11,830,000 were in families making less than $25,000 per year. A family making less than $25,000 per year is usually eligible for Medicaid. Why would these people not have applied for Medicaid?
Because you can apply for Medicaid retrospectively; that is, you can get treatment, then apply for Medicaid to pay for it. If you qualify, Medicaid will pay it even though you didn’t have coverage at the time of service. That’s why a lot of people who would qualify for it don’t have it. They know they can apply later.
I realize people focus on the Canadian and British systems, but I think the French system has something with which to recommend itself, at least in part.
-2/3 of the system is “public”. In that system, you go to the government doctors. You pay “up front” for the care and apply to the government for reimbursement. Cuts down on overutilization, which is a serious burden in both the U.S. public and private sectors, especially the public sector.
-Normally the reimbursement is 80% for most things. Medicaid pays 100%, and Medicare pretty much does.
-The government buys the drugs in bulk, but it’s not very flexible in adopting new drugs.
-Illegals can get care, but they pay “up front” and get no reimbursement from the government at all. In the U.S., they go to the ERs and get treated at taxpayer expense.
-You have to prove your legal status at the point of service. You don’t in the U.S.
-People in the “private” system often have private health insurance or simply pay cash. Not too surprisingly, a large number of the best doctors are in the “private” system.
-The government pays medical school tuition. Doctors don’t have big debts coming out of school. In the U.S., they often have enormous debts.
-The government expands and contracts medical admissions based on the needs of the population. Medical education in the U.S. is totally controlled by the universities, which have disincentives to expanding admissions.
-Medical malpractice cases are judge tried only, and in special courts. There are caps on recoveries. Attorneys for plaintiffs have to content themselves with hourly fees, not percentages. Malpractice cases in the U.S. are tried before juries and attorneys usually get 40-50% of the award.
-The government pays the malpractice insurance premiums for doctors in the “public” sector. Not surprisingly, the premiums are fairly low because of the special courts. In the U.S., malpractice insurance might cost as much as the doctor makes or even more.
-Programs to aid people who can’t afford the “up front” cost are local and regional, not federal.
Now, it must be admitted that nobody other than the tax man knows what the doctors in the “private” sector make. In the “public” sector, they make about 40% of what the same kinds of doctors make in the U.S. It must also be admitted that income tax rates are higher in France than here, and average wages are significantly lower.
Still, there is a lot about the French system that can be admired, and the U.S. ought to look at them. But, of course, this administration is set on getting a British-type system where healthcare is a governmental function, and many conservatives don’t always consider addressing things like:
-Medical education, and particularly its expansion.
-Special courts and malpractice caps.
-Limitation of attorneys’ fees.
-“Up front” payment, with reimbursement upon application.
-Totally private optional segments in which the government does not interfere.
-Identification of patients, and patient accountability.
-Local and regional options other than who can and cannot sell insurance.
:thumbsup: