The best health care story I have read in a very long time popped up on my computer recently with the intriguing, if somewhat ominous title, “Medicaid expansion can’t pass the Legislature. So what’s the alternative?”
It’s pretty amazing that those 10 states are continuing to leave Billions of federal dollars on the table in order to make a political point: 90% of expansion funding is provided by the federal government. Therefore, the 10 non-expansion states are cross-subsidizing the 40 expansion states in a big way. Go figure! Connecting funded healthcare access to employment with tax advantaged funds is an accident of WWII history & highly dysfunctional from a societal point of view. No other country does it this way. Refusal to expand Medicaid is just a surrogate for ongoing institutionalized racism. Just look at the map!!
this is so very sad. we are a "wealthy" country but the middle class is shrinking and all those people struggling just to survive don't seem to matter to most of the 1% or whatever that percentage is. and wealthy companies only think of their bottom lines and the stockholders.
You could highlight that numerous states (Missouri, Oklahoma, Montana, etc.) got around the legislature by getting it on as a ballot initiative where it generally has passed pretty easily because, as you highlight, the average person wants it and wants to be covered.
We don’t want to expand Medicaid. We need Medicare for All. And no, expanding Medicaid will not get us there, it will actually raise costs of care for the majority of Americans already struggling to afford their health care with or without health insurance.
I agree with you, but while the US waits for a real Healthcare System, those 10 states should be forced to expand Medicaid.
The ACA is not a solution for healthcare. The Health Insurance purchased on the ACA market place is too expensive and not that great. If you have a $6000 Deductible, you really don’t have healthcare. The US needs a Single Payer Healthcare system like what is offered in Bernie’s Medicare For All. No country in the world has a Private For Profit Healthcare System like the US has. Thousands of people go Bankrupt every year over Medical Bills. That does not happen in other countries.
There are many reasons why these states are not expanding Medicaid. However, the main reason is that states will eventually have to bare the funding burden when the Federal government reduces funding from the the current 90%. As the legislation was originally written, the Federal government is not required to continue the current funding level. If funding is reduced it would break state budgets wide open, and there are many states with large deficits (California, Illinois, New Jersey, New York just to name a few). There is a good possibility this could happen as tax revenues to support Social Security retirement and Medicare continue to decrease and the cost for these programs continue to increase.
As I read other comments, I see Medicare for All. As stated above, Medicare is headed for the bankruptcy within about 10 years. When the program was started in 1965 there was about 5 working for every 1 retiree, and the mortality of retirees was about age 65. Today, there is about 3 workers for every retiree and mortality is about age 76. There are close to 66 million on Medicare today and this is expected to increase to 80 million by 2030. Now throw on an additional 250 million and you have an unsustainable program called Medicare for All.
Multiple studies, including by conservative Republicans, show that Medicare for All is a significant money saver over the present scenario. And then there are the Advantage programs, wrongly called Medicare, a privatization effort with significant cost overruns and fraud from upcoding visits, and studies show no better care than traditional Medicare. This is what is breaking the system, with its obscene profits to private insurers and causing extreme distress from denial of care for many in a HMO setup.
There is more than enough money to cover these programs, just stop the never ending wars and cut back on the trillion plus dollars in the Defense Dept budget! More spent on weapons of war and supporting over 800 military bases around the world than the next ten industrialized countries combined.
Let's unpack your comments. Please provide the links to the "multiple studies" you indicate above. I would be very interested to see how they came to the conclusion that Medicare For All will be a money saver. Medicare has absolutely no cost control mechanisms in place to combat fraud, waste and abuse not to mention large claim management. It's just money in money out. Provider reimbursement is dependent on CMS and HHS, subject to political influence. Due to low reimbursement, most physicians wouldn't accept Medicare but they don't have a choice.
Medicare Advantage is not perfect but it does manage care a lot better than Original Medicare. Politicians created Medicare Advantage and when insurers figure out the system they naturally take advantage (no pun intended). Bureaucrats run Medicare and then decide what is covered and what isn't. To me and many others that's a scary proposition. By the way, many not-for-profit health insurers actively market and sell Medicare Advantage plans. Blue Cross Blue Shield Association being one of the biggest. Further, AARP is in bed with United Healthcare, and they collect handsome fees for the sale of Medicare supplemental plans. I would also like to see the links to the studies showing Medicare Advantage plans are no better than Medicare with outcomes.
No there isn't enough money to pay for Medicare For All. With the U.S. approaching $38 trillion in debt, the interest on this debt is almost $1 trillion. As the debt continues to grow interest will consume a larger part of the federal budget. The federal government could definitely do a better job managing the defense budget. But of course politicians always seem to meddle.
In conclusion, if we assumed Bernie Sanders wish list , there wouldn't be enough money to support Medicare For All, even with higher taxes. Medical For All may pole well when cost and taxes and not offered. Support collapses once Americans are told how much of a tax increase they would face.
