How does anything ever become fiscally viable?

Type 1 and LADA
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I think my big, overarching diabetes question (at this stage) is how does anything, ever become fiscally viable?

My ultimate concern is homelessness. I think I might be trying to develop a plan about how to not become homeless. That did happen to a diabetic I worked with in the last couple years, not because of diabetes, but because of how sick he got from covid. He was in an apartment. Apartments are out - not stable enough and they drain away too much wealth. They simply evaporate during a long enough hospitalization. When you leave the hospital, your homeless.

Frustratingly, Iā€™ve been talking to a diabetic lately who owns his home. But, his wife got cancer and the bills were tremendously expensive. She survived, but they threatened to take their home. I was under the impression that that couldnā€™t happen. But, someone else told me that they might have re-written the laws.

I feel like I could buy a car every year with what I spend in medical. I donā€™t even see a Doctor anymore, but itā€™s still expensive.

Whatā€™s the answer? Do I drop off a pump and go on MI? Does that save a lot of money?

It might not even have that much to do with diabetes. I talk to old guys who want to retire, but they keep working because they donā€™t want to pay $12,000 in health insurance premiums out of pocket. A lot of them keep working 30 hours/week to keep the insurance benefits active.

Is this a diabetes problem or a wider problem? Whatā€™s the answer?

Some people say that if you have one expensive medical event, then the system comes along and takes all your assets.

Right now, I suspect that the minimum salary, for a diabetic, to be able to run all the bells and whistles (pump, sensor, etc.), if you consider $20,000 in medical expenses, might be around $________. (Fill in the blank)

Note: If you make $80,000, then medical represents 25% of your income. There is no impact on taxes, I think. Housing might be $15,000 on the lowest end. Thatā€™s $35,000, just in housing and medical. That means $40,000 per year salaries are out of the question. That eliminates all $20/hour jobs. You need to be pushing $30/hour, at least, I think.

Diabetics canā€™t join the army. Truck driving is risky. What types of things can a diabetic do for a living? How would you advise a young diabetic? I think that there are unique/tricky financial situations for young people with medical expenses. I think it creates a lot of constraints that are worth discussion.

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The only valid answer is to work as hard as possible to become employable and self sufficient. The trick is to develop a skill that society will always be willing to pay forā€¦and will not be replaced by unskilled labor, or outsourced or converted to AI. A good example would be skilled construction trades such as plumber; electrician etc. There is a shortage of electricians, demand for trained electricians will continue to increase indefinitely and there are plenty of paid apprentice programs for entry level hires. That is just one example.

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I was diabetic before I started irking full time. I moved from a university health plan to a corporate plan.
I knew it wasnā€™t going to be possible for me to get health insurance on my own for most of my life, so I knew I would need to work for large companies.
Now with the current rules, I could buy it because of the preexisting insurance rules.
Diabetes has almost had no effect on my ability to do my work or to get a decent job.
Itā€™s not something I ever talked about in an interview.
My co workers would notice I have a pump and some ask about it, but itā€™s never been a big deal.

When I look back, I see that a bottle of humalog 25 years ago was $17.50 and now itā€™s over $300. It is just clear that we need to have a corporate insurance policy to get by.

I intend to keep going this way until I transition to Medicare.

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The key is to insure the outcome. Business insures itself so that the worst expenses are shifted to others. Diabetes is a fact in our lives, so what is needed is to find ways for others to value us so they will fund our own risks.

It is costly of course. But the worst outcome and the ones that eat us alive is when we have overwhelming costs without secondary payers. It is not the typical costs that usually eat us alive. It is the extraordinary costs that wipe us out. Insure against the extraordinary and invest watch your spending for the routine.

To be clear I am not minimizing the routine costs, but research shows it is the big stuff that wipes us out.

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Are you willing to check out other states?

I retired a few years ago, after 40 years with same company. I was lucky to have early experience with PCs, and companies were forming internal PC support groups. Later supported transition to SAP system support. I was in the right place at the right time. Eventually the company acquired off-shore IT folks, but retained internal employees that coordinated projects they worked on, after I had retired.

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The US has become a grotesquely unequal place and has never developed the European-style state that allowed people freedom from the fear of not having medical care. For the longest time, the safest choice was, if you could, to get a solid education and work for major corporations. That is less and less true, particularly with the gouging of young people to pay for their education.

In your case, with your MS in Computer Science, the choice is to ā€˜bite the bulletā€™ and work for large companies. Even for myself, I worked in finance for decades, but over time disliked their involvement in fostering inequality, illegality, and environmental harm, as well as being places that foster a low-quality of life at work, but then again, I needed to survive and pay my bills. I work for a major cancer center now, so the ethical concerns are lessened, but still, I havenā€™t closed the door on finance, since I can never be certain that I will need to make money in the future, and considering my background, the easiest way to land on my feet is through a financial institution.

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Change ā€œother statesā€ to ā€œother countriesā€ where they recognize that health preservation produces a positive return on investment and sickness care that might have been avoided produces a large loss.

