Actuarial value and subsidy level is the core element of the coming fight on Medicare. The delivery mechanism through which that value is transferred is window dressing.
Andrew Sprung outlines what is at stake for Medicare:
what precisely is the Medicare guarantee?
At present, there’s a pretty specific answer: for 95% of seniors, the federal government will pay about 85% of the premiums for insurance that covers a bit more than 80% of the average user’s medical costs. That’s what traditional Medicare does right now, via Parts A, B and D, for those whose incomes are below $85,000 for a single person or $170,000 for a couple.
Put another way, the federal government pays a bit more than two thirds of the average senior’s total medical costs. Low income beneficiaries have all or part of their premiums and out-of-pocket costs paid by Medicaid, though a variety of programs. High income seniors pay higher shares of their premiums, with the percentage stepped up through several income brackets. …..
For 8.8 million current enrollees in the ACA marketplace (as of June
3130), subsidies cover an average of 73% of the premium for plans with a weighted average actuarial value of 80% (surprise!– thanks to Cost Sharing Reduction (CSR) subsidies, the average AV of plans sold in the marketplace is really that high). On average, then, the ACA marketplace covers about 58% of enrollees’ costs — though that average is very uneven, ranging from over 90% for the lowest-income enrollees to close to zero for the barely subsidy-eligible (and zero for the subsidy-ineligible)*. For another 12 million people whom the ACA rendered eligible for Medicaid, federal and state government cover close to 100% of costs….Under the charitable assumptions that a typical EPFA(HR2300) subsidy would cover 59% of the premium for a plan with a 60% actuarial value, the premium subsidy would cover 35% of the average enrollee’s medical costs — regardless of whether her income were $17,000 or $17 million.
That is the the essence of the upcoming healthcare fights. Everything else is window dressing or mechanics to shift blame for large benefit cuts.
Neldob
Thanks for your consistently clear and pertinent info. I have called Calvert’s (R CA-42) office twice about the Ryan Plan and still haven’t heard where he stands.
rikyrah
Yes. Thanks for breaking it down.
Inmourning
Richard, do you know what percentage (if any) of the funding from the federal government for Medicare comes from the payroll (FICA) taxes (or self-employment taxes) people have paid over the years? Thanks.
Richard Mayhew
@Inmourning: Roughly a third of a current average Medicare beneficiary’s federal subsidy is covered by their lifetime payroll tax contribution. The rest is made up of the current working generation getting taxed (which I’m fine with)
Jeffro
Somewhat related (so we’d best be prepared when we see this kind of crap headline in regards to Medicare): did you guys know that Americans Are Divided On Obamacare?
Not that half of America wants it left alone OR EXPANDED, and only a quarter of America wants it repealed…we’re “divided”.
FU CNN.
Inmourning
Thank you. I am old enough to remember life before Medicare. My grandmother lived with us, and my mother paid her medical bills until Medicare was enacted. So, the younger generation helping fund the older generation’s health care is not new. From my perspective, one of Medicare’s benefits is its bargaining power. All insurers do this, but if I had to pay the full cost of my RA treatment monthly, I would deplete my retirement savings pretty rapidly.
WereBear
@Richard Mayhew: Exactly the point I try to make with people:
It is our money! They are trying to steal OUR money!
Baud
@Inmourning:
Probably the way to fight back. Tell all those white, middle class Trump voters that their savings are going to be eaten up taking care of their parents.
Inmourning
Baud. Good idea, when I get to the point where I can talk to a Trump voter. Right now, I am too angry and depressed.
Mike E
@Jeffro:
A ‘Friedman Unit’ is exactly how they sucker you in to their shitshow… just a few moar months and they’ll get the coverage right! Heh.
gogol's wife
Next time I get my hair cut, I’m going to say to the woman who screamed at me about Hillary Clinton having BLM at her convention but has now completely dropped the subject, “So how do you and your husband [who has multiple health problems] plan to pay for your health care once Trump gets rid of Medicare?”
Baud
@Inmourning: Yes that was advice for others. I don’t talk to these people. I barely talk to people I like and respect.
