Middle-Class Shame Will Decide Where America Is Headed

Via:  Bob Nelson  •  one week ago  •  45 comments

Middle-Class Shame Will Decide Where America Is Headed
Who can appeal to the people who feel the most like they’ve gotten a raw deal?

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512Shalynn Womack is 60 years old and lives with a lot of economic uncertainty. She’s one of a group, she says, that “didn’t get the life we thought being well-educated would provide.” Ms. Womack, who lives in Tennessee, is still plagued by “the sense that I must have done something terribly wrong somewhere along the way.”

She said that she and her husband fight about money, scrutinize their spending and often regret the purchases they make. “Certainly, we’ve choked down a big dose of anger about this downward spiral,” she told me.

Over the past few years, I have spoken to hundreds of people, like Ms. Womack, who define themselves as middle class but are seriously economically challenged. In their lives, an illness could mean bankruptcy. I talked to many people who had college degrees, were convinced they were on the right path, yet were shaken by their endless debt — from the cost of their graduate degrees, caring for an elderly parent or paying for a child’s medication.

Sometimes their professions had contracted, resulting in a loss of jobs. Sometimes it was because their work had become irregular and they had no union to negotiate for them. Health care and education cost far more than they once did and wages were barely inching up. As a result, they had personal pain — and ire — that many politicians didn’t take seriously enough.

After all, what I have called the “middle precariat” vote — or what could be called the anxiety vote — gave us this president, and now it has also given us a Democratic House. It is a powerful force.

Any Democrat who wants to win the White House in 2020 is going to need to harness the power of these voters. Indeed, the race has very much started, including the recent announcement of a presidential campaign exploratory committee by Senator Elizabeth Warren of Massachusetts, who has already started to emphasize how the middle class is “hollowed out.”

One of the first challenges is getting people to admit they are struggling financially, and to talk publicly about it. This can be hard for members of the middle class, a group that has a real sense of stigma about financial floundering. They are hobbled by a long-held obsession with privacy and don’t always acknowledge what is troubling them, according to research by Caitlin Zaloom, an anthropologist at New York University.

The second — and most basic — way of addressing the anxious middle-class vote is by acknowledging people’s suffering. At rallies, ask people with student or medical debt to raise their hands, so that they don’t quietly carry it with them for their lives, afraid to speak because they don’t want to admit they need help.

Candidates and politicians should follow the example of New York’s new Democratic congresswoman, Alexandria Ocasio-Cortez, who acknowledged that she wouldn’t be able to pay the costly rent for a Washington apartment until her government paychecks start coming in. They should openly discuss the tendency of many people to blame themselves for their professional and financial distress. Donald Trump jumped on this discomfort in 2016, after all, and made it part of his rhetoric, even though, of course, he had no intention of changing much.

Secrecy about income and money is defeatist. Anat Shenker-Osorio, a messaging expert, discovered that in focus groups which included middle-class people, she heard a lot of expressions of self-loathing. Between refrains about the cost of living and remarks like “I can’t get the kids to college,” participants made statements that conveyed their deeply held belief that not making it meant they were not working hard enough.

“They have imbibed this idea that your economic well-being is traceable principally to your own efforts,” Ms. Shenker-Osorio said.

As a result, what the electorate doesn’t need to hear are Horatio Alger stories of how candidates worked their way up from humble origins, with the implied moral that anyone can make it in America with enough hard work. These kinds of tales can insidiously lead middle-class people today to blame themselves more for not flourishing.

Instead, the new Congress and candidates of the future should tell voters that it’s O.K. to be mad about being in debt, that this is a savage society we now live in. They could talk about their own experience of debt, be it student or medical, or the debt of someone in their family. (What makes this a bit harder is how unrelatable, and depressing, the wealth of our Congress still is: in 2015, it was majority millionaire.)

To win the anxious middle-class vote, politicians must offer real solutions for the challenges in the lives of these voters, especially on health care and education. One example of this is the scholarship program that Gov. Andrew Cuomo of New York put in place: 940,000 middle-class families and individuals making up to $125,000 per year will qualify to attend tuition-free at colleges in the New York State and New York City public university systems. Though not perfect, it’s a step in the right direction.

