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The BEST Squat Tip (Do This Every Time You Lift)

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One of the most important tips for squatting I was ever told was how to create external rotation torque. Doing so sets a solid foundation of stability that allows you to lift massive weight with great technique. To create external rotation torque you need to perform the following steps:

1) Create the “tripod foot”
2) Drive the knees out to the side
3) Keep the big toe jammed down!

When we create a good arch in our foot, we inevitably form what we call a ‘tripod’ foot. The three points of the tripod consists of the heel, the base of the 1st toe and the base of the 5th toe. Our foot is basically like a three wheeled motorcycle. Our goal when squatting should be to maintain the arch of our feet and have our weight distributed evenly. If all of the wheels are in contact with the ground we get more power. If one wheel is off the ground or if the body bottoms out, power is lost and the motorcycle breaks down. When our foot is out of position (arch collapse) stability and power is lost.

Next, we drive the knees to the side (creating external rotation torque). Creating this tension creates a spring-like tightness in our hips that will ensure our knees track with ideal alignment during the entire squat.

To create this torque at the hips I use the cues to “squeeze your glutes” and “drive the knees out”. In performing these actions we essentially wind up the spring-like mechanism of our hips. If you try this, you will instantly feel the outside muscles of your hips engage. Immediately the knees will be drawn a good position in line with the toes and an arch will be created in the foot.

If we look at the arch of our foot, we notice that it moves in relation to the rest of our lower body. If the knees bow outward – the entire foot moves into a full arched position. When the knees fall inward – the foot subsequently collapses and the arch flattens out. For this reason, the correct position for our lower body can be achieved by the proper action of our hips.

We have to remember to not compromise the ‘tripod’ foot during this step. For this reason, make sure to not push the knees out too far. Some athletes will misuse the cue to drive their knees too far out to the side. The goal is to align the knees with the toes. Creating this rotational torque at the hips is one of the BEST tips when it comes to perfecting technique when squatting.

To buy the Hip Circle band I’m using in this video, check out this link: https://markbellslingshot.com/?rfsn=2400665.93d970. Use the code “SquatU10” for 10% off the bands (the grippy hip circle is my favorite).

To read more on improving your squat technique, check out this blog: https://squatuniversity.com/2016/02/05/how-to-teach-a-perfect-squat/

Master squat technique: https://squatuniversity.com/book/
Subscribe to this channel here: https://tinyurl.com/y2eq7kpr

____________________________________________________________
Big thanks to 3d4Medical and their app Complete Anatomy for the visual of the body today. If you would like to use their app at a discounted price, check out this link: https://store.3d4medical.com/applicat

Music credits
Opening track by JookTheFirst: Soundcloud: https://soundcloud.com/jookthefirst

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Special thank you to Evan Pierson Productions for his help in making this video!

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43 Comments

43 Comments

  1. Squat University

    August 14, 2019 at 3:11 pm

    The #SquatUclub is now on YouTube! As soon as I upload a new video, "like" it and comment with the hashtag #SquatUclub ASAP. I'll pick amongst those who do so within 1 hour of the video going live and pick one winner to start working on whatever you need help with (squat technique, an achy hip, help with back pain during deadlifts, etc). You must be SUBSCRIBED to my YouTube channel for a chance to win. Turning on notifications by clicking the little bell next to the SUBSCRIBE button on my channel will make sure you can be first in line to win every time!

    I’ll reply under the winners comment – so make sure you keep up on your notifications!

  2. marco stefano riccardi

    August 14, 2019 at 3:11 pm

    well this works well well well… i found my perfect hole posture thanx

  3. Hajdú Róbert

    August 14, 2019 at 3:11 pm

    I have flat feet, what should I do?

  4. Ayesha Obed

    August 14, 2019 at 3:11 pm

    Thanks for the video ! I follow you on instagram, blogs everywhere. Every video /tip/post is amazing ! I tried this out and while performing the drill, only one gluteus medius turned on, I think I have an imbalance. thanks so much for sharing this as I now know what to work on. The interesting thing is that my hamstrings turned on way sooner than glutes and while performin a bridge its okay to lift toes up but here I couldnt because I had to jam my big toe . so question – what to do if we have tight hamstrings ?

  5. G Coy

    August 14, 2019 at 3:11 pm

    Point your feet out…problem solved

  6. ribeironeto_

    August 14, 2019 at 3:11 pm

    You're the best

  7. Ramiro Netto

    August 14, 2019 at 3:11 pm

    Hey Aaron, good job as always! What's the software that you use to show these images of the muscles, etc?

  8. FitAngie

    August 14, 2019 at 3:11 pm

    You have a wonderful channel, thank you for your videos they’re very helpful.

