My grandmother died at home, just as she wanted. It cost $145,000(wbur.org)
wbur.org
My grandmother died at home, just as she wanted. It cost $145,000
https://www.wbur.org/cognoscenti/2023/02/08/medicare-home-hospice-care-sarah-romanelli
297 comments
It only looks like clickbait because you're used to a system that costs $$$ to get medical care.
In the UK when my mother got told she was terminal and had a couple of months left, she chose to spend them at home. In the end she left hospital in mid-December and died the following May. 5 months at home in a specialist bed, provided by the hospital, all of the equipment required to keep a dying person comfortable again provided by the hospital. Nurses and doctors there every day.
Because of her illness, the government paid her rent, it paid my father a carers allowance, so he was able take time off work.
Total cost: £0.
5 months of excellent at home care for £0.
You shouldn't be dismissing the article as clickbait, it shouldn't cost $145k to die, there shouldn't need to be a discussion here.
You should be so very angry that a country that takes in $3tn a year in federal taxes won't support a working healthcare system
In the UK when my mother got told she was terminal and had a couple of months left, she chose to spend them at home. In the end she left hospital in mid-December and died the following May. 5 months at home in a specialist bed, provided by the hospital, all of the equipment required to keep a dying person comfortable again provided by the hospital. Nurses and doctors there every day.
Because of her illness, the government paid her rent, it paid my father a carers allowance, so he was able take time off work.
Total cost: £0.
5 months of excellent at home care for £0.
You shouldn't be dismissing the article as clickbait, it shouldn't cost $145k to die, there shouldn't need to be a discussion here.
You should be so very angry that a country that takes in $3tn a year in federal taxes won't support a working healthcare system
Sure, the NHS does provide excellent care, but it's not free. The fact that the British won't come to terms with this is causing its collapse:
"In December, as many as 500 patients per week were dying in Britain because of E.R. waits, according to the Royal College of Emergency Medicine, a figure rivaling (and perhaps surpassing) the death toll from Covid-19. On average, English ambulances were taking an hour and a half to respond to stroke and heart-attack calls, compared with a target time of 18 minutes; nationwide, 10 times as many patients spent more than four hours waiting in emergency rooms as did in 2011. The waiting list for scheduled treatments recently passed seven million — more than 10 percent of the country — prompting nurses to strike. The National Health Service has been in crisis for years, but over the holidays, as wait times spiked, the crisis moved to the very center of a narrative of national decline."
https://www.nytimes.com/2023/01/25/opinion/uk-economic-decli...
"In December, as many as 500 patients per week were dying in Britain because of E.R. waits, according to the Royal College of Emergency Medicine, a figure rivaling (and perhaps surpassing) the death toll from Covid-19. On average, English ambulances were taking an hour and a half to respond to stroke and heart-attack calls, compared with a target time of 18 minutes; nationwide, 10 times as many patients spent more than four hours waiting in emergency rooms as did in 2011. The waiting list for scheduled treatments recently passed seven million — more than 10 percent of the country — prompting nurses to strike. The National Health Service has been in crisis for years, but over the holidays, as wait times spiked, the crisis moved to the very center of a narrative of national decline."
https://www.nytimes.com/2023/01/25/opinion/uk-economic-decli...
Sure, the NHS does provide excellent care, but it's not free.
Correct, but the US has the rather odd status of spending even more per capita in public funds towards healthcare before they even get to the privately funded portion. The NHS has a lot of problems, but at least it's not (outside of dentistry) making us pay both ways at once.
Correct, but the US has the rather odd status of spending even more per capita in public funds towards healthcare before they even get to the privately funded portion. The NHS has a lot of problems, but at least it's not (outside of dentistry) making us pay both ways at once.
The US healthcare industry is easier to understand once you equate insurance companies with the government and realize that they are jobs programs.
But that also makes it easier to understand the need to get rid of them and have the government fund healthcare.
My mom passed away recently (Monday) and it would have been impossible for her (because it was impossible for me) to try and navigate insurance claims (and subsequent denials lol), hospital billing, Medicaid, Medicare, Ohio Medicaid, and other programs. It's just level after level of waste and all of this could be combined into just one god damn program that does the same work and we would save money. But jobs. Oh and also let's not forget the now 3-6 spam calls I get daily from official sounding scam artists who try to "help" with your medical problems (steal money) in your darkest hours and most vulnerable. Does nobody seriously care? Why does the United States of America allow its citizens to be robbed?
When we were clearing out her things we probably had an entire trash bag worth of prescription medication.- Waste Maybe you should be required to return the empty? All those pills had to be safely disposed of.
Equipment - thankfully we could donate this to a local charity but many hospitals and healthcare facilities won't accept things like wound bandages even if they are brand new and sealed in a box.
Transportation - It's unreliable. Companies like Caresource contract with the government to provide rides to get patients to appointments, but they then further subcontract these rides to the most obviously shitty companies imaginable and then those companies contract the rides out to random people who will go pick people up for money. It works sometimes, but ultimately things happen. We had multiple no-call, no-shows and my mom who needed lifesaving cancer treatment had a hard time getting to scheduled appointments. More waste.
I could go on and on.
The thing that pisses me off the most is that we're explicitly opting in to spend more money. It's just a tax that goes to the health insurance industry instead of the government. Health insurance companies are just parasitic entities and do not innovate or provide market efficiencies - they just work to find how they can deny claims and try to "innovate" on billing complication. Unlike pharmaceutical companies and healthcare equipment companies. There are still efficiencies to be had there with licensing, drug patents, trials, etc. but health insurance is a complete scam. If we just did single-payer then we could see some actual innovating on the insurance side from whatever business was remaining that the "wealthy" could afford - which I'm fine with.
I do dislike the usage of "free" to describe the NHS or any government run healthcare program since it's inaccurate (nothing is free) but as another user pointed out the US system is like double cost because you pay taxes, you don't get any of the benefit, and then you have to pay too. Philosophically I prefer people to say "hey we should fund this" versus "I need my free thing from the government" because the former is indicative of a society coming together to support itself and the other is indicative of social collapse. People don't call Social Security free very often, but instead support it because "I paid for it".
But that also makes it easier to understand the need to get rid of them and have the government fund healthcare.
My mom passed away recently (Monday) and it would have been impossible for her (because it was impossible for me) to try and navigate insurance claims (and subsequent denials lol), hospital billing, Medicaid, Medicare, Ohio Medicaid, and other programs. It's just level after level of waste and all of this could be combined into just one god damn program that does the same work and we would save money. But jobs. Oh and also let's not forget the now 3-6 spam calls I get daily from official sounding scam artists who try to "help" with your medical problems (steal money) in your darkest hours and most vulnerable. Does nobody seriously care? Why does the United States of America allow its citizens to be robbed?
When we were clearing out her things we probably had an entire trash bag worth of prescription medication.- Waste Maybe you should be required to return the empty? All those pills had to be safely disposed of.
Equipment - thankfully we could donate this to a local charity but many hospitals and healthcare facilities won't accept things like wound bandages even if they are brand new and sealed in a box.
Transportation - It's unreliable. Companies like Caresource contract with the government to provide rides to get patients to appointments, but they then further subcontract these rides to the most obviously shitty companies imaginable and then those companies contract the rides out to random people who will go pick people up for money. It works sometimes, but ultimately things happen. We had multiple no-call, no-shows and my mom who needed lifesaving cancer treatment had a hard time getting to scheduled appointments. More waste.
I could go on and on.
The thing that pisses me off the most is that we're explicitly opting in to spend more money. It's just a tax that goes to the health insurance industry instead of the government. Health insurance companies are just parasitic entities and do not innovate or provide market efficiencies - they just work to find how they can deny claims and try to "innovate" on billing complication. Unlike pharmaceutical companies and healthcare equipment companies. There are still efficiencies to be had there with licensing, drug patents, trials, etc. but health insurance is a complete scam. If we just did single-payer then we could see some actual innovating on the insurance side from whatever business was remaining that the "wealthy" could afford - which I'm fine with.
I do dislike the usage of "free" to describe the NHS or any government run healthcare program since it's inaccurate (nothing is free) but as another user pointed out the US system is like double cost because you pay taxes, you don't get any of the benefit, and then you have to pay too. Philosophically I prefer people to say "hey we should fund this" versus "I need my free thing from the government" because the former is indicative of a society coming together to support itself and the other is indicative of social collapse. People don't call Social Security free very often, but instead support it because "I paid for it".
The actual phrase for describing the NHS is meant to be "Free at the point of use", but people are likely shortening for convenience. People are paying for it, but not in a tangible way.
The main thing is knowing that if you need any procedures, services, an ambulance, critical or emergency care, etc, you'll not be asked up front to pay for it, you'll just be treated. Seeing that principle erode over time is heartbreaking and terrifying.
(rant) Healthcare as an industry doesn't function properly under a capitalist model, which expects that competition and consumer choice will encourage innovation and further competition, leading to a better outcome for the consumer. If you need healthcare, you don't really have a choice in it, or your choices are artificially restricted by circumstance, so you can't benefit from a competitive marketplace. It's a broken system, as far as I am concerned.
The main thing is knowing that if you need any procedures, services, an ambulance, critical or emergency care, etc, you'll not be asked up front to pay for it, you'll just be treated. Seeing that principle erode over time is heartbreaking and terrifying.
(rant) Healthcare as an industry doesn't function properly under a capitalist model, which expects that competition and consumer choice will encourage innovation and further competition, leading to a better outcome for the consumer. If you need healthcare, you don't really have a choice in it, or your choices are artificially restricted by circumstance, so you can't benefit from a competitive marketplace. It's a broken system, as far as I am concerned.
I'd say the health insurance industry specifically doesn't function and that's because in the United States you will not be turned away from life saving treatment regardless of the cost [1]. Other aspects range from working very well to working marginally and could be improved. Public-private relationships generally seem to do well but we need to capture more of the profits when the funding is subsidized by the public, but that doesn't mean that private entities who do heavy lifting shouldn't also profit. It seems like we have some clear win-wins if we want to take them. On the whole the government is far better at cutting checks than it is at innovating.
I agree with your statement that "Free" is likely short-hand but I personally still don't like it because I prefer to think of items like that less so as entitlements because entitlements are easy to attack and dismantle. On the other hand when someone feels like they paid for something they are more likely to defend it. Social Security in the US is IMO a good example of this.
[1] Price discovery is impossible in a free market where you can't be denied service. Since society is (in my view correctly) not willing to let people die on the street if they can't pay for treatment the health insurance industry can't function except as a parasite with the aim to extract as much as it can and redistribute it to employees and shareholders. I do think healthcare costs would be cheaper under a "pure" free market where we let people die on the streets, though, but again I just don't find that acceptable.
I agree with your statement that "Free" is likely short-hand but I personally still don't like it because I prefer to think of items like that less so as entitlements because entitlements are easy to attack and dismantle. On the other hand when someone feels like they paid for something they are more likely to defend it. Social Security in the US is IMO a good example of this.
[1] Price discovery is impossible in a free market where you can't be denied service. Since society is (in my view correctly) not willing to let people die on the street if they can't pay for treatment the health insurance industry can't function except as a parasite with the aim to extract as much as it can and redistribute it to employees and shareholders. I do think healthcare costs would be cheaper under a "pure" free market where we let people die on the streets, though, but again I just don't find that acceptable.
Ambulance service might be free at point of use but that hardly matters if the ambulance never arrives.
https://www.bbc.com/news/health-64243044
https://www.bbc.com/news/health-64243044
You're right, but it isn't a helpful comment for the discussion at hand. The story in that article, and many like it, are symptoms of a larger problem, but it's not because of public vs private healthcare.
The system works, assuming it's adequately funded, which it hasn't been for a while. Salaries aren't high enough to live on (thanks to the conservative government and creeping privatisation), and then brexit and other immigration policies have caused a shortage of trained professionals and no one willing to fill the vacancies.
There's a whole heap of issues (I've left out quite a few) stacked up against the NHS, and yet it powers on, doing its best.
The system works, assuming it's adequately funded, which it hasn't been for a while. Salaries aren't high enough to live on (thanks to the conservative government and creeping privatisation), and then brexit and other immigration policies have caused a shortage of trained professionals and no one willing to fill the vacancies.
There's a whole heap of issues (I've left out quite a few) stacked up against the NHS, and yet it powers on, doing its best.
"Free" in the case of the NHS means "Free at the point of delivery",
We know perfectly well that we pay for it through taxes.
We know perfectly well that we pay for it through taxes.
I don't know why people have such a problem with this. Nobody in the UK with an IQ above 70 thinks the NHS is literally free in the sense that no money ever changes hands. "It's not really free!" is a stupid gotcha that doesn't even make sense.
It's a thought terminating cliche that weird people use to imply that making american healthcare would require raising taxes.
As we should be if we want a utopian society. Better than paying corrupted, monopolistic, lobbying US medical companies over-inflated prices for everything because people have no other choice.
The only issue with public healthcare is the government corruption that tries to kill or diminish public healthcare, but it's still a hell of a lot better for society than private.
The only issue with public healthcare is the government corruption that tries to kill or diminish public healthcare, but it's still a hell of a lot better for society than private.
Isn't that because the Tory governments have been squeezing NHS to death in terms of funding to try and privatize it?
People love to starve the beast then point to the starving beast and say "Look its dying, this was always going to happen".
In the USA a big proportion of health care costs is hospital administrators. Also, the cost of administrating all the different private insurance plans.
I wonder how much of the NHS budget is eaten up by administrators and how much that cost has increased with all privatization by stealth under the Tories?
The bulk of the budget should go to front line workers not administrators.
The bulk of the budget should go to front line workers not administrators.
>because the Tory governments have been squeezing NHS to death in terms of funding to try and privatize it?
No. Often repeated, never true. The NHS has had at or above inflation budget increases every year of Tory government[1]
https://ichef.bbci.co.uk/news/976/cpsprodpb/166A5/production...
Look! Real terms money on the Y-axis, it only goes up!
"Squeezing in terms of funding", "Try and privatise it" are common myths repeated by the Labour party to get elected, and NHS bosses to increase the pie even further.
No. Often repeated, never true. The NHS has had at or above inflation budget increases every year of Tory government[1]
https://ichef.bbci.co.uk/news/976/cpsprodpb/166A5/production...
Look! Real terms money on the Y-axis, it only goes up!
"Squeezing in terms of funding", "Try and privatise it" are common myths repeated by the Labour party to get elected, and NHS bosses to increase the pie even further.
(1) It needs more than real terms increases because of a growing, ageing population.
(2) The government is destroying it in other ways, such as not having a proper recruitment pipeline, outsourcing the lucrative parts to the private sector, and failing to pay staff adequately (literally - nurses going to food banks).
(2) The government is destroying it in other ways, such as not having a proper recruitment pipeline, outsourcing the lucrative parts to the private sector, and failing to pay staff adequately (literally - nurses going to food banks).
