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Fighting Medicaid Expansion

With Wade Goodwyn in for Tom Ashbrook.

States push back on the implementation of the Obama health care law – rejecting the expansion of Medicaid.

In this July 12, 2012 photo, two women wait in an exam room at Nuestra Clinica Del Valle, in San Juan, Texas. About 85 percent of those served at the clinic are uninsured. Texas already has one of the nation’s most restrictive Medicaid programs, offering coverage only to the disabled, children and parents who earn less than $2,256 a year for a family of three. Without a Medicaid expansion, the state’s working poor will continue relying on emergency rooms _ the most costly treatment option _ instead of primary care doctors. The Texas Hospital Association estimates that care for uninsured patients cost hospitals in the state $4.5 billion in 2010. (AP)

In this July 12, 2012 photo, two women wait in an exam room at Nuestra Clinica Del Valle, in San Juan, Texas. About 85 percent of those served at the clinic are uninsured. Texas already has one of the nation’s most restrictive Medicaid programs, offering coverage only to the disabled, children and parents who earn less than $2,256 a year for a family of three. Without a Medicaid expansion, the state’s working poor will continue relying on emergency rooms _ the most costly treatment option _ instead of primary care doctors. The Texas Hospital Association estimates that care for uninsured patients cost hospitals in the state $4.5 billion in 2010. (AP)

The U.S. Supreme Court has given the green light to President Obama’s health care plan with one caveat: you can’t coerce the states into expanding Medicaid coverage for the poor.

And even though the federal government is picking up the tab for the first 3 years, some Republican governors are saying no. That would mean millions of poor Americans won’t get insurance.

This hour, On Point: the politics of expanding, or not expanding Medicaid insurance for the poor.

-Wade Goodwyn

Guests

Noam Levey, national healthcare reporter for the Los Angeles Times.

John Otto, he represents the 18th District in the Texas House of Representatives. You can find his recent op-ed on expanding Medicaid here.

Judith Solomon, vice president for Health Policy at the Center on Budget and Policy Priorities.

Michael Tanner, a senior fellow at the Cato Institute, he specializes in health care policy.

From The Reading List

Forbes “Obamacare takes these incentives to their logical conclusion. Under Obamacare, starting in 2014, everyone with income below 133 percent of FPL will be eligible for Medicaid. For the first three years of the expansion, federal taxpayers will pick up the full cost of the expansion.”

Austin Chronicle “If Perry actually thought he would be preventing the federal law from taking effect, he was dead wrong. On June 28, the U.S. Supreme Court upheld the 2010 PPACA, and the individual mandate that conservatives detest survived. However, Perry found comfort in one part of the ruling: The law initially required that states expand Medicaid coverage to more people, under threat of having their existing Medicaid funding withheld.”

New York Review of Books “Furthermore, these states already have among the highest numbers of citizens with no health insurance. Twenty-five percent of non-elderly Texans have no health insurance, for example, compared to the national average of about 18 percent.   If the Obama Medicaid reforms were fully implemented, 15 to 17 million of the nation’s 50 million without health insurance would be covered.  In a report just issued in late July, however, the non-partisan Congressional Budget Office estimates that the Medicaid expansion will only cover some ten million more, or a full third fewer than anticipated, because of the rejection of the plan by large states like Florida and Texas and others who have not yet formally announced their intentions.”

Los Angeles Times “Nearly half a century after President Lyndon Johnson signed Medicaid into law, conservative critics of the massive government health insurance program for the poor are readying a new push to dramatically scale it back if Republicans control the White House and Congress next year.”

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  • Wm. James from Missouri

    We need to start a new discussion about “Obama care”. It needs to be replace with what I would call a ‘ modified single payer plan’ , good from cradle to grave. I would be happy to pay some more in taxes for a plan that offered to pay 60 percent of all bills at 100 percent and I pick up the difference in cash or private insurance. The government should take it out of my check just like social security. The system would have to pay for anything I would pay for that could reasonably be argued to be a “treatment” for the condition that I have. Example : If I have terminal brain cancer and choose to be cryogenically frozen until a treatment is available, I should be able to defer current treatment ( Why pay for something that has no chance of working and why allow the system to sell false hope to the dying ? ) until a future date where effective treatment is affordable and effective. Sound crazy ? I am sorry, but I will have to disagree. If all of the scientist, futurist, mathematicians, and bold thinkers are wrong about the changes that are coming ( things like exa-scale computing, the miracles of graphene, true artificial intelligence, reverse engineering the brain, etc., ( the list is long) ) and all the amazing positive effects that will follow , we might as well hang is all up. We will not survive as a species anyway. It will become an overpopulated world full of backward, civilization destructive Al-Qaeda types, so why bother with any type of insurance, private or public . Why must every political conversation be centered on these lackluster political and bean counter type of solutions. We are supposed to be the home of the free and the brave. Allowing other people to define the agenda certainly isn’t “ free” and most certainly isn’t brave.

    All this negative talk of “Medicaid expansion” and other such government sponsored programs is ridiculous. Don’t you people get it ? All of what we now know as “capitalism” will soon be challenged by the coming technological changes. Believe it ! You, yes YOU, will not be able to compete with the smart machines that are just years away from actuality. We will ALL be in need of some kind of help in the future from the “system”. In fact, I believe that the “ system” will be all about helping ! That WILL be the blessing of the coming changes.

    _In closing I feel compelled to say that I have become ever more aware that some people seem to crave suffering. They just can’t imagine a world without suffering. If they suffer, others must suffer. Maybe we need to update the Preamble to read :

    _We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, and end the suffering of mankind, do ordain and establish this Constitution for the United States of America.

     

    • MadMarkTheCodeWarrior

      Now that the Act has been passed, and upheld by the supreme court, after many, many decades of struggle, opposition to it and corruption by big corporate interests have tainted the huge accomplishment. Yes we need to graduate to a single payer system. My wife, a doctor, feels the same way. Society, heck humankind as a species must evolve or wither and die. That’s not what’s happening in Washington and state legislatures: failure of the recognition of the need to evolve. Ideology employing feigned faith invoking a pseudo-Christian white right wing religious belief in the manifest destiny of WASPs.

    • nj_v2

      Well, good luck with that, my friend. Obummer had a chance to really fight for single payer, or at least a real public option, and instead, we now have a bill which provides insurance companies a giant, extended windfall with which the industry becomes so financially powerful that they will be able to fight back any movement toward single payer for decades to come.

      The people who think that ACA is some sort of “first step” toward single payer/universal coverage are sadly deluded.

  • Yar

    Wade, truth isn’t somewhere between the rhetoric of the left or the right. The truth is, we are an obese aging nation that can’t care for the chronic conditions we have and will develop.  The 40 cents of debt we incur out of every dollar we spend is not a tax on our grandchildren, it along with insider trading has raided the retirement of baby boomers.  With our current attitude toward immigration there won’t be enough staff to cover shifts in hospitals and nursing homes, much less pay for our care.  Economics is all about “trading work over time”, most Americans don’t work, or at least they don’t do anything productive.  No, I am not talking about welfare queens, I am talking about our huge service sector which makes up our consumer driven unsustainable false economy.  The financial and healthcare industry along with higher education(including sports and entertainment), have grown like cancer and are not contributing to a stronger or smarter population. We falsely believe we are looking to some high tech future, we aren’t. We back through life looking to the past for guidance on what to expect next. When we ignore history, we are simply going through life with our eyes shut. (As we have done for the past generation)  Cheap energy, and world exploitation won’t last long.  God did not make America special.  We can’t expect our nuclear weapon powered advantage over the rest of the world to last much longer.
    Are we doomed? If we attempt to hold on to our current model of do nothing gridlock, balanced between the left and right, then yes we have already lost.   The hive we call America won’t make it through the winter of the baby boomer retirement bubble.  

    If we lower our national age by opening up immigration to young educated citizens from around the world, then maybe we can survive, at least we can continue to trade work over time for another generation and avoid invasion, for countries won’t attack the land where their children live.  Anyone who works in America should be on the path to citizenship if they desire. 
    We should also include two years of public service for all 18 to 24 year old’s, Get them off the couch and build some muscle tone so they will be able to work (it will pay for itself in lower future health cost). What is wealth when we break the cycle of trading work over time?  Unless we invest in youth we won’t have anyone with which to trade and our money becomes worthless.

  • Gregg

    Of course States are pushing back. Of course doctors are retiring early. Of course businesses are dropping insurance plans altogether. Of course the original $940B price tag was a lie. What did we expect?

    • lodger

      Single payer financing is the only fix to this mess. Which is why the rest of the civilized world has some form of it. (Interesting how Romney goes to Israel and lauds their single-payer system, yet denounces it here.)

      • Gregg

        Single payer has always been Obama’s dastardly goal.  

        • lodger

          ‘Dastardly’ is inflammatory and solves nothing.  What would a non-dastardly solution look like to you? You think insurance companies holding all the power isn’t ‘dastardly’?

          Is your solution to let poor/uninsured people die in the streets for lack of medical care? As long as hospitals are required by law — as they should be –to treat medical emergencies that land on their doorstep, we’ll have this mess. 

          • TFRX

            “Dastardly” doesn’t rise to inflammatory the way Gregg uses it, it’s just juvenile.

          • Gregg

            Pfft.

          • Gregg

            I chose my words carefully. I believe Obama is trying to fundamentally transform America. I hope he fails.

          • TFRX

            Pfft. More of that crap from you.

            That one quote does a lot of work in GreggWorld, doesn’t it?

          • Gregg

            It’s a pretty serious quote to ignore.

          • lodger

            Is for-profit financing of access to healthcare less dastardly?  It’s ok for insurance companies to cut people off, deny treatment,  or deny people coverage to begin with?

            There’s a reason it’s illegal in most civilized countries. 

          • Gregg

            Yes.

        • nj_v2

          That’s why he stopped supporting a public option, which would have been a logical first step toward single payer.

          • Gregg

            “By any means necessary” is the hallmark of Alinsky progressives. It took bribes, lies, cooked numbers, reconciliation, control of both houses and a Supreme court more concerned with image than the Constitution to get what he got. 

            http://www.youtube.com/watch?v=fpAyan1fXCE

          • nj_v2

            Signpost that what whatever follows should not be taken seriously: Invocation of Alinsky.

            I wonder if Gregg wears a clown suit when he posts. I bet he look cute with his little, red nose and floppy shoes.

            http://billmoyers.com/content/who-is-saul-alinsky/

            “Alinsky published his third book, Rules for Radicals, A Pragmatic Primer for Realistic Radicals, in 1971, and it’s become popular even outside the communities and audiences he called his own. One prominent example: Dick Armey’s FreedomWorks, a conservative advocacy organization that assists tea party groups, has distributed Alinsky’s books in training sessions.

            Saul Alinsky died of a heart attack in 1972, but his legacy lives on not only through the work of the IAF –  now represented by 47 organizations across the country – but through the tactics of grass roots groups on all sides of the political playing field.”

          • Gregg

            Awww, how cute. Look at what NJJ did there.NJJ now shifts and squirms, avoiding Obama’s very words. Now you want to talk about Alinsky?

      • Brandstad

        If single payer works so well, what else would you like to change to single payer? Food, Housing, Clothing?

    • TFRX

      More of that “retiring early” canard.

      • Gregg

        Here’s an idea, ignore the piles of documentation by experts in the field and shoot the messenger who compiled it. Then go back to sleep.

        http://blog.heritage.org/2012/03/14/side-effects-doctors-fear-obamacare/

        • TFRX

          Here’s an idea: If it’s true, it’ll be someplace else besides the Heritage Foundation.

          • Gregg

            That was too easy to predict. So, the cited sources Heritage compiled weren’t good enough? Or did you stay awake long enough to consider the informed evidence?

          • TFRX

            I hope I’d be predictable on that front.

            Because I wouldn’t follow the Heritage Foundation out of a burning building. I wouldn’t trust your policy instincts to pack a skydiver’s parachute.

