Yeah. You are probably right. But lacking them paying those other taxes - and as shitty as US healthcare is, this boon to the wealthy old kind grates on me. Someone like my sister is just maximizing the amount she is going to be able to leave to her kids.
Add in my personal objection to the amount of healthcare expended on extremely aged people at the very end of life.
Right. Bring back the high marginal tax rates the USA used to have. Have capital gains taxed at the same rate as other income. Bring down the cutoff for estate taxes to $1M plus one personal residence of up to $1M.
And stop taxing Social Security and Unemployment.
It’s my personal experience that this is not the case. In the past decade, I’ve witnessed the passing of both my parents, several aunts and uncles, and a fair number of other ‘extremely aged people’. In all of the cases, without exception, there were no heroic measures taken, no extended hospitalizations, and no midnight ER trips. Instead, without exception, all of these folks were kept comfortable and pain-free while they lived out their last days.
Hospice care is one of the few shining stars of our healthcare system.
I agree.
This cite suggests average final year costs of $80k.
https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(22)00176-4/fulltext
I’m not sure if that is the average. If so, some would be significantly higher.
This site says a quarter of all medicare is spent in recipients’ final year.
There are plenty of other sites offering info outside the “fair number” of your acquaintances. Different people may reasonably differ as to whether the dollar amounts are high or not.
There’s an answer for that – not that I in any way approve, but it’s an answer that would sit well with the wealthy in the US hyper-capitalist culture and still co-exist with a universal health care system. Let the wealthy pay exorbitant amounts for “concierge” (or so-called “boutique”) medical services …
A much greater problem is being upset not by wealthy people getting free health care, but by the idea of “the undeserving” getting free health care, despite how false and counterintuitive this is because everyone benefits from a streamlined system with lower costs. The irony is that excluding your deadbeat neighbour from getting “free” health care is not just barbaric, but on average more expensive because of the cost of the system to expend great bureaucratic effort to exclude them.
I vehemently disagree. How well we care for our aging population is one of the hallmarks of a civilized society. Among the many things that makes me really proud of the health care system in Canada is how well my mother was cared for in her final years, when she was in her mid-90s. It included medical equipment at home and regular visits from four different health care workers and a personal care worker, as well as really attentive care during her periods of hospitalization. I would have it no other way. I would not want to live in a society that felt otherwise.
Incidentally, this has nothing to do with electing to have a voluntary “do not resuscitate” living will, which is an entirely different issue.
That’s cool. People can definitely disagree on such things. I don’t know what the quality of your mother’s life in her final years or the cost of the home equipment and care workers - which I’m sure was much less than anything in-patient. I think most folk in their 90s ought to be made comfortable, but I’m not sure how much should be spent to prolong their lives. And I know that my personal preferences are not sound basis for national policy.
I was actually going to add another edit to my post about that, but it fits better as a response here. She suffered from CHF – congestive heart failure – but was well enough to be marginally mobile and get around with a walker for longer distances. She loved her flower gardens and the sounds of the numerous birds around the property that she felt were singing just for her – and who was I to dispute that? Among the equipment the public health system provided was a portable oxygen concentrator that let her leave the house. I would frequently drive her to an upscale boutique grocery store that she loved – it was the sort of place that typically rich people shopped at – which neither of us were – but she was a careful shopper and really appreciated the quality and the attentive service.
In short, she had a remarkably good quality of life in her final years, and I’m forever grateful to our health care system for making it possible. We will all eventually be in the same place, and we should hope to be treated with the same compassion, if only for selfish reasons.
I wonder if we (USA) as a society believe that healthcare is a basic human right. I believe it is (at the very least it ought to be a basic right in a country as wealthy as ours) but I don’t think every American shares that view.
And if someone is going to doctor’s office much more than seems reasonable it can be an indication that there are mental and emotional issues such as severe loneliness that need to be worked on so they should be seeing a doctor anyway.
No, we don’t. Most Americans don’t see it that way. When I’ve debated healthcare with self-proclaimed conservatives (on other message boards), they get very angry when anyone mentions a right to healthcare. So, I’ve tried to focus instead on the responsibility that we as citizens have to get healthcare coverage - mostly because it actually helps keep costs down and helps keep hospitals/cllinics in business when people are insured - and I’ve focused on comparing us to other countries and stressing that we can achieve also UHC if every other country in the world has figured out how to do it. I’ve also said that other countries have achieved UHC with private plans (Switzerland, for instance), to get them to understand that UHC isn’t inherently some sort of eeeeeevillll Bolshevik plot.
