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In Other News, Medicaid Expansion Works Beautifully

While the wonk created Rube Goldberg contraptions known as the exchanges goes through their problems, one aspect of ObamaCare has gone off without a hitch - Medicaid Expansion:

The underdog of government health care programs is emerging as a rare early success story of President Obama's technologically challenged health overhaul. Often dismissed, Medicaid has signed up 444,000 people in 10 states in the six weeks since open enrollment began, according to Avalere Health, a market analysis firm that compiled data from those states. Twenty-five states are expanding their Medicaid programs, but data for all of them was not available.

[...] The Obama administration plans to release October enrollment statistics this week, but publicly available figures already provide a contrast between a robust start for Medicaid expansion and lukewarm early signups for new, government-subsidized private plans offered separately under the law. "Medicaid is exceeding expectations in most places," said Dan Mendelson, Avalere's president. "It is definitely a bright picture in states that have chosen to expand."

The wonky proponents of the exchanges aren't particularly interested, but it does prove that the public insurance component of ACA is the superior part of the program.

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  • Display: Sort:
    And that we were right (5.00 / 2) (#2)
    by Dadler on Thu Nov 14, 2013 at 11:03:28 AM EST
    And that the failure to fight for the public option will mean that, if it is implemented ever, it will take even longer than it should have.

    Yet again, an utter failure of imagination on behalf of my "beloved" Democratic party. And its pitiful, submissive acceptance of right wing paradigms defining the debate. Well, that and a few dollops of corruption and plain ol' stupid.

    But hey, maybe people we'll see the light and demand it earlier. And win.

    Hey, a man can dream.

    The fix announcement (5.00 / 2) (#3)
    by TeresaInSnow2 on Thu Nov 14, 2013 at 11:17:29 AM EST
    Hope, hope, hope, change, change, change.

    Please, Obama and insurance company, give me another year in my "substandard" plan.  I am such a rube, I know, but having up-front coverage for my own conditions is much more helpful to me than getting "good" Obamacare coverage, at the cost of having no up-front coverage at all, double the deductible and higher premiums.  

    Of course, I highly doubt that insurance will go along with this.  They've already issued the plans.  But hope, hope, hope.

    And I'm being facetious (none / 0) (#4)
    by TeresaInSnow2 on Thu Nov 14, 2013 at 11:20:22 AM EST
    My coverage was not great, but compared to the Obamacare plans, it was AWESOME.

    Parent
    At what point do people just give up on this? (none / 0) (#11)
    by Slado on Thu Nov 14, 2013 at 01:08:15 PM EST
    He doesn't have the legal authority to do this fix so what's the real plan?

    The cynic in me thinks this was a totally political move to put pressure on the House and few stupid republicans to bail him out along with democrats looking for any exit they can find.

    Republicans would be smart to throw their hands up in the air and let this thing keep imploding.

    What a mess.

    This guy doesn't have a clue.

    Parent

    I find (5.00 / 2) (#53)
    by Ga6thDem on Fri Nov 15, 2013 at 07:44:39 AM EST
    that interesting. The real problem with Obamacare is it shows the absolute failure of the privatization model that Republicans love so much.

    The thing is if the GOP does not vote for the fix they have lost the right to complain to about people losing their insurance.

    I don't think Obama planned this but the GOP is once again reaping what they have sowed. If they had kept their mouths shut and let the plan fail or succeed on its own the would have been better off. Now they have put themselves in a position of actually having to vote for the fix to the problem that they have been complaining about or look stupid. I'm guessing they will choose to look stupid once again.

    Parent

    My sentiments exactly (as they say) (none / 0) (#57)
    by christinep on Fri Nov 15, 2013 at 09:27:16 AM EST
    It really is the "fish or cut bait" scene for Repubs.  (Other versions of "fish or cut bait" may be more apt ... but, I've self-censored those expressions.)

    Parent
    Give me a break (none / 0) (#60)
    by Slado on Fri Nov 15, 2013 at 10:27:15 AM EST
    Nothing could be farther from the truth.

    The death of Obamacare would prove that large central planning doesn't work.

    Republicans favored all sorts of things including the individual mandate (not the employee mandate) .

    Dems put this nto practice on a National level and own it and then piled on top all the standard liberal/progressive policies like extra regulations, more goodies for non payers etc.....

    The combination of the two plus general bureaucratic incompetence has led us to this point.

    To now try and say Obamacare is republican ideas at work is just laughable and frankly irrelevant.

    Even if true (which its not) it doesn't matter.   This is a democratic program and will go down in history as one.   For better or wors.

    Parent

    It does prove that health insurance programs (5.00 / 4) (#62)
    by MO Blue on Fri Nov 15, 2013 at 10:45:32 AM EST
    based on Heritage Foundation recommendations and enhanced by the insurance and medical industries don't work.

    The truth is what it is. Will the Dems be blamed for passing the insurance based system developed by the Republicans in the 90s and implemented by a Republican governor? Sure that more than likely is what will happen and is the only valid point in your comment.

    Parent

    More than likely will (none / 0) (#133)
    by MKS on Sat Nov 16, 2013 at 08:40:23 AM EST
    happen....

    Central Planning will be to blame.

    That will be the narrative if Obamacare completely fails.  How you get from there to single payer remains a mystery.

    Parent

    It will be that government should not (5.00 / 3) (#134)
    by MO Blue on Sat Nov 16, 2013 at 09:22:54 AM EST
    be involved in health care and that the private insurance based "free market" is the only way to go.

    The fact that Obamacare was poorly designed and had a risk of failure always put any and all types of government based health policy in jeopardy. The promise that if you like your current insurance, you can keep it was always untrue due to elements of the legislation that were designed to eliminate good coverage. That along with the p!ss poor roll out only increases the a risk that was always present even though Obama supporters did not want to acknowledge that there was any risk involved in the legislation.

    Many think if Obamacare fails we will be able to get to a single payer system. I am not that optimistic. Either Obamacare will be patched up enough to limp along and we will continue to be charged more and more for increasing less coverage or it will be dismantled and we will wind up with another plan designed by the Republicans that is even worse.

    Under either scenario I don't see us getting to single payer anytime soon. I believe that Dr. Emanual was right when he stated that Obamacare is what it is and it is not going to lead to single payer.

    Parent

    A public option (5.00 / 2) (#141)
    by MKS on Sat Nov 16, 2013 at 02:32:41 PM EST
    could be grated onto Obamacare.....

    If Obamacare is scraped entirely, the Republicans win...and there will be no health care for millions upon millions....  

    Parent

    There will be no health care for (5.00 / 5) (#144)
    by MO Blue on Sat Nov 16, 2013 at 03:11:58 PM EST
    millions upon millions even if Obamacare survives.

    In case you have forgotten, the Dems continued to weaken the public option at every turn until such time that the conditions that they established guaranteed that the option would not and could not compete against private insurance. If the Dems had included the final version of the public option, it would have failed miserably in a relatively short time. Don't see how anything has changed since Obama made a deal with the health care industry not to include a robust public option. The industry does not want it and Obama wants their help to keep this POS system alive.

    This is not a slam per se but I do find it ironic that those of us who advocate for single payer are consistently told that we are being unrealistic yet supporters of ACA keep claiming that Obamacare will be continually improved into something great and wonderful. In this corporate centric environment, all these changes to made it better are as likely to happen as implementing a single payer system - meaning ain't going to happen any time soon.  To the best of my knowledge, all the changes that have been made to system since it was signed into law have made it less progressive and not more.  

    While I am not going to remain silent on the deficiencies of this insurance legislation, I am not cheering for it to fail right now either. While I believe the ability of people in the U.S. to get good quality affordable health care will continue to deteriorate, the deterioration will be slightly slower under Obamacare then it would be under whatever system that the Republican devised.

    Parent

    Not now, but in 2016 (none / 0) (#180)
    by MKS on Sun Nov 17, 2013 at 04:54:34 PM EST
    Let's see what Hillary can do.

    The cake is baked for Obama. A Democratic Congress will be needed and that is unlikely to happen prior to 2016.

    Parent

    "Grafted," not grated. (none / 0) (#143)
    by MKS on Sat Nov 16, 2013 at 02:43:41 PM EST
    Large (5.00 / 2) (#65)
    by Ga6thDem on Fri Nov 15, 2013 at 12:15:44 PM EST
    central planning is the basis of privatization. Obamacare is a perfect example of the pitfalls of privatization---it costs the tax payers MORE money for inferior results and enriches the few at the expense of the many. Military privatization has done the same thing. Privatization of Peachcare here in GA has done the same thing---people don't get care and WellCare walks away with a boat load of money just for "managing" the program.

    So the GOP just wanted to mandate people buy insurance but not their employers? That is WORSE than Obamacare. So a waitress was going to be forced to buy junk insurance under the GOP. That's really wonderful.

    I don't know why you and Jim are so defensive about this and saying over and over it's a democratic plan. I think you two doth protest too much. All we have to do is point to Romneycare in Mass and Newt Gingrich and Bob Dole and a host of others to show where the idea came out of. Obama should not have passed a Republican plan but he thinks that the GOP is the "party of ideas" and he likes their ideas better it seems. And the irony is that the part of the plan that is liberal is actually working while the conservative parts of it are failing.

    Parent

    It's Really Odd... (none / 0) (#90)
    by ScottW714 on Fri Nov 15, 2013 at 01:57:30 PM EST
    ...when you consider that Slado's claim to fame is that he is not a republican.

    Parent
    Conservative libertarian (none / 0) (#148)
    by Yman on Sat Nov 16, 2013 at 08:57:08 PM EST
    = Republican who doesn't really care much about the social agenda, as long as they just keep their hands off his $$$.

    Parent
    Heh (5.00 / 2) (#147)
    by Yman on Sat Nov 16, 2013 at 08:53:42 PM EST
    The death of Obamacare would prove that large central planning doesn't work.

    Right.  Just as it doesn't work in Great Britain ...

    ... and Japan ...

    ... Canada ...

    ... Norway ...

    ... Sweden ...

    ... Spain ...

    ... Italy ...

    ... etc., etc.

    Parent

    And then Obama (none / 0) (#61)
    by TeresaInSnow2 on Fri Nov 15, 2013 at 10:28:39 AM EST
    Obama has said that he would veto Upton's "fix".  So they're all in a garbage stew of their own making.

    Parent
    Obma's fix is just more of the same (none / 0) (#14)
    by Slado on Thu Nov 14, 2013 at 01:15:03 PM EST
    You'll have to excuse me (none / 0) (#16)
    by TeresaInSnow2 on Thu Nov 14, 2013 at 01:39:28 PM EST
    I am in survival mode right now.  The law is devastating at my house.

    Parent
    I can only imagine (none / 0) (#21)
    by Slado on Thu Nov 14, 2013 at 02:23:01 PM EST
    Sorry.

    I have a friend in the same spot.  He had his own plan.  His wife had hers and now they just had a baby.

    They both got letters about 3 weeks ago.

    They have no idea what to do.  

    Sucks.

    Parent

    Yep (none / 0) (#23)
    by TeresaInSnow2 on Thu Nov 14, 2013 at 03:08:28 PM EST
    And our insurance commissioner just said no to Obama's ploy.

    So Congress will have to vote on it. And it means "bargaining".  Sucks to be whoever is on the losing end of that situation.

    Parent

    Yeah, right. (none / 0) (#111)
    by Donald from Hawaii on Fri Nov 15, 2013 at 03:15:37 PM EST
    Slado: "This guy [President Obama] doesn't have a clue."

    Whereas by sole virtue of your wealth of right-wing bromides and libertarian platitudes, you do.

    LOL.

    Parent

    If you like your health insurnace you can keep it (none / 0) (#31)
    by ragebot on Thu Nov 14, 2013 at 06:08:19 PM EST
    and this time I really mean it.

    Parent
    You could have had the public option... (5.00 / 4) (#5)
    by redwolf on Thu Nov 14, 2013 at 11:50:14 AM EST
    Most american business want to be out of providing healthcare.  Instead the Dems went for the that sweet kick back money from the insurance industry.