            You are a knave and liar.

          • Gregg

            Cite a single lie, jerk. I don’t lie. To say otherwise is a lie.

    • Brandstad

      Obamacare costs careening out of control
       
      Four days ago the headline that NPR doesn’t want to acknowledge or report was “CBO: Obamacare to Cost $1.930 Trillion, Leave 30 Million Uninsured”

      • TFRX

        NPR, without my even trying, caught you lying (again).

        • Gregg

          The price is actually $2.6 trillion.

          • TFRX

            Because they changed the timeline. You live in a context-free world, don’t you?

          • Gregg

            A decade is a decade.

  • John Cane

     

    Some one denied benefits or has reduced benefits in Texas or
    other low benefits states ought to sue in
    Federal Court citing the 14th Amendment’s equal protection clause.  The relief sought would be granting the
    same benefits enjoyed as if that person lived in the state with the best benefits.  Some say that might violate the federal
    -state partnership that exists in Medicaid, but then the Federal Court ought to
    declare that part of the law unconstitutional because “equal protection”
    trumps a state -federal arrangement that differentiates benefits of a federal
    program, In other words, if there are federal funds involved, the benefits must
    be uniform across the country.  If
    a case like this got in front of the SCOTUS, it would give Chief Justice
    Roberts another  chance to do the
    right thing for health care in the USA!

  • SteveV

    Over the years I have observed what I refer to as “back door legislation”, that is finding ways to start programs that people would not otherwise fund. The government comes in and funds the program fully.  Over time the funding is reduced, then eliminated. In the meantime a segment of the population has become “dependent” on this program while the majority don’t want to pay for it out of their own pockets. I don’t know enough about this program (health care) to judge if this is the case, but I am cautious about strings attached to any monies from our governments, both state and federal.

    • Brandstad

      Please give me three examples of programs that you have seen this happen to.

      • SteveV

        Only 3? I worked for the state for 35 years and lost count of how many programs and workers were hired through Federal “Grants”, funded on a year to year basis. The problem came when these funds lost their political “patronage” and were cut. Police officers, social (justice) programs, even equipment that later proved costly to maintain. My point is simple. Whatever you develop, do so with an eye to your long term ability to maintain it.

        • Brandstad

          I am still waiting for 3 specific examples…

          I suppose you don’t have them since you haven’t been able to give any yet.

  • Brandstad

    Governors’ Worst Nightmare: Obama Proposed Shifting Costs of Obamacare’s Medicaid Expansion to the States

    Last week, I wrote about why states have asignificant fiscal incentive to drop out of Obamacare’s expansion of the Medicaid program. States fear, among other things, that the federal government will shift more of the program’s costs to the states over time, leaving states with an unsustainable spending commitment. It turns out that this fear isn’t merely theoretical. During the “supercommittee” deficit-reduction talks last year, President Obama proposed reducing federal funding for the Medicaid expansion by$100 billion over ten years, with states picking up the difference. No wonder governors from both parties are thinking twice about the program.

    http://www.forbes.com/sites/aroy/2012/07/19/governors-worst-nightmare-obama-proposed-shifting-costs-of-obamacares-medicaid-expansion-to-the-states/

  • http://gregorycamp.wordpress.com/ Greg Camp

    The opposition to the law is its creators’ own fault.  The benefits trickle in over time, but those who were against it could swing into action immediately.

  • Davesix6

    This law engenders partisan division in part because it was passed by a partisan Democrat Party. The bi-partisan vote and sentiment has always been against this very bad law.

    • TFRX

      You forgot to say “partisan” “Democrat” (sic) “Party” enough.

      People widely approve of many of the ACA’s planks. But I don’t expect you to acknowledge that.

      And my “Jew lawyer” friend wants to know what the deal is with you referring to “Democrat party”.

    • lodger

      What bipartisan vote and sentiment?  Where on the republican side is there any effort to be bipartisan, especially in regards to healthcare reform?

      Please provide examples. 

  • TFRX

    “I know that many conservative govs and leges didn’t think the ACA would be upheld.”–Wade

    What I hear from those pols is “We didin’t think we’d actually have to do some governing! Governance is hard!”

  • Sam Walworth

    The poor and disabled need to Earn their Health Care, just like everyone else.

    Its a no brainer.

    (Sarcasm)

  • Davesix6

    More and more Doctors and Hospitals across the nation are refusing Medicaid for non-emergency services, because they can’t afford the bureaucracy and low reimbursement payments.

  • http://gregorycamp.wordpress.com/ Greg Camp

    Didn’t Goodwyn just explain the reason for a national and comprehensive healthcare system?

  • Cindycb

    Oh, so do I understand correctly, Rep Otto, we have money “on the shelf” for TX to receive a block grant, (and to spend how much more money trying to create their own medicad/medicare program let along implement one), but no money “on the shelf” to simply take the medicad/medicare plans that have been a part of American lives, elderly and disabled, for how long?

  • KickTexasOutOfTheUnion

    The guy is afraid of rationed care??

    Where does this guy live? Care is already rationed. No insurance-no care.

    • Sheri

      I think the guy was concerned that there are so many people who need care but currently can’t afford, that if they suddenly all become eligible, those of us who have been getting medical care all of our lives might have to wait occasionally, too. This rationing of care argument seems to me to MAKE THE CASE that there are many, many people who desperately need medial care.

      • Kicktexasoutoftheunion

        I don’t think so. It is just republican$ and their true and tested hyperbole. Why make a reasonable argument when you can just scare people?

  • Dee

    People should rise up against their extremist Republican governors in their US….and boot them out!  

    Of course, I imagine those are the same governors who 
    support extending the Bush Era Tax Cuts to millionaires 
    & billionaires who don’t need the money. How atrocious!

    Call them out or boot them out. Whichever is necessary

    • Brandstad

      What extremist Republican governors ?

      Are you talking about the current debate of weather to keep tax rates the same as they have been for the last 10 years or raise taxes durring a recession.  I remember a very wise person that just happens to be our presadent that said it would be stupid to raise taxes durring a recession!

      • TFRX

        You forgot to say “Jahb Creatorzz!” in addition to your claptrap of an expiring tax break equaling a tax increase.

  • Scott B., Jamestown NY

    By Otto’s statement about Texas wanting to write the rules as they see fit, that usually translates out to women having less access to care, reproductive right first and foremost. Look at what Texas has already done by rejecting money from the Federal government because it also ended up paying clinics run by Planned Parenthood. Texas didn’t want the money used for abortions (which it can’t), with Perry and conservatives making it sound like the majority of Planned Parenthood’s business is abortions (only 3%) and jeopardizing the health of women. So Texas throws the baby out with the bath water and jeopardizes the all-round health of thousands and thousands of women.

  • Smarterthanacrab

    Showing/talking about medical research articles assumes that the speakers intend to have a rational conversation and have an intellect larger than a pubic louse. Much easier to scream rationed care and death panels.

  • Davesix6

    My Doctor and local Hospital won’t accept any Medicaid insurance. Don’t know where the studies showing all this participation by doctors are comming from.

    • Smarterthanacrab

      liar

  • TFRX

    It takes until 23 minutes for the left wing guest to acknowledge the fact that the ACA is a money saver for the federal govt. Isn’t that a background fact?

    It is good, however, to have someone quote the New England Journal of Medicine.

  • Scott B., Jamestown NY

    There’s no reason the gov’t can’t get payment to the doctors more quickly, and billions could be saved every years by standardizing paperwork for insurance and medicaid.  

    • Brandstad

      We are broke if you hadn’t heard. 

      Most government reimbursement delays are veiled ways to save money by delaying payments

      • Mike Card

        What is your definition of “broke?”

        • TFRX

          Hey, they need a crisis!!1!one! because there’s a Democrat in the White House.

        • Gregg

          Spending 100% of GDP while $16 trillion in debt is a good definition of “broke”.

          • Mike Card

            So a family with an annual household income of $100K and a mortgage balance of $125k is “broke?”

          • Gregg

            No, a family with an income of 100K that spends 100k before they pay the mortgage on their 5 million dollar home is a closer analogy.

          • Mike Card

            You are Brandstad’s finance proxy, then?

          • Gregg

            I’m not smart enough to know what that means but I do know we’re broke.

  • http://www.facebook.com/danwcarver Dan Carver

    Representative Otto made a good point in saying that participating in the expansion would be taking money that the federal government borrowed.  But in his plan, he’d get together with other states and try to get federal grants, which to me sounds like money from the federal government that will have to be borrowed.  Is money from the federal government in the form of grants somehow better and more ethical than money from the federal government in the form of support for a national program?

    • Mike Card

      Yeah.  If there’s money involved, he’d just as soon it was in his own billfold.

  • http://gregorycamp.wordpress.com/ Greg Camp

    The caller tells us that Medicaid and Medicare suffer lots of fraud, but gives no details, and the host asks for none.  The point of a program like this is to go into the details.

  • Brandstad

    Don’t forget to eat at Chick-fil-A today to support free speach!

    • Mike Card

      Chix-fil-A has free spinach?

    • J__o__h__n

      Keep adding to the obesity epidemic with crappy fast food!

    • Ray in VT

      I’ll be eating more kale to support free speech.

  • Ellen Dibble

    Are Americans getting more sickly?  Therefore more costly to maintain?

  • TFRX

    We’ve already got this Texas pol caught out exaggerating stuff.

    Can we get a fact checker on every phrase out of his mouth for the rest of the hour? Or is it just a “fling feces in the air and make the left-wing guest take all her time correcting him” deal?

  • Davesix6

    I have personally dealt with Medicaid on behalf of my Mom and Dad, it has been one of the most frustrating experiences I have had.
    I would submit that anyone who is in favor of Government controlled healthcare has never dealt with government provided healthcare.

    • lodger

      That’s because there are rules to qualify for Medicaid so there are by necessity bureaucratic hoops to jump through.

      If everyone was covered these bottlenecks would evaporate.

    • Mike Card

      Government controlled healthcare?  The best healthcare I’ve ever received was when I was in the US Army–I’d even trade Medicare in a heartbeat to get in on it again.

  • Karen C.

    I’m sick of the “everyone can go to the ER” response.  The ER doesn’t work for people with a chronic illness that requires managed care.  For these people, like my son, if you’re so ill you need the ER, it’s probably too late to save you.

  • jim

    it is nuts to deem Medicaid is a failure. 

    i do feel over 90% of Medicaid receivers need this programme. for that i think the program is a SUCCESS, unless the inept congress can help provide a better solution to healthcare, instead of sucking up to the US food industry. this industry is the leading cause to the health problem of this country due to the obese food and obese leading products targeting every americans.

  • http://gregorycamp.wordpress.com/ Greg Camp

    If you’re poor, you’ll get (lousy) healthcare.  If you’re rich and have no pre-existing conditions, you can buy good insurance.  What worries me is all the lower-middle-income people who either can’t afford insurance or are denied coverage, but at the same time don’t qualify for state care.

    • Davesix6

      Good point Greg, Looks like under Obamacare these people will have to either buy their own insurance or pay a penalty to the IRS for not doing so.

      • http://gregorycamp.wordpress.com/ Greg Camp

        If decent insurance is available even to people with pre-existing conditions, good.  A rational system would offer care to all, with means-tested fees.

  • Davesix6

    Where are all the savings promised by Obamacare? My insurance premiums and deductables keep going up.

    • TFRX

      Let’s worry more about the rantings of someone who trusts his own instincts over, say, the New England Journal of Medicine.

    • lodger

      Blame your insurance company for that.

      I just got a check in the mail from my insurance company because they now have to give back the money they don’t spend according to the new formula. 

      I can also get a free checkup every year. No copay.

    • Peter

      You do realize that most of the provisions of the ACA don’t take effect in 2014, right?

  • abbycattt

    As far as providers, consider Nurse Practitioners and Physician Assistants to help provide care to this population.

