The issue of obtaining sufficient value for health care dollars spent is real and hugely important, but I don't think the new generation of anticoagulants (popularly but incorrectly called blood thinners) is an example of poor value. I treated patients with warfarin when it was the only option, so I am familiar with the difficulties involved in doing it safely. Also, for 25 years I have been reading summaries of 2,000+ medical malpractice claims yearly for my malpractice prevention newsletter for physicians. In my experience, warfarin generated a hugely disproportionate share of serious injuries and malpractice claims. Those human and economic costs must be considered along with the price of the drug. The processes and systems required to manage warfarin safely for long periods of time are complicated, ongoing, and prone to errors. It requires a conscientious, motivated patient who will obtain regular blood tests to monitor the level of anticoagulation and make adjustments as instructed (which requires more time, additional costs of care beyond the price of the drug, and hassle for the patient not present with the newer anticoagulants), as well as the need to minimize interactions with diet and other drugs -- and still the levels of anticoagulation can vary considerably in any one patient. All anticoagulants are dangerous, but the newer ones are significantly safer than warfarin: the doses are standardized, and the level of anticoagulation is more consistent and does not require monitoring with blood tests. I cannot remember seeing a single malpractice claim involving Eliquis and Xarelto except for the ones inherent to all anticoagulants, mainly stopping and restarting them around procedures and operations that pose a risk of dangerous bleeding. Warfarin can be taken relatively safely with a responsible patient and safe system of care, but the newer drugs are preferable. Xarelto is now available as a generic for less than $100/month.
My wife and I have used WellCare for 3 years, no issues at all, but we use only 3 common drugs, cost to us $0 or $15 for 3-month supply. Premium is only $0.40 per month this year, but going up to $16.80/month for 2025.
oh, that one's just a pup! At one point the average age of our 3 vehicles was 17. I literally drove my 24-year-old Volvo into the grave(yard): the local Air Quality Management Board paid me $1,000 to drive it to the junkyard for dismantling. (hey this humble brag thing is fun!--bragging, one-upping and feeling good about it)
me, too. Full name is maxifiplanner. The default settings are conservative in the direction of not running out of money (e.g., the default assumption is that one lives to age 99) but all defaults can be varied by the user to explore alternative scenarios or the effect of making various moves. Takes into account all the complicated interactions between the various variables, which is something individuals cannot do with spreadsheets. I highly recommend.
For many years I occasionally had the exact same dream, mine was about a class in graduate school! I haven't had it for a long time, and had forgotten about it, but now that you've stirred up that old memory . . . . but don't worry, I won't hold it against either of you! :)
A partial alternative or supplement to an annuity ladder, for those who are able, is I-bonds which if bought before the end of April 2024 are paying a guaranteed fixed rate of 1.3% over inflation for the 30-year life of the I-bond. They can't be cashed in the first year, and there's a 3-month interest penalty if cashed before 5 years, but after that there is no downside to cashing them at any time. The interest compounds tax-deferred and is state tax free (not an advantage in states without an income tax, like Florida). Administratively the only hassle is up front, establishing the TreasuryDirect.gov account; once purchased you can forget about it until you cash it. Individuals can only purchase a maximum of $10,000 each calendar year (plus another $5,000 can be bought with a federal tax refund), but one can buy the maximum this month and then again in 2024. A living trust can also buy one each year, as can any businesses you own that have a separate bank account. A website I recommend for information about I-bonds (and TIPS) is tipswatch.com
I think that depends on what you mean by "not that much lower." According to the SSA, if you were born between 1943 and 1954 your retirement benefit would have been 32% higher at age 70 than if you had claimed benefits at your Full Retirement Age of 66. Note that the 32% is on top of the yearly SS inflation adjustments, which have totaled about 20% over the past 5 years. And since you claimed your benefit a year before your FRA, your retirement benefit at 70 would have been even more than 32% (plus inflation) above what you received by claiming at 65. With your savings over those 5 years you'll certainly be ahead for a long time, but hopefully at some point you'll reach a "break-even" point and be behind after that. (I'm not a pro so please correct this info if it is wrong!)
Yes. One problem with the break-even calculation is that it is difficult to estimate accurately on your own: it is affected by the interaction of taxes, continued earnings from work, retirement account withdrawal strategies, etc. I don't know how well the various software packages (free and commercial) take those factors into account.
