I am about to throw in the towel after 35 years

[tggzzz]

Still the insane health insurance costs seem mostly limited to the US. In the Netherlands I pay exactly the same for health insurance whether I'm self employed or not. I do have to take care of my pension plan and income insurance in case I become ill.

That is exactly my understanding too from expat friends of mine, some of whom are now contemplating returning to the UK after several decades reaping the rewards of the US, including becoming naturalised and bringing up families. I don’t know if this is a recent thing, or just because deductibles and premium grow as you get into your 50s.

I have a relative in SoCal. He is staying there at the moment because despite being in his late 70s he is still a productive aerospace engineer.

However, he also has a house here, and it looks like he'll return when he no longer has health insurance there.

Yes, he has kept up suitable NI payments here so that he won't be regarded as a foreigner. He knows the value of the NHS and the difficulties in the US health care system.

[james_s]

Obviously no system is perfect, but the US spends far more money on healthcare than any other nation and people seem to forget that the way it gets around the delays experienced by people seeking treatment in places with socialized healthcare is by flat out denying treatment to a large portion of the population that can't afford it. So if you're wealthy enough then the layers and layers of waste are of little consequence and the healthcare system in the US is arguably the best in the world. However if you're everyone else, instead of waiting months you may well just be told to pay up or buzz off. Personally I'd rather see every citizen have access to healthcare, even if it means some of us have to get a bit less of it. Given how much more we collectively spend per person than other nations, I would expect the situation would turn out better assuming we just maintain the current levels of spending but do so in the form of taxes instead of paying private for-profit insurers. Given health insurance is in effect a *huge* corporate tax on hiring, quite literally a job killing tax, it must create a bit of a conundrum for the right wing between the evils of "socialism" and their affinity for corporate welfare tax breaks.

It's little different than the way the express toll lanes they added on the highways near me a few years ago reduced commute times. They do so by excluding those who can't or refuse to pay to use them. Those who can rave that they spend much less time sitting stuck in traffic, but for everyone else it is worse as traffic in the general lanes and side roads spiked tremendously as soon as the tolls kicked in.

[coppice]

Yes, he has kept up suitable NI payments here so that he won't be regarded as a foreigner. He knows the value of the NHS and the difficulties in the US health care system.

I'm not sure what you mean by that. You only need to be British to be eligible for NHS care.

[vtwin@cox.net]

I don't think you need great networking skills. You can only do a limited amount of work by yourself anyway. In my own experience you will always manage to find some projects even if you are doing only a little bit of advertising. Linked-in and internet fora are great ways to get in touch with people who may need your skills. Sometimes it does get quiet and that is a good opportunity to visit some of the existing customers and see what they are up to. I call it shaking the tree and it doesn't take long for something to fall out. And then there are also the recruitment agencies which can land you a nice gig but these are usually long term jobs (which I'm not fond of so I never  went that route).

Obviously you're more of an extroverted personally and do not understand introverts. I avoid social media. I use FB solely to keep in touch with my parents, who are in their 80s and pretty much housebound at this point, and although I have a linked in account, I never use it and could be bothered. It holds zero interest to me, to read crap I could care less about in other people's lives. If I did anything, it would probably be through a recruitment agency. The idea of "shaking the tree" as you call it, to me, reeks of sales and doesn't appeal to me in the least.

[Simon]

Obviously no system is perfect, but the US spends far more money on healthcare than any other nation and people seem to forget that the way it gets around the delays experienced by people seeking treatment in places with socialized healthcare is by flat out denying treatment to a large portion of the population that can't afford it. So if you're wealthy enough then the layers and layers of waste are of little consequence and the healthcare system in the US is arguably the best in the world. However if you're everyone else, instead of waiting months you may well just be told to pay up or buzz off. Personally I'd rather see every citizen have access to healthcare, even if it means some of us have to get a bit less of it. Given how much more we collectively spend per person than other nations, I would expect the situation would turn out better assuming we just maintain the current levels of spending but do so in the form of taxes instead of paying private for-profit insurers. Given health insurance is in effect a *huge* corporate tax on hiring, quite literally a job killing tax, it must create a bit of a conundrum for the right wing between the evils of "socialism" and their affinity for corporate welfare tax breaks.

It's little different than the way the express toll lanes they added on the highways near me a few years ago reduced commute times. They do so by excluding those who can't or refuse to pay to use them. Those who can rave that they spend much less time sitting stuck in traffic, but for everyone else it is worse as traffic in the general lanes and side roads spiked tremendously as soon as the tolls kicked in.

