Your tax dollars at work.
Well, yes. Part B premiums cover about 1/4 of the cost of providing health care to participants. Tax dollars pay for the other 3/4. So the government is increasing the tax dollars it is contributing toward recipients' care from $445.50/mo (3 x $148.50) to $510.30.
Medicare is one of the only places in which the government has actively sought to hold down medical costs. That's true even in the ACA, where despite the hype, most of the cost containment measures were on the Medicare side.
You're right that in some areas Congress doesn't have a backbone. For example, deferred and then eliminated the Cadillac tax.

In a sense, the whole claims system is a game. The insurers do everything they can to come up with excuses to deny or delay paying the fair amount on claims.
My doctor's office had a claim denied because they had not stated explicitly that the coding was in ICD-10 (the current coding system) rather than ICD-9, which had been obsolete for years. They had to refile with no changes, just a declaration that it was coded correctly.
Medicare Advantage insurers game the government by trying to make their customers appear as sick as possible. The way the system works, "To provide an incentive for insurers to cover sicker patients, the plans are paid commensurately more for their care."
So the insurers push customers to accept a one time in-home visit from an insurer's clinician to find any condition that would get the insurer more money. Of course that's not what the insurers tell their customers the visit is for. And it raises all our costs.
"If you are healthy and the visit results in an increased risk score, you won’t have to pay more for your care. But the higher Medicare reimbursement your insurer receives may contribute to the nation’s rising health care costs."
https://www.health.harvard.edu/blog/medicare-advantage-when-insurance-companies-make-house-calls-201512168844
In this game, I find I'm more on the side of the providers. Especially PCPs, where as @sma3 noted, margins are razor thin. Which is not to say that I haven't seen gross abuses of the system by providers. But I haven't seen nearly the level of nickel and diming that the insurers do that drives up administrative costs. Just MHO.

Hi Pudd,
Thanks for stopping by.
Comments and quetions for Old_Skeet should be directed to him on the Big Bang Board. I believe his handle "Old_Skeet" is still in "timeout" on the MFO Board.
Here is what I was able to locate for your questions. This is my thinking not saying that it is correct as applied to VYCAX.
Q: What is float adjusted market cap?
A: "The number of shares used for calculation is the number of shares "floating", rather than outstanding. An index that is weighted in this manner is said to be "float-adjusted" or "float-weighted", in addition to being cap-weighted. For example, the S&P 500 index is both cap-weighted and float-adjusted."
Q: What do options do for the fund?
A: "Options speculation allows a trader to hold a leveraged position in an asset at a lower cost than buying shares of the asset. Investors use options to hedge or reduce the risk exposure of their portfolios. In some cases, the option holder can generate income when they buy call options or become an options writer."
Assumption: Options lower the cost to position and maintain the fund within target ranges as it rebalances positions quarterly. In this rebalance process, most times, the fund generates capital gains (a source of income) which are subject to taxation on the share holder. In addition, the fund pays a dividend.
Best regards,

Here's the benefits sheet on the old Select Client Services.
https://individual.troweprice.com/staticFiles/Retail/Shared/PDFs/FullBenefits.pdf
Something else missing on the new Summit Program benefits sheet is Turbotax. The online version was free at the $250K level, and downloaded products were free at the $1M level.
I'd say that they were more targeting the mass affluent than the high net worth investors. Really, is that free subscription to Kiplinger's Personal Finance at the $1M level going to get you to double your $500K investment with them?

$250k seems to be lot of dough for the privilege of getting TRP’s closed funds.

As you know, Vanguard investors need $1M (Flagship status) to access certain closed Vanguard funds.

Many European countries do not use single payer systems.

Everyone in France must buy health insurance, sold by a number of nonprofit funds [i.e. multiple payers]. ...
Switzerland has a universal health care system, requiring all to buy insurance. The plans resemble those in the United States under the Affordable Care Act: offered by private insurance companies, community rated and guaranteed-issue, with prices varying by things like breadth of network, size of deductible and ease of seeing a specialist.

https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html
See also: International Health Systems for Single Payer Advocates
https://www.pnhp.org/single_payer_resources/international_health_systems_for_single_payer_advocates.php
Even with a single payer system (e.g. original Medicare), providers would still need to code claims to receive payment for services rendered:

What are ICD Diagnosis Codes Used For?
Help Medicare claims paying offices process Medicare claims

https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-Training-Material/Downloads/ICD-Diagnosis-Code-Requirements-Part-I.pdf (see slide 5)
Codings are used not just for billing purposes but to keep accurate records and communicate clearly. From the UK's National Health Service, describing a coder's job:

