It seems to have been a few years since we discussed this. But as I’m getting closer to collecting Medicare and seeing many of my friends/family doing so, I don’t quite get why relatively well-off people are given such a boon near the end of their lives.
In short, I’ve seen several people in their late 60s being amazed at the health care available to them at much lower cost than they ever paid when working. (Yes, many of these bens are through supplemental insurance.) I am awfully certain that the poorest off of these 10 or so people I’m thinking of has a net worth exceeding $3 million. They could certainly pay for A LOT of medical care themselves. I’m not retiring for a couple more years, but I expect to be similarly situated when I do.
Somehow it strikes me as a little “wrong” that people with such assets/income are gleefully trying to figure out how to spend $100 per quarter on health supplies, and joining gyms for free. I see them choosing health care and providers based on what will be cheapest for them, rather than what they think might be the best care. And then, since they have little/no skin in the game - and plenty of free time - they use as much health care as is available.
I STRONGLY support a robust healthcare safety net for those in need. And I support universal healthcare. But this behavior I’m seeing strikes me as a boon to the wealthy - those who succeeded in our economy, as well as supporting generational passing of wealth. A part of me thinks folk OUGHT to have to spend some sizable portion of their assets for their aged health care. And if they choose not to, maybe they oughtn’t live so long.
The only argument I really can imagine is if a VERY generous preventative health care reduces catastrophic end-of-life care later. But, I’m not sure how much I think ought to be provided at what cost how close to the end of life…
(And, I acknowledge I am the unreasonable guy who thinks there ought to be significant means testing on Social Security Old-Age retirement bens - but I’d prefer that this discussion be limited to Medicare.)
If they paid into the system, then they should get it, whether they win the lottery or not. It may not seem fair to you, but that’s how the system works in the US.The same applies to Social Security.
Are you suggesting we pay in and not get anything back, or we don’t have to pay in at all?
There is no cap (like social security) on the Medicare tax. Rich people pay quite a lot into the system and get to participate at the same level as people who paid a lot less. That doesn’t bother me. Paying in for a lifetime and not getting any benefits at all would bother me. I suppose you could do away with the payroll tax and fund Medicare through general revenue. That might make it easier (politically) to means test it.
It seems to me that you’re not quite understanding what “universal health care” actually means, though you claim to support it. In civilized countries universal health care means that everyone has access to medically necessary health care irrespective of ability to pay, because it’s considered to be a basic human right. It’s just that simple. The whole idea of health care necessary to preserve life and prevent suffering being limited only to those who can afford to pay for it is a uniquely American and reprehensibly barbaric concept.
Right. I’m not saying the system doesn’t work this way. I’m questioning why it is set up to work this way.
I am often surprised at statements I hear from relatively well-off (and downright wealthy) folk, as to “what they paid in.” Or “what they are owed.” Whereas I see it from a perspective more of, “Damn, am I fortunate that I succeeded as much as I have. Maybe I should expect to be paying down some of this nut I’ve amassed!”
Well, I think I DO understand what it means. But I suspect that I would favor universal healthcare that is more limited than what I hear my friends/family receiving. These are all folk who were receiving healthcare through their workplace insurance for decades. None of them went without needed care. And now, when they have greater wealth than ever before, and fewer concerns WRT jobs/raising families, they are getting a higher level of care at less cost.
Here’s an idea: Why not make that higher level of care at less cost available to everyone, including while they’re still working?
Part of the reason why health care is more expensive in the US is because of all of that means testing. Means testing means a lot of expensive bureaucracy to do the testing.
Yes, and if the US actually had real universal health care, they’d have been getting an even higher level of care at even less cost throughout their lives. As great as Medicare is, the reality is that it totally sucks compared to real UHC. Asking the retired to pay more out-of-pocket for their health care is not solving anything, it’s just reflective of the fundamental problem with health care in America and is actually undermining one of the very few successes that this pathetic broken system has managed to achieve.
Some of us, as business owners paid 100% of the cost of our health insurance. We also paid 100% of the premiums for our employees. And, we paid medicare tax without a cap. So yes, I feel “entitled” to the Medicare benefits. Yes, I’m very fortunate. Yes, I’ve amassed great wealth. And yes, I could continue to pay $1,200 a month for health care if the system was changed and Medicare was no longer an option.
But why stop there. I could afford my own security guard, so why give me a government paid police force when I need to call 911? Why let me in the public library, when I can afford to buy my own books?
Everyone gets Medicare. At the same base level, even if we’ve paid a great deal more for the same benefits. I’m still not sure why that bothers you.
I’m from the UK. We have Universal Health Care (the National Health Service or NHS.)
At its launch by Bevan on 5 July 1948 it had at its heart three core principles: That it meet the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay.
One personal example:
I was diagnosed with liver sepsis (can be fatal) by my doctor after a blood test
I was given one hour to pack, then taken to hospital by ambulance
I was put in an isolation ward and given strong antibiotics on a drip
within four days I was cured
I spent another 3 days recuperating in a general ward
This cost me … nothing. (In effect I’d already paid for it through taxes.)
