Obamacare

Obama Administration to States: Don't Cut Medicaid. Instead, Do More With Less.

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State budgets across the nation are in crisis, and a big part of the reason why is that they can't afford their Medicaid programs. Arizona has already proposed dropping roughly 280,000 individuals from its Medicaid rolls, and is looking to the federal government for permission. Other states may soon follow. In response to the , the Obama administration's Health and Human Services department has provided some guidance. By judging by this write up in The New York Times, I'm not sure it's all that helpful:

An administration official, discussing the letter on condition of anonymity, said: "Cuts can hurt people. We certainly see that."

The official said that, instead of taking an ax to Medicaid, states should find ways to save money and improve care at the same time.

This is the sort of wisdom that only the federal government's auteurs of bureaucracy could come up with: Instead of making cuts to services, states should find ways to save money that also make care better. After all, doing more with less is usually so easy. And clearly no one has thought of this idea before. If they're still short, presumably HHS will encourage them to find those pots of free gold that are constantly getting left near the ends of rainbows.

I kid! And sure, maybe there really are efficiency gains to be made:

For example, the official said, states should more aggressively manage the care of the sickest Medicaid recipients.

"Just 1 percent of all Medicaid beneficiaries account for 25 percent of all expenditures," Ms. Sebelius said, and 5 percent of the recipients account for more than half of Medicaid spending.

Sorry, but isn't "aggressively manage the care of the sickest" patients code for "doing less for resource-intensive patients in order to save money?" Now, doing less in order to save money may be necessary for fiscally problematic programs like Medicaid. But that sounds an awful lot like those potentially harmful cuts that our friendly anonymous administration official was warning could hurt people just a few sentences earlier.

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  1. Death panels, anyone? Anyone?

    1. Gotcher ‘excessive expense control unit’ right here.

      1. It will all be fair — The president and members of congress will be exempt of course. Also HHS administrators, so Ms Sibelius is safe.

        1. No one is safe from the Medicaid Inquisition!

  2. For example, the official said, states should more aggressively manage the care of the sickest Medicaid recipients.

    “For instance, an ordinary pillow held down against a patient’s face for just a quick moment or two = Big BIG $$$ Savings!!!”

  3. I think Obama is right. I think Washington state in order to balance its budget should fire everyone in the Department of Ecology so we can pay for the care of the poor and infirm.

    CTED and all state grants for land use planning should be cut as well.

    The University of Washington really does not need humanities studies. How about making students pay their own tuition for those kinds of studies.

    The state could also repeal the Growth Management act…this would free up a lot of worthless spending on the local level.

    1. Might want to eliminate that tunnel planned Seattle as a start…but yeah, there is still waste to be cut before you need to cut programs that actually help people.

      1. They should build a tunnel just big enough to bury the fucking city council in.

    2. You fail to take into account how very essential every service government provides is. The harsh reality is that the least essential thing in the whole equation seems to be that one percent of highend Medicaid beneficiaries. I mean, it’s nice to have their votes and all, but really, what else do they provide for the common good? It’s simple cost/benefit.

      1. Personally, I consulted the services of 7-10 humanities graduates this week.

        Asses don’t wipe themselves.

        1. Personally, I consulted the services of 7-10 humanities graduates this week.

          Just remember that they never carry change for anything larger than a twenty, and tip them properly if the pizza arrives within the thirty minute delivery window.

      2. The harsh reality is that the least essential thing in the whole equation seems to be that one percent of highend Medicaid beneficiaries.

        How is it that just 1 percent of Medicaid beneficiaries account for 25 percent of all expenditures?

        1. When it rains it pours. A few people are having surgery, hospital stays, batteries of tests, while others just have the odd doctor visit if they use it at all.

          I’d be surprised if that doesn’t hold for health insurance beneficiaries in general.

          1. As I havent been to a doctor (non-eye) in over 15 years, and have had insurance all that time, there is no question about it.

            Of course, that is the point of insurance…to pay for rare catastrophic events. I rarely collect from my homeowners insurance either (although did a few winters ago when ice storm brought a tree down on my house).

            1. Of course, that is the point of insurance…to pay for rare catastrophic events.

              Like the way auto insurance pays for oil changes?

              1. Auto insurance doesn’t pay for oil changes because it doesn’t pay for blown engines.

                Auto insurance with glass coverage does pay for windshield chip repair, to avoid paying for a new windshield in the future. Insurers in many different fields are willing to pay for small preventative services to avoid paying big bills in the future; that’s not unique to health insurance.

                1. Auto insurance doesn’t pay for oil changes because it doesn’t pay for blown engines.

                  Why then, should health “insurance” pay for either abortions or successful deliveries when pregnancy is 100% preventable?

                  1. Even sovereigns aren’t immune to non sequiturs, apparently.

                2. Actually, glass coverage pays for chips because the state (at least mine) requires it.

                  They might do it without the state law…they might not.

                  I think the state considers it a safety issue.

                  1. That’s a chicken and egg question. A few insurance companies start covering something and then people come to expect it, so the state mandates it.

    3. According to this site, WA spent over $3 billion on Medicaid in 2008, and you can bet that amount has risen. The cuts you’re talking about are drops in the bucket compared to that.