Juice Box
@Inmourning: Actually, part of the problem is that Medicare is specifically prevented from bargaining for drugs. If Medicare could get the same drug prices that the VA gets, a lot of the pressure would be removed from Medicare.
I live in California, so there’s no point in pressuring my Senators. I’ve outsourced my anti-privitization campaign to my parents in Arizona. I suspect that Arizona’s senators may get a few complaints from seniors.
Another Scott
@Richard Mayhew: How do we fight the “common sense” that if a person’s individual contribution only covers 1/3 of their lifetime costs then the system isn’t “sustainable”? (Similarly with the “OMG! Only 2 people will be paying FICA for each retiree soon!!”) Obviously, the people who came up with these systems understood changing demographics and understood the magic of economic growth (the economy doubling or tripling over a lifetime means that more money is available to pay for retirement expenses). But too much of our “discourse” (such as it is) is constrained by “common sense” that tries to relate the national economy to a family budget (I wanted to strangle Obama when he talked that way).
Families don’t go bankrupt when they take out a 30 year mortgage. Neither does SS/Medicare.
Until we can find a way to break this meme that “Medicare/Social Security are going broke” then it will be very hard to protect them. Dean Baker at CEPR tries to fight back against these stupid memes, but he has far too little visibility.
Similarly, the meme that any tax increase on the 1% is exactly the same as a tax increase on someone making $25k a year. Crap like this is going to kill us all.
Any ideas?
Thanks.
Cheers,
Scott.
Yoda Dog
CNN, NYT, NPR are not our friends. I don’t know why we even bother complaining anymore, we damned well shouldn’t be surprised by their bullshit. I, for one, am done with all of their “news.” They fit quite nicely into my Fuck-You-Forever file with all the other enablers.
O. Felix Culpa
Good morning, Richard. For your records, Senator Tom Udall (D-NM) has come out firmly in support of Medicare and against privatization. Here are excerpts from an email his office sent a week ago:
ETA: In case anyone is interested, here’s the link to his petition: http://bit.ly/2gbp9EV, followed by a donation request of course.
What Have the Romans Ever Done for Us?
I said this on the thread below but Medicare voucherization creates an incentive for everyone who has the means to save to save as much as they possibly can against an old age catastrophic medical problem, which will occur with a near certainty. Cancer, heart problems (even the minimally invasive procedures are probably tens of thousands of dollars), etc. If that stuff isn’t covered by Medicare to the hilt anymore, well, you have to pay for it with your savings or die. This is one reason the Chinese save to the extent they do – they no longer have universal health care (despite being “communist”) so they have to pay for ma and pa’s (or their own) old age health care – that means saving a massive nest egg. If people start doing that, consumption drops and we’re back in recession, fast. They’re jeopardizing economic growth with this scheme, but I doubt they know that.
MomSense
Speaking of the ACA, my oldest signed up for his plan last night. He chose the most expensive silver because it has a better vision plan and because ER visits are less expensive. $25 per month, $250 deductible and $500 out of pocket max. In his world of student loan debt and expensive housing he told me that the ACA is the best institutional support he has so of course the Republicans want to kill it.
TS
@What Have the Romans Ever Done for Us?:
There are so many things they don’t know – and hearing about the people Trump intends to appoint to run the government, they don’t know what they don’t know. They also don’t know what they do know & there is nothing they know that is useful for the jobs they are accepting. They don’t even know enough to decline the positions.
I am using this lack of knowing to reduce my panic attacks. It will be a crashed economy and/or WWIII but sooner, rather than later, this administration will collapse.
Botsplainer
@Baud:
Most states have statutes mandating financial support of financially fragile parents, regardless of whether the parents were abusive dickbags, monetarily irresponsible, drunks, gamblers, neglectful or just plain evil. In my jurisdiction, they would be handled in family court and are very likely categorized as domestic support obligations at bankruptcy law, thereby becoming nondischargeable.
I was putzing around one day, trying to see if our statute had ever been ruled on in terms of constitutionality, but came up blank.
