AEIdeas

The public policy blog of the American Enterprise Institute

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Discussion: (5 comments)

  1. a “new” paper from American Enterprise that says this:

    “Even if Barack
    Obama is elected for a second term, there is considerable uncertainty about whether the deal struck in 2010 can be maintained in future years. Laws can be changed, and increasing budget pressures at the federal level could translate into a cost shift to the states.”

    so probably not so “new” and certainly dated in terms of the election.

    The think not recognized about MedicAid is that people who do not get doctor’s care STILL get health care but they get it from the hospitals and other medical providers that are forced to treat them because of EMTALA.

    Often people who do not get access to earlier stage periodic medical care, sustain chronic untreated disease that becomes very expensive in the latter stages – stages that taxpayers and those who have insurance pay for.

    If we did not have EMTALA and there was no moral conscience, then we COULD save money by just killing MedicAid all together and letting people just die of disease.

    But since we have EMTALA where we already agree to pay to treat disease for indigents, then the issue becomes what is the most cost-effective way of doing this?

    Obviously, if there is a shortage of physicians who will accept MedicAid, without changes, it translates into many more expensive ER physicians and personnel to treat the indigent.

    We have to decide if we are going to continue to have EMTALA or not. If we continue to have EMTALA then we have to decide if this is really how the rest of us want to pay for medical care for the indigent.

  2. 1775Concord

    66% of what private insurers pay? No, Medicaid pays less than half of what private insurerers pay to doctors. Medicaid pays 22 cents on the dollar for usual and customary charges billed by doctors. But private insurers have been cheating doctors for years because 1) they own the patients and can tell doctors what they will pay, 2) doctors cannot unionize or negotiate…it’s take it or leave it (I don’t know how the NYC doctors can bargain as a group, as the Federal Trade Commission has forbidden doctors from banding together to negotiate), 3) the amount used in this article about “what private insurers pay is meaningless because insurers have ratcheted down pay to doctors simply because they can do it, and it increases the profit bottom line for insurance companies. Medicaid pays doctors even less than overhead, and doctors cannot run an office with this amount of charity, as they lose money on every patient. Subsidized hospitals with Medicaid money from the state plus billing at Medicaid rates does something, but increased funding mandated by Abysmalcare will bankrupt the state…as it is on its way to doing in Massachusetts with Romneycare. You cannot solve the problem of high gas prices by putting drivers on Gasicaid and forcing gas station owners to accept 80 cents a gallon from those on Gasicaid.

  3. The other thing that is really seldom reported on articles that question MedicAid expenditures is who is receiving the benefits.

    Without making it clear, many may think it is able-bodied indigent but that’s not the case at all:

    21% are the aged usually in nursing homes that Medicare does not cover.

    20% are kids

    45% are disabled

    only 14% are adults

    http://www.cbpp.org/cms/index.cfm?fa=view&id=2223

    the real question is when the discussion is about the cost of MedicAid – and implications that it must be cut, the real question is what would we intend to do with the 86% who basically largely unable to care for themselves?

    It’s pretty easy to talk about cutting entitlements when the conventional wisdom that emanates from some either do not understand or do no care that 86% does not go to “slackers”.

    MedicAid IS means-tested also.

    I’m not arguing that it should necessarily be increased or expanded or even that perhaps it should not be shrunk but the devil is in the details when 86% of the recipients are elderly, disabled or kids.

    we almost never hear specifics about how it ought to be reformed.

    What the “new” paper recommends: ” One way to answer that question is to put the Medicaid expansion to the market test: give everyone a choice of private insurance or Medicaid and let them decide for themselves how they wish to spend the subsidy and,potentially, some of their own money.” clearly is off in LA LA Land with the 86% of recipients.

    All I can say is what planet are they on when they are basically advocating that the elderly in nursing homes, children and handicapped “use their own money” to “go out and bargain for cheaper care”.

    one must ask what’s the value of such “studies”?

    1. skh.pcola

      Your child-like ignorance and statist zeal is pitiable. You spew your inanity all over the Internet and have shown a remarkable tenaciousness that allows you to remain ignorant. You are too stupid to realize it, but most people laugh at your comments. Mental retardation is funny, except when the consequences have disastrous results, as always happens when your ideology is implemented.

      1. @skh.pcola really?

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