That apparently depends on which benefits - Medicaid apparently still uses an asset test for long term care benefits.
From that link :
Medicaid beneficiaries who need LTSS will be denied LTSS coverage if they have transferred assets for less than fair market value during the five-year period preceding their Medicaid application. This rule applies when individuals (or their spouses) who need LTSS in a long-term care facility or wish to receive home and community-based waiver services have transferred, sold, or gifted assets for less than they are worth.
Some comments from someone that works in health insurance and has previously worked with Medicare Supplement / Replacement plans
If you’re outraged at rich people getting $100 stipends or gym memberships, that’s absolutely peanuts compared to regular healthcare spending on even the typical old person. It wasn’t at all uncommon to pull a subscriber that had so many claims for a year the system couldn’t display them all at once.
Health insurance is symply too expensive for even the Middle Class to afford while working on in retirement, so there’s going to be some kind of extremely subsidy one way or another, whether with Medicare or with say having retirees buy their own commercial plan. If you want to go with means testing, you’re limiting it to a tiny fraction of the population, and thus any savings aren’t going to be that significant. I
Moreso, do we really want to discourage other people from growing the economy, and put their kids in a position where they’re reliant on government aide instead of being able to take care of themselves. In many areas of the country it’s functionally impossible for ordinary people to buy a house just on their wages, so they’re reliant on the family passing them down a house or substantial assetts to buy a house.
It’s not just small potatoes, it’s literally rounding errors in the grand scheme of things. The reason why the things you mentioned have relatively relaxed cost controls is because they make up such tiny fractions of healthcare cost. You’ll know when you get into the really expensive side of healthcare because all of a sudden, medicare doesn’t look so generous and there’s stringent criteria and expert panels that have to make hard choices on what is and isn’t covered under medicare, there’s very little room for discretion because we live in a world of finite resources and some people who would otherwise live have to die because of a lack of money to heal everyone.
You can have whatever opinions you want about Mrs Jones going to see a GP 8 times a year instead of 2 but I hope you can see that people aren’t choosing to get chemo drugs or complicated invasive surgery or round the clock palliative care just because they don’t have to pay for it and those are the things medicare dumps their real budget into.
Excellent point. Plus, without Medicare, many of the children of the retired would be forced into the position of spending their money for the massive medical bills of their parents. College debt is bad enough for them.
Medicare B premiums are means tested in a way, the premiums you pay depend on your income. If you make 97k or less you pay $164/month. The numbers go up until you make 500k a year, at that point you pay $560/month.
Apparently Medicare D is the same, if you have a higher income you pay higher premiums.
So, if you support universal healthcare and a strong safety net for healthcare, then you should support Medicare being not means-tested. Means-tested programs in the US are often under-funded, and subject to attacks by the right-wing. And the people that receive means-tested benefits are often treated as if they’re less than full citizens, as if they’re lazy and shiftless or stupid.
But programs like Medicare and SS, which are basically universal for the elderly, get full support because everyone is in it, regardless of their income. Programs that are available to everyone get more support, and are not as under-funded or attacked by right-wingers. And the recipients of SS & Medicare are not treated as if they’re undeserving lazy malingerers.
Now, I’m a big supporter of Medicaid. It’s a great program for the poor and for disabled, and it especially helps children. But the recipients of Medicaid are not a politically strong group, and they’re often treated as if they don’t deserve the benefits. This is why there are still 9 red states and 1 purple state that haven’t expanded Medicaid. And some red states have attempted to put in work requirements that are burdensome and often requiring so much documentation, that they’re too expensive and self-defeating as they don’t encourage work and don’t get people their healthcare either.
So, back to your original statement about wanting a strong safety net…if that’s what you want, then you want Medicare to remain universal for the elderly. And in fact, you should probably want to expand Medicare to more people who are not elderly…like down to a lower age than 65…
OK true. But the basic program is available to all. I think of a fully-means-tested program as something like Medicaid or SNAP (food stamps), where your ability to even be in the program is limited to people with very low income or with disability, etc. Being allowed into Medicare isn’t limited to just the poor.
