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I would abolish Medicaid.
http://www.statehealthfacts.org/comparetable.jsp?ind=182&cat=4
If you look at these numbers, the vast majority of states spend around 85% of Medicaid funding on children (20%), elderly (25%) and disabled (40%) people. These are three groups that have a hard time fending for themselves. So what you are proposing is taking away their care and giving them care at free clinics.
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would build free clinics all over the country .... and staff them with medical school graduates who could do their residency there and also earn a reduction in their student loans as payment.
How would these clinics be funded?
Also, I don't think that Medicaid is solely responsible for flooding ERs. In fact, a recent study showed that it is not only the poor who overuse the ER, but even greater overuse is mediated by non-poor people who have a primary care physician.
http://www.ncbi.nlm.nih.gov/pubmed/18407...Pubmed_RVDocSum
I don't know what the answer is to avoiding ER overuse, but abolishing Medicaid won't do it.
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Well, I don't know how it is in other states ... but today .. disabled people go on Medicare not Medicaid. (At least that's what happened to a friend of my mother's who suffered a permanent injury)
However, if the choice is having no health care, or having health care with restrictions (which is what everyone with a "paid" plan has) then restrictions might be a prety good compromise. I can only go by what I have seen first hand. I work with a number of people who have Medicaid. They work a limited work week. (maybe 20 - 25 hours) They routinely call off to take the baby to the ER because something is wrong ..... usually a cold .... or mild fever ...... or sinusitis ..... or an upset stomach ......
My medical plan .... that I pay for .... says that a trip to the ER costs me $100 out of pocket. That $100 is applied to my deductable or co-payment if I am admitted.
People on Medicaid pay nothing.
Sorry, but I do not believe that people who pay nothing to their own care and support should get better care than those paying the bills. That makes no sense to me whatsoever. Clinics are a solid method of providing health care for those who do not pay their own way. most major cities already have free clinics .... and these could be augmented, or expanded, and would still be far, far less expensive than the curent system.
it would be less expensive to have a clinic in Youngstown, for example, staffed with younger doctors, and providing all care for those currently getting free care, than to pay for doctors all over the county ..... hospitals providing non-emergency services in ERs ..... not to mention that the current system is bankrupting our hospitals. Paperwork would be immediately simplified and lessened. Medication could be dispensed on site. No hard drugs .... but antibiotics and moderate pain medications could be stocked and dispensed on site.
As far as how I know that "free" services and underpayments from Medicaid are bankrupting our hospitals .... because that's why our hospitals are closing either entirely, or closing down ER services. they simply cannot afford to care for the poor, and the ERs are clogged with people using Medicaid as a doctor visit.
Forum Health went bankrupt here in Youngstown because of this very issue. We lost Southside Hospital because of this very issue. Medicaid pays far less than private insurance for ER visits ... and the hospital can't even collect a co-pay. Many doctors can't afford to take on additional Medicaid patients. How does this serve anyone well?
Micah 6:8; He has shown you, O mortal, what is good. And what does the Lord require of you? To act justly and to love mercy, and to walk humbly with your God.
John 14:19 Jesus said: Because I live, you also will live.
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Well, I don't know how it is in other states ... but today .. disabled people go on Medicare not Medicaid. (At least that's what happened to a friend of my mother's who suffered a permanent injury)
However, if the choice is having no health care, or having health care with restrictions (which is what everyone with a "paid" plan has) then restrictions might be a prety good compromise. I can only go by what I have seen first hand. I work with a number of people who have Medicaid. They work a limited work week. (maybe 20 - 25 hours) They routinely call off to take the baby to the ER because something is wrong ..... usually a cold .... or mild fever ...... or sinusitis ..... or an upset stomach ......
My medical plan .... that I pay for .... says that a trip to the ER costs me $100 out of pocket. That $100 is applied to my deductable or co-payment if I am admitted.
People on Medicaid pay nothing.
