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Sorry, Liberals: Protecting the Medicaid Status Quo Won't Save Patients

The program desperately needs radical surgery

Medicaid provides health care to 75 million Americans. It's also a hideously expensive program that is at the center of the raging health-care debate in Washington. Republicans want to scale back the program, and Democrats warn that doing so will cause nothing short of mass death.

But that is not a credible—or responsible—claim.

ObamaCare extended Medicaid eligibility to able-bodied adults at up to 138 percent of the poverty level. To do this, the federal government promised to pick up 100 percent of the tab for the first three years, and then 90 percent in perpetuity in participating states. Republicans want to trim back Medicaid eligibility to the pre-ObamaCare days, when "only" the poor, children, the disabled, the elderly, and pregnant women qualified.Hospital bedssoho42 via Foter.com

Conservatives also want to take the opportunity to fundamentally reform the program, which consumed half of most state budgets and a tenth of the federal budget even before the ObamaCare expansion. To this end, Republicans want Uncle Sam to stop handing states on average 50 cents for every Medicaid dollar they spend and instead give them a fixed lump sum on a per-patient basis and tie its growth to general inflation.

If Senate Republicans' plan is enacted—a big "if" at this stage—federal Medicaid spending would drop from $4.6 trillion between 2018 and 2026 to about $3.9 trillion.

This reduction is hardly draconian. However, given that liberals want health-care spending to go in only one direction—up—it's hardly surprising that they'd fight this. But their claim that the cuts will kill Americans—about 208,500 over the next decade, per a Vox analysis—is pure sensationalism.

Let's think about it.

Vox's calculations are based on straightforward projections from a Congressional Budget Office report that estimates that scaling back ObamaCare spending would mean loss of insurance for some 22 million Americans. Vox also claims that every 830 people covered means one life saved, hence, presto, the GOP plan will mean killing 208,500 people.

The first problem with this analysis—apart from its chutzpah—is that it assumes that all insurance saves lives, even a substandard plan like Medicaid, which accounts for the vast majority of the people covered by ObamaCare. That is emphatically not the case.

As I have argued before, Medicaid is perhaps the civilized world's worst program. It costs just as much as private plans—about $7,000 per patient—but produces worse outcomes, including higher mortality, than private coverage. So given that one of ObamaCare's dirty little secrets is that many of its Medicaid enrollees are folks kicked off their private plans due to the Medicaid expansion, the law may have actually cost—rather than saved—lives in this cohort.

But what about the uninsured? Extending Medicaid to these people improved their health and diminished mortality, right? Wrong. Plenty of reputable studies suggest that this might not be the case:

  • A 2010 study by the University of Virginia of 893,658 patients in the university hospital found that individuals on Medicaid had the worst post-surgery survival rate of any patients, including the uninsured, after controlling for age, health status, income, and other relevant factors.
  • A 2011 Journal of Heart and Lung study found that of 11,385 patients undergoing lung transplants, Medicaid patients were 8.1 percent less likely to survive than the uninsured after 10 years. They also found Medicaid insurance was a significant predictor of death within three years, after controlling for other clinical factors.
  • And then there is the famous 2013 Oregon study — the closest thing to a lab experiment in the real world — co-authored by ObamaCare architect Jonathan Gruber. It contrasted uninsured patients who were randomly assigned to Medicaid with those who remained uninsured and found that the Medicaid patients did not have significantly better outcomes for diabetes, high cholesterol, high blood pressure, and even mortality.

The main evidence to support Vox's claim that Medicaid improves mortality rates comes from Massachusetts' experience with universal coverage. Vox claims ObamaCare emulates Massachusetts' system, but as the Manhattan Institute's Oren Cass points out, that comparison doesn't fly: In contrast to ObamaCare, Massachusetts' private plan component accounted for about 80 percent of coverage, while Medicaid comprised 20 percent at most.

And even if Medicaid's mortality outcomes were somewhat better for the uninsured, it would still not necessarily follow that extending the program would save lives on balance—or that eliminating the program would do the reverse. In a world with finite resources, one also has to consider the opportunity costs or other ways of spending that may potentially save more lives.

