Comment by derbOac | Hacker News Reader

Comment by derbOac | Hacker News Reader

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I came to say something similar but less succinct.

I've been in a transitional state career-wise, partially by choice, but I think there's two major factors not really mentioned by the article, and in fact, factors I think the article reinforces.

The first is ageism, like you say. But I think ageism is a lot more subtle than other things, because it's not only an assumption of age-related decline, but more generally an assumption that people can't change. So if you become known for X, it's hard for people to see you as anything but that. You get typecast, and those assumptions become societal constraints. It's like there's career "rails" and if you go off the rails, people don't know how to process it.

The second is a sort of lack of recognition of how much randomness and fads plays a role in certain fields. What I mean by that is that the reasons some people attain relative notoriety and status is often due to butterfly effects or societal viccitudes, and these become revealed only over time.

I think in general, there's a very superficial way we process people and their potential for change or new work. Even when they're capable of it, they're often prevented from doing so because of assumptions and stereotypes.

Sure, cognitive decline happens, but it's not as dramatic as it seems in this article.

Sometimes I feel as I've gotten older it's just a process of seeing more of the wizard behind the curtain. I read articles like this and get depressed only because it perpetuates the societal ills that lead to the problems in the first place.

What a trashy article. A lot of elderly Americans, including in the upper middle class, never retire due to Medicare being inadequate. You can quite literally save millions for retirement as an individual, and have coverage for drugs and treatment under Medicare, and still run out of money due to having to pay extortionate prices for covered drugs.

This line in the article is quite revealing and strange, contextually: "Maybe not. Though the literature on this question is sparse, giftedness and achievements early in life do not appear to provide an /insurance policy/ against suffering later on. "

I personally have 2 rare neurological diseases affecting my peripheral nervous system and I require an orphan drug, a blood product, that was covered under Medicare Part D when I lived in America. If I only had traditional Medicare in America, I would be liable for Medicare Part D Catastrophic Coverage Limits, and I would be forced to pay $50,000+/year total for all of my medical care under Medicare.

Technically, yes, I can get a Medicare Advantage plan, which has an out-of-pocket limit. The problem is that the vast majority of these plans are HMOs, and that does not go well with rare disease. Also, one of the rare diseases that I have is very rare, with case reports and cohorts at best in the medical literature. So, if I want to stay alive (like it is a choice?), I really cannot be on an HMO.

By the way, 7-8% of the general population collectively has some sort of a rare disease. There are about 8,000 or so rare diseases. So, it is not uncommon to have a rare disease.

Also, if you have cancer, or are likely to get cancer (elderly, perhaps?) having an HMO via a Medicare Advantage plan is not a good idea if you likewise want to stay alive.

The problem is that once you are on a Medicare Advantage plan, you basically cannot go back to traditional Medicare. This is because Medigap plans (Medicare Part B Supplemental plans) allow medical underwriting even after the Affordable Care Act went into effect, unless you live in 4 US states! So, you basically can never get a Medigap plan again after switching to a Medicare Advantage plan. It is, quite literally, a deadly, but not well known error that Americans make when they are on Medicare.

This is one of the top reasons why I left the US and never plan on living there ever again, even if I have to file and pay taxes as a US citizen. I naturalized and acquired another citizenship over the US healthcare system.

I wasn't aware there was a recognized problem with HMOs? Some of the best care I've experienced in America is at Kaiser.

Do you have any data to show that Medicare Advantage plan members have lower 5-year cancer survival rates than other patients? Because most other studies have shown that Medicare Advantage plan members receive better quality care on average. Just because you had a bad experience doesn't mean the system is failing everyone else.

> You can quite literally save millions for retirement as an individual, and have coverage for drugs and treatment under Medicare, and still run out of money due to having to pay extortionate prices for covered drugs.

This is a totally ridiculous statement. Medicare-assisted drug costs are absolutely NOT going to bankrupt someone who has very wisely saved "millions" for retirement.

I have watched both my parents now pass, and I actually helped them both work out which Medicare plan to select based on their specific medications by creating a spreadsheet and carefully going thru the documentation of each plan and doing the math.

2 million dollars can rather safely throw off 3% after-taxes, so thats 60k/year not counting the odd 1800 that the federal government pays everyone with Medicare "benefits", that that is 6800/month someone who has saved "millions" has for income, and that's not even touching the principle nest egg.

There is no possible way someone's monthly drug costs are going to be anywhere even CLOSE to that number..I think each of my parents spent around 1200/month for what seemed to me to be way more "medication" then they could possibly need.

Unless you somehow come up with numbers that are way, way different than mine, your assertation that drug costs could bankrupt someone with "millions" saved is rather laughable.

I know someone on Medicare that has a 1 pill a day prescription with a sticker price that multiplies out to $45,000 a year. I don't know if that is what ends up getting paid though, and I guess it's still not going to burn through millions.

It seems to me in the US, and probably elsewhere too, that wherever outside financing enters the industry, it just ruins the whole industry in a handful of decades. Education, Healthcare, Housing.. it starts with an intention of helping people that don't have the means and then ends up in a situation where a majority of the population is either dependant on the companies to get the thing or have to forgo the thing entirely..

This is true to the extent that I think it is OK to lie to get a job or opportunity if you know you can do it. For example there might be opportunities where if I pretended I had no coding experience it might be better than saying I have.

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