[besson3c]

My wife's grandma is at the very end stages of her life. She has had osteoporosis and arthritis for her entire life, and this has slowly been getting worse over the years to the point now where she needs to prop her head up with her hand, she has lost all mobility and independence, and recently the pain became so unbearable that she openly stated that she wanted to die. This prompted her being prescribed morphine so that her remaining time would be comfortable, but she's hanging in there despite her mental faculties being greatly reduced by the morphine.

In addition to these medical issues she has also had surgery for colin cancer, and has had a heart attack. Still, I wouldn't say that her medical needs are that outrageous and unusual, it's just been a long and withdrawn process as she's been fading little by little for a long time now.

She's been in some sort of "home" for several years now, and her needs for advanced care have increased. Right now, she needs somebody to handle her meds, shower her, remember stuff for her, and basically help get her through her day - she is on hospice care now. My wife and her Mom have been doing a lot of stuff, but there has just been far too much to do on their own especially considering that they both work. So, Grandma, like many others has been trying to afford her care from her modest middle class salary, social security, and savings from her prior years.

The point here is that right now her care is costing $4000/month. Medicare is paying for part of it, VA assistance is paying for some (her husband served), social security is factoring in, and we're paying for the rest. I think we all know how crazy expensive health care is, but to give you a more concrete idea as to what sort of amount we are talking about here for end-of-life sort of health care needs, there you go, and this is without anything particularly fancy in the way of medical treatment.

The point of this thread is not to say that Medicare is sustainable, it isn't, our health care costs are ridiculous, I realize that. I'm not promoting any sort of political action in particular here, just sharing a little snapshot of the costs she is facing now. When people say "take your hands off my Medicare", this is why. For the time being it is certainly helping Grandma a great deal, it's hard to imagine what we'd do without it.

Health care costs frankly scare the shit out of me.

[stumblinmike]

In before Mac....

[stumblinmike]

Obviously your priority is your loved ones health and well being, and not how much money it costs...until we, as a country, share the same values, we will hear the rantings of the right, screaming against entitlements, while blindly pouring money into the "defense" budget. Pathetic, really...

[besson3c]

I don't think it's fair necessarily to generalize the right as being uncaring towards loved ones and their health, they just think that the better solution does not involve a government program like Medicare. That's a whole other debate, my point of this thread was simply to share some of the costs that are relevant to us and might be relevant to others some day, if not so already.

[stumblinmike]

Your opinion is noted....

[besson3c]

Well, I think what I wrote is factual and not just my opinion for the most part, although I will give you that a subset positions of the right over Obamacare seem downright incoherent, e.g.

- "the bill is too large/complex" as the primary/sole argument
- "we don't want government run health care" and then when the bill is introduced that focuses on the private insurance exchange thingamabob "we don't like that either"

It's virtually impossible to separate the rhetoric from the actual positions from the sorts of people that were going to object with whatever the Democrats came up with just because. Factoring in all of this is what makes the entire mess somewhat incoherent to me, but I stand by my statements of the core argument relating to the premise of the government helping to be a part of health care in any way, including stimulating/regulating the private market, and that is a fair argument.

[ghporter]

Long term care is expensive. I've seen analyses that equate the weekly cost to what a cruise would cost... And that's just maintenance care: managing medications, providing skilled or semi-skilled help with daily living tasks like dressing, bathing, etc. The fact is that doing this sort of care requires a number of people with anywhere from several months of training to advanced degrees. You need aids, nurses (RNs and LVNs), certified nurse assistants, recreation managers, food service specialists, physical, occupational and speech therapists, and of course the physicians who have to diagnose residents and prescribe whatever care they may need. And that's just long term care-care for people who are no longer able to keep up with their own daily tasks for whatever reason. Factor in a stroke or something much more involved, and you add in much more involved and detailed care-up to several hours of therapy every day, medication protocols managed by senior nurses, frequent physician visits... It adds up.