In the US, if the cost is buried and spread around, we reward corporate greed.

As far as job security, there is no longer such a thing. If you arenā€™t prepared to make 3 major career changes in your lifetime, you will need to be extraordinarily good at something that canā€™t be eliminated, or youā€™ll become unemployable.

Every profession that I believed couldnā€™t be eliminated is under attack by AI or automation - including the oldest profession. [WARNING: sensitive viewer may be offended]

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My company also went though bankruptcy, and many were laid off. I was offered another job within company, different position. There are still many vacant mfg buildings that are not used, or were demolished. Part of demise was the revolution of smart phones!!

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I need to read through responses more completely later. On my way to work. Just wanna let you know they testify today - all of 'em - Optum/UHG, Sanofy, etc.

Most interesting federal meeting since they pulled the insulin manufacturers up in front, and when they pulled the diabetics up in front of a hearing to discuss the pump hacks. This relates to CAā€™s lawsuit. @El_Ver . Dr Vincent RajKumar from the Mayo is using this as a first step to being able to afford cancer drugs. He means business. What will they say?

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My best advice as a 40-year Type 1 is to find employment at medium to large companies as they usually have better insurance policies. Maybe not look at having all of the bells and whistles. I think the pumps are great but I decided they are not worth the money and havenā€™t been on one for over a decade due to costs. learn to look at the various health plan options and figure out what all of the costs are in each plan. A plan with a higher monthly cost from you has lower co-pays and lower out-of-pocket maximums. It would also have lower co-insurance for covered items like sensors and such.

On older people staying in the workforce and not retiring, once they are eligible for Medicare they can get pretty good coverage with basic Medicare or with a supplemental plan.

The biggest problem with the US healthcare market is the capitalistic thoughts that everyone needs to make their money and we need all of these complex layers to operate the system. This is coming from the lobbying and support from the various insurance, doctors, and other groups that bribe the politicians. Also, look at the BILLIONS of dollars spent every year on healthcare advertising, only the US and New Zealand allow this sort of thing. I canā€™t speak for NZ and what their healthcare system works but here in the US it has created a monster. Yes the US has some great healthcare and some of the best research and development.

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I lived with Regular and NPH for several decades. I even got pretty good at MDI - NPH is not so gnarly when its spread through 4 shots a day. I think store-brand test strips may be cheaper today than Chemstrips were in the 80ā€™s.

And back then I paid for everything out of pocket as a student from odd jobs I worked - all OTC because my insurance wouldnā€™t cover anything at all for a pre-existing condition.

Itā€™s not the hi-tech CGM and pump world many of us are used to recently. But itā€™s certainly possible to get by with Wal-Mart OTC insulin and test strips for a fraction of what Iā€™m spending today after deductibles.

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I lived on nph too, and several times I almost didnā€™t. I was only taking 2 injections of nph per day and the rest were regular only. But my schedule was so unpredictable, I often could not break to eat every 4 hours.
It wasnā€™t until I switched to ultra lente and humalog that I got any kind of reasonable control.
For me pumping has given me the best control that I can manage. Iā€™m generally in the mid 90% for in range. And my a1c is often 5.8 or 5.9. And that is something I never even imagined back in the 80s.
A lot of people do even better on MDI but I like pumping more than an even lower a1c

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I have had Type 1 since I was in my early 20s. Iā€™m now 63, so diabetic all of my adult life basically.

My husband and I were both municipal employees for our whole careers. We are retired now. During our course of employment, we had wonderful benefits available to us. We have college degrees and took in decent paychecks. Now we have wonderful retirement benefits which includes decent pensions and health insurance for life.

I have many times looked back over our lives. Were we smart? Were we just lucky? I donā€™t know. As a person with diabetes I have been thankful to have had it so good as far as the finances and benefits have gone. We knew we were in good places with jobs that would have been hard to replace if we lost them. We kept them, built seniority and didnā€™t job hop.

I canā€™t stress it enough! If you (or your spouse) can get a job at town hall or the county office or at the state level or the federal government and can hang in until you are vested in the retirement plan, you will be set for life. Municipal positions are maybe not the most exciting jobs, but the long term payoff has the potential to be very good.

My husband was a police officer, and I worked for a government land conservation agency.

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Let me think about that perspective, Rphil2.

MNā€™s labor market is pretty solid right now. I feel good about MN. They say that it takes a couple years to ā€œget through the door.ā€ I think Iā€™ve hit that mark now. I left medical just in time. I changed industries for personal reasons, but there have been layoffs in medical tech here and in Chicago.

Iā€™m software, James. Iā€™ve learned that software is a very different animal than comp sci. I didnā€™t anticipate that. I moved from a large company to a mid-sized (to small) one. I feel good about it - no ethical concerns. Iā€™m self insured so if the company dries up, Iā€™m covered. The work here could dry up. If we donā€™t have another recession, Iā€™ll remain employable and be able to move somewhat seamlessly to another company. If the labor market seizes up, I assume that I will be sunk. Fingers crossed.

