Yeah, Medicaid estate recovery is fucked. It goes back to older conceptions of social welfare where there was presumed to be some obligation on the part of the family or estate to pay before the government. (See also immigration affidavits of support.)
California had plenty of desire to get rid of it, but couldn't entirely because it would have cost a lot - Medicare doesn't pay for much nursing facility service, so Medicaid typically picks it up for a large chunk of people and that's expensive. Also the federal government imposes minimum requirements on what states must try to recover. What we were able to do as of 2017 was go down to the minimum federal requirements, so we eliminated recovery if:
* It would be from a surviving spouse or domestic partner, or a surviving child under 21 or blind or disabled
* It's in a trust
* The house is less than 50% of local median value
--and to only recover for nursing facility services from people permanently institutionalized, not for all health care premiums.
Oh, and those bullets are connected by ors, not ands.
The flip side of this is you need to be truly, catastrophically poor to qualify for Medicaid, to the point where Social Security can disqualify you. I would guess the majority of folks that get bit by this own a house; your primary residence doesn't count as an asset until after you are dead.
I am very much in the weeds on Medicaid right now. I have two elderly relatives who are close to flat broke but qualify for almost no assistance.
I'm of two kinds on recovery. (1) Medical debt is fucked, period. But (2) investing $$$ into a house doesn't magically make it a divine intergenerational entitlement.
The obvious solution is to blind your children.
investing $$$ into a house doesn't magically make it a divine intergenerational entitlement
I strongly agree on this principle when it comes to taxes (see yesterday's post), but I think when it's a social welfare program it makes more sense to charge it off everyone via taxes.
Right, the problem is more that Medicaid is means tested at all than that there's anything specifically unseemly about recovering from the estate. Once you accept (which we shouldn't) that it's a program for the indigent only, it makes sense that Medicaid recipients wouldn't be able to leave assets to their heirs.
Iowa is probably supposed to be a dystopia, to stop those bastards from growing all the corn.
Right, the problem is more that Medicaid is means tested at all than that there's anything specifically unseemly about recovering from the estate. Once you accept (which we shouldn't) that it's a program for the indigent only, it makes sense that Medicaid recipients wouldn't be able to leave assets to their heirs.
I'm not sure I agree with that actually. Not sure quite why I think this, even in the case where we have means-testing as a non-preferred-but-the-best-for-now program, that means-tested program should still as a principle be funded by general taxation, rather than recovering from individual estates. Except perhaps especially heinously wealthy estates.
Heebie, sadly it get worse. I've read that in many states, ex-cons are billed for the costs of their incarceration. No joke.
9: Isn't the issue that in order to pass the means test they're required to spend down their assets? So if they have any assets at death that was money that was supposed to be spent before medicaid started paying?
11: I think that too is unseemly. (It doesn't apply to the large number of people who post-ACA qualify based on low income alone, but I think the requirement kicks back in when you turn 65, and possibly for any long-term nursing facility care.)
What would improve medicaid is if we made it an interest bearing loan non dischargeable in death. The cost of your medical care would be inherited by your descendants, who would have to work in debt bondage against the amount until it was fully paid off.
I have been in the weeds on this. My parents screwed things up Royally. My mother is only protected at all by the fact that her father an grandfather set up not big trusts that are so old there is no look back worry, and the trustee gives no money to her directly.
This is why Medicare needs to be more generous, and we just need single payer. But I believe that social care in the UK is means tested too. And Canada. Yawnoc, you have my sympathies. If you ever want to talk on the phone, I would be happy to. Dealing with the financing of elder care was the most lonely experience of my life, because nobody wants to talk about it.
The guy I mentored through prison is in a funny spot. He has a college degree now, but realistically the kinds of jobs that would hire for someone with a conviction are manual labor. He is an only child and moved in with his mother. They did put the modest house in trust and it will be transferred to him in case she needs a nursing home.
He had a heart attack while driving and hurt his back, so he is on MassHealth through disability. It makes no sense for him to work, because he needs that level of health insurance and the work he can get would likely not be safe. He is thinking about trying to work part time when he files for social security and has access to Medicare.
11 and 12 are right mostly, but if you get it because of SSI disability or need long term care type supports even if in the community, you are ina different category.