We may be up for a real legal workout if Medicare gets hammered. I have great commercials in mind – various ’60s – ’80s parental lifestyle and kid interaction scenes, followed by a phone call to beleaguered parents arriving home to a shabby home after work at 7 to face a parental call that “the check is late”, and “I’m getting calls from debt collectors while you’re supposed to be handling this”.
raven
@Yoda Dog: ” don’t know why we even bother complaining anymore”
no shit
Botsplainer
@What Have the Romans Ever Done for Us?:
Recessions are a feature, not a bug, for conservatism. Economic instability and the wreckage of lives creates profit opportunity for the Masters.
WereBear
I doubt they care.
OzarkHillbilly
@TS: The main flaw in their thinking is that what is good for business, is good for the economy. That has always been their blind spot.
MomSense
@Botsplainer:
I was thinking about the ads we can run. Remember the kitchen table sitting couple that killed ClintonCare? I think we should run ads with a “sandwich generation” couple sitting at their table trying to figure out which bedroom to give grandma and grandpa while their teenage daughter complains at them that she is not giving up her bedroom. Keep going from there.
Botsplainer
@OzarkHillbilly:
Nobody thinks more than 10 minutes into the future in the business world. All about short term nonsense.
OzarkHillbilly
@MomSense: I was thinking of an ad with an old man sitting at his kitchen table going through a never ending pile of medical bills. No words, just the sound of him leafing thru them, one after another after another after another… And then he picks up a picture of a son or daughter and his grandchildren, fade out….
Single gun shot.
O. Felix Culpa
@OzarkHillbilly: That ad would have impact. Reminiscent of LBJ’s anti-Goldwater “Daisy” commercial.
Including the raven-mandated: Fuck LBJ.
D58826
From the article explaining why it might take up to 3 years to replace after the repeal of Obamacare.
I have a simple solution
1. rename it Reagancare in honor of St Ronuluis the Unready
2. fix the flaws.
http://www.thedailybeast.com/cheats/2016/12/01/gop-may-stall-aca-replacement-for-years.html?via=desktop&source=copyurl
raven
@O. Felix Culpa: thank you, thank you very much. . .
Botsplainer
OT – I hate emotionally invested and emphatic social workers. Sitting in a conference room awaiting my turn in an unrelated case, and this self-important twit is giving me the mental equivalent of a nasty gut flu with everything flying out both ends.
MomSense
@OzarkHillbilly:
I think a lot of seniors would stop taking their meds or save up their meds to take them all at once.
This seems insane to be at a point in our economy where we are finally making progress on employment and increasing wages only to decide to throw all of this uncertainty and fear into the economy. It’s almost like they are trying to cause a panic/recession. Hmmmm.
D58826
In another interview, which I can’t find at the moment, Graham explained why the young/healthy have to be part of the system to cover the costs of the sick, i.e the basic principle of insurance. He also talked about what a new plan has to have that sounds a lot like the mandate and the three legged stool.
Botsplainer
@MomSense:
My list of comfy, pasty, puffy people to summarily deal with when the Revolution finally arrives is long. Many will be surprised, and will tout their appearances at charity fundraisers as they plead to be spared the wall…
D58826
@MomSense:
feature not a bug
Jeffro
@O. Felix Culpa: This is excellent (seriously): it clearly points out that they’re out to “destroy Medicare” and that “Medicare benefits are not handouts”. LOVE. IT.
Go for it, GOP – we’ll gladly take your assistance in knitting the Dems back together and firing up seniors too
Jeffro
@Jeffro: Btw folks – one easy talking point to come out of these Obamacare poll results: more Americans want Obamacare expanded than want it repealed.
Hmm…government run for the few, not the many…it’s almost a theme with these guys…
Josie
@Botsplainer:
They do all seem to have a certain look about them, don’t they?
MomSense
@D58826:
We haven’t discussed the OPEC news yet. Harbinger of good times, that is.
liberal
Completely wrong. How could you possibly construct a reasonable insurance market for those 65+ in age? Ridiculous.
O. Felix Culpa
@Jeffro: The Chicago Tribune’s (not a liberal newspaper) headline on presumably the same Obamacare poll:
Framing is everything and our media overlords know it. Interestingly, now that they stand to lose Obamacare, “Just a quarter of Americans say they wanted to scrap the law, down from nearly a third in October.” Wankers.