      1. Well, the “tunnel portion of the plan” costs the state and city $1.9 billion, plus whatever the none-tunnel portion adds to that. That’s adds up to something…

        1. That’s a one time expense. If it takes 5 years to build that thing, Medicade will have spent $15 billion during its construction.

          1. When life gives you medical lemons, make Medicade!

      2. Washington Department of Ecology has a budget of about a half a billion $s

        It has also been around long enough to start paying out pensions.

        1. Cuts to Dept of Ecology have so far amounted to about 300 million. They have taken a 21% budget cut and are looking at an additional 25% budget cut this time around.

          1. “Cuts to Dept of Ecology have so far amounted to about 300 million. They have taken a 21% budget cut and are looking at an additional 25% budget cut this time around.”

            Well, it’s a start.

  4. “The official said that, instead of taking an ax to Medicaid, states should find ways to save money and improve care at the same time.”

    I’m a little surprised that Libertarians won’t acknowledge this conversation with anything other than a death panel joke. Money is wasted on end-of-life care that does not benefit the Medicaid patient but simply continues suffering. There is a big gap between taking care of the patient with the ‘Indian manover’ and keeping people comfortable so that they may die naturally, and without intervention

    1. “Money is wasted on end-of-life care that does not benefit the Medicaid patient but simply continues suffering.”

      Thanks for your opinion on what constitutes life worth living. So are you saying that we need some type of government panel to decide who gets life-prolonging treatments?

      1. Thanks for your opinion on what constitutes life worth living. So are you saying that we need some type of government panel to decide who gets life-prolonging treatments?

        Only if the government is paying for it.

        If people want to spend tens of thousands of their own dollars just to live long enough to see who wins Dancing With the Stars, that is their business.

        But I sure as hell do not want the U.S. government to pay for medical treatment without a reasonable expectation of acceptable results

        1. Michael, she personally accepts the results of her difficult situation, and she is obviously an intelligent woman with a life ahead of her-your link is completely off the mark

          1. Michael, she personally accepts the results of her difficult situation, and she is obviously an intelligent woman with a life ahead of her-your link is completely off the mark

            And if she wants to pay for her treatment out of her own pocket, fine. It is her money.

            1. she was seeking private donors for her expenses-nothing wrong with that

    2. Money is wasted on end-of-life care

      Thank goodness we have you to make those sorts of decisions for us, then.

      I mean… *whew*.

    3. I think you forgot the part about libertarians not wanting Medicare to exist at all…

    4. We’ll make sure to unplug you first butthead.

      1. marlok,JoJo Zeke and darling John D

        You presumed that I would run around hospitals pulling plugs like it is a game of tag, and I thought I made it clear with my Cuckoo’s nest reference that it is not the case.

        Do you know advanced Alzheimer patients receive mammograms? WTF for? (other than some stupid doctor ordered the procedure).

        I am sure none of you have ever had your penis in a vice but a mammogram is damn painful, and serves no purpose for prevention of a disease that will not be the cause of death.

        Remarkably, all kinds of ridiculous procedures are done on the elderly for disease prevention that outweighs their life expectancy, not too mention the pain and discomfort.

        1. I am sure none of you have ever had your penis in a vice

          By the time my eighteenth birthday finally rolled around, the final count of vices into which I’d willingly introduced my penis (at that point) could only be represented by an irrational number.

          1. Yes Jojo and thanks for the visit to my site-feel free to comment there too 😉

            1. and I’d bet you’d do it all over again

    5. Re: Rather,

      I’m a little surprised that Libertarians won’t acknowledge this conversation with anything other than a death panel joke.

      Your surprise may be explained by the fact that you lack any humor… or character.

      Money is wasted on end-of-life care[…]

      Whose money? Yours? Stop paying taxes, then.

      […]that does not benefit the Medicaid patient but simply continues suffering.

      Hopefully, you will not get a job as the excessively nice orderly…

      1. “You[‘re] surprise may be explained by the fact that you lack any humor… or character.”

        OM, I have both and did you just pull a non sequitur? 😉

        1. Did you seriously just correct something by making it worse?

          “Your surprise” = the surprise you feel
          “You’re surprise” = the surprise you are

          Geez you‘re dumb.

        2. Re: Rather,

          OM, I have both and did you just pull a non sequitur?

          Yeah, what would I know? I am just a lowly Mexican, except…. I did not write “You’re”, I wrote “Your” (possessive) to explain your surprise at people making jokes – explained by the fact you lack humor, character… and good grammar, to boot.

  5. Just for the sake of argument, shouldn’t my guys be proposing something like:

    – hire unemployed to build new hospitals and free clinics
    – loosen/remove medical licensing requirements
    – fund education for a ‘tour’ at one of the new hospitals/clinics

    instead we get bureaucratic authoritarianism, wonderful

    1. Maynard, you forgot to mention that you like tax cuts as well.

      1. and what would he say ’bout the carbon problem?

    2. I don’t think construction unions or the AMA would appreciate that.

  6. How about we just make Obama crawl back into whatever space alien asshole he can out of. Please.

  7. Easiest way to cut medicaid: require a $5 co-pay. That’s all. 50% of your costs (and 80% of your visits) would be GONE.