    The big problem with Obama is hurts the majority of people while helping a small minority.  This exact opposite effect of programs like social security and medicare.  If you want a successful program you need to hurt a few people (mostly the rich) and spread the benefits to the greatest number of people.  This is of course impossible with Obamacare because people with pre-existing and chronic conditions cost so much more than healthy people. Thus you'll always be hurting more people than you help.


    One factor, tho (5.00 / 1) (#58)
    by christinep on Fri Nov 15, 2013 at 09:37:49 AM EST
    If the ongoing battle healthcare reform seems big/nasty/hardline, it would pale compared to the ferocity and fear that jettisoning the entire "capitalist" model of health care that the US has suffered through all these years.  Regulatory reform, such as might describe large parts of the ACA, spurred outcries of "death panels" and more; the fear & loathing machine of organized conservatives, imo, would have been much harsher proportionate to more government operation or involvement.  

    The mix really does get you part way there ... and, that means a lot to the many millions who have not been able to be insured until ACA (as well as the regulatory reforms respecting rights regarding application and insurance performance.)

    Just something to consider.

    Parent

    Great they have Medicaid... (5.00 / 1) (#6)
    by kdog on Thu Nov 14, 2013 at 12:05:54 PM EST
    but am I the only one bummed to learn of another 444,000 people making less than 15,856 per year individual/32,499 Family of Four?

    My hat's off to these people cuz I have no clue how they do it...must be some good strong stock.  Granted, some of those folks are surely making money under the table somewhere, which would explain how they eat...but still.  

    If they weren't (5.00 / 1) (#12)
    by Zorba on Thu Nov 14, 2013 at 01:10:01 PM EST
    making some money under the table before, they're probably trying to now, since their good stamps got cut on November 1.

    Parent
    And (5.00 / 1) (#18)
    by TeresaInSnow2 on Thu Nov 14, 2013 at 01:41:27 PM EST
    because their Medicaid will be cut if they make one penny over the eligibility.

    And people on subsidies will do the same, because if they go over subsidy threshold they have to repay.  

    Parent

    Meant "food stamps" (none / 0) (#15)
    by Zorba on Thu Nov 14, 2013 at 01:15:29 PM EST
    Stupid autocorrect.

    Parent
    some auto corrects (5.00 / 2) (#132)
    by fishcamp on Sat Nov 16, 2013 at 07:54:38 AM EST
    are pretty funny though,  rarebit is actually ragebot and there's a couple more out there.  I would go through all the names but I have to make up several deep drop Grouper rigs.  Lead is so expensive these days that we crimp 400 lb. leader to the 5 lb. lead balls to get down 600' in strong current.  I need a mate...send photo of boat.


    Parent
    And that is 10 States. (none / 0) (#17)
    by ScottW714 on Thu Nov 14, 2013 at 01:39:39 PM EST
    I wonder what that number would be if they extrapolated it over the entire country including the states that took a pass on expansion.

    Parent
    Yeppers! (5.00 / 3) (#7)
    by DebFrmHell on Thu Nov 14, 2013 at 12:09:26 PM EST
    Very excited about Medicaid. [/sarc] Now all I have to do is quit my job, sell my house, and move out of Texas.

    Voting for Wendy Davis!

    100 percent covered by Feds (5.00 / 5) (#10)
    by Big Tent Democrat on Thu Nov 14, 2013 at 12:56:35 PM EST
    Next question?

    For 2 years only (1.00 / 4) (#27)
    by beefeater on Thu Nov 14, 2013 at 05:26:25 PM EST
    then they're on their own.

    Parent
    Before commenting on this subject further, (5.00 / 4) (#29)
    by MO Blue on Thu Nov 14, 2013 at 05:47:25 PM EST
    it might be advantageous for you read up on the subject so that you post accurate information.

    The federal government will pick up 100% of the cost of the Medicaid expansion for the first 3 years (2014-2016) not 2. Thereafter the government will pick up no less than 90% of the costs on a permanent basis. The government absorbing at least 90% of the cost on a permanent basis can in no way be interpreted as the state being on their own by any rational person.

    Parent

    Where do the feds get the money (none / 0) (#36)
    by ragebot on Thu Nov 14, 2013 at 07:46:15 PM EST
    to cover 100% of the cost.

    Parent
    Do you really not understand... (5.00 / 2) (#41)
    by Dadler on Thu Nov 14, 2013 at 11:10:31 PM EST
    ...that the Federal government is WHERE money comes from in the first place? Do you believe that money is like some living organism that divides miraculously if we don't regulate it? For heaven's sake, we live in a fiat system, and every choice we make about things like this has NOTHING to do with money, since in our system, it is factually impossible for the federal government to go financially bankrupt. That is what being sovereign in your own currency means. So...we make these decisions to cut social security or medicaid or food stamps NOT, and obviously so, because we lack some inanimate trinket of not intrinsic but, but or political and ethical and moral reasons. We simply CHOOSE to make people suffer. And that is just the fact.

    Parent
    that should read... (5.00 / 1) (#42)
    by Dadler on Thu Nov 14, 2013 at 11:12:12 PM EST
    "So...we make these decisions to cut social security or medicaid or food stamps NOT, and obviously so, because we lack some inanimate trinket of no intrinsic value, but for purely political and ethical and moral reasons."

    Parent
    And in other economic news (none / 0) (#49)
    by ragebot on Fri Nov 15, 2013 at 06:20:54 AM EST
    Mugabe wins the Nobel Prize for economics

    Parent
    A. Cost savings in many areas (none / 0) (#52)
    by ruffian on Fri Nov 15, 2013 at 06:33:02 AM EST
    You can argue about the effects on health care of paying hospitals and doctors less for certain procedures, paperwork reductions, and other cuts, but they are where some of the money will come from.

    B. Medical device tax

    C.  other stuff? A&B are the big ones I know off the top of my head.  

    Parent

    lol - From the FED (none / 0) (#55)
    by Mr Natural on Fri Nov 15, 2013 at 08:57:39 AM EST
    In other news, according to Janet Yellen's testimony yesterday, QE ain't stopping any time soon.

    Parent
    Well, you're certainly (5.00 / 6) (#13)
    by Zorba on Thu Nov 14, 2013 at 01:14:26 PM EST
    full of compassion, aren't you?  Bless your heart.
    You do realize that many of these people are working, but don't make very much money?  And many who are not working, most assuredly want to but cannot find a job because there aren't enough jobs available?


    People like this operate out of (5.00 / 4) (#19)
    by Anne on Thu Nov 14, 2013 at 01:44:41 PM EST
    ignorance and urban legend, and have no more clue about the demographics of Medicaid and food stamps than what they find in the darkness of their lower colon.

    Where are negative ratings when you need them?

    Parent

    Speaking of ratings.... (none / 0) (#20)
    by vml68 on Thu Nov 14, 2013 at 02:17:58 PM EST
    you might want to fix yours.... :-) You gave him/her a 5.

    Parent
    Oops! Thanks for letting me know... (none / 0) (#22)
    by Anne on Thu Nov 14, 2013 at 02:34:59 PM EST
    I fixed it.

    Parent
    When I see... (5.00 / 2) (#35)
    by DebFrmHell on Thu Nov 14, 2013 at 07:45:32 PM EST
    posts like the ones here, it gives me faith in humanity.  When I try to address issues of poverty, insurance online, I am usually met with replies like the person above.  Thank you.

    Parent
    Yes, health care (5.00 / 4) (#24)
    by KeysDan on Thu Nov 14, 2013 at 04:31:05 PM EST
    is dangerous to poor people's health.  So, you are clearly on to something--denial of  medical, nursing or pharmaceutical care is just the ticket.   And, that includes no free emergency or urgency care.  Just turn them away and tell them not to bleed on the floor.   My rating probably reflects rating inflation, but parents do exert pressure and the smart grader responds.

    The Congressional Budget Office (5.00 / 1) (#25)
    by KeysDan on Thu Nov 14, 2013 at 04:49:37 PM EST
    estimates that Medicaid expansion will add very little to what the states' would have spent without ACA.  And, as BTD points out, the federal government picks up 100 percent of the costs from 2014 to 2016 (the first three years) and no less than 90 percent on a permanent basis.  

    I have a daughter on medicaid (5.00 / 12) (#28)
    by the capstan on Thu Nov 14, 2013 at 05:28:12 PM EST
    in South Carolina.  She has no job, but she does have her dad's social security, which is paid to the organization that cares for her..  The state says it costs $55,000 a year to provide her with food, shelter, caretakers, transportation, health care, and meds.  Medicare is a necessity--it is the basis of it all.  She's not lazy or indolent.  She has Down;s syndrome.  At 81, I can no longer take care of her--and my pension and SS couldn't stretch far enough to cover her needs too.

    Do you have a handy ice floe for her--and me?


    Oh no, another "taker" (5.00 / 4) (#30)
    by NYShooter on Thu Nov 14, 2013 at 06:04:26 PM EST
    Bless you, Cap, I'm sorry, I just couldn't help it. You, at least have the consolation of knowing there are millions of your fellow citizens in similar situations.

    I have said over, and over, again that before we can even start a debate about health care between the different political factions we should answer this one question: "What kind of a country do we want to have? Are we, as the bible says, 'our brother's keeper,' or, will Darwin rule the roost, 'every man for himself, survival of the fittest?"

    Unfortunately, we've allowed our system to become so corrupted that even a basic question like the one I postulated would prove to be impossible to discuss. As long as we permit slogans, one liners, and, pitting one group against another to be the rules for debating serious issues the debacle we have is the one we will live with.

    I wish I had the answer......I don't.

    Parent

    The owner of this site has a rule (5.00 / 4) (#34)
    by MO Blue on Thu Nov 14, 2013 at 07:29:02 PM EST
    regarding civility. Most of the time that rule is a plus. Unfortunately, there are rare times when it stifles the only really appropriate reply to a comment. This is one of those times.

       

    Here's an interesting point (5.00 / 1) (#44)
    by TeresaInSnow2 on Fri Nov 15, 2013 at 12:24:22 AM EST
    From that ever so good and true healthcare law.

    Remember capped out of pocket maximums and how wonderful they are?

    Well, apparently, our govt did nothing to regulate what had to be included in those OOP maximums.

    From  Healthcare.gov

    The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. This limit never includes your premium, balance-billed charges, or health care your health insurance or plan doesn't cover. Some health insurance or plans don't count your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. In Medicaid and CHIP, the limit includes premiums. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

    In other words, we cap out of pocket maximums but insurance companies have the right to include NONE of your expenses in those maximums.

    "Affordable" Care Act.  The most corrupt law ever.

    Well obviously, (5.00 / 4) (#47)
    by Edger on Fri Nov 15, 2013 at 04:19:10 AM EST
    it was and is meant to be a cap on insurance company expenses. Hence the name Affordable Care Act.

    One of the guiding principles of slippery salesman and con artists is never correct a prospects assumptions.

    "Contrary to the claims of some of my critics and some of the editorial pages, I am an ardent believer in the free market." -- B. Obama, L.O.L.


    Parent
    House votes 261-157 (none / 0) (#109)
    by jbindc on Fri Nov 15, 2013 at 03:08:03 PM EST
    to pass Republican bill giving helath insurers the option of extending canceled plans through 2014.

    Thirty-nine Democrats crossed party lines to vote for the bill.

    It probably stands no chance in the Senate, but if it does, Obama has threatened a veto.

    Parent

    Boston fan puts on an amazing show (5.00 / 2) (#54)
    by Dadler on Fri Nov 15, 2013 at 08:19:42 AM EST
    Dadler (none / 0) (#64)
    by jondee on Fri Nov 15, 2013 at 11:34:21 AM EST
    if you never linked to another interesting thing, that would still make up for it.

    Parent
    CBO's list this week on deficit reduction (5.00 / 3) (#59)
    by MO Blue on Fri Nov 15, 2013 at 10:14:47 AM EST
    The CBO found that a public option based on Medicare would reduce the deficit by $158 billion through reduced spending and increased revenue.

    In the Congressional Budget Office's estimation, premiums for the public plan would be between 7 percent and 8 percent lower, on average, during the 2016-2023 period than premiums for private plans offered in the exchanges--mainly because the public plan's payment rates for providers would generally be lower than those of private plans. In addition, the public plan would be likely to have lower administrative costs than private plans. However, CBO expects that the public plan would be less inclined than private plans to use benefit management techniques (such as narrow provider networks, utilization review, and prior-approval requirements) to control spending. [...]

