Rx for Medicare
Howard Rohleder | Jun 9, 2022
RONALD REAGAN SAID “the nine most terrifying words in the English language are ‘I’m from the government and I’m here to help’.” Government programs are put in place to address real concerns. But they often come with unintended consequences. When created in 1965, Medicare addressed the real need of senior citizens who couldn’t afford health care, just as Social Security was established in 1935 to help seniors in poverty. Both have become pillars of American retirement, but not without cost. At the start, Medicare copied the insurance industry’s prevailing “fee for service” model for paying physicians, while hospitals were paid on a “cost-plus” basis. “Costs” were Medicare’s portion of hospital operating costs. The “plus” was meant to provide hospitals with some margin to reinvest in their plant and equipment. We’re all economic animals and respond quickly to financial incentives. Physicians found that providing more services, and hospitals found that spending more money, resulted in more income. Rewarded for growth, our health care system suddenly supported many more doctors, facilities, personnel, technology and drugs. The benefits to seniors were great: improved access to health care and steadily lengthening lifespans. But so was the unintended consequence: Medicare contributed to a health care cost explosion. Health care expenditures rose from 5% of GDP in 1960 to 8.9% by 1980. As Medicare’s costs mushroomed, regulators began a long tug of war with providers to bend down the cost curve while still delivering promised medical care. Over the next four decades, there were waves of reform attempts: Studies showed more care didn’t necessarily mean better care, so some controls on utilization were added. Hospital charges varied widely from one area to another, or even within the same city, so standardized payments were imposed by region. Medicare found it was paying to fix medical errors, so…
Read more » Share This Message
Howard Rohleder | Jan 3, 2026
In my years working in Hospital Administration, I routinely had staff telling me about patients or families caught in a medical crisis caused by a fall or major surgery or simple aging. They were “surprised” to find that when they were told they could no longer live safely in their home, that Medicare was not going to pay for their needed long term care living arrangements. I’m assuming that this information will not be a surprise to Humble Dollar readers. But I found this post on Linked In from a Senior Care Educator and Advocate named Katie Monahan Brooks, CDP, DCS. I don’t know her and I don’t know the Humble Dollar policy about reposting what she posted on Linked In. But she has expressed this more clearly and bluntly than I could have. And, it is apparent from her writing that she wants this message broadcast far and wide. My hope is that Humble Dollar readers can be part of this education process. Here is what Ms. Brooks wrote, unedited by me: “I’m done pretending this confusion is acceptable. If I have to explain one more time that Medicare does NOT pay for senior living, I might actually lose what’s left of my sanity. Let’s be painfully clear: Medicare pays for your medical care. It does NOT pay for your housing, daily care, or supervision. Assisted Living, Memory Care, and Independent Living are NOT medical benefits. They are housing with support. And yet—every. single. week.—I sit across from families who are shocked. Angry. Betrayed. “Why doesn’t Medicare pay for this?” “Isn’t this healthcare?” “No one ever told us this.” And that’s exactly the problem. This isn’t just a misunderstanding. This is a massive, nationwide education failure that leaves families blindsided in the middle of a crisis—when emotions, guilt, fear,…
Read more » Gaining Perspective
Howard Rohleder | Oct 19, 2021
ON MONDAY, OCT. 19, 1987, stocks plunged more than 20%. I was relatively new to investing—and the crash shocked me. I realize now that, when you’re starting out, no matter how much you study, the trait you’re most lacking is perspective. When I began investing, I approached a successful investor and asked for tips to learn about the market. Part of his advice was to watch Wall Street Week with Louis Rukeyser on PBS. That Friday in 1987, Lou started the show with a monologue explaining that the world was not coming to an end. Over the next few weeks, bolstered by his words, I added to my stock funds. Prior to 1987, I had been scared out of some of my stock funds by normal market fluctuations, not realizing that drops in price were often the best time to buy more. Over the years, I learned that dollar-cost averaging and rebalancing help take the emotion out of investing. Looking back, I see that this was all part of a normal learning curve. As a new investor, you can gain perspective by talking to trusted mentors, listening to experts and reading up on market history. But there’s no substitute for actually living through multiple up and down markets, and learning from your own successes and failures. This highlights the value of starting to invest in early adulthood. A strategy of dollar-cost averaging into index funds may sound dull to your 20-something self. At that juncture, you might believe you can beat the market averages by picking stocks or timing the market. But as is often the case, the negative sting of lousy results will be your most valuable feedback. The good news: The earlier you get through your period of trial and error—and develop some perspective—the more time you’ll have…
Read more » Getting in Line