Indeed, a 2016 study in the journal Health Affairs found that states that spent a smaller portion of their budgets on Medicaid and Medicare than on social programs such as housing, nutrition, and even public transportation, showed "significant" gains on a myriad of health factors, including mortality, over states that did the reverse. It is possible that this is purely coincidental. But it may also be the case that these programs improved general quality of life and lowered stress levels, thus bettering baseline health and preventing people from falling prey to life-sapping illnesses in the first place.

And what holds true for state-level spending might be doubly true for individuals spending out-of-pocket.

The main advantage of health insurance in general and Medicaid in particular is not really to prevent death but to protect against catastrophic illnesses that wipe out patients financially—in other words, to provide a psychic comfort. But patients are not willing to pay any amount for any insurance product to receive that comfort, presumably because at some point, other uses of the money — like a car fitted with state-of-the-art safety features or a more expensive home in a low-crime neighborhood—can offer an even stronger sense of security. As George Mason University economist Alex Tabarrok recently pointed out, in Massachusetts, buy-in for Medicaid-like programs fell precipitously when patients were asked to bear more of their cost. Medicaid recipients value the program at about one-fifth its actual cost, research shows.

In other words, they'd buy only after an 80 percent discount.

By liberal logic, if they declined to buy in, they'd be courting death. But the calculus of health insurance is much more complicated than their simplistic arithmetic.

This piece originally appeared in The Week

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  • Shirley Knott||

    It's ridiculous. The death rate is the same as it has always been -- one per person.
    Nothing is going to stop people dying.

  • Citizen X - #6||

    Life is a sexually transmitted disease that is 100% fatal.

  • Zeb||

    Wow, clever. No one ever made that observation before.

  • sarcasmic||

    Maybe people on Medicaid have worse outcomes because they make poor decisions, evidenced by the fact that they are on the dole.

  • Rhywun||

    Could be one of those "relevant factors" they controlled for but yeah that was my first thought too.

  • Corduroy||

    How do you control for a lifetime of abuse and neglect?

  • Rhywun||

    Huh?

  • SQRLSY One||

    Are you perhaps referring to how the taxpayers are, forever and a day, always abused and neglected? Always over-taxed, and always assumed to be totally greedy, selfish, and incompetent? Incapable and / or unwilling to make their own freely selected charity choices, for and with their own money that they have earned? Always forced into having politicians and bureaucrats making their charity choices for them?

  • KerryW||

    Maybe people on Medicaid have worse outcomes because they make poor decisions, evidenced by the fact that they are on the dole.

    And my first thought also. Perhaps people without insurance actually try to live healthier and safer lives exactly because they don't have insurance -- getting them into Medicaid might make them less healthy if they then made worse choices.

  • Tony||

    Yeah many made the poor decision to become old. Some made the poor decision to be born to poor parents.

    Do you ever wonder why you have a worldview that doesn't incorporate anyone but able-bodied capitalists into it? Reminds me of a book I read.

  • ChipToBeSquare||

    What book was that?

  • ChipToBeSquare||

    "Benefit to the community precedes benefit to the individual... The state should retain supervision and each property owner should consider himself appointed by the state. It is his duty not to use his property against the interests of others among his own people. This is the crucial matter. The [United States government] will always retain its right to control the owners of property... A policy of laissez faire in this sphere is not only cruelty to the individual guiltless victims but also to the nation as a whole"

    Wanna guess what the bracketed part said before I changed it?

  • Sevo||

    Tony|7.17.17 @ 4:08PM|#
    "...Reminds me of a book I read."

    I'm sure it had lots and lots of pictures.

  • MJBinAL||

    WOW!

    Hey, gather round guys! Tony read a BOOK!

    So Tony, tell us more! Was this a book with pictures only, or did it have actual words in it!

    I mean, we are so impressed! Up until now most of us did not believe you could read!

  • commentguy||

    Why don't you tell us about these books that don't have any words. I don't think I've ever seen one.

  • Lester224||

    People included in the Medicaid expansion are typically not 'on the dole'. They are mostly working poor. Look it up.

  • Citizen X - #6||

    They say people will die but they are wrong

    Um.

  • Dillinger||

    if Australia can repeal gravity...

