This is a hard slog to read, and I apologize for that, but I think the best way to find out how states see health care reform and Medicaid expansion is to ask the people responsible for putting it in place.
This report is based on a structured discussion with the Executive Committee of the National Association of State Medicaid Directors (NASMD), and selected additional Medicaid directors, in late May 2010.
The Executive Committee of NASMD is comprised of eleven leading Medicaid directors, including two each from four geographic regions of the country (the Northeast, Midwest, South and West) plus the Chair, Vice Chair and Immediate Past Chair. The views expressed in this report reflect the discussions with these directors, who represented a total of 11 states.
Beyond the challenges of implementation tasks, Medicaid leaders perceive that reform is deeply transformative for the Medicaid program.
Officials said that Medicaid has come to be regarded more as a health coverage program, and health reform reinforces this trend.
By enrolling more and higher income members and increasing integration with the commercial market, Medicaid will move farther away from being a welfare style or social program.
This development has implications both for organizational culture within Medicaid agencies and sister agencies and for the public’s perception of Medicaid. As one example, one Director suggested there could be a move in his state to integrate Medicaid with health coverage for state employees to be able to leverage even greater purchasing power in the health care market.
One director envisioned a future fully integrated health plan system where individuals and small employers accessed a single front door for Medicaid, CHIP and exchange coverage and would not need to be aware of whether they were on Medicaid or not.
The shift in public perception described by the state directors is the same thing that happened with S-CHIP, in my (admittedly) limited, anecdotal experience.
Parents here don’t perceive S-CHIP as welfare, probably because most of them are working. They see it as a health insurance plan for their children, period. That insulates the program, politically.
Conservatives knew that would happen, which is why they fought like hell to stop it.
arguingwithsignposts
And why I will never vote for the asshat that currently occupies the seat in my district. And he’s a f**kin’ doctor. too early in the am for this.
Calvin Jones and the 13th Apostle
So why not just pass Medicare for all? Given what we know, it would be hugely popular with everyone, including the teabaggers.
Martin
Sully has a nice vid from Kaiser Foundation explaining the changes in the HCR bill.
And if he’s correct that major insurers are refusing to write policies for children, there’s gonna be new legislation to write, and they’re not going to like it.
FlipYrWhig
@Calvin Jones and the 13th Apostle: Because teabaggers will say that _they_ deserve such things because they worked hard all their lives and this is just one rough patch. But other people (hem, haw, you know who I’m talking about) just sit around all day waiting for a handout, and those lazy bastards don’t even try, so you and I can’t afford to pay for them too.
Xenos
@Martin: Why is it a problem? I mean, aside from the kids not being covered… and there are some obvious solutions for that.
If the insurance companies can not make money in the health insurance business then they might as well get out of it and let the federal and state governments set up non-profit administrations to do it, like nearly every other well run system on the planet. If we can kill the profit margin, everything else just flows from that.
Lolis
Medicaid is actually a lot better than Medicare. I was on Medicaid for almost a decade. No copays for anything, almost all prescription drugs are covered, all the ones I ever needed were. Now I have Blue Cross with my job and the copays and coinsurance fees are ridiculous.
Part of why I wasn’t sad to see the public option go is that we should go to a straight Medicare or Medicaid system and not create some public option that would be designed not to drive insurance companies out of business. In a decade, insurance companies may regret the day they blocked the public option.
Martin
@Xenos: Yeah, there are obvious solutions, but they won’t appear spontaneously.
kay
@Calvin Jones and the 13th Apostle:
Look, I know a lot of people hate the health care bill. I’m asking you to look past the position you adopted and read and listen to how it might actually play out, bad AND good.
The states are going to be really important players. IMO, that alone incites a knee-jerk negative reaction among liberals.
But I don’t see state government that way, and I don’t see the intersect between states and the feds that way. I think a lot of that conflict is politically and ideologically based, not reality-based.
Martin
Oh, and why does Christine O’Donnell oppose national security measures?
kay
@Martin:
I have to look at it, but this came up in mid-August. I didn’t pursue it, but it’s out there, so I’ll look if I get time.
kay
@Martin:
And you have to look carefully at anything Sullivan posts on health care, just as a general rule.
