- downvotes from Americans who do can't tolerate critics
Medicaid is not "free" there are requirements, but assuming you qualify, there are hidden costs. Like for example.
> The DRA created a five-year "look-back period." That means that any transfers without fair market value (gifts of any kind) made by the Medicaid applicant during the preceding five years are penalizable.The penalty is determined by dividing the average monthly cost of nursing home care in the area or State into the amount of assets gifted. Therefore, if a person gifted $60,000 and the average monthly cost of a nursing home was $6,000, one would divide $6000 into $60,000 and come up with 10. 10 represents the number of months the applicant would not be eligible for medicaid.
Maybe it's me as Italian that am a simpleton, but for me that's a cost.
If someone parents here get treated in a hospital, they are treated freely.
If after 4 years they want to gift their children with a few thousand euros to pay, for example, for their marriage, they don't have to worry about it.
Worrying has a cost.
The incentive of the Medicaid system is to lie about the real entity of the assets one possess.
> Medicaid is not "free" there are requirements, but assuming you qualify, there are hidden costs. Like for example.
Totally different program (medicaid nursing home care) and not relevant because (1) it isn't medical care and (2) someone who has assets to draw down from is, by definition, not poor.
> If after 4 years they want to gift their children with a few thousand euros to pay, for example, for their marriage, they don't have to worry about it.
This isn't a realistic scenario (at least in theory). Medicaid nursing home eligibility is evaluated on a case by case basis and penalties are only incurred if the Medicaid applicant's intent is to defraud the government (i.e. you can't give away your money for the sole purpose of acquiring government benefits).
> someone who has assets to draw down from is, by definition, not poor.
So it is a paid program
Payed by your poverty.
If you end up inheriting money from a distant uncle, you have to pay back.
> you can't give away your money for the sole purpose of acquiring government benefits
That's understandable.
And it's only necessary because the country with the highest spending per capita on healthcare cannot agree that the only reason why they don't create a free universal healthcare system is not because it is economically unfeasible (if it is for Italy, it is for USA, I usually argue that USA could do a much better job than us), but because they fear that without the incentive to become rich and distance yourself from State benefits, the system would collapse.
It's only a cultural problem: nobody wants to rely on the State providing base services because nobody wants to think of themselves as "being poor" because only poor people use public services.
When you come from countries where public figures, politicians, presidents, Queens and Kings and even the Pope go to public hospitals, you can't imagine why it should be a bad thing.
> If you end up inheriting money from a distant uncle, you have to pay back.
If you inherit money from a distant uncle, your uncle is presumably no longer alive to utilize state provided long-term care and you don't have to pay anything back. You're trying to contrive a counterexample that simply isn't applicable.
It's not contrived to receive money from your family, it is in fact the most common way on this side of the ocean.
It is contrived to help the citizens of your country in needs and then ask for the money back!
My parents don't have to worry that in their 80s they would have to pay because one of their nephews was born with some condition or preterm.
They only have think about being good grandparents.
When I was born I was put in the incubator for 16 days and have been in hospital for 24 days total. how much would
that havee costed to my family?
My parents were nurses, they weren't completely poor so they surely had to pay for it, but not rich either.
Between me and my brother my mom stayed home, in payed sick leave, full salary, all expenses covered, for 36 months.
If they were in USA they'd have bankrupted or given up on having children.
My mom had a pre condition, she already had two miscarriages, I'm quite sure the insurance company would have used that notion to not pay.
Do you realise how ridiculous that system is?
What are the benefits of having such a system, when in the end USA life expectancy is only one year longer than China?
Look at this study.
If the system is so good, why USA ranks so badly?
(this is only one of many, all the international institutions, including WHO, agree that USA healthcare standards are lower than the average western standards and much worse than the highest western standards, despite how much money they pure into it)
> Then you wouldn't be inheriting anything in the legal sense of the word
First of all, the uncle could be Mexican or French.
Secondly, devolving one's inheritance to someone else is completely legal (at least in my country).
> The government here heavily subsidizes the healthcare plans of people near poverty
They are paying for the insurance, not for the healthcare!
I don't know why is so hard for Americans to understand the difference.
So instead of having a State run system to give the people the best healthcare possible, they use a large amount of money to pay private institutions and still have shitty health care[0], while also spending more than anybody else [1]
> When a senior is applying for long-term care Medicaid, whether that is for services in one’s home, an assisted living residence, or a nursing home, there is an asset (resource) limit. In order to be eligible for Medicaid, one cannot have assets greater than the limit. Medicaid’s look-back period is meant to prevent Medicaid applicants from giving away assets or selling them under fair market value in an attempt to meet Medicaid’s asset limit.
> There are low, published co-pays, similar to Italy.
