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A whole lot more Medicaid, but there’s a catch

It looks like the stimulus package is going to spend a whole lot more on Medicaid AND subsidize the purchase of COBRA for laid off workers. Unlike the “let them eat cake” brigade who’ll decry this as extending welfare to the worthless, I have no problem with it. So long as it really is only a temporary measure,

But let’s be clear—Medicaid is dumb public policy. It’s divided between paying for care for the poor and paying for mostly long-term care for the elderly and chronically disabled, and also has subsidies for hospitals in poor areas thrown in. Then it has S-CHIP as its bastard relation. Furthermore, while the Federal government giveth, the states (which are broke but can’t borrow—California alone is $45 billion in the hole!) are by necessity going to have to take away.

There’s no rationale to have that Federal/state divide on paying for health care for the poor and some of the elderly.

Equally there’s also no rationale for having anyone link their
health coverage to employment—least of all those who are not employed
any more. And don’t forget that COBRA only applies to those who have a
program to buy into. In other words it doesn’t apply for those whose
former employer has gone belly-up taking their health plan with them.

So people need help now, and the stimulus package is about all we
have left. But the temporary stimulus once in place must not become a
reason not to fix the underlying problem with American health
care. We need a single progressively financed insurance pool. When we
get that hopefully employment-based insurance and Medicaid will be a
thing of the past, and not a moment too soon.

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  3. Am I reading the below correctly is this company reporting 2.1 billion a quarter in revenues and that they have decided to help poor people make food choices for those who’s income is liminted and based only what their budgets dictates and what they can only really afford to buy and pay for and this will help them overcome “food insecurity” and this is done so that there choices will be like milk or cheese over say other choices then milk and cheese like kool aid for their kides…. and this has what to do with what they are quoteing like the U.S. Department of Health and Human Services as “households where there is a lack of access to enough food to fully meet basic needs at all times due to lack of “financial resources” and defined by the U.S. Department of Agriculture. You know its neat to throw around big Deparment names to impress but if I had my say these Departments should really look at how others are using their names and in what context etc. and if the poor children ages two through five are lactose intolerant do you still push what the Deptment of Agriculture says? What about the thousands of kides who are allergic to peanuts and or peanut butter? What ever happened to Mom knows best in any language?
    Key developments for AmeriChoice Corporation October 31, 2010 7:15 PM ET Bloomberg Businessweek.
    AmeriChoice Corporation Reports Revenue Results for the Second Quarter and Six Months Ended June 30, 2010 07/20/2010 AmeriChoice Corporation reported revenue results for the second quarter and six months ended June 30, 2010. For the quarter, revenues were $2,460 million compared to $2,040 million a year ago. The revenue increased $420 million or 21% year-over-year, driven by strong organic growth. For the six months, revenues were $4,796 million compared to $3,951 million a year ago. Sesame Workshop and AmeriChoice Partner on National Healthy Habits Outreach Project 03/4/2010 Sesame Workshop and AmeriChoice Corporation are partnering to develop a bilingual education outreach program aimed at “helping low-income families make food choices that are affordable”, nutritional and set the foundation for lifelong healthy habits. AmeriChoice will brand the partnership UnitedHealthcare, by which it is known in many markets. More than one in five children in the U.S. have insufficient access to nutritional and affordable food, the result of a challenging economy that continues to affect low-income Americans. The initiative will offer support and creative resources for families with children between the ages of 2 and 5 to cope with “food insecurity ” defined by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services as “households where there is a lack of access to enough food to fully meet basic needs at all times due to lack of financial resources. AmeriChoice Corporation Reports Revenue Results for the Third Quarter Ended September 30, 2009 10/20/2009 AmeriChoice Corporation reported revenue results for the third quarter ended September 30, 2009. For the quarter, the company reported revenues of $2.1 billion grew $475 million year-over-year, a 29% organic growth rate.

  4. MATTHEW HOLT Sir i have medicaid and i had to 35 fixs to my collor bones and feet and to my knees and Epilepsy i have bones that broke easy and i was born with it so did i ask for it no i did not so walk a mile in my shoes for a time and you will know what it is like Sir and yes i have medicaid Thank you for you time Sir

  5. I dont think it is fair at all! I am so tired of some people getting hand outs and having children on the taxpayers dollars and just creating more mouths to feed that they knowlingly cant support without financial help. People that get housing, etc. It cost me $7000 to have my son, yet a women right next to me with medicaid paid nothing! And that same women gets free formula, reduced daycare, etc. Basically my husband and I are paycheck to paycheck b/c we are trying to do things the right way and becuase we are the wrong color! Other people get to have hand outs and pay $50 a month for daycare and $10 a month for water bills? WTF?