Not his area of strength. I don’t think he understands any of it.
kay
@Lolis:
It’s interesting, because conservative states that limited Medicaid benefits may benefit the most from the new law, which is horribly unfair and unjust, but may serve to insulate it in the Senate.
Many of them always got a higher federal share of Medicaid paid for them, up to 70%, and if they expand rolls they get 100% for the first three years and 90% after that.
By limiting more than liberal states, it seems to me that they benefit disproportionally under expansion, because a larher share of their state population will be new enrollees.
No good deed goes unpunished, right?
Martin
@kay: No, I agree. But I know the Kaiser Foundations work well, so that’s solid. As to the insurers dropping plans, yeah, I prefaced my first statement with ‘If he’s correct’ which you can feel free to interpret as ‘I don’t trust Sully to correctly report this kind of stuff at all’. To his credit, he’s well above average at correcting his record in categories such as this.
Midnight Marauder
@kay:
His only area of strength is writing about torture. That’s it.
kay
@Martin:
I know you know a lot about it, because I’ve learned a lot from your comments, although I think you and I have a fundamental difference on the incentives and motives of state governments.
I have an elaborate argument against the idea that “selling insurance across state lines” will benefit consumers, inspired by you.
Republicans put up a plan in 2005, and the CBO scored it. The kicker is the weasel language they used, where the state with the least expensive mandate would be the state of origin. It took me forever, but I found a list of each state’s mandates. The most expensive mandates are the services everyone uses.
Even with all that, the CBO said “across state lines” shaves 5% off the cost of a policy. But it’s a crappy policy, and it doesn’t cover anything people actually use.
I’ll put it up eventually.
Amir_Khalid
@Martin: Oh, so that’s how James Bond prepares his written reports! Makes sense to me.
kay
@Midnight Marauder:
This is lame and sentimental, but I like him because he’s not a professional, and he takes a lot of risks.
He seems real (and flawed) to me in the way that human beings are real.
He’s absolutely unconcerned with anyone else’s real world problems, though. I love how he dropped immigration issues after he was “in”. That’s typical.
Trevor B
My son is on medicaid, wow does it kick ass. My insurance bluecross blueshield is the biggest shister operation I have ever dealt with, they always ask for more money then the service cost in the first place as a deductable, and there is no telling if my insurance will cover that service anyways. Medicaid on the other hand buys my son insurance through Bluecross blueshit, just so he is double covered. but since it is such a hassle to use paid insurance we almost always use his medicaid card, then medicaid can deal with the insurance, no money out of pocket, and no worries about if the insurance covers the procedure. I say medicaid for all, and we will all be happy.
Davis X. Machina
@kay: Every teacher is familiar with this. You can’t be a ‘Most Improved Student’ unless you cock up first. I told my children that if they came home with a “Most Improved” award, they had to sleep in the back of the minivan in the driveway.
But if you dont’ give the MI award to someone…no one gets any better.
Zifnab
@kay:
See, the difference between you and me is that you don’t live in Texas. When the Texas state government gets it’s hands on public money, wasteful or negligent spending is almost a foregone conclusion.
I think Rick Perry turned down something like $70 million in aid because he didn’t want to improve the cocked up job he’s done running the state’s insurance programs.
PhoenixRising
Medicaid rocks. My kid was on it a few years ago, and my only rec’d diary ever at the Great Orange Satan was about how S-CHIP (Medicaid for self-employed parents’ kids) saved our business.
Republicans and others who are bought by the for-profit health insurance industry can’t afford to let people with healthy kids find out how badly their private insurance company is ripping them off. That’s why they fought a public option for those of us who don’t have it–their only product is about as useful as driving gloves and they know it’s a secret…
kay
@PhoenixRising:
Liberals should use that description.
My husband plays a little game with self-employed conservatives. He calls it “find the health insurance”. It’s always there. A spouse, a part-time job with a public agency (where we get health insurance) or S-CHIP.
But they’re all opposed to gubmint programs, because they’re maverick-y liberty-lovers, and they don’t know why these deadbeats can’t find health insurance.
