As you know, Medicaid is run by the individual states (who don't print their own money and can't run long-term deficits), though it is subsidized with federal funds. In fact, a large portion of the maligned 2009 stimulus package was in the form of aid to the states, most of which was used for the purpose of staving off Medicaid cuts and mass layoffs for teachers. Clearly what we need are higher federal subsidies to raise Medicaid reimbursement rates to reduce the disparity with Medicare and private plans. Why, wasn't there a law passed recently that did just that??
I'm not sure what you are disagreeing with in my post?
I realize that Medicaid is run by each individual state and that a good deal of work has been put in to keep things from becoming disastrously worse; however, it is still also true that Medicaid pays less than other insurances and that many physicians are
turning Medicaid patients away or forcing them to wait longer for an appointment. (Edit: Realized its locked. Hold on. I'll try to find an unlocked copy. Edit 2.0:
Click here). I know that, in my area, it is almost impossible to see a specialist if you have Medicaid; I often have to go out-of-county (45 - 50+ minute drive), despite the fact there is no shortage of that specialty in my own. The only reason I still have a local PCP (small, group practice), in fact, is because they allowed already established patients to continue on as patients even after they stopped accepting Medicaid.
Yes, there was a law passed recently for that purpose; however, the trend is still that reimbursements will continue to get lower.
Lazy analysis. It's very hard to come out on top politically when the other side is doing nothing but kicking sand in the gears of the governing process. I agree that Obama has seemed to give too much ground at times, but he extracted key concessions and it would usually turn out, in the end, that it was the other side who had been bamboozled (e.g., debt ceiling "deal", govt. shutdown "deal").
When did I complain about Obama giving too much ground? Read my posts again -- I didn't.
With the way the Tea Party is acting (ie, anything you say is wrong and we will stop you), I'm not expecting him to get every bill through. I wouldn't expect that, anyways (of course, when PPACA was passed, there was a Democratic majority). My complaints concern his comments and speeches just as much as they do his actions. From the time of the first election, in fact, this was my impression of him: inexperienced, naive, idealistic and not sure how things worked. This doesn't just to apply to health care, either (ex, foreign policy. There were numerous times he stated during the original campaign that he would meet with leaders of countries such as Iran without preconditions. While this may sound good on paper to many, in reality, it would be a horrendous idea. Comments like this showed me he really didn't understand what he was getting himself into or how politics worked. There are other examples, if you would like me to post them).
As for it being a lazy analysis, I wasn't attempting to write an academic analysis. I was stating an opinion and frustration. You yourself made a lazy assumption, here: that I was simply one of many who felt he hadn't been tough enough. That wasn't what I said.
As we've seen, Obama's "reasonable guy in the room" posture has set up a marked contrast with his fanatical opponents, and it's given him the political space to start hammering them for their intransigence.
I agree that the GOP has taken a fanatical and frightening turn that is unhealthy for this country. They have developed an inability to negotiate or have a reasonable discussion.
Obama's approval rating is still below 50%, true, but everyone else's is much worse.
A candidate's approval rating proves nothing other than that a certain percentage of
the voting population approves of that candidate. That said, I do believe -- out of our current options -- he is likely the best option we have due to the fact he is non-fanatical (Romney would be survivable, too, in my opinion; just not my first choice for numerous reasons). This does not change my opinion of him, however, nor does it mean I think he is necessarily a good president, either; I do think that he is better than the others out there and that he is not a bad president, per se.
Seems to me like the man knows what he's doing, and he's been handling crisis after crisis with general aplomb. (Not to say Obama's been perfect, but your half-hearted accusations of incompetence, I guess for the purpose of sounding high-mindedly noncommittal, just don't square with what most of us are seeing.)
No, it does not mean that he knows what he is doing. It
does mean that he is not horrendous (I agree) and that he is an astounding public speaker; but that is all. I also have no doubt he is confident, self-assured and able to keep his cool. That, once again, does not equate to not being naive.
