And I am 100% certain that most people who get shoved into Medicaid either have no idea or have no choice but to sign on the dotted line. That's the tragedy here. Our government is making people sign onto something almost out of desperation.
Let me make my position 100% clear, because those down-voting my post and attacking it might not have understood this. Actually, no, I failed to communicate it.
Medicaid Estate Recovery is an abomination.
It should NOT be a part of the program.
It should NOT exist.
We should provide medical care to the needy without ANY recovery requirements whatsoever.
If someone needs a million dollars in medical care they should receive it.
They should not have to worry about being on the hook to repay it in any way.
That is what a decent and compassionate society does and how it behaves.
If this estate recovery business were done by a private insurance company they would be destroyed by both public opinion and brought-up on fraud charges. We should demand better from our government. We should demand that estate recovery be completely removed from Medicaid.
> That is what a decent and compassionate society does and how it behaves.
Capitalism, especially in the USA, is not an economic system that concerns itself with or encourages a compassionate society. Medicine is one of the most obvious ways that capitalism is literally killing people.
I believe that with the right leadership and a conversation with the nation we could converge on a system that was fair, took care of the needy and got government and insurance companies as we know them to day out of the system to the necessary degree.
I don't, for a moment, believe that we can get both government and insurance companies entirely out of the system in the US. In the first instance, government, you would not want to. Oversight and rules are important. In the second instance, insurance companies, there could be an argument of their need in absorbing some of the risk. Admittedly, not an easy problem.
What we have today, this hodge-podge of laws, agencies and programs is a complete disaster. This should be obvious and evident to anyone who takes the time to take a full dive into the absolute mess healthcare is in the US. The ACA did not fix anything, it made it worst, because it isn't a real solution.
I won't claim to have the solution. As I alluded above, this requires leadership that can bring forth a national-level conversation that, over a year or four, can converge on something that can deal with all issues equitably.
One angle is what I might term a to be a moral obligation: We have the moral obligation to take care of each other. What follows, then, is that we all contribute to a fund or a national health insurance policy of some sort that covers absolutely everyone with, perhaps, reasonable co-pay's to take some of the edge off. If one of us needs a million dollars of medical care he or she should be able to get it.
This should also come with some obligations. I think there's nothing wrong with the idea of requiring regular checkups of some sort. This is where it gets complicated. What do we do about people who destroy themselves through substance abuse. I don't know how we deal with that and other matters.
Anyhow, I think we can all agree that we ought to be able to do far, far better than this mess created by our politicians in playing sick partisan games with one of our most basic needs. And this has been true over at least the last 50 years, no political party is devoid of blood (almost literally) on their hands.
We truly need to take this up to a much higher intellectual level in order to converge on a good solution.
It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid. The reaction is evidence of the political polarization out there and the disconnect that exists with what politicians have done to our healthcare system. It's a mess and what we have isn't getting any better.
It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid.
The analysis in your heavily downvoted comment is blatantly wrong!
Is Medicaid means tested? Absolutely.
Is Medicaid for elderly patients heavily means tested? Absolutely.
Is what you said: Medicaid enrollment as of 2016 reached over 70 million people. Here's the requisite chart:
Every single one of these people has, effectively, entered into a promissory note with the government. They DO NOT have health insurance, they have a loan. true? Nope, only people over 55 who have remaining assets are subject to estate recovery.
Everything I said is accurate. Yet, you insist in missing my greater point:
This issue shouldn't even exist.
We, as a society, should revolt at having such clauses in a medical program that is supposed to help people.
The US healthcare system should take care of every single US resident. Period. Rich, poor, healthy and ill. And it should do this without the kind of thing I have highlighted regarding Medicaid.
It is my experience that it is extremely difficult to convince people who have a religious attachment to things. So be it. I put the matter on the table. I've done all I could here to raise awareness. And that's the end of the story.
It is my experience that it is extremely difficult to convince people who have a religious attachment to things. So be it. I put the matter on the table. I've done all I could here to raise awareness. And that's the end of the story.
The stuff you are complaining about only applies to people that are over the age of 55.
A 10 year old and their mother that get primary care through Medicaid, they don't ever have to pay anything back (except if they later access Medicaid after age 55, but the asset test would apply to the care received after age 55, not before 55).
So, you don't think it is immoral to have this estate recovery thing?
I don't know why you are focusing on this age business. It does affect a large number of people. And it is objectively wrong.
It is wrong because it is immoral and fraudulent to present it as insurance when it is not.
It is wrong because it is immoral and fraudulent to deceive people.
It is wrong for a country like the US to have a law that results in the government sinking it's hooks into a large percentage of the people on that program.
We should not have such provisions in any healthcare program at all. Period.
You are missing that one point. The most important of all.
Again.
We should not have such provisions in any healthcare program at all.
We should have programs that help people and provide healthcare for all with no such conditions or stipulations.
We should help the poor without having them give up whatever property they have or may have for the sake of having health care.
