Bankruptcy Booms Among Older Americans
nytimes.com
nytimes.com
Nursing homes and hospices are designed to suck out your funds until you are dry, then dump you on state aid.
1. https://www.senioradvisor.com/san-jose-ca/how-much-do-san-jo...
"The average annual cost to seniors nationally is $80,300 for a semi-private and $91,250 for a private room in 2015"
2. I originally had "in a state funded hospice", but opo pointed out that medicare will strip you of your benefits due to their claw back system. You may want to look into committing a felony, for state funded care.
Basically, the strategy turns $100k into something like $6k/yr for the rest of your spouse's life (depending on age and gender), and makes you eligible for Medicaid. That said, you probably want to buy a slot in a nursing home that accepts Medicaid first, then "run out of money" and apply for Medicaid once you're in the nursing home. It's illegal to kick you out if they accept Medicaid and you're transitioning from private payment to Medicaid.
That said, nursing homes are hellholes, and I'd rather die with relatively minimal palliative care, in my own home, with friends and family visiting. That doesn't require BS like this. There's some circumstances where the Medicaid route may be better, so it's nice to know of this option.
>...To prevent candidates from simply giving away their money or resources to qualify for Medicaid, the federal government implemented the “look-back period”. This is a set period of time prior to the individual’s application during which the Medicaid administering agency reviews all the financial transactions that the senior has made. If a transaction is found in violation of the look back period’s rules, the applicant will be assessed a penalty. Penalties come in the form of a period of time that the applicant is made ineligible for Medicaid.
https://www.payingforseniorcare.com/medicaid/look-back-perio...
The "lookback period" is usually 5 years.
Also since nursing homes lose money on medicaid patients they tend to have limits on how many medicaid patients they will accept. If you are on medicaid, you might not be able to to find a reasonable nursing home that will accept you.
A better answer us to buy long-term care insurance. If you go into a nursing home and you eventually have to go on medicaid, it is illegal for them to kick you out.
The gift route gets clawed back; the system is designed to take all your money first before subsidizing care.
And death is easy to bear and forget than living through the pain of seeing your family go through helpless moments, and the humiliation of poverty till the eventual arrival of death.
Human life takes a lot of make up and dressing to make it look good.
Friends and family aren't exactly hitmen.
Long term care insurance should be purchased after age 60 to offset those care costs: https://en.wikipedia.org/wiki/Long-term_care_insurance
[0] https://www.motherjones.com/kevin-drum/2018/08/just-stop-it-...
Anyone at any time can get sick, get hit by a car, etc. That's why everyone needs it.
Technically, the utility of health insurance is greatest when you are youngest and least when you are oldest. Saving an 8-year-olds life could mean allowing them to live to 80. A 72-year-old that can't get medical care will have at least lived to 72.
The U.S. health care system has it backwards. We should at least be giving heath insurance to the young. You could argue that it is moral to provide for health insurance for retirees, even if they spend way more on health insurance than everyone else and won't get much additional utility from it, but the idea that you would only give guaranteed health insurance to the oldest (and wealthiest age bracket) makes no sense.
For example, saving a person's left eye is less valuable if they still have their right, because they can still see, versus someone who was already blind in their right eye that would leave them completely blind. So they're willing to spend more to save that person's left eye if they would otherwise be completely blind.
Similarly, saving the life of someone young is of higher utility than someone old, because their life expectancy is longer.
These sorts of calculations bother some people, but it is a practical reality that these decisions have to be made. I actually think NHS works pretty well and it's better to be open and transparent about these sorts of decisions, versus the American system.
You have finite resources. You have requests for resources which exceed your capabilities to service. You need to determine an order.
In an ideal utopian world, no one would ever need these services. In a less ideal world, everyone who needs these services would be serviced quickly and effectively with only positive outcomes.
In the real world, you have to make choices. These are very hard choices, and they have longer term impacts. It is literally "the good of the many vs the good of the few."
