Supreme Court

This Supreme Court Decision Could Have a Big Effect on Medicaid and State Budgets

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credit: dbking / Foter / CC BY

A Supreme Court ruling yesterday could have a big impact on one of the country's biggest programs. In a 5-4 decision, the High Court ruled that health care providers do not have the right to sue states over low Medicaid rates.

Under the law, states, which manage and jointly fund their Medicaid programs in conjunction with the federal government, are required to set rates in ways that are "consistent with efficiency, economy, and quality of care," but do not encourage excessive health care utilization.

In the suit, a group of providers in Idaho argued that they had the right to sue the state when rates were low enough that they didn't meet this standard. The state of Idaho argued that providers should not have a right to legal challenge. A lower court had previously ruled in favor of providers, saying Idaho had to cough up another $12 million in reimbursements for the program.

Writing for the majority, however, Justice Antony Scalia declared that the legal standard was too vague and too broad to be adjudicated by the courts, and would inevitably lead to numerous drawn-out legal disputes. Instead, he said, that providers who felt the rates were too low could appeal directly to the Department of Health and Human Services.

The case made for some strange alliances: Liberal Justice Stephen Breyer joined Scalia, as well as conservative Justices Clarence Thomas and Samuel Alito, while the rest of the liberals—Sonia Sotomayor, Ruth Bader Ginsburg, and Elena Kagan, plus Anthony Kennedy—form the dissent. The Obama administration, meanwhile, had filed briefs siding with states against health care providers, putting the White House on the side of the mostly conservative majority.

The upshot here is that states facing big budget crunches will now be able to make big cuts to Medicaid, which is typically among the largest budget items for states, and doctors and other providers will have little recourse except to complain to the federal government.

We've already seen one version of this play out in California, where providers sued the state over a 10 percent cut in Medicaid rates made during a budget crisis. That cut was initially blocked by a court challenge, but finally allowed in late 2012. To give an idea of how big a budget issue this is, California has said that legal challenges to rate cuts since 2008 have forced it to pay more than $1.5 billion

This week's Supreme Court decision, a lawyer representing pharmacists told the Sacramento Bee, "will make it extremely hard for any beneficiary or provider to be able to force the state" to hike payments, although some have suggested that the ruling may leave providers some other ways to sue. 

What it means, though, is that for providers, state-set Medicaid rates have now become take-it-or-leave-it. Which means that, should rate cuts start coming down the line again, some providers are going to decide to leave it. Because state budgets are under less pressure now than during the financial crisis, this may not have a huge immediate effect. But someday, state budgets will look tight again, and reimbursement cuts will once again be pushed through. And when that happens, it will, at least at the margins, make it more likely that doctors will exit the program. In addition, providers starting their careers, or starting new care organizations, will be somewhat less likely to take the program.

Overall, this is a victory for taxpayers; states will now be able to slash Medicaid budgets with less fear of being drawn into lengthy legal squabbles. But it's a problem for Medicaid, and for Obamacare, which relies on an expanded Medicaid program in many states for its increases in coverage. The program's beneficiaries will have coverage—but with fewer doctors and other providers, they will have a harder time getting care.

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  1. But it’s a problem for Medicaid, and for Obamacare, which relies on an expanded Medicaid program in many states for its increases in coverage.

    It’s also a problem for non-Medicaid patients who see providers that take Medicaid, since their rates will be jacked up to make up for the shortfall.

    1. If only this were the case. All to often, the private insurance companies will see what the government payors do and take it as an indication that it is appropriate. Hospitals have very little bargaining power when it comes to most insurance providers.

      1. I guess I shouldn’t have used the word “rates.”

        I mean that that procedure that cost $800 before the Medicaid cuts now costs $850 or $900, and the difference is passed on to the rest of us. If the insurance doesn’t cover the difference, then you get the bill. The hospitals are like any other business. They have to turn a profit. If Medicaid reimbursement drops, then they must charge everyone else more.

        1. That’s a good point. Yes, it’s not like a non profit can just lose money and stay in business. I will say that even the best of them live on razor thin margins though.

          1. Average hospital margins are usually in the 2% range. Many lose money. Some have higher margins.

            Yeah, we can’t take a 7 figure hit without making it up somewhere.