It is important to get these voters beyond the shame of debt, perhaps by allowing student debtors to be able to declare bankruptcy related to student loans, something that is nearly impossible to do now, and obtain debt forgiveness.

An actual “Medicare for all” proposal would get at the heart of what is a real challenge for many. Michèle Lamont, a sociologist at Harvard who specializes in culture and inequality, told me that her work found that when candidates promote a policy like Medicare for all, even if it doesn’t come to fruition they are signaling that they understand voters’ need for solidarity and give voice to their hopes and difficulties by making them visible.

And politicians should not turn their backs on populism. Although now it may be seen as the province of the xenophobic right, it was, in previous eras (the 1890s!), a crucial progressive inspiration within our country.

Politicians from both parties understand the power of anger and anxiety as a motivating factor for voters. Post-President Trump, it’s impossible not to. But the frustration that comes from people who find themselves slipping down the economic gradient is one of the most powerful untapped resources in American politics today.

A few possible Democratic candidates for the 2020 nomination, from Bernie Sanders to Beto O’Rourke, seem to understand this possibility, and have been attempting to redirect Americans’ anger toward fighting for the things they need, like reasonably priced education and health care. Mr. Trump, no doubt, will continue to mine this territory in a re-election campaign, despite his role in fueling our neglect to begin with.

Middle-class and poor voters have more in common with one another today than they do with the economic ultra-elite. And if they can continue to organize into coalitions, they could be truly powerful forces. Maybe they’d take to the streets most weeks and shut down our cities on a more regular basis, like they do in France.

Then again, maybe the people we elect can express our pain for us instead, so we wouldn’t have to.

Alissa Quart is the executive editor of the Economic Hardship Reporting Project and the author of “Squeezed: Why Our Families Can’t Afford America.”

Lead image: Beto O’Rourke is one possible Democratic candidate for 2020 who seems to understand the power of talking to people who think they’ve gotten a raw deal.
Todd Heisler/The New York Times

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Bob Nelson
1  seeder  Bob Nelson    one week ago
... what the electorate doesn’t need to hear are Horatio Alger stories of how candidates worked their way up from humble origins, with the implied moral that anyone can make it in America with enough hard work. These kinds of tales can insidiously lead middle-class people today to blame themselves more for not flourishing.

... the new Congress and candidates of the future should tell voters that it’s O.K. to be mad about being in debt, that this is a savage society we now live in. ...

To win the anxious middle-class vote, politicians must offer real solutions for the challenges in the lives of these voters, especially on health care and education.

We often hear on NT, "They'd be fine if they'd just work a little harder!" That's not always true. Not even often.

 
 
 
Buzz of the Orient
2  Buzz of the Orient    one week ago

Universal single-payer healthcare is NOT an impossibility.  I grew up with it and lived with it for most of my life and I have nothing but disdain for those who oppose it notwithstanding the bankruptcies and deaths caused by its not being mandatory in a so-called "civilized" country. 

 
 
 
Bob Nelson
2.1  seeder  Bob Nelson  replied to  Buzz of the Orient @2    one week ago

It's totally possible everywhere except in the wealthiest nation in the world...   jrSmiley_88_smiley_image.gif

 
 
 
Jack_TX
2.2  Jack_TX  replied to  Buzz of the Orient @2    one week ago
Universal single-payer healthcare is NOT an impossibility.

In the United States....at this stage....it is.  Had we done it 50 or 70 years ago, it would have been doable.  But that ship sailed one way and we sailed another, and the distance between is now way too far to swim.

That doesn't mean there aren't a lot of things we could do that would actually work.   But we don't want to talk about those, because we're too busy devolving into Idiocracy.

  I grew up with it and lived with it for most of my life and I have nothing but disdain for those who oppose it notwithstanding the bankruptcies and deaths caused by its not being mandatory in a so-called "civilized" country. 

There are a few far left organizations who intentionally misrepresent this information, so be careful about what you believe.