Comments
The issue of obtaining sufficient value for health care dollars spent is real and hugely important, but I don't think the new generation of anticoagulants (popularly but incorrectly called blood thinners) is an example of poor value. I treated patients with warfarin when it was the only option, so I am familiar with the difficulties involved in doing it safely. Also, for 25 years I have been reading summaries of 2,000+ medical malpractice claims yearly for my malpractice prevention newsletter for physicians. In my experience, warfarin generated a hugely disproportionate share of serious injuries and malpractice claims. Those human and economic costs must be considered along with the price of the drug. The processes and systems required to manage warfarin safely for long periods of time are complicated, ongoing, and prone to errors. It requires a conscientious, motivated patient who will obtain regular blood tests to monitor the level of anticoagulation and make adjustments as instructed (which requires more time, additional costs of care beyond the price of the drug, and hassle for the patient not present with the newer anticoagulants), as well as the need to minimize interactions with diet and other drugs -- and still the levels of anticoagulation can vary considerably in any one patient. All anticoagulants are dangerous, but the newer ones are significantly safer than warfarin: the doses are standardized, and the level of anticoagulation is more consistent and does not require monitoring with blood tests. I cannot remember seeing a single malpractice claim involving Eliquis and Xarelto except for the ones inherent to all anticoagulants, mainly stopping and restarting them around procedures and operations that pose a risk of dangerous bleeding. Warfarin can be taken relatively safely with a responsible patient and safe system of care, but the newer drugs are preferable. Xarelto is now available as a generic for less than $100/month.
Post: Rats!!
Link to comment from March 29, 2025
Disability claims currently account for 11% of Social Security spending, not 1/3. link
Post: Should Social Security benefits be income tax free?
Link to comment from February 1, 2025
My wife and I have used WellCare for 3 years, no issues at all, but we use only 3 common drugs, cost to us $0 or $15 for 3-month supply. Premium is only $0.40 per month this year, but going up to $16.80/month for 2025.
Post: Wellcare for Part D by Andrew Forsythe
Link to comment from October 12, 2024
I preface my inexhaustible supply of fascinating stories with: "Stop me if I already told you this one today . . ."
Post: Signs of the Times
Link to comment from July 20, 2024
oh, that one's just a pup! At one point the average age of our 3 vehicles was 17. I literally drove my 24-year-old Volvo into the grave(yard): the local Air Quality Management Board paid me $1,000 to drive it to the junkyard for dismantling. (hey this humble brag thing is fun!--bragging, one-upping and feeling good about it)
Post: Humble Bragging by Jonathan Clements
Link to comment from July 13, 2024
me, too. Full name is maxifiplanner. The default settings are conservative in the direction of not running out of money (e.g., the default assumption is that one lives to age 99) but all defaults can be varied by the user to explore alternative scenarios or the effect of making various moves. Takes into account all the complicated interactions between the various variables, which is something individuals cannot do with spreadsheets. I highly recommend.
Post: Faulty Assumptions
Link to comment from February 21, 2024
For many years I occasionally had the exact same dream, mine was about a class in graduate school! I haven't had it for a long time, and had forgotten about it, but now that you've stirred up that old memory . . . . but don't worry, I won't hold it against either of you! :)
Post: Retirement Dreams
Link to comment from February 21, 2024
A partial alternative or supplement to an annuity ladder, for those who are able, is I-bonds which if bought before the end of April 2024 are paying a guaranteed fixed rate of 1.3% over inflation for the 30-year life of the I-bond. They can't be cashed in the first year, and there's a 3-month interest penalty if cashed before 5 years, but after that there is no downside to cashing them at any time. The interest compounds tax-deferred and is state tax free (not an advantage in states without an income tax, like Florida). Administratively the only hassle is up front, establishing the TreasuryDirect.gov account; once purchased you can forget about it until you cash it. Individuals can only purchase a maximum of $10,000 each calendar year (plus another $5,000 can be bought with a federal tax refund), but one can buy the maximum this month and then again in 2024. A living trust can also buy one each year, as can any businesses you own that have a separate bank account. A website I recommend for information about I-bonds (and TIPS) is tipswatch.com
Post: A Taller Ladder
Link to comment from December 13, 2023
I think that depends on what you mean by "not that much lower." According to the SSA, if you were born between 1943 and 1954 your retirement benefit would have been 32% higher at age 70 than if you had claimed benefits at your Full Retirement Age of 66. Note that the 32% is on top of the yearly SS inflation adjustments, which have totaled about 20% over the past 5 years. And since you claimed your benefit a year before your FRA, your retirement benefit at 70 would have been even more than 32% (plus inflation) above what you received by claiming at 65. With your savings over those 5 years you'll certainly be ahead for a long time, but hopefully at some point you'll reach a "break-even" point and be behind after that. (I'm not a pro so please correct this info if it is wrong!)
Post: Searching for When
Link to comment from December 6, 2023
Yes. One problem with the break-even calculation is that it is difficult to estimate accurately on your own: it is affected by the interaction of taxes, continued earnings from work, retirement account withdrawal strategies, etc. I don't know how well the various software packages (free and commercial) take those factors into account.
Post: Searching for When
Link to comment from December 6, 2023