            1. “Yeah, we can’t take a 7 figure hit without making it up somewhere.”

              It’s “volume,” correct? That’t the answer, isn’t it?! Do I win a prize?

              1. We do it be selling harvested organs on the black market.

          2. Non-profits don’t just “lose money”, co-ops, for example, put net income into an equity account which periodically gets paid out to the members of the organization.

  2. Unfortunately, some hospitals (non profits) don’t have the luxury of “leaving” it. Do you think healthcare providers would willingly lose money on every government case if they weren’t forced to to maintain their non profit status?

    1. Its not just that. I know of no hospitals that don’t participate in Medicaid.

      Because they are going to see these people one way or the other. Regardless of whether you are a non-profit, federal law requires that you assess every single person who walks into your ED, and once they are assessed, you really have to treat them unless you want to be sued.

      1. Yes, but for profit hospitals do no have to admit patients, their physicians do not have to accept them as patients, etc. Also, you can always refuse to accept the low paying insurance and then bill the patient for the entire amount. That’s a way to bypass the issue of under payments from Medicaid, even if you might not recoup your losses.

        1. but for profit hospitals do not have to admit patients,

          If they come in through the ED and need to be admitted, then yes, for-profit hospitals do have to admit those patients.

          No physician, whether they work for a for-profit or a non-profit, has to see a patient in their practice. Many non-profit physician practices have limited Medicaid patient panels, as well. It is their option. But hospitals don’t have that luxury, because of EMTALA.

          And you cannot “balance bill” a Medicaid patient, even if you refuse to accept payment from Medicaid, if you are a Medicaid provider (like all hospitals are). Even if you do, they’re a fucking Medicaid patient – by definition, they have no money.

          1. Depends on how you do the accounting, but most hospitals don’t actually lose money on Medicaid patients. The average cost of providing a service may be greater than the Medicaid payment, but the marginal cost of providing that service is less than the Medicaid payment. So as long as private payors (and Medicare) are paying at rates decent enough to cover capital expenses, hospitals typically have no problem accepting Medicaid patients, especially if the alternative is that these patients are uninsured and use no services (EMTALA aside).

            The problems start when you reach some critical mass of Medicaid patients.

            1. Depends on how you do the accounting, but most hospitals don’t actually lose money on Medicaid patients.

              It varies by state, but Medicaid typically covers between 20% and 60% of the hospital’s out of pocket cost of providing care to Medicaid patients. There may be a few procedures that Medicaid covers the full cost, but all in all, Medicaid just reduces, but does not eliminate, losses.

              And hospitals are the world experts at cost accounting. Ask any hospital financial wallah about their cost report.

              . The average cost of providing a service may be greater than the Medicaid payment, but the marginal cost of providing that service is less than the Medicaid payment.

              If all you cover is your marginal costs, you’ll go out of business. You have to cover all costs, marginal and allocated fixed costs. When you allocate fixed costs, hospitals lose money.

              And if you say “EMTALA aside” when discussing hospital Medicaid patients, you are missing a large part of the issue.

              1. This is the classic trap of high capital cost/low marginal cost businesses, like hospitals. Pharmaceutical companies are like this too. They have huge capital costs to create the first pill, but producing each additional pill is cheap. So as long as you can find a sucker to pay for that first pill, all the rest of the users can free ride so long a they pay the marginal costs of their use. In pharma, the sucker is the US healthcare system writ large, and the free riders are the rest of the world’s socialized medical systems. In the hospital industry, the sucker is the private insurance companies.

          2. They must see the patient and offer treatment – not a cure.

            Example: Last year a new hire called in sick and went to the ER, thought he was having an asthma attack from the worst cold on earth. Diagnosis was a collapsed lung. The hospital asked for $500 to continue, and when he said he didn’t have $500, they gave him an inhaler and a script for antibiotics to fill elsewhere and sent him on his way.

            The extent of EMTALA has become more urban legend than fact. If you ain’t right this second dying, all they must do is offer treatment until you’re stable enough to walk out the door.

            1. If you ain’t right this second dying, all they must do is offer treatment until you’re stable enough to walk out the door.

              EMTALA requires that the hospital treat you until you are stable for discharge. That can get pretty fucking expensive, and that’s not an urban legend.