Yea because medical costs are higher and paid for privately? In the UK we have (or had) one system that treated everyone the same and now badly because government won't fund it and tthose that can afford to pay more wont. A bed/room in a hospital in the US cost what a luxury room in a hotel costs before anyone even gets treated.

[tggzzz]

Yes, he has kept up suitable NI payments here so that he won't be regarded as a foreigner. He knows the value of the NHS and the difficulties in the US health care system.

I'm not sure what you mean by that. You only need to be British to be eligible for NHS care.

I'm not entirely sure either; for obvious reasons I haven't quizzed him in detail.

However, he has lived and worked in the US since the mid 60s, which might have a bearing on it.

[Rick Law]

Still the insane health insurance costs seem mostly limited to the US. In the Netherlands I pay exactly the same for health insurance whether I'm self employed or not. I do have to take care of my pension plan and income insurance in case I become ill.

That is exactly my understanding too from expat friends of mine, some of whom are now contemplating returning to the UK after several decades reaping the rewards of the US, including becoming naturalised and bringing up families. I don’t know if this is a recent thing, or just because deductibles and premium grow as you get into your 50s.

I have a relative in SoCal. He is staying there at the moment because despite being in his late 70s he is still a productive aerospace engineer.

However, he also has a house here, and it looks like he'll return when he no longer has health insurance there.

Yes, he has kept up suitable NI payments here so that he won't be regarded as a foreigner. He knows the value of the NHS and the difficulties in the US health care system.

Medicare is government run healthcare for retirees - if the expat worked in the US for over 10 years (and residing in the USA legally at retirement), it would be available to him/her and spouse.   Many if not most USA employers moves an employee's health coverage to Medicare upon retirement (or at 65 years old whichever is later).

Medicare part A and part B cost very little (approx $1.5k/yr for both A&B) and are "basic coverage":  you go to the hospital and it is paid for.  Part A & B together is more like the old traditional health insurance - insure against the unexpected.  You can also get part C and D at additional cost to make it like health maintenance (HMO) plans which would pay for the expected and unexpected - regular doctors visits like annual check up, eye glasses, what not.  Part C & D are private insurance offered cooperatively with Medicare.

Often mixed up is MedicAid which is like Medicare but for qualified low income individuals.  So for qualified individuals without adequate income, health care is available.  MedicAid is funded by the federal government in its basic form but different States offer different coverage with additional States funding.

But, if you make too much to be poor, too little to be rich, and too young to be retired...  You are on your own.

It is not so much that USA offers no help for medical, it is that we have holes in coverage and coverage is uneven.  For example, if you are not in the USA legally, California will cover you, but some other states may not.  And, being State run, you may be ruled "unqualified" in one State and 20 feet away from you across State line, you would be qualified for coverage.

Fun thing about State laws.  NJ and NY are connected by many bridges.  (Repeating what I read in news upon a law change) NJ and NY define legal death differently - brain death vs brain/heart.  So, you can be in an ambulance and legally dead one moment and 3 feet later across State line, you are back alive - legally speaking.  Think about this: (not that any reasonable prosecutor would, but...) technically you could charge the driver with homicide if the driver makes a U turn because by doing the U turn, he caused the patient to go from being alive to being dead.

...
Yea because medical costs are higher and paid for privately? In the UK we have (or had) one system that treated everyone the same and now badly because government won't fund it and tthose that can afford to pay more wont. A bed/room in a hospital in the US cost what a luxury room in a hotel costs before anyone even gets treated.

Besides mere profit considerations, USA laws is that hospital MUST take care of emergencies with or without insurance.  So, they charge the insured a lot more to cover those without.

In other words, people with/without insurance are typically treated and are for sure treated in emergencies.  Those with insurance pay for themselves and pay for those without insurance via inflated prices.

A hospital room makes luxury hotel looks economical...

[jmelson]

I HAVE HAD ENOUGH WORKING FOR THE MAN[/b][/u], to loosely quote Roy Orison.

I never want to be an employee again.

Well, I have an arrangement at a university where they pay me peanuts of "full time" salary, but I actually get away with working about half-time.  This gets me health insurance and their dependents tuition benefit, meaning they pay up to half of their own (insane) tuition for my kids to go to some other university.  (None of them could likely get into the place I work at!)  Since we have SIX kids, this is an insane benefit!

