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That seems crazy. We agree to pay down debts with interest above 7% before making any long term savings. But pay the immediate, today 20-35% post tax hit for medical expenses, because long term HSA investments will outperform it?
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May 8, 2017 18:04
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GoGoGadgetChris posted:That seems crazy. We agree to pay down debts with interest above 7% before making any long term savings. But pay the immediate, today 20-35% post tax hit for medical expenses, because long term HSA investments will outperform it? You get the deduction now, leave the money in the HSA instead of a taxable brokerage account so that the investment gains remain untaxed, and then write yourself a check out of the HSA in 30 years to reimburse yourself for all the expenses you incurred in your lifetime. It's essentially a way to temporarily keep money in the HSA instead of a taxable brokerage account without losing any of the tax benefits of the HSA. It's completely irrelevant if you don't already max out all 401k and IRA space. Personally I don't bother and I just pay out of my HSA.
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May 8, 2017 18:12
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Ah, that does make some sense. I probably won't do it just because... 30 years of receipts, but it doesn't seem nearly as crazy. Do you worry at all about legal changes in the next 30 years?
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May 8, 2017 18:15
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GoGoGadgetChris posted:Do you worry at all about legal changes in the next 30 years? Most people that do it seem to assume they would get plenty of notice of legal changes, so if congress tweaked the law to put a time limit on reimbursements they would do everything that year. I don't know how often they change laws like that with no notice - I have seen a few other retroactive tax changes so I'm sure it's at least a little possible that everyone doing it will get screwed at some point. That is one of the reasons I don't bother with it. Another reason is that it's a relatively small amount of money if you are in fact maxing out all of your retirement options already. My wife and I have probably spent $20k out of our HSA in 10 years - that's like 1 year's 401k contribution limit for one person.
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May 8, 2017 18:24
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Plus if I were to miss the rules change, I'd expect to have more medical expenses in the future anyway so more chances to reimburse myself. Or if I were to manage to not need the funds at all, the worst case scenario is I withdraw the HSA funds like I would a t-IRA when I hit retirement age.
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May 8, 2017 19:23
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GoGoGadgetChris posted:Do you worry at all about legal changes in the next 30 years? Yes, constantly, particularly that 1) IRA and/or 401k withdrawal rules will change, especially with some form of balance cap or means testing that will materially alter my retirement strategy 2) IRA and/or 401k loopholey rules that benefit me will be changed, specifically the backdoors and some of the quirks of solo 401ks
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May 8, 2017 20:20
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Droo posted:Another reason is that it's a relatively small amount of money if you are in fact maxing out all of your retirement options already. My wife and I have probably spent $20k out of our HSA in 10 years - that's like 1 year's 401k contribution limit for one person. But HSAs are far and away most useful to young people who generally have few medical expenses and a long retirement runway. If you start stuffing an HSA at 22 or 23 and are lucky enough to go a decade or two with overall trivial medical expenses it will turn into a lot of money in 40 years when you get old and sick.
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May 8, 2017 20:24
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BEHOLD: MY CAPE posted:But HSAs are far and away most useful to young people who generally have few medical expenses and a long retirement runway. If you start stuffing an HSA at 22 or 23 and are lucky enough to go a decade or two with overall trivial medical expenses it will turn into a lot of money in 40 years when you get old and sick. I'm not saying not to fund it, I'm saying I don't bother hoarding receipts for 30 years with plans to reimburse myself so that a relatively small amount of money can temporarily be in the HSA instead of a taxable brokerage account. I just spend out of the HSA as I go.
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May 8, 2017 20:27
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Really its just a question of risk aversion. If you're more risk averse, use your HSA now to pay for healthcare expenses. If you're less risk averse, pay cash and hope you don't lose out on the opportunity of that cash.
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May 8, 2017 22:39
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I'm sorry but however the numbers work out there is something fundamentally wrong with a person and/or society if they are opening funds for their healthcare expenses 40 years down the road. gently caress that poo poo.
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May 10, 2017 21:11
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Pryor on Fire posted:I'm sorry but however the numbers work out there is something fundamentally wrong with a person and/or society if they are opening funds for their healthcare expenses 40 years down the road. gently caress that poo poo. Give us another 10 years and we'll have funds to save for your kids' adult healthcare expenses similar to college funds! 
