9 ms·

'Everybody In, Nobody Out': What's Known About the Medicare for All Act of 2019

43 points by howard941 8y ago

creaghpatr 8y ago
>The bill embraces the principle of a single standard of care for all Americans. It will not allow participating institutions and providers to offer private care for covered services to the rich. Allowing the wealthy to "buy out" of the system has led to the erosion of care for everyone else in countries, such as Australia, who have experimented with it. The new House bill will also include substantial new language to begin to remedy healthcare disparities and expand service to underserved communities. Mother, should I trust the government?
- WrtCdEvrydy 8y ago
  > It will not allow participating institutions and providers to offer private care for covered services to the rich I feel this is going to be a major talking point... Canada's system kinda works like this. Basic coverage with additional coverage you can purchase.
  - creaghpatr 8y ago
    This bill is less about what it gives and more about what it takes away. Can they convince 155 million people to give up their employer-sponsored insurance for a government option?
    - pjc50 8y ago
      That's not what's happening though; it's the providers who have to pick one or the other, not the public. Again, this sounds a lot like the UK system, where employer insurance exists but is genuinely a perk rather than something you need to survive.
    - crooked-v 8y ago
      I would in a heartbeat if it means more take-home pay and/or never having to think about which providers are "in network" again.
      - AnimalMuppet 8y ago
        See pjc50's parallel comment to your own. You may still have to think about which providers are in the government plan.
      - Mirioron 8y ago
        The chance that this will end up giving you the same level of care for less money is practically zero.
        WrtCdEvrydy 8y ago
        It depends. Insurance companies are able to negotiate better rates as they get larger.
  - rwj 8y ago
    That's true, but not quite the same. There is one system and one payer for emergency care, as an example. You can't pay for additional or better care. However, eye glasses aren't covered by the public system. Additional coverage would help here.
    - alasdair_ 8y ago
      That’s also how the uk works. Even there, it’s still possible to go to a completely private hospital for most things but generally not for true emergencies.
- zdragnar 8y ago
  So, if the government denies a treatment that could save my life due to some cost / benefit calculation, I can't get access to that treatment, even if I manged to raise funds for it on my own? Come to think of it, if this passes, I'm going to lose access to a medication that I'm taking right now. Insurance denied coverage for it because they want me to try a half dozen others first, even though all of them have significantly worse side effects. I'm only able to get what I'm currently taking because the manufacturer covers the cost through their charitable foundation for anyone who can't get insurance / insurance approval. If "medicare" for all banishes not only private coverage but all private care, and that extends to coverage for drugs, I'm f*cked. Death Panels indeed :(
  - creaghpatr 8y ago
    Your government-enforced death will enable millions more to have basic coverage so don't feel bad.
    - zdragnar 8y ago
      Granted, it's a condition that practically guarantees that my lifespan will be shorter than if I didn't have it. On the other hand: 1) We already have medicaid programs for the poor 2) We already have medicare programs for those not in the workforce (age, disability, etc) 3) We already offer subsidies for those who cannot afford traditional plans but don't qualify for a medicaid or medicare program 4) Medicare still costs money. It's a public insurance plan, not "free for all". So no, it won't give millions basic coverage that they couldn't already get. I'd prefer my death to be a bit more meaningful than fulfilling getting some politician political points, because that's pretty much all it would do under such a system. The above points don't add up to a perfect society; maybe we could work on improving those instead. Edit: For those not in the know, elderly pay for medicare out of their Social Security income. Anyone who reads "Medicare for all" as "Free healthcare for all" is either misinterpreting what's being offered, or what's being offered is a lie.
  - alasdair_ 8y ago
    There will still be private providers. Edit: read my response below before downvoting. There will be non-participating private providers.
- Arnt 8y ago
  Maybe, maybe not. Yes is a real possibility. I was born in a country where government is largely trusted and live in another. It's a mixed story depending on branch, but by and large people trust the government no less than they trust the average bigco, and partly more. But you're in the US, which seems different, so maybe not. And I've always wondered: Why is that? You Americans seem to distrust your government so much. Why do you vote as you vote and get a result you don't like?
  - SmellyGeekBoy 8y ago
