E.Who uses nursing home care? 1. People who are overrepresented are middle and upper class people 2. Medicaid is program for poor but why is it middle/upper class people 3. Nursing home finds people with money F. Middle class people “spend down their assets” to get into nursing homes 1. Spend their money on the nursing home 2. Sell house, car, everything 3. Now apply for medicaid and pays for remainder of treatment until they die 4. Go into public mental hospitals ANOTHER VERSION OF Class 24 -Health Insurance; Problems in Health Care System Private insurance · Oldest and most original form of health insurance o Originally fee for service now 85% of public have insurance o Blue cross – hospital charges o Blue shield – doctor’s charges § Blue cross blue shield now changed into profit making company. Use to non profit but not anymore ú When it was new, everybody paid the same community rate ú Came up with premiums based on group of people you lived with ú First example of cost sharing - sick people who use more services paid lower premiums, healthy people overpaid in premiums because they barely used it (cross-sharing · Usually pay 80% · Gap insurance policies designed to pay regular 20% that your regular insurance can’t cover · At first tried to avoid high risk cases
· Free choice of physicians · Excluded many people from insurance (those with illness already, pre-existing conditions), long term care, home health care · Many lost insurance when they got sick, change jobs (meant you are older, older are higher health risk)- Now you cannot lose coverage · Changes in private insurance o 1970’s – implicit rationing through HMOs o 1980’s – explicit cost rationing through DRG’s o 1990’s – explicit treatment rationing through managed care Social security · Designed as safety net for when people retire. Not thought of as insurance and not primary income ( just supplement ) but it is concerning that it is half the income of the elderly · Accounts for more than half the income of elderly o People really depend on ss payments Food, shelter, health care, often ss used to pay for health care o No other retirement program · Pay as you go program o The money you pay now are almost completely funding payments to ss recepients o Common misconception that it is accumulated o Savings Account with your money in it : LIES (no pocket money you’re entitled to) o Money they bring in now is used to pay entitlements to current recipients o Current retirees getting more money than they put into it o Future retirees going to get less than they put in § Only 2/3 as large · Past retirees go back more money than they put in o Married after 65 in 1977: gets max payroll $7,700 total for all years he worked (since 1937), would get $8,400 per year for the rest of his life · Future retirees will get back less than they put in o 1977- Max contribution of Social Security got 2.5x back o 1997- Max contribution only of contribution ⅔ o Early cohorts got more out of the system o
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- Fall '08
- medical care, The hospital