http://www.aei.org/publication/medicaid ... ge-at-all/Across the country, cash-strapped states are leveling blanket cuts on Medicaid providers that are turning the health program into an increasingly hollow benefit. Governors that made politically expedient promises to expand coverage during flush times are being forced to renege given their imperiled budgets. In some states, they’ve cut the reimbursement to providers so low that beneficiaries can’t find doctors willing to accept Medicaid.
Washington contributes to this mess by leaving states no option other than across-the-board cuts. Patients would be better off if states were able to tailor the benefits that Medicaid covers–targeting resources to sicker people and giving healthy adults cheaper, basic coverage. But federal rules say that everyone has to get the same package of benefits, regardless of health status, needs or personal desires.
These rules reflect the ambition of liberal lawmakers who cling to the dogma that Medicaid should be a “comprehensive” benefit. In their view, any tailoring is an affront to egalitarianism. Because states are forced to offer everyone everything, the actual payment rates are driven so low that beneficiaries often end up with nothing in practice.
“Dozens of recent medical studies show that Medicaid patients suffer for it. In some cases, they’d do just as well without health insurance.”–Scott Gottlieb, M.D.
Dozens of recent medical studies show that Medicaid patients suffer for it. In some cases, they’d do just as well without health insurance. Here’s a sampling of that research: . . .
Medicaid is Worse Than No Coverage at All
Moderator: Global Moderator
Medicaid is Worse Than No Coverage at All
Re: Medicaid is Worse Than No Coverage at All
I have no idea what these people are talking about....
Medicaid funds residency programs, and in return teaching hospitals provide care to Medicaid recipients. Residents and fellows do the primary care-giving, with supervision by teaching faculty. It's long been understood that the time you spend taking care of Medicaid patients is essentially pro bono work, because the reimbursement has never been enough to justify the paperwork cost of submitting bills. It's the equivalent of teaching requirements for non-clinical faculty, and it's one of the reasons why academic physicians earn maybe half of what physicians can earn in private practice.
Hospitals consider Medicaid to be a lucrative deal, as the residents are essentially free labor and they get additional block funding to make up for lack of reimbursements due to treating large numbers of Medicaid patients.
The problem of course is that the Medicaid population is growing a lot faster than the tax base (and we know why that is), so yes, the costs are getting harder to sustain. They're cutting coverage of things like brand name drugs, but I'm not aware of anything beyond that. The number of physicians they have access to can't decrease unless residency programs are losing spots - and I know for certain they aren't. So Medicaid patients are not having trouble "finding doctors", it's just that they have to go to academic/teaching hospitals. A bit more inconvenient, but free and typically high quality care in return? Please guys, quit complaining.
Medicaid funds residency programs, and in return teaching hospitals provide care to Medicaid recipients. Residents and fellows do the primary care-giving, with supervision by teaching faculty. It's long been understood that the time you spend taking care of Medicaid patients is essentially pro bono work, because the reimbursement has never been enough to justify the paperwork cost of submitting bills. It's the equivalent of teaching requirements for non-clinical faculty, and it's one of the reasons why academic physicians earn maybe half of what physicians can earn in private practice.
Hospitals consider Medicaid to be a lucrative deal, as the residents are essentially free labor and they get additional block funding to make up for lack of reimbursements due to treating large numbers of Medicaid patients.
The problem of course is that the Medicaid population is growing a lot faster than the tax base (and we know why that is), so yes, the costs are getting harder to sustain. They're cutting coverage of things like brand name drugs, but I'm not aware of anything beyond that. The number of physicians they have access to can't decrease unless residency programs are losing spots - and I know for certain they aren't. So Medicaid patients are not having trouble "finding doctors", it's just that they have to go to academic/teaching hospitals. A bit more inconvenient, but free and typically high quality care in return? Please guys, quit complaining.
Re: Medicaid is Worse Than No Coverage at All
I'm wondering, then, if there may be large variances in the quality of care depending upon the geographical area, and, in particular, its proximity to an academic/teaching hospital.
One of my neighbors, whose family is on Medicaid, has been talking about how difficult it is to even get a call back from the local hospital-affiliated clinic. She recently had a situation involving a 1-year-old with abdominal pain and distention--stuff that would get you in right away in a more populated area. Apparently it took four or five days, notwithstanding repeated calls, just to get through to a nurse. I would have been cautiously skeptical about such a claim but for the fact that I've heard essentially the same story so many times from so many different people.
Last month, in connection with a routine dental exam, I asked the (small town) dentist how he liked his work. Interestingly, the one specific thing he cited as causing his professional life to be less than ideal was the fact that the "standard of care" is the same for him as it is for dentists in a large metropolitan area. I was a little surprised that he would openly admit such a thing, but there it was.
One of my neighbors, whose family is on Medicaid, has been talking about how difficult it is to even get a call back from the local hospital-affiliated clinic. She recently had a situation involving a 1-year-old with abdominal pain and distention--stuff that would get you in right away in a more populated area. Apparently it took four or five days, notwithstanding repeated calls, just to get through to a nurse. I would have been cautiously skeptical about such a claim but for the fact that I've heard essentially the same story so many times from so many different people.
Last month, in connection with a routine dental exam, I asked the (small town) dentist how he liked his work. Interestingly, the one specific thing he cited as causing his professional life to be less than ideal was the fact that the "standard of care" is the same for him as it is for dentists in a large metropolitan area. I was a little surprised that he would openly admit such a thing, but there it was.
Re: Medicaid is Worse Than No Coverage at All
Not sure I understand what the dentist was complaining about...