I feel like we, as diabetics, might have some interest in anti-monopoly legislation because thatā€™s how the system seems to operate. Do you agree or disagree with that assessment? @pstud123 Itā€™s tough because of my age. My age group has watched every American system collapse since we came of age. It makes us a ā€œnervousā€ generation. Iā€™m Gen Y, so I hadnā€™t established myself before the sh*t hit the fan with 9/11 and ensuring uncertainty. Gen X established themselves before everything went to hell. Thatā€™s the primary psychological dividing line between the two. I work for Gen Xā€™ers and 1980ā€™s ā€˜headbangers,ā€™ but also young Boomers who are waiting to get onto medicare before they can retire. Thereā€™s a real gap in worldview with the Boomers.

Much of Minneapolis lays vacant. I donā€™t think you can call it a commercial real estate ā€˜bubble.ā€™ Itā€™s the effect of covid and many companies leaving their physical locations within the city.

These are different conversations about the healthcare system than we were having ten years agoā€¦in some ways. In some ways things are the same. But, in some ways itā€™s hard to wrap hands around what our next chess move should be after the concessions by Lilly.

I feel like I could do this and I often wonder if I should. The only catch is that I drive an hour (at least) everyday to work. I feel like the risk associated with my long commute makes such a transition untenable, whereas otherwise I could do this and I kinda want to. But, at the same time, the largest payout is to premiums, so I wonder if the financial benefit would be worth the risk.

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Hereā€™s to the Gen Xā€™ers (Jane's Addiction - Jane Says (Official Music Video) - YouTube), 80ā€™s headbangers (Metallica: Enter Sandman (Official Music Video) - YouTube), and young Boomers (Sonny & Cher The Beat Goes On - YouTube) who are pulling us gen Yā€™ers into the workforce after so many years of running the streets like wild, undomesticated stray dogs. I know it hasnā€™t been easy.

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It seems that all of what is being said here is pretty valid and that the US healthcare system (like a number of things in the US - has anyone noticed the US ranking in life expectancy as one example) falls behind the rest of the developed world. There is a reason that statistics reveal that a very large percentage of bankruptcies are a result of medical debt, even among covered individuals. I think most everyone here have talked about reasons for this and they are diverse and complicated. But a system that nurtures profit, greed, whatever youā€™d like to call it does not seem to be the best one.

Insurance is supposed to cover our risk, yes the risks are varied but it is the major risk that we can never predict and the idea of insurance is supposed to protect us from that risk. Personally I donā€™t care about paying no copay or a small copay to see my doctor for an annual physical. I want to know if something terrible happens I can survive without the life that Iā€™ve built or plan to build going to hell and a handbasket.

Hang in there mohe0001, we all could use a bit of good planning and some luck to go along with it!

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You can have it delivered.

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You know what happened yesterday?
So, they are enacting some large Omnibus Healthcare Bill here. Much of the reform stuff happens at a State level. They have begun a phase of pushing on the hospital system. Eventually, I believe they will work their way up to the insurers and medical device companies. MN and CA will play a role when it gets to devices.

They passed some leg that says the hospitals canā€™t charge three times as much as a clinic for the same care. They believe this might be motivation for ā€˜consolidationā€™ of the hospital system into several major players (its leading to rural healthcare shortages and monopolistic behavior). I havenā€™t really been following it. What happened yesterday?

Mayo Clinic threatened to leave Minnesota.
Thatā€™s a big, big deal here for a bunch of reasons.
The Nurses Association is in a rage.
The Mayo Clinic is a gigantic building made out of marble. You canā€™t just move a building made out of marble.

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You sell or abandon the building, and eventually, it gets repurposed for another use. This happens all the time when a business feels mistreated by a community and gets a better deal elsewhere. Greed kills the goose that lays the golden egg. Some people and/or some communities never learn.

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What a ghastly waste of millions of dollars in donation money. Makes me sick.

Welcome to being restricted by a market, Mayo. Itā€™s such a large part of the patient experience, Iā€™m surprised you donā€™t have more resiliency and experience dealing with it. Perhaps you can setup shop in a new location that is frozen in time and medical monopoly. Those places are becoming harder to find. Best of luck to you. Perhaps you have exhausted your good karma in this state. The Verve - Bitter Sweet Symphony - YouTube

Everybody likes capitalism until they are on the sharp end of the capitalism stick. This is fundamentally a fight to restore some integrity to the American medical markets. Its uncomfortable, but probably healthy for everyone, including the Mayo. Perhaps Mayo can learn to put on their ā€˜big kidā€™ pants.

Markets are like children. You gotta know that they will throw tantrums. Its in the nature of the things. I think there is, however, a lot of uncertainty in how to reform the markets (due to their innate complexity). It might be a little bit of just throwing ā– ā– ā– ā–  at the wall and seeing what sticks - a little medical experimentation. What if we could recover the 20% of GDP getting leeched out of the economy by the medical system? I wonder if we could make the experience of those who come after us better.

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