[rebootthesystem]

Perhaps I am being too idealistic.

I believe that with the right leadership and a conversation with the nation we could converge on a system that was fair, took care of the needy and got government and insurance companies as we know them to day out of the system to the necessary degree.

I don't, for a moment, believe that we can get both government and insurance companies entirely out of the system in the US. In the first instance, government, you would not want to. Oversight and rules are important. In the second instance, insurance companies, there could be an argument of their need in absorbing some of the risk. Admittedly, not an easy problem.

What we have today, this hodge-podge of laws, agencies and programs is a complete disaster. This should be obvious and evident to anyone who takes the time to take a full dive into the absolute mess healthcare is in the US. The ACA did not fix anything, it made it worst, because it isn't a real solution.

I won't claim to have the solution. As I alluded above, this requires leadership that can bring forth a national-level conversation that, over a year or four, can converge on something that can deal with all issues equitably.

One angle is what I might term a to be a moral obligation: We have the moral obligation to take care of each other. What follows, then, is that we all contribute to a fund or a national health insurance policy of some sort that covers absolutely everyone with, perhaps, reasonable co-pay's to take some of the edge off. If one of us needs a million dollars of medical care he or she should be able to get it.

This should also come with some obligations. I think there's nothing wrong with the idea of requiring regular checkups of some sort. This is where it gets complicated. What do we do about people who destroy themselves through substance abuse. I don't know how we deal with that and other matters.

Anyhow, I think we can all agree that we ought to be able to do far, far better than this mess created by our politicians in playing sick partisan games with one of our most basic needs. And this has been true over at least the last 50 years, no political party is devoid of blood (almost literally) on their hands.

We truly need to take this up to a much higher intellectual level in order to converge on a good solution.

It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid. The reaction is evidence of the political polarization out there and the disconnect that exists with what politicians have done to our healthcare system. It's a mess and what we have isn't getting any better.

[maxerickson]

It is interesting to see the reaction had on HN when someone like me, who recognizes the emperor has no clothes, comes along to critique a very real problem with one of these programs, Medicaid.

The analysis in your heavily downvoted comment is blatantly wrong!

Is Medicaid means tested? Absolutely.

Is Medicaid for elderly patients heavily means tested? Absolutely.

Is what you said: Medicaid enrollment as of 2016 reached over 70 million people. Here's the requisite chart:

https://www.statista.com/statistics/245347/total-medicaid-en....

Every single one of these people has, effectively, entered into a promissory note with the government. They DO NOT have health insurance, they have a loan. true? Nope, only people over 55 who have remaining assets are subject to estate recovery.

[rebootthesystem]

Everything I said is accurate. Yet, you insist in missing my greater point:

This issue shouldn't even exist.

We, as a society, should revolt at having such clauses in a medical program that is supposed to help people.

The US healthcare system should take care of every single US resident. Period. Rich, poor, healthy and ill. And it should do this without the kind of thing I have highlighted regarding Medicaid.

It is my experience that it is extremely difficult to convince people who have a religious attachment to things. So be it. I put the matter on the table. I've done all I could here to raise awareness. And that's the end of the story.

Be well.

[maxerickson]

It is my experience that it is extremely difficult to convince people who have a religious attachment to things. So be it. I put the matter on the table. I've done all I could here to raise awareness. And that's the end of the story.

Aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaagh.

The stuff you are complaining about only applies to people that are over the age of 55.

A 10 year old and their mother that get primary care through Medicaid, they don't ever have to pay anything back (except if they later access Medicaid after age 55, but the asset test would apply to the care received after age 55, not before 55).

[rebootthesystem]

> Aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaagh

So, you don't think it is immoral to have this estate recovery thing?

I don't know why you are focusing on this age business. It does affect a large number of people. And it is objectively wrong.

It is wrong because it is immoral and fraudulent to present it as insurance when it is not.

It is wrong because it is immoral and fraudulent to deceive people.

It is wrong for a country like the US to have a law that results in the government sinking it's hooks into a large percentage of the people on that program.

We should not have such provisions in any healthcare program at all. Period.

You are missing that one point. The most important of all.

Again.

We should not have such provisions in any healthcare program at all.

We should have programs that help people and provide healthcare for all with no such conditions or stipulations.

We should help the poor without having them give up whatever property they have or may have for the sake of having health care.

We need to be a better society and we can't claim to be that when we have a law that allows government to place a lien on someone's property because they had the misfortune of needing medical care.

As for all the means testing BS you continue to sling around. That went out the window with Obamacare. The only thing that matters now is a percentage of the Federal Poverty Level. It varies per State. In CA it's 138%, which means about $22K for an older couple who's kids have left the nest. Over ten million people have been shoved into Medicaid in CA (called Medical here) in 2016.

It turns out to be that a lot of fixed income older couples who own homes of significant value can easily fall under this FPL requirement. Hence, again, the over ten million people shoved into the program last year in CA alone.

You are sadly misinformed. I urge you to read the links I've provided in this thread so you can get a real picture of what's going on and how things work. I get the sense that you've had exactly zero contact with this system from any imaginable angle. I and my family have, from both the professional angle --my wife being a Doctor-- and the patient angle, with my parents and her parents.

Here's yet another link:

https://www.healthinsurance.org/california-medicaid/

And here's a quote from that article:

"This has become more of a problem since the ACA’s Medicaid expansion took effect in 2014, as people are now funneled into the Medi-Cal system in much greater numbers than they used to be. Covered California enrollees with income up to 138 percent of the poverty level are directed to Medi-Cal, regardless of the value of their assets (there’s no asset test for subsidy eligibility or Medicaid coverage under the ACA).

As a result, some families have been receiving bills from Medi-Cal after their loved ones pass away, including bills to cover the cost of payments that the state makes to managed care plans, even if the deceased didn’t use any medical services."

Let that last line sink in: "EVEN IF THE DECEASED DIDN'T USE ANY MEDICAL SERVICES"

The famous line from The Matrix applies here:

"You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes."

I've shown you where the rabbit hole goes, yet you continue to believe whatever you want to believe despite overwhelming factual evidence. I can't fix that. Enjoy that steak.

[maxerickson]

As for all the means testing BS you continue to sling around. That went out the window with Obamacare. The only thing that matters now is a percentage of the Federal Poverty Level. It varies per State. In CA it's 138%, which means about $22K for an older couple who's kids have left the nest. Over ten million people have been shoved into Medicaid in CA (called Medical here) in 2016.

Checking income is a means test.

As for why I keep bringing up the age thing, it's because you keep making incorrect claims where it is a relevant factor and statements implying that receiving Medicaid benefits has grave financial consequences for all recipients (receiving the benefit doesn't even have grave financial consequences for the elderly; it just isn't very generous).

[rebootthesystem]

"means testing" refers to something very specific which includes asset valuation.

Obamacare/ACA/Medicaid no longer include means testing. It's a simple income test against FPL.

Where did I say that Medicaid has grave financial results for all recipients?

Again, you continue to ignore the point:

The fact that these hooks exist in Medicaid is objectively wrong. Very wrong.

They (the hooks) are also very real and, yes, they affect millions of people. So real that there are myriad attorneys specializing in complicated asset protection schemes intended to shield people from them.

The trouble is this is only available if you have the money to afford some very expensive and complicated legal work.

In other words, the poor and lower middle class are totally screwed and can't defend against this. This is horrible.

We should not do this to our people.

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1- Are you saying it is OK for Medicaid to have estate recovery rules?

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2- Are you saying estate recovery isn't real?

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Please clarify because I truly don't understand where you are coming from.