You begin by recording the stay of an elderly woman who had a hip operation two days ago. From her medical notes, you find out the ward she stayed on before surgery, how long her operation took, her recovery time and any other treatment she received. Then you use the special alphanumeric code you've been trained in and record everything on the computer system.
These records can be understood throughout the NHS and used to plan for future patient care.

https://www.stepintothenhs.nhs.uk/careers/clinical-coder

I have owned general global funds in the past. And I have been getting rid of them. The last to go will be DODWX from my IRA sometime very soon. Then VMNVX from my taxable account just as soon as I can harvest a tax loss.
My feeling now is that global funds dampen any opportunity to rebalance from foreign to domestic, or vice versa. Then too, it is not unusual to find a few foreign stocks in my domestic funds, and a few domestic stocks in my foreign funds.
The funds that breaks this rule are GPGCX and GGSYX. I couldn't buy any more of GISYX, or any of their other funds at my IRA broker. So I bought what was open to me.
I am not averse to buying global funds in sectors that appeal to me. I am happy with GLFOX. And in the near future I will be buying some globally oriented funds in the green economy. Anyone interested can read my comments here:
https://www.mutualfundobserver.com/discuss/discussion/58867/climate-change-funds#latest

@Catch22 - Thanks for the chart. As you know, TAIL isn’t designed to make money over longer periods. The manager expects negative returns most years. So, not sure what to compare it to in a day and age when stocks only go up.
Others I’ve looked at:
SWAN About 90% treasuries and buys longer dated call options on the S&P (passive management)
DRSK About 90% investment grade corporates and buys longer dated call options on selected stocks.(active management)
FTLS About 70% long and 25-30% short on selected stocks (active management)
Here’s my favorite one conceptually - DFND, which shorts stocks that it thinks will pay lower dividends in the future and goes long on stocks it thinks will grow their dividends. It’s considered defensive in the sense that investors tend to rush into dividend paying stocks during times of market stress. Generally good reviews. The problem is it bounces around a lot and is currently on an uptick. I would only buy in after a prolonged period of weakness.

I was looking at some of my old notes today. I see I forgot a couple of the ETF's I was looking into. Descriptions are from etf.com.
RNRG

RNRG offers exposure to companies that produce energy from renewable sources including wind, solar, hydroelectric, geothermal, and biofuels including YieldCos — a holding company for renewable energy projects that have been spun off by a larger energy utility. The portfolio is market-cap-weighted, with a cap of 6% on individual names. While YieldCos are sometimes marketed as MLPs for renewables, note that these firms use a traditional C-corp structure with no inherent tax benefits. Dividends from the fund are taxable. The Fund name and investment strategies changed effective November 19, 2018. The fund originally tracked the Indxx Global YieldCo Index through November 16, 2018 and the Indxx YieldCo & Renewable Energy Income Index thereafter. On Feb. 1, 2021, the fund name, ticker (YLCO) and index changed, dropping its focus on YieldCos while still including them in the fund.

You can read more about yieldco's here:
https://cleanenergysolutions.org/instruments/yieldcos
SIMS is similar to GRID, but gets into more than just smart electrical transmission:

SIMS is passively-managed to provide exposure to firms which the index provider defines as companies involved in: smart building infrastructure, smart power grids, intelligent transportation infrastructure, or intelligent water infrastructure. Each company is further classified as either “core” or “non-core,” depending on the level of involvement in innovative infrastructure. The index is initially equally weighted, but then tilts the overall portfolio weight towards core firms by 20%. As a result, pure plays are overweighted. Prior to June 25, 2019 the fund traded under the ticker XKII.

This CHART is TAIL vs SPY for one year (253 business days). You may drag (left) at the 253 day area and travel backwards for a moving one year period, OR you may right click the 253 day and select ALL (or other choices) to view the total pattern back to the 2017 inception date for TAIL. You may ALSO right click in the chart and select ANIMATE. ANIMATE is not encouraged if one has consumed excess alcoholic beverage or has other certain medical circumstances. :)
Remain curious,
Catch

One can use Portfolio Visualizer (PV) to see how he arrived at the age 70 investment portfolio values. PV shows slightly lower values. That is possibly because when one asks PV for a 6% rate of return, it doesn't use 6%/12 (0.5 basis points) for the monthly return, but 0.487 basis points (compounds to 6% annually). Just a guess.
Here's the PV setup for 6%. Mouse over the graph for the 8 year (age 62-age 70) result.
On the withdrawal side (after age 70), the video makes two simplifying assumptions:

• You will die at age 90. 5% withdrawal x 20 years = 100%. That leaves longevity risk.
• The real rate of return of the portfolio is zero. This addresses @bee's point that the portfolio grows over time. The video's portfolio does grow in nominal returns at precisely the rate of inflation.

bee does a nice job with PV in showing how one might have invested in the past. Kudos for incorporating a couple of bear stock markets in the mix. That said, there are two implicit, and IMHO fairly aggressive, assumptions made:

• The funds selected (or any fund of one's choosing) will continue to outperform the market. I've added a 60/40 S&P 500/bond market mix (rebalanced annually). This didn't survive 15 years. PV link.
• The markets going forward will produce real returns similar to those of the past 20 years. Schwab is projecting average real returns over the next decade of around 4.5% in the stock market and negative bond returns. And that's before considering higher inflation - the projection was from last May, before inflation took off.

Source page: https://www.schwab.com/resource-center/insights/content/why-market-returns-may-be-lower-in-the-future
With respect to sheltering the portfolio from taxes via a Roth IRA: this assumes that the part time worker is not already putting that money into an IRA (and maxing out), else contributing more to an IRA might not be an option. In any case, one could not contribute even half the age 62 benefits to SS. $1400 x 12 mo = $16,800. Including the $1K catch up amount, the max that one can contribute to an IRA is $7K.
Looking at the Roth conversion option: let's assume one is in the 12% tax bracket, no state taxes. If one converted $140K and somehow managed to remain in the 12% bracket, then that would use up the $16.8K in SS, thus effectively adding that amount to the Roth IRA. In reality, that would move one into the 22% or 24% bracket; hardly a good strategy. Not to mention that this would make more of the SS benefits taxable. Further, in order to execute this plan for eight years, one would need to have $1.12M in a traditional IRA available for conversion.
This has a better chance of being feasible if one is in a higher tax bracket (that would reduce the amount of the conversion necessary to incur $16.8K in taxes). However, given the correlation between income and longevity, the higher income person is also more subject to longevity risk and thus would likely benefit more from the lifetime income guaranteed by SS.

Regarding the annuity option: we don't know where the cost figure comes from, or what type of annuity it is. Though I agree with what I think is @JonGaltIII's assumption - life only, no inflation adjustments. One can buy joint and survivor annuities, but they cost more. I don't believe there are any inflation adjusted fixed immediate annuities left on the market, but there should still be some that provide for annual increases of a fixed amount (say, 2%). Of course those also cost more.
If there is the possibility of a surviving spouse, that just makes SS look even better. With SS, if the spouse with the larger benefits dies first, the surviving spouse gets those benefits instead of one's own. Unless one expects both spouses to live past the break even point (~82 give or take), the optimal strategy is often for the lower benefit spouse to take SS early (62) and the higher benefit spouse to defer to age 70.

@Old_Joe
I retired in 2019 after 40 years in primary care medical practice, both self employed and as an employee.
When I was self employed, my livelihood and the salaries of all of our employees depended on the knowledge and expertise of the billing staff, who worked long hours to get us every dollar they could out of the insurance companies. Despite many hours talking to them, I still do not understand medical billing. We paid these folks good salaries to sit on the phone for hours and wrangle with other staff at Blue Cross for example, over $15 or $20. But we figured if they spent 30 minutes collecting $50 we were ahead of the game.
A lot of physicians don't bother, or hire a billing service, who just tries once. In primary care, however, the margins are so thin ( our overhead never dropped below 55%) every dollar counted.
I think we would have been better off charging $50 a visit, cash. We would have needed far fewer staff, but it was unclear ( and I could never get an answer) if we didn't take insurance, if our patients would have had any of their tests or prescriptions covered. That is where the real costs in health care are, not doctor's salaries, especially primary care.
Once I joined a hospital owned practice, it was their problem, but I can tell you collections and efficiency fell off the cliff.
It is in the financial interest of the insurance companies to make this as complicated as possible, as they live off of the 25% America spends on administrative expenses. Highest in the world!