Sorry, but I do not believe that people who pay nothing to their own care and support should get better care than those paying the bills. That makes no sense to me whatsoever. Clinics are a solid method of providing health care for those who do not pay their own way. most major cities already have free clinics .... and these could be augmented, or expanded, and would still be far, far less expensive than the curent system.
The issue I took with your above post was that your solution was completely abolishing Medicaid. But it really sounds like you mean reforming Medicaid. I don't disagree that the program could use some cleaning up, but abolishing it completely is not an option.
People who are disabled go on Medicare. People who are poor and disabled (some of the most vulnerable people in our society) go on Medicaid. People on Medicaid are on Medicaid b/c they are very, very poor; and they are either a child, old, or disabled, three groups that don't have a lot of earning power. By this very definition, the $100 you or I pay may be a humongous portion of their yearly income.
IMO, the ER overuse problem you speak of is a very real problem. But it is not all Medicaid. In fact I showed you a link above that shows the overuse problem is really with people with paid plans. So the overuse problem is separate from Medicaid. It can't be dealt with by solely making changes to Medicaid. It has to be something that affects everyone.
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Forum Health went bankrupt here in Youngstown because of this very issue. We lost Southside Hospital because of this very issue. Medicaid pays far less than private insurance for ER visits ... and the hospital can't even collect a co-pay. Many doctors can't afford to take on additional Medicaid patients. How does this serve anyone well?
I'm not going to pretend that I know as much about Youngstown as you do, but it seems to me like it's not that Medicaid is flawed in this situation, but that a particular urban area is declining in population and has a high unemployment rate (less patients and a higher proportion of Medicaid patients). Even if Medicaid is abolished in Youngstown, people on Medicaid are not able to pay. Those hospitals still wouldn't have enough paying patients, and they still would've gone out of business. Similar things have happened in Cleveland through the years; when a city loses half its population in a 40 year period and experiences a high unemployment rate, it just can't keep all the hospitals open. I don't think this calls for wiping out Medicaid. I think it would be a huge mistake to make blanket federal policy based on what is happening in cities that are on the decline.
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Actually .... if you look at New York you will find similar problems.
They are neither small ..... nor, at least according to ESPN reports, in decline.
Micah 6:8; He has shown you, O mortal, what is good. And what does the Lord require of you? To act justly and to love mercy, and to walk humbly with your God.
John 14:19 Jesus said: Because I live, you also will live.
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I think it would be a huge mistake to make blanket federal policy based on what is happening in cities that are on the decline.
But this is what our government has done for decades.. and it's not just whole cities.. hell we get ONE FAMILY that has a problem and we create laws to fix it that affect 300 million people.. ok, that's an exaggeration but that is the knee jerk mentality of our federal government to create broad sweeping laws to affect a minimum number of people.
yebat' Putin
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They are neither small ..... nor, at least according to ESPN reports, in decline.
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Actually .... if you look at New York you will find similar problems.
Is the problem systemic to all NY hospitals? Or is it localized only to poorer areas with a much higher proportion of Medicaid patients? Do you have a link? If localized to poorer areas, these patients wouldn't be paying anyways. JMO, but I actually think that hospitals would prefer receive some payment via Medicaid rather than just having to eat it and provide charity care, which is what would happen if a very poor person has no Medicaid.
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But this is what our government has done for decades.. and it's not just whole cities.. hell we get ONE FAMILY that has a problem and we create laws to fix it that affect 300 million people.. ok, that's an exaggeration but that is the knee jerk mentality of our federal government to create broad sweeping laws to affect a minimum number of people.
JMO, but I feel that its almost the other way around. Problems went unsolved for decades, and when no one stepped in to help certain people out, the government stepped in. Unfortunately there isn't good data (at least that I could find) for this one, but I thought Social Security was instituted b/c it was a common occurence to see elderly folks living on the streets, completely destitute after they retired. Medicare came about roughly 20-30 years after our current system of employer based health insurance came about, and it became apparent that no insurance companies wanted to insure older people, b/c it's not very profitable for them. Medicaid came about b/c people who are very poor, and either disabled, old, or a child cannot fend for themselves. And before the Reagan era EMTALA law, they were denied care at hospitals b/c they could not pay.
