Filial Responsibility Laws

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jennypenny
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Re: Filial Responsibility Laws

Post by jennypenny »

Spartan_Warrior wrote:Also:
George the original one wrote:Businesses with bad debts typically sell those debts to credit hounds. Hospitals and care facilities are no different in this regard.
Sure. Do those credit hounds get to hound the debtor's offspring? (Serious question. I wouldn't think so, but I could use another source of outrage.)
I don't know if they 'get' to, but they absolutely do it. It's SOP.

Spartan_Warrior
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Re: Filial Responsibility Laws

Post by Spartan_Warrior »

It was my understanding they could only go after the estate in most cases, unless you cosigned a loan. Nevertheless, so. Much. Outrage. Right now!

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Ego
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Re: Filial Responsibility Laws

Post by Ego »

Spartan_Warrior wrote: I've asked three times and won't again: What is your position here, George? Do you think this is a reasonable law? Why or why not?
It's funny.... but I think many here are owners of stock so they can see both sides of the issue. I can tell you for sure that if grandma stopped paying her rent here she'd be out on the street with poofie, freckles and a pile of suitcases. And if I had the opportunity to collect back-rent from her kids, I'd probably do it. If you were the sole owner of a board and care facility, what would you do?

Is it fair? In my mind any rationalization that could be used by the children (why should I have to pay for that.....?) could also be used by the system as a whole (Why should WE have to pay for that....?)

What would happen if we had a form of direct democracy where those who believe strongly in the fact that they don't want to live in a society where grandma's care might be rationed (or where she would be refused the right to own poofie & freckles while on government assistance) would also be forced to pay the costs of their vote?
Last edited by Ego on Tue Aug 12, 2014 1:40 pm, edited 1 time in total.

George the original one
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Re: Filial Responsibility Laws

Post by George the original one »

> What is your position here, George? Do you think this is a reasonable law? Why or why not?

My position can be summed up by saying "Someone has to pay".

It can be the patient, the patient's family, the government (local, state, federal), or the caregiver... or a combination of all three. It is naive to assume that any entity in that list should be left out of the equation while there is a doubt of the ability of the patient to pay for services rendered.

In theory, the patient would have the proper insurance to cover what they could not pay for. Reality is that few people do. Responsible ERE people with a pile of cash likely do not have enough to pay for this care on their own and will need insurance. To think a million or two in cash, without insurance, is adequate for old age is very naive.

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Re: Filial Responsibility Laws

Post by jacob »

I wonder whether the anger is simply due to an underlying impression that health care prices are no longer fair?---That they in fact seem rather arbitrary and totally overinflated and the only thing that stands between people and financial obliteration is the finite and again arbitrary probability that the insurance company won't screw you over.

To wit, it seems that the medical-industrial industry often deals in its own funny-money that has no relation to reality except when the "claims" aren't contained within the system and suddenly has to be paid with real money.

Example:

Charge for a 10 minute CT-scan: $5700
Coverage for same: $5601
You owe: $99

Well, $99 is fair enough for 10 mins. Supposedly, it's a fancy and expensive piece of machinery. However, charging $35000/hour---the insurance-free rate---for its use reminds me of overpaid CEOs. There's simply no way it can reasonably cost that much in a freely competitive system.

Tyler9000
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Re: Filial Responsibility Laws

Post by Tyler9000 »

George the original one wrote: My position can be summed up by saying "Someone has to pay".

It can be the patient, the patient's family, the government (local, state, federal), or the caregiver... or a combination of all three. It is naive to assume that any entity in that list should be left out of the equation while there is a doubt of the ability of the patient to pay for services rendered.
Meh. A private company should not be able to forcibly collect money for unsolicited services from any individual they have no contractual relationship with. That's not naive -- it's the law in pretty much every other similar scenario (mortgages, student loans, etc). The fact that it is not the law in this situation in many states is wrong and should be corrected. Whether it is a result of an anachronistic law conveniently left in place or a new one slipped in is irrelevant.