You don't need to qualify, you just need to go tot the hospital.
> Ialy does not have universal long-term care for the elderly
That's not the exact picture though.
If you read the document you posted, it clearly says that
"Only 35% of the residential care beds available are public, whereas 43% belong to private not-for-profit institutions and 22% to private for-profit ones (Table 7). The number of elderly persons in institutional care is still relatively low by international standards, being 19.8 per 1,000 inhabitants aged 65 or older."
The key points are
- elderly care in Italy has always been in the hands of religious intitutions, that's what the 43% of private non profit institutions are. (and that is honestly an entirely different can of worms, but a can of worms nonetheless. I could talk about what opus dei does here it for hours ...)
- Italy is an old country, 25% of the population is >=65, most of them are in relatively good health conditions, as the study confirms.
- only 22% of the long term beds for elderly are private for profit, usually they are for richer people, who want to separate themselves from the rest of us.
- in total, on 15 million elderly, only less then 300k are hospitalized and only 60k of them are paying.
- the vast majority of the elders are taken care of at home, if they are not self sufficient, the State gives the family an allowance to take care of them.
- the problem here is the opposite: many try to trick the State into thinking they need monetary help faking disabilities they don have.
Not counting that elders in Italy have pensions, all of them, regardless of the amount of retirement savings (savings here are mandatory, a minimum of 23% of the salary, of course more savings mean higher pensions, but with zero savings people still get a - fairly low - pension) , payed directly by the State, adjusted for inflation, and that we spend around 15% of our GDP in pensions.
I can't speak for the entirety of the Europe but from my experience with certain countries in the EU, there is a pervasive culture of avoiding risk at all costs in favor of stability. The culture extends from the government to investors and even employees.
Government has no appetite for creative destruction and pushes policy favoring large incumbents over upstarts. Investors have no appetite for risk and only seek conservative investments. The best minds (that don't leave the EU) would rather work for large companies, schools, government, etc. than at smaller, riskier organizations that may not be around in a few years.
My family in Europe thought I was a loser and/or crazy for leaving a job as an adjunct professor to work at a 100-person startup. It makes no sense to us but it's understandable to someone who views landing a lifetime cushy bureaucratic job as the gold standard.
You don't even need to look as far as Canada to see what single payer healthcare implementation will look like in the US. Hospitals in the US that disproportionately serve populations on Medicaid/Medicare are notorious for their poor quality and consistent underfunding.
The US has universal healthcare. If you're poor or elderly, you have access government provided insurance. If you're near poverty, you have access to government healthcare subsidies. For everyone else, it's illegal to not participate in an insurance plan.
"for-profit medicine" is a gross mischaracterization of US insurance. Half of US healthcare expenditures come from the government and a significant portion the other half isn't even "for-profit" e.g. the largest private insurance provider in the US by far is literally a not-for-profit organization.
this is the general answer. Why is congress punting the "lawmaking" bureaucracy to the executive instead of it being under its own branch.
There are 2 possible reasons I see.
1) having to change the political leadership of it every 2 years (instead of 4) means it possibly wont be as effective.
2) as there is both a "lawmaking" and "enforcement" aspect to it, it makes sense for it to be under "one roof" so to speak, and it would probably be more problematic for the executive to cede that to congress than vice versa.
perhaps there are other reasons? and one can counter the above reasons?
1) Congressional leadership tends to change hands less often than presidential.
2) I'd argue that the two powers are separable. The subgroup writing the rules tends to be different from the one executing them. There's also nothing stopping these groups from consulting with one another.
is 1 really true? we have elections every 2 years for it. how many periods of time have we had no change in control of the senate or the house for 4 2 straight elections? what about fo 4 straight? vs how many times we've had dual term presidents? (serious, don't know the answer to that question, though i could probably look it up)
> is 1 really true? we have elections every 2 years for it. how many periods of time have we had no change in control of the senate or the house for 4 2 straight elections? what about fo 4 straight? vs how many times we've had dual term presidents? (serious, don't know the answer to that question, though i could probably look it up)
> Policy-wise, I would like to capital gains reform and strict responsibility for congress when making financial decisions (eg no more "borrowing" from SS/Medicare, pass a budget as required in the Constitution, etc).
I see this sentiment repeated often, but what does it mean exactly? The government has borrowed from SS, for example, since its inception in the 1930s. The entirety of SS assets are held in government debt and all efforts to diversify these assets have become politicized as "privatizing SS".
One could say that there should be an ammendment guaranteeing that congress can no longer borrow from funds earmarked for specific programs, or at least citizen entitlement programs.
What makes you think such an amendment would have enough support to pass? Prior attempts at Social Security reform which diverted as little as 15% of assets away from treasuries were incredibly unpopular.