Give me a few examples of the knee jerk policy that you speak of (I don't doubt that this has happened, but I haven't thought enough about it to come up with any good instances of my own).
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Dawg Talker
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The Healthcare Reform Act...
I thought I was wrong once....but I was mistaken...
What's the use of wearing your lucky rocketship underpants if nobody wants to see them????
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The problem is twofold.
I pay a $100 deductable for ER services as part of my private insurance coverage. My insurance then picks up the balance of the charges.
Medicaid pays only a fraction of that amount.
Further, whereas private insurance customers have the disincentive of a larger copay to dissuade them from going to the ER for a stuffy nose, there is no such mitigating factor with regard to Medicaid patients.
The simple facts are these:
The country is going broke providing care for those who do not contribute to the cost of their care. Hospitals are going broke, because they are not being reimbursed the same as other medical plans. The system is broke, and needs a massive overhaul with massive cost containment measures, most specifically for those who contribte nothing to their own care, and in patient responsibility for these persons. They are bankrupting the system. They are abusing the system. This has to stop. There is absolutely no reason whatsoever why persons receiving absolutely free medical coverage should receive better care than those who have to pay for, either in part or in whole, their own coverage.
"Free" always leads to abuse. Our Medicaid system is set up like this comparison .....
We are going to pay for your car, gas, and food. Cost is no concern to you whatsoever.
Are you driving a new or used car as a result? An entry level car, or a top end luxury model? Do you drive where necessary, or as a recreational activity?
Our Medicaid system gives people a new, high end, luxury model .... with unlimited gas .....and we're left holding the bill. The system need scaled back dramatically to bring costs in line. I brought up one idea. The curent ideas all seem to involve cutting payments to doctors and hospitals while requiring that they provide services on demand. That does not, and will not work. services must be curtailed for those who receive free coverage, and there must be penalties for abuses of coverage. (IE: going to the ER for a stuffy nose)
Micah 6:8; He has shown you, O mortal, what is good. And what does the Lord require of you? To act justly and to love mercy, and to walk humbly with your God.
John 14:19 Jesus said: Because I live, you also will live.
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jc Soaring costs force Canada to reassess health model By Claire Sibonney - Analysis Claire Sibonney - Analysis – Mon May 31, 2:38 pm ET TORONTO (Reuters) – Pressured by an aging population and the need to rein in budget deficits, Canada's provinces are taking tough measures to curb healthcare costs, a trend that could erode the principles of the popular state-funded system. Ontario, Canada's most populous province, kicked off a fierce battle with drug companies and pharmacies when it said earlier this year it would halve generic drug prices and eliminate "incentive fees" to generic drug manufacturers. British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee. And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery. It's likely just a start as the provinces, responsible for delivering healthcare, cope with the demands of a retiring baby-boom generation. Official figures show that senior citizens will make up 25 percent of the population by 2036. "There's got to be some change to the status quo whether it happens in three years or 10 years," said Derek Burleton, senior economist at Toronto-Dominion Bank. "We can't continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services. "At some stage we're going to hit a breaking point." MIRROR IMAGE DEBATE In some ways the Canadian debate is the mirror image of discussions going on in the United States. Canada, fretting over budget strains, wants to prune its system, while the United States, worrying about an army of uninsured, aims to create a state-backed safety net. Healthcare in Canada is delivered through a publicly funded system, which covers all "medically necessary" hospital and physician care and curbs the role of private medicine. It ate up about 40 percent of provincial budgets, or some C$183 billion ($174 billion) last year. Spending has been rising 6 percent a year under a deal that added C$41.3 billion of federal funding over 10 years. But that deal ends in 2013, and the federal government is unlikely to be as generous in future, especially