jollyroger's picture

    Hey Andrew Cuomo! Feel the Bern, (don't fuck the poor)

    Andrew Cuomo, admittedly, is no Mario Cuomo, so the fact that his father would rise from the grave and strangle in him his crib before seeing him patch his budget hole by ripping skin off Medicaid, should not distract us from the all out assault being waged on the front line medical care delivery system that since the ACA mandated expansions, has come to be seen as the CADILLAC plan for working class Americans.


    Of some interest, then, are the travails set forth in the terrifying article from a NY Times editorial board member detailing the interactions with the new "managed care" version of Medicaid.


    Medicare for all will obviate all this be replacing the joint state/federal Medicaid program in its entirety.

    Spoiler Alert:  Like many who are reading this, I had some experience in the prior century with an elderly parent transitioning into a Medicaid funded stay in a nursing home, and, boy howdy, one thing that never loomed was an actuarial  dimension!


    Medicaid nationwide is famously the largest single item on most states' budgets, and it is the burden of  long term care costs (subsumable under M4A like all the state burden sharing costs,) currently Medicaid's only, that will shift to an entity that can print money by contrast with  States that are mandated to balance the budget!.


    Wherefore, Andy (you poor pastel imitation of your father), feel the Bern, motherfucker!


    When M4A critics bleat about the cost of converting to single payer, they manifest remarkable complacency vis a vis the costs of continuing as we are.


    One cost is Andrew Cuomo pocketing 2 and 1/2 Billion dollars of budget relief.

    There is major major delusion in this country about Medicaid. Everyone uses it like we have a socialized nursing home network in this country but won't admit to it that that is what they are doing. Everyone does it because when they reach middle age they look into long-term care health insurance for their old age and find that it is prohibitively expensive and they might not even be accepted to buy it because they already have chronic health issues like high blood pressure or some such.

    Most of the country's cost of Medicaid is not poor people's medical coverage, but nursing home coverage for elderly with Medicare who have been made artificially poor by "spend down" tactics so that their family does not have to spend down every cent first when they go into a nursing home.

    Hello millennials: the "nursing home" for your elderly parents is not covered by their Medicare.

    Medicare only covers up to 20 days per annum in such a facility under the following stringent requirements

     ONLY IF:

    1) you have spent at least 2 midnights as a inpatient in a hospital for a procedure or acute incident and need more healing and/or rehab afterwards; if your doctor(s) did not formally admit you, but keep you in the hospital "on observation", you're out of luck.

    2) There is a chance of improvement. If after a couple days in a nursing home after the hospital, they say you cannot improve from their services, you pay the bill, Medicare does not.

    [Related aside: Just so happens Congress not that long ago changed Medicare policy so that it covered hospice services 100% under Part A. Clearly they did this because they want your parents who cannot improve to go into hospice (at home hospice service is an included choice) and stop accessing expensive recurrent hospitalizations not to mention to stop going to nursing homes after they spend down their estate so they can get Medicaid coverage.]

    Hello again millennials, specifically the ones expecting to inherit their parents house after they die in a nursing home, under the impression that one can keep one's primary abode after going into a nursing home on Medicaid, after "spend down" and/or hiding of assets. Check with your state. Of late, many have enacted laws enabling them to "clawback" the house and all remaining property from the estate to repay the state for the Medicaid funds expended on the nursing home.

    This is because of the problem that Jolly is drawing attention to. States are drowning under the cost.

    Bernie's "plan" is not addressing this particular problem though, not that I have seen. It's only about including the under 65 population in what over 65 gets, all equal. If it was, the cost estimates would not be palatable. We would rather be in denial about how we are using Medicaid and let the states deal with the massive cost. So they are starting to contra houses and sell them for the taxpayers benefit!

    I got super lucky,got both my parents into assisted living insurance plan back in the short period before insurance companies realized it was a bad deal. One used the hell out of it, the other not, but yeah, $7k-$8k per month adds up over the years, and I'm sure it'll be much worse by my time unless miraculously robots bring the costs down.

    These days shopping for  any sort of long term care insurance in the marketplace is the proverbial "cold shot".


    Assisted Living policies have to be priced to reflect that 7-8k monthly drawdown, and none that I have ever heard of covers more than three years of assisted living (I suppose the implicit assumtiion is that you will "graduate" before the end of that period...


    Medicaid, per contra, of course, does not run out in three years.


