From: stephen@sprunk.org   
      
   On 27-Apr-15 13:35, Adam H. Kerman wrote:   
   > Stephen Sprunk  wrote:   
   >> On 27-Apr-15 11:27, Adam H. Kerman wrote:   
   >>> Stephen Sprunk  wrote:   
   >>>> On 25-Apr-15 21:27, Adam H. Kerman wrote:   
   >>>>> You may have noticed that Medicare isn't means tested, so   
   >>>>> that's simply not true.   
   >>>>   
   >>>> And why do we have Medicare in the first place?  Private   
   >>>> insurance for seniors was so expensive (if available at all)   
   >>>> that virtually none of them could afford it.   
   >>>   
   >>> You can't support that statement.   
   >>   
   >> Good grief, Adam; that was an established fact ~50 years ago when   
   >> Congress enacted Medicare in the first place.  Since then,   
   >> seniors' income has gone up at less than the rate of general   
   >> inflation, while medical costs have gone up at twice the rate of   
   >> general inflation, so there is no question they couldn't afford it   
   >> now.   
   >   
   > We keep people alive for hours or days at extraordinarily high cost   
   > for absolutely no benefit to the patient, something that wasn't done   
   > 50 years ago, so you're making an apples and oranges comparison.   
   >   
   > We're also doing surgery today that wasn't done way back when; not   
   > comparable.   
      
   Irrelevant to the issue of whether seniors could afford such care, if   
   not for Medicare, and thus whether means testing is useful.   
      
   If your proposal is to eliminate Medicare and let seniors die earlier   
   rather _anyone_ spending that money, well, that's another discussion.   
      
   > In fact, health care would likely be dirt cheap without including   
   > the end-of-life crap.   
      
   Well, roughly half of all spending is in the last year of life; if we   
   were to somehow exclude that, we'd cut spending quite a bit, but the   
   result still wouldn't be "dirt cheap".  That'll never happen anyways due   
   to the hysteria about "death panels"--and the extremely high voter   
   participation rate of seniors.   
      
   >>>> The cost of means testing would be higher than the savings   
   >>>> from denying coverage, just as we've seen recently in states   
   >>>> requiring drug testing for welfare benefits, so it is a net   
   >>>> savings to just offer it to everyone.   
   >>>   
   >>> You can't support that statement either.   
   >>   
   >> The "means testing" overhead in welfare is an _enormous_ expense,   
   >> and people slip through the cracks anyways due to undocumented   
   >> income.   
   >   
   > Ok, so Medicaid just has no way to deliver services to those poor.   
      
   No, Medicaid is provided to many people who shouldn't qualify because   
   their income is undocumented, so their "means" is lower than the govt   
   databases says it is.   
      
   OTOH, due to means testing, many of the working poor lose benefits even   
   though they're not making enough to buy replacements, which either   
   forces them to make less than they could _or_ go without, and going   
   without often means they end up paying even more, e.g. via lost wages.   
   This is part of the welfare trap.   
      
   > Funny how that doesn't prevent seniors from being on Medicaid to pay   
   > for nursing home care.   
      
   ITYM Medicare.  Nursing homes might be paid for by their kids (rather   
   than take them in and have to care for them themselves) or by selling   
   their house, which won't show up as "income" in a means test.   
      
   S   
      
   --   
   Stephen Sprunk         "God does not play dice."  --Albert Einstein   
   CCIE #3723         "God is an inveterate gambler, and He throws the   
   K5SSS        dice at every possible opportunity." --Stephen Hawking   
      
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