  • Ellen Dibble

    To Jan the caller’s point about the deductibles so high that people forgo reasonable care.  Also, if you go to the emergency room, it is flooded with people whose only access to care is at that point, apparently, and you end up suffering there in the waiting room for hours and hours and hours, in public, rather than at home, where you have all water, handy bathroom, all the sorts of medicines and so on that might hopefully help.  You learn not to even think of emergency rooms unless you’re unconscious and someone else is making the decision for you.

  • Elizabeth in RI

    Rep Otto said that he didn’t want Texas expanding its Medicaid rolls because the Federal portion needed to be borrowed and that is not sustainable. And while I agree that we need to work toward a long term solution (which includes revenue increases), I am flummoxed by his statement that there ought to be federal block grants given to these states so they can do what they want. Where does he think that money will come from?? It too will be borrowed. And I’m afraid that Texas doesn’t have an impressive record at just doing what it wants. So I’d rather know that my borrowed federal tax dollars are being spent on at least a minimum level of care.

    • TFRX

      And I’m afraid that Texas doesn’t have an impressive record at just doing what it wants.

      That’s quite a polite way of putting it.

  • Charles A. Bowsher

    “We have the best Health Care in the World” is a quote from our KY Congressman Mitch McConnell.  What no one seems to realize is that he is not talking about you or me, he is talking about himself, as a member of Congress.  We are behind the rest of the industrialized world who have figured out that a sales commission for an insurance salesman, or Insurance Company overhead never contributed to anyone’s health.

    Wellness care for all is the first step to bending the cost curve.

    Note to the John Otto.  The woman who was given the written prescription for her daughter and didn’t fill it probably couldn’t afford to pay for the prescription!

    • Vigilarus

      Actually, medical tourism to hospitals in India has better statistical outcomes than our vaunted hospitals in the US. Cheaper too.

      Every other developed nation pays less and gets better results than us. ‘Best in the world’? Rubbish.

  • SLBVT

    A couple years ago there was a 60 Min. show about medical fraud in Florida and the state seemed willing to devote VERY minimal funds to investigate, even though they would save MILLIONS.  Also some southern states have extremely low bars before people are ineligible for assistance.  How can we trust that states will do a good job without fed. oversight?  

    • TFRX

      “Millions for obstacles, not one cent for governance” goes the saying.

      That’s a feature, not a bug.

      And if you think medical fraud in Fla was bad then, wait till you read up on Teabagger Gov Scott.

    • Mike Card

      Florida’s governor was convicted of the largest Medicare fraud in history–he is not an advocate for pursuing medical fraud.

  • Liam Mcdonnell

     

     

     

     I just heard I believe
    somebody from Texas say that if medicate is expanded it will lead to rationing.  The definition of rationing is denying
    something that is necessary.  Health care
    is absolutely necessary.  Since 50
    million people have no health care and millions more are much limited health
    care due to cost sever rationing already exists in the US.  US have the best health care system if you
    can afford it.

    ust heard I believe
    somebody from Texas say that if medicate is expanded it will lead to rationing.  The definition of rationing is denying
    something that is necessary.  Health care
    is absolutely necessary.  Since 50
    million people have no health care and millions more are much limited health
    care due to cost sever rationing already exists in the US.  US have the best health care system if you
    can afford it.

  • JayB

    You know, I didn’t take seriously the quip last election that the Republican health care plan was for the weak and elderly to die and get out of the way.  Now I’m not so sure.

  • FM

    Gov. Romney said such nice things about Poland, why didn’t he mention their health care system “The  state healthcare system is funded in two ways – through government budgets to healthcare and through compulsory individual contributions to the state healthcare insurance scheme.”

  • Davesix6

    If I believed the US Government could;
    Provide Healthcare insurance for all
    Reduce fraud and coruption
    Reduce costs
    I would be for it, the fact is and has been pointed out, the government has never been able to do anything like this in any other area.
    Fraud and corruption increase with government control. Just look at Medicare/Medicaid as they exsist today. 

    • http://gregorycamp.wordpress.com/ Greg Camp

      Healthcare systems in other countries work quite well and at lower cost.

      • J__o__h__n

        No, we’re perfect and anyone who thinks otherwise is a socialist. 

    • lodger

      The key question is: Can the US government finance it better than private companies (who have a fiduciary duty to their stockholders) and provide better coverage/care? 

      The data proves they can, and do. The single payer systems we do have (Medicare, Medicaid, VA, TriCare, etc.) are far more efficient than private carriers. And customer satisfaction is higher.

      Your ‘government has never been able to do anything’ is just an ideological bias, belied by actual facts.

  • Witterquick

    I think we are missing an important component of the health care system, fee for service (FFS).  From Wikki;  FFS is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments (including unnecessary ones) because payment is dependent on the quantity of care, rather than quality of care.  You give the MD the opportunity to make more money, they will almost every time.  Given the opportunity, wouldn’t you??

  • http://gregorycamp.wordpress.com/ Greg Camp

    Oh, dear, do you mean that people who are eligible for healthcare might try to get it?  How uppity of them.

  • Cmhmd

    We already do ration care! That’s the whole point of MA expansion – LESS RATIONING!!!!!!

    ACA increases MA reimbursement for Primary care to correct those problems

    Workforce issues are addressed in ACA – more incentives for PCP.

    It will take some time, and not all MA eligible will enroll at once. We need medical homes, teams with CRNPs, PAs etc

    I am still dumbfounded that the Rep thinks we are not already rationing. Does he live in America?

    We ration by income, BTW, in case he still doesn’t get it

    There is fraud on wall street too. Should we shut it down?

    Even conceding MA fraud at a rate of, say 5%, that is FAR more efficient than any private insurer in the US

    Can you get chemotherapy in the ER? How about prenatal care? Diabetes management? Sheesh!

    MA cost growth driven by DISABLED and Dual eligibles. What should we do about them?

    Moral hazard does not apply in health care. Who wants a second colonoscopy. People get care bc they need it not bc it’s free 

    • Mike Card

      Good question about the Rep:  “Does he live in America?”  He lives in Texas.

  • C Kelsey

    Once again, a so-called “Entitlement Program” is being challenged in part because of the “fraud” it engenders.  Why does Corporate Fraud, including and especially the Financial Institutions, go unpunished and such a big deal is made of the comparatively minor fraud of people in need.

  • Aaron

    In Matthew 25 Christ says regarding the poorest among us; 
    ‘Truly I say to you, to the extent that you did not do it to one of the least of these, you did not do it to Me.’ And these will go away into eternal punishment, but the righteous into eternal life.”

    I have to think that those states that simultaneously reject the expansion of health care coverage and access for the poorest Americans whilst having among the largest rates of weekly church attendance will have some explaining to do when they encounter the big guy in the sky.

  • Joby

    False choice between paying for medical care or teachers.  Please point out to the fact that taxes on the ultra wealthy and corporations are at historic lows and there is opportunity to raise revenue rather than punish the middle and lower economic classes

    • Che’ Riviera

      But… but…  those are the “job creators”!

  • John in Amherst

    There are a lot of complex, interrelated reasons why we face a crisis in medicare & medicaid coverage.  Part of this crisis – a shortage of GP’s willing to see medicaid patients – is related to low rates of reimbursement for routine care.  Part is due to the extreme push by docs to compensate for low reimbursement by seeing more patients per hour, which is incredibly frustrating to patients and docs alike – not many patients like being treated like piecework, nor do docs like practicing that way.  Part is due to the high cost of med schools and the levels of debt many assume to complete med school, which is related to issues like government support for education and research.  Part is due to the extreme disparity between the incomes of GPs and specialists, which drives docs to specialize, which is in part (and ONLY in part) related to the willingness of patients, often at the urging of attorneys, to sue (i.e.: the need for torte reform), and partly based in aspiring docs’ mercenary tendencies.   
    Obviously there is a lot that needs fixed.  The GOP impulse to axe the ACA, without proposing any solutions, is unfortunate as it is typical of the current teaparty inspired notion that there is no such thing as a good government program unrelated to the military.  The GOP needs to make up its mind: either follow the edicts of the Christianity they so vociferously espouse, work on rectifying a host of problems and start caring for the poor and the sick, or admit that they are only interested in religion as a tool to enforce their version of morality.  This is not a problem the “marketplace” will resolve.

  • http://gregorycamp.wordpress.com/ Greg Camp

    We already have community clinics.  They work, but not well, and they can’t provide the best care for people with chronic illnesses who need prescriptions regularly.

  • Tina

    “How to bend the cost curve”?  Wouldn’t it be best if the whole thing were based on the non-profits that serve so many functions from social to cultural in this country?  Using “free market” corporations who want to make profits for their shareholders is a bad idea.  Using this law to “open up markets” for for-profit companies by colonizing illness and its prevention is a bad idea.  Any money made should be plowed right back into the business in the form of further development, research, etc., including pharmaceutical research, IF corporations are knit into the plan, as they have been (I would have preferred single payer).  Can anyone tell me about the presence, or lack thereof, of for-profit companies within the ACA?  Blue Cross, AARP, etc.:  do they have separate arms that are non-profit and are what are operating within this plan, or are shareholders still major stakeholders in this plan?  I don’t know the answer, so specifics would be welcome.  Thanking you in advance in case I don’t see the answer for several days.  Thanks!

    • notafeminista

      Well now it might.  But non-profits frequently means the church in some fashion and the Left doesn’t like that.  Next?

      • Tina

        Is your projection absolutely inevitable?  I think this needs more discussion, lest we throw the baby out with the bath water.  I worked in non-profits most of my working life, yet none of them were related to any religious institution, nor were they affected by or inflected by any. Thanks. 

      • JGC

        Depends on which church, or Church.  Even though the Mormon Church followers are strongly suggested to tithe 10% of their annual income back to the Church, and they do, by and large, where does the money go?  From Bloomberg Businessweek (July16-22) one study estimates that the Mormon Church donates only 0.7% of its annual income to charity while, for example, the United Methodist Church gives about 29%. 

        “One Mormon worries that the church gives too little to humanitarian causes, even though its leaders like to boast about Mormon welfare programs. “They spent more money on a mall in three years than they did in 25 on humanitarian aid.”  LDS Church spokesman writes in an e-mail, “Though the church’s monetary donations are significant, much of the ‘value’ of our service is not monetary, but in the hundreds of thousands of hours of service and talent and expertise given by church members to help others around the world.”

        So the Mormon Church gets 10% of their followers earnings while moving less than 1% of their annual income back into charitable causes; the followers get the full tax deduction on their federal taxes,as did the Romneys; but how does this laundering of donations benefit the general populace?  

        Church donations and other non-profit donations cannot replace a strong social safety net provided by the government to all, regardless of faith or lack thereof. 

  • PaulCJr

    I welcome the new National Health Care System. Why you ask? From past experience. Back when I was in college, I didn’t have much money and couldn’t afford health insurance and was no longer able to be on my parents health insurance. My school did have a clinic, but it wasn’t meant for robust medical care. Well I got sick, and I mean really sick. For a while I was paying for my health care out of pocket, then I became so sick I couldn’t work. From there I started to charge my health care on my credit card because I need medical attention. After a while I wasn’t able to even do that and dependent on public health clinics and emergency rooms. Had there been a Nation Health Care System, I might have not gotten as sick as I did, and not cost tax payers the money I did when I went to public clinics and hospitals. I welcome this new health system to help save people from the experience and the huge amounts of debt I had to take on to get better. Thankfully I made a full recovery and was able to pay off my debt when compared to a lot of people that have gone into financial ruin due to their debt incurred by medical expenses. 

  • Peter

    The conversation doesn’t make sence. The fact is the US wastes one trillion dollars a year and what we need to do is go to a single payer.

    In the Boston Globe this morning they had a story comparing US healthcare with Isreals. In it that state 7 children per 1000 live births died for lack of access to healthcare. That represents 70,000 children a year. One hell of a price to pay for idiology.