    One rationale for adding a public plan to the exchanges is that it would help reduce premiums for some individuals, families, and employers who would buy insurance through the exchanges but would not qualify for subsidies. Premiums would be reduced both because the public plan would be one of the lowest-cost plans available in many areas and because adding a low-cost option would increase the competitive pressure on private plans,leading them to decrease their premiums.

    link

    Wow, would cost less for individuals and companies, would not resort to insurance company tricks like narrow provider networks, utilization review, and prior-approval requirements and would save the government money. What's not to like? Oh wait it might dry up campaign contributions from the insurance and health care industries. Can't have that now can we.

    It is a shame that our government is in the pocket of the insurance and medical industries. Affordable universal health care could be a reality if they weren't.

    Wonderful (1.00 / 8) (#26)
    by beefeater on Thu Nov 14, 2013 at 04:52:04 PM EST
    So for this Administration more people on welfare is to be touted as a success?

    How sad is that?

    And this bit of ignorance (5.00 / 4) (#32)
    by sj on Thu Nov 14, 2013 at 06:09:59 PM EST
    is why no one is touting "Medicaid for all", CoralGables. See what means testing gets you?

    Parent
    Sad but true (none / 0) (#38)
    by CoralGables on Thu Nov 14, 2013 at 08:10:17 PM EST
    That AM talk radio develops many a Limbaugh Neanderthal.

    Parent
    It must be really demeaning for you (5.00 / 7) (#33)
    by Edger on Thu Nov 14, 2013 at 06:49:36 PM EST
    having to drive your car on roads that you didn't pay for yourself...

    Parent
    He's covered his car in dollar signs - (5.00 / 3) (#56)
    by Mr Natural on Fri Nov 15, 2013 at 09:02:13 AM EST
    - to ward off influences of the evil socialist road paving.

    Parent
    Yeah well... (5.00 / 1) (#63)
    by Edger on Fri Nov 15, 2013 at 10:46:04 AM EST
    I'm going to bill his credit card a buck for every inhale and every exhale on every breath he draws from now on.

    Where do people get off thinking air should be free anyway? Damn commies. Yeesh.

    Parent

    Yep (none / 0) (#1)
    by jbindc on Thu Nov 14, 2013 at 11:01:12 AM EST
    And one of the things to watch is how many young people sign up for Medicaid, instead of 1) staying on their parents' plans, if possible, until age 26, or 2) buying individual plans on the exchange. (Of course, the demographics of who has "signed up" at this point have not been released).

    The X-factor in all of this is that the administration calculated the success of the law based in part, on the fact that millions of young healthy people would be part of the pool.  But if these young healthy people are opting for Medicaid instead, then the pools are going to be filled with older, and maybe not as healthy, individuals, thereby driving up costs and killing the whole reason the law was passed in the first place.

    Hypothetical: assuming a person is eligible for (none / 0) (#48)
    by oculus on Fri Nov 15, 2013 at 06:05:04 AM EST
    Medicaid but may also be insured via a parent's health care plan, and, assuming said parental unit is willing to pay for the latter coverage, what will the person who is eligible for Medicaid decide?

    Parent
    Depends (none / 0) (#107)
    by jbindc on Fri Nov 15, 2013 at 03:05:49 PM EST
    If mom and dad are willing to absorb (and assuming under 26 adult does not have to pay them), the parental plan is probably better.

    Of course, parent(s) may tell under 26 adult to get Medicaid, as parent(s) cannot absorb the cost.

    Bottom line - whatever is cheaper (in most cases, barring any special needs).

    Parent

    The law was created (none / 0) (#50)
    by Politalkix on Fri Nov 15, 2013 at 06:23:44 AM EST
    to provide the people who are too poor or too sick to get medical coverage when needed. The progressive platform has always been to help the poor and the sick and have the rest of society to help support this goal by absorbing the cost.

    Parent
    Medicare and Medicaid (none / 0) (#51)
    by Politalkix on Fri Nov 15, 2013 at 06:30:21 AM EST
    should read...have the rest of society support this goal by absorbing the cost.

    This progressive goal was also the driving force behind Medicare and Medicaid.

    Parent

    Of course they do (none / 0) (#37)
    by Edger on Thu Nov 14, 2013 at 07:50:21 PM EST
    but medicaid is about delivering health care to people who are not congressional reps or investment bankers...

    great (none / 0) (#39)
    by labrat on Thu Nov 14, 2013 at 10:09:52 PM EST
    As a healthcare worker in a state with 17.7% Medicaid patients already, I'm not impressed. Medicaid already owes our hospital millions. Say goodbye to any chance of ever getting a damned raise. (Haven't had one in 7 years.)

    and to the guys above - the Feds will only cover Medicaid expenses for people that qualify under expansion guidelines. The states are on the hook for the full boat of any additional enrollees that were already qualified but were not enrolled before the ACA.

    A couple of questions (5.00 / 2) (#40)
    by MO Blue on Thu Nov 14, 2013 at 10:50:50 PM EST
    How much is owed by people who use the ER for their medical care since they do not have any insurance or any funds to pay out of pocket?

    Has the CEO and top administrators at the hospital gone without a raise for the same 7 years?

    Parent

    Question for those who are knowledgeable about (5.00 / 1) (#77)
    by vml68 on Fri Nov 15, 2013 at 01:00:09 PM EST
    this.... I was under the assumption that ERs have to accept any patient that shows up regardless of their insurance or lack thereof.
    Yet, when I was in the ER last year, I saw quite a few signs saying they don't accept Medicaid. How is that possible?

    Parent
    Maybe (5.00 / 2) (#83)
    by TeresaInSnow2 on Fri Nov 15, 2013 at 01:13:48 PM EST
    The hospital generally doesn't accept Medicaid patients, even though the ER is, as you've said, required to?

    Basically, the ER is for stabilization.  Once patients are stabilized, they don't have to care for them anymore.

    They'll likely need to be sent elsewhere if they need real care.  It's the same thing the narrow network Exchange plan patients will deal with.  The drawback for the Exchange patients is the grey area between what is and isn't covered in an ER.  If the "plan" deems that something isn't covered, the the patient will have an out of network charge AND a balance bill...and no out of pocket max on out of network ERs.  At that point, it'll be worse than being a Medicaid patient.

    Parent

    Don't know the answer but (none / 0) (#84)
    by MO Blue on Fri Nov 15, 2013 at 01:19:40 PM EST
    curious what state you are in and the type of hospital.

    Parent
    I am in NJ. Not sure what you mean by type (none / 0) (#102)
    by vml68 on Fri Nov 15, 2013 at 02:32:53 PM EST
    of hospital.

    Teresa - you are probably right. I assumed since it was posted in the ER that it was for ER services.

    Parent

    Well there are different classifications (none / 0) (#114)
    by MO Blue on Fri Nov 15, 2013 at 03:42:02 PM EST
    There are private hospitals, teaching hospitals, and charitable hospitals. There may be more classifications. Different types get treated somewhat differently by the federal (maybe state) governments.

     

    Parent

    It is a non-profit teaching hospital. (none / 0) (#124)
    by vml68 on Fri Nov 15, 2013 at 05:43:57 PM EST
    n/t

    Parent
    Non profit teaching hospitals (none / 0) (#130)
    by MO Blue on Fri Nov 15, 2013 at 09:36:57 PM EST
    normally get local, state and federal tax breaks. In some states in return for those tax breaks, they are suppose to accept Medicaid and Medicare. I guess that does not apply or is not enforced in your state.

    Parent
    I'm soooo tired of that ruse (1.00 / 3) (#66)
    by labrat on Fri Nov 15, 2013 at 12:19:32 PM EST
    The VAST majority of people who abuse our ER are Medicaid patients.

    Most responsible working uninsured avoid the ER as much as they can as they get hit with the bill when they have to use it.

    Parent

    Do you know why (5.00 / 2) (#69)
    by TeresaInSnow2 on Fri Nov 15, 2013 at 12:25:49 PM EST
    many of them abuse the ER?

    Because they can't find a doctor who will see them!  Or if they can, the doc is so far outside of their area that they can't practically get there.

    Sorry, but your condemnation of "those evil poor people" is truly disgusting.

    Parent

    bullshit (1.00 / 2) (#70)
    by labrat on Fri Nov 15, 2013 at 12:34:28 PM EST
    Most of them abuse the ER seeking drugs, Period.

    Parent
    LANGUAGE, please (5.00 / 2) (#71)
    by jbindc on Fri Nov 15, 2013 at 12:35:29 PM EST
    language (none / 0) (#78)
    by labrat on Fri Nov 15, 2013 at 01:05:00 PM EST
    sorry - got carried away

    Parent
    Just use asterisks... (none / 0) (#80)
    by kdog on Fri Nov 15, 2013 at 01:08:20 PM EST
    for example, I'd rather buy my percs from the guy in the alley 4 for 20 then even think of f8cking with the ER.  Besides, the ER will just try to pawn off that prescription strength Tylenol bullsh&t on ya because they're scared of the DEA.

    Parent
    you would not believe (none / 0) (#86)
    by labrat on Fri Nov 15, 2013 at 01:31:15 PM EST
    what some of these patients do for drugs. Some of them show up in our ER up to 15 times a month (and when they are not in ours they are in other area hospitals.) Sometimes 3-4 ER's in the same day!
    I'm talking real abusers here. They come in for lunch, they fake hypoglycemia for a ride home in an ambulance, they steal supplies (last week someone ran out with pillows!). All we can do is smile at them and say "how can I help you today"? It's insane.

    Parent
    I believe it... (5.00 / 1) (#87)
    by kdog on Fri Nov 15, 2013 at 01:45:47 PM EST
    my sister in law is an x-ray tech, she's told me stories of the addicts faking it looking to score.  Though I'd be careful to paint too broadly with that brush...some are people in real pain who need relief.

    I think your beef is with congress, if anybody could buy them as easy as buying aspirin, as it should be...they wouldn't be down at the ER fishing for scripts.  And doctors wouldn't have to worry about losing their prescription pad for helping patients dealing with real chronic pain.  Drug war f*cks everything up.

    Parent

    Just because someone may be looking for drugs (5.00 / 3) (#95)
    by shoephone on Fri Nov 15, 2013 at 02:17:36 PM EST
    doesn't mean medical professionals are required to simply hand out pills. That's not how ER's operate. But isn't it nice that the new troll derailed the conversation?

    Parent
    No... (none / 0) (#101)
    by kdog on Fri Nov 15, 2013 at 02:31:25 PM EST
    and I'd estimate in most cases they don't give out any good drugs...just the aforementioned Tylenol w/ Codeine bullsh*t or nada.

    But the ER is required to at least hear them out, which to be fair does waste time and resources.  But as far as the problems with our systems of health care and health insurance, this "problem" is so far down the list it doesn't even rate...it's classic kick the dog.

    My sister the RN shares similar complaints as labrat...I try to explain to her she is letting her daily work drudgery cloud her thinking of the big picture, but she doesn't get it.  To be fair, any job will do that to ya if you're not careful to keep perspective...I go home from the cube  cursing shameless millionaire owners who want everything for free, and homeowners of McMansions who think they're entitled to everything under the sun just because their plumbing do-hickey is defective.  Then I go home, pull a couple tubes and remember people are people, and it's just the nature of the work-beast.  Ya can't judge whole swaths of people based on limited personal experience...but easier said than done.

    Parent

    I agree with you there (1.00 / 1) (#91)
    by labrat on Fri Nov 15, 2013 at 01:59:56 PM EST
    I despise our current drug regulations.

    My beef is with the myth that the working uninsured just willy nilly use the ER. In my experience - they don't. The people that I personally see that are most abusive of the use of ER's are Medicaid patients. For the most part the abusers are drug seekers and young mothers with children. They display (in general) a total lack of regard for the resources they demand and an air of entitlement, not gratitude. That's been my experience for what it's worth. A very small segment of people that are consuming an enormous amount of resources wastefully. Sadly, no one wants to address this problem because as you see - everyone labels you as heartless.