    Speaking as an outsider - Did you see what their choice was last time around? I'm far from pro-Trump but it seems Hillary would have come with a whole different set of issues. Unfortunately it's the whole 2-party system that's broken. I'm speaking as someone from a country with pretty much the same system (the UK). Voting for anyone other than the candidate you dislike the least is essentially a wasted vote. I and plenty of others in my country really wish we knew the answer (and so do many Americans, from what I've seen). I'd be interested to hear where you are from. From what I know about Japan I gather that people are generally satisfied with their leadership. Maybe New Zealand as well?
    - alasdair_ 8y ago
      Scotland (still part of the uk for now) has proportional representation rather than first past the post. This can help avoid the wasted vote idea.
  - creaghpatr 8y ago
    If you look at the success rate for US public schools, you may want better odds under a healthcare system. The VA is a good example of government run healthcare that continues to fail its members to an astonishing degree.
    - alasdair_ 8y ago
      A major part of the reason the VA fails is that it is legally bound to provide coverage for people all over the country, with a center within X miles of every person that needs it, while only getting funding to cover roughly one percent of the population. Singler payer healthcare works a lot better if everyone is covered because then resources can be allocated more efficiently.
- habosa 8y ago
  Feels like a bad idea to me. Why not just tax the hell out of the private treatment to make sure the public treatments stay funded? I guess the concern is similar to the public vs private school situation, where some areas have bad public schools because everyone with any money chooses a private school and has no incentive to fund the public system. Still I find the idea of government-only medicine to be scary. In the past we've had politicians who have decided that things like abortion, stem-cell therapy, and medical marijuana were all moral evils. I am glad people had private options to get those things.
  - pjc50 8y ago
    This is not proposing abolishing the private option. It is just establishing a distinction between private and public providers, so you don't constantly get pestered for topup fees.
  - drewrv 8y ago
    Using the school analogy, imagine if schools had a private component and a public component. All kids got an education there, but there would be an incentive to charge more for a better education. And an incentive to blur the lines between what's a required fee and what is nickel and diming the parent.
aaronbrethorst 8y ago
I think that being able to leave a job and still have the same health care would be transformative for entrepreneurialism in the United States. I’ve known lots of folks over the years who’ve felt tied down to a job because they were the only member of their family to have health insurance, and they couldn’t afford to risk their spouse or children getting sick.
- minikites 8y ago
  I think that's a big reason so many non-insurance companies are fighting against the idea of universal healthcare for all citizens, they like having this tremendous power/leverage over their employees.
  - drewrv 8y ago
    That's interesting. I've wondered for a long time why non-healthcare industries don't lobby hard for universal healthcare. It's a huge cost and administrative nightmare.
- howard941 8y ago
  Agreed. There's actually a term for it: Job lock. https://en.wikipedia.org/wiki/Job_lock https://en.wikipedia.org/wiki/Job_lock
- oddevan 8y ago
  This. When I lost my job in 2013, I considered making an attempt at a freelance/contract career. That stopped when I got a rejection letter (not an increase in price, a full-stop rejection) from my preferred open market insurance provider. (And it was for being too skinny.)
- pnutjam 8y ago
  My insurance isn't great, but I hit my copay (and Out-of-pocket-max) for the year in January, so I'm locked in for the year.<br><br>Come to think about it, maybe this is part of the plan for High Deductible plans.
jcriddle4 8y ago
Want to bet the actual legislation is just minor tweaks to ObamaCare re-branded as "Medicare for all"? Why do I suspect the article is overly optimistic and that the author is just reading into vague and noncommittal comments made in meetings that they think will make it into the bill?
- aaronbrethorst 8y ago
  The ACA is loosely based on the ultra-conservative Heritage Foundation’s 1990s-era alternative to ‘Hillarycare.’ Medicare for All, definitionally, offers single-payer access. The Heritage Foundation was trying to prevent exactly that. Also, I can tell you’ve never spoken to Congresswoman Jayapal, because she doesn’t make vague or noncommittal statements (source: I’m a constituent and have been to several of her constituent coffee events.)
  - jcriddle4 8y ago
    "Medicare for All, definitionally, offers single-payer access..." Yes that is what the definition of Medicare for all should be but we are already seeing presidential candidates trying to redefine "Medicare for All" to the point that it doesn't mean much at all. I hope you right on Jayapal but till we see the bill's text we won't know.
    - aaronbrethorst 8y ago
      we are already seeing presidential candidates trying to redefine "Medicare for All" to the point that it doesn't mean much at all. What are you referring to?
      - jcriddle4 8y ago
        https://www.cnn.com/2019/01/29/politics/kamala-harris-medicare-for-all-eliminate-private-insurers-backlash/index.html https://www.cnn.com/2019/01/29/politics/kamala-harris-medica...