And, I have a home business.  I sell a bunch of board-level products for CNC motion control, and also copies of the stuff I design at work related to nuclear research, to other universities and national labs.  The bonus there is there's no risk, I do the design at the univ. then just make them at the home business, where I have a P&P machine and other tools.

I also run my own web server out of my house, with a web store, do my own taxes with a tax program, and my own accounting, etc.
So, I figure out what might sell, design stuff, order parts, prototype, design and order boards, assemble, test, do customer support, ship boxes, and everything else.

Speaking of taxes, the home business expense is really pretty amazing!  If you dedicate a fairly big portion of your square footage (nearly all of my basement) then you can deduct maybe 1/3 of the annual cost of the house, utilities, taxes, etc. from your profits!

Jon

[jmelson]

In other words, people with/without insurance are typically treated and are for sure treated in emergencies.  Those with insurance pay for themselves and pay for those without insurance via inflated prices.

One big deal is that people without insurance pay FULL PRICE for treatment.  If you have insurance, then they negotiate a lower price for everything, from open-heart surgery to an aspirin.  These negotiated prices can be astonishingly less than the full price, in some cases TEN % of full!

In a sense, those without insurance, but who CAN pay, pay for those who can't pay!

Jon

[nctnico]

I don't think you need great networking skills. You can only do a limited amount of work by yourself anyway. In my own experience you will always manage to find some projects even if you are doing only a little bit of advertising. Linked-in and internet fora are great ways to get in touch with people who may need your skills. Sometimes it does get quiet and that is a good opportunity to visit some of the existing customers and see what they are up to. I call it shaking the tree and it doesn't take long for something to fall out. And then there are also the recruitment agencies which can land you a nice gig but these are usually long term jobs (which I'm not fond of so I never  went that route).

Obviously you're more of an extroverted personally and do not understand introverts. I avoid social media. I use FB solely to keep in touch with my parents, who are in their 80s and pretty much housebound at this point, and although I have a linked in account, I never use it and could be bothered. It holds zero interest to me, to read crap I could care less about in other people's lives. If I did anything, it would probably be through a recruitment agency. The idea of "shaking the tree" as you call it, to me, reeks of sales and doesn't appeal to me in the least.

Well, I don't have an FB account and in general I don't like to be in crowds. And shaking the trees is more like sending an e-mail asking how someone is doing.

[Rick Law]

...
Well, I have an arrangement at a university where they pay me peanuts of "full time" salary, but I actually get away with working about half-time.  This gets me health insurance and their dependents tuition benefit, meaning they pay up to half of their own (insane) tuition for my kids to go to some other university.  (None of them could likely get into the place I work at!)  Since we have SIX kids, this is an insane benefit!
...
Jon

I've heard of an insane solution - enroll in your local community college and get student coverage...  much cheaper!

[T3sl4co1l]

Note how this graph paints a massively skewed picture! Self employment dropped by only 2% but the graphs makes it look like it is half.

Correction: two percentage points.  That is, percentage relative to the total.

Self employment, relative to its initial value, dropped by 11% (100 x (1 - 17 / 19) = 10.526...%).

So in cases like this, one must be triply careful not to be misleading!

Tim

[Mr. Scram]

One big deal is that people without insurance pay FULL PRICE for treatment.  If you have insurance, then they negotiate a lower price for everything, from open-heart surgery to an aspirin.  These negotiated prices can be astonishingly less than the full price, in some cases TEN % of full!

In a sense, those without insurance, but who CAN pay, pay for those who can't pay!

Jon

That mostly points towards "full price" being incredibly inflated.

[stefanh]

Good luck Dave 

[rstofer]

Work for a dozen years or so with any government agency - long enough to be vested in the retirement plan and receive a decent income.  Fine, so what's the point?  Well, in many cases, you can also buy medical insurance through the agency's plan at a substantial discount compared to buying an individual plan from the HMO <or whatever>.

Then you can choose to break loose and do your own thing so long as you can keep up the insurance payments but it is usually charged against your retirement income.

Not all agencies work this way but it's worth considering.

[nctnico]

Work for a dozen years or so with any government agency - long enough to be vested in the retirement plan and receive a decent income.  Fine, so what's the point?  Well, in many cases, you can also buy medical insurance through the agency's plan at a substantial discount compared to buying an individual plan from the HMO <or whatever>.

I'm pretty sure the Sovjet Union had a similar healthcare system 

[Bud]

Well, I don't have an FB account and in general I don't like to be in crowds. And shaking the trees is more like sending an e-mail asking how someone is doing.