  9. Gustavo Motooka

    August 14, 2019 at 3:11 pm

    Awesome tips ever!!!!
    The best Chanel

  10. kinglee1984

    August 14, 2019 at 3:11 pm

    Cues or mobility to stop the back rounding slightly in the deadlift

  11. Retreaded Rambo

    August 14, 2019 at 3:11 pm

    If I could get my feet flat on the ground during a squat I'd have a party

  12. Don john

    August 14, 2019 at 3:11 pm

    I have been doing this by watching your previous videos too. Really feel it now while squatting.. Only wish there was a channel like yours for all compound lifts like deads, ohps, etc. Keep going.. Appreciate your help.

  13. Tushar Dhumne

    August 14, 2019 at 3:11 pm

  14. Kellie Manning

    August 14, 2019 at 3:11 pm

    As always excellent video and good advice. I have recommended your page to lots of people (clients and others trainers) as I love your videos. Personally I have found a major change in my mobility and form since following your page. Your squat warm up video is one of favourites and I use these exercises every training session as always trying to improve my mobility.

  15. Michael Pietrzak

    August 14, 2019 at 3:11 pm

    Are you recommending to not angle my toes out?

  16. Mike Eastside

    August 14, 2019 at 3:11 pm

    You help me a lot with my squat with your video thx from france

  17. Cresencia Higgins

    August 14, 2019 at 3:11 pm

    my squat has been struggling for months. my coach has been helping recently and this video has really opened my eyes as well. i have a terrible hip shift that i havent fixed for months which caused a crazy imbalance of strength in my legs and glutes. i didnt know how to activate my glutes in a squat until now. i hope this helps me in the future! thank you!!

  18. Patrick McMahon

    August 14, 2019 at 3:11 pm

    One of the best squat info vids I've seen in a long time

  19. Evy Gabryel

    August 14, 2019 at 3:11 pm

    I did it and is a huge difference, thank you so much #SquatUclub

  20. Ahmad Ahmad

    August 14, 2019 at 3:11 pm

    You are very knowledgeable sir.

  21. Rushikesh Patil

    August 14, 2019 at 3:11 pm

    Hi Aaron. I know this tip of yours from your "Official Squat checklist" video and this tip help me a lot to turn on my glutes. Thanks for the more information. You're the best.

  22. Malek P

    August 14, 2019 at 3:11 pm

    Thanks for the valuable information.

    Could you please exclude music in the background? Because it makes it difficult to focus on what you are saying, and I take these videos very seriously.

  23. Hansi Liu

    August 14, 2019 at 3:11 pm

    toes point straight forward? doesn't this create excessive torque on your knees?

  24. Acumen Athletics

    August 14, 2019 at 3:11 pm

    Love the anatomy lesson on top of the squatting tips. So easy to understand. Thank you.

  25. Simon

    August 14, 2019 at 3:11 pm

    Really great advice, am taking this with me to the squat rack.

    A question I do have; why do I see everyone around me doing very heavy squats with toes pointed out?

    Love the content!

  26. Arthur Silva Sens

    August 14, 2019 at 3:11 pm

    When warming up to my workouts, I usually do some hamstrings stretches. But as my hamstrings flexibility improves over the days, I'm felling more pain at my RIGHT groin during the stretch. It is also notable that my left hamstring is getting way more flexible then my right hamstring.

    If I would take a guess, I would say that my Coccyx is messed up and applying pressure on my right leg, but could you give us some information about why this could be happening?

  27. Jack Marshall

    August 14, 2019 at 3:11 pm

    Is one of your shoulders up higher than the other?

  28. Chris McKinley

    August 14, 2019 at 3:11 pm

    Watched this earlier today, just finished some squats and this got rid of minor hip pain I was having from full range of motion squats. Thanks for your advice and techniques

  29. James L

    August 14, 2019 at 3:11 pm

    Great video.

    I'd like to hear your views on stance width. I find to hit depth I need to keep a relatively narrow stance, which can cause knee pain. A wider stance alleviates any knee pain but then I struggle with depth!

    My working hypothesis is I need more hip flexibility in wide stance, interested in your thoughts.

  30. asdf

    August 14, 2019 at 3:11 pm

    I always feel a little pain in my groin when I squat. In the evening after the training I still feel the pain. It feels as if the groin has overstretched. Can the method in the video solve the problem?

  31. Si_monster

    August 14, 2019 at 3:11 pm

    I have calve pain when I squat really deep, how?