Spartan_Warrior
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Re: Filial Responsibility Laws

Post by Spartan_Warrior »

I agree, someone has to pay, and those options (patient, patient's family, insurance/government, or the provider/business) do seem to cover the bases. The answer that we've come up with culturally and politically seems to be that the patients are responsible for themselves and for anything that their insurance doesn't cover. We have a social safety net to provide government insurance to those who have no other insurance available. We also have an understanding in capitalism that risk is borne by the capitalist, in this case the providers. The burden of deciding whether or not to serve a customer and whether or not that customer can pay is the business's responsibility.

Therefore, the natural order of "who should pay" seems fairly clear: Individual/estate, then insurance/government, then business owner.

Obviously business owners don't like eating costs. Obviously they will want to do everything they can to recoup costs. No one disputes that. Businesses are in the business of making themselves money. Unfortunately, they also sometimes make bad investments, bad decisions, and lose money. The recent trend is to privatize profits and subsidize losses, which is exactly what's happening here. If the corporation can't get the money from the individual, from some other corporation (insurance), or from the government, it damn well demands the right to take it from SOMEONE!

The main problem here, as I mentioned before, is predominantly when the businesses/providers assume that service X is covered by Medicare and it actually isn't. They tell the patient the service is covered (as well as the usual heroic medicine babble about how necessary and helpful it's guaranteed to be) and then they go ahead and provide service X. They then bill Medicare and find out service X isn't covered for whatever reason. They then shit the bed and pass the charges to the unsuspecting patient. I know all about this as a matter of occupational hazard. In fact a principle duty of mine is to answer questions from providers about what services are or aren't covered under a particular Medicare benefit. 9/10 times the provider is asking retroactively, 9/10 times the service isn't covered, and every time I send the response knowing it means one more grandma or grandpa (or their kids apparently) is about to get blindsided with an unexpected, most likely unreasonable medical fee. (Could be another reason I despise my job, but that's neither here nor there.)

The talk from the government side is always, how do we regulate the private entities to keep them from gaming the system without stifling "the free market" and "competition"? No one ever stops to ask whether the system is designed to be gamed, or whether the for-profit free market is the best solution for a universal human issue like health, because of course we're politically hand-tied. In fact, amusingly, I would say most of the work and money spent by the government on Medicare seems to be related to regulating, advising, litigating, and otherwise corralling all the corporate providers, suppliers, contractors, etc. to toe the line. I bet the agency could be a quarter of its size if it just provided insurance directly without the "free market" middle men--but then who would finance political campaigns?

In case you couldn't tell, to me this is all just an obvious clarion call for socialized health care and getting these for-profit hucksters out of the business altogether. Jacob's point regarding the overall outrageous prices speaks to this notion as well.

George the original one
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Re: Filial Responsibility Laws

Post by George the original one »

> The burden of deciding whether or not to serve a customer and whether or not that customer can
> pay is the business's responsibility.

Here is a partial problem. There are laws that require care to be rendered. Such as: if you see an accident, you are supposed to stop and render aid.

Thus businesses are partially hamstrung in that they cannot legally shove a patient out the doors if the patient cannot pay for needed care. Hence filial responsibility.

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Re: Filial Responsibility Laws

Post by jacob »

Spartan_Warrior wrote:In fact, amusingly, I would say most of the work and money spent by the government on Medicare seems to be related to regulating, advising, litigating, and otherwise corralling all the corporate providers, suppliers, contractors, etc. to toe the line. I bet the agency could be a quarter of its size if it just provided insurance directly without the "free market" middle men--but then who would finance political campaigns?
Bingo!

The same probably goes for defence and education.

The free market in these cases are perverted because there's no pricing signal. Demand is practically infinite and there's only one supplier (who is shopping around for services when they call 911?). With no pricing signal and unlimited means to bill-after-the-fact, administrators and regulators will then insert themselves in the moneystream in order to absorb all that nice free money.