The mean salary for an NHS nurse is £33k, if you need to go to a foodbank on that salary, you'll need to go to a foodbank on £36k or £40k.
Yes, there has been mismanagement with the recruitment pipeline, because every government prefers to pillage poorer nations for their healthcare staff since it's quicker than training them.
But remember, that's not the original claim is it - I didn't say the Conservatives are doing a perfect (or even good) job, I said they're not "squeezing it dry of funding" and not "trying to privatise it", which are both, still, false.
Also "outsourcing the lucrative parts" - give source for your claim please. They do cross subsidize, allowing private patients to pay for treatment in NHS hospitals, but that's not the same thing.
Yes, there has been mismanagement with the recruitment pipeline, because every government prefers to pillage poorer nations for their healthcare staff since it's quicker than training them.
But remember, that's not the original claim is it - I didn't say the Conservatives are doing a perfect (or even good) job, I said they're not "squeezing it dry of funding" and not "trying to privatise it", which are both, still, false.
Also "outsourcing the lucrative parts" - give source for your claim please. They do cross subsidize, allowing private patients to pay for treatment in NHS hospitals, but that's not the same thing.
> Also "outsourcing the lucrative parts" - give source for your claim please.
This one indicates "unfunded mandates" - a trick the GOP in the US has done for decades (notably so-called Medicare Advantage which created a crisis that didn't exist): https://www.theguardian.com/commentisfree/2022/apr/05/tories...
Another specific tactic is privatizing things that didn't need privatization (or the result is less efficient than what existed before, but it happened to make some corporations and ministers/secretaries a lot of money) - see "failed efficiency savings and privatization" here:
https://www.opendemocracy.net/en/nhs-crisis-rishi-sunak-cons...
Of course, Brexit (another Tory gift to their owners) really messed up things for NHS and caused a number of challenges (see above).
This one indicates "unfunded mandates" - a trick the GOP in the US has done for decades (notably so-called Medicare Advantage which created a crisis that didn't exist): https://www.theguardian.com/commentisfree/2022/apr/05/tories...
Another specific tactic is privatizing things that didn't need privatization (or the result is less efficient than what existed before, but it happened to make some corporations and ministers/secretaries a lot of money) - see "failed efficiency savings and privatization" here:
https://www.opendemocracy.net/en/nhs-crisis-rishi-sunak-cons...
Of course, Brexit (another Tory gift to their owners) really messed up things for NHS and caused a number of challenges (see above).
> £33k
That seems… incredibly low for a licensed profession
That seems… incredibly low for a licensed profession
Bear in mind that that's apparently the mean salary, which one would expect to be somewhat higher than the median (as it's more affected by high salary outliers in upper bands).
The people in the NHS that I talk to say it's running on goodwill and sticking plasters right now.
The people in the NHS that I talk to say it's running on goodwill and sticking plasters right now.
Mean is meaningless. What's the minimum?
> Sure, the NHS does provide excellent care, but it's not free. The fact that the British won't come to terms with this is causing its collapse.
In the words of Luke Skywalker: Amazing. Everything you said in that sentence is false.
But focusing on the "it's not free" part; perhaps a distinction should be made in terms of "background passive costs paid regularly (e.g. taxes)" vs "additional costs once you're ill".
What is "not" free in the NHS is the first, but the latter is generally free.
This distinction becomes very meaningful when you realise that, in the US, things like the £145k quoted in the article fall in the latter category, while still paying for the former (in terms of regular insurance or whatnot).
This "dishonest" comparison made when the "NHS is not free" argument is thrown to justify why in the US things cost money, is to ignore the fact that you are also paying the background stuff in the US too, even in the absence of illness, but this is rarely counted in these discussions.
I would love it if someone armed with more numbers than I could give a breakdown of what it costs annually a person to passively contribute to the NHS through taxes vs an average US medical insurance scheme (assuming the US does not have other healthcare related taxes which I do not know about).
In the words of Luke Skywalker: Amazing. Everything you said in that sentence is false.
But focusing on the "it's not free" part; perhaps a distinction should be made in terms of "background passive costs paid regularly (e.g. taxes)" vs "additional costs once you're ill".
What is "not" free in the NHS is the first, but the latter is generally free.
This distinction becomes very meaningful when you realise that, in the US, things like the £145k quoted in the article fall in the latter category, while still paying for the former (in terms of regular insurance or whatnot).
This "dishonest" comparison made when the "NHS is not free" argument is thrown to justify why in the US things cost money, is to ignore the fact that you are also paying the background stuff in the US too, even in the absence of illness, but this is rarely counted in these discussions.
I would love it if someone armed with more numbers than I could give a breakdown of what it costs annually a person to passively contribute to the NHS through taxes vs an average US medical insurance scheme (assuming the US does not have other healthcare related taxes which I do not know about).
> assuming the US does not have other healthcare related taxes which I do not know about
The U.S. government pays about the same amount per capita (1.2 trillion for ~400 million people or $3000/person) on healthcare as the UK gov. That’s before private insurance costs. Some of this is on things like Medicare, Medicaid, and the VA, which are nationalized health systems for specific portions of the population, but the point still stands that we’re not avoiding taxes going the private route.
The U.S. government pays about the same amount per capita (1.2 trillion for ~400 million people or $3000/person) on healthcare as the UK gov. That’s before private insurance costs. Some of this is on things like Medicare, Medicaid, and the VA, which are nationalized health systems for specific portions of the population, but the point still stands that we’re not avoiding taxes going the private route.
> the NHS does provide excellent care, but it's not free. The fact that the British won't come to terms with this is causing its collapse:
This is complete nonsense. The British public knows very well that the HNS is (or was) and should be "free at point of use", and also paid for via tax. The public want it and want it well funded. The current British political establishment does not like this state of things and seeks to privatise it, but due to the popularity of the NHS, cannot just come out and and say it.
"That's the standard technique of privatization: defund, make sure things don't work, people get angry, you hand it over to private capital."
This is complete nonsense. The British public knows very well that the HNS is (or was) and should be "free at point of use", and also paid for via tax. The public want it and want it well funded. The current British political establishment does not like this state of things and seeks to privatise it, but due to the popularity of the NHS, cannot just come out and and say it.
"That's the standard technique of privatization: defund, make sure things don't work, people get angry, you hand it over to private capital."
> The fact that the British won't come to terms with this is causing its collapse
No, the collapse is caused by the government which has been methodically dismantling it for a couple of decades now, replacing it with private health insurance and moving the ownership of NHS trusts and GP offices to private companies.
No, the collapse is caused by the government which has been methodically dismantling it for a couple of decades now, replacing it with private health insurance and moving the ownership of NHS trusts and GP offices to private companies.
I feel like if you look at the amount of equipment and staff here it obviously costs a huge amount to deliver this care. Regardless of who pays the $100k+ cost remains.
Generally socialized healthcare is also cheaper because you have a single payer negotiating. You also don’t have all the middlemen that are spending time figuring out whether or not your insurance covers X Y or Z. So while it costs $140k out of pocket in addition to all the same background costs, in a socialized system it costs a heck of a lot less in addition to being free out of pocket. The trade off is that healthcare can be difficult to obtain as you have to navigate a very complicated system and there’s limited resources because it’s more accessible - if you’re upper middle class you can have similar struggles to find care as those who are poorer. The rich are oblivious to this because they can just pay for private care or travel to where private care exists.
It doesn't cost $145k to die, it costs $145k to have 24-7 in-house medical support for a year.
And somebody has to pay the medical support staff.
The sense that "this is necessary so it should be free" is not unique to the parent comment, but it is incorrect.
And somebody has to pay the medical support staff.
The sense that "this is necessary so it should be free" is not unique to the parent comment, but it is incorrect.
That “somebody” is the government in most developed places in the world. Except the United States which ties your healthcare to capitalism.
"The government" has no money of its own. Everything "the government" does is paid for by private citizens in the form of taxes, without exception.
These taxes are harvested from capitalist economic activity.
These taxes are harvested from capitalist economic activity.
Ummm… doesn’t the government literally print money? Sure you can’t just print infinite money as it devalues the currency, but I don’t think stating whether or not the government has money is a helpful framing. The government has an entirely different relationship to money. I could be wrong but taxes are more a way to keep value of the currency by creating some artificial scarcity. Sure, the government tries to keep a balance between taxation and expenditure to avoid devaluing the currency too much, but that’s not the same thing. In fact, governments regularly run deficits (spending money they don’t have) without collapsing. The only real risk is of a major currency devaluation because you managed the inflation incorrectly.
Consider the “out” for the US debt ceiling being bandied about is minting a trillion dollar coin.
Consider the “out” for the US debt ceiling being bandied about is minting a trillion dollar coin.
I’m pretty sure everybody understands that.
What would the cost be if you had near 100% private in home care for whatever reason in the UK?
It’s basically what they chose in this case, Medicare would’ve paid for the hospital and hospice. Even if there was a bill no one is obligated to pay it unless the estate has money for private care. In this case it’s assumed her estate doesn’t have the funds to pay for private care or rent an apartment.
Her case also seems complicated because assisted living and hospice couldn’t tend to her needs but the hospital thought a lesser facility could provide it. Bouncing her back and forth.
It’s basically what they chose in this case, Medicare would’ve paid for the hospital and hospice. Even if there was a bill no one is obligated to pay it unless the estate has money for private care. In this case it’s assumed her estate doesn’t have the funds to pay for private care or rent an apartment.
Her case also seems complicated because assisted living and hospice couldn’t tend to her needs but the hospital thought a lesser facility could provide it. Bouncing her back and forth.
> Nurses and doctors there every day.
But presumably not 24/7 = 168hr per week, which makes all the difference (and the vast majority of the $145k in costs). 168hr / week of care will require 3 to 4 FTEs, no way around that.
But presumably not 24/7 = 168hr per week, which makes all the difference (and the vast majority of the $145k in costs). 168hr / week of care will require 3 to 4 FTEs, no way around that.
I can be simultaneously angry that our medical system sucks and still believe that setting up a mini hospital in dying elderly people’s homes is a colossal misuse of government funds.
Exactly. People are quite ridiculous when it comes to healthcare.
I just had an elderly family member that would have died if not for the hospital saving their life but they can't stop complaining about the $4k they have to pay.
One would have to be painfully ignorant of basic economics to not see that setting up a mini hospital in a person's home is not going to be cheap. It is practically like complaining about the cost of taking a private vs commercial jet.
I just had an elderly family member that would have died if not for the hospital saving their life but they can't stop complaining about the $4k they have to pay.
One would have to be painfully ignorant of basic economics to not see that setting up a mini hospital in a person's home is not going to be cheap. It is practically like complaining about the cost of taking a private vs commercial jet.
Is it? Presumably said person was a tax paying citizen that had paid more than their share throughout their life, the same goes for the children. How would it be a colossal misuse of government funds for people to get what they paid for?
People “get their share” by living in a society that is held together by those taxes imo. There are surely many edge cases, but in countries like Canada/US/UK I think people generally get their due.
Regardless, setting up a mini hospital in someone’s home is just dumb. There is no reason for such a high level of service. You want to die at home? Sure. I’m down for MAID at home.
You want a suite of private doctors and equipment at home? Pay for it. If you want public service you should go to public service facilities.
Regardless, setting up a mini hospital in someone’s home is just dumb. There is no reason for such a high level of service. You want to die at home? Sure. I’m down for MAID at home.
You want a suite of private doctors and equipment at home? Pay for it. If you want public service you should go to public service facilities.
many places in the US have a similar option called at home hospice care. Also free. Provides equipment and multiple home visits a week.
Every system costs $$$ to get medical care.
Close to 50% or the federal budget is spent on social security, Medicare and Medicaid. It's a massive wealth transfer to the elderly already.
What's the long term plan for the UKs elderly healthcare programs that it's an aging country?
What's the long term plan for the UKs elderly healthcare programs that it's an aging country?
>It only looks like clickbait because you're used to a system that costs $$$ to get medical care.
No it is clickbait because it says "she died at home" when in fact she died in an expensive rented apartment. This fact is unrelated to the reality that the system is broken and people can't get the care they need.
No it is clickbait because it says "she died at home" when in fact she died in an expensive rented apartment. This fact is unrelated to the reality that the system is broken and people can't get the care they need.
Sounds unsustainable to be honest.
Ah, yes. The country that invented the "Liverpool Care Pathway" (i.e., let the patients die of thirst, sedate them when they complain) to save money.
https://en.wikipedia.org/wiki/Liverpool_Care_Pathway_for_the...
As others have pointed out, it didn't cost "£0". It cost your fellow citizens the full amount. "The government" didn't pay her rent. Your fellow citizens did. "The government" didn't pay your father a carer's allowance. Your fellow citizens did. "The government" didn't pay for doctors and nurses to travel to her home. Your fellow citizens did.
Now, I, personally, would prefer to see massive reforms in the U.S. system. But pretending that any system is going to cost "£0" is just intellectually dishonest.
https://en.wikipedia.org/wiki/Liverpool_Care_Pathway_for_the...
As others have pointed out, it didn't cost "£0". It cost your fellow citizens the full amount. "The government" didn't pay her rent. Your fellow citizens did. "The government" didn't pay your father a carer's allowance. Your fellow citizens did. "The government" didn't pay for doctors and nurses to travel to her home. Your fellow citizens did.
Now, I, personally, would prefer to see massive reforms in the U.S. system. But pretending that any system is going to cost "£0" is just intellectually dishonest.
What makes you think this is a relevant response? Everybody knows that the NHS is funded by taxes. This is not a secret, there's not some common misconception that health care isn't actually paid for with money. "Your fellow citizens [paid]" isn't the gotcha you seem to think it is.
> What makes you think this is a relevant response?
Because the OP was claiming it cost "£0", when it clearly did not.
> This is not a secret, there's not some common misconception that health care isn't actually paid for with money.
Maybe you should tell the OP, since he is clearly operating under that exact "misconception".
Because the OP was claiming it cost "£0", when it clearly did not.
> This is not a secret, there's not some common misconception that health care isn't actually paid for with money.
Maybe you should tell the OP, since he is clearly operating under that exact "misconception".
No you are just putting words in people's mouths. As an american, when I tell someone "I had to pay $400 to go get an ultrasound", nobody responds "ACKSHUALLY you paid $400 plus the $400 a month you pay for your premiums plus whatever funding comes from governments from your taxes". That point is only brought up to talk about how we actually pay a fuckload for healthcare even though it's a private industry and that's supposed to make it efficient or whatever.
> No you are just putting words in people's mouths.
Oh? So he didn't say "it cost £0"? I just made that up?
Spin harder, dude.
Oh? So he didn't say "it cost £0"? I just made that up?
Spin harder, dude.
> Total cost: £0.
> 5 months of excellent at home care for £0.
a lifetime of having way more than HALF your income stolen from you..... 0? okay..
a lifetime of having way more than HALF your income stolen from you..... 0? okay..
Some of us see it as paying for services, not that the government are thieves. And we are pretty happy to pay, given the hellscape examples shown in the good old US of A.
The NHS has its own share of tragic stories. https://archive.is/lkqY5
> People who suffer heart attacks or strokes wait more than 1½ hours on average for an ambulance. Hospitals are so full they are turning patients away.
It's positively utopian! Meanwhile, in the hellscape:
> On average in the U.S., the length of time between a call for help and the arrival of emergency medical services is about eight minutes.
[0] https://www.reuters.com/article/us-health-emergency-response...
It's positively utopian! Meanwhile, in the hellscape:
> On average in the U.S., the length of time between a call for help and the arrival of emergency medical services is about eight minutes.
[0] https://www.reuters.com/article/us-health-emergency-response...
I am not highlighting the US as a shining example of anything. but if you are happy to pay, make it optional? it seems to me that you are happy to force others to pay? biggest gang wins?
seems to me that "some of us" will be perfectly happy buying the services, and some other of us will be perfectly happy NOT buying the services
seems to me that "some of us" will be perfectly happy buying the services, and some other of us will be perfectly happy NOT buying the services
Then choose to live where the taxes are low and services are shit. Don't take the piss out of our choices. They do not affect you.
replying to sibling-response:
and where would I go? it seems that universally around the world there are a large amount of people that feel that they are entitled to rob their fellow citizens, at ultimately what is gunpoint threat of being put in jail.
if I just go mind my own business, and conduct business with other likeminded people, and the regime finds out, they will send their brownshirts with guns to drag me away, simply for refusing to give them half
and where would I go? it seems that universally around the world there are a large amount of people that feel that they are entitled to rob their fellow citizens, at ultimately what is gunpoint threat of being put in jail.
if I just go mind my own business, and conduct business with other likeminded people, and the regime finds out, they will send their brownshirts with guns to drag me away, simply for refusing to give them half
First things first: Get the fuck off the roads I pay for with taxes, stop drinking water I'm paying for, stop using ANY medical care because that gets government funding in the US, stop using electricity because there's often government involvement in that, stop using the internet, that was built with tax dollars, stop breathing the air that the government attempts to keep clean etc.
I am not in the US, and I cannot stop using the things others pay for, because they FORCE me to pay for it aswell, or they will haul me away to jail. and in doing this, they also keep ANY competition away, because who can compete with "free".
I pay for water, and then i pay 150% taxes on the water because reasons.. I would just hire someone to drill a well for me on market terms, but the regime made it illegal
edit: actually its about 300% taxes on the water
I pay for water, and then i pay 150% taxes on the water because reasons.. I would just hire someone to drill a well for me on market terms, but the regime made it illegal
edit: actually its about 300% taxes on the water
Do your own research. This is an article that leads to 0% taxation options, first thing Kagi suggests: https://www.theceomagazine.com/lifestyle/property/lowest-inc...
I’m not sure “uproot and move” is an acceptable solution to wanting to opt out of parts of a society. You certainly wouldn’t give this suggestion as a solution to just about any other problem people have. Especially when the places you can move probably make up like 1% of the earth.
I don’t understand your logic. You claim that the “services” offered to you by your government are worth the taxes you pay. But you don’t want them to be opt-in. Aren’t you tipping your hand a bit? Seems like you might not be so confident that the services are worth it, and that a ton of people wouldn’t opt out.
I don’t understand your logic. You claim that the “services” offered to you by your government are worth the taxes you pay. But you don’t want them to be opt-in. Aren’t you tipping your hand a bit? Seems like you might not be so confident that the services are worth it, and that a ton of people wouldn’t opt out.
Government isn't a business. Society is the rules we regularly agree to keep playing. Your parents made the choice to birth you into a society. If you don't like playing by society's rules that everyone else understands results in a better life, then go live in Somalia or an unincorporated territory somewhere.
If you really don’t drive on public roads or use any public services, you can probably get away with not paying taxes.
so you are atleast agreeing that you think the biggest gang should set the rules and force them upon other people who do no harm to ANYONE, but simply wish to be left alone?
> where would I go?
Somalia seems to be the only actually tax-free country. I think border control is lax enough that you can "safely" go live there if you wish.
Somalia seems to be the only actually tax-free country. I think border control is lax enough that you can "safely" go live there if you wish.
Somalia isn't "tax-free". It just has rival gangs of warlords collecting taxes, rather than having one gang with a monopoly on it.
Not the same thing.
Not the same thing.
Hmm, this almost seems like the logical conclusion of a government with no revenue.
There are plenty of failed states on the planet where you can live with basically no taxation at all.
In America we have half our income "stolen" from us as well. We just pretend it's not.
Top marginal income tax rate in California is like 55% and includes zero medical care. That’s extra.
and then sales tax, and then tolls on imported shit, and then the accumulated increases in prices due to others taxes.. at the end of the day, you pay WAY above half your life in taxes. in Europe its of course even more fucked up, where taxes are above 95% of some goods you buy
What goods are you thinking about? I think even tobacco (generally the most taxed product) is under that.
gasoline for example
I'm all for more expensive gas. Oil price doesn't properly factor in externalities and it needs to be much more expensive to incentivize transition away.
then how about doing the sensible thing and mandating that ALL the money the externalities cost be collected, and spent on undoing it? think burning gasoline causes X shit to happen? fine, go pay for that instead of salary to some member of parliament. but no, thats not what happens, all these "green" taxes go straight to the coffins that pays for all the retarded shit the regime wants
I assume by referencing MPs you're referring to Canada's carbon tax? You know that's a revenue-neutral tax right, none of it is kept by the government. It's all returned to taxpayers. Also "coffers" not coffins.
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It's not possible to pay more than 50% in earnings related taxes (income tax and national insurance) in the UK because the national insurance is capped at £23k and the highest tax band is 45% (on earnings over £150k). Even if you earn £1m/year you still take home more than £500k.
According to helpful tool on ListenToTaxMan.com tax is 46% if earning £2million/year.
https://listentotaxman.com/?year=2022&taxregion=uk&age=0&tim...
https://listentotaxman.com/?year=2022&taxregion=uk&age=0&tim...
yeah and when you spend it, you are taken for 20% sales tax, not to mention that the prices in general are far higher, because the people who made it need to pay taxes too
You could also end up with some serious illness when you're young and in need of special care without which you don't have any opportunity to build that income you're talking about.
Each additional person being able to contribute means another person has contributed to your economic wellbeing and a egalitarian society where people's opportunity is not lost do to bad luck.
I would argue taxation is only theft if the money is spend on extremely bad, costly and possibly corrupt policy decisions like US wars in Vietnam, Iraq, Afghanistan or even the war on drugs. Probably a lot of these policy decisions are influenced by lobbying from various industries and special interest groups. Follow the money.
I would argue taxation is only theft if the money is spend on extremely bad, costly and possibly corrupt policy decisions like US wars in Vietnam, Iraq, Afghanistan or even the war on drugs. Probably a lot of these policy decisions are influenced by lobbying from various industries and special interest groups. Follow the money.
I've lived in the UK and the US. The taxes are about the same.
Ridiculous. https://www.gov.uk/income-tax-rates It's clearly closer to "just under HALF your income..."
okay... so now lets say i pay 30% in taxes on my income, great.. now I go into a store, and I buy some things.. woop, how much sales tax? oh shit, now we're at 50%. how many tolls and various other insane things have to be paid to the government?
Even if you include VAT the chances are that you spend quite a small amount of your money on VAT-rated goods. There's only so much stuff you can buy. Most of your earnings are probably going on a mortgage or being invested, neither or which have VAT on them.
This is why initiatives to reform our healthcare system fail. People disillusioned with what it entails. They see taxes. They see money going to waste or worse, to people who don't deserve their support. Like the elderly. Or the sick. I'm not sick, why should I have to pay for you? American Greed Inc.
wouldnt it then be much better to separate it out, so likeminded people can pay for what they want? you say a large amount of people are happy to pay? great! make a healthcare system like you want. Guess what? I also wish to purchase healthcare services, I just dont want to be forced to purchase the crap the local regime forces upon me.
and what does it matter to you if I can opt out of paying? one less person to serve? great? everyone is happy.
and what does it matter to you if I can opt out of paying? one less person to serve? great? everyone is happy.
right... the mortgage to pay for my house, constructed and made with materials that were once sold, and had VAT collected.
either way, that is not the case for the majority of my income. and dont get me started on when I go to purchase gasoline here in europe, not only am i first hit with 50% income tax, then a cool >20% sales tax, and then the outrageous taxes on the gasoline itself and the related industries. so I buy €100 worth of product, and more than 95 of them go to the government. Thanks! you sure did 95% of the work for me there (not)
either way, that is not the case for the majority of my income. and dont get me started on when I go to purchase gasoline here in europe, not only am i first hit with 50% income tax, then a cool >20% sales tax, and then the outrageous taxes on the gasoline itself and the related industries. so I buy €100 worth of product, and more than 95 of them go to the government. Thanks! you sure did 95% of the work for me there (not)
We get close to half our income stole in the US if we make enough... and it doesn't take that much.
You can lose all your savings and your home in the US as a result of just Healthcare expenses alone. Do you think that is a good idea? None of the other industrialized nations of the world do. Hmmm.
and in the UK you can die while waiting for the ambulance.. in canada they will recommend you go kill yourself... every system has problems, but there is a thing in common with all the systems.. they all have the hands of government deeply involved
This just means that the Taxpayer took up that money. I'm sorry for your loss but this is insane. I'd rather die in a hospital where I don't take up valuable time from doctors and nurses to commute to my home to take care of me instead of taking care of people that might actually get better. This is a level of egoism that borders on narcissism and the tax payer has to pay for it.
The American Healthcare system is insane but at least in this one regard the cost of being an unreasonable egoist is not being paid by the rest of society. Go fucking die in a hospital like everyone else and don't take away limited resources from people that might actually get better. Or if you do, at least pay the bill yourself.
The American Healthcare system is insane but at least in this one regard the cost of being an unreasonable egoist is not being paid by the rest of society. Go fucking die in a hospital like everyone else and don't take away limited resources from people that might actually get better. Or if you do, at least pay the bill yourself.
You clearly have no clue what an end of life shuffled between nursing home and hospital looks like cost wise.
State paid nursing home fees are like $150k/yr last time I checked, most of that going to administration. It's certainly not going to the nursing assistants that they don't hire who aren't checking on you. Plus the portable mobile equipment (xray etc) that someone drives over and wheels in to perform perfunctory diagnostics, plus the ambulance rides back and forth to the hospital as the nursing home covers their ass, plus all the bills you rack up at the hospital as you're repeatedly dumped into the emergency room.
Like it or not, that system has already been heavily socialized in the US. The only time someone is on the hook to pay is if their estate has money, which is avoidable with some estate planning (5?) years ahead of time. That's the fallback option for everybody "lucky" enough to reach it. It's gruesome, but not because it's cheap.
FWIW When I was going through this with my dad, the private "insurance" company (a medicare advantage vendor) was starting a program where they had on call doctors that they wanted to send to your home, because keeping you out of the hospital saved them a significant amount of money.
State paid nursing home fees are like $150k/yr last time I checked, most of that going to administration. It's certainly not going to the nursing assistants that they don't hire who aren't checking on you. Plus the portable mobile equipment (xray etc) that someone drives over and wheels in to perform perfunctory diagnostics, plus the ambulance rides back and forth to the hospital as the nursing home covers their ass, plus all the bills you rack up at the hospital as you're repeatedly dumped into the emergency room.
Like it or not, that system has already been heavily socialized in the US. The only time someone is on the hook to pay is if their estate has money, which is avoidable with some estate planning (5?) years ahead of time. That's the fallback option for everybody "lucky" enough to reach it. It's gruesome, but not because it's cheap.
FWIW When I was going through this with my dad, the private "insurance" company (a medicare advantage vendor) was starting a program where they had on call doctors that they wanted to send to your home, because keeping you out of the hospital saved them a significant amount of money.
The American System (hint, i am not american) is very broken. Yet any sane system would obviously see benefits of centralizing end of life care for sick people. If you manage to build a system that's so broken that centralization of healthcare is MORE expensive for everyone than decentralized at home care than that system is the problem.
And to be clear: It would be great if we had enough doctors, nurses and resources for everyone to die in their own home with all the amenities of a hospital specialized to end of life care but hat is practically impossible. And I don't mind socializing healthcare. On the contrary, I think it's a necessity for any civilized country. But given the aging societies of basically all western nations I would bet all I own that by the time I need end of life care, at home care with private nurses will become the privilege of the super wealthy.
Here in Germany, the system is already essentially collapsing and it's not even a money issue, it's a personal issue. But sure let's burn it all to the ground for the now-dying so by the time my generation needs it there's nothing left.
And to be clear: It would be great if we had enough doctors, nurses and resources for everyone to die in their own home with all the amenities of a hospital specialized to end of life care but hat is practically impossible. And I don't mind socializing healthcare. On the contrary, I think it's a necessity for any civilized country. But given the aging societies of basically all western nations I would bet all I own that by the time I need end of life care, at home care with private nurses will become the privilege of the super wealthy.
Here in Germany, the system is already essentially collapsing and it's not even a money issue, it's a personal issue. But sure let's burn it all to the ground for the now-dying so by the time my generation needs it there's nothing left.
I don't necessarily disagree about the costs of decentralization, but will say that it appears to rely on some assumptions like that the family won't be providing any care, etc.
I don't think that doctors and nurses are the limiting factor for home care, but rather CNA's and home health aides - basically people that check in on patients around the clock and make sure they're kept clean and attended to.
In the context of the US system, your original comment is just completely off the mark. Our healthcare system is universally terrible, independent of the cost ("not my job" at every level). Consigning a elderly person to that system is basically the last thing anybody wants to do, hence the focus on dying at home etc.
I can't speak about Germany's system. But it's worth remembering that money is not equivalent to resources, and that spending an imprudent amount of money on elder care right now doesn't imply that there won't be resources left for you later. Whether the system is "burnt to the ground" has more to do with if the institution is destroyed or hollowed out, rather than how much it costs.
I don't think that doctors and nurses are the limiting factor for home care, but rather CNA's and home health aides - basically people that check in on patients around the clock and make sure they're kept clean and attended to.
In the context of the US system, your original comment is just completely off the mark. Our healthcare system is universally terrible, independent of the cost ("not my job" at every level). Consigning a elderly person to that system is basically the last thing anybody wants to do, hence the focus on dying at home etc.
I can't speak about Germany's system. But it's worth remembering that money is not equivalent to resources, and that spending an imprudent amount of money on elder care right now doesn't imply that there won't be resources left for you later. Whether the system is "burnt to the ground" has more to do with if the institution is destroyed or hollowed out, rather than how much it costs.
The claim is that this $16,200 monthly cost was cheaper than the alternative. So it's not entirely silly to include rent in this figure.