  32. Mia ruiz

    August 14, 2019 at 3:11 pm

    Thank you for all this tip so helpful

  33. Leo Messi

    August 14, 2019 at 3:11 pm

    Excellent vid!!! I literally started having ankle pain about a week ago, because i misunderstood this concept with what you also named: external rotation movement.
    Do not try to move your foot outwards while squatting if you do not want ankle pain for days!!
    Thank you doc.

  34. Matt Hall

    August 14, 2019 at 3:11 pm

    Great content, but curious about "general populations" ability to squat with the foot angle you demonstrated. Most people start off with some ankle mobility issue or morphology that lends not being able to squat with feet facing directly forward. I know when I first learned to squat it was discouraging to notice my squat didn't look like that. Maybe addressing that not everyone will have such a straight forward foot angle would be helpful. Again, very good content and your contribution is appreciated.

  35. Emilee Werries

    August 14, 2019 at 3:11 pm

    What happens when I try this in my kitchen after watching the video? Dog sits on foot. Best squat ever.

  36. Alexis Bellod

    August 14, 2019 at 3:11 pm

    If you really want to understand how to perform and squat go watch Julien pineau (strongfit) squat vidéo.

  37. Benny Gilligan

    August 14, 2019 at 3:11 pm

    Absolutely brilliant I am loving this channel keep up the great content

  38. Larry Dickman

    August 14, 2019 at 3:11 pm

    Doc, I have been doing this drill with the bands on my light days. Thanks for doing such a good job explaining why it works!

  39. Tholle

    August 14, 2019 at 3:11 pm

    The information and production quality of this video was absolutely incredible. Thank you!

  40. Myron Gainz

    August 14, 2019 at 3:11 pm

    Building strength in the glute medius. Mine feels like one big knot. I've tried foam rolling and dry needling to loosen it. But maybe if I strengthen the area the knot will open out…?

  41. Mike Basic

    August 14, 2019 at 3:11 pm

    did he just say, "hi, I'm doctor horse shit" ? 0:00

  42. AGFitnessHealth

    August 14, 2019 at 3:11 pm

    Hi
    Any reason you didnt suggest the toes to be slightly facing out? The video with Anna Martin showed the more sport specific stance with toes facing out

  43. Bo Wang

    August 14, 2019 at 3:11 pm

    I tried this method a few weeks ago and had great results during my squat, felt my hips turning on right from the onset and have that tension build up when I am coming outta the hole. However, a week later, I tried applying the same concept, but I couldn’t activate my hips like before, I couldn’t feel the spring like tension during my squat…Is it because my hips were strengthened from the week before and is gonna require more torque to activate it?

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Health

Podcast: Medicaid’s Dark Secret

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For many participants, Medicaid — the program that provides health care to millions of low-income Americans — isn’t free. It’s a loan. And the government expects to be repaid. Are you surprised to hear that? So was today’s guest. Rachel Corbett recently wrote an article explaining in what circumstances you could be at risk. Join us to find out if this could happen to you, how you can protect yourself and what is next for the healthcare program.

SUBSCRIBE & REVIEW

Guest information for ‘Rachel Corbett Medicaid’ Podcast Episode

Rachel Corbett is the author of You Must Change Your Life: The Story of Rainer Maria Rilke and Auguste Rodin, which won the 2016 Marfield Prize, the National Award for Arts Writing. She has written for the New Yorker, the New York Times Magazine, The Atlantic, and other publications. She lives in Brooklyn.

 

 

 

About The Psych Central Podcast Host

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.

Computer Generated Transcript for ‘Rachel Corbett Medicaid’ Episode

Editor’s NotePlease be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to this week’s episode of the Psych Central Podcast. Calling into the show today we have Rachel Corbett, who has written for The New Yorker, The New York Times Magazine, The Atlantic and other distinguished publications. Rachel, welcome to the show.

Rachel Corbett: Thank you for having me.

Gabe Howard: We are very, very pleased to have you because you wrote an article, Medicaid’s Dark Secret in the October 2019 issue of The Atlantic and your research turned up some frightening information. So before we dive into the questions, can you give us a quick summary of that article?

Rachel Corbett: Yeah. So it’s about Medicaid, which is maybe I should define it, it’s a little bit different from Medicare. Medicaid is the government program that is mostly free for low-income and disabled Americans. About 75 million Americans are on Medicaid. But what we don’t know and what I what I wrote about in this piece is that Medicaid actually in many cases is not free. It’s actually a loan and it’s a loan that people pay back once they die. And their estate, whatever their children were going to inherit, are actually collected by the government in order to pay back the costs of whatever health coverage they use. And this is a program that is not very well known about. It’s been on the books for decades. But people don’t know until somebody dies, a loved one, a parent dies and then they suddenly get a bill. And so this article looks at this whole program, how it was implemented, who it affects and what it really means for people who might have a family member on Medicaid.

Gabe Howard: I think that many people believe that Medicaid is a safety net. It’s designed to help people who are essentially in harm’s way, they can’t help themselves. But it seems like you’re saying it’s not a safety net, it’s a no interest loan where the government then comes in and just takes everything. Is that exactly what you’re saying?

Rachel Corbett: Well, not exactly. So in some cases, if you are a low-income person who is under the age of 55, it is a safety net. It’s free. If you’re over 55, which is, you know, most people who are sick and going to need the most health care, it is not. It is actually a no-interest loan. The program that I write about is called Medicaid Estate Recovery. And that’s the law that says anyone over 55, any coverage you receive from Medicaid is eligible to be recovered by the government after you die. So in a way, it’s a safety net because at least you can get health care. You know, at least you’re not going to be denied your cancer treatment or something when you’re still alive. But at the same time, it’s not what you think. It’s not free. Your children will be paying back through your home or whatever assets you own after you die. And I should point out, too, that it’s not every it varies by state. So some states, any prescription drug you get, any operation, anything, don’t ever cover the costs of other states. Only long-term care like nursing homes.

Gabe Howard: Let’s put this in terms of mental health, because the majority of our audience is interested in how this impacts people who are mentally ill. Let’s say that you’re 25 years old, you are desperate, you’re severely mentally ill, you’re homeless, you’re sick and you’re able to get Medicaid to support you. What’s the negative implications of that? What’s the potential bad that could happen? You know, the good is, like you said, you get the health insurance. But what’s the negative?

Rachel Corbett: Well, if you’re twenty five, you’re OK really. I mean, there’s no recovery from the government if you’re under 55. So you’re in good shape basically for that age.

Gabe Howard: I guess then my question so. So you’re twenty five. Yeah. But we want you to live to be fifty five. Sixty five, seventy five.

Rachel Corbett: Right.

Gabe Howard: So from twenty five to fifty five you’re good. But then you turn 55, and all of a sudden, the government starts looking at you funny and you’ve been in some cases disabled, in the example that I used, for 30 years and now all of a sudden it sort of switches up on you. Is that correct?

Rachel Corbett: That’s true. If you’re someone who’s going to be on Medicaid long term, then you may actually be the worst because you may not know that once you turn 55, the policy changes and, you know, to you, there’s no difference in the kind of coverage you’re getting or in your need or whatever. But I don’t know how they will necessarily notify you in that case if you’re just signing up for Medicaid. There is a notice in the fine print that the government will come after you once you die. If you’re already on it, it might even be harder to actually find out because you probably are so used to getting the coverage and benefits. You don’t necessarily think about it. But yeah, once you turn 55 and suddenly the prescriptions you’ve been taking your whole life could be under scrutiny. If you know, if you have like a home care worker or you’re in a facility of any kind. Costs are really going to come back and suddenly it’s no longer free. Suddenly the tab starts the moment you turn 55.

Gabe Howard: In my research for this show, which is not nearly as in-depth as your research, I asked some folks, I was like, hey, were you aware of this? And people said, no. And they just said, flat out no. And that was it. This was all kinds of different people as well. Some people had caregivers and I asked their caregiver if they knew that this was a concern for their loved one. And they were like, well, but my loved one’s been on it for, quote, years. So I understand what you’re saying there by if you’ve done something every day, for again, in our example, 30 years, you don’t expect the rules to suddenly change. And as much as I hate to say, buried in the fine print is not reasonable. It’s really not reasonable. You’re talking about somebody who is sick and needs government assistance and you sent them, what, essentially is fine print and said, hey, we think that you can understand this even though you’re sick and you can’t work. So it seems like it sets people up to fail. Would that be your opinion of this?

Rachel Corbett: Yeah, I mean, you know, it’s hard to know the motives of the people who wrote the log in, the people who enforce it, but I think that it certainly has that effect because imagine, you know, if you’re in a desperate state, urgently need medical care, you’re not reading the fine print. 

Gabe Howard: Right.

Rachel Corbett: And even if you are, you’re probably not a lawyer and you may not understand what it means. You know, I spoke to lawyers who said that they have clients come in all the time and they just have no clue what this is talking about. You know, it’s literally on page 20 of a 34-page application in some states. So, I mean, I don’t know anyone who reads 34 pages of fine print. And you know, if you’re lucky, you might have a good caseworker who explained this to you. But in the vast majority of cases, I don’t think people have any idea. And I don’t think that a lot of doctors and people in the health care industry even know, because that’s a lot of the feedback I’ve gotten since the article has come out. I’ve seen people who work in the industry who are completely shocked to know that this is going to affect their own patients, their own colleagues. So that’s, I think, the reason it works. Because the other thing is that, you know, it’s going to happen to you if everybody knew this policy existed, you could move your assets around. You know, people who do estate planning were usually wealthy or people do that, they go to a lawyer to do their estate planning. The lawyer can tell them, oh, you might want to put your home in a trust so that you can avoid Medicaid estate recovery later in case you have to go on Medicaid. But, you know, most people don’t do estate planning. They don’t have a lot of assets to begin with. So this really does, I think, work most effectively on people who don’t know that it exists.

Gabe Howard: There’s so much to unpack there, the first thing that I want to say is I think that the average person doesn’t read the end user license agreement when they install software on their computer and they’re not sick, they’re not desperate, they’re not worried that they’re going to die. They just want to use Microsoft Word.

Rachel Corbett: Right.

Gabe Howard: So you can really see how maybe contract law or contracts or fine print is not your primary concern, because I think that some people listening to this would think, well, if it’s written down, that’s on you. I think we need to do maybe a better job of explaining look at asking an individual to compete with the Department of Justice with the government is maybe not a fair fight. And I understand what you said, that you don’t know the motivations of the government or of the people who enforce the law or why the law is the way that it is. But you do know the history of the policy. Can you explain that a little bit? Like, how did we get here?

Rachel Corbett: Yeah, so Medicaid estate recovery has been on the books since the 1960s, I believe. But it was always just an option for states to enforce if they decided that they wanted to recoup some of the costs of their Medicaid programs. They could take the assets of some recipients. And I think only Oregon did it or it was very, very few states actually did this. And then in the 1990s, in 1993, actually, Bill Clinton signed his budget act and that made a state recovery mandatory in every state. So that was the real game changer. And this was you know, I talk in the piece about how this was coming at a time when we had this a lot of rhetoric about personal responsibility and the welfare state. And there was a lot of ideas that poor people were kind of con artists or just lazy. They just didn’t want to work and they wanted taxpayers to shoulder the burden for them, you know? And this really outraged people. And there was a rising debt, national debt. And there was a lot of like this is just as welfare as it was. A lot of Ronald Reagan had, you know, started talking about welfare being a spider’s web of dependency and all of this language. And Newt Gingrich was trying to gut Medicaid and Medicare at the time. So, anyway, Bill Clinton, I think, saw this as like a way to sort of appease that wing of government and also help balance the budget.

Gabe Howard: You mentioned that this was a way to help balance the budget. Has it been effective at recouping the cost of health care expenditures? Is it at least working?

Rachel Corbett: Well, that’s a great question, because the answer, interestingly, is no, resoundingly no. I would say that on average, it recovers about 1 percent, actually a little less than 1 percent of what we actually spend on Medicaid. So the last time they did it, an analysis by state, they found in some states like Kentucky, the average amount recovered from a family was ninety three dollars. So that means they took the last three dollars from someone out of their bank account. You know, you can imagine, if you only have $93, that’s going to put you into crisis. And $93 is absolutely nothing for the federal government.

Gabe Howard: Well, and it’s not even just about the $93, right? It’s also about this bureaucracy that was visited upon this family after the death of their loved one. Let’s not forget that it’s not just about taking the ninety three dollars, it’s also the federal government is contacting you after your child passed away or your mother passed away or. I don’t want anybody to call me when somebody I love died, let alone for my last ninety three dollars. Like, I think both things are kind of horrible. And you also pointed out that this is seems to be unfairly visited upon the poor more often than people who have the means to hire a lawyer and put their assets in a trust or do estate planning, etc.

Rachel Corbett: Yeah. I think you’re exactly right. Imagine you’re mourning the loss of your mother or father, a spouse, and then you get a bill and that is how it comes in the mail. It’s a bill. You don’t know what it is. They’re saying you owe three hundred thousand dollars. I mean, you can imagine how traumatizing that is in that moment. And then you have to call up, you know, the bureaucrats in the agency and have them explain and they might tell you, all right, well, you don’t have to pay all $300000, but we’re gonna take whatever they had and put it towards that $300000. And if there’s nothing left, then okay, we’ll cancel the rest of the debt, but we’re going to take everything. But the shock of seeing that bill for every expense, which could be a bill for a million dollars. You know, and it’s just they don’t really tell you what that means. It’s just this terrifying moment. I talked to dozens of people who had that moment where they just get a bill right after the funeral.

Gabe Howard: Wow.

Rachel Corbett: And then they call. And it’s just totally traumatic.

