[africanboy]

You can take for granted two things in life:

- death

- 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.

[biggermike]

> 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).

[africanboy]

> 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.

[biggermike]

> 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.

[africanboy]

What if he's not dead?

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)

https://www.healthsystemtracker.org/chart-collection/quality...

[biggermike]

> What if he's not dead?

Then you wouldn't be inheriting anything in the legal sense of the word. That's why it's a contrived scenario -- it doesn't exist in reality.

Besides, the point is moot, as Medicaid nursing home care isn't Medicaid medical care, which is what the original topic was about.

> My parents were nurses, they weren't completely poor so they surely had to pay for it, but not rich either.

The government here heavily subsidizes the healthcare plans of people near poverty (up to 4 times the poverty level), not just the poor.

[africanboy]

> 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]

Isn't it the textbook definition of "idiotic"?

[0] USA healthcare ranks 37th according to WHO study that evaluated 191 countries https://www.who.int/healthinfo/paper30.pdf

[1] https://www.commonwealthfund.org/publications/issue-briefs/2...

[rayiner]

> Medicaid is not "free" there are requirements, but assuming you qualify, there are hidden costs.

There are low, published co-pays, similar to Italy.

The example you're quoting is for Medicaid nursing home care, a very expensive program with a distinct set of requirements: https://www.medicaidplanningassistance.org/medicaid-look-bac...

> 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.

Italy does not have universal long-term care for the elderly: http://www.ancien-longtermcare.eu/sites/default/files/ENEPRI.... Like the U.S., it has some support for lower-income people who need long-term care.

[africanboy]

> 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.