  • Scott B., Jamestown NY

    Money is going to have to go out before we start seeing a return.  Savings aren’t going to happen over night, and the ailing aren’t going to be suddenly healed. 

    Listen to the healthcare experts much of this is based on preventative healthcare, like regular checkups, screenings, having a primary healthcare provider where more people can access them, so that people don’t end up in ER’s where the cost of getting those people healthy is multiplied many times over.  It’s like the old auto repair commercials: Pay a little now or pay a lot later. It’s not hyperbolic when people say that the cough that could have been treated at the Dr’s office for a relative pittance is going to cost thousands when that uninsured person shows up in an ER with pneumonia.

    • Guest

      I have been involved with several large government entities that self insured.  All of these governments ended up hiring consultants to figure out why their self insurance costs were so high.  The answer each time?  A very large percentage of employees did not have a primary care physician even though they had insurance, and received their medical care in the emergency room.  I wonder if it is wishful thinking that the ACA people will engage the newly insured in preventative healthcare like regular checkups and screening, or will they continue as they have in the past and go to the emergency room when they need a doctor.

      • Scott B., Jamestown NY

         Having been on medicaid, I was able to get a checkup where my primary provider spotted something was up that was later found to be cancer. Had I not had medicaid I would not have been able to afford a check up and I don’t know that I’d be here to type this had I not. My former employer did not offer insurance, and insurance would have been out of range for me anyway, as I have a pre-exisiting condition that has to do with my knees popping out of joint -which has ZERO effect on my health and in 30-odd years has only resulted in two trips to the ER, both of which I was covered by the insurance of my parents or employer.
          Medicaid’s care has been – paying for my second opinion, treatment, and the thyroid replacement hormones. In fact the insurance company that medicaid uses here liked the idea of a second opinion because it could save them money in the long run.
          Not that medicaid, or any insurance is perfect. My wife has a condition that requires a medication. Only one brand (each uses a different method of doing what it does) works for her, so it’s a battle every time she has to go in for Rx renewal. They want to put her on any generic or  brand except the one that works, to save money.  Those meds don’t work and actually cost them more money because, as it has happened **every** time she goes through this, the other medications don’t work for her, and often she has side effects that the specific brand doesn’t, so she ends up in the doctor’s office ( and the ER a few times), and getting test after test,  all resulting in another cycle of  a different medication that doesn’t work for her,  exacerbates the problem, and it starts all over.  All to “save”about $25@ month. So far this has cost the insurance co at least $100 in Dr’s visits and will be costing hundreds more for the  tests, including an upper GI, that going to tell them what the last one did – That all the other meds are aren’t working.

    • notafeminista

      We have that now.  HMO anyone?  Didn’t/doesn’t stop people from going to the ER.

  • http://twitter.com/drphilxr Philip Kousoubris

    Its simple, and I’m embarrassed to post this, but the huge costs of medicine are NOT from nurse and doctor fees (20%) but an aggregate of too many “unseen hands” in the pot. Unseen to the general public, and unheard in commentary. 

    Nobody talks about: medical equipment manufacturers, surgical implant manufacturers, home health care equipment makers and resellers. We focus on hospital costs, our providers, and pharmaceutical corps because they are VISIBLE. Please someone look into the hidden costs. They are huge (~60% of total bill), and where a great amount of profit still lies. 

    • Che’ Riviera

      Solution…  remove profit motive.  Treat medicine as a public utility.

    • notafeminista

      Don’t forget administrative costs as well.  Receptionists, billing departments, coding departments and the like.

  • ockitaris

    Just why do the republicans hate the poor.    The system that conservatism created (PERSONAL OWNERSHIP OF PROPERTY) guarantees that there will be poor people.    Possibly it is the result of an axiom that my psychology professor related to me that we hate those we wrong greatly.   This failure to take care of each other probably be the broken timber that will destroy America.

    • notafeminista

      Interesting point.  How come there were/are poor people in Soviet Russia, East Germany, Venezuela, Myanmar, China, Tibet, Nepal, Cuba, Zimbabwe, Mexico…………..ad nauseum.

  • marangyi

    I think that the elephant in the room is that our medical system is based on always trying to cure illness rather than on creating health. Promoting healthy lifestyles requires the courage to stand up to the food lobby who make money by pushing sugar and other poisons. 

    Since courage is a commodity that is sorely lacking on both sides of the aisle in congress, we’re going to continue to wrestle with this issue while our representatives continue to take money from the lobbyists whose client’s products are keeping us sick.

    Ron Matthews
    Marlborough Mass.

  • Ellen Dibble

    Somewhere on the news I heard that there was a program that asked certain poor communities what they needed to get on their feet, rather than having the government (and its profit-oriented lobbyists and campaign funders) do a top-down design for bootstrapping failing communities.  Apparently they got some good and successfully deployed advice.
        How about on health doing something similar?  Instead of asking those who profit from providing health care, ask those who are seeking to be healthy at a minimum cost?  

  • Scott B., Jamestown NY

    A great deal of money could be saved if they standardized prices for things, say, like a broken bone.  One story in the news recently was how at one hospital a broken bone was a few hundred, and across town it ran into thousands.  My mom dislocated a hip and asked for something for her dry lips. They brought a dab of Vasoline in a candy cup and the bill for that was $20.  She could have bought the gallon size of that at teh dollar store for that price!  My mom was in her late 70′s and waited 8 hours with the hip out of the
    socket on a gurney with no pain medication, waiting for the one doctor
    to be called into the hospital.  The Feds could easily say “You get $____ for a broken arm.” But they also need to encourage timely care and reviewing outcomes.

    • notafeminista

      The Feds could easily say that.  The Feds HAVE easily said in the past (see wage and/or price controls during the FDR and Nixon administrations).  The states have tried it (see NY rent control).  It doesn’t work.

  • Tina

    We can’t just “Free Clinic” (to turn it into a verb) a disease like cancer.  Free/Cost Adjusted Clinics are certainly a good idea, but when “experts” talk like they are THE answer, I get confused.  A Clinic could help with a cancer diagnosis, getting treatment to the person earlier, therefore.  But the cost of the treatment would bust the budget of a Free Clinic.

    The New York Times just told about a woman in Mississippi who was dieing  (sp?) of bone cancer “in her back room”.  Come on America!  We need to plan for worst case scenarios:  those experienced by individuals and by whole communities (hurricanes, tornadoes, forest fires, random shootings, etc.).  We need to have the most expensive needs budgetted for, and then We Wait:  someone, or a number of someones, will need our communal help.  Get the money out of the military and prepare to go to war against the Inevitabilities — as a nation, pleased to be able to help, because it might be us (we?) or our loved ones who need the help at some point.  Besides having a health care Plan for All, we must ALSO have a Catastrophic plan, or have it be knit into the general plan, NOT as the straw that breaks the camel’s back, but as an Inevitability that Wise Nations know to plan for.    

    • Che’ Riviera

      But how can we maintain global hegemony if we cut the military?

  • Ellen Dibble

    Someone in this thread posted about the comparative efficiency and thriftiness of Israeli health care.  It turns out Romney has been hailing it, universal and government-managed.  See Boston dot com.  I’m having trouble getting the link.  I think this is an excerpt, which sort of has a chart.  
    “WASHINGTON — Mitt Romney’s praise for the Israeli health care system, made near the end of his foreign trip, followed him as he returned home Tuesday, raising eyebrows because he lauded a system that has more government control than the Obama health law Romney so strenuously faults.
    RELATED

    GRAPHIC
    US-Israel health indicatorsContact the candidatesClick to raise your voice on the campaign.Romney, speaking to donors Monday, commented on how Israel — a “pretty healthy nation” — spends far less on health care than the United States does. Israel’s success in controlling costs is often attributed to the heavy role of its government and a requirement that everyone have coverage, some of the same qualities Romney condemns in the health law Obama authored.”

    • Ellen Dibble

      More from Boston dot com:  ““We’re laughing — for a Republican to praise the Israeli health care system, which is managed care, universal coverage, with no small amount of federal government control and oversight,” said Karen Feinstein, president and chief executive of the Pennsylvania-based Jewish Healthcare Foundation, which has been studying the differences between the Israeli and US health care systems.”
      More:  “Israel’s national health care system, created in 1995, provides universal coverage by requiring citizens to join one of four competing insurance plans that, by law, have to provide certain base-level services. The plans cannot reject customers because of preexisting conditions.”Romney explains further as quoted in that article that Israel spends 8 percent of GDP on health care, versus 18 percent in the USA, so, to paraphrase, perhaps we can learn something from their example.

  • TomK in Boston

    The more we argue about the different components of our crazy, ultra-complicated health care system, the more obvious it becomes that the solution is a simple, single payer system. The rest of the world has figured this out and they pay as little as half of what we do for better results, what is our problem?
    (that’s a rhetorical question, our problem is ideology and the health care oligarchs who are pocketing the $)

    Every developed country has a different national system, it’s amazing that we can’t find something to like. It was funny to see Etchasketch praising the Israeli system. Too bad he can’t apply that logic to the USA. Now he can’t even get behind his own Romneycare.

    Just think. No uninsured, no freeloaders in the ER, no screaming about a “mandate”, no horrifying prospect of Ryan Groupon rationing, no insurance company death panels deciding if you can get insurance and, if you are, what procedures are covered and how much you owe, no bill collectors in the OR, and the question of “medicare expansion” would never come up. Nice, huh? Too bad our corporate overlords won’t let us have it.

    • Che’ Riviera

      We can’t find a version we like because we refuse even to look.

    • Ellen Dibble

      I think it ought to be called idiotology, not ideology, the idea as seen by zombies with dollar-signs for eyeballs, seeking profit from our various maladies and disabilities.  The more we are sick, the more they profit.  How so?  Isn’t that totally irrational?  Shouldn’t it be MORE profitable for the nation if people are healthier and need less health care?  But wait, if some health service can be insinuated into the panoply of care insurance carriers cover, then there are profits for all, that is, for all who own share in the various companies involved, which is to say quite a few of Americans with 401(k)s, I suspect.  The health system giveth; the health system taketh away.

    • lodger

      Also a majority of voters support single payer in every poll, and have since Truman, who first proposed it.

      Read Hijacked: The Road to Single Payer, by Dr John Geyman, an MD and a republican.

      • TomK in Boston

        Every doctor I see supports it. 

  • Frvaughan

    why have not we heard about the performance, financial consequences, et of the state of Mass. ? 

    • Brandstad

      I would suspect you have been listening to too much NPR and not enough FOX NEWS

      • TFRX

        There’s no such thing as not consuming Fox News.

        It’s the tire fire whose acrid stench floats into all other media worried about seeming “too liberal”.

        That includes everybody.

      • jefe68

        Fox news has been banned in Canada due to it’s false reporting an a wide range of issues.
        NPR has some of the best in the busniess working for them. You can go on regurgitating their talking points, that’s your right, but to insult peoples intelligence is a bit much.

        • Gregg

          Oh sure, next you’ll be saying NPR is more fair and accurate than Rush. 

          • jefe68

            You’re such a funny wee man…
            I hope you’re kidding here, Rush is not a journalist and his show is not a news show. If you think it is, then you are a bigger fool than I thought.

          • Gregg

            I never said he was a journalist but he is more fair and accurate than most who say they are. How often do you listen?

          • jefe68

            Enough to know why I don’t. Fair you say?
            You are a real comedian. I’m trying real hard here to be polite, I’m not sure I can keep that facade up much longer. But you do a good job of digging some nice ditches for yourself.
            Rush’s bloviating is many things, being fair is not one of them.

            Anyway since when does the news need to fair? News is supposed report on the stories of the day. Much like Watergate did. Fairness has nothing to do with it. Getting at the story is the idea.  

          • Gregg

            Fair provides context to the accuracy.

          • Mike Card

            Rush is a radio entertainer–a loud-mouthed, drug-addled, lard-ass, to be sure, but he is NOT a news reader or commentator.  His charge is not to be accurate or fair; his job is to be entertaining.

