions have set into their contracts 5% increases for the next 6 years! This when all of the other non-union staff has either had either a pay freeze or a tiny increase. Keep in mind that the average RN makes well over $110/yr. After 5 years that's $147k. And you wonder why health care costs are rising.

Guaranteed funding to the health care system by the government is ridiculous. More competition like any thing else, is the only solution to bringing down costs.

"Taxes will go up, but insurance premiums will go away. Probably a net win. Works pretty well in Canada, Europe, Japan."

sorry but my health insurance premium is currently $0. i chose not to have health insurance. as a citizen living in a free society it is my right to decide whether i want to spend money on health care or not. telling me i must have health care and must pay for it via increased taxes is a form of oppression. why do so few people realize this? and dont try and tell me i should have insurance and i'm foolish to not. thats laregly besides the point and again is asserting that i am not free to make such decisions for myself.

"For an interview with insurance company employees who get bonuses depending on how much coverage they deny, see the movie “Sicko” by Michael Moore."

ha ha ha ha

Given Moore's reputation for, uhh, "creative editing," (see Roger & Me and everything he's done since), I'll pass on wasting my time with Sicko. You're saying that your source is Michael Moore. Seriously? You couldn't even find a journalist?

moonmac,

I don't even charge for that! No probalo.

Just yesterday I was returning some cans for the deposit ( which NO one else in my family has -ever- done ) and there were these 3 "emo" guys really making a day of it? I stood there ( somewhat annoyed ) as each-and-every movement they made was exaggerated to the 'nth degree and the one kid ( w/ mismatched sneakers ) finally... finishes.

So ( like you didn't know what was coming? ) his butt-buddy starts feeding cans over into his shopping cart, and I mean these things are crumpled and nasty... Anyway way I say "Huh uh dude, you're done!" Predictably he launches into a windy explanation as to why their egregious behavior is perfectly "acceptable" and I completely shut him down. "You're DONE!" More objections ensue. "You're DONE!" Grab your receipt and pack it in.

"It's not OUR fault we have bottles and cans to bring back!?" (Ever the victim)

"OUR"? What, are you guys "goin' steady"? You're done. Huffs off in protest. So just keep in mind, -whatever- Health Care System we elect, this is what's coming behind you to 'support' it! Btw, it's usually like this every time.

The Israeli system works reasonably well. It's not perfect, but it seems to avoid the worst of both single-player (uk and canada) and totally-for-profit (us) systems.

And to make a comparison more meaningful:
Average Israeli yearly salary is $20K (median is very different)
Minimum yearly wage for full-time employee is $10K
All income taxes (medical insurance tax, social security, income) get paid by the employer before the employee sees a penny.
Lowest tax bracket is 20% (5% medical + 5% social security + 10% IRS), which is for 0-$12K
Highest tax bracket is 56% (5% medical + 5% social + 46% IRS), which is for earnings above $100K.

In general, products are expensive (e.g., food costs about 50% higher) but services are cheap (university tuition is $2500/year in a state university, and $5000/year in a private university; most people study in a state university).

All of you people in favor of national health care need to carefully think about how the system REALLY works in Canada, Great Britain, and the rest of Europe. There are many, many horror stories. Do your duty as a citizen, take off your partisan blinders, and look at both sides of the issue. Don't just accept statistics thrown out by partisan sources. The issue is just not as simple as "have the government pay for everything." The money has to come from somewhere and there will be unintended consequences.

I'm not saying that nationalized health care is all bad. I can tell you that the health care system in Austria, has some good points, but boy, it has some bad points as well. Costs are controlled by rationing, period.

Oh, and to the person endorsing free tuition. Austria tried that too. Even the socialists there had to admit it was a failure. Students stayed in school for seven and eight years taking one or two classes per semester. Great system.

Australia lets students go on the dole right out of college. The result? Two years of sitting on the beach at taxpayer expense for thousands of students.

But I digress...

I'm with a small company and routinely employ men in their 20's. None of theme have health insurance. They could buy it for $75 per month or less, but don't bother. They sure as hell spend plenty of money on other things, I can tell you that. Is this my problem as a taxpayer?

Given that the U.S. does not have a single entitlement program that is under control, what reason do I have to believe that a medical entitlement system will be any different?

The ridiculous argument I hate the most is that preventive medicine will lower health care costs. Nothing could be further from the truth. Death from a heart attack at 55 is cheap. Three bypasses and several years in a nursing home in the ensuing 30 years are expensive. Morally, the question is more complicated, but mathematically, it's simple.

Our system has problems, that I freely admit, but let's not blindly hope for some miracle cure and end up throwing the baby out with the bath water.

Eliminating personal responsibility from almost any aspect of society is a dehumanizing mistake. Health care is no exception. This will sound awful, but here it is anyway: Stand at the entrance of a Wal-Mart for 20 minutes and tell me how much those people care about their health? How much effort do they spend taking care of themselves and their families? Now, tell me that you want to pay for their health care without making them suffer the consequences of their own actions.

Patrick seems to have lost his free market chops when it comes to paying his doctor's bill. Take it from me, watching people who can't pay their doctor's bill is as much fun as watching people who can't pay their mortgage. Losers.

There's no free market in medical care anyway. You shop around when you're bleeding?

Not that I would deny anyone the right to choose doctors or pay for private insurance. Only that our current system is _worse_ than a single-payer system.

"....pb3030 Says: All of you people in favor of national health care need to carefully think about how the system REALLY works in Canada, Great Britain, and the rest of Europe. There are many, many horror stories."

Wow. OK, how about health car rationed by insurance companies and poverty. Horrible enough? Well, then there's the old one of people turned away from emergency rooms because they didn't have insurance.

Look, the bottom line is, almost every other advanced country in the world somehow manages to provide national health care. Are you telling me that the USA is somehow too stupid or too poor to afford this?

Yes, single-payer health care is not a panacea. There is none. It's just better than the greedhead, unregulated every-man-for-himself free-for-all that we've got now.

Does anyone have examples of what they pay for insurance?

I am under Tricare so I only pay $114 per quarter. So far I have paid nothing out of pocket for daughters birth (including sonograms), 2 colonoscopies (ancestor med history had me get probed much earlier than normal), any meds, annual physicals (including MRIs) and lots of blood labwork. I am in very good health, I can't imagine what they put a sick fellow through.

My English Grandma bought trip medical insurance before coming to USA for a visit. She cought pneumonia on the flight and ended up in the hospital for a week. No out of pocket expence for her private room, meds, and care.

My mom was in a nasty car wreck last year that broke some ribs. She had a private room in a local hospital for a few days, hooked up to what reminds me of the Star Trek sick bay instrumentation, where a screen shows heartbeat, ph0 and a few other visual graphs. Ambulance trip was paid by county, emergency treatment was covered, and medicare paid for
the remaining treatment.

I paid medical insurance for my nephew up until a few months ago. The cost was $238/mo.

Even if we do not get a NHS style coverage, I wonder how many Americans could accomplish the same by choosing a less expensive house and/or more practical car and use the savings to buy insurance. Emergency room care is already free.

Headset,

We pay around $200 a month for (2) empty-nesters ( 46 and 50 y.o ) in decent health. BC/BS thru wife's emp.

Our problem is that we'd be better off going w/ LifeWise and just getting a catastrophic policy and recoup premiums off of Sched. C but it's difficult for people that have always been on an emp. based system to "just let go".

I'll be on Tricare @ 60 but I'm sure it will be different by then.