              Even for “urgent” patients who don’t need admission, we still have to assess (not free). And, once we’ve diagnosed, we have to provide care that meets the usual quality standards.

              What you describe above is almost certainly an EMTALA violation, and a failure to meet the standard of care for collapsed lung that will be a liability event for the hospital (and the ED doctor) unless the patient magically recovers.

              1. “That can get pretty fucking expensive, and that’s not an urban legend.”

                Would have been more pithy if I’d said the urban legend is that there’s no cost to providing health care.

                Surely you have also noticed the inflated views of what a magical wand EMTALA is. Progs be all, “They can just go to the ER.” Asinine statement; as if social ills can be cured by any hospital, paid for by fairy farts.

                “What you describe above is almost certainly an EMTALA violation, and a failure to meet the standard of care for collapsed lung that will be a liability event for the hospital (and the ED doctor) unless the patient magically recovers.”

                I found it pretty stunning myself. My best friend is in the field, so I called, saying all, “IS HE GONNA DROP DEAD IN THE MIDDLE OF WORK??”

                1. I guarantee you, if I heard my ED had done something like that, people would be up against the wall.

                  1. I treated people with pneumothorax. It would be a, very, unusual situation that would allow me to send a person home without PROPER treatment. If the patient worsened and died, how would they defend themselves? Then again, it would save money not treating the patient! It may be impossible for a poor family to find lawyer willing to take such a case, meaning the hospital, and treating physicians, would get away with negligent homicide! Don’t believe in death panels, yet?

      2. That right there is why I have never understood the progs argument for Obamacare being that people are denied healthcare and DYING because they don’t have insurance.

  3. Interesting test case for “judicial activism”.

    Which would be the activist decision here? Ordering the state to pay more because the statute, if it is to mean anything, must set a floor and be enforceable by the courts? Or say the statute is unenforceable and thus defer to the presumed legislative intent that this be purely an administrative matter, and then defer again to the executive branch’s inaction?

    1. Striking down the law as too vague and confusing. Any law which is so vague and unclear that the “best” judges in the land are divided 5-4 on what it means — strike it down, tell the legislature to try again.

    2. I don’t think the providers have standing to sue under the law (see below), so both decisions would be activism.

      Now, if it were PATIENTS suing due to loss of Medicaid provider access, Option 1 would probably be a right decision, since if rates that are so low Medicaid patients can’t find providers those rates would probably not qualify as “consistent with efficiency, economy, and quality of care”.

      Option 2 sounds more like judicial abdication than activism. If we’re talking about patients with poor or no Medicaid access, I don’t see how that would be a sound decision.

  4. It seems to me that the only people who have standing to sue are patients, since they’re the only ones who could be materially harmed by too-low rates. The healthcare providers don’t, since the government doesn’t owe them a certain amount of money. The providers freely choose to take Medicaid, they aren’t forced to (yet). Patients, on the other hand, could have their access to Medicaid harmed by rates that are too low, since there might be fewer Medicaid providers.

    1. A bit OT: There’s an interesting case (Barrows v. Burwell) winding its way through the courts in which a group of Medicare patients has claimed, among other things, that they have a property interest in Medicare and that therefore CMS decisions to deny claims without due process constitute a violation of the patients’ Fifth Amendment rights (i.e., it’s an illegal taking).

      1. Given Flemming v. Nestor, I don’t think that case will go anywhere.

    2. It seems to me that the only people who have standing to sue are patients, since they’re the only ones who could be materially harmed by too-low rates.

      They can’t be balance billed, so they suffer no harm at all.

      The healthcare providers don’t, since the government doesn’t owe them a certain amount of money.

      Well, that’s what the case was about: whether states were required to pay a certain amount of money by the (vague) statutory language.

  5. Once again, Reason’s anti-gummint mentality misses the fucking story

    This from Reason’s idiot in waiting on healtcare

    Overall, this is a victory for taxpayers; states will now be able to slash Medicaid budgets with less fear of being drawn into lengthy legal squabbles

    FACT: Medicaid reimbursements are so low that Medicaid’s rate of uninsured was greater than the private market! Tha

    1. FACT: Medicaid reimbursements are so low that Medicaid’s rate of uninsured was greater than the private market!

      What does that sentence even mean? If you have Medicaid, you’re not uninsured. So how can there be a “rate of uninsured?”