And there you go...

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Re: Filial Responsibility Laws

Post by jacob »

@GTOO - Filial responsibility doesn't follow logically from the legally forced care. It could just as well be taken down to a business risk. E.g. if you want to be in the position of running something like an Emergency Room AND you're obligated to help anyone who shows up, then you have to expect a certain amount of people being unable to pay.

It's like running a credit card company. The typical response is to socialize those costs and jack the prices on those customers who do pay.

Going after family (and friends?) is simply an unusual response.

Edit: Add, going after the spouse is a usual response and I don't think many would object to that practice. Marriage is a contract entered voluntarily between consenting adults. Being born is nothing like that.

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Re: Filial Responsibility Laws

Post by Spartan_Warrior »

@George: That is true in certain medical situations, e.g. hospital emergency rooms can't refuse service, emergency responders are obligated to provide care, etc. In practice, though, I'm not aware of much in the way of a similar restriction on long term care facilities wrt to refusing service. You are correct that they can't toss them out once a payment's late, but they can refuse service to begin with. They can't discriminate based on age, race, sex, etc., but as far as I know nursing homes, hospices, etc. can (and do) pick and choose patients based on profitability. (They don't exactly advertise this, of course.) Refusal to admit can be for any number of reasons, from inadequate number of beds to inability to provide the needed level of care, and even, yes, the patient's payment method and financial werewithal:

"Current laws do not prohibit nursing homes from discriminating against people seeking admission based on their source of payment."

http://www.atlantalegalaid.org/fact18.htm

I do agree that we're caught in limbo as a society, with a lot of "half-measures" in the way we treat health care. If we agree that care should always be provided whether it's profitable or not, we ought to take that to its logical conclusion rather than allowing hucksters to keep trying to scrape profits out of it by whatever means necessary.

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jennypenny
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Re: Filial Responsibility Laws

Post by jennypenny »

My anger isn't really directed at the health care system. It's just general angst over a generation that has over-consumed their entire lives and might grab even more on their way out the door. Have you paid for a funeral lately? The absurdity of burying someone in a $10K box with a $3K headstone (because that's what they picked out :roll: ) and then finding out that they might owe back rent/taxes/medical bills that you're now responsible for is a big part of it.


What this still comes down to (for me) is that I am held responsible for financial decisions over which I have no control. If MIL picks an expensive assisted living facility, she will run out of money sooner than if she chose a more moderately-priced living arrangement or lived with us. We could end up overpaying for her to stay somewhere she's comfortable because she burned through her money too quickly. Our standard of living, which is already well below hers, would then be reduced further because she lived more extravagantly than necessary. It's too easy to envision that scenario happening. :(


I don't mind paying (one way or another) for someone's care and comfort. I'm NOT paying for extravagance or waste. My grandparents' generation lived at home during their twilight years, were waked at home and buried in modest arrangements. My parents would have waked if I had tried something that pedestrian for their funerals.

Spartan_Warrior
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Re: Filial Responsibility Laws

Post by Spartan_Warrior »

jennypenny wrote:My grandparents' generation lived at home during their twilight years, were waked at home and buried in modest arrangements. My parents would have waked if I had tried something that pedestrian for their funerals.
:lol:

GandK
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Re: Filial Responsibility Laws

Post by GandK »

I agree 100% with the above, @Spartan and @jp.

I will only add that the problem of bill-happy medical care in a credit-happy society is compounded by the fact that we are squeamish as a culture about the idea of running cost-benefit analyses before we perform medical procedures. To use an extreme example, if a procedure costs $1 million and it prolongs someone's life for a decade, that's very different than the same procedure prolonging their life for a week. And although most people would acknowledge that, and say that the former but not the latter was a reasonable use of resources, the many shades of gray between the one and the other get people up in arms.

