6 ms·

I don't think that's the issue. The issue is that the United States provides such a poor safety net for those with health issues that one person's failing healt

by ericb 5y ago

I don't think that's the issue. The issue is that the United States provides such a poor safety net for those with health issues that one person's failing health destroys the economic potential of one or more people around them. From a sheer utilitarian perspective, healthcare and safety nets are positive ROI. Imagine the job-producing startups that don't exist because "how do you pay for insurance?"

horsawlarway 5y ago
It's worse than just lost startup opportunities. I think healthcare in the US is riddled with ways to "accidentally"* spend the entire accumulation of your wealth, leaving absolutely nothing to the next generation. Long term care is needed by a lot of folks over the age of 65 (~70% of adults age 65 will require at least partial long term care). Even "reasonably cheap" care (in my experience, roughly the same quality as living in a college dorm, with a roommate and a meal plan) can easily run 10k/month - or 120k a year. Of those needing long term care (roughly half of all folks): Men will need that care for an average of ~2 years, women nearly 4 years. 20% will need that care for 5 years or longer. I watched my parents spend all of their inheritance covering long term care costs for their parents (Alzheimers is a bitch). Once the inheritance was gone, they worked longer than they would have preferred to continue covering those costs (my mother only retired this year when my grandmother died of covid - as horrendous as it sounds, it was almost a blessing). My personal take is that "single family homes" and "private healthcare" are a literal fucking disaster for long term wealth inequality. That policy combination takes a lot of middle class families and leaves them poor. * - I personally don't think it's an accident at all, I think it's very, very intentional.
- dragonwriter 5y ago
  To be fair, long-term care is not just an opportunity to accidentally (from the perspective of the holder, not the system) get rid of one’s accumulated wealth, it is often the motivation for intentionally doing so prematurely, in order to qualify for Medicaid (which pays for the majority of long-term care in the US.) OTOH, for people who don’t have the knowledge or professional advice to do this (which, of course, correlates strongly with having more wealth to start with), it is a trap for accidental wealth drain rather than intentional redistribution, so the poor get generationally poorer, while the better off are also better able to protect generational wealth, both benefiting from programs for the medically indigent.
  - coryrc 5y ago
    Every dollar spent on the elderly who had their whole life to prepare is a dollar not spent on a child growing up in poverty who has not yet had a chance. Families should take care of their own. If nobody is willing to do that for you, you probably aren't deserving.
    - lazide 5y ago
      Well, except it isn’t right? We can and do budget them separately. Might be more fair to say ‘every tomahawk missle fired randomly at a target at the Middle East is an entire middle class families lifetime income down the tubes’.
      - coryrc 5y ago
        It's just as fair in my opinion.
- ancode 5y ago
  > I think healthcare in the US is riddled with ways to "accidentally"* spend the entire accumulation of your wealth, leaving absolutely nothing to the next generation. That's not true, the money isn't just lost. The money is passed to the children of the person who extracts the money from the sick people. It's by design.
  - lmm 5y ago
    The money isn't passed on intact though. At the end of the day we pour a huge proportion of our real production - human hours of labour - into prolonging the lives of people who are barely remembering or experiencing anything.
- makomk 5y ago
  This isn't just a US thing. For example, even though healthcare is nominally free at the point of use here in the UK, that doesn't cover long-term care for the elderly - you will have to pay privately for that out of your wealth to companies of varying degress of sleaziness until you have no more left, at which point the government will hopefully consider picking up the bill. Our current conservative goverment is planning on capping this and it seems fairly controversial.
- 0des 5y ago
  > my mother only retired this year when my grandmother died of covid - as horrendous as it sounds, it was almost a blessing I can only imagine the hardships your family endured for this sentence to come out. I'm glad things are working out for you guys and I'm sorry for your loss.
- sophacles 5y ago