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May 10, 2017 21:38
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Don't even get me started on 529s, the fact that the University systems have become so efficient at hoovering up every extra dollar available that the "good advice from smart people" is that it's actually wise to start saving for that infinite money vortex before your goddamn kid is born. My god it's nearly as insane as healthcare.
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May 10, 2017 22:01
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Pryor on Fire posted:Don't even get me started on 529s, the fact that the University systems have become so efficient at hoovering up every extra dollar available that the "good advice from smart people" is that it's actually wise to start saving for that infinite money vortex before your goddamn kid is born. My god it's nearly as insane as healthcare. This was me when I first came to BFC as a recent graduate/first time job holder a few years ago. Thankfully everyone knocked some sense into me.
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May 11, 2017 06:23
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Pryor on Fire posted:Don't even get me started on 529s, the fact that the University systems have become so efficient at hoovering up every extra dollar available that the "good advice from smart people" is that it's actually wise to start saving for that infinite money vortex before your goddamn kid is born. My god it's nearly as insane as healthcare. It's hosed, while it's extremely bad in the US the whole student loan thing is just a money printing operation in the West. I was there for the protests at the time. We even had NZ's Minister of Education jump out of a window to escape campus. He couldn't use his car as we'd started a chant as a decoy so the Police didn't realise we were letting the air out of his tyres. We protested against it but the Government did it anyway. Now students are hosed. I know too many people with BAs and $50k of student debt. The upsides are in NZ that it's 0% interest for now and is a 12% "tax" above $19k per year. I don't see how getting a degree and then working in retail is adding productivity to the Country or that there is a lifetime benefit of having an extra 12% tax that they''ll pay for 30-40 years. Changes need to be made so the educational system isn't there to gently caress over 90% of the students.
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May 11, 2017 06:23
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Devian666 posted:It's hosed, while it's extremely bad in the US the whole student loan thing is just a money printing operation in the West. I was there for the protests at the time. We even had NZ's Minister of Education jump out of a window to escape campus. He couldn't use his car as we'd started a chant as a decoy so the Police didn't realise we were letting the air out of his tyres. We protested against it but the Government did it anyway. Now students are hosed. I know too many people with BAs and $50k of student debt. The upsides are in NZ that it's 0% interest for now and is a 12% "tax" above $19k per year. I don't see how getting a degree and then working in retail is adding productivity to the Country or that there is a lifetime benefit of having an extra 12% tax that they''ll pay for 30-40 years. It's extremely upsetting that something that owns this hard had no lasting effect! 
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May 11, 2017 06:24
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pig slut lisa posted:It's extremely upsetting that something that owns this hard had no lasting effect! It was national news at the time but the Government had no intention of reversing course. It also wasn't the only unpopular thing going on. The Government eventually changed and changes were made to the student loan system so that people wouldn't end up with annual payments less than the interest charged, and later the removal of interest. At least in a recent interview the former Prime Minister from that era acknowledged that neo-liberalism has failed and we need to move on.
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May 11, 2017 23:33
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Pryor on Fire posted:I'm sorry but however the numbers work out there is something fundamentally wrong with a person and/or society if they are opening funds for their healthcare expenses 40 years down the road. gently caress that poo poo. Don't look up how many people go bankrupt annually in the US over unexpected healthcare expenses. Hell, don't watch Breaking Bad. The US is the dystopian hellscape version of the average rich western nation and don't let anyone convince you otherwise.
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May 12, 2017 06:51
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I had to take an ambulance from a hospital to a mental hospital last month and the ride alone cost me $1600. gently caress that. Next time I'm just gonna risk death.
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May 12, 2017 20:17
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http://i.imgur.com/f8bq31k.gifv
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May 12, 2017 21:15
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MiddleOne posted:Don't look up how many people go bankrupt annually in the US over unexpected healthcare expenses. Hell, don't watch Breaking Bad. The US is the dystopian hellscape version of the average rich western nation and don't let anyone convince you otherwise. Yeah honestly I think bankruptcy is the more attractive option as a healthcare strategy, at least for most financial situations.