Long term care facilities are 5-10k USD per month. For the cheap ones. So $16k seems reasonable for in home care. There are also different intangible personal and family costs to facility-based or home-based care that folks should also consider.
However, there's a lot of options that are even cheaper.
Possibly a little clickbaity, but it was a first hand experience from the author. There are likely thousands of examples of this exact scenario playing out every year: $old_family_member needs assistance and all of the options cost $small_fortune. What do we do? I think the theme is important rather than the _exact_ details of this particular situation.
[deleted]
I found the article extremely informational by explaining what the situation could look like for my aging parents.
In fact it even motivates me to start planning out costs with them.
Sometimes the point of articles can simply be to relate one’s own experience to other people.
In fact it even motivates me to start planning out costs with them.
Sometimes the point of articles can simply be to relate one’s own experience to other people.
thats how I read it to - the family didn't want the burden of doing the care, and also don't think anyone should have to pay for it - who are these magical fairies that are going to show up in your final days and take care of you for free?
If the deceased person owed the medical bills - well guess what? she is dead and won't have to pay them unless the creditors go after her estate - if the family's complaint that now their inheritance is going to be less than they thought - too bad.
If the deceased person owed the medical bills - well guess what? she is dead and won't have to pay them unless the creditors go after her estate - if the family's complaint that now their inheritance is going to be less than they thought - too bad.
This is a pretty uncharitable read of it. Assume good intentions and think about it from the grandparent's point of view:
"I saved my whole life, and wanted to make sure I could give a little back to my loving family, but instead the healthcare industry soaked it all up during my final months."
In civilized countries, somebody else would pay for it. Not through magical fairies, but through taxpayer-funded public healthcare. Instead, in the USA, we're Rugged Individuals™ so we prefer to have a gigantic profitable End Of Life Industry precisely designed to sponge up whatever remains of an elderly person's savings. If you have $500K in assets left, your end of life care will cost $500K. If you have $100K left, your care will cost $100K. If you have $10K left, it will cost $10K.
The solution, in our flawed system, is to do smart estate planning so you die with zero assets. I don't need my parents' money when they go, and I've already told them if they want to help out my sibling or give it to charity, either do it before they die or get it in a structure that can't be confiscated by death profiteers. Either way, have $0 to your name when you finally pass away. Don't give these vultures another gold-lined toilet for their executive suite.
"I saved my whole life, and wanted to make sure I could give a little back to my loving family, but instead the healthcare industry soaked it all up during my final months."
In civilized countries, somebody else would pay for it. Not through magical fairies, but through taxpayer-funded public healthcare. Instead, in the USA, we're Rugged Individuals™ so we prefer to have a gigantic profitable End Of Life Industry precisely designed to sponge up whatever remains of an elderly person's savings. If you have $500K in assets left, your end of life care will cost $500K. If you have $100K left, your care will cost $100K. If you have $10K left, it will cost $10K.
The solution, in our flawed system, is to do smart estate planning so you die with zero assets. I don't need my parents' money when they go, and I've already told them if they want to help out my sibling or give it to charity, either do it before they die or get it in a structure that can't be confiscated by death profiteers. Either way, have $0 to your name when you finally pass away. Don't give these vultures another gold-lined toilet for their executive suite.
I don't think it is uncharitable at all.
"I saved my whole life, and wanted to make sure I could give a little back to my loving family, but instead the healthcare industry soaked it all up during my final months."
An awful lot of people in this country will never get an inheritance; why is it fair to ask them to pay higher taxes so that the most privileged people can leave bigger inheritances to their kids?
I have no problem with people leaving money to their kids - after they pay their own bills. Don't ask me to pay them so your kids can get a bigger windfall.
"I saved my whole life, and wanted to make sure I could give a little back to my loving family, but instead the healthcare industry soaked it all up during my final months."
An awful lot of people in this country will never get an inheritance; why is it fair to ask them to pay higher taxes so that the most privileged people can leave bigger inheritances to their kids?
I have no problem with people leaving money to their kids - after they pay their own bills. Don't ask me to pay them so your kids can get a bigger windfall.
"In civilized countries, somebody else would pay for it."
Somebody else paying doesn't make the cost go away. Would it be better to make their children or grandchildren pay?
Would they be better off if they payed 150k in taxes and had no inheritance because of that?
Somebody else paying doesn't make the cost go away. Would it be better to make their children or grandchildren pay?
Would they be better off if they payed 150k in taxes and had no inheritance because of that?
> In civilized countries, somebody else would pay for it.
Why is this civilized?
Why is this civilized?
Typically not - you're looking at nursing home care. That means you'll pay $300+ a day for care that is awful at best and horrific more typically. Sometimes hospice patients have a better experience because the outside entity (the hospice) has eyes on the patient and (in)competence of the nursing home staff.
The tragedy of modern medical care if you're over 65 is that it's hard to die. Medicare only pays hospitals for results, so there are powerful incentives to limit hospital stays as much as possible - unless you're in an ICU or similar scenario, if you are hospitalized more than a week it's likely because someone fucked up, and Medicare will reimburse the hospital next to nothing as a result.
It's easy to get sick or become incapacitated, but people can and will "save" you and leave you in a situation where you are not well, but not dead. The options are 120 days of Medicare nursing home coverage, followed by a slow drain of all of your assets and ultimately Medicaid enrollment. Nursing home means you're effectively warehoused, and the more help you need, the less care you get as you become a cost center.
It's not just a matter of finances, it's a matter of humanity. The harsh reality is your disabled loved one will be treated like cattle unless someone who cares is directly engaged in caring for you. After the horror that my father went through after a suffering a stroke, and the pain caused to my mother after she took on full-time care, I did what most doctors do and have DNR care instructions on file with every hospital in a 50 mile radius.
The tragedy of modern medical care if you're over 65 is that it's hard to die. Medicare only pays hospitals for results, so there are powerful incentives to limit hospital stays as much as possible - unless you're in an ICU or similar scenario, if you are hospitalized more than a week it's likely because someone fucked up, and Medicare will reimburse the hospital next to nothing as a result.
It's easy to get sick or become incapacitated, but people can and will "save" you and leave you in a situation where you are not well, but not dead. The options are 120 days of Medicare nursing home coverage, followed by a slow drain of all of your assets and ultimately Medicaid enrollment. Nursing home means you're effectively warehoused, and the more help you need, the less care you get as you become a cost center.
It's not just a matter of finances, it's a matter of humanity. The harsh reality is your disabled loved one will be treated like cattle unless someone who cares is directly engaged in caring for you. After the horror that my father went through after a suffering a stroke, and the pain caused to my mother after she took on full-time care, I did what most doctors do and have DNR care instructions on file with every hospital in a 50 mile radius.
Which is nothing compared to hospital level care at the hospital.
The point is:
>Medicare should restructure hospice reimbursement to cover more of the hands-on caregiving, thus decreasing the financial burden of dying at home.
The main pitch is somewhat hidden in the middle of the article. Its a tough point to open with, but I think leading with the thesis statement is proper.
>Medicare should restructure hospice reimbursement to cover more of the hands-on caregiving, thus decreasing the financial burden of dying at home.
The main pitch is somewhat hidden in the middle of the article. Its a tough point to open with, but I think leading with the thesis statement is proper.
I think it’s also intentionally misleading though. It’s not dying at home. It’s riding out the rest of your days under detailed medical supervision which presumably intervenes and prevents you from dying.
And it is written by a geriatric nurse practitioner, so presumably they would benefit. Not that it would necessarily be inappropriate.
> As much as I sympathize, the title is clickbait and I'm not entirely sure what the point of the article is.
Yes. Where are all the people who were apoplectic about the Nord Stream post?
Yes. Where are all the people who were apoplectic about the Nord Stream post?
For all those in the US who hear nothing but horror stories about how bad it would also be if you lived in another country, particularly in Canada, I always feel it's important to relate stories like this.
My father died in Canada last year after a 9 month battle with cancer during which time he spent almost 2 months in cancer ward. He was not rich. He recieved cutting edge targeted chemo-therapy. He died peacefully with the aid of MAID in his small home town.
It cost my mother $150.
My father died in Canada last year after a 9 month battle with cancer during which time he spent almost 2 months in cancer ward. He was not rich. He recieved cutting edge targeted chemo-therapy. He died peacefully with the aid of MAID in his small home town.
It cost my mother $150.
And if he did not go for MAID? Will our healthcare cover the care? I am Canadian but have no clue about this particular side.
I can only counter the fear with more stories.
Of course at this point in his life he had 4 doctors. His cancer doctor was not happy with the decision, she wanted to (and they could perhaps have), kept him strung along for several more months. His cardiologist and nephrologist (cancer was targeting his heart and kidneys) has done multiple proceedures and had plans for the rest of his life (again, we're talking months, at most). His family doctor was a wonderful provider and friend. There were no whispers from any medical staff saying "do it", "do it".
My father was fiercely logical, probably akin to many who post here. It was his choice to end his life on his terms. I have the conversations where he was assessed recorded, the only coercion was his.
I recognize MAID has detractors and is a very complex subject. We still (of course) discuss what happened and are grappling with his loss, but from my perspective it was empowering, it minimized suffering (for all of us, not just Dad) and gave someone their last feeling of agency.
Of course at this point in his life he had 4 doctors. His cancer doctor was not happy with the decision, she wanted to (and they could perhaps have), kept him strung along for several more months. His cardiologist and nephrologist (cancer was targeting his heart and kidneys) has done multiple proceedures and had plans for the rest of his life (again, we're talking months, at most). His family doctor was a wonderful provider and friend. There were no whispers from any medical staff saying "do it", "do it".
My father was fiercely logical, probably akin to many who post here. It was his choice to end his life on his terms. I have the conversations where he was assessed recorded, the only coercion was his.
I recognize MAID has detractors and is a very complex subject. We still (of course) discuss what happened and are grappling with his loss, but from my perspective it was empowering, it minimized suffering (for all of us, not just Dad) and gave someone their last feeling of agency.
I am in no way trying to judge here. My question was simply who would have had to pay for his care if he did not go for MAID.
My grandfather in law died of dementia in Canada and it cost $5k per month for the years he was there.
Cancer treatments typically falls under medical expenses, something a health insurance will cover. Assisted living or long-term care for the eldery in a nursing home usually does not, so I'm not sure what your example tells us about the differences.
While as a relatively healthy person I've been continuously disappointed at paying approximately $1500 a month in taxes[1] towards the Canadian public health care system (a quick google suggests ~30% of tax revenues), I also was happy to see that my grandpa spending ~6 months in palliative care cost them very little (if anything), compared to something like $180K in the US.
I think the biggest point of contention is that reasonably well kept and healthy people are receiving little to nothing for their money in the present. eg, I got tons of push back asking for simple lab tests like cRP or dermatology cancer screening which would have been less than 10% of what I contribute to the system. Another time I literally waited in a ER room until my loss of blood made me a triage priority. The amount of resources available due to the market distortions means they have to defer you until you're worse off than when you walked in.
Compare that to fast (always <1 hr, even for non emergency things like a dislocated finger) and reasonable waits anytime I've been to a hospital in the US. Mind you I've also probably spent a total of $40k (not my portion) in ~8 yrs of residency between insurance costs and copays, more than half due to a heart attack scare and ER trip that ended up being myocarditis from the vaccine.
So what's my point in all this rambling? I think there's a ton of unlocked value in the US system to do more preventative care, but the US is anti-paternalism and often lets people do stuff that costs them in the long run (unwittingly or knowingly). But there's a hidden truth to Canada's system appearing so rosy -- at least as the payer and consumer I feel I get more for less in the US. Whereas in Canada you have better average outcomes because you take marginal care (eg preventative tests) from those who pay, and give it to those who cannot pay but may have a marginally more improvable conditions (eg bleeding out, having a heart attack).
[1]: compare to about a quarter of that in medicare on much higher earnings
I think the biggest point of contention is that reasonably well kept and healthy people are receiving little to nothing for their money in the present. eg, I got tons of push back asking for simple lab tests like cRP or dermatology cancer screening which would have been less than 10% of what I contribute to the system. Another time I literally waited in a ER room until my loss of blood made me a triage priority. The amount of resources available due to the market distortions means they have to defer you until you're worse off than when you walked in.
Compare that to fast (always <1 hr, even for non emergency things like a dislocated finger) and reasonable waits anytime I've been to a hospital in the US. Mind you I've also probably spent a total of $40k (not my portion) in ~8 yrs of residency between insurance costs and copays, more than half due to a heart attack scare and ER trip that ended up being myocarditis from the vaccine.
So what's my point in all this rambling? I think there's a ton of unlocked value in the US system to do more preventative care, but the US is anti-paternalism and often lets people do stuff that costs them in the long run (unwittingly or knowingly). But there's a hidden truth to Canada's system appearing so rosy -- at least as the payer and consumer I feel I get more for less in the US. Whereas in Canada you have better average outcomes because you take marginal care (eg preventative tests) from those who pay, and give it to those who cannot pay but may have a marginally more improvable conditions (eg bleeding out, having a heart attack).
[1]: compare to about a quarter of that in medicare on much higher earnings
I’ve also sat in an ER, waiting to be seen while in a lot of pain or with someone in a lot of pain or with visible injury. The only time I’ve actually been triaged immediately was when I had so much blood running down my face that the nurses didn’t want me to scare others in the waiting room. This was all in Dallas at good hospitals.
I’ve waited months to be able to see a doctor. In fact, I’ve just recently seen a dermatologist after a 9-month wait. No one else had anything sooner.
I’ve learned with the US system there are a lot of hoops you have to jump through for care if you want insurance to be happy. I have to go to one or two other clinics or quick care facilities in order to get in to see the doctor that I actually need. And once I have a prescription it’s always a prior-authorization fight to actually get the meds.
And all of this, knowing that I can’t ever take a sabbatical since COBRA, on top of my monthly expenses, would be prohibitive.
So, it feels like the US system is the worst of all worlds. I’ve got the waiting and the pushback and the expense.
I’ve waited months to be able to see a doctor. In fact, I’ve just recently seen a dermatologist after a 9-month wait. No one else had anything sooner.
I’ve learned with the US system there are a lot of hoops you have to jump through for care if you want insurance to be happy. I have to go to one or two other clinics or quick care facilities in order to get in to see the doctor that I actually need. And once I have a prescription it’s always a prior-authorization fight to actually get the meds.
And all of this, knowing that I can’t ever take a sabbatical since COBRA, on top of my monthly expenses, would be prohibitive.
So, it feels like the US system is the worst of all worlds. I’ve got the waiting and the pushback and the expense.
Top tip. Don't go to Parkland if you don't have to.
>reasonably well kept and healthy people are receiving little to nothing for their money in the present
Even if I never use public health services my entire life (I mean I obviously already have) I'd still be happy to keep paying that tax.
Why? For the same reason that I don't mind as a gay man who will never have kids that my taxes also go to: welfare/benefits for families in need, helping children, building/benefiting infrastructure I will never use.