There’s a universal nature to Medicare that makes it much more popular among the overall American public. Also, it pays more than Medicaid, so more doctors accept it.
The answer to your question lies in the book The Longevity Economy which is highly worth your time.
Essentially, elderly people were revered for their knowledge and wisdom and generations of families often lived together or close by. Even in 1850, life expectancies were on the order of forty years. Elderly people tended to work, and the idea of retirement for leisure and the association between age and frailty were far less prominent. There are obvious physical and occasional mental limitations with aging but in general the elderly were considered capable of a contribution, which was often necessary in any case.
This changed due to several factors as lifespans lengthened. Private care homes, new pension and financial service companies and growing insurance industries widely advertised and emphasized debility to gain business. The idea of removing older people from the workforce to engage in leisure and give younger generations a shot became widespread. Everyone ages, but the US has always liked individualism and often been reluctant with generous handouts. But the idea of contributing to pension schemes was a vote winner both parties endorsed. Pensions were not a thing in 1850. A lot of the ideas regarding aging now are “shared ideas” that often reflect more stereotype than substance. Young people think of elderhood in terms of medicine and disability when this is but a subset. Most Nobel prize winners make their main discovery when 48, and a huge amount of wisdom is forced to retire by discriminatory legislation, which is not to say that I wish both current presidential candidates were a decade younger.
But since one contributed to pensions while working, they were promoted as entitlements. These became very zealously defended. Means testing makes economic sense, but politically it was more palatable to offer these across the board. And since workers were contributing, this became widely seen as fair, and not a handout in the same way as fighting poverty. Attempts to change this are politically difficult for many reasons.
The sensible approach to all this is that universal programs like healthcare should be equally available to all (no means testing) and be funded out of general taxation. Then of course general taxation can be progressive, so the economics can end up being similar to means testing where wealthier people pay more. Those who think wealthy people should not pay more can try to make general taxation regressive, but it will likely be more transparent (and unpopular) what they are doing.
I’m kinda surprised this thread has gained a second life (or had its life unnaturally extended! ;))
I remain unsettled at the economies of the US healthcare system. I am not thrilled when I perceive well-off retirees receiving very expensive medical services for what I perceive to be well below market rates. Of course, I also am not thrilled when I see poor people seeking treatment at emergency rooms for the sniffles and other routine health matters.
I think that my idea of “universal” health care would cover a limited range of treatment, and would require some higher copays for wealthier people.
The fact that some people cannot even understand simple taxation is not an argument that they are more likely to understand more complex funding methods.
Well, it’s certainly not intended to be. I was arguing against the idea that more regressive taxation would be “transparent” and therefore “unpopular” by virtue of being more likely to be understood.
You’re arguing against simpler and more transparent taxation on the basis that some people can’t even understand simple things. That’s the definition of making the perfect the enemy of the good.
I have obviously completely misunderstood your argument and am unsure which simpler and more transparent taxation I’m arguing against. Is it sales taxes?
By general taxation I’m not drawing a distinction between corporate/income/sales tax, these are all forms of general taxation. I’m drawing a distinction between taxation that is general revenue and taxation that is designated to fund specific programs, like SS & Medicare tax. Something that is a basic human right like healthcare should not be treated like an insurance program where people feel only those who make certain specific contributions get it because they have “bought” it, or that provision of service should be means-tested. It should be provided universally and equally to everyone, be free at the point of service, and be funded through general taxation. And the general taxation system, as transparent as possible, is where we can best make choices about fair contributions to society.
I disagree with nothing in this post. I did disagree that making general taxation more regressive is likely to be more transparent but that’s a tangential question that I’m happy to disagree about.
It’s surely much more transparent than expecting people to understand exactly how each specific program like SS & Medicare is funded, and how much relative contribution each person is making factoring in means testing also.
It’s simpler and more transparent to pay for healthcare out of general taxation without means testing. I haven’t said otherwise in this thread nor would I because I believe that pretty strongly.
I had one quibble about a minor side issue but I don’t think I’ve been able to explain what that point was and I no longer care. I think we should drop it but you now have the opportunity to have the last word.
