Reply to Are your parents in a nursing home paid by Medicaid? Are you concerned the program will get cut?

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[quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous][quote=Anonymous]
I work in health policy.

The Paragon Health Institute is a conservative health care think tank that will have a lot more sway over policy in the Trump administration.

Here is a recent white paper of theirs about how to reform long-term care in the U.S. They think Medicaid is the reason long term care is so expensive and that the country would be better off if all but the poorest families were required to pay for it on their own (without Medicaid’s help) or through new long-term care insurance arrangements. Better buckle up kids, this ride won’t be for the feint of heart.

Long-Term Care: The Solution

https://paragoninstitute.org/medicaid/long-term-care-solution/

“Congress should remove Medicaid as an end-of-life, wealth-preserving, fail-safe for the middle class and affluent. Medicaid should not reward people who neglect to plan responsibly for LTC by both paying for services and providing asset protection. New public policy should incentivize early planning for LTC that employs private wealth, including savings, home equity, life insurance, and a revitalized private LTC insurance market. Recent research documents lower risk of severe LTC expenses and indicates that consumers have more funds available to pay privately for LTC than previously believed. These facts suggest a way to revitalize the senior living market financially to the benefit of LTC consumers and providers alike. With more private LTC financing, fewer people will become dependent on Medicaid. Medicaid can then become a better payer of last resort than it is now. This paper explains how and why this new approach is plausible, practical, and preferable given current demographic and financial conditions.”

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This "concept" of a plan has no basis in reality. My parents were thrifty and still needed Medicaid for LTC. I find this absolutely maddening.[/quote]

But YOU have wealth. That's the kicker. The government doesn't want you passing along your elderly if they (or you) have resources. Medicaid is supposed to be for last resort. For the truly indigent. Like dogfood eating out on the street. Sounds like the Trump Administration is going to love this policy advice. If the government won't pay, what are you going to do?

"wealth-preserving, fail-safe for the middle class and affluent."[/quote]

No, I don't have wealth. I assisted my parents, now some of my siblings as well as my college kids. I'm tapped out. This is all set up to keep working class folks working class while they privatize all profits for themselves.[/quote]

Right. It’s all about rich people getting to pay less in taxes, which will result in middle class families having to spend any retirement and college savings on caring for elderly family members who pre-reform would have qualified for Medicaid help. When families have less money, they have to work longer, the supply of labor goes up and the cost of labor is cheaper for big business. Plus, if Medicaid becomes a minor payer for long term care, more people will be paying (higher) private rates for care.[/quote]

Well you should clarify and make that be "the ultra rich" pay more.  The middling rich--those who earn most income from a W2/CapGains/Interest/Dividends pay out the wazoo for taxes--there are no legal loopholes for them.  37% on most of income, Medicare, SS, and 8-10% on majority of income at state level.  It puts them close to 55-60% tax overall.  We don't need "more taxes" at that level.  We need to find a way to tax the ultra rich.

But people also need to plan.  My LMC parents (in 80s, never earned more than $45-50K as family in their lifetime, normally it was much lower) managed to purchase LTC insurance and have kept it up.  They also were truly frugal, our home was not nice, but it was a safe place with heat, water and a roof over the head.  They lived on 1/2 acre+ and raised chickens and had a huge garden.  They did 95% of their home repairs themselves until age 55/60.  I personally helped dad reroof 2 homes while growing up---he figured it out because it needed to happen and we couldn't afford to pay someone.

Well those parents had over $750K when they sold their home (only $180K of it) and moved to a CCRC (we had to pay entry fee otherwise they qualified).  They always made savings a priority and we lived frugally.  I got $25 from them for bday and xmas and that was it.  If it was a bad year, we got nothing.  But they managed to save save save, despite many times of unemployment my first 15 years that set them back.  Even after, they did whatever to have a job so they wouldn't fall behind.

Now they are living a decent retirement
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+1 the US tax system sucks. The super rich need to pay in way more. Musk should make up whatever shortfall personally since he’s the richest man in the world. He basically bought our country. Can’t Trump, the supposed master deal maker, get a better deal for selling our country?[/quote]

Right now, the ultra rich will continue to use the legal means to avoid paying taxes.  Look at WA state--they implemented a 7% Cap Gains tax in 2022, on amounts over $250K, not from home sales, so basically just targeted at Stock Sales/STock options for the rich.  Not shockingly, Bezos move his "primary residence" to Florida shortly afterwards (a state with NO taxes).  He's not the only one to do that---if you are able to easily do it, you will.

We are in the W2 rich, and we pay the max.  There are no legal ways to avoid it.   So I defiantly don't want to pay more.  I want to tax the ultra wealthy but that definately won't happen in next 4 years.

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