    Parent

    This (5.00 / 2) (#92)
    by shoephone on Fri Nov 15, 2013 at 02:13:47 PM EST
    They display (in general) a total lack of regard for the resources they demand and an air of entitlement, not gratitude.

    seems a good summation of how you feel about patients living in poverty. Oh, if only they would show you gratitude while you're busy judging them and loathing their very existence! Plus all that other nonsense you said about how they think you like them because you're so good at hiding your true feelings. I very much doubt you're as good at it as you claim.

    I certainly hope you don't work at a hospital in Washington State. You are the last person I would ever want to have to encounter if I'm in need of medical care.

    You might want to consider changing careers. Working for a collection agency, perhaps. You'd get to hassle and berate people to your heart's content.

    Parent

    ok (none / 0) (#97)
    by labrat on Fri Nov 15, 2013 at 02:20:10 PM EST
    I'm loathing and heartless and I kill puppies too!

    Parent
    depending on the puppy's color (none / 0) (#99)
    by jondee on Fri Nov 15, 2013 at 02:25:15 PM EST
    and it's owner's yearly income..

    Parent
    Wow (5.00 / 2) (#112)
    by MO Blue on Fri Nov 15, 2013 at 03:33:09 PM EST
    Now it isn't just drug addicts. You have included mothers with young children to the mix.

    They are not sufficiently grateful. An air of entitlement. "Those people" just don't bow and scrape enough to suit you. No wonder you object to Medicaid.

    Ever think about going to work for one of those closed practices that only accept the richest people who can pay a large annual fee. Don't know if they will be sufficiently grateful. They may have an air of entitlement and go to the doctor to score drugs but I'm sure you would be a kinder, gentler less judgmental person when serving an elite clientèle.  

    Parent

    So according to you the majority of (none / 0) (#96)
    by MO Blue on Fri Nov 15, 2013 at 02:18:58 PM EST
    your ER patients are drug addicts on Medicaid wanting to score drugs. I'm sure some of them are as you describe but I kinda doubt that they make up the majority of the ER patients and I would guess that a portion of those addicts either are uninsured or have other types of insurance.

    Now lets create your ideal world and eliminate Medicaid entirely but keep in place the same requirements that exist now for ERs to treat people. Do you really think that eliminating Medicaid would eliminate drug addicts coming to the ER to score drugs? Personally I think the same addicts would show up in your ER. The only difference would be that your hospital would receive no payment at all for the service.

    Parent

    What I said (none / 0) (#100)
    by labrat on Fri Nov 15, 2013 at 02:26:30 PM EST
    is that those who most abuse ER services are drug seekers on Medicaid not the poor working uninsured. In my personal experience.

    Very few of our frequent flyer drug seekers are uninsured.

    Parent

    Onc more time (5.00 / 1) (#108)
    by MO Blue on Fri Nov 15, 2013 at 03:06:52 PM EST
    You object to expanding Medicaid because drug addicts on Medicaid abuse the system but you have not answered the question.

    Do you really think that eliminating Medicaid would eliminate drug addicts coming to the ER to score drugs?

    Of course, if we decide not to expand Medicaid or eliminate Medicaid altogether those who are not drug addicts would lose their benefits as well.  The working poor families who comprise 65% of Medicaid recipients would lose their benefits so that you don't have to deal with people who don't meet your standard of deserving people.

    Parent

    I can only speak for Hawaii, but ... (5.00 / 2) (#116)
    by Donald from Hawaii on Fri Nov 15, 2013 at 03:52:44 PM EST
    ... the majority of people on Medicaid out here don't use the ER as their primary portal to health care, for the simple fact that they have health care coverage by virtue of Medicaid and will seek care in other settings, such as community health centers and medical co-ops / clinics.

    Further, I'd hazard to guess that most people with debilitating drug addictions who DO show up in the ER seeking a fix are likely uninsured, rather than insured.

    Aloha.

    Parent

    Statistics prove that you are right (none / 0) (#118)
    by MO Blue on Fri Nov 15, 2013 at 04:23:52 PM EST
    The uninsured and those with private insurance each individually have higher ER visits for substance abuse than people on Medicaid.

    With the expansion that could change somewhat since more single men without families will be eligible for Medicaid. OTOH with mental health and substance abuse treatment becoming part of the required benefits more people might be able to get into programs that would help them better than a visit to the ER.

    Parent

    Guess I need to correct my comment (none / 0) (#119)
    by MO Blue on Fri Nov 15, 2013 at 04:31:56 PM EST
    If you combine all types of insurance (Private, Medicare, Medicare and other) , the insured would have a higher percentage of substance abuse related ER visits than the uninsured. If you are comparing people who have Medicaid to those who are uninsured, the uninsured has a higher percentage of ER visits.

    Parent
    huh? (none / 0) (#121)
    by labrat on Fri Nov 15, 2013 at 04:49:00 PM EST
    what stats are you pulling from?

    The drug seekers I'm referring to present in the ER with headaches, back pain and belly aches. Look at the stats on page 14 and tell me I'm all wet again.

    I just hallucinate when I go to work?

    Parent

    One more time (1.00 / 1) (#115)
    by labrat on Fri Nov 15, 2013 at 03:50:00 PM EST
    My point is that Medicaid patients are much more likely to utilize ER service (drug seeker or not)in fact over twice as likely in my state, so I'm tired of hearing about the uninsured abusing the ER.

    I never said I wanted to eliminate Medicaid - I said I didn't want to see it expanded in my state (I was wrong we have 27.7% of the state on Medicaid).

    I don't know where uninsured drug addicts score their drugs but I can tell you that all of our most frequent fliers are Medicaid patients. So I assume (maybe wrongly) that uninsured are less inclined to get them in the ER and more likely to get them on the street.

    Parent

    One more time you provide no data (5.00 / 1) (#117)
    by MO Blue on Fri Nov 15, 2013 at 04:16:46 PM EST
    to substantiate your claims

    How about providing some statistics (percentages) for how many of your frequents fliers have Medicaid, how many have other insurance and how many are uninsured.

    Your estimate of the percentage of people on Medicaid in your state was out in left field and yet somehow your perception is to be bought wholesale. I will give you a little hint - statistics on ER visits due to substance abuse do not agree with the picture you are painting of Medicaid patients visits being higher than those without insurance.

    Parent

    see page 14 (none / 0) (#120)
    by labrat on Fri Nov 15, 2013 at 04:34:28 PM EST
    http://muskie.usm.maine.edu/Publications/PHHP/Maine-Emergency-Department-Use.pdf

    Wasn't an estimate it was a my original 17.7 was a typo.

    and when I talk about drug seekers - I am strictly referring to the most egregious abusers of the ER system. In my ER, all of our most frequent fliers are Medicaid patients. We have one patient that costs us 300-500K per year for the 12 years I've been here.

    Parent

    Do these drugs come in gold capsules? (5.00 / 1) (#122)
    by vml68 on Fri Nov 15, 2013 at 05:11:56 PM EST
    We have one patient that costs us 300-500K per year for the 12 years I've been here

    What kind of drugs are you giving this person that is so expensive?

    Parent

    "In my ER, (5.00 / 2) (#123)
    by NYShooter on Fri Nov 15, 2013 at 05:21:48 PM EST
    all of our most frequent fliers are Medicaid patients." (emphasis mine)

    one patient....300-500K....12 years ?

    You're either a very troubled person, or you've, inadvertently, stepped into a chat site beyond your cognitive ability to navigate, or to be taken seriously.

    Parent

    Browsing through (none / 0) (#135)
    by christinep on Sat Nov 16, 2013 at 09:41:45 AM EST
    I just want to add, NYShooter, that you latched onto a phrase that caught my eye as well.  Sum: The writer presenting as a medical/nurse/hospital specialist strikes me as a shill.  Her/his positions have the increasing stridency and didactic phrasing as a writer or commentator for those drifting in from the right every now and then.

    Parent
    I will give you a hint (5.00 / 5) (#136)
    by MO Blue on Sat Nov 16, 2013 at 09:58:13 AM EST
    Like the cat, the labrat was drawn to the site by the Zimmerman trial.

    Unlike the cat, this is the first time he/she dropped by since the Zimmerman coverage ended.

    Parent

    There is no category for substance abuse (5.00 / 1) (#125)
    by MO Blue on Fri Nov 15, 2013 at 05:55:39 PM EST
    on page 14.

    There is a category for mental health problems. People having bad reactions to mental health drugs, people having anxiety attacks, people who are suicidal or having bi polar or schizophrenia episodes visit the ER. Per your link (page 13)

    Visits for treatment of anxiety and depression
    were the fourth most frequent diagnostic category among both MaineCare and uninsured adults.

    Except for the high prevalence of mental health and dental complaints among two of the three adult
    cohorts, the high volume diagnoses among all the
    adult groups were similar. All three groups included chest pain, acute pharyngitis, abdominal pain, bronchitis, and headache among the top eight reasons for ED visits. Uninsured adults were the only group where treatment for alcohol abuse was among the top 30 diagnoses.

    You and others might want to read the discussion of why there are a high number of ER visits in these categories. The conclusion on mental health issues is illuminating since they decided that the high number suggests undiagnosed or inadequately treated illness - or both.

    National statistic have the ratio of non substance abuse mental health ER visits 2.6 times higher than substance abuse only visits. (see page 8 & 9 PDF File) for data that breaks down the categories of mental health and substance abuse rather than just lumping them altogether.

    Parent

    drug seekers (none / 0) (#126)
    by labrat on Fri Nov 15, 2013 at 06:07:17 PM EST
    do not come to the ER for "substance abuse" treatment. They come to the ER complaining of headaches, backaches, toothaches and belly pain. Go back to page 14 and take a look at the stats for those.

    Parent
    Yep I get it (5.00 / 2) (#127)
    by MO Blue on Fri Nov 15, 2013 at 06:31:03 PM EST
    Each and every person who is on Medicaid who comes into the ER regardless of diagnosis is a drug addict trying to score drugs. Each and every person who comes into the ER for chest pain, backache, acute pharyngitis, abdominal pain, bronchitis, and headache who has private insurance or is uninsured is there because they have a legitimate problem. Also, those with private insurance or are uninsured are not abusing the system by going to the ER for a headache. No way. Their problem is real and needs immediate ER treatment.

    The people who did the study took the time to break out anxiety and depression and highlighted it as the most serious problem within the mental health category but didn't feel it was necessary to mention drug abuse. And the people who did the study only broke out treatment for alcohol abuse as a separate category to make the uninsured feel bad. Yep, that makes all the sense in the world. <snark alert.

    Parent

    And what kinds of drugs are they given (5.00 / 2) (#128)
    by shoephone on Fri Nov 15, 2013 at 06:50:15 PM EST
    for headaches, toothaches, backaches and belly pain?

    Because the only "drug" I've ever been given for those things was prescription ibuprofen.

    Are you and your cohorts handing out valium and oxycontin for headaches, toothaches, backaches and belly pain? Sounds like the problem is with the ER staff, not the patients.

    Parent

    If the headaches is a migraine (5.00 / 2) (#129)
    by shoephone on Fri Nov 15, 2013 at 06:56:04 PM EST
    (debilitating, in case you've never had one) there are at least 25 prescription medications for that, which an uninsured, poor person would likely not be able to afford.

    Parent
    Got Any Sort of Proof... (5.00 / 2) (#73)
    by ScottW714 on Fri Nov 15, 2013 at 12:50:04 PM EST
    ...like a link ?

    Parent
    nope (none / 0) (#79)
    by labrat on Fri Nov 15, 2013 at 01:06:55 PM EST
    just real life experience. I see it everyday. I can tell how busy my night will be just by knowing what doc is on in the ER. They know when the "candy man" is on duty.

    Parent
    A doctor on staff at your facility (5.00 / 2) (#137)
    by MO Blue on Sat Nov 16, 2013 at 10:04:17 AM EST
    is known to give out drugs to addicts on a regular basis but Medicaid is the problem?

    I agree with shoephone. Your facility has a major staffing problem in more ways than one.

     

    Parent

    You must be one of those sullen aides (5.00 / 2) (#74)
    by Anne on Fri Nov 15, 2013 at 12:51:39 PM EST
    whose day isn't complete unless they've made someone needing medical care feel like sh!t on the bottom of their shoe.