Binzinerator
Which is exactly why I continue to despise them. Selfish shitgrinning dirtbags, pretty damn much the whole lot of ’em.
kay
@Zifnab:
That’s funny, because I posted this glowing article on how Texas was moving very efficiently on health care law enactment at the state level. The whole premise was that Rick Perry is full of shit, and Texas is first in line with securing federal funds. That what happens with the non-political actors (state employees) is a world apart from the bluster and liberty-lov’in statements of the political actors.
But I don’t know a thing about Texas, other than what I read.
I know Ohio is ramping up, but we have a Dem governor, who has no fake-ideological objections to his share of the federal pie.
kay
@Zifnab:
Here’s the Texas article I’m talking about
NonyNony
This is also why they always – always – push “means testing” plans for Medicare and Social Security. They know that if they can make Medicare and Social Security into something for “poor people” it makes them easier to gut and kill. If they are things that everyone uses, then the middle class and upper middle class folks will get pissed when they try to cut them.
Liberals who buy the argument that means testing is a good thing because rich people have enough money to pay for themselves irritate me because the conservatives know exactly how to play them in the means testing debate and they fall into the trap every time. And that’s all it is – playing them. Every time a conservative makes a program like this “for the poor” instead of “for everyone” it chips away at public support so they can eliminate them. The more you can expand access to programs like this, even to people who might not need the help, the more likely the programs are to succeed.
Mnemosyne
Looks like the Medicaid and S-CHIP expansions are coming just in time now that Anthem Blue Cross has announced that they’re not going to write new policies for kids if they can’t drop them for pre-existing conditions. And, of course, it’s All Obama’s Fault that they’re forced to do this.
Fuckers. There’s a bill on Schwarzenegger’s desk to ban companies that do that from selling individual policies in California for 5 years, but I don’t trust any Republican to do the right thing at this point, even one who’s been totally rejected by his own party.
redbeardjim
@kay: We currently have a Dem governor. Let’s hope we still do next year.
Kay
@Mnemosyne:
I don’t know that it’s that huge.
From your article:
I think they’re using this to lobby for a pre-enrollment waiting period. It will be politically effective, because media are going to jump all over it, so they’ll probably win this round.
They’re good at manipulating debate, and conservatives are going to help that right along.
Kay
@redbeardjim:
Shit, yeah. Nobody wants Strickland to win more than I do. I deal exclusively with state law. I put most of my energy into state candidates. Conservative governors are a daily disaster for me. I lose my fucking mind with state-level conservatives in power.
On the bright side, local Democrats are scared to death of Kasich, so they’re finally paying attention. We met yesterday and they were very attentive. Ahem.
mclaren
None of this matters.
None of it.
“Health Care: The Disquieting Truth,” Arnold Relman, The New York Review of Books, September 30, 2010.
Read the studies, people. Do the math.
The entire U.S. health care system is rapidly headed for a crash.
Quibbling and haggling and squabbling about Obama-did-this or insurers-don’t-cover-that means nothing. Absolutely nothing. The entire American health care system is going to crash and burn and collapse so soon that it makes absolutely no difference whatsoever whether insurers write policies to cover kids today or stop writing the policies, because within the next few years, no one will be able to afford health insurance — not employers, not individuals, not state exchanges, not Medicare, not Medicaid. Nobody. It’s all going to crash and burn.
Because medical costs are simply rising so fast that there is no way they can possibly be sustained.
Read the report above.
“…Most economists agree that the states will not be able to pay the rising costs of Medicaid in future years, when millions of beneficiaries will be added to the rolls.”
What is it about that sentence that you don’t understand?
“…There is increasing evidence that the inflation in the cost of health insurance cannot be supported by employers and employees much longer. In sum, the whole health system, if not radically transformed, seems headed toward bankruptcy.”
Which of those words is not clear to you?
Kay
@mclaren:
Well, in that case you’ll get your wish, mclaren, and there will be a radical restructuring of health care, post-crash.
