Another option for health-care

[JL13]

Or you could replace your hip joints with artificial ones that break after 10 years.

I dated a nurse who had a patient whose replacement hip failed but they couldn't replace it because she was too weak. So she lived in agony every day.

I'll take my free natural broken hip over a $20,000 broken one, thank you very much.

[George the original one]

Over quarter of a million for healthcare costs for new retirees these days. Of course you could just decide to not take prescription meds and live with the creaky achy joints that are to be expected when you are older and avoid much of that?

Worth reading as the quarter million dollar figure is basically insurance premiums and doesn't really account for out-of-pocket expenses.

***
The people I know with hip replacements had very limited mobility due to extreme pain before the surgery. Usually had a rapid onset, like 1-2 years. Post-surgery, the pain is gone. So even if the hip replacement failed after 10 years, that's 10 years of pain-free life & no drugs. Health insurance (or gov't) paid for the surgery.

[JL13]

Hmm well I guess my concern is what happens when you get too old to get under the knife again? Which hurts more? A broken fake hip or a broken natural hip?

[Lemon]

Hmm well I guess my concern is what happens when you get too old to get under the knife again? Which hurts more? A broken fake hip or a broken natural hip?

Well given a hip replacement (assuming you don't become morbidly obese/generally abuse it) is gonna last a decade if not more (newer models last longer, but have less data, natch) it is going win out by and large without question. Broken normal hip, you gonna end up with a replacement (as in, actually broken not arthritis etc) of some sort because the pain is that bad. Trust me you can be very sick before you don't operate on a fracture (at least where I am). As in if you are not imminently dying we will probably put in some form of replacement (here). Hip fractures the pain and lack of mobility is awful.

Old prosthetic hips do sometimes need replacing. Revisions are longer ops and so you need to be fitter to replace one.

A hip replacement for bad arthritis is a no brainer in general. Crippling pain with very little movement or being able to do most of what you can with a normal hip (some movements make you prone to dislocation, but I can cope with not being able to cross my legs given arthritic hips can't do it normally either). If I had bad arthritis very young then you have to start thinking about how you preserve things because if you are looking at 50+ years of life no way 1 prothesis will last that long. But your average 70/80 year old, fuck it the replacement will probably outlast them. As it looks likely to be the case for my gran.


Doctors do actually do some useful things, we are not out to just take money off people!

I wonder if this is in part a consequence of the US system where a conflict of interest can exist in that a doctor gets paid more for doing a procedure whereas here, I get paid the same regardless of what I do for my patients. This is I think and advantage, it stops the relationship being sullied by the fear that I might be profiting from certain decisions.

But in all honesty I would prefer patients who thought about it and I can actually give them the stats (collated/simplified as needed). Rather than the 'I want everything' without thinking about it.

[IlliniDave]

Over quarter of a million for healthcare costs for new retirees these days. Of course you could just decide to not take prescription meds and live with the creaky achy joints that are to be expected when you are older and avoid much of that?

Worth reading as the quarter million dollar figure is basically insurance premiums and doesn't really account for out-of-pocket expenses.

***

Have to consider the source in that article--it's from a financial planning outfit quoting a source that I thought was another financial planning outfit. The things I noted right away is that the data is for a couple, so per person it's probably half that, and they are using future dollars and fairly high inflation rates, which makes things sound worse. Basicaly that couple has > 40 person-years in that scenario, so the 284K is about $7000/person/year in future dollars for a pretty significant amount of insurance and a significant amount of ongoing out of pocket expense. That's about $583/mo/person (in future dollars) which isn't extraordinarily different than what most pre-retirees are paying now.

I can certainly sympathize with the approach of as little participation in modern medicine as possible. But as I age it increasingly sinks in to me that I'm going to lose my bravado and want them to keep patching me back together as well as they can for as long as its reasonably possible. In my 20s and 30s I was perfectly comfortable with the idea of just acquiescing when the time came and forgoing expensive intervention. Now in my fifties--well, not so much. Some of us are willing to give up hundreds of thousands of dollars (or more) for a few years of "freedom". I can see a number of situations where I'd throw an awful lot of money at staying alive for a few more years. Clearly it's wise to make good upstream life choices, but that does not guarantee dying will be cheap or nature will wait to rise up against us until we'd like it to. Just yesterday I was speaking with a colleague who had taken his mom for a checkup and learned she is well into her 11th year of remission versus leukemia. In her case she got to the end of the line as regards conventional treatment and was then selected for an experimental/trial program so the drugs she takes are free to her--in time presumably those drugs will be out there (and probably expensive) for other patients.

[FRx]

In the US we physicians are definitely causing more harm and doing far less healing. I'm talking about general medicine, OB/Family Med/Internal Med/ER. Surgeons for the most part do better but many unnecessary knee scopes and gallbladder removals and tumor surgeries take place every year.

The combination of a ton of unhealthy patients most of whom want an intervention of some sort along with the massive volume of patients AND the endless lawsuits is just a disaster of a combination. What's the fastest way for me to get out of an exam room? To just give into whatever that patient wants. Sure, the first few years of practice you have the energy and you'll go toe-to-toe with every patient, deny the opioids, refuse the antibiotics, say no to unnecessary sutures for tiny lacerations and steroid injections for joints that just need less weight on them.

But, after multiple patient complaints and working with less resources than an auto mechanic has you just say fuck it. Here is your antibiotics, good luck with the ensuing C Diff infection. Here is your steroid injection even though it will likely degenerate your joints more. Here is your orthoscopic knee "cleaning" because you aint gonna leave me alone unless I cut on you and here is you statin and beta blocker and ace-inhibitor and zoloft. Because if I am the last person you saw before you killed yourself and I didn't given you zoloft then I end up on the news.

Annual health visits are useless. Getting your blood pressure checked at every visit... completely useless. Baseline testing doesn't say anything about what your future and current atherosclerosis risk and plaque buildup is. The best way to stay healthy is to stay out of the doctor's office. Sure there are emergencies but I've worked in many emergency rooms and in the US the majority of what I see in the ED is not an emergency. It's just someone who emergently wanted care. Coughs, colds, strep throat and UTI's many of which heal with tincture of time.

I realize that what I see in the office is skewed. Many individuals have chosen to stay the fuck away from doctors because they know what's good for them. And those same people know exactly when it's time to seek help and they ask the right questions, chose the safest option and are off on their way. Treat your doctor like a mechanic, like a consultant, let them advise you on what you should do and then choose what's right for you.

@crazylemon, liked what you wrote.

[George the original one]

"According to a 2015 report from the Employee Benefit Research Institute, a 65-year-old man would need to save $68,000 to have a 50% chance of affording his health-care expenses in retirement (excluding long-term care) that aren't covered by Medicare or private insurance. To have a 90% chance, the same man would need to save $124,000. The news is worse for a 65-year-old woman, who would need to save $89,000 and $140,000, respectively. Be sure you're doing all you can to cut health-care costs in retirement by considering supplemental medigap and Medicare Advantage plans and reviewing your options every year."
From http://www.kiplinger.com/slideshow/reti ... OWEOzjE.99