    Yeah...we've all run into people like you, and wondered why someone with that kind of attitude chooses to work "caring" for people.


    Parent

    none (2.00 / 1) (#81)
    by labrat on Fri Nov 15, 2013 at 01:09:01 PM EST
    of my patients have a clue what I really think of them. They like me, and think I like them. Try again.

    My beef is we do them no favors. None. We enable them.

    Parent

    Wow (5.00 / 1) (#85)
    by jbindc on Fri Nov 15, 2013 at 01:28:49 PM EST
    And people wonder where (5.00 / 4) (#94)
    by jondee on Fri Nov 15, 2013 at 02:15:50 PM EST
    the authors of One Flew Over the Cuckoo's Nest and Misery got their models from..

    Parent
    My sister's nickname... (none / 0) (#103)
    by kdog on Fri Nov 15, 2013 at 02:35:15 PM EST
    ain't Nurse Ratched for nuthin'! ;)

    But I love her to death...she knows not what she says & thinks sometimes.  She's also against alcoholics getting liver transplants...and our dear departed Pops was an alcoholic! Ice cold/heart of gold dichotomy...go figure.

    Parent

    I have a cousin who's an RN, and ... (5.00 / 3) (#113)
    by Donald from Hawaii on Fri Nov 15, 2013 at 03:40:08 PM EST
    kdog: "My sister's nickname ain't Nurse Ratched for nuthin'!"

    ... she's also a teapartyin' wingbat who would similarly complain about people abusing the ER looking for drugs. In fact, she complained about that all the way up to the time she was finally caught stealing narcotics from the hospital pharmacy.

    Then she changed her tune somewhat, and complained that because she was addicted to pain medication, she shouldn't be held legally responsible for her actions and should instead be treated with compassion.

    She eventually received a deferred acceptance of guilty plea in exchange for completing drug rehab and other community service requirements, and is now clean and sober, and singing a far different tune about drug addicts in the ER than in the past, thanks to her personal experience and brush with the law.

    That said, I've always found it somewhat sadly amusing that those persons who publicly advocate that the less fortunate should take greater personal responsibility for their own lives and fates, will then exempt themselves from their own prescribed code of conduct whenever it's personally expedient to do so.

    Aloha.

    Parent

    If you are in the health care field, (5.00 / 2) (#76)
    by MO Blue on Fri Nov 15, 2013 at 12:59:47 PM EST
    with your attitude I would suggest that you are already overpaid.

    Parent
    you would be wrong (none / 0) (#82)
    by labrat on Fri Nov 15, 2013 at 01:10:52 PM EST
    but you're entitled to your opinion.

    Parent
    So We Should Believe You... (5.00 / 2) (#88)
    by ScottW714 on Fri Nov 15, 2013 at 01:54:40 PM EST
    ...even though you have clearly lie to people, your patients, and have fairly ugly attitude in regards to people ?  IOW, I don't believe you, you are not a person of character and obviously have some sort of axe to grind.

    And save you non-sense, we have all been in the Emergency Room, I doubt the kids, old people, and other folks with serious injuries are doing it to score drugs as you keep claiming.  

    You don't respect your patients, the doctors you work with, and by the idiotic things you have said, you don't respect yourself.

    Which begs the question, why are you working in an environment you clearly hate ?

    Parent

    so (none / 0) (#93)
    by labrat on Fri Nov 15, 2013 at 02:14:02 PM EST
    because I'm defending the poor working uninsured against the constant slander that they abuse ER services, I'm not compassionate? Sorry if I don't apologize for having a lot more sympathy for the guy who can't afford insurance and finds himself in the ER and questions the necessity of everything we do for him because "I can't afford that" over the Medicaid patient that strolls in at lunch time because she has a rash.

    The uninsured get treated. They also get a bill. Some pay, some don't, but they don't get the exact same "free ride".

    Parent

    Well, well (5.00 / 1) (#104)
    by MO Blue on Fri Nov 15, 2013 at 02:44:57 PM EST
    we were originally talking about people on Medicaid and your objection to its expansion but somehow you are now protecting the working poor. Let's look at some facts:

    Medicaid provides health care benefits to certain categories of poorer Americans and legal permanent residents. Most Medicaid participants - 65 percent - are "working poor" families in which someone is employed.

    The uninsured individual who pays ZERO pays the same for ER treatment as someone on Medicaid who pays ZERO. Simple math. ZERO = ZERO regardless.

     

    Parent

    That's is What you Call Defending (5.00 / 2) (#105)
    by ScottW714 on Fri Nov 15, 2013 at 02:51:37 PM EST
    Jesus.

    But that raise you haven't gotten in 7 years probably isn't because of Medicaid.  I suspect the scoundrel responsible can be found in the closest mirror.  That guy with the bad attitude who has convinced himself no one can tell he hates them, while simultaneously b1tching about not getting a raise.

    Better watch it or you are going to end up on some crime show because the hatred boiled over and you ended up in an old folks home with an even larger chip on your should and taking it out on old and defenseless people whom you refer to with the same ugliness.

    Parent

    Hmm I wonder why if the majoraity of (5.00 / 2) (#75)
    by MO Blue on Fri Nov 15, 2013 at 12:53:02 PM EST
    emergency treatment goes to people who have Medicaid the federal government is spending $20 billion annually to reimburse hospitals -- most in poor urban and rural areas -- for treating more than their share of the uninsured. I also wonder why the hospitals in states that are not expanding Medicaid are working furiously to get legislators to change their mind.

    I suggest that you might want to contact the Republican politicians up in D.C. who are on record as stating that the only health care program that the poor need is the ER. Or better yet, you could start petitions for eliminating Medicaid altogether and denying any care to people without private insurance or the means to pay for the care.  

    Parent

    Because that's ... (5.00 / 1) (#89)
    by sj on Fri Nov 15, 2013 at 01:57:18 PM EST
    ... wa-a-y better, right?
    Most responsible working uninsured avoid the ER as much as they can as they get hit with the bill when they have to use it.
    The "responsible" working uninsured prefer getting no care to getting stuck with a bill that they can't pay (because, you're right: ER will send you that bill).

    I guess that's one way to get rid of the potential Medicaid abusers. Provide no care and let them die.

    Parent

    our CEO (none / 0) (#67)
    by labrat on Fri Nov 15, 2013 at 12:21:02 PM EST
    cut her compensation 20% when she cut ours 4%.

    Parent
    Yeah... (5.00 / 2) (#72)
    by ScottW714 on Fri Nov 15, 2013 at 12:49:05 PM EST
    ...the CEO determines her own compensation, good one.

    Parent
    kiss up (5.00 / 2) (#98)
    by jondee on Fri Nov 15, 2013 at 02:21:45 PM EST
    kick down..

    Like clockwork..

    Parent

    I'm sorry (5.00 / 2) (#68)
    by Ga6thDem on Fri Nov 15, 2013 at 12:21:22 PM EST
    but the majority of Americans are making less or haven't had raises since the collapse in 2008. If you're looking for sympathy thinking you're the only one, you are barking up the wrong tree.

    Parent
    Also, don't forget (none / 0) (#43)
    by TeresaInSnow2 on Fri Nov 15, 2013 at 12:07:20 AM EST
    that the "Affordable" Care Act cut DSH payments to hospitals.  So they get you in every direction possible.

    Parent
    SITE VIOLATOR (none / 0) (#46)
    by shoephone on Fri Nov 15, 2013 at 01:22:04 AM EST
    SPAM

    SITE VIOLATOR (none / 0) (#110)
    by jbindc on Fri Nov 15, 2013 at 03:08:16 PM EST


    Cut Out The Middle Man - Go Single Payer (none / 0) (#131)
    by john horse on Sat Nov 16, 2013 at 07:44:50 AM EST
    Let me be clear about this.  Obamacare is better than the system we had.

    My wife's cousin had the misfortune of having cancer.  The good news was that there was a good chance of this cancer going into remission if treated aggresively.  The bad news was that he didn't have any insurance.  The good news was that under Obamacare he falls under his grandmother's policy.  Obamacare saved his life.  There have been alot of lies about Obamacare.  Remember the "death panels".  The fact of the matter is that there will be alot of people who will be healthier and live longer because of Obamacare.

    Yes the public option would have made Obamacre better but there is an even better option, single payer.  If Medicaid expansion works, then why not expand Medicaid so that it covers everyone.  In other words, lets cut out the middle man (private insurers) and just go single payer.

    Eligibility for Medicaid is based on means, (5.00 / 2) (#138)
    by Anne on Sat Nov 16, 2013 at 10:15:45 AM EST
    while Medicare is based on age; Medicaid has a state component, while Medicare does not.

    If we're going to expand one of these programs, I think it makes more sense to expand Medicare.

    Start by opening it up to people 55-64; have them pay the same premium current Medicare subscribers pay. If they want/need to cover the gap, let them get a private insurance policy - as current Medicare subscribers do.

    Every year, open it up to the next ten-year group.

    It took my husband all of about 10 minutes to enroll in Medicare; the platform is already there, so no need for a cumbersome and complicated website.

    Parent

    Why not merge (none / 0) (#139)
    by Politalkix on Sat Nov 16, 2013 at 11:42:50 AM EST
    Medicare and Medicaid into one large Federal program in that case (if you want to go the single payer route)?

    Have society take the responsibility of taking care of the poor and the old together instead of having the interests of Medicare and Medicaid recipients pitted against one another.

    Some of the people who are most hostile towards expansion of Medicaid are Medicare recipients themselves.

    Parent

    Agree that a phase-in (none / 0) (#140)
    by christinep on Sat Nov 16, 2013 at 01:31:37 PM EST
    has a lot of advantages, Anne.  While I don't know that the timing of yearly expansion would be the time interval, the phase-in and expansion has a compelling argument still.  

    Parent
    The incremental approach (none / 0) (#142)
    by MKS on Sat Nov 16, 2013 at 02:42:49 PM EST
    sounds great politically.   But the 55-65 group is expensive to cover.  

    Perhaps you could get everyone to agree to higher taxes to cover only the 55-65 age group, even though everyone else would get coverage.

    I think the public option route is much easier politically....as perhaps a fix for private Obamacare providers who say they must raise rates to address the dearth of young healthy insureds...

    Parent

    Here's the problem with the so-called (5.00 / 6) (#145)
    by Anne on Sat Nov 16, 2013 at 05:03:31 PM EST
    "public option:"

    Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded. Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn't serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important. Moreover, when the wealthy jump the queue, it results in longer waits for others. Studies in New Zealand and Canada show that the growth of private care in parallel to the public system results in lengthening waits. Additionally, allowing the development of a parallel, private system for the wealthy means the creation of a permanent lobby for underfunding public care. Such underfunding increases the demand for private care.

    From PNHP's FAQ page.

    Paying for it:

    A universal public system would be financed in the following way: The public funds already funneled to Medicare and Medicaid would be retained. The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees' health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments. For the vast majority of people, a 2% income tax is less than what they now pay for insurance premiums and out-of-pocket payments such as co-pays and deductibles, particularly if a family member has a serious illness. It is also a fair and sustainable contribution.

    Currently, 47 million people have no insurance and hundreds of thousands of people with insurance are bankrupted when they have an accident or illness. Employers who currently offer no health insurance would pay more, but those who currently offer coverage would, on average, pay less. For most large employers, a payroll tax in the 7% range would mean they would pay slightly less than they currently do (about 8.5%). No employer, moreover, would gain a competitive advantage because he had scrimped on employee health benefits. And health insurance would disappear from the bargaining table between employers and employees.

    This raises points that others have also raised here, namely that we are already paying out a lot, for insurance, co-pays and deductibles, or if we don't have insurance, directly to providers for care.  

    A 2% tax would be a bargain for most people.  As an example, if I make $100,000 a year, a 2% tax is $2,000.  That is significantly less than I, at least, am currently paying for insurance - about $5,000 less just in premiums.  If I actually need care, and I add in the co-pays and the deductible, the savings is even higher.

    There is a wealth of information from PNHP; I would highly recommend your taking a look.

