Promoting Elder Justice: A Call for Reform
Senate Finance, Promoting Elder Justice: A Call for Reform, July 23, 2019
Senate Finance, Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes, March 6, 2019
Care for the sick and elderly was provided by families prior to the establishment of Social Security. Extended families provided shelter, income and health care because they had to. Allowing seniors to live independently freed the nuclear family to move without taking everyone with them. This led to a crisis in health coverage for those seniors left behind.
The logic of social insurance led to both Social Security, Medicare and Medicaid. This provided care for everyone regardless of accidents of birth or death. Without it, families with no surviving parents or grandparents would pay nothing, where only children might have to pay for both parents and their in-laws. This inequality still happens with housing and it strains many marriages.
Nursing home care is currently provided outside of Medicaid for the wealthy who can self-finance (although this does not necessarily guarantee quality if children or conservators get greedy), by spending down assets or through Medicaid once the assets are gone. Catastrophic insurance can be used as an alternative to spending down assets, although this is usually on available to wealthier individuals.
For most of us, nursing home care can be provided by state facilities, for profit facilities and religious (mainly Catholic) health systems.
Public facilities are being overcome by privatization efforts and often are dependent on local budgets. They are a big ticket item that seems easier to cut, although this is often penny wise and pound foolish, resulting in bad care and spurring privatization.
Private facilities can be good or bad, depending upon rates charged and the quality of the staff. Sometimes one does not imply the other and Medicaid limits may lead to cutting corners, especially in staffing. Often, it takes a great deal of oversight by families to provide decent care, although they may just be witnesses to profit driven care which abuses their loved ones rather than being able to correct it.
Religious care is better because it usually lacks a profit motive and can, along with Medicaid funding, provide better care, although this may also lead to using members of the order who are not as well trained as professional staff. This meets the needs of many seniors, especially in rural states. Indeed, religious care holds a monopoly in some areas are for profit facilities close. Sadly, some systems in urban areas have the same bias to highly paid CEOs and lower paid staff.
In all systems, the need to save can lead to attempts to bust unions or to negotiate for substandard nursing wages or use of lower-skilled staff. Governmental oversight helps matters, but budget cuts can leave such units understaffed with unreasonable caseloads. The choice between care for patients and oversight is a continual balancing act for CMMS and states.
Medicare for All would provide an ever growing pool of beneficiaries with Medicare benefits at Medicaid prices, with the difference being paid by either a payroll tax (employee and/or employer) or with an NBRT/SVAT, which would tax both labor and profit, as above. This is a change in funding, not a guarantee of quality. Cooperative health care, however, can provide better care for less money.
In the long run, employers, especially ESOPs and cooperatives could replace health care services for both employees, the indigent and retirees and opt out of Medicare for All and receive an offset for NBRT/SVAT levies. This would allow them to hire their own doctors and arrange for hospital and specialist care with an incentive to cut cost and the ability to do so.
Expanding the number of employee-owned companies and cooperatives could be established with personal retirement accounts. Accounts holding index funds for Wall Street to play with will not help. Accounts should instead hold voting and preferred stock in the employer and an insurance fund holding the stocks of all such firms.
NBRT/SVAT collections, which tax both labor and profit, will be set high enough to fund employee-ownership and payment of current beneficiaries.. All employees would be credited with the same monthly contribution, regardless of wage. The employer contribution would be ended for health care at all levels.
ESOP loans and distribution of a portion of the Social Security Trust Fund could also speed the adoption of such accounts. Our Income and Inheritance Surtax (where cash from estates and the sale of estate assets are normal income) would fund reimbursements of the Trust Fund.
This testimony is largely a restatement of our comments from the March 6th hearing, Not Forgotten: Protecting Americans Abuse and Neglect in Nursing Homes. We welcome any legislation on this topic, although we will take this opportunity to remind the committee of our proposals.
Our asset value added tax and income surtax, which will fund withdrawals from the Medicare Trust Fund, which should be phased out when Baby Boomers have all retired.