          • Gregg

            I don’t know about his job description but he is entertaining. He’s definitely more accurate and fair than NPR in as much as one can compare a single guy to an entire network. How often do you listen?

          • TFRX

            Rush has a question for you, Gregg: “How’s Gregg’s crack-whore slut wife?”, asks Mr. Lovable Accurate Entertainer.

          • Mike Card

            I do my best to avoid listening to him, anymore.  He is a mean-spirited boor and I don’t enjoy his brand of entertainment. 

    • TomK in Boston

      Romneycare is working well. Grateful to live in MA, where it’s still the 21′st century.

    • jimino

      Not to mention the rest of the developed world which spends an average of 9.5% of GDP on health care while the USA spends 17.6%.  Elementary logic would dictate we look to those countries for ways to get costs under control, but the so-called conservative solution to this dilemma is to do the exact opposite of what everyone else does. 

      • TomK in Boston

        All we hear about the rest of the world are Faux-like stories about how bad it is. I think there should be a headline every day saying “Longer lives, lower infant mortality, half the cost”.

        • Brandstad

          You should look into the liberal talking points.  The reason almost every country has lower lower infant mortality is because they qualify what is and isn’t infant mortality different than the US. 

          • TomK in Boston

            I don’t consider WHO data to be talking points.

            Do you think every country “qualify what is and isn’t death different than the US”?

          • Gregg

            Yes, different countries measure live births from various gestation periods. Some consider the weight (500 grams I think). There are many many factors considered. One country’s live birth is another’s death. I’m surprised you cite numbers you don’t understand… on second though, not really.

          • Mike Card

            Alive or dead depends on the statistical treatment?

          • Gregg

            As far as measuring infant mortality goes, yes.

          • Mike Card

            Not really much incentive to game that system, unless this discussion is drifting off into theology.

          • jefe68

            The word mortality means that one is dead.
            You either are alive or you are not. Where do you get this BS from?

          • Gregg

            It’s a fact.

          • jefe68

            So a child dying in the US is different than in Sweden or France?

            Are your really going to go down this ridiculous path?

          • Gregg

            It went right over your head. Think. Do some research. Brandstad is correct.

          • jefe68

            No Gregg it did not.
            The US has a higher infant mortality rate than any other industrial nation.

  • Brandstad

    OBAMA’S CONTRACEPTIVE MANDATE GOES INTO EFFECT TODAY: ‘CHERISHED LIBERTY…THROWN IN A GOV‘T DUMPSTER’

    • Ellen Dibble

      Clearly couples should be satisfying their sexual needs without recourse to the old “missionary” methods.  So much less costly.

    • TFRX

      Lemme guess: Your sister never had a pregnancy scare in Missltucky.

      Hack.

      • notafeminista

        Emotionally manipulative.  Dishonest.

        • TFRX

          “Oh noes, a left-winger just isn’t reciting facts and figures going against a right winger lying his ass off! It’s unfair to fight back!”

          Stop whining.

        • TFRX

          “Oh noes, a left-winger just isn’t reciting facts and figures going against a right winger lying his ass off! It’s unfair to fight back!”

          Stop whining.

          • notafeminista

            Your narrative is false.  Stop lying.

    • Gregg

      There seems to be an assumption that opposition to Obama’s contraception mandate means no more birth control and rampant unwanted pregnancies. Can you explain this logic? I can’t.

  • Kalai

    Preventive healthcare keeps the people healthy, but Mr. Tanner is not sure how it keeps the cost down?  Really?  I looked up where Micheal Tanner was working, and it was Cato Institute, Koch funded institute, and I said, how did this person even got in to the show.  Dissapointed with you Wade.  Tch tch tch!

  • Dee

    What airheads in the Republican Party…..

    I am so fed up of the double standards and small mindness 
    in the Republican Party today. Why is it the GOP leadership 
    never seems to get the big picture when it comes to social programs and always vote in favor of programs that are a
    penny wise and a pound foolish? 

    Such as implementing the expansion of the Medicaid program which would reduce the high cost of care in the ER and the 
    need for specialties with responsible primary care program 
    for the poor up front….. 

    • Brandstad

      What examples do you have of the double standards and small mindness in the Republican Party today?

      • jefe68

        Folks like yourself making comments that are backing up her points. Such as the one you made later on this forum about Chick fil-A. Small minded does not even begin to describe it.

  • jefe68

    The issues is not whether Medicare or Medicaid is working or not.
    It’s that this country has a dysfunctional market based system that is the worst of any of the industrial nations in terms of results and costs.
    Shows like this are all well and good but are doing nothing in terms of dealing with this issue. Texas is a disaster in terms of health care for the general population but if you are a woman it’s even more dire in the health care arena.

     

  • NP Student

    In regard to statements about the current physician shortage that may worsen as more US citizens become both privately insured under the Affordable Care Act and with the Medicaid expansion.  The literature has established that Nurse Practitioners (NPs) provide equal quality of care as physicians and some studies show even surpass physicians in measures of patient satisfaction.  In many states with the most severe physician shortages, such as Alaska, NPs have full scope of practice meaning full prescriptive authority and authority to practice without the oversight of a physician.  NPs are much less costly to train then physicians and take less time to train (2 years graduate training leading to a masters degree and no residency requirement).  They provide care at a cost savings as their salaries are significantly lower then physicians for providing, especially in the case of most outpatient primary care services, the exact same services as physicians.  In Alaska the situation is a bit different then the rest of the US with Medicare provider reimbursement being lower then Medicaid.  The result is that even in the most physician-rich community in the state (Anchorage) hardly any physicians are accepting Medicare patients.  In response there is trend of NPs increasingly taking on these patients for their primary care needs.  There are instances of NPs leaving physician owned practices rather then stop taking on Medicare patients.  These NPs have established their own clinics and are seeing a predominantly Medicare population.  Their clinics are financially sound and they are making a livable salary despite an even lower reimbursement rate for NP provided care then physician care.

    NP training, as it originates from a nursing background, has a greater emphasis on patient education and considering the family system when making diagnosis and treatment plans.  This generally leads to better coordination of care for patients and has made NPs particularly successful working with “difficult” populations such as the Medicaid population who, as mentioned during the program have a more difficult time keeping appointments etc.  In fact the NP provider-type originally developed in the 1960s-70s as a response to lack of access to primary care services especially in rural areas where the population base could not support a physician salary and where physicians were unwilling to practice.  I would encourage states, such as Texas, who fear primary care provider shortages with Affordable Care Act implementation to examine their state-based regulations/legislation defining NP scope of practice.  This could be a potential source of many new primary care providers with a 2 year turn-around from education to practice with a proven track record of success with the population that will be newly insured under the Affordable Care Act individual mandate and Medicaid expansion.

    I do not mean this post to reflect negatively on physicians.  I do believe that they are victims of a dysfunctional system that over-zealously limited available medical school slots to perserve demand for physicians which in the end has caused a critical shortage leading to lack of access to care for many Americans. It is also absolutely unacceptable for Medicaid or Medicare to reimburse at such a low rate that physicians can not continue to accept Medicare/Medicaid patients. I am sure this is heart-breaking for many physicians who have sacrificed so much to complete 4 years of graduate education and many years of residency at very low pay. I do think that in an era of escalating healthcare costs the doctoral-level medical degree (MD) and the new Doctorate of Nursing Practice (DNP) should be reserved for those needing extra training in very specialized areas of care whereas education programs for providers who wish to provide routine primary care services (outpatient urgent care, preventative medicine, wellness, chronic disease management, low-risk pregnancies and births not requiring c-section) should be examined and modified to more efficiently train qualified providers in a quicker and more cost-effective manner so that basic healthcare services can then be offered at a more reasonable cost in the United States.

    I also believe that a shortage of medical providers is no excuse for delaying legislative change to entitle all Americans healthcare.  Simple economics shows that supply follows demand.  When there is a demand….a bolus of newly insured citizens….it will be met and in the case of the US healthcare system NPs have been working hard for decades to change legislation state-by-state to meet this demand.  It is within the purview of state lawmakers and leaders in the fields of physician and nursing education to facilitate access to qualified primary care providers or continue to create barriers to ready, willing highly qualified providers for the US population.

  • Dee

    addendum: Re: The Airheads in the GOP 

    Then, when it comes to big business and the Big polluters in 
    fossil Fuel industry and Big Agra, Big Phram & Big Defense 
    GOP members seem to shift from having a shocking case of constipation to having a shocking case of explosive dirrahea 
    and should never be trusted with the public good…

    • Zing

       Must be contagious. Obama caught it.

  • http://pulse.yahoo.com/_T5Z62VUKV2GDNXTKNPIXA45PHA Rob

    Medicaid Fraud is a State controlled program.
     Fraud is Rick Perry’s fault.  This is basic bait and switch.
     The program is ridden with fraud so let’s cut and
    privatize it, at the same time reduce government oversight and defund regulators.
     Pretty soon all the sheep believe all government is bad, so Republican donors get their
    billions taking over public programs.  Yea for American Democracy!!!  Profits trump public good every time.  Nothing new.

  • Hokulani2002

    What the TX representative misses, with his comment “(the poor) get care in the ER’s” totally misses the point. Why slap a bandaid on a gaping wound when you can focus ‘upstream’ and work on primary prevention? And in terms of the shortage of caregiviers, don’t overlook the abilities and expertise of nurse practitioners and physician assistants – well able to deal with a majority of primary practice problems that come in the door.

    • Hennorama

      Logic and politics are incompatible in our current hyper-partisan circumstances.  Republicans must oppose the ACA and Medicaid expansion since it was put in place by Democrats.  Therefore, it is evil, socialist and must be “repealed and replaced.”  (Replaced with what is rarely detailed, since many provisions of the ACA, such as universal coverage, are widely popular.)

      Republicans logiocally should love and support the ACA since it is primarily a private system, requiring individuals to be responsible by purchasing private health insurance.  These are CONSERVATIVE ideas.

      To quote Paul Krugman in a NY Times op-ed: “The essence of Obamacare, as of Romneycare, is a three-legged stool of regulation and subsidies: community rating requiring insurers to make the same policies available to everyone regardless of health status; an individual mandate, requiring everyone to purchase insurance, so that healthy people don’t opt out; and subsidies to keep insurance affordable for those with lower incomes.

      The original Heritage plan from 1989 had all these features.”

      Heritage Foundation is (quoting from their website) “… a think tank—whose mission is to formulate and promote conservative public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong national defense.”

      Republicans used to support these ideas, but since they were enacted by Democrats, they must now oppose them.

      Ridiculous, and a complete waste of America’s time, money and energy.

  • jimino

    Can anyone explain why PROVIDING medical care is an ethical obligation, but getting PAID for that care is best left to the market?  And if people are showing up at the ER for non-emergency care, why don’t the medical personnel just turn them away with instructions to get care at the appropriate place?  

    • notafeminista

      Ok…how about this.  Providing medical care is an ethical obligation.  Providing compensation for care and services received is also an ethical obligation.

      • TomK in Boston

        I can agree with that, but, since health care providers are doing just fine, I don’t understand the point of the second sentence. Is it like worrying about how top tax rates that are the lowest since 1929 need to be lower?

        • Gregg

          The top rate was lower under Reagan who was President after 1929.

          • Ray in VT

            You’re right, Gregg, but only for a short period of time (1988 and 1989):

            http://www.taxpolicycenter.org/taxfacts/displayafact.cfm?Docid=213

            For much of his presidency the top rate was much higher than it is today.  For instance, from 1982-1986 the top marginal rate was 50%.

          • Che’ Riviera

            You and your darn facts, Ray

          • Gregg

            Yea, Ray’s facts are better than TomK’s talking points. 

          • TomK in Boston

            No mistake, sorry – see above.

