Few questions about health reform, Medicaid

[monomania]

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Obviously, one fundamental problem is that the poor can't afford the rising costs of health care insurance, and we'd like to see fewer people uninsured. But don't Medicaid programs cover the vast majority of the poor?

If the answer is that Medicaid is insufficient in some way in its current form, and if we're going to use federal money on health reform, why not divert that money to insuring the poor by subsidizing their health care?

The second question is more general: isn't the high cost of health care just an inevitable fact of modern medicine in the U.S.? You've got more complex/specialized drugs (i.e. for hundreds of types of cancer), medical equipment that rivals that of any other nation, the need to pay physicians relatively fairly even though they're arguably undercompensated even in the U.S., and so on. I realize that other countries cut down on costs, but they do so by putting a greater burden on consumers (taxation, paying higher prescription costs, taking on a greater share of overall costs), cutting physician salaries, and often pressuring physicians about over-medication.

So, even if we do go the most drastic route to a public option, that just puts a greater financial burden on the government (already into a huge deficit) and requires more taxation to fund the program. If people are getting taxed more because government can't sustain itself, it seems like we're not really getting anywhere but simply channeling the funds through a different route.

Lastly, if Medicare can't sustain itself (projected to dry out in the next decade), then how is a public option (or "Medicare for all") feasible? Seems like it isn't... unless, of course, you'd like to bump up taxes on the citizenry, but even so, I wonder about its future quality and reliability.

 

[armybound]

Obviously, one fundamental problem is that the poor can't afford the rising costs of health care insurance, and we'd like to see fewer people uninsured. But don't Medicaid programs cover the vast majority of the poor?

If the answer is that Medicaid is insufficient in some way in its current form, and if we're going to use federal money on health reform, why not divert that money to insuring the poor by subsidizing their health care?

That's where the money for reform is slotted to go.

Medicaid programs are a combination of federal and state dollars, and the state doesn't always want to expand coverage. I saw some figures for what Texas will allow a family to make before they aren't eligible for a combination of Medicaid and SCHIP and it's really disgustingly low.

The second question is more general: isn't the high cost of health care just an inevitable fact of modern medicine in the U.S.? You've got more complex/specialized drugs (i.e. for hundreds of types of cancer), medical equipment that rivals that of any other nation, the need to pay physicians relatively fairly even though they're arguably undercompensated even in the U.S., and so on. I realize that other countries cut down on costs, but they do so by putting a greater burden on consumers (taxation, paying higher prescription costs, taking on a greater share of overall costs), cutting physician salaries, and often pressuring physicians about over-medication.

There are several ways that costs can be brought down. A lot of drugs that are on the market right now are unnecessary and unnecessarily expensive. A lot of money is wasted in overhead, which Medicare/Medicaid can address.

So, even if we do go the most drastic route to a public option, that just puts a greater financial burden on the government (already into a huge deficit) and requires more taxation to fund the program. If people are getting taxed more because government can't sustain itself, it seems like we're not really getting anywhere but simply channeling the funds through a different route.

Lastly, if Medicare can't sustain itself (projected to dry out in the next decade), then how is a public option (or "Medicare for all") feasible? Seems like it isn't... unless, of course, you'd like to bump up taxes on the citizenry, but even so, I wonder about its future quality and reliability.

The public option is just another insurance plan. People pay into it. It's not just paid by taxes.

 

[Birdsbeak]

Another problem with Medicaid is that it will only cover children up to a certain age and then it boots them off the plan. Furthermore, women who are pregnant and poor will be covered by medicaid, but after giving birth they are booted off the plan and the child is covered. I read that little tidbit in "Uninsured in America."

Medicaid has some rigid guidelines you need to meet before you are eligible to enroll. I am strongly in favor of a public health insurance option. I'd like to see access to health care expanded.

 

[LiveUninhibited]

Obviously, one fundamental problem is that the poor can't afford the rising costs of health care insurance, and we'd like to see fewer people uninsured. But don't Medicaid programs cover the vast majority of the poor?