 
 
 
Bob Nelson
2.2.1  seeder  Bob Nelson  replied to  Jack_TX @2.2    one week ago
In the United States....at this stage....it is.  Had we done it 50 or 70 years ago, it would have been doable.

I very much do not understand!

America is far wealthier than it was then. Why was it possible then but not now?

 
 
 
Jack_TX
2.2.2  Jack_TX  replied to  Bob Nelson @2.2.1    one week ago
I very much do not understand! America is far wealthier than it was then. Why was it possible then but not now?

Because the cost of care has outgrown the wealth.  Hence the current desire to solve a problem that didn't exist 40 years ago.

The healthcare industry is nearly 20% of the US economy.   In 1960 it was 5%.  

Healthcare spending in 1970 was about $74.8 billion.  In 2018 it was about $3.5 trillion.  That's about 8.3% annualized growth over that time.  

The US economy was about $1.075 trillion in 1970.  If it had grown at 8.3% annually, it would now be around $49 trillion.  But it's only about $18 trillion.

The thing many people don't understand is that you can't cut the expenditure number dramatically without destroying the entire system.  Nearly half of US doctors are over 55 years old, and most of that group are wealthy enough to retire tomorrow.  Hospitals have raised hundreds of billions of capital investment, selling bonds based on expected revenues. 

Dramatic cuts to what you pay physicians means you don't have enough doctors to treat people, and dramatic cuts to what you pay hospitals means they default on their bonds and tank the US economy.

If you try to implement single payer without huge spending cuts, the size of the tax increases make it impossible.  We're talking about base tax rates of 50% or possibly more.  Americans are just not interested in that, especially when 90% of us are covered already.  There are simpler, cheaper, and easier ways to improve things.

 
 
 
Bob Nelson
2.2.3  seeder  Bob Nelson  replied to  Jack_TX @2.2.2    one week ago

I'm surprised.

Universal healthcare is possible all around the world. In every advanced country... except one. The richest one.

Do you really find that reasonable? Perhaps, as you demonstrate, the current, private and uncontrolled system is unmanageable... but I cannot imagine that America is less competent than Italy... Belgium... whatever.

Americans are just not interested in that...

All the polls say they are interested. Very much interested!

 
 
 
Jack_TX
2.2.4  Jack_TX  replied to  Bob Nelson @2.2.3    one week ago
I'm surprised. Universal healthcare is possible all around the world. In every advanced country... except one. The richest one.

It's 50 years old or more in most of those places.

Do you really find that reasonable?

Yes.  Because I understand the math.

Perhaps, as you demonstrate, the current, private and uncontrolled system is unmanageable... but I cannot imagine that America is less competent than Italy... Belgium... whatever.

It's a matter of math and reality.  Berniecare advocates refuse to do the actual math.  They can't ever do the actual math, because it spoils their dream instantly.

It's much like the young girl who desperately wants a pony.  She complains to her father that all of her cousins have ponies and she's the only one without.  If they can all have ponies, surely she can have one.  No amount of explanation about how "they live in West Texas and you live in Manhattan" will dissuade her.

Americans are just not interested in that...
All the polls say they are interested. Very much interested!

Do find us a poll where they are interested in their taxes doubling.

 
 
 
Dismayed Patriot
2.2.5  Dismayed Patriot  replied to  Jack_TX @2.2.4    one week ago
It's much like the young girl who desperately wants a pony.  She complains to her father that all of her cousins have ponies and she's the only one without.  If they can all have ponies, surely she can have one.  No amount of explanation about how "they live in West Texas and you live in Manhattan" will dissuade her.

It's more like a young girl who desperately wants a pony and complains to her father that all her cousins have ponies and she's the only one who has to settle with a tiny stuffed animal pony. Her father let's her know it would be too expensive to buy a real pony because right now he was renting the stuffed animal pony which was taking up 20% of his income and a real pony would also cost 20% of his income so he couldn't afford to have both the stuffed animal pony and the real pony, so the little girl had to stay disappointed. "But Daddy! I don't want the stuffed animal pony anymore, can't I just have the real one?" "Nope, sorry honey, the rest of the family has grown quite attached to the exorbitantly priced stuffed animal, they don't want to trade it in for a real pony that might smell and have to be cleaned, fed and maintained".