All of humanity is in this together, on this tiny blue sphere. If people are focussed only on maximising things purely for themselves and not others at all, then have we really progressed at all as a species?
Even if I never use public health services my entire life (I mean I obviously already have) I'd still be happy to keep paying that tax.
Why? For the same reason that I don't mind as a gay man who will never have kids that my taxes also go to: welfare/benefits for families in need, helping children, building/benefiting infrastructure I will never use.
All of humanity is in this together, on this tiny blue sphere. If people are focussed only on maximising things purely for themselves and not others at all, then have we really progressed at all as a species?
to be clear my point wasnt about maxima, but about imbalance.
IMO Rejecting someone preventative care ($1k tops), when they give $18K to the system is a broken balance. The claim/demand is not $18K in, $18K out.
IMO Rejecting someone preventative care ($1k tops), when they give $18K to the system is a broken balance. The claim/demand is not $18K in, $18K out.
Oh, definitely agree with you there, then. I guess it is troublesome because the money has to come from somewhere at the end of the day.
Someone like that shouldn't be denied but I guess it begs the question of what happens if in a certain year demand for medical services outstrips allocated tax. I suppose govs should really have a slush fund for that sort of thing rather than national debt/constantly feeling they have to spend all tax money, every year.
Someone like that shouldn't be denied but I guess it begs the question of what happens if in a certain year demand for medical services outstrips allocated tax. I suppose govs should really have a slush fund for that sort of thing rather than national debt/constantly feeling they have to spend all tax money, every year.
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fortran77(2)
Only in Canada is sending your sick elderly out on an ice float called "health" care.
Cheap though.
Cheap though.
Only if the want to go: there is a solid process for determining consent. First, the applicant must pass an interview with a social worker. This is followed by interviews with two independent doctors.
Finally, the day of, anyone accompanying the family is asked to wait while “the lines are put in”. The wait is far longer than the time required to put in lines: they interview the patient again, this time to ensure that they are there of their own volition and not being pressured by the people accompanying them.
The entire is graceful and professional.
Finally, the day of, anyone accompanying the family is asked to wait while “the lines are put in”. The wait is far longer than the time required to put in lines: they interview the patient again, this time to ensure that they are there of their own volition and not being pressured by the people accompanying them.
The entire is graceful and professional.
> It cost my mother $150.
Sure, but by being taxpayers, your parents already paid a substantial portion of the cost forward by paying for the healthcare of other people. Perhaps they were net takers from the system, but presumably people on HN have parents that are net contributors to the system.
Sure, but by being taxpayers, your parents already paid a substantial portion of the cost forward by paying for the healthcare of other people. Perhaps they were net takers from the system, but presumably people on HN have parents that are net contributors to the system.
The tax pressure is comparable from the US to other western countries so it seems like it is a questions of prioritizing those tax money.
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To be blunt, I do not think I desire to eek out a few more years of my life hooked up to life support, taking medicines that prevent me from being me, and pooping my pants. I remember my grandfathers last years (both in nursing homes, hooked to machines, drugged out of their minds) and I do not wish for that.
I would rather die a few years earlier than live my last few years this way. It'd sure cost less too.
I would rather die a few years earlier than live my last few years this way. It'd sure cost less too.
This is the way a person that is far away from death thinks. No matter what you think now, you will still want to live when death is near. Even if the conditions are suboptimal.
What's your evidence for this? In my experience, losing both my parents and all grandparents, everyone was ready to go long before they did. My dad passed away comfortably in his sleep in reasonable health (for 84 year old) and he'd been talking about being ready for months. My grandmother told us she wished she was dead like all her friends for a decade before she passed away (she was late 90s). My mother had cancer and chose to go at her own time like one of the comments above about MAID.
Similar here. My grandfather told me he prayed for death to come a few months before actually dying.
So it does depend on the individual and their specific circumstances.
So it does depend on the individual and their specific circumstances.
I agree, very much depends on the individual. Currently witnessing a 94-year-old who can no longer get out of bed who absolutely does not want to die. Otherwise, I'm convinced it would have happened by now. I'm not surprised though, it's her personality.
It's definitely a lot of things, like religious beliefs, personality, fear, guilt. And I think our society is absolutely terrified of death. A rational person might reason, "Well, I'm only a burden now, I'm not going to get any more enjoyment out of life, and I'm going to die soon anyway. This is a perfect time to end my life." But we aren't taught to think like that.
We're taught that death is the worst thing that can happen to you, that when you die you might go to a place full of fire and burning and torture forever, that trying to extend your life (exercise, nutrition, psychology, cosmetics, etc) is the ultimate goal. We are not taught to get the most out of life when we're young, we're not taught the practical skills that would give us more contentment through life, and we're not taught that death is a natural and normal part of life.
We need a class in school called "don't fear, just plan: organize your way to a happy life and be fine with dying sooner." Teach people how to stop sitting around wondering how to be happy, and just give simple practical skills and workbooks. Things like "how to pick your career", "how to choose where to live", "how to actually manage your finances", "how to make friends", "how to get a significant other", "how to manage your emotions", "how to deal with conflict", "how to deal with a life change", "how to enjoy life for free", "how to balance work and life", etc. There are answers to all these things, but they aren't taught in school; we're just expected to bump into them somewhere in life, after decades of grasping around pretending like we know what we're doing. We waste so much of life because nobody has taught us what to do.
By the time you're 60, you should have already had a vivid, exciting life full of friends and opportunities and special moments. But many of us haven't! I put it down to simply not learning how. If we expect every kid to learn completely useless shit like Calculus, we should definitely teach them the more important life skills sooner.
We're taught that death is the worst thing that can happen to you, that when you die you might go to a place full of fire and burning and torture forever, that trying to extend your life (exercise, nutrition, psychology, cosmetics, etc) is the ultimate goal. We are not taught to get the most out of life when we're young, we're not taught the practical skills that would give us more contentment through life, and we're not taught that death is a natural and normal part of life.
We need a class in school called "don't fear, just plan: organize your way to a happy life and be fine with dying sooner." Teach people how to stop sitting around wondering how to be happy, and just give simple practical skills and workbooks. Things like "how to pick your career", "how to choose where to live", "how to actually manage your finances", "how to make friends", "how to get a significant other", "how to manage your emotions", "how to deal with conflict", "how to deal with a life change", "how to enjoy life for free", "how to balance work and life", etc. There are answers to all these things, but they aren't taught in school; we're just expected to bump into them somewhere in life, after decades of grasping around pretending like we know what we're doing. We waste so much of life because nobody has taught us what to do.
By the time you're 60, you should have already had a vivid, exciting life full of friends and opportunities and special moments. But many of us haven't! I put it down to simply not learning how. If we expect every kid to learn completely useless shit like Calculus, we should definitely teach them the more important life skills sooner.
I'm not sure that anecdotal evidence should really be at play here. For instance, the only person that I personally knew who paid a Dignitas subscription chose not to go through with it, but that doesn't demonstrate anything about the population at large.
Terry Pratchett, after being diagnosed with early-onset Alzheimer's, made a documentary called Choosing To Die, which you might be interested in. He had stated that he wished to die by assisted suicide, but ultimately Terry died at home from Alzheimer's.
Terry Pratchett, after being diagnosed with early-onset Alzheimer's, made a documentary called Choosing To Die, which you might be interested in. He had stated that he wished to die by assisted suicide, but ultimately Terry died at home from Alzheimer's.
Given the choice between living and dying I believe a vast majority of people choose living.
That being said I think assisted suicide should be an option and everyone should have this option.
That being said I think assisted suicide should be an option and everyone should have this option.
You're forgetting there's still a huge percentage of people that think suicide is immoral and won't do it.
Not sure about that.
This is under-reported but there is a very high number of suicide in this age category.
I don't think the desire to live vanishes, but some of us are simply not willing to live miserably for months or years.
At some point it is clear that there is no turning back, being stuck in bed for a few days or weeks can be acceptable, but not if there is zero hope of regaining autonomy.
Also, I am not found of the business side of this, I think this is extorsion, preying on the weak.
This is under-reported but there is a very high number of suicide in this age category.
I don't think the desire to live vanishes, but some of us are simply not willing to live miserably for months or years.
At some point it is clear that there is no turning back, being stuck in bed for a few days or weeks can be acceptable, but not if there is zero hope of regaining autonomy.
Also, I am not found of the business side of this, I think this is extorsion, preying on the weak.
Yes. It's the pain and the suffering that makes people maybe want to let go. But that does not equal wanting to die.
I think _some_ people will want to continue to live, and some will not. Making confident assertions about someone else's future preferences seems fundamentally unreasonable.
I recall my grandmother in the hospital with pancreatitis, in serious pain, saying she was ready to die, but her doctors reassuring everyone that actually her situation probably wasn't life threatening. She was in her 90s already. She had outlived her husband by decades by that point. She had outlived multiple batches of friends at her retirement community. She did live for a few years after that incident, but I understand why she was ready to accept death.
I recall my grandmother in the hospital with pancreatitis, in serious pain, saying she was ready to die, but her doctors reassuring everyone that actually her situation probably wasn't life threatening. She was in her 90s already. She had outlived her husband by decades by that point. She had outlived multiple batches of friends at her retirement community. She did live for a few years after that incident, but I understand why she was ready to accept death.
Why is it unreasonable?
Biologically we're hardwired to want to live.
When my grandmother got cancer the 2nd time, she decided that she did not want to suffer treatment to eek out a few more months or years. She lived at home until she died.
When she could no longer care for herself, a hospice nurse came twice a day. When the end was close, family moved into the house, and children were taken out of school. She pass in the comfort of a familiar setting surrounded by loved ones, and everyone witnessed her last breath and death rattle.
It was a very wholesome experience and how I would want to go.
When she could no longer care for herself, a hospice nurse came twice a day. When the end was close, family moved into the house, and children were taken out of school. She pass in the comfort of a familiar setting surrounded by loved ones, and everyone witnessed her last breath and death rattle.
It was a very wholesome experience and how I would want to go.
> No matter what you think now, you will still want to live when death is near.
Not true.
My father wanted to die for the last 6 years of his life.
He would talk about it and obsess about his death in eager anticipation.
His last words that followed by three days of not eating or drinking were "Can't this go any faster?"
Just not wanting to live, and not being depressed about it, made transition easier for me personally.
He was never in pain during this time, so I didn't feel compelled to help him die.
Not true.
My father wanted to die for the last 6 years of his life.
He would talk about it and obsess about his death in eager anticipation.
His last words that followed by three days of not eating or drinking were "Can't this go any faster?"
Just not wanting to live, and not being depressed about it, made transition easier for me personally.
He was never in pain during this time, so I didn't feel compelled to help him die.
It’s how you think.
People plan and choose to exit early all the time. Some people don’t want to live, even when death is nowhere near, but stick around because they don’t want to devastate their family.
Honestly, you sound like someone who likes to pretend to have insight into the human mind, but you can’t be bothered to actually invest the time listening to people you don’t understand.
People plan and choose to exit early all the time. Some people don’t want to live, even when death is nowhere near, but stick around because they don’t want to devastate their family.
Honestly, you sound like someone who likes to pretend to have insight into the human mind, but you can’t be bothered to actually invest the time listening to people you don’t understand.
I wouldn’t generalize here.
I've known dying folks that still feel as the above describes. I'm sure there are also lots that change their mind.
Your thoughts mirror my own, however I should point out that thinking this now and making that choice when the time actually comes are quite different things.
Especially when that choice is made for you by others. One grandfather did not wish to go into a home but his daughters insisted and put him there.
Having seen this for other family members: I have a compressed nitrogen cylinder reserved in the garage for this purpose. I hope my wits are about me to use it, or that a DNR keeps any hospital stay as short as practical.
> I would rather die a few years earlier than live my last few years this way.
What's your plan?
What's your plan?
I've spent a great deal of time coming up with my plan. My plan is to NOT seek a fix to everything that can possibly go wrong. For example, I'm 56 and have never had a colonoscopy and I don't intend to get one. If I get colon cancer, then so be it. If I get cancer, it's doubtful that I would go through chemotherapy. I'd rather leave life earlier than try to squeeze out every drop possible and end up withering away in a nursing home.
"For example, I'm 56 and have never had a colonoscopy and I don't intend to get one. If I get colon cancer, then so be it."
You'd rather die than have a tube stuck up your arse for 5 minutes? A colonoscopy is really not that big a deal
You'd rather die than have a tube stuck up your arse for 5 minutes? A colonoscopy is really not that big a deal
Once more -- my plan is to NOT seek a fix to everything that can possibly go wrong. Colonoscopy is 1 example.
Most recent study shows that a colonoscopy does not have any effect on cancer outcomes or early detection.
I agree with you. I've seen how bad end-of-life can get, through my grandparents. Dementia is a slow and miserable way to go.
My father is slowly declining in an assisted living facility. It costs a fortune because we have to provide 24-hr a day sitters to be with him. The last time I saw him I don't think he knew who I was.
Yes, my last memory of my grandfather was him mistaking me for a friend of his. I'd rather my children and grandchildren see me finish my race strong and with my wits about me, then drugged into a stupor.
Same. My grandmother was pissing herself and confused most days. What was gained?
Say doctor gave you 4 more weeks to live.
You can now chose to be on life support for 2 more year at the cost of pooping pants and being on drugs. I bet, life support does not sound so bad.
You can now chose to be on life support for 2 more year at the cost of pooping pants and being on drugs. I bet, life support does not sound so bad.
Since I'll likely be leaving this world through the horrors of dementia and alzheimers, I'd take the 4 weeks, because by the end of the 2 years I wouldn't even be me.
Which parts of your body are you willing to let degrade just to continue breathing and reading reddit about stuff that you will never live to see happen anyway?
Which parts of your body are you willing to let degrade just to continue breathing and reading reddit about stuff that you will never live to see happen anyway?
> Suppose that a god announced that you were going to die tomorrow “or the day after.” Unless you were a complete coward you wouldn’t kick up a fuss about which day it was—what difference could it make? Now recognize that the difference between years from now and tomorrow is just as small.
I'd take the 4 weeks. Why? Less suffering for myself and my family. Less financial burden for my family. As bonus, get to leave the insanity of this world sooner.
Same. Ripping the bandaid off is always better.
It absolutely does sound bad.
This reminded me of one of our society's most twisted and grotesque norms, forcing people on their deathbed to die "naturally", meaning to starve and dehydrate to death while being pumped full of opioids, instead of mercifully and humanely ending their life.
We treat animals better than this.
I hope by the time it's my turn my family is able to end my life once the outcome is certain instead of watching me waste away day after day in a hospital bed until my body finally fails.
We treat animals better than this.
I hope by the time it's my turn my family is able to end my life once the outcome is certain instead of watching me waste away day after day in a hospital bed until my body finally fails.
