Estimating Healthcare Costs in America

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jennypenny
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Location: Stepford USA

Re: Estimating Healthcare Costs in America

Post by jennypenny » Wed Mar 06, 2019 7:56 am

As far as prescriptions, I've had a lot of luck with GoodRx. We have a good prescription plan and goodrx sometimes beats it. IMO, drug costs are more manageable than they were a few years ago. Our prescription costs are less than half of what they used to be (+$1K/m).

Augustus
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Re: Estimating Healthcare Costs in America

Post by Augustus » Wed Mar 06, 2019 10:54 pm

Re: OP: are you a citizen? IIRC Trump was threatening to deport noncitizens who take the subsidy. I wouldn't be surprised if Medicare has similar restrictions.

You can get insurance quotes on ehealthinsurance.com if you're working your employer will likely offer you and your family coverage. The rate will vary by employer. Otherwise you'd need individual insurance through a state marketplace, which is expensive. I pay roughly 800/mo for a bronze plan for my wife, my daughter, and I.

M
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Joined: Wed Sep 29, 2010 7:34 pm

Re: Estimating Healthcare Costs in America

Post by M » Sun Mar 10, 2019 9:04 am

@Augustus: Yes I'm a US citizen. I pay over $1,000 /month for family health insurance currently. This is the cheapest plan available where I live, and we're all young and healthy so we don't actually use it all that much. I'm surprised you only pay $800 /month. Seems pretty cheap to me. Perhaps I should move to your state. :lol:

Do you think the politicians will eventually solve the healthcare problems that we face in America?

FRx
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Location: Portland Or

Re: Estimating Healthcare Costs in America

Post by FRx » Sun Mar 10, 2019 4:00 pm

A direct primary care model if you are healthy and a backup short-term health insurance plan might be a great replacement if you are genuinely healthy. It will cover catastrophic causes and keep you healthy.

Just like you found GoodRx, finding out more about alternative ways of obtaining healthcare seems to be a better use of resources than waiting for politicians to solve the healthcare issue in America. My state, Oregon, doesn't do asset testing for ACA subsidies or medicaid enrollment. So if you can get to that level you can certainly consider those options.

M
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Joined: Wed Sep 29, 2010 7:34 pm

Re: Estimating Healthcare Costs in America

Post by M » Sun Mar 10, 2019 6:00 pm

@FRx I'm classically trained as an engineer, not a doctor, so I'm not sure how the best way of determining if someone is genuinely healthy or not. It seems to me that using a really high deductible short term health insurance plan combined with a direct care model may be risky financially, unless one can say with a high degree of certainty that future healthcare problems likely will not arise in the next 10 years.

Based on your experience, can you give an estimate for what percentage of major medical problems are due to genes vs lifestyle vs dumb luck? In my case, I'm a 33 year old male. I've never smoked or drank during my life, my BMI is 20.5, total cholesterol was 113 last time it was checked. My diet consists of 4 organic eggs for breakfast, one pound or more of mixed vegetables fruit and nuts for lunch with olive oil as the dressing, and green smoothie for dinner or no dinner. The smoothie consists of berries, almond milk, and spinach. I don't eat red meat or milk or cheese. I only drink water or almond milk. No pop, coffee, juice, cow's milk, etc. I don't have anything with caffeine in it. About twice a week I have a small piece of grilled chicken with my salad for lunch. About once a week I'll eat a small piece of wild caught salmon. As a general rule I avoid anything processed, anything made in a factory, anything with added sugar in it, and I limit my carb intake. Occasionally I eat whole wheat bread with non-sweetened applesauce as a snack, but I've been trying to cut back.

I average 10,000 steps per day and alternate between 30 minutes of strength training and 30 minutes of cardio every other day.

Both of my parents suffered a variety of medical problems throughout their lives including having strokes, cancer, diabetes, etc. This is why I try and live this sort of lifestyle. Based on my genetics I may wind up with problems anyway, but since this isn't my area of expertise it's hard for me to put a number on it in terms of how many diseases are lifestyle vs genetics vs bad luck.