We spend more that any other nation on health care but have worse outcomes than almost every advanced country. If we spent what we're already spending on a healthcare plan for all everyone would be covered and for less than we're paying now. But no, half the nation has been convinced a real pony is just too much work with few guarantees, so they prefer to stick with the overpriced broken for profit health care system we have. Until they get sick or need to use their health insurance that is. Then they convert as so many Republicans did blocking the repeal of the ACA in 2017, showing up at town halls shouting at their representatives letting them know they would literally die if they were kicked off the ACA. Now don't get me wrong, the ACA wasn't the answer either, it addressed some issues but left it in the hands of for profit private insurance companies.

 
 
 
Jack_TX
2.2.6  Jack_TX  replied to  Dismayed Patriot @2.2.5    one week ago
We spend more that any other nation on health care but have worse outcomes than almost every advanced country

Do tell us why that is.

If we spent what we're already spending on a healthcare plan for all everyone would be covered and for less than we're paying now. 

No.  But as this dream is central to the fantasy, I understand you'll need to cling to it.

the overpriced broken for profit health care system we have.

If you're going to get rid of the "for profit" system, you'll need to get rid of "for profit" doctors, hospitals, drug makers, DME makers, home health agencies, hospice companies, Medicare claims processors, labs, waste disposal companies, MRI maintenance companies, and everybody else who makes the real "profit" in healthcare.   

How do you intend to do that?  What will you do when 30% of physicians would rather retire early (they have enough money) than become government employees?  Will you conscript them?   Or will we all be going to Mexico for healthcare because of the 3 year wait on knee replacements in the US?

What will you tell the teachers whose pensions are lost because the hospitals default on their bonds?  "Sucks to be you"?  How does that work, exactly?

 
 
 
Buzz of the Orient
2.2.7  Buzz of the Orient  replied to  Jack_TX @2.2.6    one week ago

All the doctors I knew in Ontario lived pretty comfortable upper-middle class lives, lived in pretty exclusive areas.  I know that there were doctors who were not happy not being millionaires so they moved to the USA where they could easily become filthy-rich. 

One method that I know how Ontario did not run out of doctors was because if they could not afford the tuition in medical schools they could enter into an agreement where they could attend medical school without expense if they agreed to serve upon graduation as a doctor for a five year period in a far north or other very remote community.  I'm not positive about the financial aspect of it - it's possible that they could have been given a student loan for their tuition that would be payment-free while they served that 5 years, and entirely forgiven at the end of it.

 
 
 
Bob Nelson
2.2.8  seeder  Bob Nelson  replied to  Jack_TX @2.2.4    one week ago

If your math tells you that Portugal can afford universal health care, but America cannot... then there is something very wrong with your math.

 
 
 
Bob Nelson
2.2.9  seeder  Bob Nelson  replied to  Jack_TX @2.2.6    one week ago
Do tell us why that is.

America is run by and for the wealthy. Healthcare in America has for purpose to pay the highest possible dividend to shareholders. The purpose of healthcare in America is not to ensure the health of all Americans.

All aspects of the American system are organized to maximize the profits of the actors.

 
 
 
Jack_TX
2.2.10  Jack_TX  replied to  Buzz of the Orient @2.2.7    one week ago
All the doctors I knew in Ontario lived pretty comfortable upper-middle class lives, lived in pretty exclusive areas.  I know that there were doctors who were not happy not being millionaires so they moved to the USA where they could easily become filthy-rich. 

Exactly. 

We have about 30 physician clients.  The lowest paid are the pediatricians, and the lowest paid one of those makes $240k.  The trauma surgeons start at $320k and go to $450k plus benefits...as salaried employees with no overhead.  The top guys own their own practices, and they range anywhere from $700k to $1.4m annually.  

One method that I know how Ontario did not run out of doctors was because if they could not afford the tuition in medical schools they could enter into an agreement where they could attend medical school without expense if they agreed to serve upon graduation as a doctor for a five year period in a far north or other very remote community.

We have similar programs here.  There is a shortage of primary care physicians in the US, because specialists make so much more.  Doctors are quite good at math, and it doesn't take them long to figure out that accepting a $200k grant isn't a very good deal if you make $200k/yr less for the rest of your career.

  I'm not positive about the financial aspect of it - it's possible that they could have been given a student loan for their tuition that would be payment-free while they served that 5 years, and entirely forgiven at the end of it.

We also have similar programs for teachers and nurses.

 
 
 
Jack_TX
2.2.11  Jack_TX  replied to  Bob Nelson @2.2.8    one week ago
If your math tells you that Portugal can afford universal health care, but America cannot... then there is something very wrong with your math.

Do show us the calculations.  

While you're doing math, explain how it is you propose we pay for your program.

 
 
 
Jack_TX
2.2.12  Jack_TX  replied to  Bob Nelson @2.2.9    one week ago
America is run by and for the wealthy.

OK.  And most of those wealthy people have hundreds, thousands or tens of thousands of employees.  Did you imagine these wealthy people enjoy paying the highest premiums in the world for their employees?   

Healthcare in America has for purpose to pay the highest possible dividend to shareholders.

Whose shareholders?

The purpose of healthcare in America is not to ensure the health of all Americans.

It never has been.  Our system has always been centered around acute care and never around wellness or preventative care.  Bernicare doesn't change that focus, BTW.

 
 
 
Bob Nelson
2.2.13  seeder  Bob Nelson  replied to  Jack_TX @2.2.10    one week ago

So once again, your own  personal example should be the basis for national policy?

Seriously?

Should we require neutral observers?   jrSmiley_91_smiley_image.gif

 
 
 
Bob Nelson
2.2.14  seeder  Bob Nelson  replied to  Jack_TX @2.2.11    one week ago
  Do show us the calculations. 

1 - Portugal has

2 - US does not have

3 - Portugal is more competent than the US

DUH!

 
 
 
Bob Nelson
2.2.15  seeder  Bob Nelson  replied to  Jack_TX @2.2.12    one week ago
Did you imagine these wealthy people enjoy paying the highest premiums in the world for their employees?  

Ummm..... They don't...

 
 
 
WallyW
2.2.16  WallyW  replied to  Bob Nelson @2.2.1    one week ago
America is far wealthier than it was then.

That sounds suspiciously like there needs to be a "redistribution" of all that wealth.

How is that supposed to be accomplished?

 
 
 
Bob Nelson
2.2.17  seeder  Bob Nelson  replied to  WallyW @2.2.16    one week ago
That sounds suspiciously like there needs to be a "redistribution" of all that wealth.

I believe so. For over thirty years, the lower two quintiles have seen no rise in either revenue or wealth, while the 1% has garnered extraordinary wealth.

Financing the healthcare system could be an excellent means of redistribution. But redistribution is in fact a separate topic.

 
 
 
Jack_TX
2.2.18  Jack_TX  replied to  Bob Nelson @2.2.14    6 days ago
1 - Portugal has

2 - US does not have

3 - Portugal is more competent than the US

This is the level of math done by all single payer supporters..... none.  Inability and/or refusal to do math is a requirement for supporting single payer.  That and a strong desire to have somebody else pay your bills.

DUH!

*eyeroll* 

There.  Now we're both acting like teenagers.  

 
 
 
Jack_TX
2.2.19  Jack_TX  replied to  Bob Nelson @2.2.13    6 days ago
So once again, your own  personal example should be the basis for national policy?

Let me see....I believe your standard phrase in these situations is:  "why do you make things up"?

 
 
 
Jack_TX
2.2.20  Jack_TX  replied to  Bob Nelson @2.2.15    6 days ago
Ummm..... They don't...

Of course they do.  US employers pay nearly a trillion dollars a year toward healthcare for their employees.   That would be replaced by taxing the employees.

