What about seniors who have no inheritance, or little inheritance, that can be taxed to provide this Medicare health care? And I agree with the posters saying that people who have been paying taxes into Medicare their whole lives, have in a certain sense already paid for what they’re getting.
One would be mistaken. Paying into it is not the same as actually paying for it. The amounts paid into Medicare are significantly lower than the amounts paid out of it (e.g., here). For that matter, about 40% of Medicare funding— mainly parts B and D— receive significant money from the general fund, i.e., from sources not part of Medicare taxes or its trust (e.g., here). The program is not at all self-sustaining.
The last month of my husband’s life, on palliative care, cost $60,000. That was strictly comfort care measures, in a standard hospital room (he could no longer be managed at home, or even at a nursing home) and not intensive care.
Two months of that would put you into the six digits. Hell, a hospital room runs around $1,000 a day, nevermind medications, various bits of equipment, procedures needed for “comfort care” to try to relieve pain and suffering.
Where in the hell do you get the notion that hospice would never run into “hundreds of thousands”?
Have you actually ever looked into costs?
“Palliative care” isn’t simply dumping someone into a corner and giving them an occasional morphine pill.
Why don’t you just suggest issuing a gun and bullet to the elderly and ill to “save costs”? Isn’t that where you’re headed? How dare sick and/or dying people demand humane care! It might cost the taxpayers money!
If nothing else, I think this thread may have been a lesson to me as to why we are unlikely to see any reasonable, intelligently tailored revision to our health care.
I thought my limited proposal was very straightforward, and very easy to communicate. And I tried to do so openly, with as little “spin” as possible. Yet I was apparently unable to do so successfully to this board which, IMO, tends more intelligent/educated than the general public.
I thought my proposal targeted a narrow slice of Medicare recipients - those who received the most expensive end-of-life care AND had sufficient assets to leave an estate. But my modest proposal faced strong opposition from various sources.
I can imagine why interested parties would not even TRY to intelligently communicate their intentions and, rather than coming up with narrowly tailored policies, simply enact whatever serves their interests and the interests of their donors and voters.
For the record, I am as big a supporter for single payer universal health care as anyone. However, I strongly believe that there must be some sort of limits. Health care which is both universal AND unlimited, is unsustainable. If a system cannot dissuade moral hazard, then other controls on access and distribution must be implemented.
Thanks for all the input, folks. I’ll be stepping back from this conversation, but feel free to keep it on life support or let it die.
Then I guess I did understand you.
I pay Medicare, then I get sick and incur, say, $250K in hospital bills and then die. Then the government bills my estate for some or all of the $250K, because I leave an estate of more than $250K, or whatever the limit might be. I get that part.
It would be another factor to take into consideration when planning my estate. Maybe I buy extra insurance in case I incur the $250K in medical expenses, or maybe I set up a trust for my kids, or otherwise shield my assets so the government gets as little and my heirs as much of my estate as possible.
As usual, the devil is in the details of the proposal - what is the upper limit, if any, on estates that are subject to the extra tax, what effect would there be on assets held jointly, what are the loopholes so that I can transfer assets before I die or while I am dying, how do we decide what is “extra” expenses of dying over and above what other Medicare patients incur, etc.
We are currently going thru something like this. My dad is in failing health, although not in the hospital. He was a successful veterinarian, and my mom has not worked outside the home for sixty years. Her Social Security is negligible, and her worry is my dad has to exhaust half of everything they have, plus pay their Medical supplemental policy, plus the long-term care insurance my dad bought doesn’t cover half of a decent nursing home. She’s never going to be on the street, at least as long as I or my siblings can help it, but she is scared. Not just of losing her husband of 66 years, but half of everything she expected to live on, and then losing the rest when she gets sick and has to go into a nursing home.
Wouldn’t it be nice if the government just paid for everything? Sure, but often the idea is that the government pays for everything by taxing the rich, and my dad is “the rich” by pretty much any definition. But he won’t be “the rich” by the time he dies. Is that fair? Dunno.
Sorry if I came across as confrontational in my questions.
Regards,
Shodan
Sorry for your situation. Aging, declining parents/spouses are stressful no matter how you deal with it.
