“Although few of us want to admit it, once we (or our parents) become old and chronically ill, we (or they) will likely end up in a nursing home with care paid for by Medicaid.

— Tom Curry, NBC News national affairs writer

The above quote comes from Tom Curry, NBC News national affairs writer in a blog-post published 8/17/2012 on NBC Politics on Ryan’s plan for releasing Medicaid from federal protections and regulations and turning it over to the states, allowing them to set their own agendas for who qualifies because that’s worked so well for them with voter suppression.

Curry misses the mark on what most people fear or even what’s “likely” to happen to most people.  Dying in a nursing home on Medicaid is not the fate of most people. Many people in the middle-class have worked hard to keep that from being their fate.  My mother worked hard, not only raising her children, but also as a teacher (in the union) and had a decent pension as well as a combination of health insurance from her job and Medicare (managed care).   Her savings and the sale of her home helped pay the rent after my father died and she moved into an apartment in a senior living facility.  That facility wasn’t technically “assisted living” but offered her the services she needed to remain independent.  Facilities like that are private and for the most part fees are not covered by insurance, Medicare or Medicaid. Her managed care helped when she had a fall or other health crisis and needed hospitalization, physical rehabilitation and/or temporary nursing home care.  In a sense she was racing the clock, trying to remain as healthy as she could for as long as she could so that whatever happened would be covered by the managed care she had.  All the rules around what is covered and what isn’t in terms of nursing home care, home attendant services, etc are very complex.  In the current system, the issue is when people’s long-term needs exceed what is covered by managed care.  That’s when savings are needed and after they are depleted or transferred, Medicaid kicks in.

In my mother’s case, her savings paid her “rent” and her “rent” increased when she needed more services that weren’t covered by managed care such as having the facility hand her her meds instead of having her self-manage that.  At the end, she had a stroke and died in the hospital a few days later.  Had she lived, and needed full time, long-term care, I don’t know how much managed care would have covered, and because she still held most of her money, it would have been a while before she would have been eligible for Medicaid. If we imagine a scenario where Medicaid is out or unreliable altogether, then we are imagining a time when people die when they run out of money, period.  In my mother’s case, in addition to life-long thrift, she benefitted enormously from her pure luck in having bought and held onto a home whose value had increased greatly by the time she sold it at the peak of a housing boom.

If she hadn’t had the savings to afford her “rent,” then I’m not sure how we would have coped. She was frail for the last few years of her life, and once my father — who had been the stronger one — passed away, she could not have lived on her own. She would have required family care that would have kept at least one of her adult children or other relatives from working full time for a number of years, as not only would shopping, cooking, cleaning and ferrying her to doctors have been required, but also keeping an eye out to make sure she was safe.  While she would not have needed to be in a nursing home, she would have needed to live somewhere with modifications such as stair-lifts and other safety modifications.

Most people’s fate is not the nuclear meltdown of depleting all their resources, needing Medicaid and dying in a nursing home. People may fear that because under the current system it’s certainly a possibility, but it’s not the most likely one.  Most people fear the erosion of protections for the middle class that would keep all that from happening.  This includes the destruction of unions that help negotiate for decent health care plans, the destruction of things like home mortgage deductions that help make home ownership (the biggest and best investment for most of us) possible, the erosion of Medicare, and the overhaul of the Affordable Care Act which will help us keep the insurance we have and keep the insurance companies from throwing us off plans.  In short, most people (at least in the middle class) fear or have reason to fear, the entire Republican agenda.

This is not to say the current system is perfect. Most people, even in the middle class, are already losing what they had a few years ago.  Benefits, like the ones my mother had, have already been slashed, and the nuclear scenario is still real when long-term care is needed and managed care benefits have been exceeded.  What’s needed isn’t simply keeping Medicaid available, what’s needed is more healthcare reform that will help us with preventative care so more of us will stay healthier longer. What’s needed is more reform, including cost-control, so if long-term care is needed people don’t need to become virtual wards of the state to pay for it.