You are speaking as if I am one of those Tea Party, Obama-bashing fanatics or disillusioned former Obama supporter. I am not. I am, however, a left-leaning moderate and pragmatist. When I see what Obama has done and listen to what he has said, I see someone who has the best intentions and highest ideals; who has the ability to inspire entire generations of people; and who wants to do good. I also see someone who came in with inadequate executive experience, which ended up hurting him as he attempted to adjust to his role as President; who holds his ideals so strongly that he cannot see what is and is not practical at the moment; who takes actions and pushes laws without a clear understanding of how they will impact the "real world"; and who was taken off guard by the opposition that he faced and spent too long hoping people would do the right thing. These are the traits I would want to see in a friend or family member, not a president.
Furthurmore, I am also not adamantly apposed to the PPACA. There are parts that I am against, as I have expressed; however, there is also a lot that I support and I believe that those parts will do a lot of good.
Please do not pigeonhole everyone who has some disagreement about Obama, PPACA, etc into one group that you have imagined us all to fit into.
With regard to "outcome-based reimbursement", presumably you mean the cost savings programs, like bundled payments or accountable care organizations (ACOs), which have been included in the PPACA only as pilot programs to study their effects on healthcare cost containment. No reason to get all hot and bothered about it just yet.
I am talking about ACOs.
This is what I am referring to (pg 4):
Linking Payment to Quality Outcomes in Medicare: A value-based purchasing program for hospitals will launch in FY2013 will link Medicare payments to quality performance on common, high-cost conditions such as cardiac, surgical and pneumonia care. The Physician Quality Reporting Initiative (PQRI) is extended through 2014, with incentives for physicians to report Medicare quality data – physicians will receive feedback reports beginning in 2012. Long-term care hospitals, inpatient rehabilitation facilities and hospice providers will participate in value-based purchasing with quality measure reporting starting in FY2014, with penalties for non-participating providers.
It is already starting, too.
Here is an April article from Kaiser.
Here is a related commentary on NPR's Health Blog.
To the OP, I highly doubt that medically underserved patients are more litigious than privileged suburbanites. Malpractice premiums are much lower in rural states compared to states like Florida, for example, and poorer urban patients tend to have less access to the legal services they'd need to mount a lawsuit.
This, I agree with.
First point, from what I've read, most doctors avoid having an all-Medicaid practice. To the extent they do accept Medicaid patients, physicians try to balance them out with privately insured patients whose higher reimbursements will partially make up for Medicaid's meager offerings.
False. Many physicians refuse completely. Read the WSJ article.
Medicaid patients also tend to receive less care overall (a couple fewer tests, a shorter doctor visits) than privately insured patients. So yes, it's not an ideal situation, but even in medically underserved areas the population is not 100% Medicaid.
This (the bolded) is true -- they also wait longer for an appointment.
While no area is 100% Medicaid, you underestimate the impact even a few patients can have. Many physicians lose money by seeing Medicaid patients and, as such, struggle while taking them or refuse to see them.
As far as the politics, could organizations like AMA, PNHP or NMA do a better job of pushing for the interests of Medicaid beneficiaries? Sure, but last year we prioritized expanding access to the uninsured. In the end, though, the inherent problem is that the kind of physicians who work in medically underserved areas and rely heavily on Medicaid reimbursements are not the ones with extra cash lying around for political lobbying. Large hospital providers who treat poor patients have some clout, true. However, they are probably more preoccupied with the constant negotiation with private insurers (the ones who actually fund the hospital) and getting reimbursed for uninsured emergency department patients whom they're obligated to treat under the EMTALA passed by Congress in 1986.
No disagreements here.
Though, even if it was made a priority, he (Obama) is still doing it wrong and with ignorance.
I see, I see. Well just another reason for me the step aside and let others serve them 😛. I'll shoot for the for-profit suburban hospitals
Your upper-middle class patients will sue you, too -- including those at the for-profit suburban hospitals.
Tell this to the ER physician who becomes the primary care provider for those Medicaid patients.
They primarily become the PCP for the uninsured. In areas with a lot of physicians refusing to take patients, having them wait longer for appointments and/or without urgent care centers that take Medicaid, yes, I can see this happening.