Or, alternately, all the many, many interested actors will battle and compromise and play tug of war to keep this leaky boat afloat. I don’t start with the premise that they’re all operating in bad faith. You do.
I know you have no interest in that boring, tendentious disheartening process, but IMO that’s what government is, and does. Your one and only solution is always some galvanizing, catastrophic event leading first to anarchy and then to bliss. I don’t think that’s how it works, but feel free to keep hoping for a disaster.
Corner Stone
Why should it be any different than every other thing you write or post?
mclaren
@Kay:
Faith doesn’t matter.
Leaky boats don’t matter.
Interested actors battling and compromising don’t matter.
All that matters is the skyrocketing cost of health care in America, and nothing, absolutely nothing, is reducing those costs.
“Interested actors” spent the last 2 years in an effort to “battle and compromise and play tug of war to keep this leaky boat afloat” and the net result has been:
Zero.
No cost reduction. None. Zip. Nada. Bupkiss. Diddly. Zilch.
All your mantric hand-waving means nothing without cost reduction, and the systemic pressures toward ever-increasing health care costs are overwhelming. “Some galvanizing, catastrophic event leading first to anarchy and then to bliss” is beside the point. Name-calling is irrelevant.
All that matters is the ever-increasing cost of health care. And there is no evidence that the rate of increase in health care costs has been reduced by one iota over the past forty years. In fact, the rate of cost increase has sped up.
I don’t know what will happen when the U.S. health care collapses. We may not get reform. We might just get a permanently broken system, the way we’ve got a permanently broken justice system with the never-ending drug war. Maybe everyone will simply not be able to afford health care forever in America, and the professions of doctor and nurse and health insurer will go away, as the professions of automobile worker and travel agent and punch card data entry operator have gone away. Maybe, as in Russia, Americans will die off younger and younger, and our median life expectancy will drift down to age fifty.
The prediction of imminent collapse for the U.S. health care system isn’t good or bad. It’s just the inevitable result of the facts on the ground.
Martin
@kay: You’re absolutely correct.
I think part of the problem the Dems are having with HCR is a difference in perspective. The WH and Congress are looking at HCR from the national perspective – how to cut costs for the federal budget, how to cut health care spending as a % of GDP. If they did nothing more than knock those two numbers down, they would consider it a success – even if it meant shittier health care for individuals. Their attitude has always been that if they can get costs in line, then they have a position to talk about quality. If costs are out of line, no discussion on quality can take place, and cutting out copays isn’t going to bend the cost curve based on higher rates of doctor visits any more than cutting the tax rates boosts overall tax receipts due to economic expansion.
The Democratic base are looking at HCR from the bottom up – from the quality side. And they should keep putting pressure on that. Obama and Congress tossed in as much of that stuff as they could, particularly in places where it helped the numbers above, but this is all for a future reform bill. They knew the first one would need to be patched up pretty quickly (probably every year from here on out) and that’s a place where they can start whittling away at the quality issues. But the base often isn’t patient enough for that to play out (see BTDs bitching yesterday).
mclaren
As I predicted, and as people like Kay screamed and howled that I was a liar and insane for predicting:
“Health Insurers Seek Rate Hikes, Citing New Reform Law,” Michael Booth, Denver Post, 20 September 2010.
Health insurance premiums have skyrocketed and fewer sick people are being covered…both results that people like Kay assured us could never happen under Obama’s new HCR non-reform bill.
Just wait. Recissions, massive premium increases, wholesale revocation of treatments promised in the insurance…they’re all coming. Just under different names.
The HCR non-reform bill has made everything worse.
aimai
Mclaren,
How do you know it made things “worse?” Since Recissions, massive premium increases, wholesale revocation of treatments promised inthe insurance, etc..etc..etc… were the norm before HCR how do you know HCR made things worse? If its status quo its a wash with some bennies for people in the group insurance plans. So fuck off and die.
aimai
Mnemosyne
@aimai:
Because mclaren is a doctrinaire libertarian who occasionally puts on a lefty mask. Government can only make things worse, so the problem must be government regulation and not that insurance companies are trying to get in their last licks before the major regulations kick in.
kay
@mclaren:
I never once called you anything like that. Stop feeling sorry for yourself. It’s unappealing, self-centered and childish. If you want to jump in with me, fine, I’ll debate, but I don’t want to talk about your feelings.