FRx
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Location: Portland Or

Re: Estimating Healthcare Costs in America

Post by FRx » Sun Mar 10, 2019 6:20 pm

@M
Please take everything with a grain of salt since I don't know everything about you. But the biggest topic to address is that your genetic are probably a 10% factor and whether those genes will express themselves negatively is the other 89%. 1% is the bad luck factor; a random mutation which just happened and you couldn't control. It could have been a chemical you've been exposed to and not aware of or something else intangible.

If your parents didn't have the healthiest lifestyles and had their cancers and diabetes and strokes later in their lives then it's fair to say that it was a lifestyle issue which you're addressing with how you are living.
The devil is always in the details but it sounds as though you are avoiding the common culprits and consuming a high plant-based diet and getting more than enough activity.

If you can make the whole-wheat bread yourself and even going as far as milling the wheat berries yourself, you'll be far better off. Unless you can get the flour from a reputable source which doesn't add chemicals to prevent clumping of the flour or sprays it with fungicides or doesn't it store it in carcinogenic containers or near the exhaust of a giant diesel tractor. You can make amazing 100% whole wheat flour without adding any processed flour and it comes out great. Use a sourdough started to decrease some of the gluten and carb load.

Applesauce seems fine. Again, the details matter. If you can manage to make it yourself, go to town. Otherwise I like that you're cutting back on that.

Your bank-busting risks as a 33 year old woman are breast cancer, ovarian cysts, uterine fibroids, bad menopause, heart disease, stroke, colon cancer, side effects from a western medical intervention, or a mood disorder. You've cut a lot of your risks down already through your dietary modification and activity levels. I don't have much to add to that other than making sure your stress levels and sleep are also optimized as much as possible.

Throw in a little fasting here and there to decrease your chance of any insulin resistance and help with getting rid of any mutated cells. Lots of great resources there.
To be honest you don't have much of a risk in the next 10 years as a woman. Your risks will start showing up after age 50 and again you are addressing them.

As for a treatment, unless you had a really fucked up cancer then you can pay for everything out of pocket and negotiate cash costs far lower than what it would cost in a traditional healthcare setting. Most of these conditions I mentioned can still be managed with further lifestyle changes.

IlliniDave
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Re: Estimating Healthcare Costs in America

Post by IlliniDave » Sun Mar 10, 2019 6:29 pm

M wrote:
Sun Mar 10, 2019 6:00 pm
@FRx I'm classically trained as an engineer, not a doctor, so I'm not sure how the best way of determining if someone is genuinely healthy or not. It seems to me that using a really high deductible short term health insurance plan combined with a direct care model may be risky financially, unless one can say with a high degree of certainty that future healthcare problems likely will not arise in the next 10 years.
One thing I noted while looking at ACA plans is that the difference in monthly premiums between say a Gold and Bronze plan is basically 1/12th the difference in deductibles. So another way of looking at it is that with the more expensive plans you are essentially prepaying part of the deductible via premiums. That led me to conclude that there was no real advantage to the higher level plans unless a person has problems budgeting. There is potentially an advantage to a relatively healthy person in selecting the Bronze-type plans and banking the difference in premiums. Worst case the money goes towards paying the deductible (putting the cost on par with a higher level plan). Best case it stays in the bank. Not sure how it plays with a direct care model, but at least as far as ACA plans, there didn't seem to be much risk going with the higher deductible options. I'm not sure what's out there fo non-ACA plans with the recent changes in the law, however.

M
Posts: 186
Joined: Wed Sep 29, 2010 7:34 pm

Re: Estimating Healthcare Costs in America

Post by M » Sun Mar 10, 2019 7:18 pm

@IlliniDave This is a good observation, and also the main reason why I generally choose one of the cheapest plans available. Unfortunately the cheapest bronze family plan in my area is still over $1,000 /month.

