Long Term Care Crisis

[Beelzebuddy]

One other wrinkle that may not be obvious for those outside burgerland: health care billing practices are not uniform. The same care can have very different price tags depending on who is paying. Here's how it works:

Uninsured person: I require this $2 treatment
Hospital: Here you go. That will be $10
Uninsured person: I cannot pay $10
Hospital: That is a shame.
Collections agency: We will pay you $2 for that $10 debt
Hospital: Deal.
Collections agency: Pay us $10 instead
Uninsured person: I cannot pay $10
Collections agency: Then pay us $2 now, and $1 every month for a year or we take your car.

Insured person: I require this $2 treatment
Hospital: Here you go. That will be $8. Pay us $1, and your insurance will pay us $7.
Insurance: We will pay you $1 instead.
Hospital: Deal.

The objection isn't so much "I shouldn't have to pay for my own EOL care" but "without a third party to negotiate payment on my behalf all the money will get pissed away immediately because that's how the system is structured."

 

[dann]

I just posted an excerpt from a WaPo article about the the effect of COVID-19 on long-term care crisis (and more) in the One Covid-19 Science and Medicine Thread.

 

[wasapi]

Sure if you can afford it. A lot of people can't. How did you manage?

medicare covers it thru the Share program in my area. I was assigned one who lives here. It was difficult for awhile since I have lived alone for so many years. But she helps clean, gives rides and provides household goods. The program is suggesting she pay me a couple hundred for rent. But so far I haven't.

 

[rdwight]

Ya, real extravagences like shelter and healthcare.

Just to focus on priorities, would you argue that it would be better to change long term care pay share or expand medicaid to cover ALL children and increase coverage options? Because that would be the tradeoff in cost. If I was campaigning for a change I know which I would want, but I am biased with kids.

 

[dann]

I don’t really know where to begin.

Don't! It's against the rules to use the word, but ... just don't.

 

[Ziggurat]

"Not starving" isn't exactly what I'd call and incentive.

Your entire argument fails in the face of the very simple fact that rich people in the US have fewer kids than poor people in the US. Do you seriously think rich people are at risk of starvation if they have more kids?

 

[Beelzebuddy]

Ya, that's insane and shows the person who wrote it has no ideas how families work. As someone with 2 young kids and discussing a third with his wife, I assure you the "where do we put the extra carseat" discussion is way down the list of conserns. We just leased a larger vehicle so we could accomidate a bigger family.

With such a detailed and verbose statistical rant the author should be fully aware that correlation is not causation, and that a study looking at correlations between regulations and an outcome tells you more about the kind of society that makes those regulations than it does the regulations themselves. Therefore I can only conclude that the author is not an idiot but merely pretending to be one for the purposes of political diatribe. It's just one long appeal to great replacement theory.

 

[ponderingturtle]

Oh, I agree. Where I was coming from is, I’m 100% for having a society, an economy, where free quality healthcare is available to everyone. Like some countries already do have. But:

As long as we’re not there yet, then this particular specific, where one is at a place where on one hand the care one needs one will keep needing throughout, it is not a temporary thing for that person; and on the other hand, that person already has savings and assets: then to focus on that particular situation as something to lament about, seems completely misplaced. In our dysfunctional society where healthcare isn’t available to all, I don’t think that particular hill is worth singling out for defending, or even seeking sympathy for.

Like I said already, the larger shortcomings this issue highlights absolutely 100% does need fixing. But this specific probably doesn’t stand out much, or at all, as something that elicits an overdose of sympathy.

(Someone who’s ill, and hasn’t the money to pay for treatment? Absolutely, we should fix that. Elderly person who needs long-term care, and hasn’t the wherewithal to pay? Absolutely, society should take care of that. But elderly person who needs long-term care, and who has the money to pay for it, but, within this imperfect system, is nevertheless lamenting about using up their savings and assets, because nothing will be left for the family? What better use for those assets than to treat the person who earned it in the first place, and who needs it now? Probably this would be last in priority of things that need fixing, if you look at subsets of the health situation that need fixing. At least that’s how it strikes me.)

Then it must also be OK to render those who are ill destitute, so for someone who has the money to pay for their treatment they should take all that money first by your standards. Clearly rendering people destitute is not a serious concern for you.

 

[Chanakya]

Don't! It's against the rules to use the word, but ... just don't.

No, I'm not indirectly, backhandedly, implying he's trolling. TA often makes a great deal of sense, and it's not like I'm trying to snidely run him down here. I literally think he may be joking, except doing it with a straight face. Even though he says he isn't. Because the idea of treating whole swathes of the populace as expendable, as good riddance if they die, makes no sense to me. That "economic argument" makes no sense to me, except as some kind of dark humor.

 

[ponderingturtle]

But if you must pick a section of the population to highlight this situation, then to choose the portion that owns assets but is loath to touch those because they'd rather pass that on to heirs who cannot be assed to care for them in their time of need but nevertheless feel entitled to these goodies, seems like picking the subset of society least deserving of subsidization, to highlight a very real issue that is better highlighted by shining the light on other, more deserving candidates, whose situation is more dire. Which is not to say that ideally everyone shouldn’t be covered, including this segment as well, like lionking discusses for Australia for instance.

You have to understand many people are afraid of being a burden on their kids, and making them quit their jobs to care for you is not exactly not being a burden. You clearly must consign yourself to poverty too now if a parent gets sick not just for your own sicknesses.

 

[Donal]

Your entire argument fails in the face of the very simple fact that rich people in the US have fewer kids than poor people in the US. Do you seriously think rich people are at risk of starvation if they have more kids?

do you think rich people don't have more kids because another car seat is too much a hassle?

 

[Carrot Flower King]

I'm confused: are we channelling Dean Swift or Ayn Rand here? Certainly not Beveridge or Bevan.