The alternative to this might be to "just let these folks depend on their families." After all, didn't we used to do that when granny got too foggy to remember her pills? But when we really did that, the work force was overwhelmingly male, and women stayed home and cared for kids and the elderly. That is no longer a viable solution.

In the 1980s we had an enormous amount of fraud in the nursing home industry. The term "warehousing" was used quite aptly about how people with even simple care needs were treated. It ain't like that today. The unfortunate flip side to much more rigorous standards for how nursing homes ("skilled nursing facilities") are run is that they cost a lot more to run-see my abbreviated list above of the kind of staffing needed for such facilities. Along with payroll taxes, in the U.S. we all pay Medicare taxes; taxpayers have paid for the services they get in a skilled nursing facility. It's just that the costs today are much higher than when the current crop of 70 to 90 year olds paid their taxes.

Medicare regulations are extremely complex because they cover everything from "my doctor says I need a cane" to extended skilled care in a hospital, inpatient rehab unit and skilled nursing facility. They are really, really dense rules. Would any of us prefer that they were simple but "open to interpretation?" Vague rules cost us billions of tax dollars in the 1980s. The only major thing I'd change in these regulations is to have health care professionals, instead of lawyers and congressional staffers, write them.

[besson3c]

If anybody else wants to share their health care expense horror stories, feel free

[Railroader]

I found out that a medical supply company was charging HHW (Indiana Medicaid) $240/month to rent a piece of equipment that costs a total of $330 retail. After 24 months the rental company will give the equipment to the user. It is a permanent piece of equipment. This will cost HHW over $5,760 When I brought it up to a (whatever you call their support people) the response I got was: "Well, we don't know how long the person is actually going to use it so we don't like to purchase those items."

[blank stare]

Yeah for Medicare.

[Railroader]

Originally Posted by ghporter 

The alternative to this might be to "just let these folks depend on their families." After all, didn't we used to do that when granny got too foggy to remember her pills? But when we really did that, the work force was overwhelmingly male, and women stayed home and cared for kids and the elderly. That is no longer a viable solution.

I disagree, that is still a very viable solution. I know plenty of families being solely supported by the husband's income and doing superbly.

[stumblinmike]

Originally Posted by Railroader 

I disagree, that is still a very viable solution. I know plenty of families being solely supported by the husband's income and doing superbly.

If you eliminated "very", and replaced "plenty of" and "superbly" with "a couple of" and "ok" this post would be believable. Outside of Mayberry, anyway....

[Railroader]

What about Indianapols? Near where the OP lives.

EDIT: I know that people are obsessed with living beyond their means and will justify forcing their wives to work, so I'll drop the argument now.

[reader50]

No need to be limited to old roles. The househusband could stay home and handle all these details, while the wife executive manages the business and keeps the stock holders happy.

[besson3c]

Originally Posted by reader50 

No need to be limited to old roles. The househusband could stay home and handle all these details, while the wife executive manages the business and keeps the stock holders happy.

Yeah, it bothers me that when people bring up going back to a single income family as a solution to various problems it more often than not (by a large margin) seems to involve the woman staying at home before even discussing careers and skills and whatnot.

[Uncle Skeleton]

Originally Posted by besson3c 

Yeah, it bothers me that when people bring up going back to a single income family as a solution to various problems it more often than not (by a large margin) seems to involve the woman staying at home before even discussing careers and skills and whatnot.

The familiar is less risky than new territory. You shouldn't let that bother you.