Thanks @sma3
I’ve considered these type of “fringe” investments as potential speculative / timing tools. But the thought of maintaining a constant weighting is most interesting. With interest rates so low, bonds no longer offer the downside protection they once did. Even the managers at PRPFX have reduced bond exposure and ditched longer dated bonds in favor of short term ones.*
*See my Barrons Thread

I have had a small position since 2019. It has done what I expected, ie buffered market declines.
March 2020 Tail was up 27% to SPY drop of 31%. It is down about 15% since I bought it, far less than inverse ETFs like SH which lost over 50%
It also pays about .7 to 1%
the usual advice is to rebalance to maintain the same % in your portfolio. That would work pretty well I think

I think we all need to be aware of the potential catastrophe if we enter a prolonged bear market. People who are depending on their equity returns to live on will be hurt very very badly.
While the 1930s are probably not a useful comparison, as the Fed was nowhere to be seen, many of us lived through the 2000 to 2013 crash. While there was a "recovery" to a previous high by 5/29/2007, within five months things went south again, and did not recover until 2013.
Taking the two periods together, it was over 13 years of no returns. The PE fell from 35 to 8.
While the Fed is obviously more willing to intervene now, with rates at near zero, and the deficit enormous, there may be less they can do.

“Everybody Ought to be Rich” - by John J. Raskov
Article - Ladies Home Journal (1929)
“Mere saving is closely akin to the socialist policy of dividing and likewise runs up against the same objection that there is not enough around to save. The savings that count cannot be static. They must be going into the production of wealth. They may go in as debt and the managers of the wealth-making enterprises take all the profit over and above the interest paid. That has been the course recommended for saving and for the reasons that have been set out-the fallacy of conservative investment which is not conservative at all. The way to wealth is to get into the profit end of wealth production in this country.”
And this - “How Can We Tell if the Market is Overvalued?”
Article by Brad McMillan (2021)
“So, is the market crazy expensive? (For the record, this is how my son would put this question.) As I mentioned above, we have three ways to get to the answer. Based on history, the answer is yes. Based on current interest rates, the market looks reasonably priced—not cheap, but certainly within a reasonable range. Finally, based on market behavior, we can see rational pricing. As I see it, history does not seem to be the best guide to our answer, especially given the multidecade trend of rising valuations. On balance, the right answer seems to be that the market is reasonably priced.”

Here is a Q & A concerning access to closed TRP funds.
"Certain T. Rowe Price mutual funds (known as “closed funds”) are generally closed to new investors and new accounts. Clients assigned to the Select Services tier ($250,000 Summit balance) or higher of the Summit Program have preferred access to closed funds in their qualifying accounts. Investment minimums and other information about closed funds are specified in each fund’s prospectus.
The 529 portfolios have access to closed T. Rowe Price funds, regardless of participation or status in the Summit Program."

Re TAIL (etf)
I’ve come upon a better description of the strategy. In particular, the fund (TAIL) relies on intermediate, rather than long term treasuries (as I earlier stated) for ballast, while purchasing put options. The manager explains that under normal conditions, the fund is expected to lose money.
Excerpt: “The Cambria Tail Risk ETF seeks to mitigate significant downside market risk. The Fund intends to invest in a portfolio of "out of the money" put options purchased on the U.S. stock market. TAIL strategy offers the potential advantage of buying more puts when volatility is low and fewer puts when volatility is high. While a portion of the fund's assets will be invested in the basket of long put option premiums, the majority of fund assets will be invested in intermediate term US Treasuries. As the fund is designed to be a hedge against market declines and rising volatility, Cambria expects the fund to produce negative returns in the most years with rising markets or declining volatility.”
Source https://www.cambriafunds.com/tail
Here’s a related bit of information cited in “Up & Down Wall Street” (Barron’s, Nov. 15). Eric Metz, an options trader is credited by Randall Forsyth as providing the following advice:
“Metz (recommends) taking advantage of a current anomaly in the options market. Premiums on calls on the Nasdaq are higher than those on put options—the reverse of the usual skew. Typically, hedgers pay higher premiums on puts to ensure against the downside of their holdings. But bullish enthusiasm currently is making for higher premiums on upside calls.”

@BenWP - Yes, sounds like you & I have same plan. I’ve found in the past that some seldom prescribed meds that cost $50 - $100 with that insurance plan can be had for approximately $10 - $15 if I use Good RX instead (at Meijers). So, I’m not totally blind-sided by your post. But - Geez - liscinopril’s an old and very commonly prescribed med for controlling blood pressure. I’m surprised that price gouging is occurring on this very common med. Cudos to you for noting the discrepancies in pricing.