The Seattle Times reports today that "Medicaid bill would force some couples to reduce assets to qualify" meaning
If Gov. Gary Locke signs the bill, the amount a healthy spouse could keep and still have Medicaid pay for the ailing spouse's care would drop from $90,660 to $40,000.The Times interprets this to mean that
Critics say the measure could force some couples who can't afford long-term care to make a painful choice: deplete their life savings so one spouse qualifies for aid, or divorce to protect the assets for the healthier spouse.the implicit assumption is that people should never be responsible for their own health care, which is just another "free" public good, like air or sidewalks.
The controversy provokes hard questions: Is it right for citizens — through asset transfers, divorce and the like — to use government programs for the needy to pay for costly long-term care? Should they be forced to impoverish themselves first? How much of their personal assets should be protected? Should they be expected to pay long-term-care insurance premiums for years on the gamble they might one day need it?Actually, these questions are not hard. No, people should not spend or gift away their assets in order to qualify for safety-net programs. And we always end up paying for long-term-care one way or another. The question is whether we (a) can choose to either buy our own insurance or self-insure through ordinary savings, or (b) are forced to pay for somebody else's vision of long-term health care through higher taxes.
If the Seattle Times is trying to build support for a middle-class long-term care entitlement, they should have chosen a more sympathetic poster child. The article focuses on Nancy Doty, a 75-year-old retiree whose husband lives in a boarding home with late-stage dementia.
[Doty] used to work at the state Department of Social and Health Services (DSHS) helping determine eligibility for entitlement programs. She already has "spent down" a lot of money — dropping her assets from $135,000 to just under the current limit of $90,660 — to try to qualify her husband for Medicaid. ... Last fall, she spent about $35,000 in six weeks to make the Medicaid asset-qualification cutoff. She anticipated her husband, Jack, 78, might need Medicaid. She got new windows, kitchen countertops and sink, fixtures for the bathrooms, a washer and dryer and painted the house. Still $10,000 over the asset limit, she traded her 1996 Honda for a newer car this year.I hope Nancy Doty and her heirs enjoy the new car and the new kitchen. Why shouldn't they, when the government pays for Jack's nursing home care, for free! Posted by Stefan Sharkansky at June 23, 2003 05:01 PM
Just a comment on the Candian health system. There is far less overhead with the single payer system. Here the accounting system in a hospital occupies maybe one, two, or three rooms. In the US, it needs an entire wing to deal with the multiplicity of plans. It is not neccessary to go on welfare to qualify. Doing this transfers costs from one source to another.
One here never has to trade off the cost of children's health against other items.
Reading about the financial chicanery in the private American hopitals makes me wonder about how much this costs the system.
Posted by: Tzvi on June 24, 2003 09:25 AMI'm missing something here. I live in California, another state that has asset limits. And people have gotten divorced and given everything away to get a spouse into a Medicare (Medicaid?) facility.
But I believe that a residence counts towards "assets". So here, at least, that tactic would buy you nothing.
And you can buy a bit of health insurance - long-term care insurance - for the $35,000 she spent last year.
In her case, once the illness has set in, nobody's going to sell you insurance.
Nursing home care can run around $4000 to $6000 a month ($4K for a 4-bed room, $6K for a single) at a full-service nursing home here. You woudn't like it. I don't know what a good facility charges.
Posted by: Mike on June 24, 2003 04:36 PMActually I think this is more reason why nobody should get married. We should each be responsible for our own lives and interact with the government as individual, as citizens, not as Marrieds or Singles or Divorceds or Separateds.
Posted by: Tara on June 30, 2003 04:19 PMI am all in favor of people voluntarily helping others who need it with their health care expenses.
In what world is it moral to _force people at gunpoint_ (AKA, use Taxes) to pay for someone's health care expenses, especially when they are perfectly capable of paying for it themselves to the point of buying things they don't need in order to "qualify" for the help.
For Tara's comment: In what world is your personal relationship with the government somehow more important than your relationship with your spouse? You've been raised on some pretty messed up logic. You shouldn't need a _relationship_ with government, that way you _would_ be responsible for your own life.
Posted by: Kitchener on July 14, 2003 11:54 AM