[CRASH HARDDRIVE]

I hope for the best for your grandma.

edit: n/m the initial question, I missed that it was your wife's grandma, not yours. That's what I get for skipping every other word of your posts

As for heathcare costs being high, I look at politicians as the LEAST qualified people to ever lower the costs. These are people that can't even balance a budget if their life depended on it, even when dealing with the largest guaranteed cashflow in the history of mankind, combined with the absolute lowest services rendered for money charged ratio on the planet. (IE: a company that brings you a gumball in the grocery store gumball machine renders a higher level of service for the money charged, than government does for the average taxpayer vs. taxes collected. And the gumball maker can actually figure out how to make a profit and meet an honest payroll. )

The farther the political class is kept from heathcare, the better. The day real world business management skills and real world competition is applied to healthcare and meddling bureaucrats and the whole 'insurance' ponzi scheme racket for routine care is kicked to the curb, the lower the costs, and the better the care.

No, I won't hold my breath for any of that to happen, because there's too much money to be made off of charging healthy people for "coverage" while sick people are shunned. That's like expecting the mob to give up their lucrative protection rackets which are just a subset of the exact same theme.

[finboy]

Yes, thank goodness for Medicare, otherwise families would have to take care of their loved ones themselves.

It serves a purpose, but the real problem with Medicare is that it drives up the cost of care and crowds out alternative solutions to the problems. And the regulations designed for "one size fits all" are too cumbersome.

I have personally witnessed dozens of families who lied and hid assets in order to qualify their loved ones for Medicaid, or who created managed medical trusts in order to do that. Not only is that immoral, but it also guarantees their loved one a substandard level of care (define that however you'd like to).

Government-sponsored health care creates a set of expectations and free-riding problems that we just don't need. I don't know what the solution is, but expanded Medicare ain't it. And that, boys & girls, is just what it comes down to in the end. We will have to get back to the point where it is socially unacceptable to cast off your responsibility, as a family, for this type of thing.

We better get there fast, too, because the Boomers are eventually going to want to retire. Not soon, because they don't have the bucks, but when THEY start to need "managed care," look out!

Healthcare costs scare me too, but it scares me more that people think it's OK to take food from their neighbors kids and grandkids so that Granny's bedpan gets changed.

[besson3c]

Originally Posted by finboy 

Yes, thank goodness for Medicare, otherwise families would have to take care of their loved ones themselves.

I don't know if you mean this sarcastically, but if you do I think this is unfair.

It is nearly impossible to be able to predict for and save for future health care expenses once somebody reaches the age of my wife's Grandma.

For starters, there was no way of predicting her precise condition and state, what medical options, hosting costs, insurance options, would have been available and their associated costs, etc. There is a whole set of variables (including how investments fare), and even with a very generous padding these costs are not constants throughout a person's life.

We are managing in covering her costs, but they have definitely taken a huge bite out of her savings. One can always set aside more and more money, but there will be a point where many families simply cannot do this - you can only go so far. If she is paying $4000/month in housing, this in a year is more than what many people in this area make in their entire year's salary. Setting aside money for housing, basic living expenses, etc. on retirement and old age is one thing, setting aside money for health care and its whole slew of unpredictable variables is another. Playing the "you have not been responsible, serves you right" card is not fair (I mean this in a general way, since we are not abusing the system I realize that you are not directing what you wrote at us specifically).

That being said, I'm not suggesting that Medicare is the best solution for all of this necessary, I'm just saying that given the current state of the way things are, yeah, Medicare is helpful.

[ghporter]

Originally Posted by Railroader 

I disagree, that is still a very viable solution. I know plenty of families being solely supported by the husband's income and doing superbly.

These families are an exception in today's world. Both of my parents HAD to work to keep us sheltered and fed, and we morphed from living with my maternal grandmother to taking care of her as we got older. That was a LONG time ago. Today there are far too few families that can function as families, let alone care for an elder who has even modest medical issues. Ever deal with a person with both dementia and paranoia? It takes a lot of effort, even for a short time. I commend your acquaintances for being single-income families and getting by fine. But the next step, functioning as an extended family, is a very, very big one.

[ebuddy]

Originally Posted by reader50 

No need to be limited to old roles. The househusband could stay home and handle all these details, while the wife executive manages the business and keeps the stock holders happy.

Fine except... most women don't want this.

