Should the US expand Medicaid to 400% of the Federal Poverty Level

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There is a difference between deliberately taking a human life through abortion and working to eliminate discrepancies in care provision for those we are not deliberately killing.
Surely there are ways to work on the latter without signing off on the public funding of murder in the womb?
 
Thorolfr said:
This must be true, because at least where I live, people on Medicaid go to the same specialists (i.e. eye doctors, gastroenterologists, kidney doctors, etc.) as everyone else and I believe that they also get good quality primary care as well.
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I believe it is true. At one time in my life I negotiated employer health plans with providers. I always started with a discount to Medicare rate and negotiated from there. I always got a discount to that “already discounted” rate, and the providers were happy to get the business.

And those big providers’ facilities were almost palatial. They obviously did very well. I have seen others complain that Medicare is insufficient to keep a medical complex going in some places.
 
jeannetherese said:
There is a difference between deliberately taking a human life through abortion and working to eliminate discrepancies in care provision for those we are not deliberately killing.
Surely there are ways to work on the latter without signing off on the public funding of murder in the womb?
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It is not either/or.
 
What solutions is there for the desperate people who through no fault of their own are unable to get insured or have a difficult time getting good coverage?
 
Ridge, if you don’t mind me asking, what ideas would you like to see to help “clean up” and reform the health care system? While we do provide options like Medicaid for the poor (who qualify under certain guidelines), Medicare for the elderly (though if you’re an elderly with fixed income, being able to afford the co-pays/premiums/out-of-pocket costs could end up being difficult) as well as ESI, there are some who seem to “lose out” in the patchwork of schemes we have for the US system? What can be done to help those in the “gap” absent from expanding Medicaid coverage (and I believe health care costs could also be a hindrance to self-employment, would you agree)?

I understand where you’re from living costs are not so high but in some places of the country, things like housing are making it difficult for folks to make ends meet. Health care can be another burden.
 
Okay, and for those who do not qualify; for example those with a history of mental health conditions or living with a physical or mental disability that makes them ineligible for the military. Additionally, some people aren’t just cut out for the military.
 
boldlygo said:
Enlist in the military!!
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That’s really not an option for older people or folks with serious medical problems. In spite of the ADA, on the landing craft and other military convoys for amphibious landings, they have never built wheelchair ramps for disabled Marines.
 
How about you, Mr (or Ms) Augustinian, how would you reform the US health care system if you don’t mind me asking?
 
The United States is too complex and too diverse for a single charitable system from coast to coast.

Let each state or locality address the needs of the indigent in their area and address it the best they can.

No need to touch health care for the vast majority
 
But what about states and localities that can’t afford to care for those in need, for example I live in California with high living costs and many people in need, meanwhile, what about the residents of our poor and desolate communities from inner-city Detroit to rural Appalachia? Many people are born in the wrong zip code or in the wrong household. Pardon for my emotional rhetoric, to a point subsidarity does work, for example Switzerland has the cantons managing welfare aid to the poor, Canada has the provinces meet education (and to an extent health care but that is supported by national funding) needs. Additionally, emphasizing the whole family, community, charity, county, state and federal framework could help focus resources for those in need but it would be very complicated with so many layers.
 
I am not the Tsar. But if I was, the first thing I would want to look at are the elements of cost themselves. Just throwing money at a problem is often not the solution. It often just turns the problem into a “sponge” that requires more and more money to achieve the same or a lesser result.

I’m not a medical professional myself, though I do have some familiarity with the way medicine works in this country. The very first thing I would do is allow properly-qualified NPs to operate independently. There is no doubt whatever in my mind that they would take over a lot of the care and at lower cost than presently. Of possible interest, I am aware of one provider of mental health care that employs more than one NP. One of them is certified both in psych and in family medicine. The clinic requires that patients contact a case manager before going to an ER. Most of the time, that results in the patient going to the NP with satisfactory results. The state specifically funded that program through Medicaid to cut down on the really outrageous costs of ER care. it does work.

I would look at the way costs are paid. They are extremely inefficient, which is why providers will give significant discounts to patients who pay in greenbacks.

I would look at the malpractice laws more closely. Doctors tend to prescribe the latest (and most expensive) medication because they fear they will be criticized later if they don’t. Many, many of the “newest” meds are simply variations on older ones, or combinations thereof. The new ones are advertised on tv, and patients expect them to be prescribed because they’re the “latest” thing. Often those drugs are not the best for the condition and sometimes even “off label” use is appropriate. But that’s the kind of thing malpractice lawyers look for, so doctors avoid it, pushing costs higher than they really need to be.

The same is true with a fair amount of testing. Our medical system is a “do everything” system, which most of the world does not emulate.
 
I always thought of health insurance as primarily a guaranteed income plan for doctors and healthcare workers. But now, with Medicare, Medicaid, and private plans, it has become a guaranteed income plan not just for doctors nurses and other healthcare workers, but a guaranteed income plan for hospitals, administrators, CEO’s, and a great number of bureaucrats as well.

Since I went on Medicare I see docs more often and get more tests than previously, not so much because they are more essential or my health is worse. But rather because every provider knows exactly how much Medicare will pay, how often they will pay, and the frequency of visits for which they will pay. When third parties pay for medical care, patients are taken out of the equation; you have to please the insurors and the government.

Some physician practices are dropping out of the system entirely, mainly primary care docs, but sometimes speciality practices as well. They will take care of your medical needs for a fixed monthly fee, most include lab work, x-rays, drug discounts, and they take no insurance whatsoever. In effect, they cut out the middleman, and their prices are much lower than prices of docs who take insurance, because they cut out a huge amout of overhead.

It will be interesting to see if this trend continues.

The other side of the coin is that many docs in private practice are electing to become employees instead. They will be bought out by hospitals or regional medical complexes. They’re willing to become employees because the insurance companies and government is increasingly turning them into clerks in their own practices.
 
RCIAGraduate said:
Medicare for the elderly (though if you’re an elderly with fixed income, being able to afford the co-pays/premiums/out-of-pocket costs could end up being difficult)
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I’m 70 years old, and my wife and I are on Medicare. We have an excellent policy with no premiums. I had a reverse total shoulder replacement done by a highly-qualified surgeon, in a first-class facility, and the bill for the entire procedure, hospital stay and all, was an outrageous $350.00!
Of course, Medicare itself isn’t free…I’ve paid into it since day one, and, since I still work, I continue to pay for it, just as I pay for my other insurance policies.
 
Ideally, perhaps we could craft a revamped Medicaid program to help the poor, the working class who aren’t covered by ESI for one reason or another (maybe we need to create a program for small and medium enterprise/businesses) and others who “lose up” (i.e pre-existing conditions). Not necessarily, Medicare for All but what about something for those in genuine and critical need? What do you think sir (or ma’am)? How would you address the health care issue if I may ask?

Could another solution be building up Community Health Centers, Free Clinics and Charitable Hospitals for those in need as well (like creating a county-based program)?
 
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