Comment by rebootthesystem | Hacker News Reader

Comment by rebootthesystem | Hacker News Reader

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rebootthesystem

I am sorry, you are sadly misinformed. See this chart:

http://kff.org/medicaid/state-indicator/medicaid-enrollment-...

Here are a few examples of people under the age of 26 who are on Medicaid:

California, 57% Colorado, 69% Idaho, 73% Wyoming, 75% etc.

The only way your assertion is true is if these are worthless and will never make anything out of their lives. Which, of course, isn't true at all.

And so, a young person is shoved into Medicaid and convinced they have medical insurance when, in reality, they are accumulating debt with the government.

And, yes, as life goes on they see some success perhaps buy a house and have an investment or two and never realize the hook that got sunk and set into them when they were younger.

In California alone well over six million people under 27 years of age are walking around thinking they have medical insurance.

Even if this wasn't the case, let's turn things around a bit.

Say an insurance company, Nefarious Unlimited, was issuing medical insurance policies --real insurance-- with a hidden clause in them. The minute the insurance buyer signs on the dotted line Nefarious Unlimited is given the right to recover 100% of their costs from the persons estate. As little or as much as they might have.

Of course, Nefarious Unlimited does not inform their customers that the product they are buying is actually a loan rather than real medical insurance. They even go on TV to advertise it and tout the millions of "satisfied customers" they have.

Nefarious Unlimited would be brought-up on fraud charges so fast your head would spin. The entire board and management would probably --and rightly so-- end-up in jail. Nobody would argue with this outcome.

You see, whether or not a person has a large estate this is wrong, fraudulent and immoral. That is the point you are missing in addition to the above.

This is our government engaged in fraud of the worst kind. This should not be OK with anyone.

This isn't about political lines. This is about basic human decency and exists at the most basic levels of right and wrong.

There's no recovery mechanism for younger people, they get services and that's it. There's income and asset tests that happen before services are delivered.

You need to carefully reexamine who the asset recovery provisions actually apply to. Among other things, it'd save you time writing lengthy comments about your mistaken conclusion.

I have read all of it and then some. I have even spent money to consult with three different attorneys on the subject as my family became concerned about how this mechanism would affect our parent's estate.

You can find various corner cases where Medicaid estate recovery isn't an issues. Yes. Yet this is NOT reality for the vast majority of those being shoved into the program by the tens of millions.

I am very well informed on this front, having sought the advice of top attorneys in this domain. This is very real. You can choose to study the links I provided and educate yourself or reject it while armed with imperfect information.

In the end reality isn't modified. We'll probably start seeing the effects of this during the next twenty years. Maybe then people will wake up.

Older people mostly get health benefits from Medicare.

Medicaid is intended to be a further benefit for people that have low incomes.

It's only surprising that it examines an estate if you don't understand that it isn't designed to be anything more than a benefit of last resort.

Sure, you can't have Medicaid pay for your parents care and also keep their estate. But this isn't mind blowing information, it's the way the law was designed to work and something anyone involved in estate planning would know off hand.

You really need to do a bunch of research and reading.

Here's a tid-bit:

Quote: "Does Medicare Pay For Long Term Care?

NO. After a 3 day hospital stay, Medicare pays 100% of the cost, but only for the first 20 days of skilled nursing care. For days 21 through 100, you are responsible for a co-payment. As of this date, the daily co-pay rate is $148 per day.

But it gets worse: After 100 days of care in a nursing home, Medicare stops paying altogether, and you are responsible for all future costs, unless there is a new 3 day qualifying hospital stay (which then re-sets the 100 day clock).

You also need to be aware that Medicare does not pay for “custodial care.” If you or a loved one are in need of custodial care, it must be paid for either by writing a check, by private long-term care insurance, or by Medi-Cal."

I am not going to bother providing you with links because you are obviously not reading anything. If you are truly interested in understanding the issues you need to spend half a day googling around to build a better image of what reality looks like.

Also, my wife is a doctor. She, among other things, has dealt with precisely the segment "served" by all of these programs for at least ten years. She has left that practice. And so have tons of doctors. This is the other side of the equation.

These programs work for some but, on the aggregate, they are a disaster. It is impossible for doctors to provide good care. Patients are getting screwed right and left. My wife would easily see a dozen patients a week for free because there was no possible way to justify doing it under these programs.