naveen99 8y ago
Maybe the government should treat healthcare like it does student loans. A healthy, educated person is more likely to make more money, and pay more in taxes. So, its more of an investment then a handout. Money flow wise, it makes more sense for government to pay the healthcare for a working adult then a retired one. And they already pay for > 65 year olds and offer student loans to any student.
- ericmcer 8y ago
  That would make more sense if we had a more preventative healthcare system. We have a mostly reactive one unfortunately.
- Mirioron 8y ago
  The problem with over promising with healthcare is that you can't walk it back and healthcare becomes the most expensive or second most expensive thing on the government budget. The other problem with government healthcare is that you're basically giving the government some control over your body. It will be the government's business whether you're out of shape or overweight or indulge in too much sugar etc, because the government is paying the medical bills.
  - naveen99 8y ago
    That’s my point. If it’s an investment it’s not a cost center, but a profit center.
  - jogjayr 8y ago
    > healthcare becomes the most expensive or second most expensive thing on the government budget. Has that happened in other advanced economies? Genuinely curious - I don't know what share of the UK national budget the NHS consumes, for instance. > It will be the government's business whether you're out of shape or overweight or indulge in too much sugar etc, because the government is paying the medical bills. First off, this happens to a small extent already with private insurance companies. Companies do "wellness fairs" for employees, insurance companies give people discounts for going to the gym etc. It could increase in future right? Second, I think most people want to be healthy, regardless of who's paying the bills, because your quality of life is so much better. I could see many people not changing their oil on time and driving terribly if they were guaranteed free car repairs forever. But healthcare isn't like that.
tboyd47 8y ago
I still think some kind of Medicare-for-all legislation or "Trumpcare" is Donald Trump's ultimate goal for his presidency. "I am going to take care of everybody... Everybody’s going to be taken care of much better than they’re taken care of now."
- dsfyu404ed 8y ago
  Trump only does what benefits Trump. Trump will sign what bills benefit Trump to sign. If congress can put a healthcare bill in front of Trump that can be branded as "medicare for all" for one audience and "we repealed Obamacare" for another audience (the possibility of the latter branding being a necessity in order to get any Republicans in congress to vote in favor of the bill) then Trump will almost certainly sign it. It doesn't actually have to provide "medicare for all" or "repeal Obamacare". It just has to look enough like it does to pass it off that way to the American public. He just wants to be able to say "look everyone, I repealed Obamacare" whether or not it's technically true. The "which news is fake news" circus and people's increased skepticism of what they read and see on the news should make the latter part much easier because it gives Republicans more wiggle room to vote for something that looks a lot like Obamacare 2.0 or "medicare for all" and then turn around and act like they repealed Obamacare in front of their base in 2020. I for one am hopeful. This seems like a potential win for everyone (well, scummy insurance companies notwithstanding).
skybrian 8y ago
Can someone explain why it's worth paying attention? With a Republican majority in the Senate and Trump in office, the chance anything like this will pass before the 2020 election is nil. And whatever might pass then will be different. I'm reminded of how when Obama was in office, the House attempted to repeal Obamacare 61 times [1] and it seems it was entirely symbolic. [1] https://en.m.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act https://en.m.wikipedia.org/wiki/Efforts_to_repeal_the_Patien...
- smacktoward 8y ago
  Because every Democratic candidate for President is going to have to have a position on health reform, and Medicare for All is emerging as one of the most popular options among those that have declared so far. So the question of what exactly Medicare for All would mean in practice is of primary importance to the agenda the eventual Democratic nominee will bring to the table.
robomartin 8y ago
Medicare is NOT health insurance. It is a credit card that starts to fill-up after age 55. States, by law, are required to collect on the debt you and your family acrue for your medical care. The government, in collecting this debt, will place a lien on your estate. Beyond that, your children can be liable for what you owe. If everyone in the US were to be shifted into this program it would likely be the largest private property grab by a government anywhere in the world in modern history. Don’t take my word for it, start here and do your own research: https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html https://www.medicaid.gov/medicaid/eligibility/estate-recover... Not saying a better aporoach to healhcare isn’t necessary in the US. It is. Just saying this is not a good idea.

