[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.

[maxerickson]

Means testing has a broad and non specific meaning. Wikipedia of course isn't authoritative, but it discusses it in broad terms: https://en.wikipedia.org/wiki/Means_test

As an example, due to the pension my father left her, my mom will never qualify for any Medicaid assistance. This is a means test, she has resources above what Medicaid would provide.

The poor don't have assets to scheme to protect, so they don't really get screwed by asset tests.

The resources for elder care have to come from somewhere. Having the people receiving the care be the first payers makes a lot of sense to me. So the asset tests don't really bother me much.

Should society step in and help people who can't afford to pay? Of course. Should society work hard so that middle class and wealthy people that need long term care can pass more of their assets to their children? Probably not.

[rebootthesystem]

Hmm. OK. You probably haven't spoken to an attorney since Obamacare. I have.

Even so. We are dicing and slicing words here and the whole thing is irrelevant.

> Should society step in and help people who can't afford to pay? Of course.

> Should society work hard so that middle class and wealthy people that need long term care can pass more of their assets to their children? Probably not.

OK, it sounds like we might be coming to an understanding here. Please answer the questions I asked, because everything else is irrelevant.

Here they are again, slightly restated:

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1- Is estate recovery real?

Can we agree on that point?

Forget age thresholds. Is it real?

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2- Is this OK?

Should a nation like the US have a healthcare system with programs that place citizens past a certain age --the age where medical needs increase significantly-- in a debtor relationship with the government?

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I am willing to bet your answers will be:

1: Yes, it's real.

2: No, we should not have a healthcare program that turns medical care recipients into debtors

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If these are your answers we, then, are 100% in agreement and this back and forth has largely been irrelevant because these two questions are the meat of the objections I have raised.

We need a healthcare system that takes care of everyone, rich and poor. There should be no distinction when you walk into the doctor's office or hospital. And it should certainly not turn you into a debtor to the government. That's immoral and wrong.

As for the philosophical question of the wealthy passing assets to their children, that's an entirely different discussion. As an advanced and "civilized" nation we should not use the healthcare system as a battering ram to deal with such issues. Healthcare should be about just that, healthcare. Everyone should have access to it and it should not bankrupt anyone or turn them into debtors to the government. We need to achieve that. The issue of inheritance, etc. is a matter for a different kind of legislation and it should be kept separate from medical care. I hope you'll agree to that as well.

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I'm pretty sick of what politicians have been doing with our healthcare system over the past 20 to 50 years. It is an absolute mess. And I fear it will get worst before it gets better.

What we need is leadership that is able to have an adult conversation with the nation to explain how we need to work together for the greater good. Instead we have politicians in various political camps playing fucking games with our healthcare for political gain, not our benefit.

The right kind of leader would be able to unite the citizenry in understanding that the ONLY way we are going to end-up with a better system is if we accept that we all have the obligation to contribute --obviously based on financial ability-- in order to create a system where anyone, rich or poor, can walk into a hospital and not worry one iota about costs. What we have today is a horrible mess. And Trump, despite what many might think, is very far from the leader we need on this matter. I think we can agree on this as well.

[maxerickson]

I've never argued that estate recovery doesn't happen. Maybe you could admit that the 3/4 of people on Medicaid that aren't elderly aren't subject to it in any way, the primary thing that has lead me to pushing back on your comments. It's a pretty big deal that it doesn't apply, because that's where you started, fear mongering about how evil Medicaid is for everyone.

And I think I was clear enough in my previous comment. It's fine if the resources for elder care come from the assets of the people receiving the care. Dealing with it through estate recovery is a detail; the other way to do it would be to force disposal of the assets before providing any benefit (pretty much the situation faced today by people who don't own homes).

I think a different health care system could cost a lot less and be better for everyone. In the healthcare system we have, where funding for Medicaid is quite limited, I'm fine with it kicking in as a last resort.

[rebootthesystem]

I am not going to slice and dice numbers because that's irrelevant. The data I've seen indicates the number of afflicted is far greater than the 25% you are alluding to due to Medicaid expansion.

Yet, let's leave it at that. Let's concede it is only 25% of the folks on Medicaid. We are at 75 million people enrolled right now and firmly headed towards 100 million if nothing changes.

And so, per your number, that means 19 to 25 million people are in debt with the government for their medical care.

You keep calling it "fear mongering". All I did is provide links to source information where the way the program works is clearly laid out. And everything is factually correct.

Here's the part you don't seem to want to concede: If someone is put into Medicaid when they are, say, 40 because they don't qualify for subsidies and can't afford anything else, they are likely to stay there for a long time. And I'd be willing to bet money, they have no clue what's coming.

So, 15 years later they are still on Medicaid only now they shift over to becoming a debtor to the government for aspects of their medical care. And it so happens that after 50 to 55 years of age most people start having greater needs.

Our population is living far longer now, with 90+ not being uncommon. Which means that the 100 million or more that will be on Medicaid over the next decade or two will have a greater component of 55 or older folks. And every single one of them will owe money to the government for health care.

This isn't fear mongering, this is a mathematical reality.

> It's fine if the resources for elder care come from the assets of the people receiving the care.

Ah. OK. Now we understand each other.

I do not agree with this. Not at all. And mostly because most people have no clue they are accumulating debt.

If we did NOT call it medical insurance. If we classified it clearly for what it is. And if we made certain everyone knew what they were walking into it might be a different matter.

I know you are going to say it's right there in the forms. Nobody reads the fucking things. They want healthcare and they are placed between a rock and a hard place. They sign on the dotted line and move on.

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The fundamental disagreement here is that I am not OK with there being a program that turns people 55 and older into debtors to the government for their medical care.

You don't have a problem with the idea.

That, I think, is the bottom line. Everything else is slicing and dicing numbers. This, to me, is a question about the morality of the thing, not about statistics.