There are so many misunderstandings in that I don’t even know where to start with a comprehensive answer, so I won’t attempt one. 
A couple of easy answers…
Your cost of $500 per person per month is “hideously expensive” for Medicare, when you select the option that provides private health insurance? Are you kidding? Beyond that, social security (‘free’ government retirement payments) can be used to pay it at the age when you are eligible for Medicare. How much money coming in your direction would you find adequate? I hope the French people are able to meet your need for charity in that regard.
It’s COBRA (spelled as such) and it provides exactly same insurance you had when employed, at foreseeable cost ($1200/month in my case for a couple), for up to three years in your state regardless of whether you are fired, unless it was “gross misconduct” (i.e. stealing from the company or similar)
You don’t work for a startup without actually thinking about the risk/benefit in relation to your personal circumstances… unless you are idiot. My choice before going in that direction would be 6 months (preferably a year) of basic expenses in the bank. Nobody forces you to work for an unstable employer hoping for a big $ payoff, without any savings, or alternately without health coverage by another family member with stable employment – which is a common strategy taken by thoughtful people. All this is your choice, just as the benefits of making that choice and winning $ would be your benefit.
A very interesting insight so far thank you.
Yes, I am well aware my friends and business contacts are all wealthy, which is why I am especially interested how it is if you arent, especially because when I have chatted to them it is my distinct impression they dont really know (and it is right I think not to follow with the obvious and dont care, but I dont believe they are in that group, more they genuinely dont know and never especially thought to ask).
There are so many misunderstandings in that
No, there are none. I know you fiercely defend the US medical system, which imo is pretty indefensible – so we disagree. Oddly, most people seem to think their country’s medical system is wonderful – the UK NHS for example.
I don’t understand your second paragraph. My Medicare premiums would be a lot lower if I wasn’t earning anything, though still quite a lot. We have a friend who is eligible but doesn’t have it, because she can’t afford the premiums. Your remark about “charity” is just nonsense. I promise you I’ve paid in plenty in both countries over the years I have been working.
COBRA provides the same COVER, but the premiums are significantly higher than what the employer would pay. We used it for the maximum (18 months, not 3 years) when my wife left her company. Only afterwards I realised it would have been a LOT cheaper to switch to my employer’s coverage.
As for startups… not everyone has the option of insurance through a family member. (I did, I’m not complaining on my own behalf). If you’re well paid (in my area that’s the case) you can easily enough save enough to live for 6 months. Saving enough to cover every possible medical expense ($millions) is a different story. Pre Obamacare, getting private insurance was impossible if you had a pre-existing condition, and anyway can’t be done in three days.
Americans take this mess for granted (and even defend it). To anyone in Europe (or Canada or Australia or Japan…) the idea that losing your job means you instantly lose medical coverage is just unimaginable.
There’s also the fact that the US system costs about double any other country’s. It’s unclear where that money goes, I think mostly on the inherent inefficiencies in the hyper-complex insurance system – though drug company and hospital profits account for a lot too. My (sadly former) doctor didn’t deal with any insurance because she said she would need a full-time assistant to do so. Go to any medical practise and you see more people employed to deal with insurance companies than there are doctors.
johnh wrote:
We used it for the maximum (18 months, not 3 years) when my wife left her company.I understood you are in California. CAL COBRA pays an additional 18 months when COBRA runs out. As an aside, one of the options this allows is to cease employment at 62, then use Social Security payments to cover health insurance until you’ve 65 (three years) and move to Medicare. Given my wife’s lack of US work history and starting payments early at 62, our social security payments would be reduced in this case to the relatively modest amount of $3200/month IIRC. Still a nice option for those who want to retire at around that age, as I plan to, and plenty enough to pay for health insurance until 65 with $2000/month left over to supplement more substantial retirement income from savings etc.
johnh wrote:
Only afterwards I realised it would have been a LOT cheaper to switch to my employer’s coverage.
This is not rocket science, it just takes a little basic investigation. If you were limited to adding her only during annual enrollment, you’d use COBRA for a partial year, then add her at that time.
johnh wrote:
COBRA provides the same COVER, but the premiums are significantly higher than what the employer would pay.
The total premium is no higher and the amount paid to the insurance company is the same, the difference is that you lose the employer contribution.
johnh wrote:
There’s also the fact that the US system costs about double any other country’s. It’s unclear where that money goes, I think mostly on the inherent inefficiencies in the hyper-complex insurance system – though drug company and hospital profits account for a lot too.
By my observation the care is more personal, more flexible, less restricted, more comprehensive, faster and more technically advanced. The usual things that come with (somebody) paying more. The costs of administration prevent successful fraud, which is for example huge in Original Medicare. That’s why the government actually prefers it when you choose the ‘Advantage’ (government paid commercial insurance) option under Medicare versus increasing their fraud losses with Original Medicare. US drug company profits are largely what provide the world with new and better drugs and sales to many other countries provide only a marginal profit.