@Frx Wow - good advice. My parents lifestyle was drastically different from my own. Neither of them exercise to this day, they are both on the heavier side (one is very obese), they both consume a lot of simple carbs and sugary snacks and pop and so on. Unfortunately this is how I was raised, so I ate a lot of bad things during my childhood and early adulthood including a lot of fast food, fried food, pizza, pop, etc. I never consumed enough of it to become overweight, but I'm sure it wasn't good for my body. :?

For the past ten years I've been slowly changing my diet and lifestyle into what it is today. Both of my parents suffer from diabetes, and I have noticed that my fasting blood sugar levels fluctuate between 70 and 95 at the high end.

Are there any specific books or resources you can recommend on the benefits of fasting? This is an area I should probably learn more about.

Thanks!

FRx
Posts: 195
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Location: Portland Or

Re: Estimating Healthcare Costs in America

Post by FRx » Sun Mar 10, 2019 7:42 pm

@M

I recall a recent book called the Obesity Code but Dr. Fung - I hope I got that right. I enjoyed his writing about fasting and that's a good place to get advice on the topic because he explains it as well and offers solid facts to back it up. He offers research studies as well but it's important to not place too much emphasis on the research studies because we now have too many and the process of data gathering and the interpretation by the authors are often suspect, if not, biased.

Whatever you've done to yourself up to now it's unlikely for you to see much side effect from that if you have turned your life around. So the side effects of 10 years of smoking or heavy alcohol use or fast food intake is rapidly reversed with the new changes you've made to your lifestyle. The body is insanely forgiving and unlikely conventional western medicine the body (not you) care if there is some damage to some part of the blood vessel or the liver or the brain - you can function with very little of each. It's the cumulative damage which eventually results in problems. You could, for example, have a ton of atherosclerotic plaque lining your blood vessels but because none of the plaques are unstable and you aren't adding much oxidative stress to their structure, they won't rupture. If they rupture you don't have an overly aggressive inflammatory response and no clot will form.

As for your parents there doesn't seem to be much genetic component going on since their lifestyles are probably bigger contributors. Fasting blood sugar tests are decent but best use as a guide and the average is more important than absolute numbers. As an American it might be a good idea to check your fasting insulin levels or whatever test your doc might use to determine insulin resistance. Many lab companies these days let you order your own tests and you can find cheaper labs and pay cash if you don't want to go the insurance route.

Jason
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Re: Estimating Healthcare Costs in America

Post by Jason » Sat Mar 16, 2019 8:48 am

I recently had a medical event which involved a Grand Prix race to a local urgent care, an ambulance ride to an emergency room, one follow up with my primary physician, a visit with an eye doctor, and hopefully just two follow-ups with a neurologist. I skipped physical therapy because I hate places where the majority of people are walking around in sweat pants i.e. gyms, mental institutions, organized crime hang-out, sorority houses at a certain time of the month etc.

Each location required a co-pay. I am covered under my wife's insurance. However, yesterday, I received a bill from the ambulance company for $800.00. I figured, well, not too bad considering. But then I thought, let me call the health care provider to make sure I was responsible. They were very helpful and explained that because the ambulance company was out of network, they were ATTEMPTING to get the usual charge, as opposed to what my health care provider normally pays. The insurance company told me not to pay (YEAH!!!) and that they would speak directly to the provider, at which point they would try to negotiate it away, or down, and but because of their policy, would pay the balance.

The situation was a glimpse into the healthcare world which informed me of this - it's impossible to estimate costs because like other areas of the world, things are negotiated.

Coincidentally, I stumbled upon this recent "American are going broke to due health care costs" article.

https://www.theatlantic.com/health/arch ... cy/584998/

But what I got from the article only reinforces what I experienced first hand, there's a lot of negotiations that go on. And as the article says, an MRI cost today is not necessarily an MRI cost tomorrow.

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