We need to be a better society and we can't claim to be that when we have a law that allows government to place a lien on someone's property because they had the misfortune of needing medical care.
As for all the means testing BS you continue to sling around. That went out the window with Obamacare. The only thing that matters now is a percentage of the Federal Poverty Level. It varies per State. In CA it's 138%, which means about $22K for an older couple who's kids have left the nest. Over ten million people have been shoved into Medicaid in CA (called Medical here) in 2016.
It turns out to be that a lot of fixed income older couples who own homes of significant value can easily fall under this FPL requirement. Hence, again, the over ten million people shoved into the program last year in CA alone.
You are sadly misinformed. I urge you to read the links I've provided in this thread so you can get a real picture of what's going on and how things work. I get the sense that you've had exactly zero contact with this system from any imaginable angle. I and my family have, from both the professional angle --my wife being a Doctor-- and the patient angle, with my parents and her parents.
"This has become more of a problem since the ACA’s Medicaid expansion took effect in 2014, as people are now funneled into the Medi-Cal system in much greater numbers than they used to be. Covered California enrollees with income up to 138 percent of the poverty level are directed to Medi-Cal, regardless of the value of their assets (there’s no asset test for subsidy eligibility or Medicaid coverage under the ACA).
As a result, some families have been receiving bills from Medi-Cal after their loved ones pass away, including bills to cover the cost of payments that the state makes to managed care plans, even if the deceased didn’t use any medical services."
Let that last line sink in: "EVEN IF THE DECEASED DIDN'T USE ANY MEDICAL SERVICES"
The famous line from The Matrix applies here:
"You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes."
I've shown you where the rabbit hole goes, yet you continue to believe whatever you want to believe despite overwhelming factual evidence. I can't fix that. Enjoy that steak.
As for all the means testing BS you continue to sling around. That went out the window with Obamacare. The only thing that matters now is a percentage of the Federal Poverty Level. It varies per State. In CA it's 138%, which means about $22K for an older couple who's kids have left the nest. Over ten million people have been shoved into Medicaid in CA (called Medical here) in 2016.
Checking income is a means test.
As for why I keep bringing up the age thing, it's because you keep making incorrect claims where it is a relevant factor and statements implying that receiving Medicaid benefits has grave financial consequences for all recipients (receiving the benefit doesn't even have grave financial consequences for the elderly; it just isn't very generous).
"means testing" refers to something very specific which includes asset valuation.
Obamacare/ACA/Medicaid no longer include means testing. It's a simple income test against FPL.
Where did I say that Medicaid has grave financial results for all recipients?
Again, you continue to ignore the point:
The fact that these hooks exist in Medicaid is objectively wrong. Very wrong.
They (the hooks) are also very real and, yes, they affect millions of people. So real that there are myriad attorneys specializing in complicated asset protection schemes intended to shield people from them.
The trouble is this is only available if you have the money to afford some very expensive and complicated legal work.
In other words, the poor and lower middle class are totally screwed and can't defend against this. This is horrible.
We should not do this to our people.
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1- Are you saying it is OK for Medicaid to have estate recovery rules?
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2- Are you saying estate recovery isn't real?
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Please clarify because I truly don't understand where you are coming from.
Means testing has a broad and non specific meaning. Wikipedia of course isn't authoritative, but it discusses it in broad terms: https://en.wikipedia.org/wiki/Means_test
As an example, due to the pension my father left her, my mom will never qualify for any Medicaid assistance. This is a means test, she has resources above what Medicaid would provide.
The poor don't have assets to scheme to protect, so they don't really get screwed by asset tests.
The resources for elder care have to come from somewhere. Having the people receiving the care be the first payers makes a lot of sense to me. So the asset tests don't really bother me much.
Should society step in and help people who can't afford to pay? Of course. Should society work hard so that middle class and wealthy people that need long term care can pass more of their assets to their children? Probably not.
Hmm. OK. You probably haven't spoken to an attorney since Obamacare. I have.
Even so. We are dicing and slicing words here and the whole thing is irrelevant.
> Should society step in and help people who can't afford to pay? Of course.
> Should society work hard so that middle class and wealthy people that need long term care can pass more of their assets to their children? Probably not.
OK, it sounds like we might be coming to an understanding here. Please answer the questions I asked, because everything else is irrelevant.
Here they are again, slightly restated:
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1- Is estate recovery real?
Can we agree on that point?
Forget age thresholds. Is it real?
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2- Is this OK?
Should a nation like the US have a healthcare system with programs that place citizens past a certain age --the age where medical needs increase significantly-- in a debtor relationship with the government?
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I am willing to bet your answers will be:
1: Yes, it's real.
2: No, we should not have a healthcare program that turns medical care recipients into debtors
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If these are your answers we, then, are 100% in agreement and this back and forth has largely been irrelevant because these two questions are the meat of the objections I have raised.