 
 
 
Bob Nelson
2.2.21  seeder  Bob Nelson  replied to  Jack_TX @2.2.18    6 days ago

Jack...

Your hand-waving has gone beyond boring.

You evoke "math", while refusing to recognize simple facts. France has better healthcare than America, by every metric. The French pay a little over half as much. Those facts are very easy to confirm.

So either American medical professionals are universally incompetent... which is kinda unlikely... Or... Someone is skimming the money that should be going to Americans' health.

This is not rocket science. Americans are getting screwed.

 
 
 
Bob Nelson
2.2.22  seeder  Bob Nelson  replied to  Jack_TX @2.2.20    6 days ago
That would be replaced by taxing the employees.

Why?

According to whom?

Could you give a source?

 
 
 
Jack_TX
2.2.23  Jack_TX  replied to  Bob Nelson @2.2.21    5 days ago
Jack... Your hand-waving has gone beyond boring.

Math frequently is.

You evoke "math", while refusing to recognize simple facts.

Believe it or not, math is actually factual.  The fact is that the math on single payer in the US doesn't work, for a number of very obvious reasons.  The CBO already explained this to Bernie. You would need to more than double the amount of tax revenue in the US to pay for it.

France has better healthcare than America, by every metric. The French pay a little over half as much. Those facts are very easy to confirm.

Our obesity rate is 2.5 times what theirs is.  Also easy to confirm.  Our opiate use is 4 times theirs. 

So either American medical professionals are universally incompetent...

Not at all.  Just very, very highly paid.  Over twenty percent of US physicians are in the top 1% of household incomes.  The average physician pay in America is 78% higher than the average for the "civilized" world you like talk about.

which is kinda unlikely... Or... Someone is skimming the money that should be going to Americans' health.

Indeed.  Over $100 billion in Medicare/Medicaid fraud and waste alone.  The GAO says it's running at 11%.

 
 
 
Kavika
3  Kavika     one week ago

Both sinle payer healthcare and ''free education'' are possible and proven. 

 
 
 
Jack_TX
4  Jack_TX    one week ago
In their lives, an illness could mean bankruptcy. I talked to many people who had college degrees, were convinced they were on the right path, yet were shaken by their endless debt — from the cost of their graduate degrees, caring for an elderly parent or paying for a child’s medication.

They have planned poorly.

 
 
 
Bob Nelson
4.1  seeder  Bob Nelson  replied to  Jack_TX @4    one week ago

In the civilized world, people are safe from such disasters... from birth...

 
 
 
Jack_TX
4.1.1  Jack_TX  replied to  Bob Nelson @4.1    one week ago
In the civilized world, people are safe from such disasters... from birth...

There is no protection from indiscipline or poor planning.....like spending tens of thousands of dollars on a graduate degree without reasonable assurance that it will enable you to produce the increased income to pay for it.

Failure to insure oneself properly against high probability risks is an irresponsible decision.  People don't want to do it, because they want to spend the money on something else.

I've been there.

I have a graduate degree that I borrowed the money for.  I paid it off. 

My wife has a $150k/yr medical condition.  We have ALWAYS had health insurance, even when we were young and broke and struggled to make ends meet.  We've always paid for it ourselves, even when money was tight and we had to make other sacrifices.

My 83 yr old mother is in full nursing care, to the tune of $114k/yr.  I made her buy long term care insurance 20 years ago.  She won't run out of money unless she lives to about 130.  48% of Americans go into a nursing home before they die.  Failure to plan for that is just irresponsible.

I've put a daughter through an elite private university (mathematics), and am currently putting a son through another one (biochemistry).  We started saving when they were born.   It took discipline and good planning.  We gave up stuff along the way to make sure they didn't have to miss opportunities.  We required them to choose majors that were highly employable.  Otherwise it's just a terrible financial decision.

My daughter bought her first house three weeks after her 23rd birthday.  She's now 24 and already has a six-figure net worth.   She's disciplined and she has a plan.

My son is a broke college kid.  He has a $4k investment account that he won't touch...because he believes his financial future is more important than over partying with his friends.  He's disciplined and has a plan.