  • Sevo||

    Posted in the AM links, but relevant here:

    "Montana faces double quandary over Medicaid expansion"
    [...]
    "While Montana Democrats tout their state's plummeting number of medically uninsured - from 20 percent of the population in 2013 to 7 percent last year - the number of Medicaid enrollees has far exceeded expectations, and some worry the program cannot be sustained.
    Since it took effect in January of last year, nearly 80,000 of Montana's 1 million residents have enrolled. The state had projected only 33,000 by this time."
    http://www.washingtontimes.com.....id-expans/

    He could have decided to hand out food at half the cost and been surprised when he didn't have enough of that, either.

  • Uncle Jay||

    RE: Sorry, Liberals: Protecting the Medicaid Status Quo Won't Save Patients
    The program desperately needs radical surgery

    Medicare, medicaid and social security now take up about 49% of the budget.
    This spending has to stop because its only a matter of time these programs will bankrupt the USA.
    I would rather have the states run these programs as they see fit than the feds due to the above mentioned results.
    However, I doubt this will happen since no federal official will ever allow surrendering their power over all us little people much to the detriment of all our health.

  • Hank Phillips||

    I clicked in to see what looter press idiot had peddled the GOP-speak to Reason. And wouldn't you know it...
    Shikha, dear, in 1932, when Herbert Hoover's Moratorium on Brains was helping religious conservative Adolf Hitler's people rearm and build death camps, the American Liberal Party repeal platform calling for the relegalization of light beer 'n such was adopted by the Democrats. They won, won, won, won and won, and "legalize and liberal" from that year forward (and never before) became bound up together in religious conservative brains the way "liberal and Jew" were bound together in the Fuehrer's brain (before he splashed it). Calling whiney totalitarians "liberal" not only elevates them in the eyes of the educated, it also reflects poorly on the speaker's competence in handling the English language. This has been a public service announcement.

  • Finrod||

    The only public service you advanced there was convincing everyone you need mental help.

  • Juice||

    Hey man, you gonna be ok?

  • Citizen X - #6||

    I think i agree with what i suspect might be your point, that the word "liberal" is pretty much only used to mean its opposite these days, but i'm calling for a moratorium on overly-affected, hyper-cutesy commentary until we can figure it out for sure.

  • Robert||

    Religious conservative Adolf Hitler? Of all the things that might characterize him, how'd you determine that?

  • SQRLSY One||

    Adolf H. once said, "Who is to say that I am not specially favored by God?", implying that he was yea verily "specially favored by God". ... There you have it! Sounds like a whole bucketload of "religious conservatives" that I have know... Totally 350% convinced of their own righteousness!

  • HenryC||

    It seems to me you are more convinced of your righteousness than any evangelical I know. Every one of those I know proclaims that they too are sinners. They are convince of the righteousness of the bible, not themselves.

  • SQRLSY One||

    Yes, here is how their "righteous Bible" speaks to some of them...

    God COMMANDS us to kill EVERYONE!

    Our that them thar VALUES of society outta come from that them thar HOLY BIBLE, and if ya read it right, it actually says that God wants us to KILL EVERYBODY!!! Follow me through now: No one is righteous, NONE (Romans 3:10). Therefore, ALL must have done at least one thing bad, since they'd be righteous, had they never done anything bad. Well, maybe they haven't actually DONE evil, maybe they THOUGHT something bad (Matt. 5:28, thoughts can be sins). In any case, they must've broken SOME commandment, in thinking or acting, or else they'd be righteous. James 2:10 tells us that if we've broken ANY commandment, we broke them ALL. Now we can't weasel out of this by saying that the New Testament has replaced the Old Testament, because Christ said that he's come to fulfill the old law, not to destroy it (Matt. 5:17). So we MUST conclude that all are guilty of everything. And the Old Testament lists many capital offenses! There's working on Sunday. There's also making sacrifices to, or worshipping, the wrong God (Exodus 22:20, Deut. 17:2-5), or even showing contempt for the Lord's priests or judges (Deut. 17:12). All are guilty of everything, including the capital offenses. OK, so now we're finally there... God's Word COMMANDS us such that we've got to kill EVERYBODY!!!

  • SQRLSY One||

    "They too are sinners", they say? But not as big a sinner as I am, they are convinced, to the extent that they will vote for politicians to FORCE me to be less a sinner, in their eyes! Admittedly, right now, this is a bigger problem in the Islamic world than in the Christian world, yes, but these things do change over time...