We need a healthcare system that takes care of everyone, rich and poor. There should be no distinction when you walk into the doctor's office or hospital. And it should certainly not turn you into a debtor to the government. That's immoral and wrong.
As for the philosophical question of the wealthy passing assets to their children, that's an entirely different discussion. As an advanced and "civilized" nation we should not use the healthcare system as a battering ram to deal with such issues. Healthcare should be about just that, healthcare. Everyone should have access to it and it should not bankrupt anyone or turn them into debtors to the government. We need to achieve that. The issue of inheritance, etc. is a matter for a different kind of legislation and it should be kept separate from medical care. I hope you'll agree to that as well.
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I'm pretty sick of what politicians have been doing with our healthcare system over the past 20 to 50 years. It is an absolute mess. And I fear it will get worst before it gets better.
What we need is leadership that is able to have an adult conversation with the nation to explain how we need to work together for the greater good. Instead we have politicians in various political camps playing fucking games with our healthcare for political gain, not our benefit.
The right kind of leader would be able to unite the citizenry in understanding that the ONLY way we are going to end-up with a better system is if we accept that we all have the obligation to contribute --obviously based on financial ability-- in order to create a system where anyone, rich or poor, can walk into a hospital and not worry one iota about costs. What we have today is a horrible mess. And Trump, despite what many might think, is very far from the leader we need on this matter. I think we can agree on this as well.
I've never argued that estate recovery doesn't happen. Maybe you could admit that the 3/4 of people on Medicaid that aren't elderly aren't subject to it in any way, the primary thing that has lead me to pushing back on your comments. It's a pretty big deal that it doesn't apply, because that's where you started, fear mongering about how evil Medicaid is for everyone.
And I think I was clear enough in my previous comment. It's fine if the resources for elder care come from the assets of the people receiving the care. Dealing with it through estate recovery is a detail; the other way to do it would be to force disposal of the assets before providing any benefit (pretty much the situation faced today by people who don't own homes).
I think a different health care system could cost a lot less and be better for everyone. In the healthcare system we have, where funding for Medicaid is quite limited, I'm fine with it kicking in as a last resort.
I am not going to slice and dice numbers because that's irrelevant. The data I've seen indicates the number of afflicted is far greater than the 25% you are alluding to due to Medicaid expansion.
Yet, let's leave it at that. Let's concede it is only 25% of the folks on Medicaid. We are at 75 million people enrolled right now and firmly headed towards 100 million if nothing changes.
And so, per your number, that means 19 to 25 million people are in debt with the government for their medical care.
You keep calling it "fear mongering". All I did is provide links to source information where the way the program works is clearly laid out. And everything is factually correct.
Here's the part you don't seem to want to concede: If someone is put into Medicaid when they are, say, 40 because they don't qualify for subsidies and can't afford anything else, they are likely to stay there for a long time. And I'd be willing to bet money, they have no clue what's coming.
So, 15 years later they are still on Medicaid only now they shift over to becoming a debtor to the government for aspects of their medical care. And it so happens that after 50 to 55 years of age most people start having greater needs.
Our population is living far longer now, with 90+ not being uncommon. Which means that the 100 million or more that will be on Medicaid over the next decade or two will have a greater component of 55 or older folks. And every single one of them will owe money to the government for health care.
This isn't fear mongering, this is a mathematical reality.
> It's fine if the resources for elder care come from the assets of the people receiving the care.
Ah. OK. Now we understand each other.
I do not agree with this. Not at all. And mostly because most people have no clue they are accumulating debt.
If we did NOT call it medical insurance. If we classified it clearly for what it is. And if we made certain everyone knew what they were walking into it might be a different matter.
I know you are going to say it's right there in the forms. Nobody reads the fucking things. They want healthcare and they are placed between a rock and a hard place. They sign on the dotted line and move on.
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The fundamental disagreement here is that I am not OK with there being a program that turns people 55 and older into debtors to the government for their medical care.
You don't have a problem with the idea.
That, I think, is the bottom line. Everything else is slicing and dicing numbers. This, to me, is a question about the morality of the thing, not about statistics.
And I am 100% certain that most people who get shoved into Medicaid either have no idea or have no choice but to sign on the dotted line. That's the tragedy here. Our government is making people sign onto something almost out of desperation.
Let me make my position 100% clear, because those down-voting my post and attacking it might not have understood this. Actually, no, I failed to communicate it.
Medicaid Estate Recovery is an abomination.
It should NOT be a part of the program.
It should NOT exist.
We should provide medical care to the needy without ANY recovery requirements whatsoever.
If someone needs a million dollars in medical care they should receive it.
They should not have to worry about being on the hook to repay it in any way.
That is what a decent and compassionate society does and how it behaves.
If this estate recovery business were done by a private insurance company they would be destroyed by both public opinion and brought-up on fraud charges. We should demand better from our government. We should demand that estate recovery be completely removed from Medicaid.
Hope that clarifies my position.