    If you have no skin in the game, why NOT come to doctor’s office? You get listened to, climate controlled air, plenty of attention, and you might even score some free stuff. What kind of stuff: who cares? It’s free, baby!

    [FL medicaid has $0 co-pay, no deductible, so people bring their perfectly well kids in to get “checked out” before the family leaves on vacation.]

    1. Dating a girl who does pediatric Medicaid case management in FL. I get the urge to break shit whenever she talks about her job. People trying to get 16 month olds diagnosed with the ‘hypermental’ (ADHD) so they can collect disability, grad students’ wives who don’t work so they can nurture their babies on the state teat. Believe me there is plenty of room to cut Medicaid services without endangering the lives of actual poor children with actual disabilities.

      1. What poor children? I solved that problem with my Great Society thirty years ago.

    2. But the 80% of the visits are a low proportion of the costs. It’s hip replacements and other expensive procedures that patients are not going to have on a whim that are busting the budget.

      1. “But the 80% of the visits are a low proportion of the costs. It’s hip replacements and other expensive procedures that patients are not going to have on a whim that are busting the budget.”
        Got any cites for this?

  8. Actually, “aggressively manage the care of the sickest” is code for “death panels”

  9. Griffin3’s point is excellent. Imposing a $20 copay on ER visits in a study of medicaid members drove the utilization down 30% in the HMO where I work, making the utilization similar to commercial members’.

    Costs for some very sick patients are actually greater than the cost of a full time nurse to get them over their crisis period. Modeling patient history and predicting people who are in a crisis situation does give some cost savings.

    1. guy in the back row|2.4.11 @ 8:06PM|#
      “Griffin3’s point is excellent. Imposing a $20 copay on ER visits in a study of medicaid members drove the utilization down 30% in the HMO where I work, making the utilization similar to commercial members’.”

      I don’t know where you work, but some smart cookies at the HMO where I’m a member have been fiddling with the co-pay for the ER pretty actively.
      It’s now something like $30 as opposed to $20 for seeing a doc on appointment. That ER waiting room hasn’t been that empty in years…

    2. Yep. The biggest single problem in health care in America today? Everyone is spending everyone else’s money, from the poorest Medicaid recipient to the fattest fatcat with a gold-plated, first-dollar insurance policy.

      The price mechanism has broken down because no one in the entire system has the slightest idea of what anything costs anymore.

      1. Yep. The biggest single problem in health care in America today? Everyone is spending everyone else’s money, from the poorest Medicaid recipient to the fattest fatcat with a gold-plated, first-dollar insurance policy.

        Also many insurance policies act more like warranties, often mandated by the state.

        1. Explain how insurance policies are like warranties.

          1. Its a sketchy analogy, but see your blown engine comment above.

            Blown engine would be covered by your car’s warranty, not insurance.

            Since you made that analogy above, I assume you see how it applies here.

            1. If that’s his point he’s comparing apples to oranges again. There’s no inherent reason why one couldn’t have an insurance policy that covers mechanical failures, it’s just that a market never developed for that.

              Warranties are a completely different type of object from insurance, anyway…you don’t have to pay monthly premiums for warranty coverage.

              1. you don’t have to pay monthly premiums for warranty coverage.

                Im sure Best Buy is researching that.

              2. The problem isnt that the market never developed for it.

                The problem is states mandating coverage, instead of letting us choose. I would prefer a health insurance plan that doesnt cover maintenance. And doesnt cover lots of other stuff too. I would like a stripped down plan. If the market didnt exist for that, that would be one thing – disappointing, but my tough luck. However, states prevent those kind of plans from existing.

                Back in my early 20s, I had a cheap hi-deductible plan until KY outlawed it.

            2. “We at OmniDe strive for excellence in our product, you the customer. Under rare(ish) circumstances some of our products may contain defects that escape our Quality Control department. Should any of our cherished customers experience any unpleasant inconsistencies with their products, please feel free to return your product, and we will refund your product at full cost*.”
              -Zombie Jesus, Vice President of Operations, OmniDe.

              *Minus the cost of shipping and handling

      2. It doesn’t help that hospitals won’t tell you (and have no incentive to tell you) in advance what anything costs; even those of us who want to shop around can’t.

        It’s a flaw in the legal system, basically. If you receive a service without pre-paying, the amount you legally owe for that service ought to be the greater of {whatever fee they pre-published, $0}, rather than the lesser of {whatever they decide to bill, whatever you can convince a judge is excessive}.

        1. Actually you can shop around. It requires paying up front but hospitals will compete for the cash patient.

  10. “But that sounds an awful lot like those potentially harmful cuts that our friendly anonymous administration official was warning could hurt people just a few sentences earlier.”

    Well, they only said that cuts can hurt people, not that they disapprove.

  11. Aw fuck it. Can’t come up with even a really lame joke that claims part of the idea was that they faxed out a listing of Shamans, VooDoo practitioners and Witch Doctors willing to work at cut rate group discounts as Appendix three of the memo, without it coming off all racisty and dumb sounding.

    But there it is.

  12. It’s all because too many people abuse Medicaid and they are getting away with it. I work in an ER and see people use their Medicaid every day for colds, headaches and toothaches in the ER, at $500-$1000 a visit!