ETA: Elections have consequences. Did we learn nothing from 2000? (Stupid rhetorical question, I know.)
bemused
@gogol’s wife:
I like that a lot. Please report back if you get the chance to do this. Love to hear woman’s answer if she has one.
otoh, if the woman who screamed at you is your hair cutter, I wouldn’t ask the question until your hair cut was finished. You could end up with a buzz cut.
Iowa Old Lady
@O. Felix Culpa: That’s a really fast drop in people wanting it repealed. What do we make of that? Is it just that the question was framed differently? Has Obamacare been gradually growing on people and we’re just seeing it now? That wouldn’t account for that sudden drop though.
Woodrowfan
@bemused: A classic “Calvin and Hobbes”
https://dashinoita.files.wordpress.com/2009/06/calvin-and-hobbes-comic2.gif?w=595
Botsplainer
@Josie:
The physical archetypes are Limbaugh, Gingrich, Norquist, Levin….
Ruckus
@Another Scott:
A little gem in your comment.
Common Sense.
A professor of mine once said, “If common sense was, more people would have some.”
O. Felix Culpa
@Iowa Old Lady: Good questions. The article mentioned this was the most extensive recent poll on Obamacare, but I don’t know the factors driving the change. My uninformed speculation is that buyer’s remorse is a part of it. The prospect of losing something makes the heart grow fonder, as they say.
bemused
@Woodrowfan:
lol, exactly.
O. Felix Culpa
@Botsplainer:
Gaaaahhh! The archetypal stuff of nightmares.
low-tech cyclist
I worry that Medicaid is going to get lost in the shuffle here, even in a successful fight to save Medicare and Obamacare. And there are a few important reasons why it needs to be maintained.
For one thing, all those Republicans want poor people to get a job. But poor people typically have more health problems than well-off people. And it’s a lot harder to get and hold onto a crap job if your health is an impediment. The Republican solution to poor people with health problems seems to be ‘work until your body breaks down, then go out into the street and die.’
For another, Medicare only pays for a limited number of days of nursing home care. If your granny is no longer able to take care of herself, and has gotten to the point where you can’t take care of her either, then Medicaid is what will pick up the bills when she has to spend the rest of her life in a nursing facility.
And these are bills that would bankrupt even affluent folks like my wife (whose 92 year old granny with severe dementia has been in a nursing home for nearly 4 years now) and me within a few years, and would bankrupt most working-class folks in a matter of months if not weeks.
Jeffro
@O. Felix Culpa: Glad to see that Trib headline – nice! Once people figure out there’s no way to keep the pre-existing condition coverage without most everything else about Obamacare, Ryan and Co will likely be dead in the water on this. They may lighten the taxes on higher-end incomes (that help fund Obamacare) and increase the cost of the exchange plans accordingly, because that’s what KochHeads do, but that’s about as far as they’ll get.
Maybe they could just rename it ReaganCare or RandCare or something that makes them feel all warm and fuzzy about it, declare victory, and go home.
satby
@gogol’s wife: Why on earth would you bother going back to her and patronizing her business. There are other salons. No way she’s the only person in town to cut hair.
satby
@O. Felix Culpa: I think it’s because enough people have now been exposed to how it’s working via family or friends who otherwise wouldn’t have insurance at all.
O. Felix Culpa
@Jeffro:
Even though Obama deserves hard-earned credit, I’d be ok with that solution. After all, what’s in a name?
O. Felix Culpa
@satby: Yup. Good point. With 20 million people now insured under Obamacare, there can’t be very many degrees of separation.
ETA: Edited for clarity.
Another Scott
@low-tech cyclist: It’s hard to imagine the “Medicaid pays after Granny spends down all her money” feature going away. There are far, far too many people who worry about such things, and far too many middle-class people who benefit. There would be pitchforks in the streets.
That may be the thing that saves Medicaid…
Cheers,
Scott.
fuckwit
@OzarkHillbilly: That was my retirement plan for most of my life. It may be yet again.
germy
ArchTeryx
@fuckwit: Mine too, and my “retirement” may come way, way before I hit Medicare age.