      1. Jeff R.
        There is a definable Medicaid population — the eligibles.
        There is a definable “private” market — all others.
        Exclude Medicare eligibles..

        Before Obamacare expansion —
        The Medicaid population had an 18.8% uninsured rate.
        The private population had a 16.3% uninsured rate.

        There are just two points fucked up by Reason (and Cato)
        1) More people die uninsured in the Medicaid population than the greedy private market.
        2) Cost is the obstacle in healthcare, but we can’t give it away. (lol)

        Here’s math, with all original sources.

        http://bit.ly/1bJg8ue

        You now know more than Cato and Reason! Golly, should the American people should know about this? Starting in 2010?

        Thank you for asking. I have now proven my points – Suderman is an idiot-in-waiting on healthcare. Reason is totally fucked by their anti-gummint mentality — instead of being pro-liberty. If all you look for is government fuckups, that’s all you ever see. And why he missed the boat (again).

        As you’ll see at my link, this is in a web folder named “ReasonNarrative.” I submitted this, and more, to Reason. They turned it down, Doherty saying Reason already had a healthcare editor. Who, as you see, has no fucking idea what he’s talking about. Neither does Cato, same reason.

        Thanks again. I would not have posted this except for your question, versus over a half-page of attacks by the gang of thugs.

        Copyright 2013-2015 by Michael J Hihn. All rights reserved and defended.

  6. part 2 (got away from me)

    That means more Americans were dying without healthcare in “free” Medicaid than the private market. (pre-Obamacare expansion)

    So is the story “a victory for taxpayers” … that people are dying from political healthcare?
    If cost is the problem with healthcare, why can’t we give it away?

    If you’re a hammer, then everything looks like a nail. If all you have is an anti-gummint mentality, then all you see is anti-gummint screeching …. never a solution, which requites a pro-liberty focus.

    Obamacare won by default. Nobody on the right EVER had an alternative … with the biggest failures by Reason and Cato.

    (Let’s not hear from the blowhards who say, “git gummint out of it.” — which has failed for over 35 years … increased the percentage of self-identified libertarians by ZERO in all those decades … and sees the libertarian brand rejected by 91% of libertarians.)

    Oh, wait, we’re in a libertarian moment. Never mind.
    (the libertarian era began at least 35 years ago and we’ve achieved ….)

      1. Damn, Suge. That’s gonna leave a mark.

      2. Sugar Free says it’s not

        1. Sugar Free say’s it’s NOT the biggest story that more Americans die uninsured among Medicaid eligibles. Or it’s crazy to ask why, if price is the problem with healthcare, then why can’t we give it away? People die, but libertarians do not need any solutions — which means the dumbfuck defends gumming healthcare! But is loyal to the cult..

          1. Nope. All I’m saying is that you are an incoherent asshole.

            1. Nope. All I’m saying is that you are an incoherent asshole.

              This just in: Sugar Free increases bullying … lies about what it’s defending … ever-loyal to the cult

              1. Does this mean something to you? Because none of the rest of us even understand what you are trying to say.

                This is not the first time you have done this, stringing together words that you think are a devastating argument, yet no one else seems to understand what you are talking about or what position you are taking. And instead of attempting to clarify your position, you claim you are being bullied or repost the same semi-gibberish in a triumphal tone.

                Maybe take a moment a reflect if this is a problem we are having or a problem you are having. I am a gratuitously mean person, but I’m starting to wonder if you aren’t really experiencing some sort of cognitive dysfunction or impairment.

                1. Sugar Free turns self-righteous! This is what he says now!

                  And instead of attempting to clarify your position,…

                  This was his “response” — asking for clarification(snicker)

                  SugarFree|4.1.15 @ 12:54PM|#

                  for prompt control of senile agitation

                  back to the self-righteous bullshit

                  …you claim you are being bullied

                  “For prompt control of senile agitation” (click his link to see how pathetic a liar it is)

                  Do you have even an ounce of shame?