    1. We’re with Obama and Sibelius — we want more for less.

  13. They should name at least one government program after Ayn Rand. The Ayn Rand Medical Fund for Right-wing Hypocrits.

    1. “They should name at least one government program after Ayn Rand. The Ayn Rand Medical Fund for Right-wing Hypocrits.”

      They could name one after you, but “Stupid Shit Makes Everything Worse Law” would only pass if Pelosi was still handing out taxpayer money.

      1. You zombie fucks don’t want to talk about Welfare Queen Rand, do you, asshole?

        1. Max|2.4.11 @ 10:40PM|#
          “You zombie fucks don’t want to talk about Welfare Queen Rand, do you, asshole?”

          Why, you sleazy bastard, it’s way more fun to point out your abysmal ignorance, goat-ass-sucker.

        2. S&M dominatrix, Che Guevara, instead, Maxine.

        3. Why should we talk about her, Max? It’s no big deal. No story at all. Just bullshit you liberals found to fling.

    2. Max, H&R’s pet yorkie.

      Here, Max! Here’ boy! Go fetch! That’s a good boy!

      NO! Nooo! Don’t do your banalities on the carpet, I just had it steamed! Bad Max, bad!

  14. I wonder how Rand Paul feels about being named after a closet welfare queen.

    1. I know, right? Ayn Rand should have been an out and proud queen, like Max.

      Now stop playing with your mommy’s things Max before she smacks you on your little balls again.

    2. Max, H&R’s pet yorkie.

      Here, Max! Here’ boy! Go fetch! That’s a good boy!

      NO! Nooo! Don’t do your banalities on the carpet, I just had it steamed! Bad Max, bad!

    3. Sigh, once again we see Edward/Lefitit/Morriss/Concerned Observer/max/whatever the fuck he’ll call himself next’s abysmal knuckle-dragging ignorance demonstrated for all to see. And ignorance, I should add, that is so great, it’s a wonder he doesn’t drown walking outside in a rainstorm.

      Rand Paul is not named after Ayn Rand. his given name is actually Randall Paul. Appparently as a toddler, he preferred to shorten it to Rand. And, unlike Max, who keeps changing his name in a desperate attempt to 0 his reputation so that people will pay attention to him, Rand Paul has stuck with that monicker since.

      BTW, Max, how is that lawsuit of Urkobold going? Or, like your constant tantrums about leaving us, is that another grandiose claim you failed to execute?

      1. BTW, Max, how is that lawsuit of Urkobold going? Or, like your constant tantrums about leaving us, is that another grandiose claim you failed to execute?”
        How can we miss him if he won’t go away?

    4. You ignorant cunt. His name has nothing to do with Ayn Rand.

      It’s short for Randall.

  15. “presumably HHS will encourage them to find those pots of free gold that are constantly getting left near the ends of rainbows.”

    Exactly.

    And they can stop at a nearby winged Pegasus ranch so they can fly their gold back to town PDQ.

  16. Maybe he’ll change his name to O’Connor Paul and become a communist.

    1. Max|2.4.11 @ 10:38PM|#
      “Maybe he’ll change his name to O’Connor Paul and become a communist.”

      Maybe you’ll grow a brain cell.

    2. Max, H&R’s pet yorkie.

      Here, Max! Here’ boy! Go fetch! That’s a good boy!

      NO! Nooo! Don’t do your banalities on the carpet, I just had it steamed! Bad Max, bad!

  17. Please be assured that I am committed to working with you toward a sustainable and vibrant Medicaid system in ways that are responsive to the current challenges you are facing every day.

    That’s … beautiful.

  18. Let me be clear, with our friends in the north… we have worked out no deals for oil rich oil sands and left Americans asses hanging out in the “Green Energy” wind.
    Take it away Frenchy…

  19. Sorry – you lost me at Arizona. Anyone outside this state may have missed that our fine Governor spent $65,000 on her inauguration – When we have a $2 Billion dollar deficit. The largest cost, over $13k, was on commemorative coins. Will Reason please examine this?

    Here’s a tip; if you are going to try and cut 280,000 people off of a publicly approved initiative, that was passed by a majority of the public, you may want to cut back your spending. Also, one more tip, if you’re going to call for people to sacrifice, please do not introduce a bill to slash corporate taxes to rates that increase the deficit by wider margins (thus necessitating the need for deeper cuts to Medicare).

    Unfortunately, this absentmindedness continues. It’s similar to when Gov. Brewer blamed the government of the past two years for our problems; yet she didn’t mention that she’s been the Governor for the past two years and Republicans have had the majority in the House and the Senate for the past two years.

    This article is yet another reason I’ve stopped being a major donor to Reason. I would be OK with this if it was the Times, but not with an organization that touts itself as smarter than the other media.

    In order to grow, we must be honest with ourselves and our Government. If we want the services we have, we must pay more. If we don’t, then we must figure out what to cut. I challenge readers (and Reason) to explain explicitly what they will cut. Once that is done, let’s debate.

    1. Whatever type of Libertarian you are-I’d join.

    2. “please do not introduce a bill to slash corporate taxes to rates that increase the deficit by wider margins (thus necessitating the need for deeper cuts to Medicare).”