No. Medicaid is often not accepted by providers due to its poor reimbursement rates. As another mentioned, it is also often not funded. In my state, you have to win a lottery to get medicaid coverage.

If the answer is that Medicaid is insufficient in some way in its current form, and if we're going to use federal money on health reform, why not divert that money to insuring the poor by subsidizing their health care?

The problem is that most programs designed as essentially charity to benefit the poor do poorly in America in terms of long-term funding. The only way to ensure that the public actually supports the funding of healthcare is if you put the upper, middle and lower class on the same basic plan, but allow supplemental coverage for customization.

Subsidies will probably get scaled back over time, particularly when the republicans regain control, and with individual mandates this would be a major hardship for the poor and lower middle class. Subsidies for for-profit health insurance will be a bonanza for the companies, and instead of saving money on healthcare any extra money will go to their shareholders. Making it unsustainable over time.

The second question is more general: isn't the high cost of health care just an inevitable fact of modern medicine in the U.S.? You've got more complex/specialized drugs (i.e. for hundreds of types of cancer), medical equipment that rivals that of any other nation, the need to pay physicians relatively fairly even though they're arguably undercompensated even in the U.S., and so on. I realize that other countries cut down on costs, but they do so by putting a greater burden on consumers (taxation, paying higher prescription costs, taking on a greater share of overall costs), cutting physician salaries, and often pressuring physicians about over-medication.


So, even if we do go the most drastic route to a public option, that just puts a greater financial burden on the government (already into a huge deficit) and requires more taxation to fund the program. If people are getting taxed more because government can't sustain itself, it seems like we're not really getting anywhere but simply channeling the funds through a different route.

Yes and no. America does have more available, but not proportionate to our costs, and not available to everybody anyway. Many of the drugs the companies develop are not better than what already exists, but they market them as if they are. Banning direct to consumer ads would force them to use more of their money on research, and strengthening the FDA, or even going so far as having the FDA design studies for the drug companies to carry out would help them come out with more novel drugs for the money. Instead of comparing new drugs for conditions with existing rx to placebos, they should be required to show superiority to the existing rx, except in special cases like imminently deadly disease (cancer).

America has many other sources of inefficiency. Pluralism and profit both correlate with higher administrative overhead in health insurance, and Americans spend about a quarter of total costs on overhead. Single-payer systems spend more like 2-3% (UK, Taiwan), and pluralistic non-profit systems (Germany, Switzerland) spend 5-10%.

Pluralism reduces inefficiency of insurance in various ways including reduced pooled risk, the way the myriad disparate insurance policies require extra staff to decipher and deal with, and the way each of them require redundant infrastructure to operate.

Basically, a single-payer system represents higher taxes but this is more than offset by not paying premiums. If you have employer-based insurance, it may not seem so bad, but don't forget that the employer is also paying as much or more than you put towards it, and this reduces your wages and their profitability.

Another example of inefficiency is the problem of malpractice and defensive medicine.

Even within our government funding things via medicare and medicaid, there are inefficiencies introduced by special interests. For example, medicare/medicaid often will not cover/support custodial home care, and this forces more people to go into nursing homes prematurely at a cost of 70k per personyear. Logically it would make sense to delay entry into nursing homes as long as is medically advisable, but that would hurt the nursing homes. Medicare cannot negotiate for drug prices despite being the largest purchasher, courtesy of the pharma ****** in Congress.

No matter how you look at it, it is our system of government that screws us over, though, as it is highly conducive to special interests buying Congress and manufacturing consent of the public.

Lastly, if Medicare can't sustain itself (projected to dry out in the next decade), then how is a public option (or "Medicare for all") feasible? Seems like it isn't... unless, of course, you'd like to bump up taxes on the citizenry, but even so, I wonder about its future quality and reliability.

Part of Medicare's problem is putting government funding toward for-profit plans in the form of Medicare Advantage. Medicare is more efficient than private insurance in terms of dollars that actually go to healthcare, and it is going broke because of the special interest deals I alluded to, and Congress refusing to raise taxes sufficiently by increasing payroll taxes, income taxes, or levying excise taxes.