The NHS stuff is done by the National Institute for Health and Care Excellence based on quality-adjusted life years and they have a guideline of £20,000 per year. So if a cancer treatment lets you live ten more years in ok condition it's worth spending £200k to do it https://en.wikipedia.org/wiki/National_Institute_for_Health_...
But we shouldn't tell old people "you are useless therefore go somewhere and die". It's hard to imagine but most of the young people here will also get old one day. And they won't be wealthy enough to pay health costs out of pocket.
No one is saying that or advocating for that. I think you're unfairly assuming malice or ambivalence on the part of commenters who are trying to clarify the practical reality of the situation.
Consider for a moment, regardless of how unrealistic you feel it may be, the utility of funding the care of a 20 year old with cancer versus a 90 year old with cancer. All things being equal, a system with finite resources should prioritize the 20 year old, because the younger person will likely be less expensive to save long term and can generate more productivity for society afterwards. We'll call this our Socratic baseline.
Now obviously in the real world two patients' ailments are never equal. But if you can agree to this baseline, we can proceed to haggle as conditions more closely approximate reality and things stop being so equal.
We should not leave the elderly out to die or abandon them. But we have to be honest and balance that moral imperative with the unfortunate, practical reality that we only have finite resources. That doesn't mean we kill anyone off. It means we make nuanced decisions about how much to invest in their care - and how to do so - given their prognosis. Age is a fundamental measure of prognosis.
I am on board with taking age into account for coat of treatments. But you also need to accept that older people need more care and that that's ok. It's a difficult balance.
Paying hundreds of thousands of dollars to save a ten-year-old from cancer will be accepted because it could add decades to their life. Paying hundreds of thousands of dollars to save a ninety-year-old from cancer will not because it is unlikely to increase their lifespan very much.
That doesn't mean they won't get any care, but it would mean that the maximum that would be spent to save them would be less than someone who was expected to live much longer because of the care.
This is debatable. Most of one’s healthcare expenses will be incurred in the final months of life. The population to whom this statistic doesn’t apply is doctors—they know when the marginal benefit of treatment isn’t worth it.
If I had a choice between burning my kids’ estate to sneak out a year in agony or die with dignity, I know which I’d choose. The compassionate response isn’t always the right one.
Health, just like fire fighting, should not be a for-profit business.
End-of-life care is intensive, chronic, risky and generally involves cutting-edge techniques (since yesterday's death sentence is today's extendable life). This is fundamental to the cost of care. As a result, end-of-life costs are similar across the board [1].
If there is a unique American angle to this, it's doctors afraid of being sued spending too much on dying Americans.
[1] https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-lif...
US has a reasonable share of non-profit hospitals and other medical institutions, but the prices are not drastically different.
Random googling suggests that average doctor salary in Los Angeles is in the range $195,335–$254,517. Across the pond average doctor salary in Ireland is quoted at €48,020. For context, a registered nurse in California is making on average $94,120.
European or Asian medical professionals go to medical or nursing school with the goals of joining the middle class. In the US "graduated med school" is synonymous with raking in cash.
Your mistake is to think that nonprofit means that they don't make profit. They still pay a ton of money to their administrators and doctors. And the rest of the profit goes into fancy buildings.
Fire fighting still cost money. non profit medical still costs money. And yes, there is only so much medical care to go around.
It's a false choice. The U.S. is the wealthiest country in the history of the world, and other, poorer countries provide universal health care. The choice isn't between providing health care to old or to young people, but between providing health care to everyone or (putting more money in some people's pockets? probably not even that when the cost of uninsured, unhealthy people is factored in).
I would really like to have a source for this. Cynical me thinks this makes too much sense to be true...
"In a Stanford study, 88 percent of responding physicians said they would avoid invasive procedures and life-prolonging machines. But a newly released comparative study of Medicare recipients, as well as a longitudinal study and separate analysis of Medicare data published in January, suggest that the actual differences between end-of-life treatments that doctors and nondoctors receive are slight."