      Let’s see, where does the money come from to pay those higher corporate taxes? Why, my goodness, it comes from the customers! Meaning higher “corporate” taxes are just plain higher taxes! What a surprise!
      Sorry, cut the damn expenses.
      You probably quit contributing since the logic made your head spin.

      1. Actually, Sevo, corporate taxes come from the customers, the owners/investors, and the workers, in a proportion that varies depending on the law and market conditions.

        But just for fun, I’ll accept your premise that customers pay virtually all the corporate tax. This implies, of course, that the owners and investors are NOT paying it. This undercuts completely the libertarian argument for the lower taxes on capital gains, which springs from the idea that the money is being double-taxed.

        You just admitted it isn’t. Thanks for conceding that capital gains should be taxed as normal income.

        1. Re: Chad,

          But just for fun, I’ll accept your premise that customers pay virtually all the corporate tax. This implies, of course, that the owners and investors are NOT paying it. This undercuts completely the libertarian argument for the lower taxes on capital gains[sic], which springs from the idea that the money is being double-taxed.

          Chad-logics for the layman: Imply one thing, and then imply quite another thing through a clumsily placed strawman and equivocation.

          1. “Chad logic” includes the proposition that a tax is paid only once. You can’t claim both the owners AND the customers are paying the tax, depending on which argument you want to make that particular day.

            Yet that is precisely what libertarians do.

    3. “If we don’t, then we must figure out what to cut. I challenge readers (and Reason) to explain explicitly what they will cut. Once that is done, let’s debate.”

      https://reason.com/archives/201…..-the-state

      Jeeze, you’re late for just *everything* aren’t you?

    4. Re: ShawninPHX,

      Sorry – you lost me at Arizona. Anyone outside this state may have missed that our fine Governor spent $65,000 on her inauguration – When we have a $2 Billion dollar deficit.

      Good way to start an argument about Medicaid – with totally irrelevant and worthless tangents.

      Here’s a tip; if you are going to try and cut 280,000 people off of a publicly approved initiative, that was passed by a majority of the public,

      Majority vote or popularity does not trump the laws of economics. If there’s no more moola, then there’s no more moola, no matter the popularity of a money pit.

      Also, one more tip

      Here’s mine…

      if you’re going to call for people to sacrifice,

      Meet Rather, the resident death provider who wants to ‘sacrifice’ the ‘suffering.’

      please do not introduce a bill to slash corporate taxes to rates that increase the deficit by wider margins

      World – meet yet ANOTHER fool that thinks deficits are created because people are not robbed enough.

      This article is yet another reason I’ve stopped being a major donor to Reason.

      Pretentious bastard – I don’t have enough money to be even a minor donor, let alone a MAJOR one.

      In order to grow, we must be honest with ourselves and our Government.

      “In order to grow, we must be honest with ourselves and out chickens.”
      “In order to grow, we must be honest with ourselves and our ancestors.”

      See? I can also come up with non sequiturs just as easily!

      If we want the services we have, we must pay more.

      Interesting, since as a bargain hunter, I always try to pay LESS for the same, as most reasonable and rational people would do, I would fancy. Maybe YOU have a personal problem with money which explains your cavalier attitude, but I don’t – I LOVE it.

      I challenge readers (and Reason) to explain explicitly what they will cut. Once that is done, let’s debate.

      Challenge accepted!

      I will cut:
      All departments, even Defense, as the Constitution only allows for armies to be RAISED, not to be KEPT. Only the Navy can be kept as the Cnstitution mandates it.

      Social Security, in toto. Pensioners would be funneled into private institutions which would take charity from those that would receive back their SS taxes.

      Medicare/Medicaid. Totally. Leaving NOTHING. But, I would immediately repeal ALL LICENSING LAWS and use the so-called Interstate Commerce Clause to repeal all state licensing laws, so doctors from overseas can come to the US to practice medicine. That would lower the cost pretty dramatically. It would also allow the elderly to finally afford their own care and hospice care. I would also end all bans on importation of medicines from Canada and Mexico, and also repeal all Prescription Drug laws, so you can buy your drugs in a box instead of having an expensive college grad placing pills inside stupid little amber bottles. I shit on that very American idea.

      1. I notice Shawn in Phoenix hasn’t found a way back to see if his/her questions were answered.
        Sleazy troll is my guess.

  20. that’s beautiful
    we have worked out no deals for oil rich oil sands and left Americans asses hanging out in the “Green Energy” wind.
    Take it away Frenchy…
    laptop battery charger and laptop ac adapter

  21. Here’s a suggestion for states looking to reduce Medicaid roles. Start looking closely at real estate transfers from parents to children. How many people have heard of older persons transferring the ownership of their home to their children so the “nursing home” doesn’t get the equity.

    Think about it. Hiding what is often the largest asset of an elderly person is a fast gateway into Medicaid.

    I understand the desire of a family to preserve wealth, however, I’m not certain that they understand what that action – multiplied by the multitudes of former homeowner Medicaid patients – does to the system.

    1. Just like the people who leave garbage on their seat when they get off the bus just don’t understand the effect that has on other people.

    2. BTW, that strategy (supposedly) doesnt really work. In fact, its fraud and can lead to jail time.

      1. How is it fraud to give your property to your children?

        1. Most dont do the transfer properly. There are lots of tax loopholes to jump thru, otherwise you end up with gift tax and etc.