    More to the point, can you please explain the real-world practical difference between the two cases below:

    'A) They will tell us all what to do and not to do, while proclaiming that it is not THEM that is doing the righteous forcing, it is righteousness of XYZ Holy Book that is doing it (in THEIR interpretation, mind you!).

    'B) They will tell us all what to do and not to do, in their own self-righteous voice.

  • Kaatje||

    I'm bedbound and use an electrical hospital bed. Medicaid gets charged $350 x 14 months = $4900 for the same hospital bed you can buy online for $525, brand new!

    This overpriced piece of shit bed came with a used foam mattress. When I inquired, upon delivery, why the bed and the mattress looked used the rep said: we refurbish them.

  • Paper Wasp||

    So then why didn't you just buy it only for $525? Why do we have to buy it for you at more than 9x the cost? If you can afford broadband access and a computer, then you can afford a $525 bed.

    If you can screw around on the Internet all day, and post comments, you can work and earn your own damned electric-bed money. What do you think everyone else here does? That's right, a job where they type on a computer, just like you're doing.

    Fuck "disabled" parasites who spend all day on their computers while they're living off my tax dollars. Either get off the public teat or hurry up and die.

  • Longtobefree||

    Cite your source for the following:
    1. He bought the computer instead of someone giving it to him.
    2. He is using a computer and not a tablet or phone.
    3. Paying twenty or twenty five dollars a month for internet service out of an income that qualifies for medicaid is the same as paying $525 cash all at once. (and taking on all costs associated with maintenance of said bed)
    4. The event(s) that qualified him for medicaid is one that leaves him capable of working. I would think being in a hospital bed would be a clue to the opposite conclusion.
    5. Why it is not rational to 'follow the rules' to minimize you own expenditures. Good old Medicare (not medicaid) pays for diabetic testing supplies. I have a perfectly fine working meter and lancet, but am running low on test strips. My current coverage (it changes each year because - regulations) will cover only 80% of the cost for test strips from the manufacturer of my current meter. They will pay 100% of the cost of a new meter, new lancet, and test strips for the new meter. Madness! But which would you choose? Zero out of pocket, or 20% out of pocket? And the same idiots that wrote the laws and regulations for this are wondering why health care costs go up so fast.

  • Mrs. Premise||

    I work for a medical equipment company in PA. We get paid $126.99 a month for a semi-electric hospital bed. Charge amount is not always the amount paid. We have to replace it during the ten month rental period if anything goes wrong, even if it is due to patient abuse of the equipment. It requires an authorization, which still needs to be done on paper, and takes forever. Often. the patients pass away or go into a nursing home, and the family fails to inform us, and suddenly our bed is missing halfway through the rental period. We would love if they would just buy them outright, but that is not CMS's policy. Write your congressman if you are unhappy with the way government insurance is run.
    You can complain to someone in authority, other than the delivery technician, to see if they will give you a newer mattress. As to the bed, should perfectly good beds be discarded after rental? Do people expect brand new cars when they personally pay to rent a car? That's not the way rentals work.

  • Robert||

    Medicaid is perhaps the civilized world's worst program. It costs just as much as private plans—about $7,000 per patient—but produces worse outcomes, including higher mortality, than private coverage.


    Someone please explain to me how the name on the check paying the doc makes a dif as to mortality. I'm amazed even gov't can fuck up that badly.

  • NotAnotherSkippy||

    Probably because much of the spending is on long term senior care and so isn't really health spending at all.

  • Migrant Log Chipper||

    No, about 10%

  • JFree||

    Those numbers are simply false - and quite obviously selected by Shikha in order to deceive and further an agenda. Numbers-wise, Medicaid is two very different programs.

    The expensive shit is nursing homes for the formerly middle-class elderly and medical for the completely disabled. Those two cost $300 billion, cover 18 million for an average cost of $16,700

    The semi-cheap stuff is poor adults and children. Those two cost $180 billion, cover 64 million for an average cost of $2800. Put another way - 5% of the total health spending to cover 20% of the population. The only reason it is made to appear higher is because of fraudulent cost accounting and the desire to have this group subsidize Medicare/Medicaid via 'insurance'. And this stuff could be even cheaper if we had primary care doctors in this country and actually used them the way they are supposed to be used.