They do hate the ACA. Probably not because of anything in the bill, but more likely because it’s attached to Obama, whom they hate. If the same plan had been passed by Mitt Romney or George Bush, they wouldn’t have spent 8 years screaming “repeal and replace”. It’s politicial hate masked as a policy disagreement.
Anyway, I’m digressing. I think the answer to your question is that most Americans don’t believe healthcare is a right. And that’s one of the reasons our healthcare system is so messed up.
OK, I guess maybe we’re disagreeing on exactly what ‘healthcare’ means. In the examples I described above, all those folks were residents of senior citizens care centers. And, yes, the cost was expensive, more than the $80k figure you quoted. But these people were being taken care of as they lived their final days. Is that healthcare?
Is this true? I don’t know but I would think that every female of appropriate age/development would be given an OB/GYN just as they’re given a PCP.
And if you don’t like any waiting at all, ever, and you have enough money you can pay out-of-pocket for concierge medicine and swanky private hospital rooms. Which is how I wish it was in the US–universal health care for all, and anyone who wants moremoremore can buy supplemental insurance to push them up to the Platinum Level.
Back before I retired, many years back my company offered an HMO as a heath care option. Lower employee cost, and company cost as well I assume.
You had a primary care Doctor who had to provide referrals for any doctor other than himself. We called him the “gatekeeper”. I only kept that option for two years before rreverting to the non HMO plan.
Currently retired and on a Medicare PPO plan. My wife is having hip replacement on Feb 1st and my out of pocket is under $400.
I concur.
The GOP certainly doesnt.
We could have some form of (real, not Sanders weird idea) Medicare for all if it wasn’t for the Republicans.
All this whinging and tooth gnashing over the USA not having UHC and many other Western nations having it just makes the 'own the libs" at the GOP happy.
I’ve seen that also. Now, if you could just tell us how we can figure out if we’re in our final year, you can kill us early and save a lot of money. A Modest Proposal perhaps?
I’m not sure what care you want to do away with to save money. Even if there are lots of patients going to the doctor for company, that isn’t what costs the big bucks. (I go every six weeks to get my INR checked, which is pretty cheap. I’ve never seen people there on a social call.)
I paid a lot into Medicare when I was working. I have no problem at all with people who paid less having the same benefits I do.
If so, what’s wrong with that, under an insurance model?
I would think that for most people, their largest claims under their car insurance come after they’ve been in a major car accident.
Their largest claims under their house insurance come after a house fire or similar major disaster.
An insurance model assumes that there will be large claims at some point. In the case of health insurance, that large claim will come when the person is experiencing a major threat to their health, that may end up killing them.
If they’ve paid premiums, why shouldn’t they be able to make large claims?
Let’s say it’s true that we know some large percentage of all medicare funding is spent during the patients’ final year of life.
Let’s further say that we agree that this is not a good investment, and that this money is better spent improving the health of people who have a greater part of their lives ahead of them.
And let’s say, for the sake of argument, that we somehow know the cutoff date when someone has a year left to live, and will no longer receive state-funded medical care.
Without that support, many of these people will be unable to afford much care of their own, and the quantity and quality of their medical treatment will be significantly reduced after that cutoff date.
But then, doesn’t it stand to reason that without adequate care, those people’s health will decline, and they are likely to die more quickly than they would if they had continued to receive medical treatment? Thus, logically, we must set the cutoff date earlier to take that into consideration, and their supported care will be eliminated sooner.
Yet, again, with no medical support, quality of health will be impacted, and lifespan will decrease, and the date needs to be moved a bit forward again. And so on.
Ultimately, then, once we have some certainty that termination of supported medical care as of a specific date will lead to the death of the individual within one year, aren’t we effectively admitting that, health-wise, this person is a lost cause after that date? Why, then, fund that person’s medical care up to the one-year cutoff, knowing they’re hurtling toward their final rest? Why not eighteen months? Or two years? How much productivity is someone likely to contribute during their final years of failing health before their death? This looks like a real opportunity to me!
Or, alternatively, instead of wrestlng with an insoluble logical quandary, we can just admit that it’s a dumb premise on which to base an argument, and abandon it, never to be brought up again.
And this is why the anti-UHC people are claiming their are either will be or should be Death Panels who decide when they are going to cut up your insurance card.
I readily admit that my opinion is based primarily on my personal opinion that too many people live too long, combined with my opinion that too many wealthy people do not “pay their fair share.”
Unfortunately, likely not to be the most offensive prejudice I hold. Not much I can do other than choose not to do so myself. Will be interesting to see if I feel the same when I become increasingly decrepit.
You’d rather they go underground?