Why is a 108-year-old resorting to GoFundMe to pay for home care?
Photograph: Animaflora PicsStock/Alamy  A 108-year-old woman named Juliet Bernstein recently launched a GoFundMe to pay for around-the-clock home care that she could otherwise not afford. A retired schoolteacher who is physically frail but mentally sharp, Bernstein, who was born before the first world war, hopes to remain in the modest Massachusetts home where she retired, receiving help to cook, clean and bathe. I saw it was being done for someone whose child was very sick, Bernstein, a longtime civic activist, told the Boston Globe. So I said, Im not going to go to a nursing home. Im remaining here.  Related: An everyday story of US healthcare  or how a visit to the ER can cost you $10,000 | Emma Brockes  Bernstein has raised more than $100,000 so far, an impressive figure that still may be spent down quickly, given the realities of the American healthcare system. Bernsteins home care is not eligible for Medicare or Medicaid assistance. She cannot afford private insurance for long-term help, living on her modest pension and social security. While its heartwarming that the GoFundMe has been able to raise cash for her home care, her predicament is just one more example of how Americas byzantine patchwork of public and private for-profit healthcare options fail so many people, particularly the elderly and the vulnerable. Even if Bernstein decides to move to a nursing home, Medicare will pay for only a limited stay with such care. Medicaid provides nursing home coverage if a persons assets do not exceed $2,000, excluding a home, car and personal belongings. Since she has a pension along with social security, Bernstein does not meet that threshold. She wants to avoid the fate of many seniors who spend down their assets to qualify for long-term care under Medicaid. That would mean bleeding out her savings, selling her home and becoming effectively destitute. Tragically, to receive mostly free healthcare in America, that is the decision many elderly and ill people must make. The challenge of healthcare coverage is that it will be offered with any generosity only if you are already very rich or incredibly poor. The rich can, of course, buy whatever coverage they want, accessing the best doctors. Story continues  The very poor  those without assets at all  can receive Medicaid coverage, which is helpful by the standards of stingier, expensive private care. But the trouble with Medicaid is that many poor people cannot qualify for it if they secure enough work or manage to acquire modest assets. There are many Bernsteins across the US, individuals who must choose between receiving adequate coverage or liquidating their possessions  The working class is largely excluded from Medicaid, unless a person happens to live in a state that expanded coverage under Obamacare. Though rightwing Republicans have argued, against all available evidence, that such a system incentivizes work  the poor get less, so they must struggle to get more  its this approach to healthcare that actually encourages deep poverty as the only route to sustainable healthcare. There are many Bernsteins across the US, individuals who must choose between receiving adequate coverage or liquidating their possessions. Its an absurd predicament that should not exist in the wealthiest nation on Earth. Instead, comprehensive medical coverage  an even more generous version of Medicare and Medicaid  must be available to all Americans, regardless of income. This is the only sensible and humane way forward. Other advanced democracies, of course, already guarantee healthcare to everyone. America is the tragic laggard. Instead of single-payer healthcare or a national health service, we have been forced to endure an expensive, predatory privatized system with a fractured safety net for the elderly and the extremely poor. The medical and insurance lobbies, along with the politicians they control in both parties, have ensured there will be no change in the status quo for the foreseeable future. As much as Joe Biden is willing to spend on Covid aid and infrastructure, he has yet to show interest in challenging the entrenched elites that maintain such an unequal healthcare system. Instead, there will only be more GoFundMes, more pleas for generosity where the powers-that-be have failed.