    The horror that the times article unfolds, (which is an artifact of the shift to managed care in Medicaid administration itself) raises a whole new level of nightmare, viz the interposition of a "gatekeeper" telling the family that Pops is still "street legal" notwithstanding the florid behaviors cited.

    yeah, the insurance is basically a huge high risk gamble now! buying a pig in a poke. not buying peace of mind. you have no idea what you're going to get, it might be worse misery one way or another

    it's popular to go for "home care" now if at all possible and Medicare does sometimes cover depending on diagnosis/conditions? I know states even use Medicaid funds for things like transport to providers. Keep them out of the expensive nursing home. But that has it's own downsides, as nobody can hear the patient's screams should there be a caretaker fed up with their own life. Like with babysitting, cameras monitored by cell phone are de rigeur now....

    One has to think: like with babysitting. If the taxpayer doesn't like paying for other people's child care, they won't like paying to change other people's parents diapers, either. It really is a question of how socialist do you wanna be?

    In any case, we've gotten used to hiding the expense of nursing homes for all classes being born by Medicaid and blaming the poor for Medicaid's high expense. That hasn't been done as much for child care before school age. I learned recently that some states are starting to come up with clawing back the expense. Operating on the presumption that primary residence is safe and sound is now faulty, sure, while the person is alive, as there could always be a miracle and they need their home back. Or they want to die at home and take hospice services. But after they are dead, kids can't presume any longer that they will get the home.

    Forgive me for cherishing this rare opportunity to correct you DoubleA.


    Bernie will fix your teeth, your vision, your hearing and pay the attendant to wipe your senior years.


    M4A covers all forms of long term care currently breaking the back of Medicaid.


    How do ya like him now?


    Edit to Add.  SHUT MY MOUTH


    Bernie will NOT pay the attendant--Jayapral will!  Evidently one of the siginficant differences between the Sanders M4A plan and Pramila Jayapal's is that hers is the one (I was conflating with his) that eliminates Medicaid entirely.


    under the Jayapal proposal, states could see significant savings relative to current Medicaid spending because Medicaid would be eliminated, and there would be no state financing requirements. However, under other proposals, states would remain responsible through a maintenance of effort (MOE) requirement for all or part of current state spending on Medicaid. The Sanders Medicare-for-all program would require states to maintain their existing Medicaid eligibility standards and spending on institutional long-term care services and would continue to provide states with federal matching payments for these services, locking in variation in eligibility standards and financing across states. Long-term care accounts for more than one in five dollars of Medicaid spending and in 2016, community based long-term care services accounted for 57% of all Medicaid spending on long-term care nationally, although this varies by state. The level of state savings under the Sanders proposal will vary based on current state spending on institutional long-term care services.


    What a piece o monumental stupidity?  Why have a "maintenance of effort" standard, which only penalizes the fisc of previously humane states, and the people of previously stingy?

    ok good, then it's more realistic get the real total costs of all health care in this counry out in the open. I wasn't sure about that. Sooner or later, all the hidden ways to pay for everything gotta come out. Has to as it continues to grow as a huge part of the economy....

    As you have often pointed out, "single payer" is a cost containment measure only to the extent that enhanced price discovery is a necessary but not sufficient step.  Single provider, of course, is the way to go (cf VA, Britain, kaiser)


    Either way, making states bear any burden whatsoever is lunacy.  They print not, neither may they borrow when most vital to do so.

    Excellent point: They print not, neither may they borrow when most vital to do so.

    I used to wonder why medicaid is a shared burdened/state administrated program anyway, being as how the number of illnesses that sort geographically  from state to state is limited (to the diseases of obesity...) and I figured it had to do with abortion, but the Hyde Amendment solved that and of course, it's race.


    One may note in passing how much misery the white ruling class in the states of the former confederacy inflicted on themselves in foregone medical care so that they could revel in the orgasm of spitenfreude as they contemplate the pleasure of inflicting loss on the undeserving.


    One may further note with schadenfreude, (see what I did there?) that those states with the diseases of obesity...

    States rights to be pooh and have zero access

    I am reminded of George Bush Sr. talking bout 1,000 points of light all the wunnerful people just come together and do things out of the goodness of their hearts. I think many may draw the line at going into debt to help, though? Like say, a rural hospital in a non-expansion state. Kind of like: exercise in futiliy?

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