[ebuddy]

Originally Posted by besson3c 

That being said, I'm not suggesting that Medicare is the best solution for all of this necessary, I'm just saying that given the current state of the way things are, yeah, Medicare is helpful.

I'm sorry y'all are going through this besson. I hope this issue works itself out in a way that's best for all. Unfortunately, you've already admitted that this is unsustainable. Of course Federal programs are helpful in easing symptoms. It would be helpful if the government sent everyone a check for $250k, but this is no more realistic than the long-term nicety of Medicare and at some point, decisions will have to be made whether or not your grandmother in-law is worth it. Either she will make this decision for herself or it will be made for her. In other words, there's nothing to suggest the government can continue to care for your in-law to this degree, while picking up an additional 20+ million people, and infinitely more in aging baby-boomers.

Let me ask you an honest question... did your in-law ever fritter her money away? Would you say she had always been a good steward of her resources? Of course this is a private matter and none of my business, but my point is that too often there is more to the story than the victim-piece would suggest.

[Uncle Skeleton]

Originally Posted by ebuddy 

Let me ask you an honest question... did your in-law ever fritter her money away? Would you say she had always been a good steward of her resources?

If you're saying that people are inherently irresponsible with savings, that would be the reason we need taxes to act as a method of enforced savings: since we're not going to save for our own health care, the government will force us to put money away for it.

[andi*pandi]

Can a regular person care for grandma as well as the nurses, nutritionists, doctors etc at a home? I don't think so.

I'd say unless you're a millionaire it's pretty hard to save up for $4000/month expenses for your elder years. Even if I did have that money I wouldn't want to waste it on nursing home care for myself.

Frankly once I lose my faculties and/or start asking my family to let me die, they better let me, just peacefully up the morphine and save my life savings for my grandkids college funds.

[besson3c]

Unfortunately medical professionals will not assist in death, they are very particular about that. I'm with you though!

[Snow-i]

Originally Posted by Uncle Skeleton 

If you're saying that people are inherently irresponsible with savings, that would be the reason we need taxes to act as a method of enforced savings: since we're not going to save for our own health care, the government will force us to put money away for it.

And in that case, who in their right mind wouldn't fritter their money away. Anyone who saves would just be paying for everyone else's care through higher taxes.

I don't think that the best medical care should be a right, or a given. There will be many sad stories with this approach but less than if its the government pulling the feeding tube. And at least this way everyone is in control of their own destiny, and more people can afford the care they need, and we don't destroy our economy which all US citizens rely on to live.

[tightsocks]

Originally Posted by besson3c 

Unfortunately medical professionals will not assist in death, they are very particular about that. I'm with you though!

Sure they will.
But, only if they are the ones controlling the decision.

Publicly that refer to it as making the patient 'comfortable.'
Privately it's called terminal sedation.

[Laminar]

Originally Posted by reader50 

No need to be limited to old roles. The househusband could stay home and handle all these details, while the wife executive manages the business and keeps the stock holders happy.

But since men with similar experience and education tend to pull a higher salary than a comparable woman, doesn't it make sense for the woman to stay at home?

[ebuddy]

Originally Posted by Uncle Skeleton 

If you're saying that people are inherently irresponsible with savings, that would be the reason we need taxes to act as a method of enforced savings: since we're not going to save for our own health care, the government will force us to put money away for it.

Having people do for you means doing less for yourself. Not only is their savings program not competitive with saving virtually anywhere else, there's nothing to suggest it's being "saved" at all. It only exacerbates the moral hazard of dependancy.

[ebuddy]

Originally Posted by Laminar 

But since men with similar experience and education tend to pull a higher salary than a comparable woman, doesn't it make sense for the woman to stay at home?

Not if all she has to do is confront her employer about a raise; something women are much less apt to do than men statistically.

[besson3c]

Originally Posted by Laminar 

But since men with similar experience and education tend to pull a higher salary than a comparable woman, doesn't it make sense for the woman to stay at home?