for one-off projects. "As Ottawa looks to repair its budget balance ... one could see these one-time allocations to specific health projects might be curtailed," said Mary Webb, senior economist at Scotia Capital. Brian Golden, a professor at University of Toronto's Rotman School of Business, said provinces are weighing new sources of funding, including "means-testing" and moving toward evidence-based and pay-for-performance models. "Why are we paying more or the same for cataract surgery when it costs substantially less today than it did 10 years ago? There's going to be a finer look at what we're paying for and, more importantly, what we're getting for it," he said. Other problems include trying to control independently set salaries for top hospital executives and doctors and rein in spiraling costs for new medical technologies and drugs. Ontario says healthcare could eat up 70 percent of its budget in 12 years, if all these costs are left unchecked. "Our objective is to preserve the quality healthcare system we have and indeed to enhance it. But there are difficult decisions ahead and we will continue to make them," Ontario Finance Minister Dwight Duncan told Reuters. The province has introduced legislation that ties hospital chief executive pay with the quality of patient care and says it wants to put more physicians on salary to save money. In a report released last week, TD Bank said Ontario should consider other proposals to help cut costs, including scaling back drug coverage for affluent seniors and paying doctors according to quality and efficiency of care. WINNERS AND LOSERS The losers could be drug companies and pharmacies, both of which are getting increasingly nervous. "Many of the advances in healthcare and life expectancy are due to the pharmaceutical industry so we should never demonize them," said U of T's Golden. "We need to ensure that they maintain a profitable business but our ability to make it very very profitable is constrained right now." Scotia Capital's Webb said one cost-saving idea may be to make patients aware of how much it costs each time they visit a healthcare professional. "(The public) will use the services more wisely if they know how much it's costing," she said. "If it's absolutely free with no information on the cost and the information of an alternative that would be have been more practical, then how can we expect the public to wisely use the service?" But change may come slowly. Universal healthcare is central to Canada's national identity, and decisions are made as much on politics as economics. "It's an area that Canadians don't want to see touched," said TD's Burleton. "Essentially it boils down the wishes of the population. But I think, from an economist's standpoint, we point to the fact that sometimes Canadians in the short term may not realize the cost." ($1=$1.05 Canadian) (Reporting by Claire Sibonney; editing by Janet Guttsman and Peter Galloway) web page
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Quote:
but I thought Social Security was instituted b/c it was a common occurence to see elderly folks living on the streets, completely destitute after they retired.
Give me a few examples of the knee jerk policy that you speak of
Knee jerk.. social security. Yes, times were tough during the great depression, people needed help.. TEMPORARY HELP. Not a broad sweeping set of laws that we are still paying for 80 years later.... a set of laws that helped us on our way to greatly increased government dependance..
You want another knee jerk? How about the way a lot of the New Deal was passed.. Roosevelt had a lot of it struck down by the supreme court so he realigned the court, added more judges he liked and got most of it through.. Many consider Roosevelt one of the great Presidents, he would be tarred and feathered if he tried that today. I will give you this though, if they would have appropriately used the trust fund as established in 1939 it wouldn't be nearly as bad as it is.. but putting a big pot of money in front of a politician and telling him he can't spend it is like putting rare steak in front of a doberman and telling him he can't eat it.... as soon as you turn your back, it's GONE.
yebat' Putin
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No, they wouldn't work for free. They would get paid by the government. Based off of how healthy their patients are. It is really messed up that when you are sick and in desperate need of help somebody comes along and says:
"Yea, I'll help you. IF you give me everything you have!!"
so you want all medical staff to be government employees? are you serious?
and what happens when they malpractice and kill mom, or dad, or your daughter perhaps...what you going to do, sue?
good luck with that, try to sue the govt and see how far you get...