  • Robert||

    a 2016 study in the journal Health Affairs found that states that spent a smaller portion of their budgets on Medicaid and Medicare than on social programs such as housing, nutrition, and even public transportation, showed "significant" gains on a myriad of health factors, including mortality, over states that did the reverse. It is possible that this is purely coincidental. But it may also be the case that these programs improved general quality of life and lowered stress levels, thus bettering baseline health and preventing people from falling prey to life-sapping illnesses in the first place.


    Oh-oh...bait for "liberals".

  • albo||

    Not to get all eugenics on this, could it be that Medicaid patients have poor outcomes from medical care because they are in general part of the perpetual underclass of proles who have unhealthy habits or just plain don't give a damn about their health?

    God, I sound awful.

  • Lester224||

    Lots of Medicaid patients are poor, old, disabled or mentally ill. Those included in the expansion were mostly working poor. I'm not sure that the "controlled for" factors in that study controlled for all that much or controlled for it correctly.

    The worst part of Medicaid (and Medicare too) is that the cost controls are awful. It would be a lot more bang for the buck if there were effective cost controls.

  • MichaelL||

    One of the cost problems is the use of colonoscopy for screening for colon cancer. Screening for blood, or colon cancer DNA through Cologuard, is just as effective, in normal people. I also question the high costs for medication that seem to have resulted from insurance paying for anything sent to them. I have a feeling that the charges for this medication, just like high cost epipens and naloxone injections, could be brought down substantially. If the old prices plus inflation were used to charge us for our prescriptions, it might show us massive cost savings. It might be a pipe dream. But, we are going to run out of money. Maybe doctors will have to start working for the good of the patients, again, and not to pad our wallets. Karma will be a bitch! I am already seeing them squirm!

  • Longtobefree||

    "I also question the high costs for medication that seem to have resulted from insurance paying for anything sent to them."

    You're not on Medicare are you?
    I have a 200 page book of what medicines are covered and what medicines are not covered. And exactly what percent of the covered ones is covered. And which ones are covered, but only if you have tried cheaper ones first and not gotten 'acceptable' results before moving to the next tier. And what is not covered if you fall into the 'donut hole'. (The only calorie free donut in the world)

  • KerryW||

    OT:

    WTH? At the top of the page for this article I get an ad for Wahed Invest Inc., a shariah-compliant wealth advisor.

  • albo||

    I get a banner ad for Old Navy.

    Enjoy Gitmo, pal.

  • AlmightyJB||

    Lol

  • TGoodchild||

    Haha

  • TGoodchild||

    I saw a "get to know Islam" billboard off I-294 in Chicago this morning, showing two old white people reading copies of the Koran. Brave new world we have here.

  • Longtobefree||

    Was there a guy behind them with a scimitar poised?

  • Longtobefree||

    I got a notice from ad blocker that 8 ads were blocked.

  • Leo Kovalensky||

    "As George Mason University economist Alex Tabarrok recently pointed out, in Massachusetts, buy-in for Medicaid-like programs fell precipitously when patients were asked to bear more of their cost. Medicaid recipients value the program at about one-fifth its actual cost, research shows.

    In other words, they'd buy only after an 80 percent discount."

    No better assessment than that right there. Let this sink in for a minute... The government is paying 5 times what the average consumer would value for health insurance. Any wonder that the price of healthcare has continually gone up since the 1960s when prices for most other goods have gone down significantly?

  • Leo Kovalensky||

    I guess I should have provided a source to my claim above.

  • Longtobefree||

    Nah. We will just assume you are a progressive.

  • AlmightyJB||

    That's the main economic problem with socialism. There is zero inventive to contain costs through efficiency so the government enviably ends up doing so through rationing. The main moral problem is that it's theft.

  • grapeape||

    These are Medicaid members, not average consumers, i.e. they are poor. They do not have the capability to pay more than 20% of their healthcare costs if they have ANY substantial healthcare needs. In fact, very few people can afford to pay a substantial portion of their medical costs if they regularly receive care. The quote above just demonstrates that Medciaid recipients cannot afford to pay more than that regardless of how much they personally value the care.

  • Sevo||

    Cites, please.