Universal non means tested health care with sliding scale fees for nursing homes that don't require asset depletion is one of my most fiercely held policy positions.
The whole asset recovery stuff means that smar middle class people need to hire lawyers to plan around it, and they just shouldn't need to do that.
Next up universal childcare.
I have such strong feelings about these topics that I can't format the paragraph properly on my iPad, and I switched to the desktop.
Yawnoc - the offer of support is sincere.
I have such strong feelings about these topics that I can't format the paragraph properly on my iPad, and I switched to the desktop.
Yawnoc - the offer of support is sincere.
And the sticky mouse strikes again.
You're the one who stores maple syrup without a lid.
You're the one who put out the glue traps.
That one makes more sense.
9: Not sure I understand how general taxation squares the circle? (a) The state is willing to subsidize medical care but only for the genuinely needy. (b) It's shitty for people to have to sell house because they can't afford medical care. (c) It's no fair for homeowners to pass assets on to their heirs that non-homeowners would have had to spend down due to (a).
In fairness to CA, the asset limits here are quite generous ($130K). In not-fairness to Medicaid everywhere, it is possible to be flat broke and too healthy to get any benefits. My 100yo grandmother stands a reasonable chance of being in this situation because she can't live alone but she can walk, dress, bathe and feed herself. She doesn't need skilled nursing! She just needs to have budgeted for living an unreasonably long time!
15/16: I appreciate that! Being pathologically introverted I may not take you up on it, literally, but I'm dropping my email below. (We may be connected on social media? I'm not sure.)
I'm really bad at recognizing people from here on Facebook.
21: Not sure I understand the circle needing squaring. It's not that big a step, or that expensive in the federal picture, to just end spend-down and estate recovery in one blow. Determine the needy by income, not assets, like how the ACA part of Medicaid already works - simplicity is better for everyone. Demanding proof of assets keeps out out a lot more needy people than eliminating it would admit wealthy people.
Demanding proof of assets keeps out out a lot more needy people than eliminating it would admit wealthy people.
It all very well to do the math on that, but the actual standard is that if a single 'undeserving' person of color might get a single nickel's worth of benefit, the whole program is a sham and a fraud and should be shut down.
24: More is/shall-always-be elision as this standard has been chipped away at significantly. Obamacare made millions people eligible by income alone. Who knows how many people in the MAGI eligibility categories have assets they could be spending down? I don't! Has Fox News ever gone after that? Not to my knowledge!
A big part of the problem here is just that houses, especially in California, are just way too valuable. Why should heirs in California get a multi-million dollar windfall while everywhere else people have to spend down all their assets?
I mean the current system sucks, but changing just how houses are treated and nothing else about the system makes it worse and not better.
Maybe people in California could build more houses? Did anyone think of that?
21: Mine's in the e-mail field, and I'll send you an e-mail now
23: I would express that as "eliminate asset testing" and not "increase taxes." And I'd say you're squaring the circle by redefining "genuinely needy." (I think we mostly agree, I was just confused by how you put it.)
I was really very surprised to learn that a reasonably healthy person with zero assets can be disqualified from Medicaid by a Social Security check.
30: they have to spend it down below a certain amount so that they neve have more than $2000 in assets, and you have to make sure that the expenses are qualifying, but they can still get Medicaid.
So, like, if you're in a nursing home the bulk of your money goes to pay the bill and you get to keep a little bit - not enough to upgrade to pull-up Depends, mind you.
But that's what I meant by "reasonably healthy person"... The way I understand it, if you don't require skilled nursing (e.g., because you can dress and feed yourself) but you still need some help (e.g., managing your meds or memory care), you're SOL if you can't afford it.
On the plus side, if you can feed yourself and need memory care, it's much cheaper.
31: No, any medical expenses qualify, transportation expenses to medical appointments etc. get you below the countable asset limits. There are specific expenses which count. Elder care lawyers know this stuff.
24 brought back to mind something I've been thinking recently: if we didn't have people of color in this country, is there any doubt that white people would find new and improved ways of hating one another, of creating fresh categories of undeserving poor, of ginning up even deeper resentment toward their neighbors who somehow managed to do well? My point is either that racism is epiphenomenal to hatefulness or maybe that Americans are terrible people, full stop.