No, I actually don’t think the government ought to pay for everything. This gets to a major gripe I have with modern medicine. Just because some expensive treatment exists, doesn’t mean that it should be universally offered to everyone, and publicly subsidized. Of course, many folk will consider my position heartless. Some people are going to die sooner than they otherwise might.
I personally experienced my parents and my in-laws consuming health care in their final years with no thought as to the costs involved, while leaving some estate to their heirs (including me and my wife). Personally, I’m not sure that is a great system. Although both of my parents had ongoing conditions for which they were being treated (prostate and breast cancer, stroke, etc.), I was very fortunate that they died in their sleep, after being sentient and reasonably independent the day before.
IMO SOMETHING ought to be done to reduce the amount of care recommended for and consumed by the elderly as the near their end-of-life. As you suggest, my plan would likely be ineffectual because those most likely to be effected would be the most sophisticated WRT estate planning to avoid such costs.
And Broomstick, sorry for your loss. But the gun and bullet (or pills, booze, and plastic bag) are the route I hope to take should it get to that point.
What the tories proposed in the UK is already the law in the US. What this proposal does is expand that to cover end of life care and not just nursing home care. I don’t expect it would be popular but since it only applies to richer people it might be plausible.
Thank you. It’s bad for me, it’s bad for my siblings, it’s a hundred times worse for my mom, who is faced with the loss of her spouse of 65 years and the comfortable retirement my dad worked for his whole life. She put him thru school, she and my dad did everything “right” - paid their taxes, bought long-term care insurance, bought Medicare supplemental insurance, and then the recession took half of everything they had and now she is faced with losing half of what is left. And living alone for the first time since she was nineteen, and she’s 87.
Yes indeed, right down the line. You are exactly correct.
I’ve said it before, I’ll say it again. It does not matter if we have single payer or not - we need death panels and rationing, and a system that says “We are going to let people die in order to save money.”
But that’s not something my mother wants to hear, and I don’t know that I can blame her.
Regards,
Shodan
Sorry, but that was NOT my husband’s choice - he was adamant until the end, and by that I mean expressing his wishes a half an hour prior to his final breath, that if there had been a treatment that would restore him to health he would take it in a heartbeat. He very, very much wanted to live. Also as opposed to suicide as I am, if not more so.
My spouse was not receiving heroic care - indeed, I spent much of his last week fending off a doctor who was insisting we HAD to put him on dialysis, among other expensive and futile treatment - but rather just what was required to keep him comfortable as he died. I am not advocating pouring resources into hopeless cases, nor did I and my family do that for my parents or my husband. We spent considerable time and energy refusing treatment offered in their final days not because we were worried about money but because we didn’t want to prolong or add to the suffering of the dying, which is what a lot of heroic measures do. So while I agree with limiting care at the end of life, having practiced that myself, I do NOT advocate murdering the dying, encouraging them to murder themselves (although truly voluntary suicide under such circumstances is one of the few instances where I could tolerate it morally) or denying them the care needed to ease pain and suffering.
You opine that you did not explain yourself well and people did not understand you. That is not true. You were quite clear and eloquent and understandable. What you do not seem to grasp is that some of us very much disagree with your stance.
Also some of your costs estimates which, based on my own experience, is off base regarding palliative care.
And, as pointed out by Shodan, those most affected are also those most able to avoid being affected.
At some point the wealthy are just going to have to put on their big boy pants and pay their share of the taxes to run society, and also realize that it won’t necessarily be the wealthy deciding what’s “fair”.
How about we educate people better on what is and isn’t useful at the end of life? Like we stop recommending feeding tubes for people so near death they’ve lost the desire to eat. Or improve the home health situation so more people can die at home instead of working caretakers to the point they themselves collapse, with the dying person then ending up in the much more expensive nursing home or hospital. Just two examples.
Or, when cancer is terminal and there is nothing more curative we accept that, and by “we” I mean medical personnel as well as family (because many doctors and nurses deal poorly with death) and stop subjecting people to unjustifiable treatments. Several times in my husband’s last couple of months I had people trying to argue us into doing things that we had either already tried or were not indicated in his situation - not just random strangers but doctors who were so locked into the “Treat! Cure! Win!” mindset they were less able to accept impending death than me and mine.