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No, not "whatever service". Let me guess, you consider going to the doctor to be the same as buying a hamburger. Oh, I'm sick and may not make it a week. Nobody will do anything for me unless I have money. That is NO way to live. Making a profit because somebody is sick and desperate.
Buying a Hamburger because im hungry, or a glass of water because im thirsty is no different then going to the doctors and PAYING FOR IT when im sick.
The fact you need to understand Charlie is the world has LIMITED RESOURCES. Healthcare and doctors fall under the human capital in the 5 factors of production...they are not infinite resources, they are finite resources.
in a perfect world there would be enough healthcare for all people to consume as much as they want at a zero cost, however, that is not the case..healthcare is limited...rising costs go hand in hand with increased demand for services + decrease in numbers of hospitals, doctors, available medical beds, etc
as for making money off people who are sick and desperate
Undertakers and funeral homes charge huge sums of money to bury your loved ones, funeral home costs, and tomb stone creation....but they are just greedy criminals right?..there work really isn't worth that......right?
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Health care for free is much like water in the desert for free.
If you are in the desert and you find somebody dying of thirst after being lost and they come to you asking, no, begging for water. What do you do? Do you say:
"I see you are in desperate need of water, good sir. Why, I can help you for the low, low price of $150. I have the supply, you have the demand, seeing that I have a monopoly of this good. Give me $150, good sir, and you will live."
Healthcare and water in the desert are NOTHING alike, that is comparing apples to oranges, actually that's like comparing an apple to a septic tank
how much did the water cost to produce?
take a look at the costs, yes money put into medical research, equipment costs, paying your employees(if you run a hospital) electric, phone, internet, water, sewer, trash, cloth cleaning, maintenece, I could go on and on
Americans just have to ahve the BEST medical treatment right...that new shiny cancer finding machine only cost the hospital about 250 million dollars to purchase(a example) it has to be paid for right? you the patient wanted it, and then complain when you have to pay for it.
how bout all the people who go to the hospital with no insurance and never pay one dime of their medical bills...guess who gets stuck paying for them?
the insurance companies, and hard working folks like myself get stuck paying their bill..
I think you should go read Karl Marx books, you and him seem to have very similar ideals....after all..down with the greedy capitalist right? 
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FDR not only wanted to pack the Court ..... he wanted to expand the Supreme Court to 13-15, as he would appoint a new Justice for each and every one over the age of 70.
He would have created a liberal super-majority that would have lasted decades and created such havoc as the world had never seen.
Micah 6:8; He has shown you, O mortal, what is good. And what does the Lord require of you? To act justly and to love mercy, and to walk humbly with your God.
John 14:19 Jesus said: Because I live, you also will live.
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I think you should go read Karl Marx books, you and him seem to have very similar ideals....after all..down with the greedy capitalist right?
I already have, I have much of his collection.
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The health care system we have in place in America is designed to provide minimum care at maximum profit ... has been that way for years. Yet you describe it as if it's an efficient economic system -- costs are relative to overheads and such ... simply not the case at all. Quote:
how bout all the people who go to the hospital with no insurance and never pay one dime of their medical bills...guess who gets stuck paying for them?
the insurance companies, and hard working folks like myself get stuck paying their bill..
How exactly do the insurance companies pay for them?
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You and I pay for the Fire Department and that is just SOOO expensive. The Police Department too!! That is freaking expensive from all that beuracracy involved!!
Nice argument.. we have a couple government funded services.. ergo, we should have all government funded services.. well if that ain't about the dumbest thing I've ever heard.
Charlie have you ever worked inside the government? Have you ever even been to Washington, DC to see all of the shiny limestone buildings brimming with people dedicated to keeping government bureacracy alive? Did you know that about 1 in 3 of the other buildings in DC that don't have huge government signs on them are also full of government workers in privately owned, government leased office space?