43 points by howard941 8y ago

>The bill embraces the principle of a single standard of care for all Americans. It will not allow participating institutions and providers to offer private care for covered services to the rich. Allowing the wealthy to "buy out" of the system has led to the erosion of care for everyone else in countries, such as Australia, who have experimented with it. The new House bill will also include substantial new language to begin to remedy healthcare disparities and expand service to underserved communities. Mother, should I trust the government?

WrtCdEvrydy 8y ago
> It will not allow participating institutions and providers to offer private care for covered services to the rich I feel this is going to be a major talking point... Canada's system kinda works like this. Basic coverage with additional coverage you can purchase.
- creaghpatr 8y ago
  This bill is less about what it gives and more about what it takes away. Can they convince 155 million people to give up their employer-sponsored insurance for a government option?
  - pjc50 8y ago
    That's not what's happening though; it's the providers who have to pick one or the other, not the public. Again, this sounds a lot like the UK system, where employer insurance exists but is genuinely a perk rather than something you need to survive.
  - crooked-v 8y ago
    I would in a heartbeat if it means more take-home pay and/or never having to think about which providers are "in network" again.
    - AnimalMuppet 8y ago
      See pjc50's parallel comment to your own. You may still have to think about which providers are in the government plan.
    - Mirioron 8y ago
      The chance that this will end up giving you the same level of care for less money is practically zero.
      - WrtCdEvrydy 8y ago
        It depends. Insurance companies are able to negotiate better rates as they get larger.
- rwj 8y ago
  That's true, but not quite the same. There is one system and one payer for emergency care, as an example. You can't pay for additional or better care. However, eye glasses aren't covered by the public system. Additional coverage would help here.
  - alasdair_ 8y ago
    That’s also how the uk works. Even there, it’s still possible to go to a completely private hospital for most things but generally not for true emergencies.
zdragnar 8y ago
So, if the government denies a treatment that could save my life due to some cost / benefit calculation, I can't get access to that treatment, even if I manged to raise funds for it on my own? Come to think of it, if this passes, I'm going to lose access to a medication that I'm taking right now. Insurance denied coverage for it because they want me to try a half dozen others first, even though all of them have significantly worse side effects. I'm only able to get what I'm currently taking because the manufacturer covers the cost through their charitable foundation for anyone who can't get insurance / insurance approval. If "medicare" for all banishes not only private coverage but all private care, and that extends to coverage for drugs, I'm f*cked. Death Panels indeed :(
- creaghpatr 8y ago
  Your government-enforced death will enable millions more to have basic coverage so don't feel bad.
  - zdragnar 8y ago
    Granted, it's a condition that practically guarantees that my lifespan will be shorter than if I didn't have it. On the other hand: 1) We already have medicaid programs for the poor 2) We already have medicare programs for those not in the workforce (age, disability, etc) 3) We already offer subsidies for those who cannot afford traditional plans but don't qualify for a medicaid or medicare program 4) Medicare still costs money. It's a public insurance plan, not "free for all". So no, it won't give millions basic coverage that they couldn't already get. I'd prefer my death to be a bit more meaningful than fulfilling getting some politician political points, because that's pretty much all it would do under such a system. The above points don't add up to a perfect society; maybe we could work on improving those instead. Edit: For those not in the know, elderly pay for medicare out of their Social Security income. Anyone who reads "Medicare for all" as "Free healthcare for all" is either misinterpreting what's being offered, or what's being offered is a lie.
- alasdair_ 8y ago
  There will still be private providers. Edit: read my response below before downvoting. There will be non-participating private providers.
Arnt 8y ago
Maybe, maybe not. Yes is a real possibility. I was born in a country where government is largely trusted and live in another. It's a mixed story depending on branch, but by and large people trust the government no less than they trust the average bigco, and partly more. But you're in the US, which seems different, so maybe not. And I've always wondered: Why is that? You Americans seem to distrust your government so much. Why do you vote as you vote and get a result you don't like?
- SmellyGeekBoy 8y ago
  Speaking as an outsider - Did you see what their choice was last time around? I'm far from pro-Trump but it seems Hillary would have come with a whole different set of issues. Unfortunately it's the whole 2-party system that's broken. I'm speaking as someone from a country with pretty much the same system (the UK). Voting for anyone other than the candidate you dislike the least is essentially a wasted vote. I and plenty of others in my country really wish we knew the answer (and so do many Americans, from what I've seen). I'd be interested to hear where you are from. From what I know about Japan I gather that people are generally satisfied with their leadership. Maybe New Zealand as well?
  - alasdair_ 8y ago
    Scotland (still part of the uk for now) has proportional representation rather than first past the post. This can help avoid the wasted vote idea.
- creaghpatr 8y ago
  If you look at the success rate for US public schools, you may want better odds under a healthcare system. The VA is a good example of government run healthcare that continues to fail its members to an astonishing degree.
  - alasdair_ 8y ago
    A major part of the reason the VA fails is that it is legally bound to provide coverage for people all over the country, with a center within X miles of every person that needs it, while only getting funding to cover roughly one percent of the population. Singler payer healthcare works a lot better if everyone is covered because then resources can be allocated more efficiently.
habosa 8y ago
Feels like a bad idea to me. Why not just tax the hell out of the private treatment to make sure the public treatments stay funded? I guess the concern is similar to the public vs private school situation, where some areas have bad public schools because everyone with any money chooses a private school and has no incentive to fund the public system. Still I find the idea of government-only medicine to be scary. In the past we've had politicians who have decided that things like abortion, stem-cell therapy, and medical marijuana were all moral evils. I am glad people had private options to get those things.
- pjc50 8y ago
  This is not proposing abolishing the private option. It is just establishing a distinction between private and public providers, so you don't constantly get pestered for topup fees.
- drewrv 8y ago
  Using the school analogy, imagine if schools had a private component and a public component. All kids got an education there, but there would be an incentive to charge more for a better education. And an incentive to blur the lines between what's a required fee and what is nickel and diming the parent.