We just moved to Mexico for this very reason. My mom now has 24 hour nurse care (at home) for 1,200 usd per month. In the US we were quoted 10k per month and not 24 hour. My mom receives a small pension which puts her in a spot where she qualifies for no government benefits but also cannot afford care at the current market rate.
It’s not for everyone but she is much happier here than in a nursing home.
It’s not for everyone but she is much happier here than in a nursing home.
I suspect a lot of boomers will discover this option soon. As soon as you retire, say at ages 60-65, it is more optimal to leave the US and live in Mexico/SE Asia until health permits. Then return back to the US in your early 70s with the full support of medicare and SS.
My parents stayed in Mexico after their Medicare and SS kicked in.
Once you've been down there for 5-10 years, why would you come back? There are huge communities of retired expats in Mexico. We're talking 5-10k expats all visiting the same grocery stores, churches, etc.
My parent's best friends down there grew up in the same era they did, often in the same regions of the US. I don't know what my parents would come back to the US for?
Once you've been down there for 5-10 years, why would you come back? There are huge communities of retired expats in Mexico. We're talking 5-10k expats all visiting the same grocery stores, churches, etc.
My parent's best friends down there grew up in the same era they did, often in the same regions of the US. I don't know what my parents would come back to the US for?
> I don't know what my parents would come back to the US for?
Sure. Once you have a community in another country, there are very few reasons to return back. But not everyone can build a lasting community. For them, returning back is still an option.
That said, I agree that even hospice and LTC is cheaper in other countries. Just take your money and live there in peace.
Sure. Once you have a community in another country, there are very few reasons to return back. But not everyone can build a lasting community. For them, returning back is still an option.
That said, I agree that even hospice and LTC is cheaper in other countries. Just take your money and live there in peace.
Heh, you write "full support of medicare and SS" as if that's a solution. It's not really a solution (as the article alludes to). IME -
1. Kid(s) that will take care of you, or at least hands on supervise your care and fill in gaps in staff.
2. As little time as possible between being in rehab/hospital, and hospice.
3. Money
If you have at least two out of those three, you won't have a horrible experience dying. Otherwise you end up in the state-paid nursing home gristmill, where you can at least take solace that they've checked the boxes on the paper saying they're turning and cleaning you.
1. Kid(s) that will take care of you, or at least hands on supervise your care and fill in gaps in staff.
2. As little time as possible between being in rehab/hospital, and hospice.
3. Money
If you have at least two out of those three, you won't have a horrible experience dying. Otherwise you end up in the state-paid nursing home gristmill, where you can at least take solace that they've checked the boxes on the paper saying they're turning and cleaning you.
Only 2 and 3 are viable options for many. 2 is unpredictable. But 3 can be achieved by simply spending less in retirement. Plenty of countries out there where you can live on $1k/mo.
Yeah I don't disagree with your overall point about people retiring in low cost of living areas globally. I just don't think those people will be coming back, or would even plan to come back. Of course doing so greatly removes your ability for #1, which is about the only way to make sure you're not fleeced and discarded.
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What city in Mexico?
Not a criticism of the action, but an observation. In the book The Elephant in the Brain by Kevin Simler & Robin Hanson, the authors observe that part of the reason healthcare may be so expensive is that we (unintentionally) communicate how much we love a person by acting as if money is not an issue. This means that despite last months of life often being the least pleasant for the dying, we expend a tremendous amount of money and resources intentionally to show them (and ourselves?) that we love them.
A really worthwhile read are some of the essays online with basically the same title: How Doctors Die. Doctors, who are familiar with the process of dying in a hospital, typically do not wish to die there (it is miserable), and choose to die at home.
I wish our society had a better ritual around death. Having an option for the dying person (if they are of sound mind) to choose euthanasia would be very merciful.
A really worthwhile read are some of the essays online with basically the same title: How Doctors Die. Doctors, who are familiar with the process of dying in a hospital, typically do not wish to die there (it is miserable), and choose to die at home.
I wish our society had a better ritual around death. Having an option for the dying person (if they are of sound mind) to choose euthanasia would be very merciful.
> it cost our family $145,613.79
I'd like to know what this actually means. Where did the money come from? Was her grandmother destitute and so the money was pooled from other family members? Was this debt that her grandmother accumulated that was written off when she died? Or, was this paid out of her grandmother's retirement funds?
I'd like to know what this actually means. Where did the money come from? Was her grandmother destitute and so the money was pooled from other family members? Was this debt that her grandmother accumulated that was written off when she died? Or, was this paid out of her grandmother's retirement funds?
Agree. Also, was that the cost of hospice or of all her medical care?
If you're including rent in the cost, did grandma have a home that she sold? Would she have been paying that much in rent anyway if she wasn't sick? Would it have been cheaper if she didn't live in one of the nations more expensive cities?
If you're including rent in the cost, did grandma have a home that she sold? Would she have been paying that much in rent anyway if she wasn't sick? Would it have been cheaper if she didn't live in one of the nations more expensive cities?
>> it cost our family $145,613.79
I would be willing to wager that the 'cost' was in a reduced inheritance.
I would be willing to wager that the 'cost' was in a reduced inheritance.
That was my thought. It’s not their family’s money. Assuming the grandmother even gave the money to her family in her will, it is hers to do with while she is alive. That includes using it to pay for her end of life care.
Can relate to TFA. Cost near the end of life are eye-popping the in the US, but the alternative is murky too. Just let elder relatives live in your home? Likely won't last 3-4 days, its hard. Cost of these facilities is astronomical and ironically the staff is usually underpaid and overstressed.
Assisted death will get a lot of callout as its becoming popular but its not 100% the answer either. Legitimately wondering how older generations dealt with this problem. Did old people just die randomly and then they were buried and that was that?
Assisted death will get a lot of callout as its becoming popular but its not 100% the answer either. Legitimately wondering how older generations dealt with this problem. Did old people just die randomly and then they were buried and that was that?
People tended not to linger as long, and had tons of children and grandchildren to look after them.
My grandfather had a heart attack and bypass fifteen years ago. He's been pretty much bedridden for the last two of those, needing my mother to look after him full time.
My grandmother passed away after 6+ months of needing more and more oxygen. The last three months she needed full time care.
100 years ago they both wouldn't have lasted more than 2-3 months, and would have needed very little care for most of that time.
My grandfather had a heart attack and bypass fifteen years ago. He's been pretty much bedridden for the last two of those, needing my mother to look after him full time.
My grandmother passed away after 6+ months of needing more and more oxygen. The last three months she needed full time care.
100 years ago they both wouldn't have lasted more than 2-3 months, and would have needed very little care for most of that time.
family used to provide a lot of that care, and saw it as part of their responsibility, and was made easier when one parent was at home and not working.
Now, for the most part, both spouses work and neither has any interest, or ability in providing that care because their own living expenses are such that they can't just forgo one salary to be an at home caretaker.
Now, for the most part, both spouses work and neither has any interest, or ability in providing that care because their own living expenses are such that they can't just forgo one salary to be an at home caretaker.
Correct, society has definitely changed with women now in the workforce and the velocity(?) of people moving from where they grew up. I know my family has scattered after high school and had no intentions of returning home. Difficult for parents to relocate to children after living life in one community all their life.
> Did old people just die randomly and then they were buried and that was that?
In most places on earth the elderly live with their children. The children care for them, then yes they die.
They’ll often be buried in the yard if they have land or in a plot designated (graveyard). Alternatively, they’ll have some sort of cremation ceremony.
Pretty much been that way forever. The last 70 years in the US has gotten exceptionally weird, looking through a historical lens. Frankly, it looks like we hate our elders.
In most places on earth the elderly live with their children. The children care for them, then yes they die.
They’ll often be buried in the yard if they have land or in a plot designated (graveyard). Alternatively, they’ll have some sort of cremation ceremony.
Pretty much been that way forever. The last 70 years in the US has gotten exceptionally weird, looking through a historical lens. Frankly, it looks like we hate our elders.
Agreed, and having watched the older generations go through heartbreaking experiences to squeeze out 2-3 months of 'living' has solidified me in insisting on never putting my family through that. My hope is multi-generational households become more prevalent in the US (I thin they are still common in Latino and Asian communities in the US).
Leads to interesting debates/arguments on what is living versus simply being alive
Leads to interesting debates/arguments on what is living versus simply being alive
We don't hate the elderly, we just don't value family. We expect our kids to leave home as soon as they are able and we don't bat an eye when they move a few thousand miles away. Marriage rates have been declining for a few decades and something like half of marriages end in divorce. I have an aging mother and mother-in-law that both live alone because they "value their independence." Neither has the slightest interest in living with my wife and I, although we are fairly close. The norm is living independently and anything else is an imposition or a failure in our society.
edit: Wouldn't have thought any of that was terribly controversial. I'd be interested if those having a negative reaction would post some response so I know what makes that opinion problematic. No need to get into an argument, I'm just genuinely curious.
edit: Wouldn't have thought any of that was terribly controversial. I'd be interested if those having a negative reaction would post some response so I know what makes that opinion problematic. No need to get into an argument, I'm just genuinely curious.
From the article:
>unless they have family members who are willing to give up their own lives to be caregivers
Where my ancestors are from, this is what happened. 99% of the time, this responsibility fell on women, because they had no option.
I have no interest in seeing my wife or daughter or sister (or son) suffer the same fate, so suicide (preferably assisted) is the answer in my view.
>unless they have family members who are willing to give up their own lives to be caregivers
Where my ancestors are from, this is what happened. 99% of the time, this responsibility fell on women, because they had no option.
I have no interest in seeing my wife or daughter or sister (or son) suffer the same fate, so suicide (preferably assisted) is the answer in my view.
When my mother passed last September, about 30 miles (~50 kilometers) west of Boston, private onsite hospice care cost about $400-ish a day. It's about the cost of staying in a fancy hotel. The state also covers the cost when you are on your final days, (there's a specific medical term,) but for longer-term stays, (weeks, months,) you have to pay out of pocket.
Being "on hospice" when you are in your last months (again I don't remember the medical term), in Massachusetts is free. The family is responsible for the round-the-clock care, though. The real difficulty isn't the money: The state is very good at placing people who can't pay. The people who get squeezed are those of us who want an inheritance, or the spouses who need to keep money for their own end-of-life needs, yet are unable or unwilling to take time off from our lives.
In my case my dad was under quite a bit of emotional stress, and when he's in that state, he gets irrational and can't make a decision. My mom was clearly in her last few days, but he was afraid he'd have to pay for many weeks or months of onsite hospice stay out of his own pocket. Even if that happened, he still had her brand-new Lexus and his own 1-year-old Highlander, a much larger house than he needs...
Being "on hospice" when you are in your last months (again I don't remember the medical term), in Massachusetts is free. The family is responsible for the round-the-clock care, though. The real difficulty isn't the money: The state is very good at placing people who can't pay. The people who get squeezed are those of us who want an inheritance, or the spouses who need to keep money for their own end-of-life needs, yet are unable or unwilling to take time off from our lives.
In my case my dad was under quite a bit of emotional stress, and when he's in that state, he gets irrational and can't make a decision. My mom was clearly in her last few days, but he was afraid he'd have to pay for many weeks or months of onsite hospice stay out of his own pocket. Even if that happened, he still had her brand-new Lexus and his own 1-year-old Highlander, a much larger house than he needs...
> The people who get squeezed are those of us who want an inheritance
There's the world's smallest violin playing for these people. The amount of delusional privilege to be in a position where you not only expect an inheritance, but also expect a certain amount of the inheritance, and yet refuse to care for your elderly is mind-blowing.
It's on par with parents who kick out their adult children out at 18 years out of the house.
Those 2 groups of people will firmly be labeled as pieces of shit in my mind and no amount of arguments will ever sway that position.
There's the world's smallest violin playing for these people. The amount of delusional privilege to be in a position where you not only expect an inheritance, but also expect a certain amount of the inheritance, and yet refuse to care for your elderly is mind-blowing.
It's on par with parents who kick out their adult children out at 18 years out of the house.
Those 2 groups of people will firmly be labeled as pieces of shit in my mind and no amount of arguments will ever sway that position.
So if a doc recommends a $1M expense to keep my drugged out dad alive for another day, as I a piece of shit for saying that does not make sense?
Doctors don't make those kinds of recommendations.
It is hyperbole for sure, but there are plenty of real world cases where I would find the cost benefit not worth it. Personally I would find the cost benefit not worth it for any situation that has me lying feebly on opioids until I die.
But the point remains. If you can’t agree with the hyperbole then you’re in the wrong making grand blanket statements about the way things work and saying nothing can convince you otherwise
But the point remains. If you can’t agree with the hyperbole then you’re in the wrong making grand blanket statements about the way things work and saying nothing can convince you otherwise
> It is hyperbole for sure, but there are plenty of real world cases where I would find the cost benefit not worth it.
I married a doctor. That doesn't happen.
What does happen is that the loved ones, or social workers, push for the doctors to do everything possible, even when the doctors know that it's a futile situation. When people encounter loss they do not behave rationally.
> Personally I would find the cost benefit not worth it for any situation that has me lying feebly on opioids until I die.
"lying feebly on opioids until I die" is what happens when someone's body is shutting down from a painful condition like cancer. Hopefully you're lucky and die in your sleep of old age.
Unfortunately, assisted suicide is illegal in most places.
Generally what's legal is to let nature take its course, and your caregivers, (who can be trusted family members) decide how often to give you opioids. It's well known that painkillers at the end of life accelerate death, so as long as your wishes are known to the people giving you painkillers, the "lying feebly on opioids until I die" can be very short. (Read between the lines.)
I married a doctor. That doesn't happen.
What does happen is that the loved ones, or social workers, push for the doctors to do everything possible, even when the doctors know that it's a futile situation. When people encounter loss they do not behave rationally.
> Personally I would find the cost benefit not worth it for any situation that has me lying feebly on opioids until I die.
"lying feebly on opioids until I die" is what happens when someone's body is shutting down from a painful condition like cancer. Hopefully you're lucky and die in your sleep of old age.
Unfortunately, assisted suicide is illegal in most places.
Generally what's legal is to let nature take its course, and your caregivers, (who can be trusted family members) decide how often to give you opioids. It's well known that painkillers at the end of life accelerate death, so as long as your wishes are known to the people giving you painkillers, the "lying feebly on opioids until I die" can be very short. (Read between the lines.)
You’ve listed a bunch of facts here which are generally true but they don’t mean anything in regards to whatever point you’re trying to make.
My point is simply that it’s reasonable to make cost benefit analyses when deciding end of life care, and that you’re not an asshole for doing so.
My point is simply that it’s reasonable to make cost benefit analyses when deciding end of life care, and that you’re not an asshole for doing so.
> If you can’t agree with the hyperbole then you’re in the wrong making grand blanket statements about the way things work and saying nothing can convince you otherwise
You don't get to magically negate my argument with a strawman you invented, sorry.