  > I think healthcare in the US is riddled with ways to "accidentally"* spend the entire accumulation of your wealth, leaving absolutely nothing to the next generation. ... > * - I personally don't think it's an accident at all, I think it's very, very intentional. Its extremely intentional wealth stealing, and it's even worse than just lost generational wealth transfer. Filial responsibility laws mean that your illness and long-term care are your children's financial burden: https://en.wikipedia.org/wiki/Filial_responsibility_laws https://en.wikipedia.org/wiki/Filial_responsibility_laws . In the worst cases, people estranged from their parents for decades end up bankrupted. Depending on what state your grandmother lived in - your mother may have been on the hook even if she hadn't chosen to keep working to care for her mom.[1] The idea that paying for elderly parents' expensive (intentionally or accidentally) care is a choice only applies to people in less than half of the states. These laws make the only choice "pay the provider directly now" or "pay the provider costs and late fees, etc via the courts". So anyone who wants to claim that the people who care for their parents are chosing to do so is claiming wrong - if your parent spends their last days in one of 26 states, the parent is chosing what your wealth is used for. [1] I hope that didn't come across as suggesting your mom was only making a financial choice, or that she didn't make her choice out of love. I'm sorry you lost your grandmother and I hope your mom enjoys her retirement.
- siquick 5y ago
  My partners grandmother in Sydney moved into a care home earlier this year as she nears the end of her life. She had to pay over $500,000 upfront which gives her 10 years of care there, and then its a pro-rated amount is refunded upon death. I can't imagine there are too many people in this world with half a million dollars ready to go.
- coryrc 5y ago
  Why should strangers pay so your family can receive an inheritance? That's basically paying you because your parents were wealthy.
- lmm 5y ago
  I was agreeing with everything up until the last paragraph. If you had an inheritance to pass on you were already in the wealthy class; letting the rich spend everything they can and more on end of life care reduces wealth inequality (though it's a very poor allocation of society's production IMO).
RobertRoberts 5y ago
Can't people choose to refuse medical help? The only reason I see expenses really causing massive debt is if you choose to accept/request medical procedures you can't pay for. While it's morbid to consider the idea of just letting yourself die because you don't want to go into debt, it still is a choice... isn't it?
- leetcrew 5y ago
  not always. you obviously don't get to choose if you're unconscious and someone calls an ambulance for you. or if you get a concussion or injure yourself while intoxicated, you might not be able to fully consent to being taken to the hospital. even DNRs are not always respected.
  - lazide 5y ago
    A friend of mine has terminal cancer and is in a place like this - DNR’s pasted everywhere as the worst fear he has is he’ll get rescucitated and be even worse off.
- dnautics 5y ago
  In a whole lot of cases dying is, whether we like it or not "I/we/We[0] don't want to pay for it anymore". I have the experience of pulling the plug on my dad, not for financial reasons, but because it was very clear that he was going to die anyways and it wasn't worth the emotional energy to keep him around (luckily for us, everyone important had time to say their goodbyes and several annoying people had said their goodbyes too [1]). But it also brought into focus to me that we COULD have spent/forced the system to spend millions of dollars in extraordinary resources to keep him alive. Medical technology is quite advanced these days. Advanced != free. And there's a thing where the longer you try to prolong someone's life the more progressively expensive it becomes, not just from a "price of care" perspective but an "[externalized] cost of care" perspective. Is it worth X carbon dioxide emissions to keep a person on a "level-III dialysis machine"? Is it worth X acres of rainforest to extract an anticancer drug to keep someone's cancer at bay? Anyways the political divide, in the US, between the left's clueless utopianism and the right's underhanded support of market-distorting profitmongers, has become so farcical that it's impossible to question if humans should have "a general right to have their life extended" even if there are actual, difficult questions to go around. [0] capital We, as in "the state" [1] if you ever have the experience of being by the bedside of someone who is dying (n=2 for me), you will see people who come to visit, and have so much pathos, I suspect largely due to their own hangups about death. To be at your best in your role, you will want to shoo them away as quickly as possible.