That was me, a keen student of hatefulness.
As you know, we WASPs already failed that test, applying it to Irish, Jewish, Italian etc etc people. And then lower class WASPs. Women of any description. If our apparent capacity to hate our fellow humans could somehow be turned into energy, fossil fuels could be retired.
Have we discussed another of the seven hells of the US healthcare industry, subrogation? I've gotten these letters before and never worried about responding because their line of inquiry is usually comically off-base (your wife has had sciatica for 10 years? We're going to ask if there's anyone we can sue after this random chiropractic visit!)
However I just got a letter for the injury I had in the fall and I really have no interest in helping them pursue a lawsuit against the kid who shot me with a puck or the rink or the youth hockey organization. They say my health insurance requires that I respond- how can I answer in the least helpful way that is still true?
38: I don't think they go after the hockey league or the kid. But if it's a work-related thing, they wanted workers compensation to pay, and if it's a car accident, they want the automobile insurance people to pay.
38: By hiring a lawyer and asking they have all correspondence go through the lawyer.
Lawyers have the annoying habit of asking for payment for their services.
39- Its a volunteer org, but there's some sort of insurance through the national hockey association which I have as a dues paying member (required for anyone on-ice.). I actually wouldn't mind if they sued that organization because they're mostly middle-aged jock assholes.
Maybe there's a free chatbot lawyer?
My insurance company's lawyer, who I guess was really my lawyer, told me to answer questions honestly and with no speculation at all. Since the suit wasn't even filled for close to a year after the accident, my answer was nearly always "I don't remember." But it seemed like the main thing they were trying to figure out is if there was someone they could sue besides me. Which there was not.
They were repeatedly trying to see if I wasn't working for someone while I was driving. But I really was going to get pizza.
They didn't even let me show them the receipt from the pizza place.
In other research for this thread, I found that as of this July 1, California will raise the asset limit in toto (all non-MAGI services, where MAGI is the portion already free of an asset limit) to $130,000 for a single person and $65,000 for every additional household member past the first. On January 1, 2024, we will eliminate even that limit.
35. You see, if the white people hadn't made such a good job of the genocide of the people of colour who were already there before they turned up, they could just have gone on hating them and saved a lot of hassle.
46 and 48: For the over 65 group as well?
I'm assuming I should buy long-term care insurance soon. I don't want to burden my family and I've got a family history that involves long-term care. I put it on my calendar for next December.
Yea we're building a world where you should move all your assets to your children the second you retire.
48/49: Pretty sure - I read several summaries and none of them said any group or care type was exempt. But because asset recovery hasn't been eliminated for nursing facility services yet, many people will be billed it back further down the line.
Maybe you can wait until you start falling over like McConnell?
38/39 etc:
As my grandmother told my father as a child, on the occasion of her burning all her communist documents because the FBI was coming to interview them (on an unrelated matter but you don't want stuff like that lying around), "Answer their questions truthfully but don't say anything else."
So I guess I shouldn't mention that I have a video of the incident unless they specifically ask...
If you did kill someone and you answer the detective's questions, and he leaves but comes back saying "Just one more thing," you should just confess.
You should check to be sure you aren't Robert Culp.
Today I learned that Coach from Cheers directed the (very good) episode of Colombo where Johnny Cash was the murderer.
When I read this, I think about how the people in my family who are so hardworking cannot pay their bills, or get medical care for their children at times. Some cannot work, due to disability. They have it the worst. It's always been bad but has gotten worse. An elder would be panicked about the fact they had no money to heat their house. Everyone would be upset they had to deal with this, because sometimes they did not have money either. People would be working long past retirement. The lucky ones did retire but then when they got old, there was nothing they could do about their inability to care for themselves. If my grandfather fell on the floor, my step grandmother would have to call the fire department to pick him off the floor because she was not strong enough.
They all blame themselves for their predicament, and each other sometimes. If I say 'you know, maybe somebody who works all the time and makes $1750 take home pay and pays $750 for their health insurance each month actually doesn't have enough money to live on. And maybe that's not right' there's no place for this information to go. It just seems irrelevant.
They take responsibility for everything. They don't even think about how society is doomed because they are mostly worried about how they are doomed.
I try to tell the young people I work with that it's understandable if you want to give up, but it's also giving in. If you hit someone long enough they do eventually give up, and feel helpless. I think it's always better if a small part of you always remembers you are being hit over and over, and this is why you are tired but this person has no right to hit you and one day you might find the strength to hit back.
60- yeah, I wanted to see where the shot came from because I had no idea. I showed it to other people who wanted more details about what happened. It's from a camera used to broadcast games, so it covers the whole rink and isn't a very close up video. I looked more annoyed than injured. I can add it to the Flickr group if that's still around (weren't they going to shut off Flickr?)
Actually I already put it on the other place so some of you have probably see it.
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a debating club in which romantic students discussed Byron, sex (they invented an 'Erometer' for measuring passion) and the liberation of Poland. But too many people heard about them and wanted to join.|>
At some point we'll maybe take a look at solving this tough problems of equity for the non-wealthy without introducing moral hazards but first we must urgently endeavor to make whole various tech enterprises and individuals.
And look, I understand the point of how these banking fuckups need to be managed in a way to not fuck over society and economy as a whole, but holy shit talk about moments when the truly rigged nature of the system is laid bare.
Larry fucking Summers of course:
"What is absolutely imperative is that, however this gets resolved, depositors be paid back, and paid back in full," Summers said on Bloomberg Television's "Wall Street Week" with David Westin. And as long as that's the case, while there will be risks to banks' asset values, "I don't see -- if this is handled reasonably, and I have every reason to think that it will be -- that this will be a source of systemic risk," he said.
You, you rancid motherfucker, you're the systematic risk if you take a little longer and deeper look.
But I ignore a universal base level truth, indulging the vanities of the rich and powerful is more important to the social fabric than meeting the needs of the masses. You know, until every once in a very long while, it isn't.
Thiel almost certainly shorted SVB before telling his companies to pull their deposits and cause the bank run, right? And probably that was totally legal?
Our relative who is always edging closer to straight up right wink crankdom warned us to pull money from another bank but 1) we don't have an account there and 2) does he actually think we have over $250k in cash sitting around in any account? Or maybe he doesn't believe in the FDIC either.
69.last: Once more something had slipped through my fingers. Only this time I knew very well what it was. Money. The heart of reality. The rejection of reality the only crime. I was a dreamer, a criminal.
-- Jake Donaghue in Iris Murdoch's Under the Net
Book rec aside: I find this to be Murdoch's best novel and if you are going to read one of hers, I would suggest this one. Although I think it is good I read it in my early '20s after seeing it mislabeled as Under the tent in a used bookstore in Chapel Hill. Reread it several times, but it does not completely hold up for me these days although still recommend it.
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who had been sent to Vilnius to investigate rumours of sedition in the university, was roused from a drunken coma and signed an order licensing the police to act|>
Apparently Joyce Carol Oates (a wild and nutty sometimes incisive Twitter follow) was not an Iris Murdoch fan:
(excerpt from an uncompleted novel of Iris Murdoch focusing intensely, one might say hysterically-minuscule-ly, upon banal-stereotypical notions dressed up in philosophy-speak is no departure for the deceased novelist but her usual fatuous characters are here unleavened by wit.)
Context is she is commenting on this recent New Yorker piece: "Agnes Callard's Marriage of the Minds: The philosopher, who lives with her husband and her ex-husband, searches for what one human can be to another human."
I think her mockery applies more aptly to Murdoch's tediously lengthy The Message to the Planet one of the few other Murdoch's I've read.
And since I've Saturday morning tangentialized the thread into book stuff, let me drop a rec for which I have been looking for pretense to do so.
This one is from neb via Twitterhell and I will say it is the best rec I've gotten from any of you lot since Independent People or American Astronaut.
Book in question is Radetzky March from the '30 by Joseph Roth. Set in the last decades of the Austro-Hungarian Empire it has the generational sweep of a classic Russian novel. Highly recommended.
I think neb's comment was "Scandalous how long I was allowed to go before reading The Radetzky March" Of course for me it was scandalously longer.