That would be a sure way i ban you in my supplier list and never call you again.

[nctnico]

Well, I don't have an FB account and in general I don't like to be in crowds. And shaking the trees is more like sending an e-mail asking how someone is doing.

That would be a sure way i ban you in my supplier list and never call you again.

You won't. That would be like alienating the only dentist in a 200km radius 

[VK3DRB]

A big thank you to all who contributed to this. Very interesting comments. There are different driving factors in different countries. The US health system quagmire is not something we have to deal with in Australia, so that isn't a factor in the free health insurance issue.

It seems personal traits are a key factor. I am not an introvert; rather an extrovert with good people skills for an engineer, despite being a few sigma away from the centre of the bell curve. I have many contacts too. One of which might be a stefanh who replied to this post.

Since the original posting, my former employer has asked me to stay on part time for a couple of months as part of the transition period at a higher hourly rate, due to a critical project I am involved in and for contingency until they find another engineering manager. Transitioning is a good idea, as it gives me time to get other wheels in motion. Good engineering managers are quite rare because most engineers want to do just engineering, rather than the management tasks of servicing several levels of interrupts and returning to the task scheduler without having a stack overflow.

What is important is what you WANT to do rather than what you HAVE to do, particularly when you are relatively financially secure.

I think the key attribute, alluded to by some replies in DISCIPLINE. That is, discipline on record keeping, discipline on work effort, discipline on organisation.

Thanks for the good wishes too. Much appreciated.

- regards, a different Dave.

[Bassman59]

In other words, people with/without insurance are typically treated and are for sure treated in emergencies.  Those with insurance pay for themselves and pay for those without insurance via inflated prices.

One big deal is that people without insurance pay FULL PRICE for treatment.  If you have insurance, then they negotiate a lower price for everything, from open-heart surgery to an aspirin.  These negotiated prices can be astonishingly less than the full price, in some cases TEN % of full!

In a sense, those without insurance, but who CAN pay, pay for those who can't pay!

A few years ago I had surgery and stayed about a week in the hospital. I still have the printout of every single thing for which I was charged. It's mind-boggling.

The kicker was difference between the "full price" and what the insurer deemed "reasonable," and the latter was about 20% of the former. Of course, I owed 20% coinsurance on what the insurer negotiated, and that was still quite a chunk of change.

A large problem with health care in the US is that the "full price" is not knowable. For a routine screening, I called up a few clinics in my area, asking how much it cost. None of them would tell me. All they would say is, "what insurance do you have?" It's unbelievable.

There are a lot of people in the US who decry this notion of health insurance that covers regular doctor's office visits and checkups and that sort of thing, preferring that you buy a lower-cost/high-deductible "Catastrophic" (or "Major Medical") coverage plan, which kicks in only for something major (surgery required, cancer treatment, whatever). Everything else, like the yearly check-up, would be paid for out of pocket.

That can seem reasonable, especially given that the true cost of health insurance runs around the $20,000 a year posted earlier. Sure, go to the doctor, get the checkup, get the care you need because you are sick, and pay as you go. Except that, with few exceptions, doctors offices can't even deal with a cash customer. Everything is oriented around billing insurers and getting reimbursements. Ask your doctor what it would cost for that yearly physical. I bet they don't even have a price for that.

One more thing about that $20,000/year premium. It was mentioned upthread but it really bears repeating: the employer-based health-insurance system we have in the US really skews the argument. People who have that coverage pay a fraction of the true premium, so they think that insurance isn't that expensive. Those who do not have the employer-coverage option are faced with bearing that true cost, and many people in the former group (with employer insurance) don't see that.

Further, what the employer-covered people might not realize is that the extra cost of the premium is really a benefit in lieu of salary.

It's a total clusterfuck.

[IconicPCB]

Go to Cuba for health service, Canadians do.

I had a bunch of crowns done in eastern Europe, Paid full price.
The dentist even told me he was using some compounds sourced from Australia.
All up it was about a hundred euro per tooth... same work here in Australia would have been about AUD1400 per tooth... an order of magnitude higher.

[james_s]

Until recently we weren't even allowed to go to Cuba. Also from where I am on the West coast, Cuba is around 3,000 miles away. It's a bit silly to think that an industrial nation like the USA with such a huge economy can't compete with a tiny third world nation like Cuba in terms of health care. Maybe some day we'll get our collective head out of our ass.