Senate Finance, Not Forgotten: Protecting Americans from Abuse and Neglect in Nursing Homes, March 6, 2019
We will omit the restatement of our usual four-part tax reform proposal, but will mention that we propose that all Medicare, Medicaid, Affordable Care Act and Health Insurance Exclusion funding will be through our proposed Net Business Receipts/Subtraction Value Added Tax (NBRT or SVAT).
Our income and inheritance surtax (which taxes cash disbursements from estates and sale of estate assets as normal income), will fund withdrawals from the Medicare Trust Fund, which should be phased out when Baby Boomers have all retired.
Care for the sick and elderly was provided by families prior to the establishment of Social Security. Extended families provided shelter, income and health care because they had to. Allowing seniors to live independently freed the nuclear family to move without taking everyone with them. This led to a crisis in health coverage for those seniors left behind.
The logic of social insurance led to both Social Security, Medicare and Medicaid. This provided care for everyone regardless of accidents of birth or death. Without it, families with no surviving parents or grandparents would pay nothing, where only children might have to pay for both parents and their in-laws. This inequality still happens with housing and it strains many marriages.
Nursing home care is currently provided outside of Medicaid for the wealthy who can self-finance (although this does not necessarily guarantee quality if children or conservators get greedy), by spending down assets or through Medicaid once the assets are gone. Catastrophic insurance can be used as an alternative to spending down assets, although this is usually on available to wealthier individuals.
For most of us, nursing home care can be provided by state facilities, for profit facilities and religious (mainly Catholic) health systems.
Public facilities are being overcome by privatization efforts and often are dependent on local budgets. They are a big ticket item that seems easier to cut, although this is often penny wise and pound foolish, resulting in bad care and spurring privatization.
Private facilities can be good or bad, depending upon rates charged and the quality of the staff. Sometimes one does not imply the other and Medicaid limits may lead to cutting corners, especially in staffing. Often, it takes a great deal of oversight by families to provide decent care, although they may just be witnesses to profit driven care which abuses their loved ones rather than being able to correct it.
Religious care is better because it usually lacks a profit motive and can, along with Medicaid funding, provide better care, although this may also lead to using members of the order who are not as well trained as professional staff. This meets the needs of many seniors, especially in rural states. Indeed, religious care holds a monopoly in some areas are for profit facilities close. Sadly, some systems in urban areas have the same bias to highly paid CEOs and lower paid staff.
In all systems, the need to save can lead to attempts to bust unions or to negotiate for substandard nursing wages or use of lower-skilled staff. Governmental oversight helps matters, but budget cuts can leave such units understaffed with unreasonable caseloads. The choice between care for patients and oversight is a continual balancing act for CMMS and states.
Medicare for All would provide an ever growing pool of beneficiaries with Medicare benefits at Medicaid prices, with the difference being paid by either a payroll tax (employee and/or employer) or with an NBRT/SVAT, which would tax both labor and profit, as above. This is a change in funding, not a guarantee of quality. Cooperative health care, however, can provide better care for less money.
In the long run, employers, especially ESOPs and cooperatives could replace health care services for both employees, the indigent and retirees and opt out of Medicare for All and receive an offset for NBRT/SVAT levies. This would allow them to hire their own doctors and arrange for hospital and specialist care with an incentive to cut cost and the ability to do so.
Expanding the number of employee-owned companies and cooperatives could be established with personal retirement accounts. Accounts holding index funds for Wall Street to play with will not help. Accounts should instead hold voting and preferred stock in the employer and an insurance fund holding the stocks of all such firms.
NBRT/SVAT collections, which tax both labor and profit, will be set high enough to fund employee-ownership and payment of current beneficiaries.. All employees would be credited with the same monthly contribution, regardless of wage. The employer contribution would be ended for health care at all levels.
ESOP loans and distribution of a portion of the Social Security Trust Fund could also speed the adoption of such accounts. Our Income and Inheritance Surtax (where cash from estates and the sale of estate assets are normal income) would fund reimbursements of the Trust Fund.
posted by Michael Bindner at 10:30 AM
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