by ericb 5y ago

horsawlarway 5y ago

It's worse than just lost startup opportunities. I think healthcare in the US is riddled with ways to "accidentally"* spend the entire accumulation of your wealth, leaving absolutely nothing to the next generation. Long term care is needed by a lot of folks over the age of 65 (~70% of adults age 65 will require at least partial long term care). Even "reasonably cheap" care (in my experience, roughly the same quality as living in a college dorm, with a roommate and a meal plan) can easily run 10k/month - or 120k a year. Of those needing long term care (roughly half of all folks): Men will need that care for an average of ~2 years, women nearly 4 years. 20% will need that care for 5 years or longer. I watched my parents spend all of their inheritance covering long term care costs for their parents (Alzheimers is a bitch). Once the inheritance was gone, they worked longer than they would have preferred to continue covering those costs (my mother only retired this year when my grandmother died of covid - as horrendous as it sounds, it was almost a blessing). My personal take is that "single family homes" and "private healthcare" are a literal fucking disaster for long term wealth inequality. That policy combination takes a lot of middle class families and leaves them poor. * - I personally don't think it's an accident at all, I think it's very, very intentional.

dragonwriter 5y ago
To be fair, long-term care is not just an opportunity to accidentally (from the perspective of the holder, not the system) get rid of one’s accumulated wealth, it is often the motivation for intentionally doing so prematurely, in order to qualify for Medicaid (which pays for the majority of long-term care in the US.) OTOH, for people who don’t have the knowledge or professional advice to do this (which, of course, correlates strongly with having more wealth to start with), it is a trap for accidental wealth drain rather than intentional redistribution, so the poor get generationally poorer, while the better off are also better able to protect generational wealth, both benefiting from programs for the medically indigent.
- coryrc 5y ago
  Every dollar spent on the elderly who had their whole life to prepare is a dollar not spent on a child growing up in poverty who has not yet had a chance. Families should take care of their own. If nobody is willing to do that for you, you probably aren't deserving.
  - lazide 5y ago
    Well, except it isn’t right? We can and do budget them separately. Might be more fair to say ‘every tomahawk missle fired randomly at a target at the Middle East is an entire middle class families lifetime income down the tubes’.
    - coryrc 5y ago
      It's just as fair in my opinion.
ancode 5y ago
> I think healthcare in the US is riddled with ways to "accidentally"* spend the entire accumulation of your wealth, leaving absolutely nothing to the next generation. That's not true, the money isn't just lost. The money is passed to the children of the person who extracts the money from the sick people. It's by design.
- lmm 5y ago
  The money isn't passed on intact though. At the end of the day we pour a huge proportion of our real production - human hours of labour - into prolonging the lives of people who are barely remembering or experiencing anything.
makomk 5y ago
This isn't just a US thing. For example, even though healthcare is nominally free at the point of use here in the UK, that doesn't cover long-term care for the elderly - you will have to pay privately for that out of your wealth to companies of varying degress of sleaziness until you have no more left, at which point the government will hopefully consider picking up the bill. Our current conservative goverment is planning on capping this and it seems fairly controversial.
0des 5y ago
> my mother only retired this year when my grandmother died of covid - as horrendous as it sounds, it was almost a blessing I can only imagine the hardships your family endured for this sentence to come out. I'm glad things are working out for you guys and I'm sorry for your loss.
sophacles 5y ago
> I think healthcare in the US is riddled with ways to "accidentally"* spend the entire accumulation of your wealth, leaving absolutely nothing to the next generation. ... > * - I personally don't think it's an accident at all, I think it's very, very intentional. Its extremely intentional wealth stealing, and it's even worse than just lost generational wealth transfer. Filial responsibility laws mean that your illness and long-term care are your children's financial burden: https://en.wikipedia.org/wiki/Filial_responsibility_laws https://en.wikipedia.org/wiki/Filial_responsibility_laws . In the worst cases, people estranged from their parents for decades end up bankrupted. Depending on what state your grandmother lived in - your mother may have been on the hook even if she hadn't chosen to keep working to care for her mom.[1] The idea that paying for elderly parents' expensive (intentionally or accidentally) care is a choice only applies to people in less than half of the states. These laws make the only choice "pay the provider directly now" or "pay the provider costs and late fees, etc via the courts". So anyone who wants to claim that the people who care for their parents are chosing to do so is claiming wrong - if your parent spends their last days in one of 26 states, the parent is chosing what your wealth is used for. [1] I hope that didn't come across as suggesting your mom was only making a financial choice, or that she didn't make her choice out of love. I'm sorry you lost your grandmother and I hope your mom enjoys her retirement.
siquick 5y ago
My partners grandmother in Sydney moved into a care home earlier this year as she nears the end of her life. She had to pay over $500,000 upfront which gives her 10 years of care there, and then its a pro-rated amount is refunded upon death. I can't imagine there are too many people in this world with half a million dollars ready to go.
coryrc 5y ago
Why should strangers pay so your family can receive an inheritance? That's basically paying you because your parents were wealthy.
lmm 5y ago
I was agreeing with everything up until the last paragraph. If you had an inheritance to pass on you were already in the wealthy class; letting the rich spend everything they can and more on end of life care reduces wealth inequality (though it's a very poor allocation of society's production IMO).

RobertRoberts 5y ago

Can't people choose to refuse medical help? The only reason I see expenses really causing massive debt is if you choose to accept/request medical procedures you can't pay for. While it's morbid to consider the idea of just letting yourself die because you don't want to go into debt, it still is a choice... isn't it?

leetcrew 5y ago
not always. you obviously don't get to choose if you're unconscious and someone calls an ambulance for you. or if you get a concussion or injure yourself while intoxicated, you might not be able to fully consent to being taken to the hospital. even DNRs are not always respected.
- lazide 5y ago
  A friend of mine has terminal cancer and is in a place like this - DNR’s pasted everywhere as the worst fear he has is he’ll get rescucitated and be even worse off.
dnautics 5y ago
In a whole lot of cases dying is, whether we like it or not "I/we/We[0] don't want to pay for it anymore". I have the experience of pulling the plug on my dad, not for financial reasons, but because it was very clear that he was going to die anyways and it wasn't worth the emotional energy to keep him around (luckily for us, everyone important had time to say their goodbyes and several annoying people had said their goodbyes too [1]). But it also brought into focus to me that we COULD have spent/forced the system to spend millions of dollars in extraordinary resources to keep him alive. Medical technology is quite advanced these days. Advanced != free. And there's a thing where the longer you try to prolong someone's life the more progressively expensive it becomes, not just from a "price of care" perspective but an "[externalized] cost of care" perspective. Is it worth X carbon dioxide emissions to keep a person on a "level-III dialysis machine"? Is it worth X acres of rainforest to extract an anticancer drug to keep someone's cancer at bay? Anyways the political divide, in the US, between the left's clueless utopianism and the right's underhanded support of market-distorting profitmongers, has become so farcical that it's impossible to question if humans should have "a general right to have their life extended" even if there are actual, difficult questions to go around. [0] capital We, as in "the state" [1] if you ever have the experience of being by the bedside of someone who is dying (n=2 for me), you will see people who come to visit, and have so much pathos, I suspect largely due to their own hangups about death. To be at your best in your role, you will want to shoo them away as quickly as possible.