            Good talking point on all the poor people not paying taxes. Gregg can be counted on to parrot the Party Line du jour. Guess what, as more income is redistributed to the top, the peons will pay less tax, as they will have less income. In  righty land that’s a good reason to raise their taxes!

          • Gregg

            Because of the EIC enhancements in Bush’s tax cuts along with the lowest rate going from 15% to 10%, 6 million people saw their tax liability disappear. Despite the cut at the top rate, the top earners paid a larger portion of the overall bill. Are you seriously denying that?

            No one suggested raising taxes on the poor. Where do you get that?

            Give me a shred of evidence that money is redistributed up. You can’t. 

          • Gregg

            I can forgive TomK for the mistake as it’s a well cited talking point. I am pretty sure even Obama has said it. Of course that doesn’t make it true.

            Maybe TomK was thinking of the bottom rate. Has it ever been lower? Have there ever been more people paying zero taxes since the inception of the tax code?
            There was more revenue as a percentage of GDP generated under Bush’s rates than when Eisenhower’s 90% top rate wads in effect.

          • Ray in VT

            I also thought that it was true for the top income rate, so I guess that I was wrong about that.  The capital gains rate does appear to be at it’s lowest point since 1954, which was the furthest that the Tax Policy Center went back, so if most of one’s income is from capital gains rather than earned income, as it appears that Mr. Romney’s was for the year that he released his returns, then he likely would have paid much more under Reagan than today.

            The bottom rate today is 10%.  It has certainly been lower historically, such as in 1913 when it was 1% for incomes under $453k (adjusted for inflation).  There were a lot of brackets back then.  It’s interesting “reading”:

            http://taxfoundation.org/article/us-federal-individual-income-tax-rates-history-1913-2011-nominal-and-inflation-adjusted-brackets

            It gets to be a real problem looking at historic rates with all of these exemptions in the code, which is how some people with significant incomes can get around taxes, and then there’s the distinction between federal income taxes and all taxes.  I would think that it would be hard, no matter how low one’s income is, to pay zero taxes when one also looks at gas, sales and payroll taxes.

            I think that that is also a problem with looking at rates and collection as a percentage of GDP, as payroll taxes are, I think, higher now than they were in the 1950s.  The more that  look at the numbers the less clear that the outcomes seem to be.  It’s a pretty complex issue that often gets highly reduced in the public discussion, but there is so much nuance in there that I think that it takes some real number crunching in order to make a good case on way or the other.  It looks like the highest collection as a percentage of gdp in the post war era was in 2000:

            http://www.taxpolicycenter.org/taxfacts/displayafact.cfm?Docid=205

          • Gregg

            I agree whole-heartedly that talk of the top rate is meaningless in the context of other taxes and the economy in general. Revenue to GDP is the number that shows the results of the combined effects of most of it. But that’s incomplete too. 

            Thanks for the links. A cursory glance appears to suggest the bottom rate has not been lower for at least as far back as TomK’s 1929. I may have missed something.

            Many taxes are optional and others like the payroll tax is really not a tax on income. It’s paying in to a program that pays you back.  However, all we ever hear is, raise the top rate. It’s meaningless by itself and most likely destructive in this economy.

          • TomK in Boston

            The top tax rate on ordinary income was briefly lower. So us top bracket types are only getting the second sweetest deal since 1929, boo-hoo,maybe I should move to the caymans.

            However, with the div and cap gains rate at 15% and the estate tax trashed, the total rate for oligarchs IS the lowest since 1929. Romney types either have almost all their income as divs and cap gains, or work a con (their profession) that magically turns all their income into divs and cap gains, so guess what….their rate is about 15%. Actually, Etchasketch paid 13 or 14% in the one year he let us see.

          • Gregg

            That’s alright, many people swallow talking point whole without question.

            Cap gains should be eliminated altogether. The economy would boom. But that’s a whole different matter than your original bogus claim.

          • TomK in Boston

            I know you deliver nothing but righty talking points, but don’t beat yourself up. 

            Sorry again, but what I said is correct. The oligarch tax rate is 15%.

          • Gregg

            “Is it like worrying about how top tax rates that are the lowest since 1929 need to be lower?

            That’s what you said, it’s the talking point. It’s false. Just admit it.

            Cap Gains are a completely different animal and it is not limited to the oligarchy. It’s the same for everyone. You’re really not making sense.

    • TomK in Boston

      Can’t turn them away because of Ronald Reagan, whose signature is on the “Emergency Medical Treatment and Active Labor Act”.

      • Zing

         Why didn’t Clinton repeal?

  • Che’ Riviera

    This problem can’t be solved until we decide that health care is a right, and not a commodity for profit.  Any solution that doesn’t recognize this will fail due to all the problems already mentioned today.

    When will our national maturity level allow this conclusion?

  • Stephen706

    Medicaid needs to go away and get restarted as a program to help folks who truly need and want help… not medicaid moms with multiple babies, not medicaid families driving escalades and taking cruises with their iphones and Coach purses and cigarettes but cannot afford tylenol or motrin for their kids… see it every day

    • JRN

      Scrapping the entire system and starting from scratch sounds like a good idea. I often think about the mulit-generational welfare recipients. Those who were born into the system and have children into the system. Taking away the benefits cold turkey would leave an entire subculture completely unable to process what happened. So there would have to be some investment of time and services into incrementally weaning people out of a disenfranchising system and into one that is healthy for them and for those of us who provide services to this population.

    • Che’ Riviera

      Wondering when someone would bring up the welfare queen with a cadillac full of kids.

      • jefe68

        Me too. Something fishy with this chaps story.

    • Stephen706

      Because I see it every day… and I am in the stix… multiplle generations… use Medicaid as their entitlement to do whatever the hell they please because others will pay and support… screwing up generation upon generation who don’t know any other way…

      But no it needs to be cut out completely and restarted with some semblance of sanity…

    • Brian | Madison,WI

       OMG YES. I used to work in urgent care. One evening in january, a family brought in their kid, who appeared to have poison ivy. I live in Wisconsin, so i couldn’t figure out how they would get into poison ivy in january. the parents said, oh we just got back from florida.

      when i was looking at the chart, i saw they had medicaid, which we call medical ssistant here. i was just out of resdiency, and and i thought somthing is wrong here. i’m busting my butt ot pay back med sch loans, and a medicaid family can afford to go to fla

  • Ericawlff

    I recently took my daughter in the middle of the night to the ER…I saw approximately 5 different nurses and then after 2 diagnostic test flu test and urine test the doctor came into the room with a calculator the only thing the doctor told me was she needs to get lots of rest and fluid and wait for the virus to pass.  I am self pay because I weighed the cost of the deductible which was $6,000 and rising and then not to mention the monthly payments of $800……to me it seems like a scam.  My child goes to see the doctor maybe twice a year thank god besides any immunizations and physicals and that costs me maybe $200/yr. per child as I have three.  My question is…is it ethical to have the hospital thrust 5 different employees on you in which you have to pay a fee for each and then the doctor whom just reads the results of the tests that the nurses have done and slap you with a bill for $2,600….by the way your daughter just has the flu.  Why are lab tests so expensive at the hospital where efficiency should be at its height whereas when I go to a clinic it is a less than 1/4 of the cost of the hospital.  This seems unjust….I am willing to pay for health care for my children but Affordable care $300 mo. but this option doesn’t exist….therefore my money is not available to offset rising costs….I guarantee I could find 100 people just like me who would do the same but this option does not exist…WHY?  Because there are too many people making too much money.

    • jefe68

      Many years ago I lived in Scotland. My daughter was born there. One evening she fell ill, with similar symptoms to your child. We had an emergency phone number for our GP. I made the call and about 20 minutes later she was at our flat. It was about 10:30 or 11 PM. She examined her and told us to come by the surgery the next day to make sure all was well. Cost, 0 pounds. Britain has National Health. Well it’s not zero, we paid a taxes for it.

  • Pingback: Today’s Insurance News August 1, 2012 | Individual Health Insurance

  • Stephen706

    And people need to stop thinking of the ER if the point of service care place by default!!! It is the most expensive means of seeking care, overloads the system and 90-95% can be cared for in an Urgent care or free clinic arrangement…

  • Ericawlff

    Overloads what system?  I see a bunch of nurses sitting in glass cubicle picking their noses waiting for people to walk through the door so they can hit them over the head with outrageous fees.  Normally I go to urgent care clinics however I was nervous because my daughter wasn’t eating wasn’t vomiting either and did not have a fever so I became paranoid as it was the weekend and the place I normally go was not open.  Why can’t hospitals charge reasonable prices and cut back on cubicle residing staff?  

    • JRN

      You were fortunate to take your sick child to the ER on a rare non busy night, have their problem correctly diagnosed and you are still not satisfied. In my years as an ER nurse, I can count on one hand the nights that I had a chance to plant my backside in a seat that did not have to do with charting. Most nights we work at the bare minimum or less with nary a cubicle in sight.

  • Stephen706

    Go to an urgent care or acute care clinic… cheaper and easier…

    • Jess in Boston

      Those often have a lot of funding from states and the government.

  • Stephen706

    because EMTALA says we have to at least go through the monkey dance of seeing, processing and doing a medical screening exam prior to making any determination… and then because of the anger, nasty looks and threats that people give you when you say this is not an emergency…

    • JRN

      You mean like an afebrile, non vomiting child who isn’t hungry at 2am? Oh sorry, I’m too busy picking my nose to fix that.

      • Stephen706

        Yep, see them–takes longer to do all the paperwork than it is to see and assess the afebrile toddler!!!

  • Stephen706

    health care providers are not “doing fine”… we work our butt off after 23-30 years of schooling, have loans to pay back, overhead expenses, insurance, and so on…   

  • Ericawlff

    Why did you enter the health care field then…was it not driven by your desire to help others… to diagnose and to gain that sense of pride that you perhaps helped thwart and discover some ailment that could have been otherwise catastrophic?  Or perhaps you did it for other reasons?  I heard on several occasions my doctor groaning about medical malpractice insurance and the rising costs…but if I trust in my choice of doctor then I would be willing to sign a contract (airtight) that I trust undoubtedly their choice in care for whatever it may be that I am seeking their advice.  I would never sue a doctor I think that is just ridiculous but I also have the ability to choose someone whom I trust.  Those whom are neither capable or moral should be weeded out.  Doctor are not without taking advantage as well for example I have many friends who have had scheduled births without symptoms of inability to have regular birth because the doctor would be available at that time.  Not to mention the payout for C-sections compared to normal delivery.  I think that is egregious!

    • JRN

      I entered to help people with the understanding that I would be fairly compensated for the physically and emotionally demanding profession that it is. Managing up to 6 medically complex patients at once and having a code roll through the door with no available nurse or bed requires critical and creative thinking and a boatload of education. Try running a 55 bed ER that regularly has a census of 75+, with two call outs and no available in-patient beds, an administration who does not allow you to go on “divert” and then come back and talk to me about how over paid we are. 

      • Gregg

        I hear you and do not question your altruistic motivations. But as far as I’m concerned there is nothing wrong, at all, with striving to be the best you can be so you can make as much money as possible. If someone finds the cure for cancer they will be rich. If they do it just for the money, fine.

    • Stephen706

      We of course do it because of that desire, and we do it happily… but desire doesn’t pay the bills. Cannot comment on the miniscule subset issue of C-section veersus trial of labor–way too many factors to consider to even make sense, but they agreed to it because they want their doctor, right???

      And where else in society can you go consume a necessary commodity (food, clothing, lodging) and then get stiffed without paying for it… have you ever asked your local hospital how big their unpaid debt is for this year–or last year and so forth. Or how in debt the facility is to provide services–this happens around the country EVERY day. They work their butts off and then get nothing in reimbursement. They get blamed when things don’t go as desired and sued–yes sued, not every one is as “nice”… how do you think John Edwards made his millions?