Howard Rohleder | Mar 29, 2024
WE RECENTLY MADE a down payment on our next home. After several months of research, we joined the waiting list for a continuing care retirement community, or CCRC. We’re in our late 60s and only relocated to our current home four years ago. It’s in a metropolitan area two hours’ drive from our daughter and her young family. We know that perhaps 10 years or so from now, we’ll want to be closer to her, so we looked at CCRCs near where she lives. We have some familiarity with the CCRC concept. Both of our parents lived in CCRCs and had positive experiences. I serve on the board of directors of a CCRC where we live now. I previously shared thoughts on choosing a CCRC in a HumbleDollar article. We solicited ideas for which CCRC campuses to visit from some of my contacts. Ultimately, we visited three. There were things to like about each. Our preference was to find a type A community—those that lock in the monthly fee, regardless of the level of care you need. We only found type C communities, where you pay for each level of care at market rates. Type C communities are far more common due to the financial risk that type A communities assume. All three facilities we visited had acceptable accommodations and amenities. They all appear to have the financial strength for the long haul. We screened for those things before we visited and we weren’t disappointed. In joining the waiting list, one of our intentions is to monitor the organization. Does it continue to maintain its facilities? Does it maintain its financial strength? As the real estate cliché goes, our final selection was based on three things: location, location, location. Of the three we visited, our choice is closest to my…
Read more » Taxes Season 3
Howard Rohleder | Apr 11, 2026
This was my third season as an AARP volunteer tax aide…and my third post about my experiences. I volunteer two days a week from February 1 to tax day at two different senior centers which draw from different socioeconomic strata: one is definitely middle class; the other has many clients living on very little. I began the season wondering how the Big Beautiful Bill would impact our clients. Since most are over 65, I expected the new $6000 senior deduction to have a big, across-the-board impact. Many came in asking about it: They had either heard about the “$6000 deduction” or “no tax on Social Security.” The impact was not as much as I expected. I quickly realized that the income of many clients is so low that they are already paying little or no taxes… another deduction doesn’t matter. I did see the advantage of a flat deduction versus eliminating tax on Social Security. We have government or railroad pensioners who receive other government retirement, but no Social Security. They were able to benefit. With the phase-out for higher incomes, the BBB hit its target: my middle-income seniors were the beneficiaries. Since we see few working people, I only saw few examples of “no tax on tips” or “no tax on overtime.” I had one young married couple where she was a waitress, he was a firefighter, and they had a new baby in 2025. They hit the trifecta: her tips were excluded, as was his overtime. And, the baby was eligible for a $1000 deposit into a Trump account. The new emphasis by the IRS to eliminate paper checks caused some consternation. We have clients who do not trust the IRS to have their banking information. We try to explain that if they receive Social Security, the government…
Read more » Managing to Profit
Howard Rohleder | Oct 25, 2021
THE GAMBLING TRUISM says you can’t beat the house. That brings me to a recent HumbleDollar article that discussed choosing either a Medicare Advantage plan or traditional Medicare with an accompanying Medigap policy. Almost two dozen readers weighed in with comments. My two cents: Never forget that the managed-care companies offering Advantage plans are mostly for-profit companies that are publicly traded. The government’s purpose is to transfer its insurance risk to those companies. These managed-care companies must then manage that risk through rationing, limiting choice and negotiating provider payments, as well as encouraging healthy behavior among their customers. To the extent they’re allowed, they deny coverage or charge higher rates to those with preexisting conditions. Although Medicare Advantage was first offered in the late 1990s, enrollment really took off about 10 years ago. That was when Congress made the program more palatable to insurance companies. Advantage plans became their growth driver and industry marketing got more aggressive. Enrollment has doubled over the past decade. I looked at the major national managed-care companies in the Medicare Advantage market over that time period. Here are their stock returns for the past 10 years, without dividends reinvested, as of Oct. 18: Aetna (AET) +499% Anthem (ANTM) +537% Humana (HUM) +514% UnitedHealth Group (UNH) +873% S&P 500 (SPX) +271% Over the long haul, the stock market recognizes value. Don’t imagine that managed-care companies are charitable ventures. This factors into how they “manage” your care. Rather than choosing one of their Advantage plans, your best bet might be to become a stockholder. That way, you can smile at your brokerage statement because you’ll be betting with the house. I spent years in hospital administration sitting across the table from insurance companies. When it came time to decide, I opted for traditional Medicare plus a Medigap policy. It…
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