You’re so invested in being right, you wear blinders. Every bit of information is filtered through “this just proves what I knew would happen!”
You can’t even sit back and wait for it to fail. So what are you pushing mclaren? It isn’t health care reform, because you rarely talk about that.
There’s about seventy moving parts in that legislation. Anyone who crows they KNOW what is going to happen is lying to you.
kay
@mclaren:
Fine. Throw your hands up and hope for some catastrophic event. But don’t tell me you were looking for a public option or some other mechanism, because you weren’t. You were looking for a catastrophic event and a radical restructure, because that’s the only thing that meets your goals.
You won’t grapple with this, mclaren. If we had succeeded with a public option you’re still be predicting Peak Health Care.
Why do you even engage? You say yourself the whole system is headed for failure. Okay. End of discussion. You’re out.
kay
@mclaren:
You’re like a volunteer lobbyist for these guys. They scream and yell and apply pressure for a more favorable insurance climate, and you’re right there with them, spreading the message.
evinfuilt
@kay:
WOW, you just decribed my tea-party parents, I can’t belive it took me this long for it to dawn on me. My mavericky self-employed dad literally survived off of my moms healthcare provided by her State Job.
Ailuridae
@aimai:
You don’t understand the mclaren style of argument. It is not that things are worse than they were (that’s an absurd claim) it that he’ll write that they are worse than they were because he didn’t get the bill he wanted. And he’ll do it while typing a whole lot of words while doing the same dance all of the firebagger crowd does when talking about health care costs: claim that the convenient boogeyman in the insurance companies is the problem while ignoring all of the data that points at the actual problem. And that actual problem is and will continue to be doctor’s compensation and provider and hospital profits (all of which are so completely intertwined to be one thing).
As to kay’s actual post combining the Medicaid and state and municipal employees together in one bargaining pool is a very bright idea. Medicaid is still an “them” program to most Americans. As it expands to more of the working poor it will be less so but the reason so many fewer doctors treat Medicaid patients has a whole lot to do with those patients all being poor and nearly all of them being “them”. In any state the combined public employees pool is so large that many doctors simply can’t refuse to provide service to them. Adding the medicaid patients in the state to the same plan and bargaining pool will provide much-needed leverage against doctors and hospitals.
All that said, long term Medicaid is unsustainable as a joint federal-state program because of balanced budgets at the state level. It’ll need to be federalized before the next major recession or well see the same problem of a much-needed service denied to people when people need it the most. Ultimately a push to merge S-Chip and Medicaid into Medicare and then offer an at-cost/for profit version of medicare to self-employed folks and folks without coverage from work is where progressives need to be moving. Unfortunately the professional left and their echo chamber on this and other blogs’ comments is far too willing to repeatedly and shamelessly lie about the bill that was actually passed rather than push towards this goal which, given the popularity of Medicare is very likely attainable in the next 10-15 years.
Martin
@mclaren: Everything you are talking about are currently hypotheticals. Yes, they are a potential and possibly even likely response to HCR, but that doesn’t mean that Congress and HHS can’t response as well.
You can’t seriously make an argument in which one party has free will and the other party does not. When you do, people (correctly) beat your logic into the ground.
There’s no question that this is going to be a constant tack/countertack situation. That’s the point – but previously the insurers were doing what they wanted with no response from government. That needed to change and now it has.
kay
@evinfuilt:
I’ve had every possible flavor of health insurance in my life, so I see all the variants.
I once had to join the Chamber of Commerce, a conservative lobbying group, in order to purchase insurance.
I once actually relied on a state mandate to cover a experimental bone marrow cancer treatment, where I was the donor. My (then) governor just happened to be married to someone who was all gung-ho on organ donations, and that’s the one and only reason it was covered.
The arbitrary nature of US health care would be really funny, if it wasn’t so tragic.