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May 13, 2017 01:32
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Pryor on Fire posted:Yeah honestly I think bankruptcy is the more attractive option as a healthcare strategy, at least for most financial situations. That or just, you know, purchase health insurance.
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May 13, 2017 01:51
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OctaviusBeaver posted:That or just, you know, purchase health insurance. That would be my gut reaction as someone who hasn't been through this and has always had adequate health insurance. Am I missing something? It seems like there has to be something else causing this because it's such a frequent story.
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May 13, 2017 01:55
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It's like a conversation with the people who couldn't understand all the troubles in New Orleans. Why don't all those people just drive away from the hurricane? They can see it coming can't they? Idiots!
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May 13, 2017 01:59
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Motronic posted:That would be my gut reaction as someone who hasn't been through this and has always had adequate health insurance. Health insurance is expensive and insurance companies are masterful at loving you over even when you have it. Didn't check that that anesthesiologist in the corner was in-network before getting put under? Whoops!
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May 13, 2017 07:46
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El Mero Mero posted:Health insurance is expensive and insurance companies are masterful at loving you over even when you have it. Didn't check that that anesthesiologist in the corner was in-network before getting put under? Whoops! Basically this. You don't even have to be conscious to be responsible for an out-of-network charge in some states. Prior to ACA (I think? I think it was ACA that fixed this), you could be completely unconscious and have an out-of-network ambulance or in-network ambulance take you to an out-of-network hospital and you were still responsible for the OON charges instead of the insurance-covered in-network charges. The same applies to every person involved in your treatment, from surgeon to prep squad to anesthesiologist to monitoring doctor who just happened to come in and check your pulse in the room without asking you while you were asleep, etc etc. Any one of these people isn't in your network and you're getting billed out the wahzoo. Been there, been minorly hosed by that before. Random doctor came in and checked my wife's pulse after she had surgery before leaving again, and that 15-second pulse check cost us more than the entire rest of the surgery/recovery stay put together since he didn't participate in our plan.
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May 13, 2017 08:09
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It sounds more like the hospitals and doctors are screwing you than the insurance companies.
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May 13, 2017 20:50
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I think it's more the system and the hospitals than the doctors. The doctors don't have time to care about who's in their network.
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May 13, 2017 21:17
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spf3million posted:I think it's more the system and the hospitals than the doctors. The doctors don't have time to care about who's in their network. In many cases it's very deliberate. It's a fairly common practice (search for "drive-by-doctoring") and it's incredibly hard to fight in court especially with the agreements you sign when getting any kind of surgery. Hospitals/doctors are not incentivized to lower your costs and if two doctors in different networks agree to check each other's patients' pulses for $20k a pop nothing is stopping them.
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May 13, 2017 21:42
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Desuwa posted:In many cases it's very deliberate. It's a fairly common practice (search for "drive-by-doctoring") and it's incredibly hard to fight in court especially with the agreements you sign when getting any kind of surgery. Hospitals/doctors are not incentivized to lower your costs and if two doctors in different networks agree to check each other's patients' pulses for $20k a pop nothing is stopping them. Just googled this and it's sickening. https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html posted:Before his three-hour neck surgery for herniated disks in December, Peter Drier, 37, signed a pile of consent forms. A bank technology manager who had researched his insurance coverage, Mr. Drier was prepared when the bills started arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the anesthesiologist and even $133,000 from his orthopedist, who he knew would accept a fraction of that fee. quote:“This has gotten really bad, and it’s wrong,” said James J. Donelon, the Republican insurance commissioner of Louisiana. “But when you try to address it as a policy maker, you run into a hornet’s nest of financial interests.” healthcareinamerica.txt
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May 13, 2017 21:55
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I am still surprised some Central American country has not made themselves wealthy simply by offering quality Healthcare to middle class Americans. Once they get the reputation as the place for routine hip and knee jobs and stents, they should be set for decades.
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May 13, 2017 23:59
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Doing major surgery overseas in SE Asia is definitely a thing.
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May 14, 2017 00:05
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There are people who go to Mexico for dentistry and non-emergency internal medicine.