I've worked inside the government (I worked for GSA and worked with the FBI, FEMA, DoJ and a couple others) and I built out the office space in these anonymous buildings all over the DC area which are occupied by government workers and if you don't think that layer upon layer of red tape exists then you are just fooling yourself.. and if you don't think that won't come to healthcare, then you are just a fool.
yebat' Putin
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Those costs (losses) find their way into increased costs to those that actually do pay ergo to the insurance companies that are paying them. Who in turn have to hike up premiums to cover said costs.
You don't think that hospitals are just going to say "oh well they aren't going to pay...there is nothing we can do"...No they are forced to increase costs on other services, just as ANY other business would. They cannot continue to swallow losses on supplies and manpower and expect to stay open. Heck they divert the costs and still are forced to shut down...
I thought I was wrong once....but I was mistaken...
What's the use of wearing your lucky rocketship underpants if nobody wants to see them????
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If you are in the desert and you find somebody dying of thirst after being lost and they come to you asking, no, begging for water. What do you do? Do you say:
"I see you are in desperate need of water, good sir. Why, I can help you for the low, low price of $150. I have the supply, you have the demand, seeing that I have a monopoly of this good. Give me $150, good sir, and you will live."
Who has a monopoly? Don't most cities of any size have more than one hospital and any number of doctors? Can't people shop between multiple insurance companies? I'm confused who holds the monopoly in health care.
My second issue with your analogy is this.. are you willing to sit in the desert day after day dispensing water for free? No, it would be uncomforable and hot and nasty.. you are going to want compensated, who is going to compensate you for your time, your inconvenience and this water you are giving away? After a while you are going to say "Screw it" it's not worth sitting out here in this God awful heat with the wolves and the scorpions when I'm not making any money, you'll go do something else... unless you can have an air conditioned shelter and a place to sit and maybe listen to the radio, then you'll stay... of course that's going to cost money that you don't have because you are giving the water away for free.. so you'll leave .. which is what doctors and nurses will do. A lot of them work awful hours in awful conditions, dealing with death and tragedy day after day and they aren't going to do it for small change.
My last issue with your analogy is quite simple... what are you going to do when you notice that the same guy has past by, taking your free water, twice a week for 6 months? You are in the desert, you have limited resources and this guy really seems to be taking advantage of the situation. He could bring his own bottled water if he knows he's going to be in the desert, but he doesn't, because he knows that yours is free. Which is what companies and people are going to do if a "free" option becomes available.
All in all your analogy is weak, probably because the point you are trying to prove, is weak..
yebat' Putin
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Can't people shop between multiple insurance companies?
The short answer is yes., you can always shop between insurance companies.. But shopping and getting approved and being able to afford what they want to charge you,, now there is a whole different thing..
I don't know where the monopoly is either however.....
#GMSTRONG
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Damanshot
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Quote:
Can't people shop between multiple insurance companies?
The short answer is yes., you can always shop between insurance companies.. But shopping and getting approved and being able to afford what they want to charge you,, now there is a whole different thing..
I don't know where the monopoly is either however.....
Yes, that is part of the system that needs some work.
But government run healthcare isn't the answer, and their proposal does nothing to address the cost issues, and their causes, that created this mess to begin with.
We don't have to agree with each other, to respect each others opinion.
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Yes, that is part of the system that needs some work.
But government run healthcare isn't the answer, and their proposal does nothing to address the cost issues, and their causes, that created this mess to begin with.
This needs to be emphasized: It does NOTHING to address the costs of our current system. Nothing. (other than mandate people have insurance or get fined, AND it puts out dollars for those that can't afford insurance - which still doesn't address the COST of health care)
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The real problem with our health care system isn't the folks who don't have insurance.
Now, certainly there can be problems that arise from that, but no system is perfect ...
The problem we have is the folks who do have insurance ... that part of the system is beyond screwy, and needs immediate attention.
The current bill, as far as I can tell, will only make it worse. Or, in mitigating some of the minor problems, cause a wave of spending we simply can't catch up to.
This bill does not reduce cost or expand coverage ... it simply gives The Problem more control and leeway.
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