  6. Good, lets divert some of that Wall Street bailout money going to prop up bonuses (18B for 08) for incompetent execs who caused this mess to education. Maybe you’d like to see those multi-million dollar bonuses get a capped income tax, cause they’re already suffering under so much tax – poor little crooks.

  7. I’d rather divert some of the current tax revenue to educational initiatives. Why add more tax when there is so much waste in government already?

  8. Deron, education, either for children or parants, requires taxes – care to contribute more, or at least have the wealthy contribute the same percentage as you?
    If you look at Louisiana school system as an example, probably the worst in the U.S., local tax consessions for wealthy corporations (Int’l Paper, Shell Oil, etc) have diverted millions away from mostly local programs (education). In fact corporate relocation “extortion” accounts for millions in uncollected taxes to local and state government. The system is used to play one state against another with a game of prisoners dilemma. Here in NC property owners (over 10 acres) who generate as little as a $1000 in “farm income” pay little to no property taxes, no matter their income from other sources. Rich orthopedic surgeon down the road from me raises a few head of beef cattle as “hobby” yet qualifies for property tax concession. Property taxes pay for education. Tax codes are politcial documents not financial or social responsibility/solidarity documents.

  9. Peter – I think we both know that a debate like this has no end, because it is purely ideological. You feel that the effective rates should be equal and I don’t fault you for feeling that way. I just happen to disagree because an equally strong argument could be made that it’s not fair that some pay millions in taxes and others pay a couple thousand.
    The real debate should be: How can we improve incomes of those at the lower end? The Dems have the stage all to themselves, so I guess we see if they can deliver on that one.

  10. Deron, why would you think that you should pay 25% of your income in taxes, which reduces your discretionary spending, but the rich guy above you pay 15%? If you want to talk about fairness and equallity whats’s fair about that? Richer people can pay higher taxes and still live well because they earn more money. Think Buffet could survive on a few less million per year?

  11. Peter – I don’t particularly like our tax system and I agree that there are significant issues needing addressed. With that said, the spin that gets put on the taxes paid by the “rich” is usually way over the top. Warren Buffet might have a lower effective tax rate than some less fortunate, but that doesn’t change the fact that he still pays millions more each year to be an American than the average person. Unfortunately, you won’t see an NY Times article ever state that. That might make them balanced, and they are clearly not striving for that.

  12. “What’s wrong with having 50 universal coverage systems?”
    Because it would allow the healthcare industry to divide and conquer. Because it would restrict the ability of companies and workers to locate due to the most expensive/least expensive/coverage differences and it would restrict portability. If you lived in Iowa and traveled to Florida and needed medical care, who would pay and how much would they pay? The states should administer the federal program and collect a state portion of tax to fund the program in their state, but the state programs should also be funded by DC to make sure the states were living up to national heathcare goals of cost containment and universal access? Don’t we have 50 state coverage systems now, just not universal, hows that working?

  13. Matthew says:
    > There’s no rationale to have that Federal/state
    > divide on paying for health care for the poor and
    > some of the elderly.
    Right. What’s wrong with having 50 universal coverage systems? The states could provide healthcare financing mechanisms for all their citizens…
    t

  14. Deron, maybe you should read this:
    http://www.timesonline.co.uk/tol/money/tax/article1996735.ece and this
    http://query.nytimes.com/gst/fullpage.html?res=9901E5D8163CF934A35751C0A9649C8B63
    Can you say tax policy has helped or hurt public policy? Can you say that tax policy has done anything for the economy given our level of debt and the present economic conditions? We gave the smart guys a break on their incomes to create wealth, instead they lied and stole from us, and now want us (the taxpayer) to bail them out. I think there should be bread available that poor people and rich people can afford. If the rich want to pay more for the chocolate glazed then that’s fine with me, I just don’t want to subsidize their ability to do that through tax concessions, which play a big part in their accumulated wealth. You talk as if taxes are buried in a hole, they actually get distributed in the economy – like the over spending from debt Republicans have given us, the difference is funding by taxes means it’s pay as you go, funding by debt means you expect your kids to pay for it.

  15. I can think of no surer way to totally disincentivise physicians, especially those in primary care, from wanting to participate in Medicaid than to vastly extend the current Medicaid system. In my state (CT) Medicaid pays adult PCPs and specialists $37 for an established patient office visit (99213), which is barely over half of Medicare and about 40% of what most managed care plans pay. Hardly any orthopedic docs participate in Medicaid due to fees that are only 15% of the state worker’s comp rates. Most provider and member Mediciad eligibility files are a shambles and never up to date. CT lists lots of docs who have died or moved out of state as still participating. No wonder very few physicians are going into primary care. With massive state deficits everywhere, even Obama’s stimulus money won’t help much as the newly unemployed will swamp the system. Payment for care coordination, chronic illness management, etc…dream on. Let’s pay the big HMOs to run the system is the answer many state seem to favor these days. I’m sure United or Aetna will only contine to administer these programs if they can make a profit. But physicians be damned. What a poor excuse for efficient social policy.