                  1. So you think Thorazine wouldn’t improve your mental state? Interesting.

                    1. So you think Thorazine wouldn’t improve your mental state? Interesting.

                      You’re upset because you got documented as a somewhat blatant liar — over how you started a tirade of hate and dumbfuck statements like that, over half an entire page. But there’s no bullying.

            2. I wonder if we could map the days the staff lets him use the home’s common room computer. That would be helpful.

              1. If you stay very quiet and move near his head, you can hear the arteries cracking. It’s a relaxing sound, much like milk on Rice Crispies.

                1. More childish attacks
                  An entire half-page of personal attacks.
                  By 12-year-old children
                  NEVER touching the actual issues.
                  Give me MORE proof!!

    1. Obamacare won by default. Nobody on the right EVER had an alternative …

      If you think of Obamacare as cancer, then there is no need for an alternative. I mean, what do you replace cancer with? Grapefruit?

      1. “It’s not ah tuhomor! It’s ah grapfroot!”

      2. If you think of Obamacare as cancer, then there is no need for an alternative. I mean, what do you replace cancer with? Grapefruit?

        Lies about what I said, as an excuse to be an anti-gummint blowhard. Medicare takes $250 billion from income taxes ever year, 1/4 of every penny in income taxes, but he says … as I predicted … “we don’t need no freaking alternative.” And the rest of the bobbleheads all agree!

        As the libertarian brand is rejected by 91% of Americans, accepted by only 5.3% of Americans … no growth at all in 35+ years. And the tribe chants in unison (all the same thugs)

        1. The use of a bold font doesn’t mean that you automatically win an argument. Assuming anyone can even discern an argument buried in your rambling.

          1. The bold font is to make sure nobody misses how fucking stupid you are.

            1. Wah! Wah! An old man is trying to bully me!

              1. Me too. He almost whacked me with his cane.

              2. Serious question, SF: can you make heads or tails of what he’s saying? This looks like the output of a random word generator.

                1. Old man with Candy
                  Which of these are not clear to you?

                  1) More medicare eligibles die without health insurance than die uninsured in the private market?
                  2) If cost is the problem in US healthcare, why can’t we give it away?
                  3) Is it a libertarian goal to “save taxpayer dollars” by allowing people to die, or to provide a comprehensive market-based alternative and explain to voters how it would work better for them, and why they should elect candidates to achieve it.?
                  4) So why do libertarians have NO policy and NO proposals to restore market-based health insurance for Americans?

                  1. 5) All of the above. Between bad writing and tendentious use of statistics, there’s just a mess of false assumptions, fuzzy conclusions, and inchoate rage puddled on the floor.

                    1. Calling out Old Man Candy

                      5) All of the above. Between bad writing and tendentious use of statistics, there’s just a mess of false assumptions, fuzzy conclusions, and inchoate rage puddled on the floor.

                      Which statistics?
                      Which false assumptions?
                      Which fuzzy conclusions?
                      Will he put up or shut up … or throw another tantrum?
                      (walks away laughing)

                2. Serious question, SF: can you make heads or tails of what he’s saying?

                  Nope. It’s just word salad.

              3. SugarFree|4.1.15 @ 1:20PM|#
                Wah! Wah! An old man is trying to bully me!

                Do you consider that to be mature communication, or playground bullying?
                Do you have any comments — any at all — on the substantive issues?

                sarcasmic|4.1.15 @ 1:23PM|#
                Me too. He almost whacked me with his cane.

                Do you consider that to be mature communication, or playground bullying?
                Do you have any comments — any at all — on the substantive issues?

            2. ProTip, Michael:

              Bolding draws attention to your words, not somebody else’s. It can only show how fucking stupid (or clever) you are.

              1. ProTip, Michael:
                Bolding draws attention to your words, not somebody else’s. It can only show how fucking stupid (or clever) you are.

                Only if they’re too fucking dishonest to check the facts …. and apply purely tribal judgment ,… as you just did. I love ridiculing people who don’t know how stupid they sound.

          2. This is what SugarFree and his fellow thugs would have learned — if they had asked instead of pissing all over more than a half-page of dumbfuckery. (snicker)

            https://reason.com/blog/2015/04…..nt_5198330

        2. It is indeed sad that so many in our society reject liberty and justice for all.

          1. It is indeed sad that so many in our society reject liberty and justice for all.

            Especially when they claim to be libertarians.

