Why is it that so many people have no philosophical problem with the idea of voluntarily impoverishing themselves ( by transferring their assets to children or grandchildren well in advance) so that “the government” ( meaning the taxpayers) pays for long term care either in a nursing home or in the community. Plenty of the same people have a problem with the idea of the same taxpayers paying for everyone to have healthcare. And I say “philosophical problem” because they aren’t cheating - they’re paying by the current rules , but if the rules changed and didn’t allow these transfers , they would be outraged.
Is it just a matter of " If it helps me it’s good, if I have to pay for it it’s bad" or is there more to it?
How is Medicaid funded? I poked around a little bit and all I can find is “Medicaid is a program funded equally by the federal government and the states”. Is it a case, like SS, that people feel they have been paying into the fund all their lives and now they deserve to get some payback? I honestly don’t know.
But I’m sure, for a lot of people, it’s as you say in your last sentence.
No, not really. Paying for your own nursing home isn’t paying taxes- it’s paying for services you receive. I’m asking if there’s a reason other than self-interest why people think it’s fine to give away their assets and ask the taxpayers to pay for their nursing home and would object to any laws restricting it further (such as a 10 year lookback- plenty of people complained when it went from 3 to 5) while objecting to the idea of the taxpayers paying for actual medical care for everyone. And people supporting publicly-funded health care may not have any greater justification for shielding their assets, but they don’t give off the same vibe of “I’ve got mine”.
Many people want to be able to leave an inheritance to their loved ones and perhaps even give them something to help them with major life events. Parents giving a child a down payment on a home, or grandparents helping pay for a grandchild’s college education are the types of wealth transfers that often happen during a person’s lifetime. “It’s their money, let them spend it as they see fit” is the mentality.
But an aggressive look back period might seek to deny care to someone who made such gifts in circumstances when the need for long term care was not evident. And it promotes a level of government involvement in financial decision making that may be intrusive to some. (Better not help my grandson Johnny with his college tuition. I might need that money for LTC if I get hit by a bus. Can’t give my niece my car now that I no longer drive. Have to sell it at fair market value in case I need LTC four years from now.)
Years ago I dealt in LTC insurance and had to explain this look back period to clients. For those healthy enough to qualify for LTC insurance they had a hard time believing that government should expect them to be able to accurately foretell their need for care three years in advance and thus refrain from asset transfers. Now it is five years and wouldn’t be any easier.
Maybe it’s one of those things where people are in denial. They may intellectually know that they’ll have to impoverish themselves if they expect free nursing care, but they don’t expect that to ever happen. They’ve got it in their minds that their kids will gladly take care of them or that home nursing care will be both sufficient for their needs and affordable. Or they think it won’t be a big deal to spend down one’s assets once they are 95 years old. But it doesn’t even enter their minds that a single stroke or heart attack can turn a spry 70-year-old into a nursing home candidate quite easily. I think the average person is optimistic and believes that they will come up on the winning side of the gamble. To be more realistic requires looking at dying and death squarely in the eye.
But under universal healthcare, people aren’t given the chance to gamble. You gotta pay regardless of what happens to you in your old age. And I could see how a person might think they’ll end up paying a lot more than they would with the system we have now. I don’t know the numbers, so I have no idea if it’s true. But there is that perception.
I understand completely that that’s what people want to do . What I’m wondering is whether there is some sort of principle that allows them to expect the taxpayers to pay for their long-term care so they can make those gifts *even while *they object to the taxpayers paying for universal health care. We could, if we wanted to , have a system where Medicaid paid for long-term care for everyone, without this system of asset transfers and look-back periods. It would , however, require a tax increase (because then Medicaid would also have to pay the costs of those who needed long-term care and didn’t have the opportunity to shelter their assets.) and therefore, the people I am talking about would be against it. * I’m inclined to believe at this point that it is simply " If it helps me it’s good, if I have to pay for it it’s bad".
But that’s the thing- the “government” doesn’t expect them to do that. The “government” simply expects them to pay for their own long-term care to the extent they can afford it , and on some level ,not to make transfers once the need becomes apparent. Of course, there’s often no way to tell from the outside when the need becomes apparent and that’s why the look-back is set in some number of years but that’s the intent.
Not to mention the multiple people I’ve known who divested themselves of all their assets so that Medicaid would pay for their/their spouses nursing home who complained about another resident doing the same thing - “because he had two houses, I have only one” or the equivalent. They would not accept that he had done the very same thing they had.
The look-back was expanded due to too many people gaming the system*.
Yes, it IS a selfish position.
People are selfish.
Some times, they can find “Moral Outrage” to cover their selfishness.
Student loans can no longer be discharged in Chap. 7 Bankruptcy - too many fols were picking up their diplomas in the morning and filing their Chap 7 Petitions in the afternoon.
Many programs now require multiple MD opinions - too many people were using their Disability payments for new squash rackets.