    As for the 55-64 age group being expensive to cover, would they be more expensive than the 65-and-up group that is currently paying in around $100/month in the form of SS check deductions?  If anything, the younger, healthier age group, many of whom are still working and still paying into Medicare, should spread the risk of the older population and reduce the overall cost.


    Parent

    The Republicans (5.00 / 1) (#149)
    by MKS on Sun Nov 17, 2013 at 03:17:52 AM EST
    opposed the Public Option on the grounds that it would provide a less costly alternative since it need not make a profit, and thus the private insurers could not compete and one by one would fail....

    A public option does not require the middle class tax increase you are talking about, never mind that many or most would save money on the premiums....Let alone everyone squawking that they are losing their health care choices because of big government.   If you could get it passed, fine....But Hillary and Edwards thought it a mountain too high to climb....

    Parent

    You keep repeating this false mantra (5.00 / 3) (#151)
    by Yman on Sun Nov 17, 2013 at 06:38:29 AM EST
    A public option does not require the middle class tax increase you are talking about, never mind that many or most would save money on the premiums....Let alone everyone squawking that they are losing their health care choices because of big government.   If you could get it passed, fine....But Hillary and Edwards thought it a mountain too high to climb....

    Do you think that repetition will make it true?

    Not to mention the fact that Obama didn't think it was "too high a mountain to climb" when he promised it ...

    ... or he was also lying.

    Parent

    Single payer (2.33 / 3) (#152)
    by MKS on Sun Nov 17, 2013 at 08:31:13 AM EST
    was what I was referring to.  Obama never promised single payer.  You know that.

    The context of what I am saying is clear.  I am arguing in favor of a  public option because single payer is too difficult politically to pass.  

    I have always said that single payer was not what Hillary or Edwards or Obama campaigned on.  You know that.

    You are deliberately misrepresenting what I am saying.  

    Parent

    Really? (5.00 / 4) (#155)
    by Yman on Sun Nov 17, 2013 at 09:18:56 AM EST
    Single payer was what I was referring to.  Obama never promised single payer.  You know that.

    The context of what I am saying is clear.  I am arguing in favor of a  public option because single payer is too difficult politically to pass.

    Because you didn't actually say "single payer" ... your entire post was re: the public option.  Not to mention the fact that Anne was discussing the problems with a public option.

    I have always said that single payer was not what Hillary or Edwards or Obama campaigned on.  You know that.

    You are deliberately misrepresenting what I am saying.  

    No, I'm not.  In fact, this is specifically what I'm talking about when I pointed out your false mantra.  Medicare Plus (advocated by Edwards and Hillary) is a single payer plan - just like Medicare is.

    The fact that you can't deal with facts and reality isn't my problem.

    Parent

    This whole deal about Obama not (5.00 / 4) (#160)
    by MO Blue on Sun Nov 17, 2013 at 10:34:46 AM EST
    campaigning on single payer is just smoke and mirrors IMO. He campaigned on a robust public option and did not even allow a weak, watered down imitation of a public option to be included in his insurance legislation. It really doesn't matter one d@mn bit what he campaigned on since he didn't deliver on his campaign promises.

    We are back to ZERO when it comes to either a single payer or a public option. At this point in time neither is going to happen right now. If we want an universal, affordable health care system, I see no reason to not to advocate for the system that accomplishes our goal - single payer. This whole idea of advocating for the least we think we can get only gets us nothing as was proven by what finally went into the health insurance legislation that passed.

    Negotiation Skills 101:

    Ask for more than what you want and negotiate down to close to what you want.

    Ask for the bare minimum of what you want and you will get much less than what you want after the negotiations are completed.
     

    Parent

    More armchair negotiation (2.33 / 3) (#162)
    by MKS on Sun Nov 17, 2013 at 10:41:01 AM EST
    This negotiation 101 argument is nauseating.

    If all you pros out there want to talk about negotiation, you can't backtrack and ask for something that was already given up.  By not campaigning for single payer in 2008 (and no one did; and even Edwards did not call his plan single payer), you cannot out of the blue make an opening bid of something that was not part of your campaign.

    This whole start from single payer is total juvenile nonsense from people who have no idea what they are talking about.   The single payer ship sailed when it was not part of the 2008 campaign.

    Parent

    Really? (5.00 / 3) (#167)
    by Yman on Sun Nov 17, 2013 at 11:57:09 AM EST
    When did the public option "sail"?  Was if after Obama promised that any plan he signed would have a public option, or was it long before that?  When did imported drugs "sail" - before he promised no backroom deals with Pharma or after he made them?

    Parent
    Not what I was talking about (none / 0) (#179)
    by MKS on Sun Nov 17, 2013 at 04:46:24 PM EST
    and you know it.

    You deliberately conflate public option with single payer.   As I have explained, you are committing the logical fallacy of equivocation by changing the definition of the terms you are using.  This is why you are dishonest.  

    Parent

    Your premise that we must accept (3.00 / 2) (#198)
    by MO Blue on Sun Nov 17, 2013 at 08:38:25 PM EST
    anything that Dems cannot negotiate away to the health insurance industry is nauseating. Your need to capitulate and give away the actual health care that people here in this country need rather than stand up to the corporate owned politicians and ask for the best and not crumbs is nauseating.  

    you can't backtrack and ask for something that was already given up.

    Well of course you can. You yourself are backtracking and advocating for a public option which in case you did not notice was something that was already given up by Obama in a back room deal. The public option ship sailed away in that back room deal even though Obama campaigned on it.

    Your argument is weak, cowardly nonsense from someone who is so brainwashed by the politicians that you beg for something, anything and bow and scrape and shout your gratitude for any crumb that you are given.


    Parent

    I was always supportive (5.00 / 1) (#199)
    by MKS on Sun Nov 17, 2013 at 08:51:51 PM EST
    of a public option.....

    And, sure, if you reset the table in 2016 and start fresh, assuming Hillary runs on single payer, then you can start from there.  But unless and until someone actually runs on and wins based on a platform of single payer, there will be no basis to start a negotiation there.
    If you backtrack during a negotiation, you will be laughed at, or worse yet, if you are in fact taken seriously, the other side walks out....It is clear you have no idea what you are talking about.

    Ah, we brainwashed bots will most likely help to elect Hillary.  This will be very interesting to watch the reaction of you and the rest of the cadre here.  We will be stronger Hillary supporters than you.  I love it.

    "Cowardly?"  Not at all.  I put my ideas out there without any dressing.  I think you just reached for an insult without thinking about it.  

    Parent

    People who have supported single payer (5.00 / 3) (#204)
    by MO Blue on Sun Nov 17, 2013 at 09:28:49 PM EST
    are not backtracking at all. We supported it in 2000, in 2004, in 2006, 2008, 2012, and now. It is you who have given up on affordable, universal health care. We have not.

    Once again, you know absolutely nothing about negotiating. Negotiating is not about giving away the store before the negotiation begins. Ask for the bare minimum of what you want and the other side will ask for even more concessions until you get nothing of you want. I can though see why you would be enamored with Obama and his deals. Except he is the one laughing at how little you are willing to accept and how you cheer his giveaway to the insurance and health industry.

    Didn't have to reach at all in my description of how you approach politics. Your constant admonishments of you can't ask for that, don't ask for much and be grateful for any tiny baby step towards your goal while ignoring the 10 giant steps backwards was real easy to describe.

     

    Parent

    I would still like a public option (1.00 / 1) (#200)
    by Politalkix on Sun Nov 17, 2013 at 09:05:14 PM EST
    If the Democrats can retake the House, I would like the public option to be put back on the table. BHO did propose a public option in his 2008 campaign and won the election.

    If HRC or any other Democratic candidate runs and wins on a platform of single payer, I will also support single payer.

    Some people seem more interested in fighting windmills than doing the constructive thing of finding candidates (including HRC) who are ready to run and win on a platform of single payer.

    Parent

    If you read the entire (3.00 / 2) (#159)
    by MKS on Sun Nov 17, 2013 at 10:28:55 AM EST
    discussion what I am saying is clear.  The antecedent for "it" is single payer. You know my position.

    You are lying--again.

    Edwards never advocated across the board single payer for everyone as that is understood and is in fact being advocated here.

    Parent

    Edwards advocated for ... (5.00 / 2) (#166)
    by Yman on Sun Nov 17, 2013 at 11:54:49 AM EST
    ... everyone to have the option of participating under Medicare Plus, just as they have the option of participating under Medicare now.

    "As that is understood" doesn't mean as interpreted by MKS while trying to justify Obama's reneging on numerous healthcare promises.  Under your convoluted definition of single-payer, even Medicare wouldn't be considered a single-payer system, since people have the option of not participating.

    Parent

    Of course, Anne (2.33 / 3) (#161)
    by MKS on Sun Nov 17, 2013 at 10:35:05 AM EST
    is arguing about the efficacy of public option.  And she argues for single payer.  

    I argue for a public option.  I am saying single payer is not politically feasible; whereas, public option is.

    That is the context.  We have had this discussion numerous times.  That is why you are not merely mistaken about what I am saying.  You know better.  That is why you are deliberately lying about my position.  

    You constantly do this:  take one single comment out of context and twist it into something it was not.  That is how you create lies from truth.

     

    Parent

    Speaking of "lies" (5.00 / 2) (#168)
    by Yman on Sun Nov 17, 2013 at 11:59:23 AM EST
    Perhaps if you learned how to articulate your thoughts in a coherent manner - or if you used the term "single payer" rather than "public option" (repeatedly) in your post, you wouldn't have this recurring problem.

    Maybe a Learning Annex course in basic writing ...

    Parent

    I was clear (2.33 / 3) (#178)
    by MKS on Sun Nov 17, 2013 at 04:42:45 PM EST
    You were dishonest.

    Parent
    No, I am not arguing for a public option. (5.00 / 2) (#185)
    by Anne on Sun Nov 17, 2013 at 05:12:19 PM EST
    For the reasons cited, a "public option" is not the answer.

    But I'll post it again:


    Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded. Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn't serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important. Moreover, when the wealthy jump the queue, it results in longer waits for others. Studies in New Zealand and Canada show that the growth of private care in parallel to the public system results in lengthening waits. Additionally, allowing the development of a parallel, private system for the wealthy means the creation of a permanent lobby for underfunding public care. Such underfunding increases the demand for private care.

    More:

    The "public plan option" won't work to fix the health care system for 2 reasons.

    1 - It foregoes at least 84% of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even 95% of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16% of the roughly $400 billion annually achievable through single payer - not enough to make reform affordable.

    2 - A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan - which started as the single payer for seniors and has now become a funding mechanism for HMOs - and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients; with profitable ones in private plans and unprofitable ones in the public plan.

    Oh, and the decision not to fight for a single-payer plan wasn't made by the public, but by politicians, many of whom have been bought and paid for by big money interests.

    I'll leave you with some observations from Charlie Pierce:

    But the fact is that the country wanted its massively fractured health-care system fixed, and it had wanted that system fixed since before Bill Clinton tried it back in the early 1990's. A completely ludicrous percentage of the country also wants criminal background checks on gun purchases. Right now, if you believe the polls, it is massively in favor of raising the minimum wage. And, actually, if you go below the surface of the polling on the ACA and health-care reform, you find a substantial portion of the country that doesn't like the embattled law because it doesn't go far enough toward health-care's being a right, not a privilege and, in any case, the country repeatedly stated throughout the last 20 years that the status quo ante was an unacceptable combination of corporate avarice and personal tragedy. And yet, that is where the debate is right now, no matter how much Fred Upton says otherwise from deep in the pockets of the people who make money off human misery.

    It has become remarkable how the people of this country, an ostensibly self-governing republic, fail to get what an overwhelming percentage of them say they want from their government, over and over again. You can argue, and I have, about the power of money, increased by an order of magnitude through the egregious Citizens United decision. You can argue, and I have, about the unforgivable vandalism practiced by the Republican party and the modern conservative movement that has been the prion disease in the party's higher functions that has driven it mad. But the fact remains that, dammit, there has to be a political price to pay for actively opposing something 66 percent -- or, in the case of the background checks, 91 percent -- of the people say they want. And the electorate is the only body of citizens empowered to exact these penalties, and it has been shamefully lax in doing so. Parts of the country have contented themselves with electing morons and crazy people. (How in the name of god does a buffoon like Louie Gohmert ever run unopposed?) Great portions of the country can be duped, or frightened, into voting against their own economic interests. And the great undifferentiated apathy that attends most of our elections is a deadweight on the democratic process that grows heavier by the year. If our politicians are not responsive to our needs, then it's time for new politicians, and we're the only ones who can bring that about. And yet, it's easier to complain about an inconvenient website, or a scary letter from an insurance company, or bullshit anecdotes that fall apart under the barest scrutiny. The country is ungovernable because we, The People, have decided not to govern it any more. That, to borrow a phrase from the president, is on us.