People all over America still plan and use planning and discipline to improve and protect their finances.  And people all over America don't. 

Now...if you want to implement mandatory financial responsibility laws....I am on board.  But I doubt that's what you want to do.

 
 
 
Bob Nelson
4.1.2  seeder  Bob Nelson  replied to  Jack_TX @4.1.1    one week ago

So... You're a hero, and everyone else must do as well as you.

You are the standard for everyone.

 
 
 
Jack_TX
4.1.3  Jack_TX  replied to  Bob Nelson @4.1.2    one week ago
So... You're a hero,

Quite the contrary.  I'm just an average guy.  That's the point.  If I can do it, most people can.

and everyone else must do as well as you.

They can do what they like.  But why should it be my responsibility to pay for their lack of planning or discipline?

You are the standard for everyone.

I simply follow the standard set by tens of millions of hardworking, responsible Americans.   Every day, about 1700 people become new millionaires in this country.  They don't do it by winning the lottery, winning American Idol, or getting drafted by the Lakers.  They do it by planning, discipline, and making responsible, tedious, non-fun decisions day after day for decades.

Almost anybody can do that.  They just don't want to.

 
 
 
WallyW
4.1.4  WallyW  replied to  Bob Nelson @4.1    one week ago
In the civilized world, people are safe from such disasters... from birth...

Only in their idealized dreams. Then real life shows up more often than not.

 
 
 
Bob Nelson
4.1.5  seeder  Bob Nelson  replied to  WallyW @4.1.4    one week ago
In the civilized world, people are safe from such disasters... from birth...
Only in their idealized dreams. Then real life shows up more often than not.

Universal healthcare is real life in every advanced nation except the US.

 
 
 
Kavika
4.1.6  Kavika   replied to  Jack_TX @4.1.1    6 days ago
My 83 yr old mother is in full nursing care, to the tune of $114k/yr.  I made her buy long term care insurance 20 years ago.  She won't run out of money unless she lives to about 130.  48% of Americans go into a nursing home before they die.  Failure to plan for that is just irresponsible.

Agreed, LTC is a great insurance to have. The problem being that most insurance companies are getting out of that business. There are plenty of examples of this and the law suits against the insurance companies for dropping the coverage after paying premiums for years. 

As an example, this year my LTC and my wife's LTC policy premium doubled. That's quite the chunk of change for this coverage. 

My wife being a licensed insurance agent knew that they had to offer options to this 100% increase and was able to drag that information out of them, one of the options we took. She also advised all her clients how to go about it. 

Anyhow it seems that LTC will be going the way of the gooney bird soon. Too bad since it was a excellent way to help prepare (for ones that can afford it)  for the 50 % chance that they will end up in nursing home or have the need to be cared for at home. 

 
 
 
Bob Nelson
4.1.7  seeder  Bob Nelson  replied to  Kavika @4.1.6    6 days ago

Wouldn't it be great to be assured that our elders will be cared for?

Wouldn't it be great if there were no need to plan for this, because it's part of the healthcare system? Oh, wait... In most advanced countries that's how it is...

 
 
 
Kavika
4.1.8  Kavika   replied to  Bob Nelson @4.1.7    6 days ago
Wouldn't it be great to be assured that our elders will be cared for?

Indeed it would be. 

Wouldn't it be great if there were no need to plan for this, because it's part of the healthcare system?Oh, wait... In most advanced countries that's how it is...

It would seem that the insurance companies in the US will be dropping this coverage or severely limiting it. That is only going to make the problem here that much worse. 

 As in Australia elder care is not a problem since it is covered. The other thing that seems to be forgotten is that the care isn't exactly free. In Australia the employee pays a % of their income into the insurance fund as does the employer. Much like SS in the US. 

 
 
 
Bob Nelson
4.1.9  seeder  Bob Nelson  replied to  Kavika @4.1.8    6 days ago
... the care isn't exactly free...

Of course it isn't. Practitioners and products and processes must be paid. The money has to come from somewhere, and must be managed by someone.