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May 14, 2017 02:53
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Mercury Ballistic posted:I am still surprised some Central American country has not made themselves wealthy simply by offering quality Healthcare to middle class Americans. Once they get the reputation as the place for routine hip and knee jobs and stents, they should be set for decades. Mexico and a number of nice vacation spots in central america have very large markets that cater to medical tourists and part of Cuba opening up has been the economic promise of lots of medical tourists from the US. I think Blue Shield in California already even runs a cross-border HMO for Mexico. The arbitrage opportunity is far too large to not explore. The main obstacle is overcoming fear/racism about foreign doctors, especially because the largest customer base for this kind of thing are aging boomers on fixed incomes who believe that relying on the US healthcare system will actually give them better outcomes (despite all evidence to the contrary). Hell, my dad is in El Salvador getting dental work right now that would have cost him $40,000 here in the US. It's cost him $10,000 there from a doctor who was trained in the US. Even when you add in travel costs you end up with more than a 50% price reduction. El Mero Mero fucked around with this message at 05:39 on May 14, 2017 |
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May 14, 2017 05:25
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El Mero Mero posted:Mexico and a number of nice vacation spots in central america have very large markets that cater to medical tourists and part of Cuba opening up has been the economic promise of lots of medical tourists from the US. I think Blue Shield in California already even runs a cross-border HMO for Mexico. The arbitrage opportunity is far too large to not explore. The main obstacle is overcoming fear/racism about foreign doctors, especially because the largest customer base for this kind of thing are aging boomers on fixed incomes who believe that relying on the US healthcare system will actually give them better outcomes (despite all evidence to the contrary). My main hangup with this is that if something goes wrong it's going to be a lot harder (probably impossible) to sue a doctor in another country and actually collect anything than it would be in the US.
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May 14, 2017 15:29
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OctaviusBeaver posted:My main hangup with this is that if something goes wrong it's going to be a lot harder (probably impossible) to sue a doctor in another country and actually collect anything than it would be in the US. That is a substantial reason why it is cheaper.
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May 14, 2017 17:25
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BEHOLD: MY CAPE posted:That is a substantial reason why it is cheaper. It's not really.* It certainly is a risk you take, but the majority of the savings are going to come from lower costs for salaries, facilities, equipment, drugs, etc. *https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/
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May 14, 2017 17:30
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The section on defensive medicine costs seems to make a hell of a lot of estimates based on a limited amount of information, and they even admit that. Not that it's as easy to quantify as figuring out how much was paid in malpractice lawsuits/premiums because I doubt doctors are tagging procedures as "CYA."
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May 14, 2017 17:58
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BEHOLD: MY CAPE posted:That is a substantial reason why it is cheaper. This is incorrect. It's mostly a conservative idea that's been floated for years that's never made much sense. It's a classic case of "look at the small cost (please ignore the primary drivers)" talking point that completely distorts how people think about an issue. quote:Studies indicate that physicians in group practices preserve their net income in the face of malpractice premium increases by increasing both the volume of services they perform and the unit prices they charge. About half to three-quarters of physicians response takes the form of higher volume; price effects are comparatively modest. The malpractice costs in the US system account for ~2% of medical costs. Significant to be sure, but savings realized from overseas care are much greater than that. Costs savings from overseas care come from a combination of factors. It's some combination of: medical price control regulation + state subsidies + no insurance middle-men price fuckery + exchange rate + lower physician salaries + lower physician debt load Listed in order of greater effect to lesser effect on price
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May 14, 2017 19:04
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I think the broader point I was trying to make (very poorly) is that it's effectively impossible to achieve financial independence in the United States because of the healthcare system, at any moment you could effectively be ruined regardless of insurance or financial status (unless you're pusing like 10mil+ of liquid net worth anyway). So I guess if you truly want to mitigate risk over the long term you need to move elsewhere.
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May 14, 2017 20:32
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Pryor on Fire posted:I think the broader point I was trying to make (very poorly) is that it's effectively impossible to achieve financial independence in the United States because of the healthcare system Strongly disagree with this. There are a lot of affordable insurance options that have annual/lifetime out-of-pocket limits (for now... things may change depending on what the current administration accomplishes). I do agree though that living in another country/certain states would help mitigate medical financial risk.
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May 15, 2017 19:54
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