While I cannot claim to be an expert here, I have worked as a family physician for over 50 years and have worked in private practice and practices associated with hospital systems, dealt with HMO and PPO groups, Traditional Medicare, Advantage, and more insurers than you could imagine. I have dealt with patients in both Traditional Medicare and Advantage, the pros and cons as related to me by patients, fellow colleagues, and my own experiences as a patient covered by Medicare insurance. And I have read in detail the reports on both. And I have witnessed the surge of lawsuits and fines against Advantage for fraudulent billing practices and massive denials of needed care.
You have to understand the big difference is Traditional Medicare is a health care system that is not dependent on private industry’s (Advantage) lust for profits.
Anyway I picked one site for you to rumble through. It has multiple secondary study sites you can link to, dozens comparing the programs in measures of health care outcomes, costs, access and patient satisfaction and so forth. Including studies from the NIH and even Koch. Have fun and I hope you come to understand this better.
CBO (one of the most if not the most reliable source we have) said that some Republican states refusing to expand Medicaid added 3 million people to the 30 million total left completely uninsured ten years after Rombamacare (what I call ACA or the "Still Unaffordable and We-Don't-Care Act") passed. That's one out of every ten. That means nine out of every ten were left completely uninsured by Rombamacare by design. Illinois is completely controlled by Democrats and expanded Medicaid but still figured out a way to deny legitimate coverage to small business owners or self employed people, meaning they fell into the same coverage gap. Even though Illinois supposedly expanded Medicaid it did so in a very devious and under handed way that denied coverage by disallowing legitimate business expenses that the IRS allows. I have never seen either one of these two facts reported.
Medicaid expansion and the ACA has not improved the health of our country at all, in fact the opposite has happened: we are sicker as a nation than ever. Perhaps many State legislators believe that the State, not the Federal government, is the entity to manage health for their particular population.
All these shithole, pro business states don’t really understand the basics of health care economics. Hospitals and clinics getting paid makes your communities thrive, dumb assholes.
I can say, because I practice in Texas. When patients have insurance we get paid. When they don’t have insurance no one gets paid. The fabric of the health care economy cannot sustain unpaid care. I would love to talk to that snide Wyoming senator Asshole. Medicaid is insurance, not socialism.
It’s pretty amazing that those 10 states are continuing to leave Billions of federal dollars on the table in order to make a political point: 90% of expansion funding is provided by the federal government. Therefore, the 10 non-expansion states are cross-subsidizing the 40 expansion states in a big way. Go figure! Connecting funded healthcare access to employment with tax advantaged funds is an accident of WWII history & highly dysfunctional from a societal point of view. No other country does it this way. Refusal to expand Medicaid is just a surrogate for ongoing institutionalized racism. Just look at the map!!
this is so very sad. we are a "wealthy" country but the middle class is shrinking and all those people struggling just to survive don't seem to matter to most of the 1% or whatever that percentage is. and wealthy companies only think of their bottom lines and the stockholders.
You could highlight that numerous states (Missouri, Oklahoma, Montana, etc.) got around the legislature by getting it on as a ballot initiative where it generally has passed pretty easily because, as you highlight, the average person wants it and wants to be covered.
We don’t want to expand Medicaid. We need Medicare for All. And no, expanding Medicaid will not get us there, it will actually raise costs of care for the majority of Americans already struggling to afford their health care with or without health insurance.
I agree with you, but while the US waits for a real Healthcare System, those 10 states should be forced to expand Medicaid.
The ACA is not a solution for healthcare. The Health Insurance purchased on the ACA market place is too expensive and not that great. If you have a $6000 Deductible, you really don’t have healthcare. The US needs a Single Payer Healthcare system like what is offered in Bernie’s Medicare For All. No country in the world has a Private For Profit Healthcare System like the US has. Thousands of people go Bankrupt every year over Medical Bills. That does not happen in other countries.
You should tell the story of what happened with medicaid expansion in South Dakota.
There are many reasons why these states are not expanding Medicaid. However, the main reason is that states will eventually have to bare the funding burden when the Federal government reduces funding from the the current 90%. As the legislation was originally written, the Federal government is not required to continue the current funding level. If funding is reduced it would break state budgets wide open, and there are many states with large deficits (California, Illinois, New Jersey, New York just to name a few). There is a good possibility this could happen as tax revenues to support Social Security retirement and Medicare continue to decrease and the cost for these programs continue to increase.
As I read other comments, I see Medicare for All. As stated above, Medicare is headed for the bankruptcy within about 10 years. When the program was started in 1965 there was about 5 working for every 1 retiree, and the mortality of retirees was about age 65. Today, there is about 3 workers for every retiree and mortality is about age 76. There are close to 66 million on Medicare today and this is expected to increase to 80 million by 2030. Now throw on an additional 250 million and you have an unsustainable program called Medicare for All.
