The United States pays more for health care per capita than any other industrialized nation -- and even then, Medicare is not a comprehensive, pay-for-everything national health program like those of many nations and United States per capita health care costs continue to escalate rapidly.

Here's what you need to know about health care costs as you plan for retirement.

Americans age sixty-five and over spend four times more on health care on average than do Americans under the age of sixty-five. At the outset of this decade, the average per capita health-care outlay for a person under the age of sixty-file was about $2,800. For people over the age of sixty-five, it was $11,089. And for Americans ages eighty-five and older it was $20,001. Clearly, health care outlays are likely to get substantially larger as you age. You need to plan for them.

U.S. health care expenses have grown mightily. U.S. health care expenses have dramatically escalated each year as new medications, new treatments, diagnostic tools, and health care innovations have come onto the market.

For example, the median nationwide cost for a hospital stay -- excluding physicians charges -- was $11,280 in 1997; by 2004 it was almost double at $20,455. The average total cost for treating a heart attack climbed 40 percent in just seven years. All in, health care costs have escalated fast and the increases are gaining momentum.

Health care costs are likely to continue to grow unabated. Unlike in other countries, no laws meaningfully curb the continual climb of health care and drug costs in the United States. For example, many Americans continue to import drugs from Canada because Canadian prices are significantly lower. This is true even though the new Medicare Features introduced in 2006 offset the cost of pharmaceuticals for U.S. retirees. To curb the cost of medicines, Canada prohibits drug companies from advertising on its television channels. In the United States, on the other hand, the very legislation that created the new Medicare drug benefit (Part D) expressly prohibits the federal government from attempting to negotiate lower prices with drug companies.

Count on it: medical costs are sky-high and likely to keep climbing unless there is a radical overhaul of the system.

More and more corporations are cutting back on health care benefits as medical costs soar. Recent statistics show companies cutting general health care benefits and requiring employees and retirees to pay more for them. As one survey of corporate benefit trends concluded, "[Benefit] reductions have become not just common, but expected, with the only question now being of how much more of a reduction in benefits and or an increase in cost will be directly placed on individuals . . . In the end . . . individuals, either as taxpayers or consumers, will need to pay the bill.

I believe this trend will gain greater momentum over the next decades. It will be part and parcel of the continuing erosion of employment benefits -- like the demise of traditional pensions -- that is taking place throughout the country. Just like pensions, more and more health-care expense is going to become a do-it-yourself responsibility because heath care insurance costs are simply becoming too great for companies to shoulder competitively.

Taken all together, you can count on: (1) higher and higher health care costs, (2) more health-care-benefit cutbacks by U.S. employers, (3) the need to factor large health-care expenses into your funding plans, and (4) the need to buy supplemental health-care insurance to shield your savings from cost attack.

Americans are deeply unhappy with the country's health care programs and costs. And rightly so. As one author observed, "A recent survey showed that only 17 percent of respondents in the United States were content with their health-care system . . . Why the discontent? The superficial reasons are simple enough to describe: the system is hugely expensive, very bureaucratic, and extremely patchy. The expenses first: U.S. health care costs a third more, per person, than that of the closest rival, superrich Switzerland, and twice what many European countries spend. The United States government alone spends more per person than the combination of public and private expenditure in Britain, despite the fact that the British government provides free health care for all residents."

Of course, these views will not come as a surprise to most folks. Recent polls show that -- immediately after the foremost financial concern of having enough money for retirement -- the next great concern of most Americans is health care. More than half of adult Americans are "very worried" or "moderately worried" about being able to pay for serious illness or catastrophic health-care expense.

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