If you don't want the described case to be your own case, then make the necessary arrangements where the doctor isn't making such decisions.
You don't get to magically negate my argument with a strawman you invented, sorry.
If you don't want the described case to be your own case, then make the necessary arrangements where the doctor isn't making such decisions.
You asserted
> Those 2 groups of people will firmly be labeled as pieces of shit in my mind and no amount of arguments will ever sway that position.
But are now implying that you would be agree with my example if it were true. Thus demonstrating that your statement is wrong. You are willing to engage in cost benefit analysis for elder care. This case is simply easy and improbable to arise.
We can play with the numbers until you think it’s realistic and unreasonable. The point remains.
Straw men are dumb. But not as dumb as absolute sweeping statements of certainty.
There are many, many cases of expensive medical treatments that extend life in a miserable fashion. There are many cases of expensive medical treatments that extend life in a non miserable fashion. Doesn’t mean they make sense to do. Doesn’t make you an asshole to think about it.
> Those 2 groups of people will firmly be labeled as pieces of shit in my mind and no amount of arguments will ever sway that position.
But are now implying that you would be agree with my example if it were true. Thus demonstrating that your statement is wrong. You are willing to engage in cost benefit analysis for elder care. This case is simply easy and improbable to arise.
We can play with the numbers until you think it’s realistic and unreasonable. The point remains.
Straw men are dumb. But not as dumb as absolute sweeping statements of certainty.
There are many, many cases of expensive medical treatments that extend life in a miserable fashion. There are many cases of expensive medical treatments that extend life in a non miserable fashion. Doesn’t mean they make sense to do. Doesn’t make you an asshole to think about it.
>>The people who get squeezed are those of us who want an inheritance
You just said the quiet part out loud, and is my biggest gripe about sob stories like this - it is almost always about the children resenting the fact that some of their parents money is going to be spent on their elder care when they would prefer 'someone else' pick up the bill, so that they get a bigger inheritance.
You just said the quiet part out loud, and is my biggest gripe about sob stories like this - it is almost always about the children resenting the fact that some of their parents money is going to be spent on their elder care when they would prefer 'someone else' pick up the bill, so that they get a bigger inheritance.
Yeah, on the last day she was in the house, the social workers came to evaluate her to see if we would pay, or the state would pay.
They determined that we should pay. The (cough) mistake that we made was we gave her painkillers before the visit because she was writhing in pain. If the social workers saw the writhing, they would have picked up the tab. (The hospice later retroactively admitted her so we paid nothing.) Edit: And I don't regret giving my mom painkillers.
But, I had to make a point to my Dad that the social workers saw his nice, well kept house, all of our nice cars, pictures from nice vacations, ect, and decided that $400-$1200 to keep Mom comfortable was well within our budget.
They determined that we should pay. The (cough) mistake that we made was we gave her painkillers before the visit because she was writhing in pain. If the social workers saw the writhing, they would have picked up the tab. (The hospice later retroactively admitted her so we paid nothing.) Edit: And I don't regret giving my mom painkillers.
But, I had to make a point to my Dad that the social workers saw his nice, well kept house, all of our nice cars, pictures from nice vacations, ect, and decided that $400-$1200 to keep Mom comfortable was well within our budget.
idk that you should be fully putting this on your dad as if his was an unreasonable desire. It's a cruel fact that under our system, a lack of money means a lack of agency. Once you're out of money, the state options have massive cracks to fall through. The way I understand it (pre-hospice) - once he ran out of the ability to pay for help and couldn't keep up a facade of "full time care" himself, the state's answer would have been to ship her off to a nursing home regardless of what they both wanted. And FWIW selling a $30k car will cover like two months of part-time care.
My mom only had a few days to live. Her digestive system stopped working. He was being quite irrational about it, because the longest people live in that state is 3 weeks. (A lot of people are irrational in similar situations.)
And a brand new Lexus sells for much more than $30k.
And a brand new Lexus sells for much more than $30k.
Sorry, I had missed the part where it was definitely your mom's last days. My own mom was deathly scared of my dad passing and her not having enough money to pay for years at a private nursing home, having seen the (lack of) care patients get at the ones the state pays for. She ended up passing before my dad, who I then had to push into spending money to take care of himself because he had become so used to scrimping for her.
So my general point is that someone not wanting to have their own financial situation severely destroyed by long term care of an ailing spouse isn't categorically unreasonable. And as far as the next generation - you can either accept that medical vultures will devour your parents' estate and you'll get nothing, or you can step up and take responsibility for their care when the time comes, and perhaps inherit something. Your parent's quality of life will generally be much better if you do step up, but it's not the kind of job that can just be outsourced as we've become accustomed to with everything else these days. (and obviously this advice is modulo one's specific relationship with their parents)
I'm sorry for your loss, and hope things are going alright between you and your dad.
So my general point is that someone not wanting to have their own financial situation severely destroyed by long term care of an ailing spouse isn't categorically unreasonable. And as far as the next generation - you can either accept that medical vultures will devour your parents' estate and you'll get nothing, or you can step up and take responsibility for their care when the time comes, and perhaps inherit something. Your parent's quality of life will generally be much better if you do step up, but it's not the kind of job that can just be outsourced as we've become accustomed to with everything else these days. (and obviously this advice is modulo one's specific relationship with their parents)
I'm sorry for your loss, and hope things are going alright between you and your dad.
Thanks. Things are going fine between us. I do have half of his genes, so I can understand what was going through his head.
He's started to realize he can't take it with him.
He's started to realize he can't take it with him.
This reminds me of the trend to value women's work at home on a per hour basis.
Then an inevitable conclusion is reached: being a homemaker is like being employed but not compensated.
The point is taking care of your family is something people want to do to maintain family relationship, connections between generations and self-identity. It's a choice, not a forced expenditure.
And it's not meant to be pleasant or easy. It's not a hobby. It's a fabric of a well lived life.
Then an inevitable conclusion is reached: being a homemaker is like being employed but not compensated.
The point is taking care of your family is something people want to do to maintain family relationship, connections between generations and self-identity. It's a choice, not a forced expenditure.
And it's not meant to be pleasant or easy. It's not a hobby. It's a fabric of a well lived life.
24h at home care isn't covered anywhere except with really expensive private insurance. In most European countries the family either covers the burden financially or they do it themselves. This post is more entitlement than anything else.
"How will you afford to spend your final years of life? How much will your death cost you and your family? Can you afford it?"
We've had this talk with both my parents and my wife's parents. All four of them insisted they do not want to be a burden to us and we should never allow them to move in with us. Most of our parents took care of at least one terminal person in their life and experiencing that changed their opinions radically. It can be an almost impossible burden, no matter how much you love someone.
Thankfully in our country we have both the law and basic insurance that takes care of all those costs in the last (terminal) phase of our lives, but you still have to design your testament and other documents in such a way that your money cannot be claimed for these costs.
When the time comes, i want to be put in the Euthenasia Coaster ( https://en.wikipedia.org/wiki/Euthanasia_Coaster ) , but if they have not built that yet i might settle for the $20 heroin overdose.
We've had this talk with both my parents and my wife's parents. All four of them insisted they do not want to be a burden to us and we should never allow them to move in with us. Most of our parents took care of at least one terminal person in their life and experiencing that changed their opinions radically. It can be an almost impossible burden, no matter how much you love someone.
Thankfully in our country we have both the law and basic insurance that takes care of all those costs in the last (terminal) phase of our lives, but you still have to design your testament and other documents in such a way that your money cannot be claimed for these costs.
When the time comes, i want to be put in the Euthenasia Coaster ( https://en.wikipedia.org/wiki/Euthanasia_Coaster ) , but if they have not built that yet i might settle for the $20 heroin overdose.
I think we're looking at things backwards.
The question that society seems to be encouraging is "how are we going to pay people to take care of the old?".
The question we should be asking is "why are we paying strangers to take care of you when for most people, their children should be there at the end of life helping, showing love, and thanking mom and dad for all they've done?".
There's a significant cost to the direction that society has gone in the last hundred or so years.
> Deemphasizing the importance of family bonds by encouraging government to be the social safety net. This problem will only be exacerbated by increasing the social safety net further.
> Compelling nearly all women into the permanent workforce, ensuring that most families are in no position to be able to do anything other than maybe get in debt to pay a stranger to care for their elderly parents.
> Encouraging women to have fewer and fewer children even while encouraging mass migration to replace the existing population, ensuring that the problem will be even worse the more time goes on.
The question that society seems to be encouraging is "how are we going to pay people to take care of the old?".
The question we should be asking is "why are we paying strangers to take care of you when for most people, their children should be there at the end of life helping, showing love, and thanking mom and dad for all they've done?".
There's a significant cost to the direction that society has gone in the last hundred or so years.
> Deemphasizing the importance of family bonds by encouraging government to be the social safety net. This problem will only be exacerbated by increasing the social safety net further.
> Compelling nearly all women into the permanent workforce, ensuring that most families are in no position to be able to do anything other than maybe get in debt to pay a stranger to care for their elderly parents.
> Encouraging women to have fewer and fewer children even while encouraging mass migration to replace the existing population, ensuring that the problem will be even worse the more time goes on.
> their children should be there at the end of life helping, showing love, and thanking mom and dad for all they've done?".
Speaking to the possible point that kids 'owe' their parents for their upbringing: As a father of 5, I strongly disagree.
Fatherhood is, by necessity and actuality, service. Children don't ask to be born; I believe creating them into a position of debt is a poor rendering of that service.
Speaking to the possible point that kids 'owe' their parents for their upbringing: As a father of 5, I strongly disagree.
Fatherhood is, by necessity and actuality, service. Children don't ask to be born; I believe creating them into a position of debt is a poor rendering of that service.
There is never any forced obligation.
The point is that every parent should treat their children well enough that they love and honor their parents so much that they want to do all they can to help when the parents need help.
Even the worst psychopath parent has a bit of incentive to treat their children well if they knew that this was the difference between having some comfort in their old age or being forgotten in some dreadful government facility being half taken care of by some stranger who doesn't give a fuck if they lie in a pool of their feces for hours.
The point is that every parent should treat their children well enough that they love and honor their parents so much that they want to do all they can to help when the parents need help.
Even the worst psychopath parent has a bit of incentive to treat their children well if they knew that this was the difference between having some comfort in their old age or being forgotten in some dreadful government facility being half taken care of by some stranger who doesn't give a fuck if they lie in a pool of their feces for hours.
Doesn't this require everyone to have children and your children to live nearby? Also, it seems like the OPs aging parent required specialized care which contributed to the high cost, not everyone could provide this level of care.
Please note that I said "most people", not "all people". Most people should aspire to have family caring for them at an old age as the best possible situation at that stage.
Life insurance can be writen with an LTC rider, standalone LTC policies have gotten very expensive since they were oversold throughout the 80's and 90's. SS kicks in upto a portion of the hospice and at home care, depending on circumstances.
In Canada a growing in popularity option is to kill yourself.
In Canada a growing in popularity option is to kill yourself.
My father died at 83 at home, and the only cost was the funeral expense, which would have been the same. When he stopped coming at the hospital for regular blood work, they expected he'd die in two weeks, but he lasted six months. During those six months my mom acted as his caregiver and vigil, and the state compensated her financially. She was allowed to continue working, and since she worked from home, she did work a little next to looking after him. Once a day for those six months, a nurse from the public health system would come by and check up on him.
This is Denmark.
This is Denmark.
I agree that this is clickbait, but then I come from a family that just doesn't think this way. I've been through this twice now, for both my parents. They died at home. Not in a rented apartment. At home. We, their children and grandchildren, were their caregivers. We did everything a nurse would have done. We took shifts. We spread the burden among us.
Yes it was a sacrifice. But it was a sacrifice that was worth it, and nothing less than what we owed to our parents.
Yes it was a sacrifice. But it was a sacrifice that was worth it, and nothing less than what we owed to our parents.
> As a clinician, I’ve been trained to explain hospice to patients as “an extra layer of support” at the end of life.
Offering advice on the provision of goods and services without cost information is stupid. It’s like one grade schooler telling another “yeah, you should totally buy that real life Ferrari.”
> The problem is that the bulk of the hands-on care in hospice — including changing diapers, feeding and giving medications — still falls to the family.
Amazingly, she acted as a salesperson for services whose service level she didn’t understand. On top of that, instead of learning a lesson and sharing better approaches with others she promoted additional subsidies to the existing dysfunctional system.
Offering advice on the provision of goods and services without cost information is stupid. It’s like one grade schooler telling another “yeah, you should totally buy that real life Ferrari.”
> The problem is that the bulk of the hands-on care in hospice — including changing diapers, feeding and giving medications — still falls to the family.
Amazingly, she acted as a salesperson for services whose service level she didn’t understand. On top of that, instead of learning a lesson and sharing better approaches with others she promoted additional subsidies to the existing dysfunctional system.
As someone who has had two older people who were at home virtually till the end - my mother-in-law (she finally died in the hospital after a very short stay) and her mum (who died at home) who were both terminally ill and bedridden for a while before they died, I have to say that the inconvenience to the rest of us was worth it because it enabled them be with the family, be part of what the family was doing etc.. And so also the family benefited from being with them till the end.
It did require having nursing help at home and it did cost some money - but it was still cheaper than being admitted in a hospice or a hospital.
It did require having nursing help at home and it did cost some money - but it was still cheaper than being admitted in a hospice or a hospital.
"dying at home is often unattainable for many, unless they have family members who are willing to give up their own lives to be caregivers or the patient is willing to spend down their life savings to qualify for Medicaid to pay for around-the-clock help."
You mean like what Grandma or Grandpa did to bring life into this world. Your life I might add. You owe them so much and you haven't clue. It is worthless and shameful.
You mean like what Grandma or Grandpa did to bring life into this world. Your life I might add. You owe them so much and you haven't clue. It is worthless and shameful.
> You mean like what Grandma or Grandpa did to bring life into this world. You owe them so much and you haven't clue.
I don't agree that my children should be responsible for the obligations that follow my choice to have sex. Further, decades of parenting taught me that as far as there is a debt, it is mine to pay. Parenting is service.
ref: Father of 5. https://news.ycombinator.com/item?id=34724289#34725607
I don't agree that my children should be responsible for the obligations that follow my choice to have sex. Further, decades of parenting taught me that as far as there is a debt, it is mine to pay. Parenting is service.
ref: Father of 5. https://news.ycombinator.com/item?id=34724289#34725607
I can appreciate that parenthood is a form of service because I have lived it. What I cannot appreciate is an ungrateful child. Society will continue to descend into morass because of unwillingness to care for others. However I didn't learn this in a vacuum but had instruction as a child to value others. Generally to "love my neighbor as myself".
But more specifically...
Leviticus 19:32
Exodus 20:12
Ephesians 6:1-3
But more specifically...