Mnemosyne
@kay:
I’ve noticed before that mclaren has a fascinating tendency to claim to be on the left and yet come down on the side of corporations and big business every. single. time. My favorite so far was declaring that we can’t possibly punish companies that use illegal workers because it’s unfair to the companies.
kay
@Ailuridae:
That scares me, because I think states are the best political pressure out there. I just don’t think structuring this so it’s entirely federal is the best way to protect it.
Given the Senate, I’m more comfortable with states (and their parochial interests) protecting budgetary turf.
I think it’s MORE vulnerable federalized.
Mnemosyne
@Ailuridae:
I agree. I think one of the smartest moves they made in the new bill was to not allow states to opt-out like they can with Medicaid. That just causes way more problems than it’s worth.
kay
@Mnemosyne:
Someone smart said that each person talking about the health care bill on television should have a crawl underneath their picture, that reveals where and how they get and pay for health care.
I think it makes a difference if you’ve personally traveled through this whole system.
CADoc
The only problem with all of this is that Medicaid pays providers so poorly, way less than the cost of seeing a patient. Hence, very few private docs take these patients. I have 20% MediCal practice and that is very unusual. The rates have to be reasonable and reliable (ie you don’t get IOU’s from the state 1/2 the year) for people to get access.
Ailuridae
@Mnemosyne:
The problem is, though, that nearly half of the bill’s spending is Medicaid (about 40B a year). And a huge portion of the rest is subsidies to the lower middle class and up to pay for insurance in the private market. I doubt they will but the latter but I think the GOP could go after Medicaid broadly not just the expansion.
Regardless where progressives need to go with this is pushing all the government plans except the VA (and maybe IHS) into one pool under the title Medicare and then not differentiate the patients within the system. So if you are over 65 and have paid in you are no different than a child whose parent’s can’t afford insurance or a self-employed person like me who pays over 100% of costs to have the continuity and reliability of the Medicare or the working poor. Medicare already gets a fair shake most of the time from doctors and had its medical inflation rate under control even before the advisory board – increase its patient pool and doctors won’t have much of a choice but to stop their most egregious billing practices.
And then there would be a separate smaller class of people getting insurance from their employer. Those private insurance plans costs will continue to rise unchecked most likely because most of them aren’t big enough in any state to force doctors to charge reasonable rates. The excise tax threshold may indeed function to put a cap on nearly all policies in an area to achieve the same effect but I’m skeptical
Ailuridae
@CADoc:
There way be lost costs when you see a Medicaid patient rather than a Medicare patient, an out of pocket payer or a private insurance card holder. So you’re losing money treating a Medicaid patient rather than another higher paying patient but you’re certainly not being reimbursed less than the cost of service unless your factoring in your salary/earnings being necessary at their current rate into your costs. I have two doctors groups (private for profit) in my neighborhood (Westown Chicago) that treat 80-90% Medicaid (and S-Chip) patients yet each of them has been in business for 20+ years and judging by the cars the doctors are driving are quite profitable.
Now they are not as profitable as they could be if Medicaid was paying better or they had more private insurance patients. All that being said, I would prefer doctors outside the VA treating patients with public insurance would have only one rate scale as it simplifies things and makes it easier to counter doctor’s tendency to overcharge private insurers (a nice unmentioned side benefit of constraining the supply of doctors). I tell this to doctor friends of mine all the time (more to the specialists than the primary care physicians) – your pay is eventually going to come down substantially. The question is whether they agree to reasonable cost controls in response for their constrained labor supply and guaranteed employment or whether they allow this to continue to the point that it happens through more extreme measures.
kay
@mclaren:
The reason I resist your arguments is that they’re always fear-based, and they never lead anywhere.
I’m wary of that tactic, because I don’t understand what you really want.
I’ll give you an example. When Dick Cheney used to lean in and warn me that the terrorists were coming, there wasn’t a thing I, personally could have done about that, whether I believed him or not, and whether I was sufficiently frightened or not.
So why did he want me scared? It wasn’t going to motivate me to do anything: I can’t do jack-all about terrorism.
I ended up thinking the fear was the point.