          Im not sure of details, but its kind of like bankruptcy court. Bankruptcy courts will look at transactions from the recent past and unwind them if they look fishy. I think medicaid has similar rules.

          In other words, I think medicaid is supposed to be doing what Diane suggested.

          1. Before you qualify for the government nursing home assistance program, there is a 60 month look back to see if and when you transferred your assets for less than fair cash value or you transferred your assets into a trust system or any system of transferring your wealth for the purpose of becoming eligible for the nursing home program depriving the state of all your available resources for your long-term health care.

            1. The link where I found that also has the details on “fraudulent conveyance” under the Uniform Fraudulent Transfer Act.

      2. Not to mention that jail is probably not much worse than the average nursing home.

  22. You want to cut Medicaid and other insurance costs, by a lot?

    Make them catastrophic care policies. Real copays, actual deductibles, limited coverage for office visits, that kind of thing.

    The entire direction of health insurance (due to mandates, mostly) over the past 30 years has been in the wrong direction – less patient financial responsibility.

    Cover the stuff that actually bankrupts people, and that’s it. This ain’t rocket science.

    1. Is that presently how you receive your insurance? Or are you pulling a Rand and telling others what they should be doing?

      1. Actually, I do. I have a $5000/yr deductible. I pay the first $5k every year with Blue Cross/Blue Shield network prices, and a $340/quarter premium. I also get to put $3k/yr into an HSA for qualifying medical expenses. I have yet to use more than $500 the almost 4 years I’ve had this coverage. Its much more like home or car insurance. If I have some catastrophic medical event, it costs me $6400/yr, in normal years it costs me $2000/yr AND I get to put $3000/yr in a Roth style account, whose gains I will never pay taxes on provided I use them for medical purposes.

        Why not set up Medicaid similarly? Recipients have a $3000 ‘pot’ for healthcare. If they keep their costs under $3k, they get the difference at the end of each year.

        1. my point was that most people who bitch about insurance have not a clue that is requires self-management.

          People on Medicaid are generally incapable of authoring their own lives and would not likely have the skills-I’m not against a ‘carrot’ system but I’m not sure it could work

          1. Re: Rather,

            People on Medicaid are generally incapable of authoring their own lives and would not likely have the skills-I’m not against a ‘carrot’ system but I’m not sure it could work[.]

            Would you find it reasonable to think that giving people free medical services is what makes them less prepared for managing their own health care costs? That entitlements generate an underclass of unprepared people rather than the other way around?

            “The ultimate result of shielding men from the effects of folly, is to fill the world with fools.”
            Herbert Spencer.

            1. OM, I actually agree that welfare and cyclical poverty are intertwined. I just don’t know how to separate the needs of children with the parents who abuse the system.

              When Spencer coined “survival of the fittest”, I’m sure he didn’t include children but then a man who believes “the only function of government was to be the policing and protection of individual rights… maintain[ing] that education, religion, the economy, and care for the sick or indigent were not to be undertaken by the state.” while simultaneously espousing the importance of community had a incongruous philosophy of life

              1. Rather|2.5.11 @ 8:04PM|#
                “OM, I actually agree that welfare and cyclical poverty are intertwined. I just don’t know how to separate the needs of children with the parents who abuse the system.”

                I’m not sure either, but it’s an odds-on bet that continuing the current system won’t do a damn thing about it.

              2. Re: Rather,

                OM, I actually agree that welfare and cyclical poverty are intertwined. I just don’t know how to separate the needs of children with the parents who abuse the system.

                I won’t fall for your non sequitur.

                When Spencer coined “survival of the fittest”, I’m sure he didn’t include children[…]

                And I am sure, again, you’re flying off a tangent like every time you have no arguments, Rather. What does that phrase you quoted, or anything else you wrote, have to do with the conversation?

          2. I would think that the regulatory overhead reduction of simply issuing a debit card and only auditing the people who go over would probably save several billion dollars in states like FL, TX, NY, and CA.

            Take FL, something like 1M children are enrolled in Medicaid. We’re still talking about $3B for the cards, say another $1B for issuing, auditing, promoting, etc. $4B is less than the increase in Medicaid expenses since 2001. That leaves all of the money the state was already spending in ’01 to devote to the 5% who have serious expenses. Fine people who spend their $3000 on non-health expenses whatever they spent on the expenses. Aside from the fact that I’d rather there was no Medicaid at all, this seems like a better plan than the current implementation.

            1. Bret, I think a debit card for all welfare services is reasonable. I know it is implemented in grocery stores, and prohibits the purchase of alcohol, and I believe some types of non-food groceries.

        2. Actually, Brett, few liberals would be against a universal, high deductable plan. However, the way yours is set up is more bureaucratic than is necessary, as every health care dollar spent needs to be tracked, every year. The HSA element actually adds very little to your system, but creates a regulatory and bureaucratic nightmare, as well as forcing you to keep substantial sums of money tied up in horrible investments. Your life and everyone’s life would be easier without the HSA, and rather with simply $3000 in cash.