Many private AND academic practices, even here in NYC, are terrible about returning patient phone calls, and Medicaid clinics are inevitably going to be worse as they just don't have staff for that kind of thing. If something urgent like a 1 year old with abdominal distress happens, you either call the clinic and beg to be squeezed in for a visit, or head straight to the nearest ER. In our Medicaid clinic people usually just show up, and if it's clear they came because of something urgent we always squeeze them in. This is not an "unable to find a doctor" situation, just someone who didn't know how to utilize the medical system effectively.
Many private AND academic practices, even here in NYC, are terrible about returning patient phone calls, and Medicaid clinics are inevitably going to be worse as they just don't have staff for that kind of thing. If something urgent like a 1 year old with abdominal distress happens, you either call the clinic and beg to be squeezed in for a visit, or head straight to the nearest ER. In our Medicaid clinic people usually just show up, and if it's clear they came because of something urgent we always squeeze them in. This is not an "unable to find a doctor" situation, just someone who didn't know how to utilize the medical system effectively.
Re: Medicaid is Worse Than No Coverage at All
Ok so here's a thought that puts the federal deficit into perspective...
Current total healthcare spending in the U.S. was $3.3 trillion in 2016, presumably more than that in 2017.
Here is how much less would be spent if just two changes were made in the US health system:
1) Allow Medicare/Medicaid to negotiate drug prices: ~$100 billion.
---- This is how much less we'd spend for retail drugs if our prices were the same as Canada's. Ignoring drugs administered by hospitals for which I couldn't find any numbers published.
2) Shift from private health insurance to Medicare, with otherwise no change i.e. you'd pay premiums/copays to Medicare instead of Blue Cross or United or Anthem etc: ~$700 billion
--- Estimated by Physicians for a National Health Program
Oh and there's more. Taking the burden of health insurance off corporations and small business would do easily as much for them as lowering business income taxes, would it not? Businesses must not exactly be jumping for joy when their insurance jacks up premiums by another 40%. So add on to this an expected boost in wages, business profits, consumer spending etc. Medical bankruptcies would go down too...no more "out of network" b-s.
Projected federal deficit in 2018 is $440 billion.
I wonder why we're even talking about the deficit when there are much bigger fish to fry.
Current total healthcare spending in the U.S. was $3.3 trillion in 2016, presumably more than that in 2017.
Here is how much less would be spent if just two changes were made in the US health system:
1) Allow Medicare/Medicaid to negotiate drug prices: ~$100 billion.
---- This is how much less we'd spend for retail drugs if our prices were the same as Canada's. Ignoring drugs administered by hospitals for which I couldn't find any numbers published.
2) Shift from private health insurance to Medicare, with otherwise no change i.e. you'd pay premiums/copays to Medicare instead of Blue Cross or United or Anthem etc: ~$700 billion
--- Estimated by Physicians for a National Health Program
Oh and there's more. Taking the burden of health insurance off corporations and small business would do easily as much for them as lowering business income taxes, would it not? Businesses must not exactly be jumping for joy when their insurance jacks up premiums by another 40%. So add on to this an expected boost in wages, business profits, consumer spending etc. Medical bankruptcies would go down too...no more "out of network" b-s.
Projected federal deficit in 2018 is $440 billion.
I wonder why we're even talking about the deficit when there are much bigger fish to fry.
Re: Medicaid is Worse Than No Coverage at All
Divorcing health insurance from employment is the best part of that proposal, IMHO. That is the cause of a lot of ills. It makes the distance between the person receiving services and the person paying for them even greater, AND it's totally ill-suited for how "work" is being done and will be done in the future.
Re: Medicaid is Worse Than No Coverage at All
Ah ha. Someone else has figured this out:
https://www.bloomberg.com/news/articles ... -for-staff
This is going to be good! I would be thrilled if this new company eventually becomes the new Medicare for the under-65s. It's pretty much an open secret that private insurance as it is currently implemented is an extremely expensive hobby that the US economy simply can't afford.
https://www.bloomberg.com/news/articles ... -for-staff
This is going to be good! I would be thrilled if this new company eventually becomes the new Medicare for the under-65s. It's pretty much an open secret that private insurance as it is currently implemented is an extremely expensive hobby that the US economy simply can't afford.
Re: Medicaid is Worse Than No Coverage at All
I'll be damned if I'm going to buy my health care from Amazon.WiseOne wrote:Ah ha. Someone else has figured this out:
https://www.bloomberg.com/news/articles ... -for-staff
This is going to be good! I would be thrilled if this new company eventually becomes the new Medicare for the under-65s. It's pretty much an open secret that private insurance as it is currently implemented is an extremely expensive hobby that the US economy simply can't afford.
Does anybody see the common thread here? The "solution" always involves a monopoly.
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Re: Medicaid is Worse Than No Coverage at All
The Medazon Apocalypse is coming! Duck and cover.Maddy wrote:I'll be damned if I'm going to buy my health care from Amazon.WiseOne wrote:Ah ha. Someone else has figured this out:
https://www.bloomberg.com/news/articles ... -for-staff
This is going to be good! I would be thrilled if this new company eventually becomes the new Medicare for the under-65s. It's pretty much an open secret that private insurance as it is currently implemented is an extremely expensive hobby that the US economy simply can't afford.
Does anybody see the common thread here? The "solution" always involves a monopoly.
DNA has its own language (code), and language requires intelligence. There is no known mechanism by which matter can give birth to information, let alone language. It is unreasonable to believe the world could have happened by chance.