So, I think the same thing when you start, by spinning the worst case you can with the few facts you use, and then screaming at me that resistance is futile. Why do you want me scared? I’m not, but what’s the point of basing every argument on fear? I just don’t respond well to that. It makes me wary and causes me to distrust the person relying on that gambit.
kay
@CADoc:
You’ll hate this, but I do contract work for three counties, and I can’t keep going back for increases, because they don’t have the money. We had to provide the service less expensively. If we couldn’t, the county was going elsewhere, to someone who would.
I think that if physicians are going to argue that they can’t meet demand at the going rate, states are going to find ways around that, and get their people basic care.
I think they’re then forced to open it up to allied professions. They can’t just tell people: “this profession can’t meet your demand. Sorry.”
CADoc
@ Ailuridae
Well, in California, a private practice doc is payed $25 dollars for a standard office visit under MediCal. It takes a reimbursement of about $35-40 to keep the lights on, pay staff, pay rent. That is before I ever get paid. In primary care, you can’t make that up on volume, because if you try to squeeze in too many people, you end up making mistakes and it certainly isn’t a nice experience for the patient.
Working in a small town, I really want to serve as much of the community as possible, so I’ll take as much as I can. But when I turn around and need to get these patients in to specialists, then you can’t find them anywhere to go.
Increasing how much the feds pitch in will really help, but not if its only for 2 yrs. There needs to be consistency to entice docs to work in that system.
Ailuridae
@CADoc:
I’ll try not to be overly dismissive but how many patients are you trying to maintain that you see in an hour?
Here is a link to the actual Medi Cal payment schedule.
I’m not finding your math overly convincing.
mclaren
@Martin:
Crackpot nonsense.
It’s the same kooky gibberish we get from global warming denialists. “All hypothetical.” “Just lines on a chart.” “Nothing to worry about.” “Blown out of proportion.” “It’ll all turn out okay in the end, people will fix things somehow.”
People like Martin and Kay and Mnemosyne are the real corporate apologists. They’re the ones telling us, Don’t worry — even though greedy giant cartels are killing Americans en masse by refusing ’em insurance and refusing to provide treatment, nothing to worry about, some magic fairy will fix everything. Tinkerbell will come back to life if we just clap hard enough.
And my terrible terrible crime?
I’m not clapping hard enough.
mclaren
As always, Kay lies and and lies and lies and lies and lies.
I’m not making any argument. You’re the one who’s arguing for this or that tweak to our current broken dying health care system. I’m not making any arguments. I’m just pointing out the documented facts.
Stating documented facts isn’t a “tactic.” Kay’s bizarre description is the language of someone who thinks there are no such things as facts. That’s the kind of crap you heard from the guys who wanted the Iraq invasion in 2002 and ginned up a bunch of lies to convince people it was necessary. When the rest of us pointed out there was no evidence for WMDs, they said “I’m wary of that tactic, because I don’t understand what you peaceniks really want.”
The truth isn’t a “tactic.” It’s just the truth. Facts aren’t a “tactic.” They’re just reality.
The truth is that nothing, absolutely nothing, has slowed the exponential growth of U.S. health care costs over the last 45 years.
The facts are that an MRI in America costs $850 whereas the very same MRI from the very same machine in France costs $45. The facts are that a CBC Chem 7 blood panel in America costs $500 while the very same blood tests in Germany costs $35. The facts are that general practitioner doctors in Europe make between $100,000 and $80,000, depending on the country, while general MD doctors in America twice as much.
Dick Cheney wanted you to vote for him and give money to his fear-industrial complex.
I’m not asking anyone to vote for anything or anyone. I’m not asking anyone for money. That’s the difference.
I’m just pointing out facts about America’s broken medical-industrial complex. And everyone denies, denies, denies, denies, denies, denies, denies. You point out the facts and you’re evil, you’re a corporate apologist, you’re a tool of the super-rich, you’re a Republican, you’re insane, you’re a monster, you’re a devil, you’re a madman, yadda yadda, on and on and on.
