People of means should be, and usually are paying more in taxes. That should cover the whole shebang. Direct means testing for Medicare is just a way to prevent the people from a guarantee of reasonably priced healthcare by making it look like an additional tax on people.
There are a lot of different benefits in the UK; some are means-tested and some are not.
Applying for a means-tested benefit can be a convoluted, time-consuming and stressful process. This is compounded because the people most likely to benefit are often the people who will, for one reason or another, have the most difficulty dealing with bureaucracy and application forms.
As a relatively well-off pensioner, I get some benefits automatically: free prescriptions and bus passes for example. I also get some help with the current high cost of energy, all without having to apply. Prescriptions are currently £9.60 per item which means that my wife (also a pensioner) saves several hundred Pounds a year.
It is estimated that the total amount of unclaimed income-related benefits and social tariffs is now around £19 billion a year. £7.5 billion of which is Universal Credit, a benefit designed to help the lowest paid or unemployed families with living costs.
There is some consensus that the cost of dealing with claims can often exceed the cost of paying everyone. This means that a multi-millionaire pensioner will get the same energy allowance as I do.
To see that would require quite a vivid - and unfair - imagination.
To others:
Yeah, I suppose I would not notice this sort of thing re: Medicare, if I felt wealthy persons were taxed fairly. I’m no expert, but my guess is that many/most countries offering universal health care tax the highest earners at higher rates than the US. And IMO FAR MORE elements of wealth ought to be taxed than what the US currently calculates as taxable income.
The idea of healthy Medicare copays for the wealthy is one I could support. Do other countries have that?
No, I don’t suggest wealthy folk pay for police protections or schools. But if they wish greater levels of such services, they can live in a gated community, or send kids to private schools. Along those lines, I guess we’d need to debate what is included in “universal basic health care.” I imagine I might draw the line lower than Medicare - or other countries with universal health care. But I’m no expert.
I’ve worked 37 years in the Social Security disability arena, and have long thought the only option is some form of universal income, rather than trying to determine “disability.” Then recover it through taxes. Eliminate the entire Social Security Administration, and simply beef up the IRS a tad. But that wil never happen.
As I get older, I greatly appreciate that I don’t have to watch every penny as closely as I did before, and chase after every “deal.” I still have pretty modest wants, but I buy what I want, when I want. As I view my cohort, I regularly perceive what impresses me as a “graspy/greedy/entitled” attitude. Personally, I feel that attitude/behavior unattractive. I guess I am the only one who perceives people in my cohort looking to use the medical services that they can get cheap/free, as opposed to seeking the medical care they feel needed. But, heck, grab what you can.
I readily acknowledge that old folks grabbig a free pair of reading glasses or an extra tooth cleaning is awfully small potatoes compared to what is wrong with out health care and tax systems.
Thanks for all the responses.
That has nothing to do with Medicare benefits. I’m glad that when I was paying, there was no cap on Medicare contributions, and I wish there was no cap on Social Security contributions. I could afford it, and it would make the system more solvent. And I’m fine with making the tax progressive also.
Medicare does not pay 100% of all medical costs. There are drug co-pays. There are supplemental insurance plans that you pay for that cover some of the charges Medicare does not. Copays are collected at the doctor’s office - do you want each doctor to means test you? Medical facilities pay too much for people just doing insurance already, this would be worse. Dental and eye care come from Medicare Advantage plans, not Medicare proper. We’ve had some threads about them.
It is a point I’ve made a few times before that healthcare is so widely asymmetrical in terms of needs and ability to pay, that UHC is really the only sensible way to arrange things.
Consider cars or food. No-one wakes up one morning and finds they need Oscietra caviar or a Bugatti in order to survive the next year. Their transport and food needs can be satisfied by purchases that fall within an easily definable and affordable range.
This is not the case with healthcare. Tomorrow you may find yourself with choice of a multi-million dollar expenditure or death and there is absolutely nothing you can do to forsee it or prevent it.
In those circumstances it seems only reasonable to have a pool that is contributed into by all on the basis that they will have their most extreme needs taken of if and when they need it.
It’s very strange to me that the UK dental care system is a completely separate thing. There are NHS dentists (although good luck finding one taking on patients), but even with NHS dentistry, there are charges to pay at the point of delivery of care - the charges are fixed and presumably supported by a subsidy, but I don’t understand why it’s so different to the rest of the system.
Aneurin Bevin must have run out of sacks of gold by the time he got to the Faculties of Dentists.
Besides all the reasons others have mentioned (human rights, overhead, etc.)- making Medicare means tested would, politically speaking, likely make it far more vulnerable to being killed altogether, IMO. Apologies if someone else has already mentioned it, but I did not see it.
Swear to gawd, nobody reads my posts! 
Not that I blame them.
