Skip to content
Subscriber Only
Megan McArdle

Death Spirals and Other Problems the Republican Health Plan Doesn't Solve

The House proposal is riddled with holes, and relies on states for Band-Aid solutions.
Letting the states deploy Band-Aid solutions.

Letting the states deploy Band-Aid solutions.

Source: Stone, via Getty Images

My grandmother spent the last years of her life in a nursing home, and I like to think that my grandfather would have been proud to know that she paid her own way until she died. In a long life of seven-day-a-week work, he held one principle above all the others: “Make sure Lettie is taken care of.” And he did. When she died at 101, she was one of the rare nursing home patients who manages a multi-year stay entirely on private pay.

That nursing home stay ate most of what he’d spent a lifetime piling up, of course. And most people do not accumulate those sort of assets; my grandparents combined some good luck with ferocious hard work, talent and extremely modest tastes, enabling a small-town small business to generate enough money to pay the bills for extended end-of-life care. With an average annual cost in the high tens of thousands, a single year in a nursing home will exhaust the financial assets of most families. That’s when those patients go on Medicaid.