Jeffro
@O. Felix Culpa:
I still think this is half the reason right-wingers are so berserk about “Obamacare”. If all parties had agreed to call it the “Affordable Care Act” (or “Afford-A-Care” from start to finish, no one but Paul Ryan and Charles Koch would have ever given a shit about the whole thing.
Mayur
Jeffro: the right wingers are the ones who came up with the name.
MomSense
So Putin, Khameini and a Saudi Prince got the new OPEC deal through.
So much winning you’re going to get tired of winning. Yup I think I’m going to tire of winning very quickly.
hovercraft
@Jeffro:
Obama and the democrats tried initially to call it the Affordable Care Act, it was the republicans in their infinite wisdom who dubbed it Obamacare, thereby rendering it something that must be destroyed. Once they did that, they were in a box, they couldn’t not oppose it, and Obama made sure they stayed in the box by embracing the sobriquet. Now they are all over the place, they have the power to repeal it, but are afraid of the consequences. I think they may be giving people too much credit, after all they just voted for a shitgibbon who told them up was down and down was up, why would they doubt their ability to sell them another con?
D58826
Hmmmm. Der Fuhrer cut some kind of deal with Carrier to save maybe 1k jobs. Carrier is a subsidiary of United Technologies.
In the meantime the F35 flying turkey continues to run up huge bills. The engines are made by Pratt-Whitney, which just happens to be a subsidiary of, drum roll please, United Technologies.
is Quid pro Quo Latin for co-incidence?
trollhattan
@MomSense:
Exxon profit train is revved up and ready to roll. Winning!
gvg
@Jeffro: Definitely not. It was the right wing that named it that, with the purpose of dragging down Obama’s reputation. Its official name is the Affordable Care Act. I would deduce that they were sure it would fail so badly that it would cause harm to his reputation. They were wrong about that. I also think a lot of it is they simply hate democrats beyond reason so they think everyone does and therefore anything associated with him must be awful. There has certainly been a lot of racism associated with these 8 years but I recall the Bill Clinton hate was nearly as bad. I saw an impeach Clinton home made billboard the day after Bill’s election, before inaugeration. I did not understand it then. They went after Gore and Kerry with an irrational fury. Its true, the democrats tend to protect minorities, but the republican hate attitude has gone beyond that. They hate democrats especially our leaders.
liberal
@OzarkHillbilly: Great ad.
Not sure the Dems would run it, since they’re such pussies.
Also, sometimes stations won’t run ads if they think they’re unfair or biased (even if they’re not unfair or biased).
I had an idea for an ad, that if they voucherize Medicare, we run ads in battleground states thanking people who voted for Trump and/or Republican Congressmen for getting rid of “Medicare as we know it.”
liberal
@gvg: Yes, but I think the hate is partly an effort by those at the top to delegitimize any Democratic office holder. They start putting out the propaganda, and it’s picked up by the idiots at the bottom, who eat it up.
Another Scott
@trollhattan: Higher oil prices will lead to more US production in the shale belts which will cause prices to fall again. OPEC and Russia don’t have a way to control this. Putin needs money (the Ruble has been decimated on his watch), Iran needs money, Iraq needs money, Venezuela needs money, … There will be increasing pressure within OPEC to cheat on the quotas due to increased population in these developing countries if nothing else.
Don’t panic just yet.
Cheers,
Scott.
liberal
@Another Scott: Someone has to organize the crowd bearing the pitchforks.
Also, have you read the constant flow of feces coming from right-wingers? These people are unreachable. If Trump and lyin’ Ryan cancel Medicare/Medicaid as we know it, Fux Nooz will just not report on it. How would these shitstains even know it happened?
D58826
@Another Scott:
which will add some jobs to the region.
Botsplainer
@low-tech cyclist:
People are living longer and able to be a profit center for nursing homes because of Medicare.
My hateful, lazy, selfish old RWNJ hag of a maternal grandmother lived to be 98. She never worked a day for pay in her life, collected boatloads of cash from Social Security and cost 6 figures in Medicare bennies for all sorts of things related to her refusal to be physically active (she was tiny but ended up with hip replacements in her 90s while refusing to do physical therapy). If you asked her about welfare, though, she’d be against it while saying that “n*ggers are shiftless, lazy thieves”.