What happens when the other country isn't willing to sell? Consider a war or other disaster e.g. in the months before the pandemic, China stopped the export of face masks and other PPE, resulting in shortages in hospitals around the world.
There at other manufacturing centers than China. I don't know why people keep it repeating this line. Where do you think China gets their things made? It SE Asian countries. And they're making in roads to Africa. That's what we should be doing. We have a president talking about shhole countries-- destroying international relations is gonna do a lot more damage in a war. We should be building diverse business relationships with competing economies.
Countries are virtually never 'unwilling to sell', and there are quite a few different countries out there.
PPE shortages in hospitals were because of unprecedented demand levels, not because China didn't continue to export it. A country is actually a lot more likely to have problems handling that kind of short term demand shock if it relies entirely on domestic manufacturing
If not - the politics is involved in selling decision making - then the US starts a sanctions war, as China example shows. It sells in the end, but after being economically punished.
> Amazon promoting its own brands isn't much different from a supermarket offering its own brand items. Apple isn't a monopoly in phones because of Android. And Google's search is so inherently tied to selling ads as a business model that separating them is a difficult argument -- plus search competitors are just a click away, as evidenced by how much Google pays Apple to be the default.
But these aren't the complaints being bade, at least not the ones in the lawsuits we know of so far. The Google lawsuit, for example, targets its practice of paying companies to make it the default search engine in order to maintain it's monopoly on search. It isn't seeking Google divest from its ad business.
That being said, there's no reason search can't be separated from the ad business.
> That being said, there's no reason search can't be separated from the ad business.
I’m not aware of a business model that would keep a search company in business if they didn’t offer ads to go with it. On top of that, offering the ability to companies to target their ads to highly relevant consumers is incredibly valuable to our economy.
It's very rare to have direct proof of the effect of an economic/regulatory intervention, but luckily, in this case, we do. We've had a decade a survey data that indicates exactly what the effect the ACA had on employer provided healthcare was.
Some relevant highlights:
* More than one-third of organizations now have increased out-of-pocket limits, in-network deductibles and/or participants’ share of premium costs in response to ACA. More than one in five organizations have increased copayments or coinsurance for primary care, increased participants’ share of prescription drug costs and/or increased the employee proportion of dependent coverage cost.
* The excise tax on high-cost group health plans (a.k.a. Cadillac tax) is considered the top ACA cost driver beyond 2015. Since 2011, a steadily increasing percentage of organizations has taken action to avoid triggering the excise tax — a trend likely to continue. More than one in ten organizations already have adopted changes to prevent them from triggering the tax, 21% are working on changes and 28% plan to act sometime prior to 2018. Only one-quarter said changes were not necessary either because they have no high-cost plans (23%) or because they plan to pay the tax (2%).
That being said, the year following the passage of the ACA saw a large anomalous spike in employer healthcare costs that wasn't present in Medicaid/Medicare. It's almost undeniable that this was due to the ACA.
That’s what happens when poorer people who tend to work for employers that don’t offer benefits such as health insurance start getting healthcare.
Someone has to pay for it, and it shows up as increased premiums/deductibles/employer share of premium, but in exchange, we get rid of pre existing condition exclusions, we get in network out of pocket maximums, and older people don’t get hit so hard because younger people have to subsidize their healthcare.
Growth in healthcare costs also slowed in the years after ACA was passed as the various provisions were phased in:
This isn't an argument over the merits of the ACA. Many of are fine with Universal Healthcare but not with deluding ourselves into thinking that it's a free lunch. It's a statement of fact intended to address the false premise that we don't know the causal effect of the ACA on various healthcare costs.
We know exactly what it was as we have direct evidence as to what actions employers took in response to it e.g. increased premiums, increased out of pocket minimums, reductions in coverage, etc. The result is that, pound for pound, the same healthcare is more expensive.
> Growth in healthcare costs also slowed in the years after ACA was passed as the various provisions were phased in:
This is unsupported by the chart. In fact, it shows the opposite: the largest decreases in healthcare spending growth occurred before the passage of the ACA. That aside, the parent comment is seeking the causal effect of the ACA on healthcare costs, not a low correlating trend.
65+ has Medicare. Health problems start in your 40s, and greatly accelerate in 50s. Most Americans have clogged arteries, diabetes, or hypertension and need treatment many years before getting to Medicare age.
> And that is a risk assessment lenders would need to make. This is how all debt works.
This is irrelevant as the federal government is the owner of nearly all student debt, which is how they are able to forgive them in the first place. Student loans were de-facto nationalized under Obamacare.
You don't, actually. Medicaid is a de-facto single payer system (with the caveat that it's funded by both federal and state governments).