The other data point is the story of "La Crosse, Wisconsin," which "spends less on health care for patients at the end of life than any other place in the country, according to the Dartmouth Health Atlas" [2]. The cause? "Some 96 percent of people who die in La Crosse have an advance directive or similar documentation" while "nationally, only about 30 percent of adults have a document like that."
[1] https://well.blogs.nytimes.com/2016/06/30/at-the-end-of-life...
[2] https://www.npr.org/sections/money/2014/03/05/286126451/livi...
* Everyone should get medical care when a routine physical costs $100?
* Everyone should get medical care when a routine physical costs $1,000?
* Everyone should get medical care when a routine physical costs $10,000?
The question makes as much sense as asking "Should we have a military if soldiers have a salary of 250 billion dollars each?"
The soldier analogy doesn't quite apply, as it doesn't require complex skills and providers of the service are not in short supply. A potential candidate can surely hold out for a starting salary that's 10x the average, but others eyeing his position will likely be content with the average.
An anesthesiologist, on the other hand, or an MRI lab, might be the only game in town, and if they say the prices are going up by 10% next year, the prices are going up. One is welcome to drive to the next town over, but with taxpayers covering the expense, why bother?
What cost constraints exist in "everyone should get medical care" system to prevent healthcare providers from consuming 100% of GDP?
Meanwhile, https://www.cms.gov/research-statistics-data-and-systems/sta...
"Health spending is projected to grow 1.0 percentage point faster than Gross Domestic Product (GDP) per year over the 2017-26 period; as a result, the health share of GDP is expected to rise from 17.9 percent in 2016 to 19.7 percent by 2026."
Personally, i am against most organ transplants. The massive cost to save one life there could save thousands if spent on vaccinations overseas. Even at home, people die for lack of basic treatments every day.
http://www.slate.com/articles/news_and_politics/prescription...
Edit:
Down-voted because this isn't how things work or just because it's uncomfortably true?
If you think CA representatives won't side with the tech industry over the good of the nation then you're probably going to be proven wrong in the next few years.
It's the whole point of insurance that most people who don't need payouts cover ruinious expenses for those who need it.
The proper way of handling the cost of health care is at a nation or world level of single payer.
Fight a war on disease, not drugs.
The point of insurance is to make a profit for the insurance company.
Making profit is fine, doing everything possible to maximize profit by defeating the purpose of its very existence is where things get in the wrong zone.
Medicare, if you were not aware, is available to everyone who is a US citizen over the age of 65.
Most employers often encourage seniors to go take Medicare asap. Someone failed this man, this is basic information.
People screw up. People forget. Errors occur, constantly.
It should be an auto-sign up with an opt-out form.
Medigap is sold by private companies and can cost up to $250 a month roughly for full coverage, all the way down to like $60 for coverage after the first $2000 in expenses.
In our country everything is mostly done self service, social security is too. Oh well! I wish it was automatic, but the insurance lobbyists dont want that I think.
Some out of pocket costs include a $1300 deductible for entering the hospital. The drug part only pays 90% of drug cost. The senior drugs advertised on television generally start at $20 a daily dose. Some cancer drugs top $100,000.
This has been a workable strategy for a number of decades, although it isn't historically so.
It's up to those throwing rocks to put the rocks down.
> Facts are facts
Aside from ascribing some kind of universal evil intent to people simply based on when they were born, which is idiotic, those are cherry-picked facts that do not accurately sum up the economic reality of how the US got to where it is now.
For instance, why not include the fact that the older generation was responsible for the most prodigious productivity growth the world has ever seen? Or that they've overseen massive increases in longevity, decreases in morbidity and childhood mortality, huge increases in number of people achieving higher education, etc?
They overcame the enormously damaging economic situation of the 1970's, which the younger people have absolutely not a clue about, and many have suffered decades of decreasing employment and wealth as a result of economic shifts in manufacturing and resource production.