The Moar You Know
@liberal: Get with the times. The new source for all things conservative is CNN, soon to be renamed the Trump News Network.
It’s obviously been in the works for a while, the conversion of CNN into Fox On Steroids, but this election was their debutante party, if you will.
Richard Mayhew
@liberal: Medicare Advantage vs fee for service is the window dressing if they both end up paying 84%AV and 80% premiums
Citizen_X
@D58826:
Not so much; there are a lot of wells that were drilled at the end of the boom but not put into production. I.e. they were drilled before their leases (typically 3-year) ran out, tested, and capped. To be put into production you pretty much just have to uncork ’em and connect them to a tank.
They’re expected to put oil prices into a secondary slump, after they start rising again.
Iowa Old Lady
I think a lot of people don’t realize that while Medicare Part A (hospitalization) is free for everyone, Medicare Part B (doctor care) is not. You pay based on your income. It’s taken directly out of your social security.
Also as folks have already said here, it’s important to be clear that if you’re talking about long term care, even for people with thinks like Alzheimers, the person spends down what savings they have and then going on Medicaid, not Medicare. It’s easy to misspeak.
gogol's wife
@satby:
small town, long relationship, feel sorry for her
Brachiator
@gvg:
Since the Clinton era, the GOP has hit hard on the idea that they are the only legitimate political party in the United States. And for now, controlling the presidency and the Congress, they have achieved their goal, at least for the short term.
In addition, the racism directed at Obama has exceeded any opposition to Bill Clinton. A good chunk of Republican politicians, with the full support of their base, not only opposed Obama during his time in office, they also fed into the vile lies that he wasn’t the legitimate president.
They are taking deep pleasure in trying to undo everything that he achieved during his term, even if it hurts the country. In this they resemble the white racist Southerners who were so offended by the election of black officials during the Reconstruction era they did everything they could to undo their legislative achievements and to remove the record of their existence from history.
liberal
@Brachiator:
They couldn’t attack WJC’s race directly because he’s white.
But remember, they impeached Clinton.
Furthermore, I think “things are worse,” but that’s largely due to the progression of time, as the Republicans have become nuttier and nuttier. Though IMHO they were pretty much completely off the deep end by 1994 at the latest.
liberal
@The Moar You Know: Maybe. I never watch cable. All I’ve heard about CNN is that it’s for idiots more generally.
liberal
@Richard Mayhew: Meaningless outside of some infrastructure for providing risk pooling etc in the “old age” market. I’ve near heard anything about Ryan’s plan in the sense you describe it.
liberal
@Jeffro: I disagree. While you can debate the policy merits, a lot of people were pissed off that they were forced to purchase health insurance under the law.
I’m not necessarily sympathetic to them, but it’s one danger (political) about financing things like that through direct fees.
gogol's wife
@Brachiator:
Sad but true. I am deeply ashamed about how Obama has been treated and continues to be treated.
And to go from Obama to Trump — what a shonda.
Ragbatz
In the coming months or years, keep in mind Ted Kennedy’s decision to support Dubya’s Medicare initiatives. Kennedy felt that a foot in the door on prescription drug coverage was sufficiently better than nothing to outweigh the inevitable features of a Republican spending/taxing initiative: parsimony, regressivity, and new benefits for large corporations.
What seems likely to be the Trump-Price replacement for ACA has some of that familiar Republican flavor. A benefit level that approaches, and in some cases actually reaches, uselessness for those with low incomes. Regressive tax-shelters for those with income to spare (with bonus boost for HSA selling bankers). Then, there is the bait with which the Republicans will seek bi-partisan cover: a something-is-better-than-nothing level of premium support, set just high enough to be an attraction to people at a middle income level.
It is matters beyond benefit design, however, that set apart the choice on ACA replacement from that faced by Dubya-era Democrats seeking to establish the principle of Medicare drug coverage. As part of the policy price of getting a foot in the drug coverage door Republicans extracted enhanced subsidies for Medicare Advantage plans and a big role in drug coverage for private insurers. Bad enough, one might argue.