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Ego
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Re: Filial Responsibility Laws

Post by Ego »

jennypenny wrote:I don't mind paying (one way or another) for someone's care and comfort. I'm NOT paying for extravagance or waste. My grandparents' generation lived at home during their twilight years, were waked at home and buried in modest arrangements. My parents would have waked if I had tried something that pedestrian for their funerals.
Okay, I just dropped off a notice with one of my barely-alive tenants. Obese. Sprawled on a couch in front of a television 24 hours a day. Dialysis several times a week. Brags about the expense of the most recent procedures to keep open the dialysis shunt. Laments the choices that led to this. Life is limited to medical procedures and dealing with in-home care.

This is extravagant care in most of the world. Should we revert back to our grandparents definition of extravagant? How do we judge?

7Wannabe5
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Re: Filial Responsibility Laws

Post by 7Wannabe5 »

Of course, one could think of a number of situations in which the elderly parent and/or the private health care facility would be the innocent victim. For instance, conniving child coerces doddering parent to put wealth into irrevocable trust after moving parent into facility with intent to not pay.

I agree that responsibility and authority should be tied together but that still leaves open the huge question of under what circumstances should the members of our aging population lose authority/responsibility? Unfortunately, I do not think there is a great deal of correlation between how strongly a person while still functional states that they never want to be put in an expensive long-term care facility and whether or not they end up in one. Or maybe I am 89 years old and I fell down the cellar stairs carrying a batch of pickled peaches and broke my f*cking hip and I would rather stay in a nursing home than share house space with my D63's jerk of a third husband. etc.

Riggerjack
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Re: Filial Responsibility Laws

Post by Riggerjack »

@S_W, seriously? Lobbying? I know that's the Progressive answer to why every problem occurs, but think about it. These are ancient laws, applied in new ways. No lobbying necessary.

Yeah, I think this is a bad idea, and that the laws are being misapplied. But this is a very fcuked up area of law. I spend a lot of time looking up property records, trusts are far more common than anyone knows. The ways of dodging these end of life bills to keep the estate going are crazy. Trying to get your bills paid is in everyone's interest. The more grannies skate by on their bills, the higher the price for everyone. Insurance.and Government make this worse, not better. Pricing is removed from the decision making process, of course cost get out of control. Look at university costs, every student pays a different price, is lobbying the reason that costs are out of control?

I live in a state without these laws, so it doesn't bother me much. One more in a long list of injustices.

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Re: Filial Responsibility Laws

Post by lazyboy »

Some times this scares me to hell.

My grandfather was nearly 76 when care at home wasn´t possible any more.
He never overspend in his whole life. The opposite is true as he went to the nursing home he had over 150k, a self build home and a solid pension on his net worth. It took just 8 years until all this was gone. After that my parents and family had to jump in.

Some times I think it would have been cheaper to pay a hotel and a nurse 24/7

But the thing that annoys me the most is the room next to him laid this childfree guy getting paid everything by welfare.

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Re: Filial Responsibility Laws

Post by Spartan_Warrior »

@Riggerjack: :lol: I know the Conservative answer to any problem is to viscerally decry any semblance of a Progressive answer to the problem, but calm down, I didn't realize how old the laws were, I've already backed down from that position, acknowledged my mistake, packed my bags for my barefoot walk to Canossa, etc.

Like I said, even if these laws weren't brought about by lobbying, they sure do smack of other recent lobbying efforts that result in health providers and other corporations privatizing gains, socializing losses, and forcibly extracting money from individuals for services at government gunpoint (see: Obamacare). I would think the mistake is understandable but sorry to any lobbyists I offended, upstanding protectors of democracy that they are.
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Devil's Advocate
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Re: Filial Responsibility Laws

Post by Devil's Advocate »

Most folks here are (rightly) outraged by having their parents' medical / care thrust on them.

There is so much these two issues and threads have in common : this one, and alimony.

Our views are so often shaped basis our personal situation. Witness the spirited defence of the horror that is family law (as regards alimony etc) by some, and the near-zero support for filial responsibility laws (another horror) -- simply because we have no 80 year olds on these forums.

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