There are economic challenges in every generation. The ones facing young people today are not the same as the ones that faced their parents and grandparents. It does no one any good to try to stir up hatred at a sub-group to gain political power, which is what the generational warfare is about. Leave that for the Fascists.
It's the counterfactual basis of your argument that makes it absurd. It is undoubtedly true that this describes some people in that age cohort, but it doesn't describe it generally. They are much wealthier than both their ancestors and their descendants. While every generation faces its particular challenges, only one living generation faced those challenges by intentionally impoverishing the future.
As for the remainder of your points -- morbidity, mortality, educational attainment, and whatnot -- it is the case that the USA has underperformed all other advanced nations in these measures. You'll excuse me if I don't credit Boomers for falling behind countries like Cuba, Portugal and UAE.
And some of us went further. We didn't have kids.
Why is there an expectation for kids to inherit?
I mean, parents have typically already spent hugely on support and education. Indeed, grown children were traditionally expected to support and care for their parents. Arguably, reverse mortgages wouldn't be so popular if they still did that. And yes, I get that the economic system is fucked up. But that's not parents' fault, for the most part.
“Cheryl Mcleod of Las Vegas filed for bankruptcy in January after struggling to keep up with her mortgage payments and other expenses. “I am 70,”
Why the heck do you have a mortgage at 70?!
This is going to be an increasingly serious problem over the next few decades. Expect bankruptcy filings to increase across the board, across all generations going forward.
This is my main critique of the "sharing" economy and tech darlings like Uber and Lyft, who have accelerated this anti-labor trend. What I find especially ironic here is that these services are currently only economically viable because of VCs subsidizing the costs, who themselves source a large percentage of their funding from traditional employee pension pools, etc. But of course it's all worth it because these "sharing" companies are just sooooo convenient.
In the UK they will be covered by the NHS despite their employer practicing industrial-scale evasion of Employer’s NI. That’s a loophole that must be urgently closed tho’ the Government and the Inland Revenue are inexplicably dragging their heels about doing it (indeed the entire “gig economy”)
Save a minimum of $5500/year or 10% of your annual salary. Whichever is greater (up to your cap).
A better question would be: "do you think an Uber driver who (a) lives alone (b) in a two bedroom apartment (c) in the heart of San Francisco and (d) works 20 hours per week will be able to save $5500/year?" The answer is no. But there is a lot more to the problem than just "Uber driver".
But from what I've read, for any reasonable definition, the percentage able to save that much is arguably small. Indeed, it's arguable that most of them are losing money.
Consider the argument: "can an Uber driver save for retirement?" If we define Uber driver as: "works for uber exclusively for 40 hours per week". Our answer to the question might be yes or it might be no. Ultimately what matters is the number of people who fall into that category every day for the rest of their lives.
If we find no people fit that category or that the people who do fit that category don't fit it for very long then we can safely say the answer to the question is irrelevant.
After all, "can unpaid interns save for retirement?" is a meaningless question. It doesn't matter. Statistical categories don't retire. And people who work as unpaid interns do not remain so for very long.
A person who drivers for Uber may just need quick, supplemental cash. Cash that may be exclusively funneled into a person's retirement account.
If we compel Uber to provide a "living wage" or a retirement package, we may find that those who need quick cash go without it. And people who would have saved for retirement are now not able to.
Soylent Green
The charts do a good job of telling the story, but it basically goes like this: Children of the great Depression were terribly frugal, working hard to avoid a future financial hardship. Then the next generation (the one described in the article) decided they were not going to be miserly penny-pinchers like their parents. They bought everything with the belief they'd pay it off later. Now the next generations see the folloy in their parents behavior, so now we have the FIRE generation, once again pinching pennies.
And so the pendulum swings back and forth. And the beat goes on.
"42% of Millennials are investing conservatively, compared with 38% of Generation X investors and 23% of baby boomers, according to the Fidelity survey." source: https://www.forbes.com/sites/andreacoombes/2018/03/13/millen...
But having lived through 2007-2009, it's no surprise they have a preference for cash in the bank.