            1. So if you reject the idea of the government forcing people to buy health insurance against their will, then you oppose liberty and justice. M’kay. Whatever you say old man.

              1. So if you reject the idea of the government forcing people to buy health insurance against their will, then you oppose liberty and justice.

                (snicker) Dumbass claims that anybody … said what he lies about.
                Typical of the cyber-bullies

                1. This like Old Mexican and Ken Shultz had a retarded chimera baby.

                  1. This like Old Mexican and Ken Shultz had a retarded chimera baby.

                    I larfed.

  7. My ex-wife makes $75 every hour on the laptop . She has been laid off for seven months but last month her pay check was $18875 just working on the laptop for a few hours.
    Look At This. ???? http://www.jobsfish.com

  8. here’s what has enraged the blowhards

    https://reason.com/blog/2015/04…..nt_5196293

    “That means more Americans were dying without healthcare in “free” Medicaid than the private market. (pre-Obamacare expansion)

    So is the story “a victory for taxpayers” … that people are dying from political healthcare?
    If cost is the problem with healthcare, why can’t we give it away?

    If you’re a hammer, then everything looks like a nail. If all you have is an anti-gummint mentality, then all you see is anti-gummint screeching …. never a solution, which requites a pro-liberty focus.

    Obamacare won by default. Nobody on the right EVER had an alternative … with the biggest failures by Reason and Cato.

    (Let’s not hear from the blowhards who say, “git gummint out of it.” — which has failed for over 35 years … increased the percentage of self-identified libertarians by ZERO in all those decades … and sees the libertarian brand rejected by 91% of libertarians.)

    Oh, wait, we’re in a libertarian moment. Never mind.
    (the libertarian era began at least 35 years ago and we’ve achieved ….)

    1. I read it twice and still can’t figure out what you’re trying to say. Have you considered using Google Translate?

      1. Old Man With Candy|4.1.15 @ 2:42PM|#
        I read it twice and still can’t figure out what you’re trying to say. Have you considered using Google Translate?

        Old Man With Candy, please confirm that you have no idea what these mean:
        “More Medicare eligibles die uninsured than die uninsured in the entire private market.”
        If cost is the problem with healthcare, then why can’t we give it away?”

        1. Who are you who are so wise in the way of statistics?

          1. HIHN: Old Man With Candy, please confirm that you have no idea what these mean:
            “More Medicare eligibles die uninsured than die uninsured in the entire private market.”
            If cost is the problem with healthcare, then why can’t we give it away?

            Who are you who are so wise in the way of statistics?

            You changed the subject (lol)
            True or false, you have no ideas what those simple words mean?
            Will he answer, or just whimper some more?

            I do it for a living.

  9. states facing big budget crunches will now be able to make big cuts to Medicaid, which is typically among the largest budget items for states, and doctors and other providers will have little recourse except to

    stop treating Medicaid patients.

    You kinda left that possibility unmentioned, Peter.

    1. prolefeed
      stop treating Medicaid patients.

      This is the kind of “mind” who causes the libertarian label to be rejected by 91% of libertarians. The blowhards say, “just git gummint out of it.” — as if they were fucking dictators … never have to get elected … never have to persuade anybody …. just be as self-righteous as Huckabee, Santorum and Bachmann.

      1. Seriously, what the fuck are you even saying?

        1. Seriously, what the fuck are you even saying?

          I’ll TRY to dumb it down.

          The libertarian label is rejected by 91% of even libertarians (As an aside, the same Cato survey found 59% accepted the description of Nolan libertarians (fiscally conservative and socially liberal) … no growth in 35 years, none at all)

          They reject the label (in part) because of dumbfucks like prolefeed who say we should allow people to die. Then we see the progressive media say that libertarians would … allow people to die. DUH

          Saying (or snarling) “git gummint out” is fucking stupid. There are only two ways to achieve a free society:

          1) Create a comprehensive program, sell it to voters and elect candidates to achieve it.
          2) A military coup.

          Those who have no more than “git gummint out” are blowhards who are the biggest threat to the movement/ aka the Purity Police. And zero growth is 35 years is the proof (from Cato)

          Howzat?