It does make sense, although of course it limits the possibility of this ever changing too.

[besson3c]

Originally Posted by ebuddy 

Having people do for you means doing less for yourself. Not only is their savings program not competitive with saving virtually anywhere else, there's nothing to suggest it's being "saved" at all. It only exacerbates the moral hazard of dependancy.

So we've come around full circle again.

If we want Medicare to be replaced by private insurance, we need assurances that this will result in lower costs, a general sense of fairness, etc. Is all of this compatible with a profit motive? I think it can be, but I'm uncomfortable with just trusting that it will be without regulations and oversight (and even then I may not be comfortable, but maybe a little more comfortable). Unfortunately, this costs money as well.

[Laminar]

Originally Posted by ebuddy 

Not if all she has to do is confront her employer about a raise; something women are much less apt to do than men statistically.

Blasphemy. It's all glass ceilings and male oppression.

[ebuddy]

Originally Posted by andi*pandi 

I'd say unless you're a millionaire it's pretty hard to save up for $4000/month expenses for your elder years. Even if I did have that money I wouldn't want to waste it on nursing home care for myself.

You'd rather I pick up your tab so you can give more of your estate to your children? That's pretty audacious don't you think?

Besides, you seemed to have missed the point. A. When you're receiving $4000/month in care, you're receiving end-of-life care. This is not something you're paying "through your elder years". B. besson's grandma in-law is not paying $4000/month. VA is picking up a chunk, SS is picking up a chunk, Medicare is picking up a chunk... how much do you believe is left for besson's family to pay and who else should be responsible for paying it? C. How long do you think the government coughs up $4000/month before they decide that nursing care or the current quality of that care is not sustainable for all those who need it?

[besson3c]

Originally Posted by Laminar 

Blasphemy. It's all glass ceilings and male oppression.

Are you saying that none of it is?

[besson3c]

ebuddy: I will thank you to refer to me by my proper name: besson3c, not "besson". I happen to have a relative by that name, he's an asshole.

[tightsocks]

Serious question:
Why doesn't she commit suicide?

[Laminar]

Originally Posted by besson3c 

Are you saying that none of it is?

Typical liberal tactics.

[Uncle Skeleton]

Originally Posted by ebuddy 

Having people do for you means doing less for yourself.

Is it more important to control who "does it" or more important that "it" simply get "done" at all? Most would argue that while we should aspire to do "it" well, even "it" done poorly is preferable to letting "it" be completely ignored.

[Laminar]

Originally Posted by Uncle Skeleton 

Is it more important to control who "does it" or more important that "it" simply get "done" at all? Most would argue that while we should aspire to do "it" well, even "it" done poorly is preferable to letting "it" be completely ignored.

I'd like to see a poll showing who believes this holds true when "it"=sex.

[Uncle Skeleton]

Originally Posted by Snow-i 

And in that case, who in their right mind wouldn't fritter their money away.

Who in their right mind would form a militia to defend our borders, once the government starts doing it for us? Who in their right mind would build their own roads and bridges, or put out their own fires, or capture their own criminals? Worry less about who does a necessary job, and worry more about what that entity is doing to reduce the need for that job in the first place.

[andi*pandi]

Originally Posted by ebuddy 

You'd rather I pick up your tab so you can give more of your estate to your children? That's pretty audacious don't you think?

No, if you read my post I said I'd rather be euthanized than waste the money paying it.

[besson3c]

Originally Posted by tightsocks 

Serious question:
Why doesn't she commit suicide?

She wanted to when her pain was at its worst, but the morphine has given her some more comfort. We aren't expecting she'll last very long at this point so suicide is probably unnecessary.

[ebuddy]

Originally Posted by Uncle Skeleton 

Is it more important to control who "does it" or more important that "it" simply get "done" at all? Most would argue that while we should aspire to do "it" well, even "it" done poorly is preferable to letting "it" be completely ignored.

