I don’t know that labeling it “health care” really makes a difference to me.
I see the different gov’t attitude. Medicare steps in and covers certain expenses even for retirees with million dollar nest eggs. We don’t expect people to spend down to access Medicare benefits. (Medicare does include 90 days of NH care if there is progress toward recovery.) But, we require spending down before getting long term NH services.
Why do I feel differently about them? I guess when I think of “long term NH”, I’m expecting no recovery. This is the end, there won’t be any more reason to use that nest egg.
OTOH, I’ve got a relative who had breast cancer at age 60 - surgery, chemo, radiation. She’s doing fine 13 years later with no recurrence. If she had been 65, Medicare would have paid. After treatment, she still has normal living expenses - food, housing, transportation, … If we expect her to spend down for the cancer treatment, then she can’t enjoy the life she had saved for.
I guess the difference is that if the gov’t stepped in for long term NH, it would be protecting the heirs’ use of the money. When it steps in for chemo treatment, it is protecting the workers’ use of the money. I have a different feeling about protecting the workers’ use of their own savings vs. protecting the workers’ kids’ use of their parents’ savings.
But, it gets really mushy when Medicare is paying for sicker people.
This isn’t convincing to me. Maybe people should move along those better roads? Or maybe it’s a sign that we need a lot more roads everywhere?
It feels similar to when a dreamer says “I want to make life better here” and a cynic says “that will make more people move here, which will make life worse,” (implying a zero-sum-game that is really only true locally).
Do you have some more specifics? Is there an ideal level of congestion? Or an equilibrium? Or what exactly?
We could use honest discussions about that. I expect we do “just let people die” in certain circumstances. Doctors tell families there really isn’t any point in further treatment. The gov’t doesn’t get involved.
But, how about looser assisted suicide laws? I should be able to get a lethal prescription if, when I look ahead, I don’t see any real joy in life but I do see myself as a burden on others.
I think this is reasonable, although there’s a similar argument for Medicare not paying for hospice since it’s the end, which is unsettling. And I’m not saying you wouldn’t support CMS paying for hospice, I don’t mean to put words in your mouth.
But the framework is reasonable, how much should CMS contribute to your estate? Personally, I’m not opposed to asking people to pay for LTC to a point, but asking them to wind assets down to near-zero seems too harsh. I don’t have a ton of sympathy for someone with $5M who wants their child to be financially independent, maybe a bit more sympathy for someone with life savings of $100k who wants to leave something of a legacy.
The intuitive example is suburbanites complain that commutes take too long, so cities widen and extend freeways, shortening commute times. Shorter commute times encourage new construction, even further out, re-creating the congestion.
I don’t think it’s that simple. There are probably places when more lanes can reduce congestion long term, but I’m sure that building free roads increases road demand.
Also, I don’t think that sprawling suburb is a bad as city planners say. Many people just like lower density. If we can find a way to accommodate them (and charge them for the accommodation) then why not? (Yeah, electric cars)
I agree that the dollar amount matters. I’m sure we could reduce a good deal of mental anguish if those NH residents felt that of that nest egg is still there. I could imagine some thing where the gov’t pays for a double room by the residents can buy up into a single, and feel they’ve got some use out of their money. But, I have no good thoughts on that this morning.
I’ve worked on hospice and end of life. There is a TON of room for improvement with how we handle the end of life.
Not enough doctors tell patients and their families that there isn’t any point in further treatment. It’s easier to tell them to keep going because there’s hope. When I was working in oncology we actually looked at the data. Right at half of deceased patients had hospice, meaning half didn’t, which isn’t great. These patients aren’t generally dying unexpectedly, we know who’s dying. AND, if you look at people not on hospice, the outcomes are terrible. For people not using hospice, death in the ICU is the most likely outcome. It’s terrible for people, most terminal patients would rather die at home, even if it means dying a bit earlier. It is very low-value care.
So, why don’t we do a better job at using hospice, and getting advanced directives in place? In my experience, two things. One, these are really, really hard conversations to have, so lots of doctors and nurses don’t have them. Two, there’s no money in it. I had a physician say as much at a conference and lots of other physicians were in agreement.
Long story short, I did once find a novel way to get them paid for hospice, and hospice rates went up significantly.
OTOH, what if “I” is “we” ? We’re saving so we both can live decently and not be a burden. I think we could use a better way to protect the healthy spouse when the disabled one needs care. Maybe split the assets/income and only run down half.
My grandfather had Parkinson’s. He managed it for a long time then at 78 he had an intestinal lesion and was laid up in a hospital for 6 weeks. His condition deteriorated substantially over those 6 weeks to the point where he needed help eating. This was not what he wanted, but his only option was to go out in the backyard and shoot himself. Would have been much better to do that a more humane way.
I wonder how much traffic patterns will be affected by the COVID-19 pandemic. Employers and employees both realized that a lot of work can get done remotely. If seems like we could reduce congestion, smog, pollution, gasoline consumption by large amounts by encouraging more WFH, even if every employee only works from home 1 day/week, the reduction is around 20%. It sure seems like the biggest payoff for the investment compared to more mass transit, expanding freeways, shifting to electric cars.
Sounds good to me. I’m not sure how the gov’t encourages WFH (beyond fast internet).
The electric car thing wasn’t about reducing congestion. I was saying “suburbs aren’t that bad”. Many people will say “but suburban drivers dump CO2 in the air”. So I pre-emptively said “electric cars”.
I know electric cars aren’t supposed to reduce congestion. I hope you don’t think I implied that I thought that think they would. I included them in the smog, pollution, gasoline consumption categories of “things we’d like to reduce”.
Nuthin says “stick it to the trades people, retail workers, and hospitality workers” quite like a WFH tax credit. But if you think suburban home owners with office jobs are getting the short end of the stick - go for it.
It’s not tax credit for the workers, no he wants it for the businesses who graciously allow you to use your own energy and office space to not come in to the office.