What does this mean, exactly? Their new hobby is lolling around specialists’ waiting rooms because nothing’s more rewarding than wiling away an afternoon on Naugahyde chairs waiting to be called back to a cheerless exam room for another wait? Or they finally decided to get bunion surgery now that their toe joint is poking holes in their gym shoes? What unnecessary health care are they getting now simply because they have free time and no skin in the game?
Maybe I hang out in the wrong crowd, but I don’t discuss our net worth with friends and family (my wife and I have a pretty good chunk and I expect some of our friends and family do as well, while others definitely do not). Is this common for others beyond @Dinsdale ?
Same in Canada. Need a kidney? We got you. Have an abscessed tooth that needs a root canal and a crown? That will be $2000.
There was a debate in the Pearson cabinet over the Medicare proposal.
Justice Hall had wanted Medicare to include dentistry and pharmacy, and put that in his report.
There was opposition in Cabinet to the whole idea of Medicare, led by Mitchell Sharp, who said it would be too expensive.
Allan MacEachern led the case for Medicare, arguing that the entire Hall report be implemented.
The result was a compromise. Pearson decided that Medicare would cover doctors and hospitals.
And that’s where we’ve been ever since.
You apparently have never known an elderly person who likes the attention a nice looking young doctor gives them - especially if the doctor/nurse flirts a little.
I’ve seen it by 2 old farts, and suspect at least some of the other old persons in the waiting rooms are engaging in healthcare as a hobby. One we had to work hard to get her to stop seeing her cardiologist and off the heart meds, after her numbers improved so much there was no justification for continuing. But Medicare covered the visits/drugs, and the doc was happy to keep scheduling them… Several months later, she asked, “Why haven’t I seen Dr. Joe for so long? I LIKED him!”
Well, if you know what you earned, how you spent it, and how much you have, you can make a pretty good guess at where similarly situated folk are. Especially if you discussed investment strategies with them over the years such that you know if they’ve invested/re-invested conservatively. A couple of people - one friend and one sibling - and I have been very open in discussing our wealth (in general terms) and how we view it as we approach retirement. To me, the question of “how much is enough” and “where to I put it and what do I draw from” are kinda important, and I consider myself very fortunate to have a couple of people close to me with whom I can discuss such things openly.
We don’t have copays at all in Canada, for the things that are covered by Medicare.
On the contrary, I’ve known quite a few senior citizens, and more now that I am one. The patients you are describing, who are, let’s be clear, in the minority, are getting inadequate care if physicians simply continue to see them and don’t address the real problem. About 7% of seniors are highly lonely and may seek medical care in order to alleviate that loneliness. They’re also much more likely to seek and get opioids, sdeatives, and anti-anxiety drugs. It’s so much easier to spend 10 minutes with an elderly patient, assume they just want to see that good-looking young doc, and throw a prescription at them than to address the real issues.
“There’s a misconception that as we age, we become more withdrawn and less sociable,” said first author Ashwin Kotwal, MD, of the UCSF Division of Geriatrics and of the San Francisco VA Medical Center. “In fact, older people are more socially active than other age groups and frequently play major roles in their communities. When older people are not socially active, we need to recognize that there’s a problem.”
Bolding mine. Source.
It’s lazy medicine to continue to see these patients and not address the underlying issues. And it’s lazy logic to assume that these people are seeing doctors merely because they have the time to do so.
I must say, on this side of the Atlantic, I know I’m not the only one finding this thread absolutely jaw-dropping:
As for the broader question of communal taxation vs. private provision, there’s another angle to view it from: the taxes I pay now are in part my contribution to the return taxpayers as a whole are entitled to expect on the investment already made in the infrastructure and socioeconomic-politicolegal environment that enables to me to have that comfortable an income.
I go to the cardiology department every 6 weeks to get my INR checked, and the waiting room is hardly filled with little old ladies getting their doctor fix. Maybe our doctors aren’t cute enough. But they are too busy to push out patients who need them, so I suspect they’d do what you say.
BTW, I have no idea of how much my senior neighbors have, not even the one who was an amateur investor and who talked with me about his latest hot stock.
yes I’m quite comfortable with being hit by reasonably high taxes as the taxes paid by previous generations have laid the groundwork for me to get educated, be healthy, and work.
In a similar vein, The tuition fee and loans for university students in the UK sounds high but my daughter (who is off in a couple of weeks!) has been told by us to treat those not as a conventional debt but as a form of graduate tax.
She doesn’t start paying any of it until she earning a decent wage and will never be expected to pay all of it off. If she doesn’t earn a big wage then she isn’t penalised but if her career is lucrative then she’ll be paying much more towards (as you describe) the common infrastructure that helped put her in that fortunate position.
Hey, I read it, quoted it, and said it was the key! No one reads mine, either.