Unfortunately, leaving it up to the states is not a good idea in the US. It is one of the reasons the Feds established minimum welfare levels, for instance, because some states cut funding levels to ridiculous lows and tightened requirements so that hardly anyone qualified. The result was that poor people flooded into states with better benefits. For that same reason, there is a huge debate about Section 5 of the Voting Act. For decades some local voting laws were shaped to deliberately exclude rural black voters. Not until Section 5 was passed, was the Justice Dept. given the "teeth" to enforce fair voting rights across the country, regardless of state or local attempts to block such. Expecting every municipality in the US to treat everyone fairly is a nice pipe dream that reality has shown does not happen without some sort of enforceable federal mandate making it possible. Many national health services are moving to a two-tier approach. It's inevitable if you are in a capitalist system. You either nationalize all the drug companies everywhere, or accept that some drugs/treatments are going to cost a whopping amount because they're (a) new or (b) useful for only a small percentage of people able to pay for it. This means several changes to how the US approaches healthcare. The insurance lobby is a lot stronger than the AMA. So basic healthcare, especially for underage children, is going to pass quickly and be expanded. This is a good thing that has a fair amount of bipartisan support. The second is to decouple healthcare from one's job. This is a lot trickier and because of the failing financial health of our Medicare system, soemthing that will be eased in over time. Again, the emphasis will be on basic care. Even today you can buy catastrophic health insurance at a reasonable cost, albeit with limited total caps on benefits. People who can afford better healthcare, will pay for supplemental insurance that covers more. IOW, similar to how Medicare Part D is handled. The basic change needed for Medicare is for Congress to allow it to demand price competition. Medicare is legally barred from doing so. Where states can offer use is to encourage programs that tie together existing resources in a manner that works best locally, such as San Francisco's innovative PACE/On Lok program, which is so successful it was recognized by Congress as authorized Medicare providers (providing better care at lower cost, yet with higher satisfaction ratings). The fastest growing area of healthcare is home health services. This is a critical area where cost savings elsewhere could be utilized to help ill/disabled people stay in their homes longer and thus ease the need for institutional care. There will always be waste, but if we could even reduce 30% of that waste and redirect that money into areas that are truly needed, it would be worth the effort.

In talking to a young couple regarding how to develop a good money management system, I suggested that a good way to start is to keep track of every expenditure, to assist in evaluation. I suggested that they set up a page, probably in a loose-leaf binder, to deal with their cash operation, with date, description, and three (possibly 4) columns, with one for individual expenses, (possibly a second to add several expenditures). One column for cash income as withdrawn from bank account, or other source, etc., and a column at the right for keeping track of balance. It's important to check amount in wallet against recorded balance on hand frequently at the start, as often there appears to be more cash reported in record book than wallet ... as one (or more) expenditures had not been entered. I was informed that they didn't do much cash business, but dealt extensively with debit card. I was going to suggest later that they set up several columns to the right, to break out the expenditures into the various types, with a column for each. How to deal with the debit card transactions? I thought that it might be wise to enter each transaction, either as it happens (which I thought preferable), or as they get their monthly report from the bank relating to date and description, but not into the cash columns, as it was directly paid from the bank. To record each transaction only in the columns related to category. But - many pay bills also by cheque and by credit card. The reason for the cash columns is to ensure that every transaction is accounted for, but this is not an issue with the debit card transactions, for they show up totally in the bank report. Then when the bank report comes in, ensure that each transaction that you made is entered, and checked with the bank report, entering any that hadn't been earlier. That way, each of those two types of expenditure shows on the detailed page. I suggested that they keep a report of their bank account transactions on the back of last month's record, on the page to the left. The cheque register would show the various expenditures during the month on the full financial report of expenditures and would be entered either as they were written, or, I thought preferably, after the cash transactions for the month (possibly including the debit card activities, as well), had been finished. Then, one gets a report from one's credit card transactions and each transaction would be entered in the various relevant categories. As many report that Quicken is easy to use, and quite comprehensive, I'm quite sure that it'll have an easy way to deal with the debit card transactions. ole joyful

Interesting thoughts -- we could all improve on paperwork storage in our homes. Two things I think I'm doing well that differ from the above mentioned Script, and someone else might find some ideas in my methods: Taxes. Yes, like Script, I am scrupulous about maintaining records for my taxes. About a dozen years ago I went to the office supply and bought two big boxes of BRIGHT GREEN folders (green like money). I labeled them Taxes 2000 ... Taxes 2001 ... Taxes 2002 ... Taxes 2003 ... and so on. Given my family's typical lifespan, I made enough green folders to take me to age 110 -- probably more than I'll need, but I'm ready! They're all stored in my file cabinet, taking up very little space. Now when I receive anything tax-related -- a charitable receipt, an end-of-the-year bank statement, whatever -- I have a place to file it. In April, I have a place to file a copy of my taxes, and I can go back and see previous tax years. For the rest of my life, this system is in place. Death folder. Ours is a notebook. Two identical notebooks, actually, since we have two children. Our girls are young adults now, but they've never dealt with an estate -- even if they don't open it 'til they're old, it'll be useful to them. It contains a lot of stuff: - A personal letter to the two of them - A list of our wishes about funeral and items we'd like donated to various family members or charities - A list of things they must do immediately; it starts with going to our house and taking possession of the dog, but it also includes small details like canceling our voting registration and destroying any medicines in the house. At every turn this list includes addresses and phone numbers, including the lawyer we suggest for probate, the funeral home our family's always used, and family members who should be contacted. - A copy our will; they know what's in it -- everything split between the two of them - A list of our financial assets -- bank accounts, investments, insurance, deeds/maps of real estate ... when our youngest became a legal adult, we made the two girls co-beneficiaries of every account; note that this was done before either was married, so our two kids -- not future son-in-laws -- will own these items. - A list of the bills we pay each month -- electricity, phone, even the guy who cuts our grass. - Official copies of our birth certificates, our marriage certificates, and the girls' birth certificates -- they might not be needed, but the girls won't have to scramble to find them - A flashdrive with all of the above in digital format plus photographs that might be useful in putting together the funeral Our rule: We keep two years of tax returns in the notebooks ... the reason being that someday an accountant will file our final estate tax return, and he or she will want our last two years of returns -- so every April we pull out the notebook, discard one old return and insert the newest ... so our rule is that every April we look over the notebook and update anything that's changed. For example, last year we changed bank accounts, and someday we hope to add items concerning grandchildren to the book. Our girls know that the notebooks are stored in the safe, and they know where the key to the safe is hidden, and they know it's labeled with a misleading name so that a thief wouldn't look at it twice. Last thought on this notebook: Though this project took us the better part of a year --- we kept remembering one more thing, one more thing that really should be included -- we didn't find it difficult emotionally. I suspect that if we were older and/or one of us were in poor health, it might've been different.

What about when its too late to not get a pet? I have one and he was recently diagnosed with epilepsy, this was after $3000 worth of test and that was our last bit of money. now he's getting bad seizures and we had to do emergency vet care that we knew we couldn't afford and we are now another $600 in the hole and this is just the beginning. we can't afford this. We love our dog and are broken up over this and we don't know what to do. we are worried we won't be able to find someone to take him from us that can care for him properly and we know that we can no longer care for him properly. So far we can't find anyone to take him and if we keep him that means when he has more problems or more seizures since the medicine doesn't completely keep them from happening it just controls them to make them less severe, so when he does have them we can't afford to take him in to the hospital when he has more than 4 in a day (he has cluster seizures). We are very torn as to what to do, it seems as though euthanizing him may an option because what kind of life is that if he needs medical attention we can't give him because we don't have the money.