You know what i hate more ? The fact that our governers make sure you wont even live long enough to make use of "any" of those retirement entitlements.
Best for them would be all of us dying right after "work age".
Corporate stocks are not actually growing in value, it's just the entire money supply which is being diluted for the benefit of corporations at the expense of everything else.
If the pie doesn't really grow, why has the world economic output increased so much in the last 200 years?
If you get more of something but quality is lower then it's not necessarily progress. You might need more of that thing to get the same value out of it.
Young people can't default on a mortgage if they can't afford to save enough for a deposit on a house in the first place.
there you have it: the US healthcare system is driving responsible people into poverty, especially when paired with stagnant or falling income.
the solution is socialized universal healthcare. we will also need to re-create the social safety net somehow in a new and vastly expanded role. to be clear, silicon valley doesn't have a role to play here, aside from paying their taxes.
having that money in the bank might help prevent future bankruptcies.
1) SV companies are some of the biggest tax dodgers
2) SV companies are also some of the biggest drivers of economic inequity and tearing down these social safety nets that generations before us fought tooth-and-nail for
3) SV companies, like Facebook, are also the biggest drivers of our cultural decay, which feeds and accelerates these disturbing macro societal trends
I was with you up until there....what's the thinking behind that part?
likewise, our society can't use software alone to solve our socioeconomic problems.
note: this is not because software is incapable of being part of the solution. far from it. but software is not about to rectify these issues without a political will to do so, which is separate.
You might be complaining the state doesn't pay for the elderly to retire easily ? Ok, let's do some basic calculations to sketch that out.
Right now there's a little over 12% elderly in the US (and really more like 10% once you take out the ones still working). That number is just about to rise rapidly to 15% by 2021 or so, then a little slower to ~25% by 2050. The under 18's will likely stay constant at ~25%. That means that the government, just for elderly care and schools (NOT including health care, the military, roads and harbors and other infrastructure ...) needs half your pay. 50%. Currently it needs ~25-30% for that. This is totally independent of the actual spending, it's amount of headcount that needs to go to elderly care.
So in order to simply provide current level care, and without considering health care for elderly, or increased longevity, your take home pay, just considering elderly taxes, needs to reduce from ~75% to under 50%. Or, how this will appear from the perspective of someone who works, your taxes need to rise by half. Every tax. For California, income tax needs to rise from 40% to 60% (and it's a progressive tax, and this means the income from that tax needs to rise, so it's not just higher rates for the rich. It's mostly higher rates for the poor, not because of corruption, but because that's where the money is), average. Sales tax from 10% to 15%. And so on. A little under half that tax raise will need to happen in the next president's term (or, God forbid, Trump's second). Just so we're clear, that's a few years away.
If, as many suggest here, care needs to be increased and more broadly available ... well that costs more, of course. That means a little under half the total economic activity in the US needs to be focused exclusively on taking care of others (again, not including health care, that needs to be added on top after that).
We all know that current workers are not prepared to pay this. So why are we wining that "government will not take my elders off of me" ? It cannot do so ...
And the truly scary part is ... compared to Europe, the US is not doing too bad. Europe is a disaster waiting to happen, and will fail sooner than the US. Compared to Japan, Europe looks fine. And compared to China, Japan barely has a problem.
It's weird to realize this, but longer term things are pretty obvious: the US will open up it's borders like never before (because in the US case, that might, just might, actually fix things). The EU will ... uh ... I'd say "die", but politicians never let something die : they go to war. Against whom ? It won't be very hard at all to start a war with China in a decade, potentially sooner. It's weird but WW3 between "the EU" (Germany) and China, in 10-15 years would make sense.
https://www.dw.com/en/1-in-10-german-military-pilots-lost-he...
The political climate would need to change a lot for politicians to allow more military spending and budget cuts elsewhere. The current discussion about refugees and the unstable situation regarding Trump and the NATO might change this.
I still agree on Europe having lots of trouble in 10-15 years.