The vast majority of people are extremely ignorant of the realities in US health care.

Anyhow, that's the end of it. Thanks.

The issue here isn't that you are claiming that Medicaid is means tested (it is), the issue is that you are mixing up the rules for one group of people with the rules for another.

It's a fine thing if you want to argue that Medicaid should more generously protect the assets of the elderly, go ahead. Just don't make shit up out of whole cloth about how a young mother is going into debt to the government when she and her child have bills paid through Medicaid. That's just flat out not true. Maybe ask your doctor wife about that.

I do understand that Medicare doesn't do much for long term care. But long term care isn't a big source of the million dollar medical events you are ranting about, absent the need for further medical care, it generates a reasonably predictable monthly bill.

I believe you are reading the chart wrong. This is a break down of the distribution of Medicaid by age. 57% of Medicaid recipients in California are under the age of 26.

No, I got it right. You can click on a radio button and get a head count instead of the percentage. Both pieces of information are useful. What it does say is that the overwhelming majority of people on Medicaid are what I would term as "young", say, somewhere around 50 or younger.

And, before you say 50 is old. I know plenty of people who have started businesses and entire new careers in their 40's and 50's. This ain't the 1920's.

None of the services those people under 50 receive are subject to estate recovery.

None

You keep pushing on this. I guess I have to spell it out for you.

To be precise, Medicaid is obligated to recover cost of services provided at or after 55 years of age.

OK. Fine.

So CA enrolls twelve million people. Some young some older.

Do these people not age?

Of course they do. So, presumably, they are going to be on Medicaid for a very long time. Maybe their entire lives.

OK. That's established. People age. They think they have health insurance. Yet, they actually don't.

Out of those 12 million roughly 2.2 million were 45+ years old. One million were 65+.

So that 55+ event horizon, we could say, is very close for millions of people being shoved into Medicaid.

In fact, nationwide, about 14.5 million people 45+ were enrolled. Out of those, about 6.4 million were 65+.

These are not insignificant numbers. Source [1]

BTW, these numbers are for FY2011 when we had about 32 million people enrolled in Medicaid. Due to Obamacare and other factors we now have over 74 million and are well on our way to the 100 million mark. Finding current data seems to require a lot of work. You are welcome to do it if you want to be accurate. For now...let's double the numbers above:

45+ 28 million.

65+ 13 million.

So we are looking at roughly 41 million people at or past the threshold for estate recovery. And, of course, millions more that will eventually get there if they don't pop out of Medicaid or if they are shifted back into it because health insurance becomes too expensive.

41 million and counting. All subject to estate recovery or within a few years of it.

I, quite literally, don't understand what you are arguing about.

This is a real problem. People age and live well beyond 55 years of age. My Dad is 90. He had cancer when he was 70. That was 20 years ago. And, like him, millions of people. And most of them don't have a clue that Medicaid is debt they accumulate with the government, not health insurance.

There's another reality: Older people have greater healthcare needs. I read a report showing that the average need for a healthy older adult is around $10K per year. That being true, had my father not had a serious condition --had he been of average health-- he would have racked-up somewhere around $350,000 in medical debt to the government while on Medicaid. The actual number is closer to a million bucks.

A million dollars of debt to the government. And we call this insurance?

Let's see you face that reality and see how you react.

I'm getting sick of saying this. All of this bullshit still misses the greater point:

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We should not have a program that is falsely promoted as "health insurance" that actually has the government sink it's hooks into people's estates.

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That is immoral. It is objectively wrong. It is also fraudulent. Obamacare reports taut "27 million insured". No. It's a lie. You have millions of people shoved into Medicaid, which is not insurance. It is debt. Maybe not for all today. Certainly for millions today, maybe 30+ million. And certainly for millions of others who think they have insurance yet, as they approach the estate recovery threshold are unlikely to realize what "insurance" they actually don't have.

It's really sobering to receive a letter from the government demanding payment of $900K in medical care.

[1] http://kff.org/medicaid/state-indicator/medicaid-enrollment-...

Medicaid recipients generally don't have large estates. Invoking these huge numbers is silliness.

Go figure out the median estate recovery in a few states and I'll listen.

(Or however you want to present the statistics, but get some numbers.)

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