In the Trump-Price era, on the other hand, in order to keep alive the barest semblance of national support of health insurance for all, Democrats will be asked to sign off on a host of even worse Tom Price ideas. (Top of the list: wholesale deregulation of health insurance markets, in the guise of selling insurance across state lines.)
I’m quite sure Ted Kennedy wouldn’t be buying this.
The Moar You Know
@Botsplainer: Thank you, thank you, thank you for posting this. I did not know. It’s going to change some plans that my wife and I have pretty drastically; we have an abusive and indigent family member who will come after us for money that we don’t have, and our state does permit those suits. So we will be leaving the state we were both born in and move someplace else that doesn’t allow that shit.
Elie
@Another Scott:
All those nursing home institutional providers are big employers also as well as purchasers of medical supplies and pharmaceuticals. That money floats a lot of boats and those have economic impacts deep into communities.
D58826
@liberal: In an interview, that I can’t find the link for, Lindsey Graham said for health insurance to work there has to be a mechanism to get healthy people into the pool to off set the sick people. He didn’t use the M word but that is what he was talking about.
Keith P.
Got to say I’m pretty nervous about Medicare privatization. I’m on dialysis, so I am on Part B. For about $100/month, I get dialysis treatment (regular Medicare covers my hospitalization). If I’m out of work and am late with a payment, it’s not the end of the world, unlike COBRA, and $100/month is great. I had private insurance but was required to go onto Medicare after 3 years (I now carry a basic group policy as supplemental) I’m trying to envision what differences I can look forward to under a privatized Medicare system. EVERYONE at my clinic is on Medicare as well, so I’m wondering what happens to those who do not also work. I am fortunate enough to be able to work from home, but I can easily envision a point where I couldn’t and have to do onto full disability, but would that (or any Social Security benefit) plus voucher even cover an adequate plan?
Brachiator
@Richard Mayhew: Thanks for this useful summary on Medicare and the ACA. I know I will refer to it often.
Betsy
@Baud: What? No one under 50 has any savings!
Betsy
@Botsplainer: They do?! I’m sorry, I’ve never heard of that, but I don’t practice elder law. Can you name a couple of states where this is the case? Is is a statutory obligation against adult children generally, or are you talking more about qualifying for benefits (hinging on first-degree relatives’ wherewithal, for example.)
Betsy
@gogol’s wife: She’s counting on Democrats to preserve some semblance of a social safety net, of course. That’s what all white working-class people do, whether they vote right-wing or otherwise.
Richard Mayhew
@Betsy: Pretty sure Pennsylvania has family responsibility laws
http://triblive.com/news/valleynewsdispatch/9757033-74/law-nursing-support
http://www.paelderlaw.com/law-can-require-children-to-pay-support-for-aging-parents/
hovercraft
@Richard Mayhew:
Please may we have a fresh open thread?
ruckus
@fuckwit:
Had a HD buddy whose idea was to drive off a mountain road at high speed. He took the easy way out though, he overdosed on something illegal. 25 yrs ago.
Another Scott
@Richard Mayhew: The details may matter a lot. Ohio filial laws:
FWIW.
Cheers,
Scott.
D58826
New CW from the pundits:
1. GOP repeals Obamacare effective two years from now
2. GOP can’t come up and/or pass a replacement plan
3. to prevent going over the cliff democrats must be the adults in the room and help pass the GOP plan
4, if they don’t help then it’s the fault of the democrats
If this sounds familiar think debt ceiling and sequester.
I guess what I find frustrating about all of the ‘what should the democrats do’ articles is that what ever they do they get no credit for the upside but blamed for the downside. 74 months of job growth, 800k new manufacturing jobs, save the auto industry w/o getting any credit but Carrier moving to Mexico is the fault of Obama/Clinton until der Fuhrur rides to the rescue to save 1k jobs (with a bit of taxpayer money) .
MomSense
@Another Scott:
Once the federal Medicaid laws are repealed–problem solved (for the long term care facilities).
The Moar You Know
@Betsy: Alaska, Arkansas,
California, Connecticut, Delaware, Georgia, Indiana, Iowa,
Kentucky, Louisiana, Maryland, Massachusetts, Mississippi, Montana,
Nevada, New Jersey, North Carolina, North Dakota,
Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota,
Tennessee, Utah, Vermont, Virginia, and West Virginia.