aaronbrethorst 8y ago

I think that being able to leave a job and still have the same health care would be transformative for entrepreneurialism in the United States. I’ve known lots of folks over the years who’ve felt tied down to a job because they were the only member of their family to have health insurance, and they couldn’t afford to risk their spouse or children getting sick.

minikites 8y ago
I think that's a big reason so many non-insurance companies are fighting against the idea of universal healthcare for all citizens, they like having this tremendous power/leverage over their employees.
- drewrv 8y ago
  That's interesting. I've wondered for a long time why non-healthcare industries don't lobby hard for universal healthcare. It's a huge cost and administrative nightmare.
howard941 8y ago
Agreed. There's actually a term for it: Job lock. https://en.wikipedia.org/wiki/Job_lock https://en.wikipedia.org/wiki/Job_lock
oddevan 8y ago
This. When I lost my job in 2013, I considered making an attempt at a freelance/contract career. That stopped when I got a rejection letter (not an increase in price, a full-stop rejection) from my preferred open market insurance provider. (And it was for being too skinny.)
pnutjam 8y ago
My insurance isn't great, but I hit my copay (and Out-of-pocket-max) for the year in January, so I'm locked in for the year.<br><br>Come to think about it, maybe this is part of the plan for High Deductible plans.

jcriddle4 8y ago

Want to bet the actual legislation is just minor tweaks to ObamaCare re-branded as "Medicare for all"? Why do I suspect the article is overly optimistic and that the author is just reading into vague and noncommittal comments made in meetings that they think will make it into the bill?

aaronbrethorst 8y ago
The ACA is loosely based on the ultra-conservative Heritage Foundation’s 1990s-era alternative to ‘Hillarycare.’ Medicare for All, definitionally, offers single-payer access. The Heritage Foundation was trying to prevent exactly that. Also, I can tell you’ve never spoken to Congresswoman Jayapal, because she doesn’t make vague or noncommittal statements (source: I’m a constituent and have been to several of her constituent coffee events.)
- jcriddle4 8y ago
  "Medicare for All, definitionally, offers single-payer access..." Yes that is what the definition of Medicare for all should be but we are already seeing presidential candidates trying to redefine "Medicare for All" to the point that it doesn't mean much at all. I hope you right on Jayapal but till we see the bill's text we won't know.
  - aaronbrethorst 8y ago
    we are already seeing presidential candidates trying to redefine "Medicare for All" to the point that it doesn't mean much at all. What are you referring to?
    - jcriddle4 8y ago
      https://www.cnn.com/2019/01/29/politics/kamala-harris-medicare-for-all-eliminate-private-insurers-backlash/index.html https://www.cnn.com/2019/01/29/politics/kamala-harris-medica...