Exact response I got when people like me pointed out that there was no evidence of WMDs, that we should strengthen the cabin doors of airplanes and then post a big warning sign THERE IS A MICROSCOPIC BUT UNAVOIDABLE RISK IN AIR TRAVEL. TO PRESERVE YOUR CIVIL RIGHTS, PLEASE SIGN A STATEMENT SAYING YOU ACCEPT THAT RISK, OR TAKE ANOTHER FORM OF TRANSPORTATION OTHER THAN AIR TRAVEL. And then do nothing else about 9/11. No Department of Homeland Security, no massive invasion of Afghanistan, no troops stationed in Iraq, nothing. Just protect ourselves and go on about our everyday lives without cringing helplessly in fear from 9/11.
And when I suggested that, people like Kay screamed hysterical insults and crazed lies, just like they are now when the non-reform HCR bill has clearly and obviously not fixed our broken medical-industrial complex and we’re headed for a complete crash and burn, a total breakdown of the U.S. health care system.
Then as now, people like me are told to shut up. Then as now, the collapsing system continues to collapse but everyone who points this fact out is shouted down, told to be quiet, hysterically denounced as evil and a traitor and a monster and a lunatic.
Heinrich Schiller said it best:
Against folly, the gods themselves contend in vain.
mclaren
@CADoc:
And therein lies the problem.
Take a look at this chart. It shows clearly that American general practice MDs typically make as much as $151 per office visit in private practice for privately insured patients.
So a typical American GP MD can either make $151 per office visit from a privately insured patient…or $25 per office visit from an office visit paid for by MediCal.
No wonder doctors are refusing Medicaid and Medicare patients.
Take another look at that chart cited above. Notice something?
Routine doctor’s office visits in the U.S. cost $151, but a routine doctor’s office visit in France costs $31, in Germany it costs $22.
Exact same training, exact same tests, exact same equipment…but the German or French doctor’s visit costs 1/6 to 1/7 as much as in America.
That’s the problem.
The problem is the cost of American medical care. The problem is greed. The problem is people like CADoc and greedy insurance company CEOs and greedy hospital administrators and greedy medical devicemakers.
Greed up and down the line, massive collusion, illegal restraint of trade, sweetheart lock-in contracts, non-disclosure agreements that forbid hospitals from disclosing prices to insurers, giant cartels that lock patients into those insurers.
Greed, collusion and corruption, massive bribery up and down the line throughout America’s broken health care system. That’s the problem. Not insufficient remuneration, as CADoc is trying to claim, and not “expensive experimental technology” as medical devicemakers try to claim and not “freeloading uninsured patients” as hospitals try to claim and not “insufficient premiums to cover health care costs” as insurers try to claim.
$22 for a doctor’s visit in Germany. $151 for a doctor’s visit in America.
That’s not an argument. That’s just a simple documented fact, and it’s unsustainable.
mclaren
@kay:
Sure the states can do that. In fact, the states are doing that. The states turn people down for basic medical care, and then people go to “alternative medicine” quacks for worthless quack treatments, and the people die.
See What would 34 billion of quack money buy you?
There was a story just last week about a woman in Oklahoma who was too poor to afford dental treatment. She begged and begged the state for help, but the state had cut back on its medicaid program and no mas. She got a dental infection and died.
See Medicare, medicaid cuts threaten health care.
That’s what states are doing. They turn sick people down for medical treament, and the sick people crawl away into the street and die.
And it would be easy to say “Oh, it’s the states’ fault,” but the brutal reality remains that the states just don’t have the money. Health care costs keep climbing and climbing and climbing, up and up and up and without limit. States are broke. They’re shutting down their streetlights and grinding up their paved roads to gravel to lower maintenance costs. States are shutting down police departments and closing schools because the states are drowning in red ink.
So the states tell sick people there’s no money to pay for them to see a doctor, and the sick people get frantic and desperate and go see a chiropractor or a psychic surgeon or some quack New Age crystal healing “therapist” who will do nothing for them. And the sick people die.
That’s what’s happening. That’s the reality. That’s not an argument, it’s just a fact. That’s the reality on the ground in 2010.
The entire U.S. medical-industrial system is broken, and it’s getting worse. We’re rapidly approaching a point of catastrophic crisis where no one has access to health care. No one.