Sample: He was old and tired, and death was already lurking, but life would not yet let him go. Like a cruel host it held him fast at the table because he had not yet tasted all the bitterness that had been prepared for him.
Cheery thoughts for the weekend.
I recently read two bitter (is there any other kind?) campus novels, Disorientation by Elaine Hsieh Chou and Bad Habits by Amy Gentry. Neither were great literature--the former was interesting in the "yes, I recognize that sort of vicious battle between two academic departments that would seem to have much overlap" sense but the writing would probably have been better had the author been a bit further removed from her own grad experience. I frequently cringed while reading. The latter was a fun thriller if one enjoys the kind of book where every single person in it is a terrible person.
It seems harsh that they call it a "bank failure". Sure, the bank failed, but only after forty years. Why define it by its last, worst moment?
70: Try to sell them some Iraqi whatevers.
I, obviously, have been enjoying Ascherson's Black Sea.
That looks interesting. I'll give it a try. Thanks. I've been having trouble reading fiction lately.
Fictionally, I've been trying to read Margaret Atwood (The Blind Assassin) and Michael Innes. But it's not going well in terms of finishing books.
I finished "Thundersticks" and have decided that thematically organized non-fiction is where my head is at.
Any thoughts and/or links on the Saudi/Iran deal, anyone?
Regarding nonfiction, might be time to read Crossing the Bay of Bengal, acquired in 2020; regarding fiction, I've gotten as far as realizing that everything I've been trying to write is too dark to read even outside of a dog. Wish I were better at dark comedy.
AIMHMHB, When I worked in a bookshop Iris Murdoch was the most gratuitously unpleasant customer I ever encountered. Also, she was a full on Platonist. Fuck her.
82.1 yes. It's a good thing. And I don't care if it was brokered with Chinese help. It's probably a dead letter but maybe there's hope yet for the JCPOA.
The guys with the "Stop Executions in Iran" banner on the 80/580 pedestrian overpass in Berkeley are really dedicated, showing up every non-stormy day at rush hour. I honked for a while and then realized I couldn't get my car to make the "I have still not taken any concrete actions in service of this cause" sound, which is an aftermarket patch.
Is there a horn that means "Don't execute people for any worse reasons than parts of America "?
I don't know how much meaning I'm supposed to get out of The Blind Assassin, but I absolutely adore the aesthetic it peddles.
Buttony is definitely a deadly sin, but disagreement on its precise nature remains fierce.
Umm, when are we going to start burning shit down?
95 me.
82: I think it's part of a general exhaustion with the regional cold war since c.2011; cf. normalizations with Syria and Israel, GCC reconciliation with Qatar. Everyone's bloodied and has internal problems to worry about. PRC mediation is part of the same story: the US doesn't care enough to monopolize the region, so everyone is dealing with Chinese, Russians, French, whomever.
https://www.al-monitor.com/originals/2023/03/china-leaps-saudi-iran-diplomacy-nuclear-talks-move
https://www.france24.com/en/live-news/20230311-iran-says-deal-reached-to-buy-russian-fighter-jets
https://www.reuters.com/markets/currencies/irans-currency-slides-record-low-savers-buy-dollars-2023-02-25/
https://www.haaretz.com/israel-news/security-aviation/2022-09-13/ty-article/.premium/two-years-after-abraham-accords-why-the-uae-f-35-deal-remains-grounded/00000183-3743-d070-abef-f7d755450000
https://breakingdefense.com/2023/02/potential-f-35-reaper-deal-with-uae-not-completely-dead-senior-us-official-says/
https://www.al-monitor.com/originals/2023/03/iaea-iran-visit-opens-window-restart-nuclear-diplomacy
Back on the SVB stuff, the utterly cringing whining (and implied threats) of some of the techbros is just so fucking unseeemly.
Just amazing to watch. And dispiriting as a fellow human being.
What part of "don't keep more than $250K in a single account" do these captains of industry not understand?
98: Oh my God, yes.
So we opens a new checking account at our local mutual yesterday, because we wanted to move our safety deposit box and get away from Bank of America fees.
The guy helping us asked us why, and we said to get away from Bank of America and find something closer. We went to PDBS, because they had a better parking lot than the branch in our town.