          Second, rather than paying 100% up to $5000, and then zero after that, I would suggest that it work more like that you pay 33.3% up to $15,000 instead. The 33.3% co-pay would certainly be enough to cause people to keep costs under control, and it would also spread out volatility in one’s health care expenditures from year to year. Also, it would keep people cost concious even when they are seriously ill. Your $5000 deductable is one not-very-serious incident away from being hit.

          1. No, no. You miss the point. As long as they stay under $5000, I don’t care where or how they spend it. Its a sunk cost. Every other system costs more per person. In FL our fiscal year starts 7/1. If they have $1000 left on the card and want to buy $500 worth of beer and hotdogs for a July 4th party on the 30th of June, great. We’ll still cut ’em a check for $500. What we won’t do is have endless supervisory boards reviewing paperwork in triplicate to decide whether or not such and such transaction is a qualifying expense BEFORE paying the provider.

            The savings comes from NOT tracking every dollar. You wanna spend the $5000 on beer and smokes, great. Just don’t go over or you’ll be audited and (in this case) fined. The point is to STOP treating poor people like their every decision needs to be signed off on by five bureaucrats. Granted, some are poor because they make poor decisions, but the first time we garnish their assistance because they misspent the deductible, we’ll have everyone’s undivided attention. The audits are just a way of discouraging people from spending $5000 on beer and smokes AND going to the emergency room every time they have a cold.

            Think of it. Actual healthcare providers don’t have to build in the interest on essential +180 invoicing to this because they get paid immediately. All of the issuance of both cards and checks is pretty low overhead. We already audit the shit out of these things. Now we’re only auditing the percentage who go over. And frankly if they’ve had a $30000 hospital stay, the audit ends. At that point its cheaper to just pay up than spend 100 man-hours chasing down receipts.

            1. “No, no. You miss the point. As long as they stay under $5000, I don’t care where or how they spend it. Its a sunk cost”

              Then it is cash, as I suggested. Get rid of the HSA completely, and just give everyone $3000 or $5000 or whatever.

              Now what do you think the odds are that conservatives would ever allow a $3000 check to be handed to every American every year? Zero.

              You seem to be forgetting that you have to track your spending so that you know when you hit the $5000 deductable limit. Since it is not unlikely to hit that number even if a moderate incident pops up, I would have to track my spending all the time. However, under my plan, the deductible limit doesn’t kick in until I hit $15,000, which is much less likely. I wouldn’t have to track anything most years, because it is improbable that I would hit the limit.

              1. How would it be more difficult than food stamps? You have a $5000 balance and when its gone you get audited. That’s Level I Medicaid. You have to be Medicaid eligible to get it. The savings come from:
                a. Getting rid of the bureaucracy surrounding payments and case management
                b. Providing some level of accountability in Medicaid spending
                c. Reducing provider incentive to build in non-payment and slow payment to their prices.

                1. What percentage of people spend $5000 on medical care a year? Most seniors do.

                  That’s a hell of a lot of audits, and those don’t come cheap.

                  Just do what Singapore does: co-pays and out of pocket maximums that slide with your income and wealth. Very simple, and keeps anyone from going broke.

    2. Nearly everything in our society has been going in the direction of less individual responsibility, with the possible exception of sex offenders and no-knock raid recipients.

      1. True. Health care seems a good place to start on reversing that trend.

  23. I’m the King of Pussy Getting. I know none of you libertards have been laid because I get all the pussy.

  24. I once had a chick blowing me in the front seat, and she told me to hurry up and cum because she was going to be late for her reading circle. I asked what they were reading, and she said it was Ayn Rand’s Anthem. I pulled up my pants, opened the passenger door and said, “get the fuck out of my car, mom!”

    1. Are you sure it wasn’t this little sweetheart?

      http://rctlfy.files.wordpress……d1-epi.jpg

  25. Hi, mom. I’m still mad at you.

  26. “do more with less”

    Well, fuck. If We Ordinary People have to do it, so should government.

  27. How many of the 5% that take up 50% of the expenditures are IV drug users

  28. Isnt the proposal of “doing more with less” ultimately an admission that the status quo of government services leaves a healthy margin of inefficiency, one which could be trimmed, cost-free, if but only the will of the service providers was so benignly stoked?

    I mean, its an acknowledgement of vast inefficiency; the idea that ‘more with less’ is possible is only possible assuming *you are already running a poorly run system that wastes money*. It’s a “well, plug some of those holes this time” argument… without telling anyone which holes to plug or incentivizing the system in any way to do so.

    oh, they’ll do *something*. Mostly plug some holes, and make their favorite ones bigger to compensate.

    I had an educating discussion with an EMT once, and I asked him, ‘whats the most common call’? Old people slipping in the bath? Accidental acetaminophen overdoses?… and he was like, “No. Medicaid.” Low income people call the ambulance when their kid has a cold… because if they walk to the hospital, they have a co-pay. If its an emergency (which sticks the state with a $1000 ambulance ride), it’s free. … He was like, 60% of their job is as a Medicaid limo service.

    He was pretty cynical. And I thought I was bad!

  29. Surprise! Obama’s special envoy to Egypt thinks Hasni Mubarak is the perfect architect for Egypt’s democratic future.

    “You need to get a national consensus around the preconditions of the next step forward, and the president must stay in office in order to steer those changes through,” [former Ambassador to Egypt] Wisner said. “I therefore believe that President Mubarak’s continued leadership is critical ? it’s his opportunity to write his own legacy.”