It’s the same principle, though: Medicaid has rules that establish what the government takes and what the person can keep, just like any tax system, and like with any tax system, most people are going to work within the rules to pay no more than they have to. I don’t have to claim my kids as dependents, but I do, even though that effectively means that other taxpayers are subsidizing me for having children.
Exactly. Or we could have a system with an indefinite lookback, or a system where Social Security and Medicare also put a lien on one’s house for payments made, but we don’t. We’ve chosen a point somewhere in between, and people are working within the limits provided by that choice.
To each one’s own, but to me it seems like they’re in a more hypocritical position, not less.
Maybe you don’t understand what Medicaid is. The government doesn’t take any money and therefore it is not a tax. The nursing home or other home-care provider ( a private entity) charges you a fee. If you have insurance that covers the fee (and such insurance is sold) , then the insurance pays for it. If your assets and income are low enough that you are eligible for Medicaid, then Medicaid pays for it, as long as you didn’t give all your assets away within the look-back period. If you have neither insurance nor Medicaid, you are responsible to pay for it yourself. Just like a hospital or doctor bill.
And again, I understand why people do it- that was never my question. My question was whether there was any principle to combining it with resistance to paying for universal health care (or even universal long-term care) other than selfishness. Apparently not.
How so? They’re not saying " I want the taxpayers to pay for my nursing home , but screw that 50 year old guy who got hit by a bus. Let his wife go broke- just as long as I’ve got mine". They’re saying “The taxpayers should pay for everyone’s health needs”
The whole point of the thread is about how people deal with the fact that Medicaid sometimes seeks to take a lot of money from them. From the point of view of the person having to pay, whether we call that amount a tax or something else is just a formality, because in either event their conduct is likely to be the same. They’re going to look for ways to pay no more than they have to. We usually don’t call people selfish for taking legal deductions.
It’s the same for someone who is paying for care entirely privately. We wouldn’t expect that person to pay more than what he or she is billed, even though doing so would help the facility cover the costs of other patients. The same is true for people buying food, paying rent, or enrolling in college; we would think it’s commendable if they pay more than their own bill in order to help others, but we wouldn’t call them selfish for not doing so. I just don’t see a reason for singling out Medicaid long term care as somehow different.
I guess it seems to me like the ones most intent on imposing that obligation on other taxpayers (which I’m not saying is a bad policy choice, by the way) would be expected to be the ones less inclined to seek out available advantages for themselves.
The point of the the thread was whether there was some principle that justified people voluntarily impoverishing themselves to qualify for Medicaid, even while they are unwilling to pay additional taxes to finance health/long-term care for people who actually cannot afford it (like that 50 yr old who got hit by a bus) or for everybody. I didn’t say anyone was selfish simply for arranging things so they pay as little as possible , but so far as I can tell the only principle involved with the combination I am talking about is “If it helps me it’s good, if I have to pay for it it’s bad”. Can’t imagine what to call that that isn’t basically a synonym for selfishness.
I think our disconnect is on this point. Isn’t that what Medicaid provides; long-term care for those who cannot afford it? The people you’re citing as selfish did pay taxes for that purpose.
Medicaid provides health care, including long-term care, for those who cannot afford it. The argument is about people who deliberately make themselves unable to afford it by giving assets that would otherwise be available for their care to others, especially their kids. (The thread that inspired the OP was started by someone who stated they “are working on selling his possessions and giving away his money” so Medicaid would pay for his care and he wouldn’t have to.)
Is this fundamentally different than a parent being deliberately un(der)employed so they don’t have to pay child support, or a welfare recipient deliberately turning down work so they’ll qualify for more welfare? I don’t think that it is.
Medicaid isn’t like Social Security; there’s no account in your name and you don’t earn credits towards future payments. Medicaid is a lot more like food stamps: you qualify simply by being poor (and medically needy, in Medicaid’s case), whether or not you’ve ever paid into the system.
While the money you pay today goes to today’s retirees, Social Security maintains an account in your name, and the amount of your future payments depends on how much you put in (well, on your average salary for the 35 highest-earning years in which you paid Social Security taxes, with the amount of those taxes dependent on your earnings in each of those years). If you didn’t pay in for at least 40 quarters, you can’t collect Social Security on your own record; survivor’s benefits depend on that person having paid in for the requisite number of quarters (varies based on age at death).
By contrast, Medicaid (and food stamps and other forms of welfare) don’t have any concept of an account like that; you can be eligible even if you never contributed a single dime.
Yeah, let’s be honest, welfare cheats are often people of colour in the eyes of those who despise and fear them. But I’d wager the ‘just moving granny’s assets’, crowd is predominantly white.
So clearly, they cannot be equated as BOTH gaming the system at the expense of the taxpayer! I wonder which is the larger group? Or which costs more on the public purse?
Certainly, people who do support publicly-funded health care don’t have any greater justification for shielding their assets from Medicaid either.