  16. How I’ve missed Mr. Browning. Welcome back. But of course, I’m happy to promote socialized medicine–where the state owns the means of production. like in the UK’s NHS and the VA. Mr Browning misunderstands the meaning of progressively-financed. That means financed by tax payers at a progressively increasing rate; in other words the “let them eat cake” brigade comprising Mr Browning and his mates would pay more as a share of their waste wealth, and the poor saps who their current desires not only deprive of treatment, but stick with the bill, would at least not have to be financially decimated by the experience–as if he had his way the proletariat in England would be.
    And Eric, if we had Medicaid for all, it would sure as hell be better than Medicaid is now; because you, me & Mr Browning would use our leverage to make it so, but the effects would be felt for everybody. That’s social solidarity
    But honestly, given the 8 years we just experienced, how can we possibly even give the time of day to the people on the right of the spectrum given how completely incompetent they’ve been shown to be in every sphere of running the country. Learn to be losers, guys! Just copy the left’s example from the last couple of decades.

  17. Matthew – Healthcare and healthcare financing are two completely different things. How we finance healthcare is far from an “underlying” problem. An underlying problem is nearly 50% of the population with chronic conditions.
    Your point about “progressively financed” is going to require a whole lotta elaboration before that will fly.
    Should those with higher incomes pay more for a loaf of bread? Why not? They make more money.

  18. Please don’t reduce such complexities into ‘socialized medicine’. I’m not even sure I know what ‘socialized medicine’ means. It seems to follow closest to the systems of Canada and England. However every developed country has significant differences in how they finance and deliver care. I’ve heard that the French call the Canadian system socialist.
    Matt, I do think I’d like to allow room for some regional variances in the delivery of care. Although this still could be pooled federally and allocated among regions with jurisdictional oversight…

  19. I see only one problem with Medicaid for all – and that is getting the doctors to play ball. Most cannot even carry their overhead with Medicare rates, and Medicaid rates are even lower. There’s also the stigma of Medicaid as a welfare program and the problem of physician shortages. Maybe there will be enough physician extenders to provide access.

  20. As a rule, the “profit” motive and “free” enterprise are hard to beat when it comes to systems for allocating resources in a free society, but some institutions like churches, education and healthcare are and should be exceptions to that rule.
    So many people have a stake in the healthcare economy. With the wealth comes political clout and powerful influence over public awareness. If you so much as talk about reigning in doctors or drug companies or health insurance, you’re branded as a advocate of socialized medicine.
    As my burgeoning baby boomer generaton enters into geezerhood and science finds more ways to extend life (not necessarily quality of life), and with the “failure” of market-based healthcare, “socialized” medicine sounds rather good these days. Ain’t none of us getting out of here alive!

  21. As a rule, the “profit” motive and “free” enterprise are hard to beat when it comes to systems for allocating resources in a free society, but some institutions like churches, education and healthcare are and should be exceptions to that rule.
    So many people have a stake in the healthcare economy. With the wealth comes political clout and powerful influence over public awareness. If you so much as talk about reigning in doctors or drug companies or health insurance, you’re branded as a advocate of socialized medicine.
    As my burgeoning baby boomer generaton enters into geezerhood and science finds more ways to extend life (not necessarily quality of life), and with the “failure” of market-based healthcare, “socialized” medicine sounds rather good these days. Ain’t none of us getting out of here alive!

  22. “Medicaid-for-All”… hmm, I think I have been saying this as our future for more than 2 1/2 years… and even on THCB.
    Oh, and for the idealists out there who think that insurance companies are evil, and that lobbyists will just wither away in that environment, think again—
    We are about to take a huge step towards “healthcare-by-lobbyist”, where you will need to get permission to spend your own money on your health.
    Listen for AHIP protesting the expansion of Medicaid— silence, you say? Perhaps because they stand to make the most money on the deal— lobbying is much cheaper and the relationships are much stronger than with a lowly paying patient.

  23. Severing the link between employment and insurance? Check.
    Ending Medicaid? Check.
    Progressively financed insurance pool? Hmmmmm. Can’t you just be honest and call it socialized medicine as opposed to hiding behind the “progressive” euphemism?
    But look! In Comrade Holt’s homeland, the proletarians still can’t get health care:
    http://tinyurl.com/ctp6tv

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