      Nurses want to make a living. So do lab techs. So do office clerks. So do the dietary and janitorial staff. So the medical records clerks. So the makers of the equipment used and the software. Yes, it is a business in that regards

      • jimino

        I feel for you, doing highly skilled work at the leading edge of a broken system.  But as a self-employed person who has to purchase insurance for myself and my spouse on the non-group open market, my monthly premium is around $600, with a $7000 annual deductible, so I know first-hand what medical care costs.  But I only know it after it is received.  I always ask the provider of some service, e.g. blood draw, lab test, x-ray, what the cost will be for what they are doing and they invariably have no idea. It’s one of the things I like about going to the urgent care clinic-you know what it will cost before you agree to the care.  I think if patients were told, or at least could find out, what the price of the care they want or are about to receive is, we would all be better off.  And maybe some would be more appreciative.

        • Stephen706

          You are exactly correct and that is a big huge problem because in the ER we cannot talk about dollars and stuff. Most of us have absolutely no idea of what the charges are… it is quite shocking…

          But to go to the UCC, they expect and demand payment, rightfully so. Trust me, I see a lot of folks who either don’t have the money or don’t want to pay–cause in their mind the ER is “free.” Never mind their pack a day habit, the iPhone or Samsung… and then they ask for a prescription for tylenol or motrin or sudafed because Medicaid (read… our tax dollars) will pay for it at ZERO cost…

          Someone please tell me the emergent issue of a yeast infection at 3AM–go to Walmart and get the over-the-counter Gyne Lotrimin… or the oops I missed my period. $2 pregnancy test at Walmart (or $4)… or I had a fever 14 hours ago and just want to get it checked out and don’t want to wait at my regular doctor’s office… or my back hurts from partying all weekend, can I get a work note (read… NO!)…

          For all those who have no idea, life isn’t ER or Boston General… come volunteer and spend a little time to see what you wouldn’t believe… and for all that work and pay taxes, this is where you money goes…

        • Ericawlff

           I am in exactly the same boat as you.  My husband owns a small business and I am teaching at a small private school….the deductible is outrageous!  Why can’t they carry whatever you don’t use of the deductible into the following year, in that sense I could justify paying but paying every year including regular bills, taxes, mortgage, dental….it’s not feasible.  I too asked about the cost and the cost they quoted me was no where near the bill I received.  Also if the nurse completed all the diagnostic testing at the ER then why did the doctor need to enter the room to confirm what was tested?  Oh yes you do have a virus hearing her speak cost me 1,500 dollars?  Thank God they have urgent care facilities but it still doesn’t solve the problem of constant affordable care.   

  • Brandstad

    More Americans are showing up for Chick-fil-A appreciation day than have ever shown up for an Occupy Wall Street protest! LOL

    There are so many Great Americans out there it makes me proud to be an American

    • Ray in VT

      Nothing quite says ‘merica like a bunch of people stuffing their faces with fried food.  It’s amusing that you bring this up on a day when health care is being discussed.  ‘m more proud of these people:

      http://abcnews.go.com/blogs/headlines/2012/07/westboro-church-protesters-confronted-by-zombies/

      • jefe68

        Yeah, well he has a God given right to carry a gun and eat as much fried chicken as he want’s too.
        Both are killing Americans at alarming rates however. I’m not sure how God plays into this though…

    • Che’ Riviera

      That all seems pretty speculative and anecdotal, considering occupy protests took place at many locations over a period of time.

      Your point stands as “Hooray for Chik Fila”.

    • jefe68

      Amazing, really amazing. So this is how your mind works?

  • Pat

    Per capita, Texas has some of the highest cost and worst outcomes based on The Commonwealth Fund Commission’s “Scorecard on Health System Performance,” from 2009.   For what it’s worth, it would appear that Texas’ approach is not working.  Furthermore, Texas is in good company with other more conservative states at the bottom of that list.  I feel that from a fiscally conservative standpoint, I live in a state with much better outcomes that spends much less money per capita than Texas.  I am tired of paying for states that do a poor job at keeping their own population in good health.

    • Zing

       How does a state keep its population in good health?  Put them in jail if they don’t buy insurance?

      • jefe68

        They could start by having affordable health care with enough GP’s and more community health care incentives. Preventive care is doable if there is a will and a budget priority to match that will. 

        It is interesting how Texas also has some of the most unhealthiest people in the US. So does Mississippi, which has one of the worst lower income health care issues in the nation, it’s on the level of a small third world country.

  • Ed

    The other agenda here is to expand contraception and abortion through having all insurance cover them.

  • Ed

    This doesn’t seem to address the cost of health care, which is the problem.

    • Zing

       Correct.  The weak President ran from that challenge.

      • Ray in VT

        and if he tackled it then he would have been accused of attempting to impose price controls or something.  It’s a no-win situation for him.

        • Gregg

          Speculation.

        • jefe68

          Yeah, he would have been called a totalitarian Stalinist fascist/socialist.
          Wait, he’s already being touted as such.
          I hear he’s scary as well… that he’s in cahoots with the Brain(as in Pinky and the Brain) and is really into world domination.

          • Gregg

            It is true he was a card carrying member of a socialist organization and lied about it before the proof came out. By then he was President and the press sure wasn’t going to ask him about it. It’s also true that Communist love him and he appointed at least one as a Czar. And I suppose fascist fits better than socialist but really, that’s a bit of an exaggeration. He’s just a radical leftist intent on fundamentally transforming America.

          • jefe68

            You all better start hording them guns, ammo and fired chicken then.

          • Gregg

            You’re a hoot. What’s with the history lesson? Van Jones is a communist and Obama appointed him as a green jobs czar. I don’t see what Nicholas has to do with anything. I also understand that czars have been in cabinets since Roosevelt’s days. Apparently you are unaware of Jones’ background (and the reason he was forced to resign) and think this czar thing is new. That lack of knowledge along with you abundance of self righteousness led you to miss the point entirely. The word czar was not a reference to Communism. 

            Who said Rush was a news show. where do you get this stuff?

        • Tina

          He could have helped himself AND all of us by EXPLAINING THE ECONOMIC RATIONALE for this plan to the American public — over and over and over again.  He STILL barely does anything like that.  

      • TomK in Boston

        Right. He should have given us medicare for all.

      • TFRX

        Your zipless zinger has been placed on anonymous hold and will not appear for majority vote until 60% of the board approve.

  • RolloMartins

    Meanwhile Vermont and Maryland (or so I hear) are discovering that single-payer will save a bundle. Texas, not so much. Are the politicians stupid in Texas, or just immoral? But I suppose that’s not an either/or type question.

  • Tenantproof

    Here’s are radical thoughts raise the minimum wage to a living wage. A living wage that takes into account what costs to live in the community folks live in. Require all companies to fully subsidize employees insurance. It is criminal that multi-national corporations that make millions of dollars are allowed to not provide fully subsidized health insurance or pay taxes to the local,state and federal government to provide full, affordable insurance to its employees. Require pensions to be provided by companies to employees that can be portable and go from job to job.

    Medicare will always be needed to pay for the disabled Americans who were born or became mentally and physically disabled.

  • Peggy Brewington

    Item # 1  About 10 years ago I was visiting Canada and had to go to a clinic there.  After seeing the doctor and getting a prescription, I went to the desk.  I explained that I was not a Canadian citizen and wanted to pay for the services.  She told me the cost and I thought, ” Seventy dollars?  That’s about what it would be at home,” and I handed over my credit card.  The charge was  SEVENTEEN dollars. !! 
    Item # 2  Two years ago I was in a drug store in Vancouver.  Just for the heck of it, I checked their price for a pill I was taking.  It was less than half the price of that pill here.  And the kicker is — the pills are made in the USA.  We make them, ship them to Canada, and they sell them for less than half the price Americans pay.
    Item # 3 Earlier this week I spoke on the phone with a cousin who lives in a small town south of Winnipeg.  She told me that some Americans are coming up there to get MRIs because, in Manitoba,  they pay less than half the amount an MRI would cost them at home.

    I wonder why medical costs are so much lower in Canada.  Could it possibly be because corporations and drug companies are not calling the shots up there?

    • Gregg

      One reason drugs are lower in Canada is because America does all the R&D and Canada uses it so they don’t have to. Generics. To bring a drug to market in the US cost hundreds of millions of dollars. The regulations are brutal. Some of that is warranted. 

      The elephant in the room is tort reform. No one has a clue how much money is charged for test and procedures thats only serve to cover someone’s ass in this litigious society. there are claims made but there is no way to calculate them. Obamacare didn’t even address tort reform because (according to Howard Dean) Democrats are beholden to trail lawyers.

      • Peggy Brewington

        Do you mean to say that the American drug companies sell their pills to Canadian pharmacies for less than they charge American pharmacies?  Do they just eat the costs of R&D when exporting their products?

        • Gregg

          The short answer is yes. Canada puts a cap on what drugs cost. They also control the entire process so as a government their buying power is significantly greater. Canadian pharmacies are far less susceptible to law suits and when they occur they are less damaging. It cost American Pharmaceutical companies an average of $800 million to bring a drug to market.

          • Peggy Brewington

            But their profits are astronomical.  So they can afford to buy legislators.

      • jefe68

        Boy are you not making sense at all with this one.
        One would have thought they would charge the entire nation of Canada more. Oh wait, they are dealing with an entire nation and could it be that this may be the reason?

      • Vigilarus

        Hogwash. Malpractice compensation accounts for one percent of total healthcare spending.

        • Gregg

          Who said anything about malpractice compensation?

          • Vigilarus

             If you say that tort ‘reform’ is the ‘elephant in the room’, then aren’t you claiming that malpractice suits and compensation are the major driver of rising US healthcare costs, therefore we need to limit the right of patients to seek civil remedy for malpractice?

            As much of a whipping boy that the healthcare industry likes to make of personal injury lawyers, medical malpractice suits account for a whopping one percent of total healthcare spending.  It’s a distraction from some of the real causes of high medical costs: lack of competition, excessive profits, and fee-for-service billing.

          • Stephen706

            Are you dense???

            It is not the compensation but the THREAT of being wrong, being sued, being questioned/second guessed/doubted that makes us as a society OVER-work-up, OVER-diagnose, OVER-treat conditions and complaints whether seen in the clinic or the ER. That is what drives up the costs to prevent this litigious madness…

        • Stephen706

          No, but covering your ass… not getting the true full story from patients who neglect their health for years and them come to the ER at odd hours rather than having an established relationship with a doc all translates to repeating or duplicating or double checking…

          That is the elephant in the room

      • Brian | Madison,WI

         R&D is the reason. The FDA won’t allow studies from Europe or elsewhere but instead makes drug companies repeat studies here–even for drugs that have been used worldwide for 10 or 15 years.

    • JGC

      One reason why costs are lower in Canada is there is much, much less paperwork.  

  • Mark Victor

    New York State requires many of its Medicaid recipients to sign up with an HMO.  It also requires those who are receiving a combination of Medicare and state supplemental health benefits, like ADAP for HIV-positive patients, to do this (Medicare Part C, which is a combination of A,B, and D, administered by an HMO).

    The result has been a generally higher level of care.  Also, generally the cost to the state is lower.

    These states that are rejecting are arguing falsely that expanding Medicaid will cost them too much money.

    Maybe the health care act can be amended to reward those states that move their Medicaid patients in to HMO’s.

  • http://pulse.yahoo.com/_SJGAGBG34OPWWP7TCU5DPUNXJA Linda Wilson

     This crap about making the patient part of the cost decision cracks me up.  A couple of weeks ago, while I had my feet up in the stirrups, the nurse practitioner who was doing my Pap decided to do an endometrial biopsy because I’d been spotting and am over 40 — in other words, a “cover your ass” procedure that benefits the provider more than the patient.  Even though this provider is also my employer and I pay several hundred a month for health insurance, I got a bill for about 50% of the cost of the procedure, which turned out to be a little under $400.  I didn’t ask for the procedure and wasn’t exactly in a position to refuse it — pun intended.  How was I part of the decision?