    Parent
    My mistake (1.00 / 3) (#189)
    by MKS on Sun Nov 17, 2013 at 05:31:00 PM EST
    I was assuming a certain level of intelligence and reading comprehension.

    This what I said:

     

    Of course, Anne

    is arguing about the efficacy of public option.  And she argues for single payer.  
    I argue for a public option
    .

    Is this not clear?  Did I confuse you with the phrase "arguing about the efficacy" of the public option?  That was what you were doing arguing about that issue, true?  Did I not say you were for single payer and I was for a public option?  Did you just stop reading or was my phrasing "arguing about the efficacy" too confusing for you?

    Parent

    Oh, no dear, you haven't confused me. (3.67 / 3) (#201)
    by Anne on Sun Nov 17, 2013 at 09:09:21 PM EST
    Disgusted me, yes.  Nauseated me, for sure.

    Confused, no.  Not even close.

    Actually, since you're in the mood to be precise, I wasn't arguing "about" the efficacy of the so-called public option, I was arguing "against" the efficacy of the public option.

    And I wanted to make that clear.

    Maybe one of these days you will address the substance of the argument for why a public option is not the way to go; you've provided no substantive argument or support for why it's a good idea.  

    You can keep saying "public option, public option," but the more you do, the more you sound, well, kind of like a parrot.

    Imagine that.

    Parent

    The concern about (5.00 / 1) (#150)
    by MKS on Sun Nov 17, 2013 at 03:33:34 AM EST
    stigmatizing those who have public insurance versus private insurance....

    The French have a basic level of public insurance and many people purchase additional private insurance.....The Germans have had public insurance for the poor since the 1880s and have a mixed system still....

    Taiwan jumped in head-first to single payer--when it was prosperous and its economy strong.  People resist big change when they are insecure....If it were boom times, then perhaps it could be accepted.....Or a major crisis like WWII or an incoming comet....Barring that people will resist change--especially when accompanied by the "largest tax increase ever" and "socialized medicine where the government takes over health care."    

    Parent

    Facts combined with math is a good thing (5.00 / 4) (#158)
    by MO Blue on Sun Nov 17, 2013 at 10:17:54 AM EST
    Workers on average pay $4,565 per year towards the cost of their employee coverage. Source: 2013 Employer Health Benefits Survey

    The median household income in the United States June 2013 was $52,098. Source

    A 2% tax on $52,098 would be $1,041.96.

    A 2% tax would save the median household income $3,523.04 on the cost of the insurance alone. Add in several thousand dollars for deductibles and co-pays and a household would save even more.

    Parent

    2% tax would not be a bargain (1.00 / 1) (#153)
    by Politalkix on Sun Nov 17, 2013 at 08:41:33 AM EST
    for most people who work for large employers, AFAIK. It would be more than what people will be paying through Obamacare.

    The number of people buying medical insurance in the individual market is considerably smaller than people buying group insurance through their employers.

    Parent

    A 2% tax would absolutely be a (5.00 / 3) (#154)
    by Anne on Sun Nov 17, 2013 at 09:05:43 AM EST
    bargain, because you keep missing this part:

    The difference, or the gap between current public funding and what we would need for a universal health care system, would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax would replace all other employer expenses for employees' health care, which would be eliminated. The income tax would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments.

    How many people with employer-sponsored coverage have no co-pays, no deductibles?  I don't know of anyone who has that kind of deal.  I also keep running into people whose employers are pushing more of the cost of insurance onto them - raising deductibles, increasing co-pays, etc.

    And while a lot of employers subsidize the employee's insurance premium, they don't generally do so for the other family members, so that has to be taken into consideration, as well.

    You know, here's what's so annoying: I gave you a link to a source for comprehensive information, detailed explanations of how all of this would work under a national health plan.  You didn't take advantage of it, didn't even take in the limited excerpt I put in my comment.

    All I can conclude from that is that it's more important for you to think of ways single-payer wouldn't work, and why would that be?  Honestly, if it's because you're protecting/defending the fact that Obama preferred this sh!tshow of a private insurance plan, that's just sick.

    Parent

    I gave you a fact (5.00 / 1) (#157)
    by Politalkix on Sun Nov 17, 2013 at 09:37:43 AM EST
    based on my experience and interaction with people. You do not like this fact and are getting testy about it.

    People working for large employers (many who are young and healthy) just see what you are proposing as a way to subsidize the needs of older, non-healthy populations and people buying health care in the individual market at their expense. There may be some selfishness on their part, but I am just saying how things are (in the same way you and jbindc inform us about reality in the way you perceive it).

    This is not about you and me, so there is no need to get so testy. Large employers are already working with insurance companies to reimburse any deductables if their employees choose to adopt a healthy lifestyle under Obamacare. Medical insurance companies are providing health coaches and are making 24-health consultation services available to keep costs of health care down.

    If people working for large employers are not happy with their insurance companies, they can complain to HR and get their insurance company changed. These people are not willing to take the risk that their complaints to politicians and government bureaucrats will be heard if they are not satisfied with the medical care that you are proposing.

    Just as you are passionate about getting what you want, many other people are equally passionate about what they would like to have! Get a politician to campaign on single payer and have him/her win the Presidency. We can talk after that happens. There is no reason to show your annoyance at me. BHO did not campaign on single payer (neither did HRC or Edwards).

    Parent

    You are still proposing a (5.00 / 1) (#163)
    by MKS on Sun Nov 17, 2013 at 10:44:34 AM EST
    Middle class tax hike.    No matter how well based, no matter how much money will be saved, it is still a tax increase.  You are still going to make your system mandatory for all--to avoid the stigma of being a program for the poor.  You will be forcing people to make a big change.

    Sure, many would think it a good idea. I do.  But you are missing the point of how this would play for most.  

    Parent

    You can raise my taxes 2% all day if (5.00 / 4) (#171)
    by Anne on Sun Nov 17, 2013 at 12:14:23 PM EST
    I get to save two or three times that in insurance premiums, co-pays and deductibles.

    Parent
    Your view is not the issue (2.67 / 3) (#181)
    by MKS on Sun Nov 17, 2013 at 05:06:13 PM EST
    How it is viewed by others is.  This is the disconnect in your analysis.

    Go all Walter Mondale advertising a tax hike and see how it goes.

    Parent

    You keep saying this (5.00 / 3) (#172)
    by Yman on Sun Nov 17, 2013 at 12:17:41 PM EST
    You are still proposing a Middle class tax hike.    No matter how well based, no matter how much money will be saved, it is still a tax increase.  You are still going to make your system mandatory for all--to avoid the stigma of being a program for the poor.

    You do realize that Medicare isn't "mandatory for all", don't you?  (and yet, it's still a single-payer system).  Because I don't recall Medicare having "the stigma of being a program for the poor."

    Parent

    I am responding to (1.00 / 1) (#183)
    by MKS on Sun Nov 17, 2013 at 05:09:20 PM EST
    Anne's proposal to not have a public option in order to prevent stigmatizing the program as one for the poor.

    You don't actually read the thread before you post, do you?

    Parent

    How this would play for most? (1.00 / 1) (#165)
    by Politalkix on Sun Nov 17, 2013 at 11:14:36 AM EST
    7% payroll tax on employers-Employers would say that they will have to reduce the number of employees to pay for this tax. People will blame the political party proposing the single payer for causing unemployment.

    2% tax on individuals: When a significant amount of people in this country do not pay income tax because their incomes are not high enough to merit it, asking them to pay 2% of their income will be seen as a tax on the middle class or the poor to support "big government".

    Nobody would believe that a government administered universal health care system would guarantee that everyone got medical care based on their needs and not income. People would laugh and say "Right, in the former Soviet Union, Brezhnev or a local party honcho got the same level of care as a mechanic in a steel plant-are you that stupid to think that we will believe that?"

    Parent

    Once again, try reading and thinking (5.00 / 3) (#169)
    by Anne on Sun Nov 17, 2013 at 12:11:51 PM EST
    things through:

    The payroll tax would replace all other employer expenses for employees' health care, which would be eliminated.

    You seem to be not understanding that the payroll tax on employers isn't in addition to what they're spending on employee health care coverage, but instead of it.  What is often one of the largest expenses companies have - which is why many have stopped offering it - would be replaced with a 7% tax.  What are the chances that what employers are currently paying is much larger than 7%?

    As for the "nobody would believe" statement, why not ask people on Medicare if they feel they are getting care based on their needs, not their income.

    In addition, have you considered that employers shouldering so  much of the cost of insurance prevents them from hiring more employees?

    "The employees ultimately bear the full cost of of the health insurance plan they get form their employer," says Kate Baicker, a Harvard economist who served on President George W. Bush's Council of Economic Advisers from 2005 to 2007. "Even though they're only writing a check for a part of it, they're bearing the full cost."

    This is known, in economics, as the wage-fringe tradeoff. Companies have a set amount they can spend compensating workers, the lowest amount they think they can pay without losing their workers to a competitor. They make these payments in wages and benefits. Any addition to one category will come out of the other.

    "I think economists find this an uncontroversial concept," Baicker says.  "When you get a dollar more in wages, it has to come out of a benefit."

    Baicker and Amitabh Chandra, another Harvard economist, co-authored a paper in the Journal of Labor Economics that found any 10 percent increase in health premiums "results in an offsetting decrease in wages of 2.3 percent."

    Link

    Got any talking points that address that?  Because, so far, in spite of being provided links and other reference material, you have so far failed to do much more than offer bumper-sticker excuses from your a$$.

    Parent

    Think before you post (1.25 / 4) (#173)
    by Politalkix on Sun Nov 17, 2013 at 01:17:28 PM EST
    I have read enough about single payer (including the links you provided) to understand that it is not a bargain for many people as you are claiming.
    I also have a suggestion for you. When you want others to read your links, please extend the same courtesy to them. I remember once asking you to read "Dreams from my Father" and other books and articles written by the President to have a better feel for where he was coming from instead of rendering judgement from afar. You took pride in informing me that you would not do it. Some of us extend more courtesy to you than you do to us (atleast, I read your links). I will have to tell you that your sense of entitlement was not earned.

    Can you explain to me why Google, Apple, IBM or many other companies would like to transfer the responsibility of medical care to the government? I have attended benefits seminars with several large employers. HR representatives have consistently said that medical benefits are used to help sell their companies to potential hires, so they would not like to transfer the responsibility of providing benefits to the government (atleast not at this time). Most people that I know also believe that they are getting these benefits because they work harder and smarter than other people (yes, even people who are in the lower rungs of the corporate ladder) and that these benefits are earned through meritocracy. Why isn't there a mad rush by the big companies to turn over health care over to the government if they are currently paying more than what they would pay through single payer? Either these companies are not paying more or if they are, they think that investment is worth it to retain employees.

    It is really bizarre to think that all large corporations are being forced by medical insurance companies to retain Obamacare when a better option of transferring the responsibility of medical benefits to the government was already available to them. Health insurance companies do not have that sort of power.

     

    Parent

    Well, by all means, we should do (5.00 / 2) (#177)
    by Anne on Sun Nov 17, 2013 at 04:38:57 PM EST
    whatever is best for the corporations, and not for the people.

    I mean, without being able to offer health insurance, there probably isn't anything they could offer that would be attractive to potential employees, right?

    Corporations are in the position of offering insurance because there is no other system.  There can be no mad rush to a government system because there is no government system.

    Sheesh.  

    Parent

    Anne (1.25 / 4) (#187)
    by Politalkix on Sun Nov 17, 2013 at 05:19:51 PM EST
    Please stop this armchair discussion. It is not helping anyone.

    You wrote "There can be no mad rush to a government system because there is no government system."