My own choice in healthcare is to spend as much as I can afford on it, e.g. choosing my most expensive option at work, and maintaining control of the maintenance of my own body… because in any country its better when you do.
to JohnH who living in USA and has not seen a case of covid I have to say that you live in a bubble
here in Dallas we have our intensive care unit full of patients, about 3500 new cases a day in the city, the obituary page which used to be 1/2 a page on Fridays now it goes for 4-5 pages. Of 7 of my working partners 4 got the covid and 1 almost died. I have at least 10 or more of my close friends that suffered from the virus. It is hard to believe the first sentence. Maybe I need to move to where JohnH lives. We have currently no vaccines available except for medical personnel and people over 75.
The city is deserted at night but for xmas and New Years the shopping malls were full……
to JohnH who living in USA and has not seen a case of covid I have to say that you live in a bubble
Of course you are right. Moving here would certainly be better than moving to LA, but still not great. You would also have to live like we do, i.e. working from home, going out very little, seeing only people we know well and even then outdoors and well distanced, and so on. If you moved here and travelled on the (mostly empty) public transport, went out to work every day and got together often with friends and family you would be as vulnerable as anyone else. We don’t live the monk-like seclusion Peter evidently does, but not far off. Still, it remains true that among our friends etc, who all live much the same way, there has not been a single case. (Actually that’s not QUITE true, we have one rather distant friend who almost certainly had it, though eventually tested negative. He prob95 would have died without the care he received).
@Silvaire… in fairness I am generally cr*p at managing anything to do with money (else why would I own a plane?). My wife’s insurance was among the very best, so it made sense to keep it going rather than use my OK-but-not-great startup’s. Still, it cost $$$$$.
Healthcare in France is really excellent, far better than the UK and better than here too, in fact all the things you say, flexible, quick, reactive, and much less expensive too if somehow you do end up paying. It’s not impossible to get that level of care here, but you have to put a lot of effort into finding it and keeping it. Our “obvious” provider here (Sutter) is like a giant factory, you get to see a doctor for 30 seconds, they are painful to deal with, you feel like (and are) a cog in a machine. And if ever you do have anything wrong, you will have a battery of tests which (a) makes them more money and (b) makes it harder to sue them. Double win for them, a lot of hassle and risk for the patient.
My AME would also be my generalist if/when I needed one, and he does provide personal care and attention, as did my now-sadly-departed French doctor here. But that is the exception.
Never, ever use your AME for primary care.
My last AME visit and FAA 3rd Class medical renewal (a month or so ago) took something like 15 minutes and he would not have wanted me to reveal or discuss anything that wasn’t legally mandatory. Obviously that’s not health care, it’s a formalized government inquisition by somebody who on a personal level wants you to pass and is aided in doing so by knowing as little as possible, nothing that isn’t directly addressed by the written requirements.
I certainly do not and see no reason to live in monk like seclusion. I pay no attention whatsoever to any extralegal government dictates unless that might involve jail time, only my own judgement and consideration to others with different choices in their behavior. My flying and airport activity is unaffected. I have never worked from home and plan never to do so. I go to work by choice every day with others of similar mindset and will not stop doing so until my savings no longer require it, or they lock the door. My home is not an office (I don’t even have a computer at home), nobody is paying me rent for it to become so and my family does not need exposure to my often unpleasant work environment – it’s called work for a reason
Here’s some interesting local data about who’s ending up on intensive care with COVID in Wales.
Obesity makes less of a difference than I was expecting. About 1/5 are under 50. Being male is a bad start. Of course these are the people who are ill enough to be on intensive care but fit enough that they may survive, so will not be generally representative of severely ill COVID patients.
kwlf wrote:
Here’s some interesting local data about who’s ending up on intensive care with COVID in Wales.Obesity makes less of a difference than I was expecting. About 1/5 are under 50. Being male is a bad start. Of course these are the people who are ill enough to be on intensive care but fit enough that they may survive, so will not be generally representative of severely ill COVID patients.
Notably, the mean age of ICU patients with Covid-19 was in the late 50s. The last paragraph indicates that may also be due to older patients dying more quickly.
Also, social status seems to be a major risk factor, with “deprived” people being a lot more likely to end up with severe Covid-19, apparently.
This is old news in public health: poor people invariably have worse outcomes and are more likely to get ill in the first place, almost regardless of the illness in question.
It is remarkable that this effect is still quite strong even in a country with universal, free healthcare. In the US it must be much worse, for the reasons discussed in the previous pages (poor and deprived people are usually not “proactive” at managing their health insurance…or anything else for that matter)
It’s not social status in relation to avoiding CV-19, it’s money.
I found the use of the word “deprived” in the article astonishing, compete nonsense, an awful label that signifies acceptance of permanent class barriers, social failure. The derisive, paternalistic judgment this implies about the dependence, capabilities and intelligence of low income people is even worse. The thing that people without money generally have in common in my area is having come within recent memory from somewhere outside of the country in which they were prevented by others from advancing themselves. That no longer applies here and they do not view themselves as “deprived”. That is a label you apply to animals that seems almost intentionally designed to demotivate and demean people. Awful.