I also think that if we did take the “can you afford medical care?” question out of the equation then people would be more willing to accept that nothing more can be done. Right now the poor worry that they’re not being properly treated because they’re poor and if they were rich they could live. If EVERYONE regardless of wealth had access to the same care that anxiety would be greatly diminished so when a doctor says “the chemo is no longer working, let’s stop it” patients and families will be more likely to trust that that is the case rather than fearing the money ran out and they’re being sentenced to death because they’re poor.
I grasp very well that people disagree with my proposal - and my values. But some posts impressed me as simply not understanding what I proposed, or simply wishing to offer their philosophy re: health care.
In your husband’s case, based on your past posts, I doubt he and you had a sizeable estate which would trigger my proposal. So what I suggest would have no impact on the care he received. And that’s great that he wanted to fight up to the end. Tho I generally would favor an earlier out for the endstage terminally ill, your husband’s $60k for 1 final month does not strike me as horribly inflated and unwarranted.
And great for you for refusing the Dr’s recommendation of dialysis. That is exactly the type of expensive, end-of-life care that I believe should be greatly restricted.
I favor higher taxes on the wealthy - and would happily consider myself among them with my low 6-figure income and low 7-figure net worth. But, as Shodan states, we need some form of rationing - at the beginning, throughout, and at the end of life. Simply saying the wealthy should be taxed more IMO underestimates the medical community’s insatiable appetite for cash.
My proposal didn’t address something I regularly encounter in my job, people who have never been employed and never will be, many whom have greatly contributed to their health conditions through personal choices, yet who onsume huge amounts of medical care. There are so many different ways that healthcare can be addressed. But SOMEONE will likely be disadvantaged by any change. I have little faith in our country coming up with a reasonable approach - at least not until countless unreasonable approaches have been tried and failed.
How about reducing the cost of care to the levels in the rest of the industrialized world?
At least we agree on that.
Despite my usual opposition to suicide as a general thing, which is quite strong, for terminally ill people I can accept it as an option so long as the system is very, very careful not to endorse or promote it. It has to be truly voluntary on the part of the patient and not the result of external pressures, with lots of safeguards. Likewise, for a limited set of incurable conditions where suffering can not be relieved it might also be a tolerated option
People who are educated and informed are likely to reject such technology on their own, which would make reducing unnecessary utilization.
$5.45M in 2016.
Thanks.
According to this cite, it raised $8.5B in 2012. In 2011 Medicare spent almost $550B. If we doubled or tripled the amount collected it wouldn’t make much of a difference.
Same problem as usual - we can’t fund the government, or at least the major parts of it, by taxing the wealthy. They don’t have enough money.
Regards,
Shodan
I don’t think Dinsdale suggested that this would resolve the problem of fully funding Medicare on its own.
What I said was “if we doubled or tripled the amount collected it wouldn’t make much of a difference.” Do you disagree?
Regards,
Shodan
Yes and no. It would make a $17bn reduction in the deficit, using your numbers. Granted, that’s not a large fraction of the Medicare budget, but it’s a lot of money. As one incremental step taken along with others, it seems like a good idea.
ETA: For what it’s worth, as God-Emperor I would reduce the estate tax exemption substantially so it would make more of a difference, but that’s another story.
I also think that, in addition to the $ saved/recouped, it would help advance the conversation regarding the costs of healthcare, and one’s choices as to how one consumes it.
Viewed in isolation, so much of modern medicine is remarkable. But just because a therapy exists, I do not understand how it is scalable - at least under the current system.
Sure, other folk have suggested alternative approaches such as controlling medical costs, or a single-payer system. I readily acknowledge that those would obviate the need for my proposal. And I hope we move in those directions. My proposal would not prevent such continued progress. I suggest it solely as a not-impossible, likely transitional step to address some portion of the issues regarding our healthcare system.
Dinsdale, I’m curious - why do you start with the premise that it would be a good thing to recoup healthcare costs from the individuals? Do you recommend that for any other government service?
Should there be a similar tax on the estates of wealthy individuals to cover their education that they received free? Or to recoup the cost of all those highways they used during their lifetime? Those are just as much “entitlements”.
If not, why do you think healthcare costs should be recouped?