I don't think anyone has suggested that we completely ignore "it". The more important question is who does more of it and who does less of it. It seems to me most are arguing that the government do less.

[ebuddy]

Originally Posted by andi*pandi 

No, if you read my post I said I'd rather be euthanized than waste the money paying it.

I read your post as a general agreement with "thank goodness for Medicare" and a response to my post. You reiterated my point on "savings" and responded to it.

I'm asking you, do you think it's reasonable to expect me to pay a portion of your medical expenses so you can give your children a larger inheritance?

[ebuddy]

Originally Posted by besson3c 

ebuddy: I will thank you to refer to me by my proper name: besson3c, not "besson". I happen to have a relative by that name, he's an asshole.

Would b3c suffice?

[ghporter]

Originally Posted by besson3c 

Unfortunately medical professionals will not assist in death, they are very particular about that. I'm with you though!

There's this thing called "advance directives." It is a legal document that states YOUR wishes when it comes to everything from whether you want CPR to what sorts of other live-preserving acts you want. It's enforceable in court, too. Doctors really hate it when there's a chance they could have to go to court, so even the "I gotta preserve even this painful, extremely poor quality life" guys tend to actually observe what advance directives call for. One thing: it can not be secret, or nobody would even bring it up. You have to ensure everybody in your family knows about it so they can make sure YOUR wishes are being followed. Oh, and if someone in your family gets in the way of these wishes, others can go to court and ensure they get out of the way. Very handy, that.

[ebuddy]

Originally Posted by besson3c 

So we've come around full circle again.

If we want Medicare to be replaced by private insurance, we need assurances that this will result in lower costs, a general sense of fairness, etc. Is all of this compatible with a profit motive? I think it can be, but I'm uncomfortable with just trusting that it will be without regulations and oversight (and even then I may not be comfortable, but maybe a little more comfortable). Unfortunately, this costs money as well.

There are ways of leveraging incentives and encouraging healthy monetary behaviors. Government can and certainly should have a role, but that role should be modified away from the current paradigm of symptom-mitigation. Their current role is encouraging behaviors the collective cannot sustain because it merely creates more symptoms to mitigate. At some point Medicare will have to seriously consider how much money should be doled out for end-of-life care or any number of other conditions. I think that point is quickly approaching with the proposal of adding millions to its annual obligation and with an aging population of baby-boomers.

[andi*pandi]

Originally Posted by ebuddy 

I read your post as a general agreement with "thank goodness for Medicare" and a response to my post. You reiterated my point on "savings" and responded to it.

I'm asking you, do you think it's reasonable to expect me to pay a portion of your medical expenses so you can give your children a larger inheritance?

I think it's amazing you misunderstood my post in that way. I was responding to the situation of having a family member in that type of care, and what care I'd want.

I've seen too many people save all their life for their dream vacation just to get sick at retirement. Then because they are too rich on paper for medicaid, they pay full price at the hospitals and nursing homes, until guess what, the money is gone and they do qualify. A waste.

As Snow-i said, you'd be a fool to scrimp and save just to have it be sucked into the system and end up getting the same facilities/treatment as the others who didn't scrimp. No, I don't think that's fair.

Am I perfectly clear to you now, or would you like to read your own agenda into my posts again?

[Uncle Skeleton]

Originally Posted by ebuddy 

I don't think anyone has suggested that we completely ignore "it".

Then what did you mean by asking if grandma had wasted resources prior? Isn't it that some people are grasshoppers and others are ants?

[tightsocks]

Originally Posted by ghporter 

There's this thing called "advance directives." It is a legal document that states YOUR wishes when it comes to everything from whether you want CPR to what sorts of other live-preserving acts you want. It's enforceable in court, too.

Problem is, you can't have an advance directive that specifies that you should be put to death.

You can specify that treatment be withheld, as well as food and water, but we don't have the right to specify how we die.