  • John B. Egan||

    Wouldn't it make more sense to fix our nation's health care problems, and resolve not only the issue with Medicare, but pretty much cut the $3.2 Trillion we spend as a nation on health care in half? Or maybe, instead of whining about the Medicare problem, realize that the citizens of our nation are more important than spending as much on our military as all 10 largest militaries in the world combined, and divert a large hunk of that towards taking care of our people? Why is it when it comes to health care, 'Muricans fight for the right to protect a horribly expensive and flawed system that is worse than any other developed nation? Would you demand to pay $50,000 for a $25,000 Toyota Corolla, knowing that the car would only run 4 days a week? How stupid are we? Why are we constantly screwing with peripheral issues rather than fixing the real problem? i seriously expect better analysis from the Hoover Institute articles.

  • Ride 'Em||

    People will concentrate on problems they can control. For example, community organizers, who become politicians, will concentrate on throwing money at the problem because they can't find a cure for cancer or poverty.

  • AlmightyJB||

    Nice article Shikha.

  • Tony||

    We'll reform public healthcare as soon as Republicans, libertarians, and other assorted corporate whores get their grubby hands away from the levers of power, thank you.

  • SQRLSY One||

    Libertarian hands are about as far away from the levers of power as Donald Trump's ego is far-away removed from any semblance of honest humility.. Scientists estimate this distance to be roughly equal to the number of light-years as is equal to the number of sub-atomic particles in the known universe! And that's indeed a VERY sad thing, in both cases.

  • Brian||

    Your masturbation euphemisms are completely boring.

  • SQRLSY One||

    Well, perhaps you would be more amazed if you realized this:

    At the same time as I was writing this fine piece of prose, I was also...

    Twaddling my tarnished, twisted turnips!

  • Sevo||

    Tony|7.17.17 @ 4:36PM|#
    "We'll reform public healthcare as soon as Republicans, libertarians, and other assorted corporate whores get their grubby hands away from the levers of power, thank you."

    Just as soon as Tony's fave villains are replaced by his well-loved armed and jack-booted thugs, why all shit will be free, right, shit-bag?

  • Mock-star||

    like "we" did in 2010? No thanks.

  • Migrant Log Chipper||

    "Hi, I'm Tony and I'm a raging moronoholic, it started one day back in......

  • grapeape||

    "Alex Tabarrok recently pointed out, in Massachusetts, buy-in for Medicaid-like programs fell precipitously when patients were asked to bear more of their cost. Medicaid recipients value the program at about one-fifth its actual cost, research shows.

    In other words, they'd buy only after an 80 percent discount."

    That is because they are poor you fucking dolt. Yes they cannot spend any significant portion of their income on medical care because they have extremely little income and have more immediate needs.

    This let people suffer attitude dressed up with bullshit rationales for why it is a good idea to let people suffer makes it impossible for me to ultimately find much common cause with libertarians and attitudes like this are why I will be voting Democrat for the foreseeable future. I can't believe the GOP nominated someone that got me to vote for Clinton. With this healthcare bill they are pushing the damage down ticket.

  • Sevo||

    "...I can't believe the GOP nominated someone that got me to vote for Clinton...."

    That explains a lot.
    BTW, how about some cites on your claims.

  • grapeape||

    What do you want me to cite exactly? That Medicaid recipients are poor?

  • MaleMatters||

    Re: "the Medicaid patients did not have significantly better outcomes [than the uninsured] for diabetes, high cholesterol, high blood pressure, and even mortality."

    One reason, I suspect, is moral hazard. See:

    "Will Obamacare make a bad situation worse?" http://relevantmatters.wordpre.....ion-worse/

  • SteveDDD||

    Medicaid doesn't treat patients. It simply pays bills, as any insurance company does.

  • Shootist||

    Medicaid doesn't actually pay bills, it pays a pittance that is useless for those in need of care. And Obamacare (in Florida, at least) is worse. In my case, age 60, $600 a month, $6000 deductible and no physicians in program within 50 miles (of Orlando). Useless and less than useless.

  • ||

    Lots of speculation here as to why Medicaid patients may have worse results than individuals without any insurance. My observations of the "care" provided to some people I know who are on Medicaid suggests that they may be misdiagnosed by incompetent (or possibly overworked) medical providers, and (1) given prescriptions that are harmful, and/or (2) given unnecessary surgeries that fatal. You may want to Google iatrogenic and/or read what Nassim Taleb has written about the harms caused by inappropriate and too much medicine.