I understand from my American friends that such treatment would cost a lot in the USA.
Apparently you even have to pay for an ambulance?!
When I travel to the USA, I am advised to take out $1,000,000 in insurance just to cover potential medical bills.
Our NHS can bulk buy drugs (saving money) and doesn’t need to negotiate with doctors, lawyers and insurance companies over costs (like in America.)
I assume that the companies making money out of healthcare in the US make regular donations to politicians to keep the gravy train flowing.
I completely agree. While we’re at it, let’s also make means-tested police and fire protection, public schools, highway access, public park access, and anything else you can think of that the government offers free of charge to everyone. Of course, putting up the barriers necessary to means-test people might cost more than it would save, but we can’t let rich people enjoy their wealth - they must spend it on what the rest of us get for free because…because…I say so!
Re-reading the OP, this stuck out. I suppose on one level it’s true for all ages, you can pick a provider who is “in network” or you can chose one that will cost you more. I gather most people choose in network, but I doubt they think they’re sacrificing “the best care.” Hopefully, all options will provide competent medical care. Why should wealthy Medicare recipients be less cost conscious? Does that seem “greedy” or something?
Apart from how you are “certain” of this - there are a lot of Americans who’ve managed to save that amount of money for retirement (10% have socked away at least $1 million), and are planning to have that see them for up to a couple decades or more. A major health crisis could eat away a big chunk of their savings and force them to give up their homes and other things they’ve worked their lives for, if they don’t have Medicare to cover a major share of expenses.
I don’t get the resentment toward people who are supposedly cackling with glee about visiting the doctor and getting those colonoscopies and major surgeries they’ve always dreamed of, but could never have afforded before.
You could make the same argument about Social Security. A retiree with $3M doesn’t need SS benefits.
If Americans don’t personally benefit from the deduction, they won’t support the deduction being taken out. If Medicare or SS were means tested, then the Americans who weren’t eligible for them would probably get those programs canceled. Letting the Americans who don’t need those programs benefit from them means that the programs are around for the Americans who do need them.
Health care in the US is in larger part paid for by group insurance through employment. Individual coverage is much more expensive. If we didn’t have Medicare for retirees, they’d have to either go without insurance or purchase the much more expensive individual policies.
Sure. And I would. But as I said, I’ve been outshouted before in other threads.
And I would favor any number of additional taxes which would limit the generational transfer of wealth. But again, another thread.
I suppose what I perceive as unattractive behavior/attitudes are largely caused by our intensely fucked up healthcare. Need look no further than pharma’s position that they HAVE to be filthy rich, or they won’t develop any new drugs…!
I think my biggest complaints are with for-profit healthcare. People tend to take whatever care they are entitled to. And care providers have a tendency to prescribe what they can get paid for.
Procrustus the one instance that influenced that comment was someone who had recently had A LOT of dental issues. I am EXTREMELY impressed with my dentist, and I recommended him. She responded about wanting to see who is in her network. We chose not to buy supplemental dental. I - as she - can pay for any number of tooth cleanings and crowns until we die. In something like that, it shocked me that she’d be looking for a dentist who offers coupons or something.
Without Medicare there would be no alternative insurance — the whole point of Medicare is that private insurance covering the elderly would be prohibitively expensive. And without insurance, even three million dollars could be gone in a flash with any significant medical issue.
I can just see you shouting at a well to do old person “get cancer, already. You have some nerve staying healthy so you can give money to your kids!”
Since I made a reasonable amount of money when I worked, I paid in a lot to Medicare, and I’m subsidizing those who didn’t make as much. I’m fine with that. (Social Security payments are progressive also, those who paid in less get relatively more than those who paid more. Also a good thing.)
Obviously those with money would buy insurance, and I suspect what would happen is that the level of care for those on Medicare would decline. I think Medicaid care is not as good as insurance care, thanks to lack of funding.
Would you let people back on Medicare after they paid a certain amount and were no longer rich?
Medicare is hardly perfect, but it is a lot closer to UHC than anything else we have.
More importantly, if they start limiting your benefits because you make too much, what’s the incentive to vote for anything along those lines? Why should you fund that library, or the police, or whatever if you can pay for it yourself as you go?
That’s the problem here- it is and should be an all or nothing thing, not something that needs to be means-tested and available to those who can’t pay as much.
There shouldn’t be means testing. Everyone should be on Medicare equally.
Signed, a resident of a European country where we have civilized single payer universal care, instead of the barbarism of the American for profit system.
Where the precise balance should be between (on the one hand) ease of access to the care you need without faffing around with payments and insurance companies and (on the other) incentivising prudent self-care and not wasting public resources, and where the boundaries are between essential clinical and social needs and “nice to have” extras, and between raising general taxes or charging per item of service - is always a matter of debate, with changeable results.
Your point is a perennial issue in the UK, in regard to social rather than medical care (which are organisationally separate here), to the point that successive governments have tried and failed to adjust those balances and boundaries, because there’s such a hullabaloo from some group or other who perceive that they’d be the losers. So governments find the whole thing too difficult to deal with and kick it down the road.
(In effect I’d already paid for it through taxes.)