Gabe Howard: We’ll be right back after these messages.

Announcer: Want real, no-boundaries talk about mental health issues from those who live it? Listen to the Not Crazy podcast co-hosted by a lady with depression and a guy with bipolar. Visit Psych Central.com/NotCrazy or subscribe to Not Crazy on your favorite podcast player.

Announcer: This episode is sponsored by BetterHelp.com. Secure, convenient, and affordable online counseling. Our counselors are licensed, accredited professionals. Anything you share is confidential. Schedule secure video or phone sessions, plus chat and text with your therapist whenever you feel it’s needed. A month of online therapy often costs less than a single traditional face to face session. Go to BetterHelp.com/PsychCentral and experience seven days of free therapy to see if online counseling is right for you. BetterHelp.com/PsychCentral.

Gabe Howard: We’re back discussing the article Medicaid’s Dark Secret with author Rachel Corbett. It’s important to point out that they’re not just taking the cash that’s on hand. They’ll take your house. And I feel, and I think you agree, that this is particularly cruel to go after people’s houses.

Rachel Corbett: Yeah. So, you know, the house is often the largest asset that people own. So from the government’s perspective, this is the most lucrative way to get the debt that’s repaid. But there’s something really unsavory about taking people’s houses. This has been very politically unpopular. You know, when this bill has been debated in states, when it rarely does come up. Politicians have often said, like, I don’t want to going after people’s houses. That’s emotional. People have deep psychological attachments to their homes. You know, it’s not just money. It’s not just money in an IRA. People’s houses, people have family memories attached there. The children that they’re taking it from, probably grew up there. So, and maybe plan to pass it on to their children or, you know, as a way to sell and put their kids through college or who knows? You know, that it’s just more than an asset. You’re right.

Gabe Howard: It’s also possible that family members could be living there.

Rachel Corbett: Right. So this is where it gets a little tricky because there is an exemption in the law that if you are a child who took care of your parents or at least two years before they had to enter a facility, a nursing home say, then you’re exempt from estate recovery. But the problem is that a lot of people who do live with their parents do take care of them and actually saves the states hundreds of thousands of dollars by providing that care for free themselves don’t actually qualify because the exemption language is so specific. You can imagine a lot of people I talked to had a situation where their mother fell and then had to go into a nursing home right away because she needed immediate care. And they come in, they make arrangements, maybe they move in and they say, OK, we’re gonna take her out of the nursing home, I’ll take care of. I’m going to move in. But they didn’t technically live there for two years before she had that fall. So it doesn’t matter. It doesn’t matter that they may spend their next 10 years living there, providing that care. Oftentimes, you don’t know. It kind of requires you to be a bit psychic. Like, how do you know, two years before an emergency that you need to be moving in?

Gabe Howard: Wow, that’s absolutely incredible. And I imagine. And I’m trying desperately not to be sarcastic, but I imagine that this language is on page 34 of the 50 page document, etc. I mean, you’re explaining it in layman’s terms and I’m having trouble understanding it. And I have to imagine that it’s just not that simple because nothing with the government ever is simple.

Rachel Corbett: Right. It makes sense if you think about it. OK. If you live with your parents and you give them care, you save the government. That money, you should be able to keep the house. That makes sense. And I think that’s how people who actually even understand the law say the children in this position may know that, hear that and think, OK, I’m going to do that. That seems fair, but they’re not figuring out the specifics. Actually, two years before or say they took them out of a nursing home and then they lived there and then they had to go back to nursing homes two years later. It doesn’t matter, because they already were in the nursing home once. It is made to be difficult to understand, I think. I mean, I don’t know, again that is me assigning motive. I don’t really know. But it feels that way, to a lot of people. A lot of people feel like they’ve been duped. That’s what I heard from families who went through this. There’s several women in the story I interview who are in exactly this position where they’re living at home and their mother has died. They’re still living in that house that they’ve been living there for, in some cases eight, 10 years, and now they’re about to be homeless because the government going to take their mother’s house.

Gabe Howard: And it’s important to point out, especially in the context of our show, there’s a lot of people who live with mental health conditions and mental illness, who do live at home and when their parents get older, etc. It’s certainly understandable if they need to go to a nursing home or they need to go to care, etc. And suddenly the parent that they relied on to make ends meet because, you know, listen. We like to talk about how people with mental illness can get disability, but disability is often not enough to live on your own. There’s family and support systems who are often helping and those people in the natural order of things will die first. And now all of the sudden, that house that mom and dad thought would take care of their child or whomever is now in serious jeopardy unless the person who is living with mental illness on disability can manage this system that you and I are having trouble understanding. It really just seems like it’s setting families up to fail in a situation where they shouldn’t have to. Like you said, at 1 percent. So we’re doing all of this to families to save 1 percent. And it sounds like these problems are going to continue. Is that true? Is does the end of your article state, hey, and they fixed it? It’s all over now?