    Wisner pointed to a need to “control rhetoric.”

    “The more Egyptians hear from the outside world that the president’s got to go, and this has got to happen, that’s got to happen, we create a negative force inside of Egypt itself,” he argued.

    That metallic rattling sound you hear is yet another foreign policy can being kicked down the road by this administration. And you can bet that, if the protesters take this advice, Mubarak will crack down harder than ever before and stay in office (or at least pull a Putin) past September…and Obama’s people will claim they never could have seen that coming.

  30. heller’s Plan to Balance the Budget

    1. Cut foreign aid in half: +$17 bil in 2015 +$17 bil in 2030

    2. Eliminate earmarks: +$14 bil in 2015 +$14 bil in 2030

    3. Eliminate farm subsidies: +$14 bil in 2015 +$14 bil in 2030

    4. Assorted federal pork funding cuts: +$30 bil in 2015 +$30 bil in 2030

    5. Cut state aid by 5%: +$29 bil in 2015 +$42 bil in 2030

    6. Reduce nuclear arsenal and space spending: +$19 bil in 2015 +$38 bil in 2030

    7. Reduce military to pre-Iraq size and reduce troops in Asia and Europe: +$25 bil in 2015 +$49 bil in 2030

    8. Reduce Navy and Air Force fleets: +$19 bil in 2015 +$24 bil in 2030

    9. Cancel/delay certain weapons programs: +$19 bil in 2015 +$18 bil in 2030

    10. Reduce non-combat comp and overhead: +$23 bil in 2015 +$51 bil in 2030

    11. Reduce troops in Iraq and Afghanistan to 30K by 2013: +$86 bil in 2015 +$169 bil in 2030

    12. Medical malpractice reform: +$8 bil in 2015 +$13 bil in 2030

    13. Reduce tax break for employer-provided insurance: +$41 bil in 2015 +$157 bil in 2030

    14. Tie Medicare growth to GDP growth +1% by 2013: +$29 bil in 2015 +$562 bil in 2030

    15. Reduce SS for high income individuals: +$6 bil in 2015 +$54 bil in 2030

    16. Tighten eligibility for dibility benefits: +$9 bil in 2015 +$17 bil in 2030

    17. Use more accurate measure for SS inflation calculation: +$21 bil in 2015 +$82 bil in 2030

    Total budget savings in 2015 = $423 billion (projected deficit for 2015 is $418 billion)

    Total budget savings in 2030 = $1,368 billion (projected deficit for 2030 is $1,000 billion)

    No tax increases, minimal welfare cuts, practical, and leaves plenty of room for inaccurate estimates.

    1. what about helle’s plan to visit Rather’s blog and then deny it 😉

      1. That I know I didn’t visit your blog just makes your assertion that I did even more pathetic every time you repeat it. Really, continue saying it for my enjoyment, you delusional cunt.

        1. helle, you know I can prove it. Baby, I’m giving you a chance to be a man

          1. OK, please prove it. I can’t wait to see you fall flat on your face.

    2. #2 is irrelevant to spending.

      #4 is vague.

      #7,8,11 overlap with each other.

      #10 is vague and possibly quite ratfuckerish if you’re talking about medical benefits for wounded vets.

      #12,13,15 are counting chickens before they’re hatched.

      #17 is extremely dubious, as the CPI measurement is already lowballed.

      1. #2 is irrelevant to spending.

        Huh? Earmark spending is irrelevant to spending?

        #4 is vague.

        Eliminating various agencies, cutting research funds for fossil fuels, reducing funds for the Smithsonian and the National Park Service, eliminating certain regional subsidies, and eliminating the Office of Safe and Drug-Free Schools.

        #7,8,11 overlap with each other.

        No they don’t. #7 is about reducing the total amount of personnel employed by the military. #11 pulls troops out, but doesn’t reduce the amount of personnel in the military. #8 reduces the amount of ships and aircraft being used.

        #10 is vague and possibly quite ratfuckerish if you’re talking about medical benefits for wounded vets.

        I specifically said noncombat, no wounded vets would be affected by this. There are alot of details to this plan, you can look up noncombat compensation reform if you want to learn about them.

        #12,13,15 are counting chickens before they’re hatched.

        I don’t understand what you mean, all these figures are projections.

        #17 is extremely dubious, as the CPI measurement is already lowballed.

        Nah, the proposed measurement is directly tied to cost-of-living increases, which is what the SS inflation measurement is supposed to be about.

        1. The money to which earmarks are attached is going to be spent whether it’s earmarked or not. The earmarks only take the decision away from executive branch bureaucrats.

          And those are projections assuming current law. If you change the law, you change the projections.

          1. Then it falls on the executive branch not to spend it. That’s still budget savings. You can’t just assume that the money would be spent for something else.

          2. And how would changing laws change the fact that enacting those reforms would save money?

  31. LOL, I honestly dont think they know if they are coming or going lol.

    http://www.internet-privacy.tk

  32. Skelley on Obama/Vinson:
    http://blog.nola.com/stevekell….._2011.html

  33. I have a feeling that “Agressive management of the sickest” really means denying care so they die faster!

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