    • Duchesne

       I am guessing you would also be the first to sue if they didn’t do it and something was wrong.

      • Logan

        If you’re not given a choice and a cost estimate, then I see a whole lot of reasons to sue besides simple malpractice.  If you took your car to a dealer and they did some repairs without both an cost estimate and a signature, then I’m pretty sure you’d feel like your legal rights had been trampled on.   Likewise, if you went to a restaurant and they brought you food before you’d ordered or seen a menu, then mailed you the bill a month later with an estimate of the cost of the meal.

        • Brian | Madison,WI

           Actually . . . no. Physicians have an option of doing what they think is best at the time that they are in there. This called ‘therapeutic privilege.’

          • Logan

            That’s a blantant abuse of power.  “Therapeutic Privilege” is supposed to be used for the benefit and safety of the patient, and not as routine policy to pad the pockets of the doctors and hospital by doing unecessary proceedures with no prior indication of the financial strain on the patient.   It’s supposed to prevent patient from doing harm to themselves (as in suicide), not as a backdoor to forcing them to commit financial suicide. 

          • Stephen706

            You truly have no intellectual or professional frame of reference, let alone knowledge base…

            Mid 40′s year old irregular spotting screams endometrial hyperplasia and cancer… and every EMB I have done starts with explanation and informed consent prior to instrumentation and biopsying, so the discussion may be brief, but it’s there… 

            That’s why it was done!

    • Gregg

      Those that claim tort reform is not needed do not acknowledge the dynamic you describe cannot possibly be measured in terms of additional costs. It happens every day, on every level in every doctors office and hospital.

  • Kyle

    I am a Medicaid recipient, and I went to a dentist’s office to receive a cleaning. The staff informed me that I had several cavities which required fillings. After receiving two of these fillings I was told that the office no longer accepted medicaide. When I went for a cleaning at a different facility which did not accept medicaid, I was told that I had no cavities at all. I see no issue with expanding the program, yet I wonder if this profit-based methodology will benefit anybody. It certainly didn’t benefit me.

    • Gregg

      I don’t have insurance, when I go to the dentist I pay for it. On my last visit I got a 25% discount for doing so. Paying for service, what a concept.

    • Stephen706

      Ok, so if Medicaid “incentivised” them to doing work unnecessarily, tell me again why that is good…

      Stop the madness!!! Either you had cavities or didn’t have cavities, which was it? Get rid of a program that is ripe with abuse from all sides.

  • http://twitter.com/TongoRad TongoRad

    Republicans are still fighting the Civil War. Health care is not a states rights issue.
    Think of the massive overhead and bureaucracy necessary to administer such a Balkanized system.

  • http://twitter.com/TongoRad TongoRad

    To the whiny doctor who called in about “difficult” patients: You serve patients, patients do not serve you.

    • Stephen706

      True, but it is a two-way street… respect, APPRECIATION, and thanks go a long way along with payment for services provided… and cannot fix 30-years of self-abuse in one easy operation…

  • Stephen706

    What hasn’t been mentioned is that over 70% of health-related issues are LIFESTYLE generated… smoking, overweight/obesity, diabetes (type 2), hypertension, stroke/TIA, heart disease, lung disease to include asthma/emphysema, kidney failure, repeated pregnancies and child birth, HPV and cervical cancer, hepatitis B/C and HIV, and on and on…

    So why should I be a fan of a program that doesn’t tell the smoker QUIT SMOKING, does not tell the obese work on diet and exercise, work to prevent unwanted pregnancies but also prevent unaffordable ones.

    Folks who look from the outside at what we do have no idea how many times on a daily basis. Example: I see a patient who has survived a heart attack with a stent or bypass surgery that still SMOKES…. translate WTF do you want me to do about your repeated chest pain when you won’t even do the basic for your life??? And the ER bill every time exceed $2000… thank you tax paying public… or the smoker with bad emphysema who still smokes and wonders why they cannot breathe… ER bill over $1500 every time…

    Folks get it yet? 

    • Logan

      Set aside for a moment the rediculousness of blaming sick people for being sick in a world full of nominal risks.   You are critizing a system that would grant preventative medicine which is A) far cheaper than ER visits, and B) would result in patients being able to make smarter long term choices after consulting with physicians who do little more than administer extremely rushed emergency care.  This would reduce the cost burdern per patient and improve health and productivity of all americans resulting in overall economic gains.

      If you stopped hating poor and under-educated people for being sick and poor in a dangerous world, you might see there’s a bigger picture here.  A world where we could all come out ahead.

      • Stephen706

        Another outsider who just doesn’t get it and where am I blaming the sick for being sick or crap such as that… 

        this is a free country and you have the right to do as you please (within reason)… but you also have to live with your mistakes and take responsibility… that is what is completely missing and Medicaid and welfare only reinforce bad, misfortunate, destructive behavior in these folks.

        And where the $%#$ do you come up with hating poor and undereducated people–I am the one in the trench everyday taking care of people, allcomers, no matter what… I don’t see you there because you have no obvous frame of reference…

        Does a revamped program have potential–certainly, but not under the current management and operating structure…

        • lodger

          Completely agree on the absurdity of smokers who require ongoing care for chronic avoidable problems.  Since tobacco companies are allowed to use addiction as a sales technique, I think hospital bills for smokers should be paid, say, 75% by the tobacco companies.  They profited off the addiction probably for decades in each customer. The least they should do is pay for their healthcare as the customer is dying.

          I’m outraged that I as a taxpayer am paying for the people covered by Medicare, Medicaid, VA, Tricare, etc. who smoke. 

    • Mittens Romoney

      Smoking is good! Tobacco companies make billions in profit! Junk food also makes billions in profit for food corporations! A real American president would give these companies a big tax cut so that they can spend it on more advertisement, and would let the zero-incremental value customers die (oops, I meant to say, they will benefit from competition in the free market).

  • Mittens Romoney

    When will our President learn to be American and stop this healthcare foolishness ?!?! The American way is NOT to spend money on health and education. Real Americans spend money only on defense contractors and coal mining subsidies. A real American president would let the FREE MARKET sort out who needs antibiotics or not. You are old, sick, and out of your job at the refinery? The free market will sort you out! You happen to be a match for a financier who needs a new kidney? The free marke… oh, wait! there will be a government incentive for that! See! Your owners are not without compassion…

    • Mike Card

      It would be possible for you to receive medical treatment under a number of programs.  All you need to do is reach out for help.

  • John Conant

    Mr. Goodwyn:
       I am the physician who called in to your show today.  I was disappointed in you response to me, “not on my back.”  It would have been a lot more interesting and constructive  for everyone if you had probed the issue instead of giving your emotional response to my defense of physicians.  Your response suggested to me that you do not know enough about the unpleasant atmosphere  that physicians have been working  in for a long time.  My analogy is that practicing medicine today is like making love outside in a thunderstorm;you like doing it but it is miserable. 
        You have probably not considered that doctors pay taxes just like everyone else; we are contributing  our share and in some case more than most citizens.  Over the years I have provided hundreds of thousands of dollars of free care(as have most physicians) and that does not include the huge loss I have sustained by taking care of Medicaid patients.  It costs me more to see a Medicaid patient than Medicaid pays for the visit.  If I do surgery the loss is huge.  Is there any reason that I should provide services to strangers at my expense to anyone that wants it?  Suppose a patient I operate on  asks you to stay with him or her for 24 yours in case he or she has a problem afer the surgery. Would you take off a day of work and sit with that person.  If I take care of a patient I am responsible for him or her 24/7/365. I cannot leave town unless I provide equivalent coverage.  Did you know that? I suspect that you would would not stay with that patient.  When I have presented this scenario to others the answer has always been, “Why should I?”. Yet I suspect you think I should provide the service at my expense.   What is more I take on a malpractice risk for every patient I see. 
        I hope that you now understand that your comment, “not on my back” was offensive to me and I imagine to most physicians. In reality what you are probably thinking, “not on my back” it should be on the doctors back, why should I do it.  Sir, simply saying you care about the poor does nothing.  Doctors do something.  We have been taking care of the problem that you are just learning about for years. Perhaps you should talk to some doctors in the trenches and find out what we go through in the current envirnoment before you  issue knee jerk insults to a group that has provided a lot of free care for years without any recognition or appreciation.  Did you know that  if one particpates with Medicaid it put the physician at risk for being audited and fined large amounts of money for something as heinous as not countersigning a nurse’s note.  Yes it does happen and the fines are large. Why would anyone want to provide free care and be put at risk for more damage.  Do you wonder why few physicians want to get involved?
     
    JKC
     
    P.S.  I think it is a fair assumption that you are a progressive person as are most if not all that work for NPR.  If you are you are probably supportive of Mr Obama and his desire to increase taxes.  If that is so why don’t you send in more money and make a contribution to the system just as physicians do.  I have asked many progressives if they would voluntarily send in more money.  Not one has said yes and not one would explain why he or she would not do it.  Take a look at how much you do, financially and otherwise, for others before you denigrate physicians.

    • Stephen706

      Folks who don’t do what we do have no concept or idea… I am in the ER seeing the patients first-hand… simply no clue when you read their responses and comments.

      What blows my mind even more is when I counter folks with the “right” to free health care is that some things more important in life include food, shelter, clothing, but I don’t see anyone going to walmart and being allowed to walk out with food or clothing, nor go to a hotel or apartment and just sleep for free, nor go to McD and eat but not pay anything for the food… 

  • sheron britt

    As I sit here reading this article and all of the comments, I have to say I really dont know where to begin, so first of all let me start by saying I work for a healthcare provider in an emergency room and would not be apprehensive in the least to say that if the average American knew just exactly how bad of a problem Medicare and Medicaid abuse was  ( MORE MEDICAID THAN MEDICARE ) they would be floored !!! to say the least and I am speaking of literally hundreds of Medicaid & Medicare recipients carelessly abusing Emergency Room services on a weekly basis, not a yearly basis or even monthly, hundreds on a WEEKLY basis and at least 85% of those abusers are what we in the healthcare world call “FREQUENT FLIERS” which basically means they repeatedly and regularly visit the E.R  several times PER WEEK and to be frankly honest… for no other reason except /// 1. ITS FREE    2. THEY CAN … and if you would like more detail symptoms include :  ” I havent had a bowel movement since yesterday” /  “my pinky finger hurts”  / “I got up last night to go to the bathroom and stubbed my toe” / “My throat has been sore for about 30 minutes” / “I’m out of my pain medication” / and one last kicker “I was at the club and had too much to drink and I dont feel good” and yes all of these are actual complaints from medicaid patients and because I work 3rd shift, all were seen between 11pm and 7am, I have been employed with this facility for 5 years and the small example of complaints I have listed here are seen on a daily basis in the er and yes sadly by frequent fliers. This, my friends is where the problem lies, these people are receiving free healthcare but yet have the money to go “to the club” and have too much to drink, I, to date, have yet to see one that did not have a much more expensive cell phone than myself,and the women almost always have their hair and nails done and are wearing expensive designer clothing,and most walk in laughing and talking with their friends as if they were at the gate of a county fair, and for those who think I’m exaggerating, I challenge you to talk to any E.R staff especially front end staff anywhere in America and I guarantee you will get the same situations I’m telling you about here, and I have completely forgot to mention the “Disabled” patients that have both Medicare & Medicaid whom are repeatedly having one child after the other, yes , that’s right , you are disabled, but not too disabled to spit out and care for 4 or 5 children. …EXPAND MEDICAID ??? How about taking some of these low life, deadbeats that only deserve a swift kick in the rear end off Medicaid and start paying more attention to their living habits and you will see why they have no money to purchase health insurance , its at the bar,the hair salon, and the malls of America. I for one would be the first volunteer to work for the government free of charge to monitor some of these MEDICARE & MEDICAID RECIPIENT CASES AND DO SOME MUCH NEEDED “HOUSE CLEANING “….WHOSE WITH ME ???????????

ONPOINT
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