Multiple studies, including by conservative Republicans, show that Medicare for All is a significant money saver over the present scenario. And then there are the Advantage programs, wrongly called Medicare, a privatization effort with significant cost overruns and fraud from upcoding visits, and studies show no better care than traditional Medicare. This is what is breaking the system, with its obscene profits to private insurers and causing extreme distress from denial of care for many in a HMO setup.
There is more than enough money to cover these programs, just stop the never ending wars and cut back on the trillion plus dollars in the Defense Dept budget! More spent on weapons of war and supporting over 800 military bases around the world than the next ten industrialized countries combined.
Let's unpack your comments. Please provide the links to the "multiple studies" you indicate above. I would be very interested to see how they came to the conclusion that Medicare For All will be a money saver. Medicare has absolutely no cost control mechanisms in place to combat fraud, waste and abuse not to mention large claim management. It's just money in money out. Provider reimbursement is dependent on CMS and HHS, subject to political influence. Due to low reimbursement, most physicians wouldn't accept Medicare but they don't have a choice.
Medicare Advantage is not perfect but it does manage care a lot better than Original Medicare. Politicians created Medicare Advantage and when insurers figure out the system they naturally take advantage (no pun intended). Bureaucrats run Medicare and then decide what is covered and what isn't. To me and many others that's a scary proposition. By the way, many not-for-profit health insurers actively market and sell Medicare Advantage plans. Blue Cross Blue Shield Association being one of the biggest. Further, AARP is in bed with United Healthcare, and they collect handsome fees for the sale of Medicare supplemental plans. I would also like to see the links to the studies showing Medicare Advantage plans are no better than Medicare with outcomes.
No there isn't enough money to pay for Medicare For All. With the U.S. approaching $38 trillion in debt, the interest on this debt is almost $1 trillion. As the debt continues to grow interest will consume a larger part of the federal budget. The federal government could definitely do a better job managing the defense budget. But of course politicians always seem to meddle.
In conclusion, if we assumed Bernie Sanders wish list , there wouldn't be enough money to support Medicare For All, even with higher taxes. Medical For All may pole well when cost and taxes and not offered. Support collapses once Americans are told how much of a tax increase they would face.
While I cannot claim to be an expert here, I have worked as a family physician for over 50 years and have worked in private practice and practices associated with hospital systems, dealt with HMO and PPO groups, Traditional Medicare, Advantage, and more insurers than you could imagine. I have dealt with patients in both Traditional Medicare and Advantage, the pros and cons as related to me by patients, fellow colleagues, and my own experiences as a patient covered by Medicare insurance. And I have read in detail the reports on both. And I have witnessed the surge of lawsuits and fines against Advantage for fraudulent billing practices and massive denials of needed care.
You have to understand the big difference is Traditional Medicare is a health care system that is not dependent on private industry’s (Advantage) lust for profits.
Anyway I picked one site for you to rumble through. It has multiple secondary study sites you can link to, dozens comparing the programs in measures of health care outcomes, costs, access and patient satisfaction and so forth. Including studies from the NIH and even Koch. Have fun and I hope you come to understand this better.
https://www.citizen.org/news/fact-check-medicare-for-all-would-save-the-u-s-trillions-public-option-would-leave-millions-uninsured-not-garner-savings/
CBO (one of the most if not the most reliable source we have) said that some Republican states refusing to expand Medicaid added 3 million people to the 30 million total left completely uninsured ten years after Rombamacare (what I call ACA or the "Still Unaffordable and We-Don't-Care Act") passed. That's one out of every ten. That means nine out of every ten were left completely uninsured by Rombamacare by design. Illinois is completely controlled by Democrats and expanded Medicaid but still figured out a way to deny legitimate coverage to small business owners or self employed people, meaning they fell into the same coverage gap. Even though Illinois supposedly expanded Medicaid it did so in a very devious and under handed way that denied coverage by disallowing legitimate business expenses that the IRS allows. I have never seen either one of these two facts reported.
Politicians with "no symapthy for those people" should be campaigned against as the Anti-Christ.
Unfortunately those politicians are doing the will of lobbyists & then the same politicians become lobbyists
Medicaid expansion and the ACA has not improved the health of our country at all, in fact the opposite has happened: we are sicker as a nation than ever. Perhaps many State legislators believe that the State, not the Federal government, is the entity to manage health for their particular population.
Ah, Medicaid remains entirely run by 51 different states’ respective healthcare authorities, not the federal government
There’s the rub. Medicaid ran by States’ contractors with all the laws, regulations, reimbursements, and authority under the Federal government.
All these shithole, pro business states don’t really understand the basics of health care economics. Hospitals and clinics getting paid makes your communities thrive, dumb assholes.
I can say, because I practice in Texas. When patients have insurance we get paid. When they don’t have insurance no one gets paid. The fabric of the health care economy cannot sustain unpaid care. I would love to talk to that snide Wyoming senator Asshole. Medicaid is insurance, not socialism.