Rachel Corbett: Unfortunately, no. I think this is a big problem that a lot of people are trying to talk about fixing I think in many ways. But to your first point, I just want to say there is a second exemption, a second exemption, which is for a disabled child. And I think it’s important to note that if you’re a disabled child of any age who is living with your parents at home, you’re also supposed to be exempt from recovery. But like you also said, that means you have to apply for the exemption and have the wherewithal to do that, because you’ll probably still get that bill saying they’re coming after the house. You have to know about that exemption and know that you qualify for it and be able to actually make those calls. File all the forms and potentially get a lawyer to do that. And so depending what kind of disability you have, that, you know, may or may not be feasible.

Gabe Howard: And these are monumental tasks, and one of the things that struck me when you said it is, listen, if you have enough money and resources, you can hire lawyers. These are lawyers. These aren’t your friends. These aren’t your family members. These are people who hold advanced degrees and specialized training in dealing with the laws surrounding this. And lawyers are expensive. They’re worth every penny, but they’re expensive. They’re also hard to come by, and especially in lower income families, there’s a lot of distrust surrounding the legal system because they’re so expensive and because it’s hard to understand what’s going on. It seems like we’re not taking into account who were serving with these laws. It just really sounds like it’s this knee jerk reaction to, hey, we’re gonna bother a whole bunch of people. We’re probably not going to get any money out of it, but it’s OK because wealthy people can afford it. So it’s really only going to hurt the poor. So we don’t need to do anything about it.

Rachel Corbett: Yeah.

Gabe Howard: Am I oversimplifying it? That seems to be what you’re saying.

Rachel Corbett: I mean, it can feel punitive, I think, to some people, because, you know, a lot of the people are people who worked their whole lives. You’ll say they did everything right. They got just enough money to buy a house to, you know, so that middle-class dream and leave a little something to pass on to their children. And these are the people who really like we’re living by the letter of the law, doing everything they supposed to do. And these are the people that it most affects. If you have absolutely nothing, you have no assets, nothing, then you’re not affected, because you don’t actually have to pay anything. And if you have a lot, you may have been doing estate planning and worked around this issue or never had to go on Medicaid in the first place. So really, I don’t know that this was the intent, but the effect is definitely that the people who are suffering the most and paying the price are those who are in a lower middle class and who scraped by just enough to leave something for their kids. And that is heartbreaking to me. You know that this is not necessarily helping us fix the costs of Medicaid, which is, you know, to be fair, a huge burden on the system. Medicaid isn’t working properly. It’s very expensive to maintain. But this isn’t the solution. It seems to me at least this isn’t one that’s working well.

Gabe Howard: I’m in the same boat as you, which is I don’t understand the government’s motive for doing this. This doesn’t seem to make families safer. It doesn’t seem to make families stronger. And it seems like the people who are most impacted by this are people, like you said, who are doing everything right. They’ve worked hard enough to get that little piece of the middle class American dream. And the effects I like the word that you use there. The effects of this seem to be very punitive. Is there a solution to any of this? Do you have any ideas on how we can get ourselves out of this? Because I can’t imagine anybody listening to this is like, well, this sounds like a good system. I think most people are going to be like, oh, yeah, this is not this is not okay.

Rachel Corbett: Yeah, I think it spiraled out of control even from what it was initially intended to do, I think states have gotten more and more aggressive in terms of what they collect, going after more and more. And I think we’ve lost touch with even what was originally intended to be. And even that I think that we wouldn’t agree with. But I wonder if the solution will be less about overturning this particular law and this policy and more about reforming the health care system overall. I’m not sure that some states have had success in reforming this law. For example, in 2016, California passed really important legislation that dramatically reduced what the government could recoup from families on Medicaid, and they can only recover a very limited set of assets now. So it can work state by state. Minnesota also had some legislation. Some people after the ACA was passed and Medicaid was expanded. Some states said that will no longer implement state recoveries for people who were on the expanded Medicaid. Many of them didn’t know when they were getting on it that this was a policy. But in terms of the future, I think, you know, Democrats aren’t really talking about this. Democrats are talking about expanding the ACA or instituting Medicare for all. I think Bernie Sanders is the only candidate who has explicitly said in his Medicare for all plan that he would abolish the state recovery as part of his plan. I know that Elizabeth Warren is also against the state recovery, although I don’t know if she mentioned it explicitly in her Medicare for all plan. I think that if there actually was Medicare for all, this would be rendered moot because we wouldn’t have Medicaid anymore. Short of that, if we go into more of an expanded ACA, or we, I don’t know, we just don’t know whether this would be. Someone would have to kind of abolish this mandate, and I’m not sure people are really talking about that on the federal level at this point.