naveen99 8y ago

Maybe the government should treat healthcare like it does student loans. A healthy, educated person is more likely to make more money, and pay more in taxes. So, its more of an investment then a handout. Money flow wise, it makes more sense for government to pay the healthcare for a working adult then a retired one. And they already pay for > 65 year olds and offer student loans to any student.

ericmcer 8y ago
That would make more sense if we had a more preventative healthcare system. We have a mostly reactive one unfortunately.
Mirioron 8y ago
The problem with over promising with healthcare is that you can't walk it back and healthcare becomes the most expensive or second most expensive thing on the government budget. The other problem with government healthcare is that you're basically giving the government some control over your body. It will be the government's business whether you're out of shape or overweight or indulge in too much sugar etc, because the government is paying the medical bills.
- naveen99 8y ago
  That’s my point. If it’s an investment it’s not a cost center, but a profit center.
- jogjayr 8y ago
  > healthcare becomes the most expensive or second most expensive thing on the government budget. Has that happened in other advanced economies? Genuinely curious - I don't know what share of the UK national budget the NHS consumes, for instance. > It will be the government's business whether you're out of shape or overweight or indulge in too much sugar etc, because the government is paying the medical bills. First off, this happens to a small extent already with private insurance companies. Companies do "wellness fairs" for employees, insurance companies give people discounts for going to the gym etc. It could increase in future right? Second, I think most people want to be healthy, regardless of who's paying the bills, because your quality of life is so much better. I could see many people not changing their oil on time and driving terribly if they were guaranteed free car repairs forever. But healthcare isn't like that.

tboyd47 8y ago

I still think some kind of Medicare-for-all legislation or "Trumpcare" is Donald Trump's ultimate goal for his presidency. "I am going to take care of everybody... Everybody’s going to be taken care of much better than they’re taken care of now."

dsfyu404ed 8y ago
Trump only does what benefits Trump. Trump will sign what bills benefit Trump to sign. If congress can put a healthcare bill in front of Trump that can be branded as "medicare for all" for one audience and "we repealed Obamacare" for another audience (the possibility of the latter branding being a necessity in order to get any Republicans in congress to vote in favor of the bill) then Trump will almost certainly sign it. It doesn't actually have to provide "medicare for all" or "repeal Obamacare". It just has to look enough like it does to pass it off that way to the American public. He just wants to be able to say "look everyone, I repealed Obamacare" whether or not it's technically true. The "which news is fake news" circus and people's increased skepticism of what they read and see on the news should make the latter part much easier because it gives Republicans more wiggle room to vote for something that looks a lot like Obamacare 2.0 or "medicare for all" and then turn around and act like they repealed Obamacare in front of their base in 2020. I for one am hopeful. This seems like a potential win for everyone (well, scummy insurance companies notwithstanding).

skybrian 8y ago

Can someone explain why it's worth paying attention? With a Republican majority in the Senate and Trump in office, the chance anything like this will pass before the 2020 election is nil. And whatever might pass then will be different. I'm reminded of how when Obama was in office, the House attempted to repeal Obamacare 61 times [1] and it seems it was entirely symbolic. [1] https://en.m.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act https://en.m.wikipedia.org/wiki/Efforts_to_repeal_the_Patien...

smacktoward 8y ago
Because every Democratic candidate for President is going to have to have a position on health reform, and Medicare for All is emerging as one of the most popular options among those that have declared so far. So the question of what exactly Medicare for All would mean in practice is of primary importance to the agenda the eventual Democratic nominee will bring to the table.

robomartin 8y ago

Medicare is NOT health insurance. It is a credit card that starts to fill-up after age 55. States, by law, are required to collect on the debt you and your family acrue for your medical care. The government, in collecting this debt, will place a lien on your estate. Beyond that, your children can be liable for what you owe. If everyone in the US were to be shifted into this program it would likely be the largest private property grab by a government anywhere in the world in modern history. Don’t take my word for it, start here and do your own research: https://www.medicaid.gov/medicaid/eligibility/estate-recovery/index.html https://www.medicaid.gov/medicaid/eligibility/estate-recover... Not saying a better aporoach to healhcare isn’t necessary in the US. It is. Just saying this is not a good idea.