Paid by employees, employers, whatever; paid as taxes or separately; paid to private insurance, public insurance, or a government agency; ...

There are all the combinations you can imagine... and then some.

The key is always the same, though: the payer (private or public) must have no role in medical decisions. That's the only way to be sure that the patient's health is not secondary to cost.

 
 
 
Kavika
4.1.10  Kavika   replied to  Bob Nelson @4.1.9    6 days ago

My comment was in response to some comments that I've seen on different articles that the care is free. As you as well pointed out, it isn't. 

The key is always the same, though: the payer (private or public) must havenorole in medical decisions. That's the only way to be sure that the patient's health is not secondary to cost.

Exactly.

 
 
 
Jack_TX
4.1.11  Jack_TX  replied to  Kavika @4.1.6    5 days ago
Agreed, LTC is a great insurance to have. The problem being that most insurance companies are getting out of that business.

Sadly, yes.

There are plenty of examples of this and the law suits against the insurance companies for dropping the coverage after paying premiums for years. 

The thing about health insurance is that you don't need to sue.  Call the state department of insurance and report them for a regulatory violation.

As an example, this year my LTC and my wife's LTC policy premium doubled. That's quite the chunk of change for this coverage. 

That's the really hard part.  People who bought them on a limited payments basis are usually OK, because they're done paying.  My wife and I are buying a life insurance plan with an LTC option.  One of the advantages is that the premiums are guaranteed not to increase.

My wife being a licensed insurance agent knew that they had to offer options to this 100% increase and was able to drag that information out of them, one of the options we took. She also advised all her clients how to go about it. 

Good advice is imperative on things like this.

Anyhow it seems that LTC will be going the way of the gooney bird soon. Too bad since it was a excellent way to help prepare (for ones that can afford it)  for the 50 % chance that they will end up in nursing home or have the need to be cared for at home. 

You may be right.  That's another reason we're doing the life insurance route.  

 
 
 
Jack_TX
4.1.12  Jack_TX  replied to  Bob Nelson @4.1.7    5 days ago
Wouldn't it be great to be assured that our elders will be cared for? Wouldn't it be great if there were no need to plan for this, because it's part of the healthcare system? Oh, wait... In most advanced countries that's how it is...

How do you propose to pay for it?

 
 
 
Kavika
5  Kavika     5 days ago

With the cost of medical school, the time involved to become a doctor and the additional costs of insurance etc. it seems according to some of the reports that I've read that we have a shortage of doctors and it will grow in the coming years. GP's seem to be the group that has and will have the biggest shortage. Most of the reports show that doctors are concentrated in urban areas where there earnings potential is the greatest. That leaves the rural areas in dire need of doctors. 

It would seem to me if the trends continue that doctors pay will continue to increase, the number of doctors will decline and that is where the rubber will meet the road. A growing population (especially in elder care) declining number of doctors and the supply and demand will lean well towards the doctors being able to charge what they please. Of course there will be more and more PA's and larger medical centers where doctors can share labs/xray allowing them to see more patients. Will that suffice, I don't believe so. 

IMO the future of health care may be in for a huge shake up. 

The next looming problem is the population is graying (old folks) and this is a separate problem that will only get worse. The ''baby boomer'' generation are retiring and growing old very very quickly. The majority of people are not prepared for this or what the cost will be for them and the country. This will not end with the ''baby boomer'' generation. The millennium generation is larger than the baby boomers. The problem isn't going away with the end of the baby boomer generation. 

Seems as a country that we best get out heads out of our ass and address these problems. 

 

 

 
 
 
Bob Nelson
5.1  seeder  Bob Nelson  replied to  Kavika @5    5 days ago
Seems as a country that we best get out heads out of our ass and address these problems.

Exactly.

Each of these problems is treatable... on condition of facing the facts. If we make policy based on fact-free dogma, we're screwed.

 
 
 
Jack_TX
5.1.1  Jack_TX  replied to  Bob Nelson @5.1    5 days ago
Each of these problems is treatable... on condition of facing the facts. If we make policy based on fact-free dogma, we're screwed.

Absolutely.

 
 
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