Leviticus 19:32
Exodus 20:12
Ephesians 6:1-3
I realize this may seem like a tangential point, but this story highlights the dire shortage of caregivers, especially elderly care workers. This shortage is a factor behind high costs and substandard care. Many of these jobs don’t necessarily require extensive medical training; a caring hand is literally the most valuable gift, especially near end of life. Immigrants can help fill these roles, but the United States restrictive immigration policy prevents this. The problem is only going to get worse as the Boomers continue to age, and as US demographics tilt towards an older population. Immigrants can help avert this crises while at the same time beginning a better life for themselves. We should do a better job of welcoming immigrants.
"the United States restrictive immigration policy prevents this."
It is more than a restrictive immigration policy. Many other caregiver policies exist as well. I have an acquaintance that runs an adult foster care home with 5 rooms. When he added a second facility he went from providing care to being a paperwork pusher for the federal, state and local governments. This is the real reason is costs so much.
It is more than a restrictive immigration policy. Many other caregiver policies exist as well. I have an acquaintance that runs an adult foster care home with 5 rooms. When he added a second facility he went from providing care to being a paperwork pusher for the federal, state and local governments. This is the real reason is costs so much.
> For this reason, dying at home is often unattainable for many... Currently, Medicare only covers an average of two hours per day, five days a week, of home health aide coverage for a patient in hospice care.
This article left me fairly confused. Why is the author talking about dying at home and in a hospice interchangeably?
This article left me fairly confused. Why is the author talking about dying at home and in a hospice interchangeably?
Many hospice services are provided at patients’ homes. Hospice is end of life care, it doesn’t require a medical facility in most cases. A “hospice nurse” will do rounds to ensure everything is okay but for fairly stable patients, the bulk of the time/energy is provided by the family.
Another day, another horror story about the American health & care system.
I'm just speechless about all of that at this point and very glad the I live in Europe, where we have things like these figured out.
(edit: yeeeeaaaaaah, not everything is perfect in Europe, either, but nobody will be left with a bill of 150k € if your grandmother wants to die in her home.)
I'm just speechless about all of that at this point and very glad the I live in Europe, where we have things like these figured out.
(edit: yeeeeaaaaaah, not everything is perfect in Europe, either, but nobody will be left with a bill of 150k € if your grandmother wants to die in her home.)
This comment (and many others) make me think most people are not reading the article. This isn't about someone dying at home. This article is about prolonged end-of-life 24hr care at home.
OP's grandmother had a team of support people giving her medication, changing diapers, monitoring equipment for an undisclosed period of months.
No where in Europe is 24hr support available for free in your own home. That simply isn't scalable.
Moreover, it should be noted that none of the family was willing to do this - so they were forced hire outside care.
The US healthcare system isn't great - but this article smells like spoiled rich people annoyed that they have to pay for rich-people-level service themselves.
OP's grandmother had a team of support people giving her medication, changing diapers, monitoring equipment for an undisclosed period of months.
No where in Europe is 24hr support available for free in your own home. That simply isn't scalable.
Moreover, it should be noted that none of the family was willing to do this - so they were forced hire outside care.
The US healthcare system isn't great - but this article smells like spoiled rich people annoyed that they have to pay for rich-people-level service themselves.
I don’t quite agree. Universal Healthcare isn’t a blank cheque. My grandmother had a similar story in Canada. The public system wouldn’t have paid for all the advanced in-house care. It would tell her to move into a nursing home somewhere and still wouldn’t cover all of that either.
She was fortunate enough to afford the constant care and was basically employing a full-time nurse. That adds up.
She was fortunate enough to afford the constant care and was basically employing a full-time nurse. That adds up.
If you're suggesting my taxes should pay someone's rent and practically private medical care, you've got something else coming.
Watching someone pass away is never pleasant, but there are limits to public generosity.
Watching someone pass away is never pleasant, but there are limits to public generosity.
well, perhaps not. i am in the uk and am currently spending about 1000.00 GBP per month for carers to come in twice a day for half an hour each time - i have heart and mobility problems. and this is towards the cheaper end of the spectrum.
Take a look here as you may be able to get some help from the NHS - https://www.nhs.uk/conditions/social-care-and-support-guide/...
Also, check with your local council as there's a lot of support that is not well publicised (particularly for making modifications to your home - which can lead to reduced council tax bills). Unfortunately GPs often don't seem to be aware of what is available - it could be worth talking to your local hospice (even if you aren't end of life) as they tend to be much more clued in.
Also, check with your local council as there's a lot of support that is not well publicised (particularly for making modifications to your home - which can lead to reduced council tax bills). Unfortunately GPs often don't seem to be aware of what is available - it could be worth talking to your local hospice (even if you aren't end of life) as they tend to be much more clued in.
the last time i was in hospital, last summer, the only way of getting out was to agree to pay for home care myself - nhs-funded care was simply not available due to a chronic staff shortage. people needing care were stuck on wards for weeks - the so-called bed-blockers.
i'm not complaining about the nhs here - in general the help and treatment i've received has been exemplary.
i'm not complaining about the nhs here - in general the help and treatment i've received has been exemplary.
For reference, we get better baseline Medicare in the US:
> Currently, Medicare only covers an average of two hours per day, five days a week, of home health aide coverage for a patient in hospice care.
> Currently, Medicare only covers an average of two hours per day, five days a week, of home health aide coverage for a patient in hospice care.
That's for a patient in hospice care, i.e: end of life. I believe the parent comment is describing on-going healthcare.
The UK is not part of Europe. ;-)
But yeah, if you've got the money to take care of yourself, you'll have to pay it. My grandparents had a low-enough income that the care takers (twice a day) were free for them.
But yeah, if you've got the money to take care of yourself, you'll have to pay it. My grandparents had a low-enough income that the care takers (twice a day) were free for them.
Can you please elaborate on how end of life care works in Europe (which country are you in?).
In the US you have a lot of different options depending on financial ability and your choices. Some aren't choices, and some are. In this case the individual choose to spend an in-ordinate amount of money - their choice and they have to pay for their choice.
Do you have the luxury of choosing in your country or does the government choose for you?
In the US you have a lot of different options depending on financial ability and your choices. Some aren't choices, and some are. In this case the individual choose to spend an in-ordinate amount of money - their choice and they have to pay for their choice.
Do you have the luxury of choosing in your country or does the government choose for you?
> Do you have the luxury of choosing in your country or does the government choose for you?
I'm unsure where this belief originates from, but it's not true that state provided care is the only care in countries that offer it. There's very few places on earth where money cannot be used to improve quality of care: the state guarantees provision of a minimum level of care, rather than impose a limit on the maximum.
I'm unsure where this belief originates from, but it's not true that state provided care is the only care in countries that offer it. There's very few places on earth where money cannot be used to improve quality of care: the state guarantees provision of a minimum level of care, rather than impose a limit on the maximum.
Ontario, Canada - effectively chooses for you. You cannot go around their decisions unless you leave the country.
How would you get 24h home care in Europe? Impossible
End of life care on the NHS is pretty comprehensive - https://www.nhs.uk/conditions/end-of-life-care/ and https://www.nhs.uk/conditions/social-care-and-support-guide/...
My father passed away last year and towards the end he had carers at the house 24x7.
My father passed away last year and towards the end he had carers at the house 24x7.
Elder care? It exists, and it's nowhere as expensive.
My grandma's non medicalised public retirement house costs $2k+ per month, she's not even sick.
A 24/7 _at home_ and _medical_ care will cost a fortune anywhere in the world and is never covered unless you have a very expensive private insurance to begin with
A 24/7 _at home_ and _medical_ care will cost a fortune anywhere in the world and is never covered unless you have a very expensive private insurance to begin with
I'm not saying it would be cheap, I said it would not be this expensive.
Also, there are different healthcare systems around the world. I don't know why you would be so sure about the impossibility of at-home nursing.
Also, there are different healthcare systems around the world. I don't know why you would be so sure about the impossibility of at-home nursing.
> I don't know why you would be so sure about the impossibility of at-home nursing.
Hospitals and health systems are at capacity pretty much everywhere, they can barely keep up with people in them, they won't dispatch nurses and docs around.
And my example was in France, far from being hell on earth when it comes to health
Hospitals and health systems are at capacity pretty much everywhere, they can barely keep up with people in them, they won't dispatch nurses and docs around.
And my example was in France, far from being hell on earth when it comes to health
24/7 care is 168hr/week, so the costs will be about 4 FTE in local salary. It's only less expensive elsewhere because wages are lower elsewhere.
There is intensive care in Germany but it's mostly done in clinics. Although it seems that sometimes it seems like that can be done at home, too.
Just throwing it out there, in europe do they hire a full-time, round the clock nurse, plus monitors and medicine for end of life care?
I seriously doubt that.
That’s what this person spent on their grandmother. There’s a huge difference between “wanting to die at home” and “wanting round the clock care at home”.
You can die at home for effectively free.
I seriously doubt that.
That’s what this person spent on their grandmother. There’s a huge difference between “wanting to die at home” and “wanting round the clock care at home”.
You can die at home for effectively free.
> Just throwing it out there, in europe do they hire a full-time, round the clock nurse, plus monitors and medicine for end of life care?
You could do that. I have seen it before, back in Spain. It is expensive, but not $13,000 a month.
It would not make much sense to pay this much, when nurses themselves make, on average, a small fraction of that.
You could do that. I have seen it before, back in Spain. It is expensive, but not $13,000 a month.
It would not make much sense to pay this much, when nurses themselves make, on average, a small fraction of that.
The median wage for a Registered Nurse in the US is around $6,400 a month. That's a large fraction of $13,000.
Maybe you forgot that you need 3 to 4 nurses to cover a 24*7=168hr week.
That’s not how it usually works, but if the author needed to do so, where did she find three nurses in NYC at $13,000 a month? That’s barely $15/hour.
Socialized healthcare is nice, but a lot of people don’t realize how terrible the wait is. I can get an appointment to see a doctor within a day. I can usually get appointments with specialists within two weeks.
As everyone knows, most of the US budget goes into defense. Most Americans are not keen on that fact, but I don’t see Europeans complaining about it when countries like Russia go on the rampage.
As everyone knows, most of the US budget goes into defense. Most Americans are not keen on that fact, but I don’t see Europeans complaining about it when countries like Russia go on the rampage.
What's the long term plan for European healthcare with the current demographics issues? Who's going to pay for all the elder care?
"Britain’s NHS was once idolized. Now its worst-ever crisis is fueling a boom in private health care"
- article from CNN
- article from CNN
There are certain elements of the current Conservative government who want the NHS to be replaced by private care.
Some of this is driven by ideology - low tax, small state. And some of it is driven by greed - lobbying by large US healthcare groups, or more obviously owning shares in those groups.
This has led to an almost deliberate policy of mismanaging and underfunding in real terms the NHS.
Some of this is driven by ideology - low tax, small state. And some of it is driven by greed - lobbying by large US healthcare groups, or more obviously owning shares in those groups.
This has led to an almost deliberate policy of mismanaging and underfunding in real terms the NHS.
Great Britain is not part of the EU. Neither am I from the UK.
>but nobody will be left with a bill of 150k € if your grandmother wants to die in her home.)
In the USA, my grandma died in my parent’s home 10 years ago and there was no bill. She was upper 90s, refused treatment, and doctors prescribed morphine for us to give her so she could die peacefully.
I think a nurse came everyday just to check on things.
In the USA, my grandma died in my parent’s home 10 years ago and there was no bill. She was upper 90s, refused treatment, and doctors prescribed morphine for us to give her so she could die peacefully.
I think a nurse came everyday just to check on things.
It's very weird to see someone posting about money spent for her grandma. In other cultures it's a shame.
That's the point the author is trying to make. That it is unjust to have to spend so much for end of life care and that as a society we should feel ashamed
The grandmother required 24-hour care, which they received for $13K/month.
For a 30-day month, that's $16.77/hr to the worker plus $1.28 to SS/Medicare if you allow for 0 minutes of shift-hand-off, PTO/sick, etc.
How much less than $16.77/hr do we think that care should cost? (Note that Massachusetts has a $15 minimum wage. This care cost less than 12% over minimum wage.)
For a 30-day month, that's $16.77/hr to the worker plus $1.28 to SS/Medicare if you allow for 0 minutes of shift-hand-off, PTO/sick, etc.
How much less than $16.77/hr do we think that care should cost? (Note that Massachusetts has a $15 minimum wage. This care cost less than 12% over minimum wage.)
Yup, it seems people gloss over that 24*7 care means 168hr per week, i.e. 4x42hr or 3x56 hr of labor per week. The only ways to make this cheaper is 1) lower salaries, 2) fewer hours or 3) have someone else pick up the tab (which can sometimes work on the individual level but not on the societal level)
Free obviously /s, because people dont understand basic economics and are either delusional it will be cheaper in a monopoly (socialized) (assuming you even have the choice to die at home with it) or want to imagine people working for free like doctors and nurses.
That being said the corruption in the us system is insane, insurance companies being protected by regulations against competition, big pharmas regulatory capture and media control, etc.
The answer is a more competitive marketplace, including non profits. Not a eu socialized model.
That being said the corruption in the us system is insane, insurance companies being protected by regulations against competition, big pharmas regulatory capture and media control, etc.
The answer is a more competitive marketplace, including non profits. Not a eu socialized model.
Exactly. 24h will cost the same everywhere. Maybe you can use a video baby monitor at night to reduce from 24 to 16h a day
I think you're reading the parent post the wrong way around: in many cultures, paying for your relatives is an honour and obligation. i.e: Paying a lot of money for your grandmother's end of life care is the bare minimum, not something to complain about or expect the state to handle.
How much does paying for your relatives cost in places where those cultures exist, relative to median income?
In other cultures there is no way it would cost that much, or anything at all.
It's more a way to shame the system, where dying at home costs so much.
What's to be done about it though? Round the clock care requires people. Those people have to be paid. Paid enough to attract people to do the work. Someone has to pay for it. Shifting it to the tax payer base doesn't change the math, it just moves the food around on the plate.
Honestly, if I lived well into my 80s and a last few horrible months was going to cost over $100K of money I didn't have to spend and eat up 2-3 peoples full time efforts, I'd probably just opt out.
Honestly, if I lived well into my 80s and a last few horrible months was going to cost over $100K of money I didn't have to spend and eat up 2-3 peoples full time efforts, I'd probably just opt out.
What's the shame -- paying for your grandma, or posting about it?
Having one in the first place. ;-P
There are no other cultures on Hackernews, only Nacirema.
From what I can gather, the $145K cost was the cost of medical care over the months (years? the article never says) at the end of the grandmother's life -- not the cost of "dying at home".
The bulk of the cost seems to come from:
> the total monthly cost was $16,200: $13,000 a month for the 24-hour care, plus $3,200 to rent the apartment
It seems silly to include rent, and then of course round-the-clock private care is going to be $$$.
As far as I can tell, the grandmother needed hospital-level care, but the family didn't want to keep her in a hospital. It's not surprising that hospital-level care at home costs a small fortune.