  • Shootist||

    I'm right of Genghis Khan. That said, to love your country your country should be lovely. Healthcare MUST be paid for by the people for the people. There is no other real option. Single payer is a horrible idea, the horror of which, is only transcended by not having every individual covered for catastrophic illness or injury.

    Announce that everyone is covered for catastrophic illness or injury (cheaper for everyone) and give the otherwise indigent poor, $5000 a year to pay for incidental medical and dental.

  • Tom Jefferson||

    Would catastrophic illness include pre-existing conditions or be limited to diseases/virrii they caught? I think I like your idea.

  • JMatt||

    Titles like this mean you will only be preaching to the choir.
    My opinion only, of course, but I think Reason is better than this.

  • Tom Jefferson||

    We'd have a lot more money towards it if they ended the endless wars we're fighting. Something like 50% of the federal budget is going towards military. I'm not saying we need to get rid of all the military and wars, just scale back and free up some cash that could be used to help the country. Instead, we're fighting a needless war in Afghanistan (we were only there to get Bin Laden and he's been dead since 2010), and inciting terrorism against us by getting into everybody's business all the time. If we just stepped back and acted like allies to countries instead of pushing in on them, we'd get a lot more accomplished for the world and our own country, AND not have to be so militaristic and defensive against terrorism.

  • Red Rocks Baiting n Inciting||

    Getting out of the Middle East would save about $100 billion a year. The annual deficit is 4-10 times that, and Medicare/Medicaid has hardly lowered the overall cost of healthcare--over $1 trillion a year is spent on those programs combined from federal coffers. How is shifting money from one government agency to another going to save money?

  • trudybeauty||

    On the one hand, you have it right. But, as with everything "libertarians" come up with, they always have their other hand where they get it wrong.
    Medicaid is hideously expensive. We can easily see how to fix it by looking at Canada, UK, Germany, Sweden, Denmark, Holland, Belgium, Austria, Switzerland. You know, that stuff you call "socialism" as an epithet and I call actual functioning examples of better systems.
    Of course, there are none for your view of how to deal with this or any other issue. Or, would someone (after years of my asking) like to provide one? You know, empirical evidence?

  • Red Rocks Baiting n Inciting||

    Lol at citing Canada and the UK.

    Of course, there are none for your view of how to deal with this or any other issue.

    Sure there is--60 years ago, before Medicare, Medicaid, and every other government attempt to interfere in the health care market, a normal live birth and two days in a private room in the hospital cost about $800-1000, inflation-adjusted. Today, it's about $25K (what was charged for the birth of our youngest), with an average of $10K just for the birth. The US was hardly a third-world shithole back then.

    Claiming that adopting European-style systems is the only way to fix the problem is classic question-begging, and deliberate ignorance of the actual factors that have made it so increasingly expensive to begin with--namely, the lack of price transparency and refusal to prosecute monopolistic behavior on the part of healthcare providers.

  • Longtobefree||

    Medicaid is a government run program. To expect efficient, cost effective results is believe in unicorns.

    Compare any government regulated medical procedure to any non-government regulated medical procedure.
    Setting a broken bone to lasik surgery.
    An appendectomy to breast augmentation.
    In one case, the costs have gone down and the results improved. In the other case, costs have gone up and the results remained constant or declined. Guess which is which.

    So exactly why is there a problem repealing Obamacare?

  • Mark22||

    How about we get serious about adopting a European model of healthcare, starting with slashing per-patient Medicare/Medicaid expenses by (not to, but by) 50-70%?

    We can start by eliminating coverage for almost all non-generic prescription drugs, elective abortions, elective surgeries, birth control, and limit care for those with life expectancies of less than 6 months to palliative care. Then, we should eliminate a lot of choice of doctors, as well as introduce months-long waiting times.

    If that isn't sufficient, we can always nationalize clinics, medical practices, imaging centers, etc. You know, like in the UK.

    How about it? If you want European-style single payer, you ought to be satisfied with European-style health care delivery.

  • swampwiz||

    This essay is garbage from the very beginning, as it claims that Medicaid is more expensive than regular coverage. The fact that it might cost more is due to the fact that VERY SICK FOLKS TEND TO BE ON MEDICAID! And they tend to be on Medicaid precisely for that reason, to lower costs.

    Oh, and trying to equate "value" to the consumer based on the elasticity of price is garbage analysis. Food, clothing & shelter are a much higher level of perceived need to a poor person.

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