Depends on the state. I know in CA this has been interpreted as a general obligation. It’s very rarely used. That will change with the voucherization of Medicare.
My wife and I are going to need to talk with a CA attorney about this ASAP. We have a parent that will happily and deliberately bankrupt us and need to protect what little assets we have, and sadly, I expect that means moving.
Betsy
@The Moar You Know: OK, wow. You learn something new every day.
Botsplainer, Cryptofascist Tool of the Oppressor Class
@Betsy:
Lots of articles out there, but here is Kentucky’s statute:
I think filial nonsupport is ripe for a constitutional challenge, but not with a conservative stacked judiciary.
Conservatism is all about enhancing pain.
Another Scott
@MomSense: Yeah, if they really do mess with Medicaid this way, then there will be lots and lots of pain and lots and lots of other consequences.
:-(
Cheers,
Scott.
What Have the Romans Ever Done for Us?
@TS:We can hope they fail spectacularly and very quickly. I could see that happening. My fear is the economy stays just good enough just long enough to give Trump a shot at re-election but there will probably be other fiascoes unrelated to the economy that bring him down anyway.
@Botsplainer: @WereBear: They may not care about the damage they cause but I think they care about the response of the electorate to another Republican built recession. A crappy economy is bad for winning elections if you’re in charge. Yeah, Obama overcame that issue but Trump has no where near the political talent Obama has.
Miss Bianca
@MomSense: Teenage daughter: “It’s not fair! *I* didn’t vote for Donald Trump! *You* did! *You* give up your bedroom!”
kc
wut
Keith P.
I was explaining the concept of Obamacare (mandate + pre-existing condition conundrum) to some anti-Obama friends. The general notion is that for pre-existing conditions to be coverable, the pool needs to be loaded with healthy people, so you mandate everyone has insurance. What would be the consequences of adopting something more akin to the private system (some of them, at least) where you can join a group when you get a job, but you have something like 6 months probationary where a pre-existing condition wouldn’t be covered, but after that, you’re good? I know it leaves some gaps, but I would the issue there would be something like a cancer patient having 6 months of chemo bills rather than an indeterminate amount. would this keep providers in the black, and would it still avoid a health crisis? Is it even a better alternative than the pre-ACA way (I think so)?
MomSense
@Miss Bianca:
Exactly. I can totally see that scene.
StringOnAStick
@The Moar You Know: Here is a link to an article about requiring adult children to pay for their elderly parents care cost: Elder law. It contains a link to a list of which states have those laws on the books.
Question for our legal types: does it matter if you live in a state that does require support from the kids for elderly parents and the parents live in a state that doesn’t? Or vice versa?
Betsy
@Botsplainer, Cryptofascist Tool of the Oppressor Class: “I think filial support is ripe for a constitutional challenge”– boy, I’ll say.
“Conservatism is all about causing pain.” This has a lot of explanatory value. I like to ask conservatives: Why do you hate America?
Because the Swiss (for example) would never do these things to another Swiss. “We’re Swiss, by God! We deserve the best!”
invhand
@Keith P.:
Well Keith, 6 months of chemo bills can run $100K, easy. If you do not have the $100K why should I, a health care provider, assume you are good for it? How, ethically, can the government compel me to devote my time and treasure to someone who will a) be dead if they do not respond to treatment or b) be broke (and often unemployed) if they do? So the problem isn’t just financing treatment (on this Mr. Mayhew and I disagree), it is access to treatment.
Barriers that look small to those with means may effectively exclude people without means. This is the point of a lot of Republican reform, to preserve public programs for those above a certain socioeconomic threshold while preventing uptake from those below the threshold. The question for people like me who thinks that government programs should provide benefits to the poor is, “Why have the program at all?” Just get rid of Medicare. We have Medicaid for the poor, if your not poor, pay for your own damn healthcare or die. Why is it any concern of mine?
Ken Houghton
@gogol’s wife: Do that =after= she finishes cutting your hair.
Either that, or you have to post the results.