  10. You realize that you just posted in bold something that you have already posted in the same thread, right?

    For whom’s benefit did you repost this? In what way does this further your “argument”?

    1. You realize that you just posted in bold something that you have already posted in the same thread, right?

      That’s what I said I did. (snicker).

      In what way does this further your “argument”?

      Not a bit. It just shows later readers what caused your hissy fit.
      And how you got caught in a blatant lie here:

      https://reason.com/blog/2015/04…..nt_5196715

      Why do you call me “senile” for saying this:

      “That means more Americans were dying without healthcare in “free” Medicaid than the private market. (pre-Obamacare expansion)
      So is the story “a victory for taxpayers” … that people are dying from political healthcare?
      If cost is the problem with healthcare, why can’t we give it away?

      Did your parents raise you to be like this?

      The first step in fixing anything is to define the problem.
      Instead of telling insults and lies, why not tell me what parts of that have confused and enraged you so?

      1. No answer from the attacker

    2. This is what SugarFree and his gang of street thugs would have learned — if they had asked instead of pissing all over more than a half-page of dumbfuckery. (snicker)

      https://reason.com/blog/2015/04…..nt_5198330

  11. Announcing a new contest

    Start with my comment here:

    https://reason.com/blog/2015/04…..nt_5196293

    1) Count how many are stalking me
    2) Guess how many stalkers I’ll have by 9pm Eastern
    3) Send your guess to my personal email

    Bonus questions.
    1) What percentage have ANY questions or comments to the issues I raised (currently 3%)?
    2) What percentage were personal insults (currently 100%)?
    3) How many responses had one or more documented lies (currently 4)

    And an essay question. What would a new visitor to this site conclude, having come here looking for lively and open debate on all sides of key issues, as she explores libertarianism?

    1. What would a new visitor to this site conclude, having come here looking for lively and open debate on all sides of key issues, as she explores libertarianism?

      That incoherent posts with lots of bold font don’t seem to impress people?

      1. That incoherent posts with lots of bold font don’t seem to impress people?

        I’m not here to impress dumbfucks like you. I’m here to expose how shallow you are to everyone else. And you’re all cooperating perfectly.

        This is just one example of your dumbfuckness:

        https://reason.com/blog/2015/04…..nt_5197034

      2. I’d bet the new visitor would say something like:

        “Holy crap. These people have no filters. This looks [like fun]/[awful]. I think I’ll [stick around]/[run away].”

  12. Michael Hihn, insane?
    But he doth protest too much!
    Michael Hihn, insane.

    1. DK|4.1.15 @ 3:43PM|#
      But he doth protest too much!
      Michael Hihn, insane?

      Protest too much? ME? Scroll back up the page.
      More than half the entire page … the entire page …
      is personal attacks against me … half the entire page
      Not a single comment on the issues.
      All personal attacks
      Against my simple statements of facts
      To shout me down.
      Punish me.
      Initiate aggression
      You just joined their gang.
      And I’m laughing at all of you,
      Whining because I DARE to practice self defense
      and I keep baiting you into ever-larger thugs.,

  13. What is not being considered here is that providers operate under a government enforced legal monopoly over access to medical drugs and services. If these legal monopolies did not exist, then medical providers would be in the same situation as any other person who has to deal with “competitors” offering the same goods and services for less money. In other words “government” is already providing medical professionals with “protection” that allows them a higher income than what they would be able to command in a free market. What the providers apparently want is not only “protection”, but also the right to an income level of their own choosing. That allows them to extort more money from both the taxpayers and their patients for their own benefit.

  14. Doctors and other providers always have recourse; opt out of accepting Medicaid.

    1. Doctors and other providers always have recourse; opt out of accepting Medicaid.

      They do. In huge numbers. Thus the Medicaid population (income eligibles), has a higher uninsured rate than the “greedy” private market. That’s a solution?

      And — pre-Obamacare is all we have — 12 million people, 1/4 of our uninsured, are eligible for Medicaid and SCHIP (children), but never enrolled (mostly no doctors). But why deal with relevant facts, right? Like more people die uninsured by Medicaid than uninsured by the “greedy” private insurers.

      This is why we lose and — can you tell? — I’m pissed off by a failing movement and working to change it.

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