 

[Donal]

Logan's Run, apparently.

 

[ponderingturtle]

This thread has convinced me, america needs to bring back life time care maximums so that people who hog all the medical care have a personal reason not to.

 

[Chanakya]

Then it must also be OK to render those who are ill destitute, so for someone who has the money to pay for their treatment they should take all that money first by your standards. Clearly rendering people destitute is not a serious concern for you.

Agreed, if someone is ill, and needs care long-term but not for all their life, and in the process is rendered destitute, then that's ...not acceptable. But it makes sense to me, generally speaking, that someone who already has savings and assets, shouldn't be a burden on society just so they can pass that on to their adult heirs who will not (or cannot) care for that elderly parent, at least not until we reach a situation where everyone everywhere is fully covered for healthcare needs. That doesn't sound fair either. ...And, thinking about this a bit, I don't rightly know how to set terms such that someone that's EOL ends up using their assets first, but those that might recover and get back to regular life is spared that.



eta:

You have to understand many people are afraid of being a burden on their kids, and making them quit their jobs to care for you is not exactly not being a burden. You clearly must consign yourself to poverty too now if a parent gets sick not just for your own sicknesses.

I'll stop after this, because as you can probably see I haven't quite got this all figured out entirely consistently, even though I've commented freely enough in this thread. And I don't want to make this all about me. But to address the above, I understand and appreciate this. And in this situation, if it is an EOL matter, then those who don't want to be a burden on their kids; and have the means to pay, at least in part, for care; well, I don't see why they shouldn't do that (that is to say, refrain from being a burden on their kids by paying for their own care to the extent of their assets), I don't quite see why it seems so very important to them to leave their all to those kids. It's one thing if they're literally kids, you know, literally actually children. Then, sure. But if they're adults, then why should society bear the cost of that care, just so those assets can get passed on to those adult heirs? That makes no sense to me, at least not until we've reached a situation --- that is actually how many economies operate --- where everyone everywhere gets to access full healthcare.

 

[ponderingturtle]

Agreed, if someone is ill, and needs care long-term but not for all their life, and in the process is rendered destitute, then that's ...not acceptable. But it makes sense to me, generally speaking, that someone who already has savings and assets, shouldn't be a burden on society just so they can pass that on to their adult heirs who will not (or cannot) care for that elderly parent, at least not until we reach a situation where everyone everywhere is fully covered for healthcare needs. That doesn't sound fair either. ...And, thinking about this a bit, I don't rightly know how to set terms such that someone that's EOL ends up using their assets first, but those that might recover and get back to regular life is spared that.

What about those people who will always be a burden on society because their care costs hundreds of thousands of dollars a year, but they can be a productive member of society if they get the care, is it just the infirm who get cleaned out or should that person know that what job they get is irrelevant as they will never see any of the money from it?

The standard you seem to be advocating is that the infirm should expect to be destitute, but higher bills from someone who is not infirm get covered to not become destitute.

 

[Ziggurat]

do you think rich people don't have more kids because another car seat is too much a hassle?

That was just one example of an incentive. It's hardly the only one, and I never claimed it wasn't.

But there are a lot of middle class people who could afford more children, but don't because doing so would impact their lifestyle in undesirable ways. The car seat issue is just one example of how that can happen.

 

[Chanakya]

What about those people who will always be a burden on society because their care costs hundreds of thousands of dollars a year, but they can be a productive member of society if they get the care, is it just the infirm who get cleaned out or should that person know that what job they get is irrelevant as they will never see any of the money from it?

The standard you seem to be advocating is that the infirm should expect to be destitute, but higher bills from someone who is not infirm get covered to not become destitute.

Like I said, I'm not quite sure how to set terms such that the EOL situation is clearly separated out from a general care need; even though in terms of what is fair the two seem very different to me.

But, thinking this through a bit, and venturing a last comment on this, I'd say that if I myself (I'm many decades away from being elderly, but my parents are kind of there) ended up needing long-term care, then in a situation where full healthcare isn't available to the entire populace, I really shouldn't grudge it if my savings and assets were used up in (part) compensation for my ongoing care, regardless of whether with that care I returned to productive life or not. The alternative would be that I eat my cake and have it too, which is fine when it's cakes all around (as it is in some countries), but it's unfair when a great many go unfed.

 

[The Atheist]

Uhhh, okay, so you did mean all of that quite literally!

Correct.

How can you look on a segment of the population as somehow less worthy of living, even if they do need more care?

Asked and answered.

Should we give a 90-year-old a heart transplant so he can spend another 5 years drooling into his shirt?

We limit healthcare in lots of ways. Limiting the amount spent on people at the end of their life seems a lot less sensible than spending money on kids and young people.

I mean, it is up to society, up to us all, to shape up our economy such that we accommodate all who are part of that society. And not the other way around. What is the point of a shiny economy if that is the result of “culling”, whether literally or figuratively, portions of the populace?

Somewhere in the rest of this century, those questions will come home to roost. Japan is the bellwether, with a very old population that is far outpacing new taxpayers joining society.

(I feel a bit ridiculous arguing this, much like I did in the other thread, because I keep thinking you’re doing the tongue-in-cheek thing here.)

I assure you I'm not.

 

[dann]

Yes, let us pretend that a 90-year-old "drooling into his shirt" is at the top of the list when a donor heart becomes available.
Let us pretend that all 90-year-olds are drooling.
Let us pretend that people older than 80 can't (and shouldn't!) lead meaningful lives.
(Or have the goalposts been moved to 90 now?)

I noticed this spry 86-year-old, five years older than Biden, earlier today:

At this point, she may have "closed up shop down there", but in spite of having been treated for non-Hodgkin lymphoma, she seems to be doing fine.