The guy said that about half of their customers said that they were fed up with Bank of America, but he'd had a customer that day who had pulled money out of SVP and he was thinking that there might be more this week.
He s as if that as a married couple we could have 750 k across 3 checking accounts - one in each of our names and a joint account. I have like 10 savings accounts at capital one. That got high-ish when I was saving for a down payment, but never 250k.
You can still buy a whole house near me for $250,000.
98: Wouldn't it be kind of ridiculously complex to do something like payroll for a large company with no account having more than $250,000. Or even $750,000 if the corporation was married?
Wouldn't it be kind of ridiculously complex to do something like payroll for a large company with no account having more than $250,000.
Sure, but large companies can hire enough people to manage the complexity. Alternately, they can buy insurance to cover deposits not otherwise insured.
I've decided that I don't have any money. All I have is a very low cost of living and a gastric disorder.
I'm still mad at Bank of America for cutting my credit limit in 2008 because at the moment they made the cut, I was worth more than Bank of America. They sent me a really snarky letter about how they were limiting my credit for my own good.
Anyway, I'm the beating heart of gr American proletariat.
I won't even get an iPhone to stop these stupid typos, because Android has a more common touch.
Banks like SVB offer extended sweep insurance that automatically splits the funds across multiple banks to take advantage of the $250k limit at each. I'm offered that at a brokerage for up to 1.25M cash (2.5M for joint accounts). I read that businesses can get up to $150M covered by a similar mechanism. But some combination of industry capture (terms of some VC funding required keeping all cash at SVB) and greed (limits returns on the cash) meant no one there did it.
I read that Giannis longlastname keeps his salary spread across dozens of banks to keep it under the FDIC limit. I have trouble believing an all star NBA player can handle it while a company with a dedicated CFO can't.
Maybe the CFO wasn't the dedicated kind of worker that I am?
Probably has an iPhone and a house that has more than one garage.
There's probably a good "It's a Wonderful Life" parody in this crisis. I'm not going to write it because I'm too busy working.
Like, I wouldn't mind raising FDIC insurance to cover losses up to $1 million. But the policy that was paid for is $250K so that's what it is.
Anyway, seems like a full bailout is underway. So much for moral hazard.
I knew Silicon Valley Bank was bad news back when they were giving away a free Juicero with every new account.
Also a bailout is bad because of inflation.
This all creates a good reason to stop hiking interest rates, tho.
I guess inflation means I'm not going to buy a bigger house, so I'll stay in my current place as the embodiment of workerness.
I'm just glad that all my assets are all safely invested in digital apes.
Another bank failed, so check to be sure it wasn't the NFT bank.
As long as TIAA is telling the truth about my OTB index fund, I'll be fine.
I never knew the $250K rule, for what it's worth.
So apparently FDIC for some time has had the chops to keep all depositors whole in all the hundreds of banks it's wound down over the decades. Over $250,000 isn't legally guaranteed, but the protection is so routine it's not really a bailout.
Sorry, 125 was to 123. I was hoping to coax Moby into increasingly idiotic explanations of mundane things.
And I already had this plugged into a calculator to prove my point.
Over $250,000 isn't legally guaranteed, but the protection is so routine it's not really a bailout.
I do think having all the money available by Monday is novel, as opposed to after all the banks assets have been sold.
Also I feel like an "assessment on all the banks" is the kind of thing that respectable economists usually like to point out as a cost that gets passed on to consumers. So, while its not taxpayer money per say, its still a tax on everyone who has a bank account.
I can't believe he won for that and not "George of the Jungle. "
George of the Jungle is more charming a movie than you'd think.
Yeah. I liked it and there's no way I'm ever going to watch The Whale.
I will probably watch the whole of Cocaine Bear when it's streaming. I think the gore will be less arresting on the small screen.
Another vote to never see The Whale.
I wonder how What's Eating Gilbert Grape holds up.
I may watch Encino Man, now that it's got multiple Oscar winners.
Is there appetite for a dedicated SVB thread?
No! Let's do Oscars! It was a good year!
Movies are great. I guess. I didn't really see enough of them to comment on the Oscars.