Gabe Howard: It’s incredible. It’s just absolutely incredible. You have taught me so much and I’m positive that our listeners are going to get a lot out of it. One of the things I think they’re going to get out of it is that they need to talk to their elected officials and find out how this impacts them, how they can protect themselves and how we can get rid of this nonsense altogether. Because I think visiting this on on poor people, regardless of the intention, as you said, the effect is is not good. And the fact that it’s only recovering 1 percent just shows that it’s not even working.

Rachel Corbett: Yeah, what the government actually recoups compared to what they spend on Medicaid and compared to what they spend on a lot of other things, frankly, that benefit wealthier groups of individuals. So for the federal government, it’s really not a lot. For people, the families it affects, it can be life changing.

Gabe Howard: I couldn’t agree more. Thank you so much for agreeing to be on the show. Where can our listeners find you? What’s your Web site? I understand that you have a book out. Please tell us where to learn more about Rachel?

Rachel Corbett: Yes. Well, I have a book on a very different subject, it’s about the artist Rodin and the poet Rainer Maria Rilke. But if you have any listeners interested in art, they should definitely find that, it’s called You Must Change Your Life. And I have a Web site, it’s Rachel-Corbett.com.

Gabe Howard: Again, thank you so much for being here. It has been enlightening.

Rachel Corbett: Thank you.

Gabe Howard: You’re very welcome. And thank you to our listeners who are here. Remember, please like us on social media, share us everywhere, give us as many stars, hearts or bullets as you can and use your words and tell people why you like the show. And remember, you can get one week of free, convenient, affordable, private online counselling anytime, anywhere, simply by visiting BetterHelp.com/PsychCentral. We will see everyone next week.

Announcer: You’ve been listening to The Psych Central Podcast. Want your audience to be wowed at your next event? Feature an appearance and LIVE RECORDING of the Psych Central Podcast right from your stage! Email us at [email protected] for details. Previous episodes can be found at PsychCentral.com/show or on your favorite podcast player. Psych Central is the internet’s oldest and largest independent mental health website run by mental health professionals. Overseen by Dr. John Grohol, Psych Central offers trusted resources and quizzes to help answer your questions about mental health, personality, psychotherapy, and more. Please visit us today at PsychCentral.com.  To learn more about our host, Gabe Howard, please visit his website at gabehoward.com. Thank you for listening and please share widely.

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Snapshots of My Patients – The New York Times

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No fun having cancer.

Many people have an aversion to posing for a photograph. For years I avoided having my own picture taken in social situations, embarrassed at how unflattering the image always seemed to appear, and maybe in denial at how accurate it actually was. Some of my patients similarly refuse, perhaps because they may feel they aren’t looking their best in our waiting area, preparing for chemotherapy; and perhaps worried that the photo might make their cancer diagnosis that much more concrete. In these cases, the upper left corner of the computer screen contains a white box with the message “Patient Declined Photo.”

I probably would decline too.

When prompted to have their picture taken, some of my patients do manage to summon a smile, though I can’t tell whether it is genuine or “habit being so strong,” as Raymond Carver described the thanks he gave to the doctor who told him he had lung cancer in his poem “What the Doctor Said.” For some of my millennial patients in particular, I am convinced the smile is ironic, reflecting the paradox of expressing joy before a checkup with a cancer doctor.

Patients can also upload their own photos to the electronic medical record, providing a glimpse of what their lives look like outside my clinic. One 21-year-old stares winsomely at me from her bedroom, her dresser and a small picture in the background, from a time that preceded her cancer diagnosis.

If she only knew what was coming.

Another woman in her 40s cheekily uploaded a picture in which she’s flanked by two dogs in her yard, all three facing the camera and grinning ear-to-ear on a beautiful, sunny day. It’s as if she’s thumbing her nose at cancer, using the photo to say that it won’t define who she is. Now that I know she has dogs, they have become a frequent topic of conversation during our visits.

That image brings me joy every time I open her medical record.

The photos are a snapshot in time, capturing a truth that may no longer be accurate: patients bundled up in a scarf and hat when I see them in August, or wearing a tank top in the dead of winter; patients who appear gaunt and bald, their photos taken during the throes of chemotherapy, now greet me in clinic with rounded cheeks and a full head of hair, in remission from their cancer.



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Health and Fitness By Zul And Akim

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