    CEOs from all sectors of the economy would lobby furiously to get the government to create a government run system if that would reduce costs for them and provide more profits (as you are saying single payer would do because companies are paying over 7%). If CEOs of health insurance companies got in the way and needed to get trampled for the benefit of CEOs in other sectors of the economy, that would have happened by this time.

    Parent

    Sure (3.67 / 3) (#174)
    by Yman on Sun Nov 17, 2013 at 04:08:24 PM EST
    Can you explain to me why ...

    Right after you point to the slightest bit of evidence for your ridiculous assertion:

    2% tax would not be a bargain for most people who work for large employers, AFAIK.

    Because that is seriously funny.

    Parent

    BTW - The average employee contribution (3.67 / 3) (#175)
    by Yman on Sun Nov 17, 2013 at 04:21:06 PM EST
    ... for health insurance is $9,068 for individual coverage or $16,351 for family coverage.

    For that 2% single-payer tax to not be a "bargain", your average worker for a large employer would have to earn $453,400.  Your average two-earner family would have to exceed a combined income of $408,775.

    Parent

    Link (3.50 / 2) (#176)
    by Yman on Sun Nov 17, 2013 at 04:21:43 PM EST
    Cry me a river (1.00 / 4) (#182)
    by Politalkix on Sun Nov 17, 2013 at 05:08:05 PM EST
    but the very smart scientists, engineers and techs in Google, Amazon and IBMs won't be ready to increase the employee contribution to 2% from what they are paying now. Neither will the people who are not paying Federal Income tax at this time.

    There won't be too much sympathy to subsidize the contribution rate from 13.5% (or 6%) to 2% for divorce lawyers who brag about making $250/- per hour in this country.

    BTW, when I mentioned large companies, it was not those that just hired over 200 people. Large employers are those that hire over 5K-10K people.

    Seniors are taken care in this country through Medicare. The very sick and poor will benefit from Obamacare and expansion of Medicaid. The rest of the people (except 2-3%) are quite OK with Obamacare.

    If you want single payer, find a candidate who is willing to campaign on it and let her/him win the Presidency. Same with members of Congress. Any sneaky attempts to subsidise your health care will be mocked in the meantime.

    Sorry for sounding a little rude. I never reply to your posts or even rate them. Since that never stopped you from being a j*rk about my posts over the years, you get this one reply back and a few ratings of "1" as a remuneration of your efforts.

    Goodbye, Back to "ignore" mode....

    Parent

    No longer a divorce lawyer (3.00 / 2) (#186)
    by MKS on Sun Nov 17, 2013 at 05:14:33 PM EST
    but now working for a big company.

    Parent
    Didn't you know (2.00 / 4) (#184)
    by MKS on Sun Nov 17, 2013 at 05:12:16 PM EST
    Anne is the only objective person here?  She only wants what is truly best for all and has no bias at all.  None.  Zero.  Only she can hear the Music of the Spheres and can divine and articulate what is fair and objective.

    Parent
    AFAYK - heh (5.00 / 2) (#156)
    by Yman on Sun Nov 17, 2013 at 09:31:48 AM EST
    2% tax would not be a bargain for most people who work for large employers, AFAIK. It would be more than what people will be paying through Obamacare.

    Based on what?  Are you actually claiming that most people who work for large employers pay less than 2% of their income for their health insurance?

    Because that would be ridiculous.

    BTW - I just took a position with one of those "large employers" and one of the perks was their fantastic health insurance.  With their substantially lower-than-average employee contribution, I'm paying about 13.5% of my annual income for family coverage.  Individual coverage would cost me @ 6%.

    2% would absolutely be a bargain.

    Parent

    If the 2% (5.00 / 1) (#164)
    by MKS on Sun Nov 17, 2013 at 11:08:20 AM EST
    is on the income of all family members, but only one person in the family gets the company insurance, then you may have a much closer call.

    Dual income families only need one insurance plan......A child who is still on his or her parents' plan does not need insurance and would get nothing for a 2% tax on his or her income.

    You have to sell a middle class tax increase for what many, at least Anne, say should be a mandatory across the board single payer for all plan (and not the Edwards Public Option that you say is the same thing when it is not.)  

    Knock yourself out.  If you want to try the single payer grail, try it.  We'll see.  

    Parent

    You're right (5.00 / 2) (#170)
    by Yman on Sun Nov 17, 2013 at 12:13:41 PM EST
    I didn't include my 6-year-old's lemonade stand money.

    Heh.

    Dual income families only need one insurance plan......A child who is still on his or her parents' plan does not need insurance and would get nothing for a 2% tax on his or her income.

    Right.  Which is why I pointed out that I'm paying 13.5% of my income for family coverage, and would pay 6% for individual coverage - three times higher than the 2% tax that Politalkix claimed would not "be a bargain".  If you use my wife's income as well, we would be paying @ 8-9% of our combined incomes - more than twice our combined tax amount of 4%.

    Didn't include the lemonade money.

    Either way, there is absolutely zero evidence for the proposition that the 2% tax would "not be a bargain for most people who work for large employers".

    Parent

    You know (5.00 / 2) (#188)
    by MKS on Sun Nov 17, 2013 at 05:22:54 PM EST
    children can stay on their parents' policies until well past lemonade stand age?  Right?  You remember that?  

    You add in all the salaries and it reduces the financial calculation even under you analysis.....

    You guys are not getting it.  I am a supporter of single payer and perhaps even something akin to the Brits socialized medicine.  The problem is that few others are of the same mind.  You can pat yourselves on the back all you like on how the math supports you.   But you have to sell a large middle class tax increase and the replacement of the private insurance model, or a "government takeover of health care."

    With your charm, I am sure you can do that.   You are so persuasive, after all.  And you have convinced me, a natural supporter of single payer, so you should have no problem with skeptics....
     

    Parent

    You're right (5.00 / 2) (#190)
    by Edger on Sun Nov 17, 2013 at 05:38:44 PM EST
    It would never fly.

    2% is not just a "large middle class tax increase" it's freakin' huge. Ginormous. Nobody would go for that instead of a bank and back breaking umpteen thousands of dollars a years for the right to have even more ginormous deductibles and denials too...

    And not only that, but a "government takeover of health care" would never work. It's been proven all over the world and everybody knows that Socialized Medicine Sucks. Nobody in his or her right mind would want that, and any politician who so much as suggests it is obviously deluded.

    You keep 'em on the straight and narrow there, mks, and don't let anybody tell you different.

    Parent

    Why don't you (1.00 / 1) (#191)
    by MKS on Sun Nov 17, 2013 at 05:44:03 PM EST
    coordinate the PR for your tax increase plan with Walter Mondale?

    Parent
    No time. (none / 0) (#192)
    by Edger on Sun Nov 17, 2013 at 05:49:52 PM EST
    I'm all tied up in insurance brokerage acquisition meetings, and putting together an irresistible direct mail package. Leave your email address and we''ll make sure you're in on the ground floor of all the hottest deals we'll be shoveling out the door tomorrow morning. The deals we'll have for you will blow you away!

    Parent
    Whatever you do... (5.00 / 2) (#194)
    by Edger on Sun Nov 17, 2013 at 06:18:02 PM EST
    Never forget that "The President Wants You to Get Rich on Obamacare", and you don't want to let the poor f***er down. He's having a rough enough ride already lately with web developers turning their contracts into gold mines inventing bugs and stretching out development time as long as possible, and if this latest scam of his falls apart he can kiss that corner office cushy job on Wall Street in 2016 bye bye.

    New York Times

    Today's discussion centered on the most significant change in decades to the nation's health care policy, the Patient Protection and Affordable Care Act, a.k.a. Obamacare. As Scully walked to the front of the room, some 50 managers from hedge funds, mutual funds and private equity firms tucked into the round tables. Others gathered in the hallway. A hush of anticipation hung in the air.
    [...snip...]
    During the past year, anxiety about the onset of Obamacare has created a chill in some parts of the economy.
    [...snip...]
    Before he even began his speech, one attendee said he feared that only three million new patients, far fewer than estimated, would be signing up for insurance. "No way," Scully said. "Way more -- way more. At least 15 million, maybe 20 million. The Democrats have a huge incentive to make this work."
    [...snip...]
    "It's not a government takeover of medicine," he told the crowd. "It's the privatization of health care." In fact, Obamacare, he said, was largely based on past Republican initiatives. "If you took George H. W. Bush's health plan and removed the label, you'd think it was Obamacare."

    Scully then segued to his main point, one he has been making in similarly handsome dining rooms across the country: No matter what investors thought about Obamacare politically -- and surely many there did not think much of it -- the law was going to make some people very rich. The Affordable Care Act, he said, wasn't simply a law that mandated insurance for the uninsured. Instead, it would fundamentally transform the basic business model of medicine. With the right understanding of the industry, private-sector markets and bureaucratic rules, savvy investors could help underwrite innovative companies specifically designed to profit from the law. Billions could flow from Washington to Wall Street, indeed.



    Parent
    I am a Hillary supporter (none / 0) (#195)
    by MKS on Sun Nov 17, 2013 at 06:27:08 PM EST
    Good for you. (none / 0) (#196)
    by Edger on Sun Nov 17, 2013 at 06:36:24 PM EST
    She's another one who needs all that help she can get selling obamacare. You better send her a check today.

    Goldman Sachs Gives Hillary Clinton Almost Half A Million Dollars In Less Than A Week

    In speeches on October 24 and October 29, Goldman Sachs gave Clinton $200,000 a speech. Thursday's speech was a closed door meeting with Goldman and its clients. The prior Tuesday she spoke at a session hosted by Goldman CEO Lloyd Blankfein.

    From Goldman Sachs to the Carlyle group, business interests are lining up to give huge amounts of cash to the Clintons personally for such speeches.

    In the meantime, the two parties are moving to ensure that the same faces and choices will be given to voters despite overwhelming discontent over the two-party monopoly on power. With a system protecting incumbents and control of the two main parties, such public opposition remains largely immaterial and business interests are already putting money down on candidates like Clinton -- and the "style of honesty" that they crave.



    Parent
    Yes, I know, you (5.00 / 1) (#197)
    by MKS on Sun Nov 17, 2013 at 06:45:02 PM EST
    oppose the Democrats....

    When you accomplish something, let me know.  

    Parent

    How in the world did Bernie Sanders (5.00 / 2) (#203)
    by shoephone on Sun Nov 17, 2013 at 09:25:13 PM EST
    ever get elected to the Senate?

    Parent
    And I thought you (3.00 / 2) (#193)
    by MKS on Sun Nov 17, 2013 at 06:11:38 PM EST
    were re-living your glory days of the anti-globalization riots in Seattle a few years back....

    I am a partisan Democrat.  The Democrats are the only route for actually getting anything done.  As a non Democrat, you are outside the system and thus are mostly ignored.  Perhaps you can move the Overton Window.   In the meantime, others are actually working to accomplish a positive result.

    Parent

    Non-Democrats aren't ignored in Seattle (5.00 / 2) (#202)
    by shoephone on Sun Nov 17, 2013 at 09:23:54 PM EST
    anymore. Not since Kshama Sawant -- that dirty socialist! -- beat a longtime Democratic incumbant and won election to the city council. Ya know, Seattle...where all the anti-globalist rioters control everyone's minds with witchcraft.

    Parent
    And (none / 0) (#146)
    by TeresaInSnow2 on Sat Nov 16, 2013 at 05:47:50 PM EST
    As for the 55-64 age group being expensive to cover, would they be more expensive than the 65-and-up group that is currently paying in around $100/month in the form of SS check deductions?  If anything, the younger, healthier age group, many of whom are still working and still paying into Medicare, should spread the risk of the older population and reduce the overall cost.

    What we have instead via Obamacare is that we on the individual market, especially those outside of subsidies, are carrying the 55-64 group right out of our pockets with no government aid.....

    And yes, they are expensive to cover, will possibly price me out of having insurance.  As I've said many, many times that's one main problem with Obamacare.  The individual market has become the pre-65 high risk pool.

    Having the whole country pay the price instead is much fairer.

    The whole "it's too expensive to lower the Medicare age" is moot now. We've done it.  Now make it affordable via getting rid of the insurers.

    Parent