I would like a clean debate on why didnt Obama just expand medicaid?

[Sallow]

If you're asking why Obama didn't expand medicare to cover everyone, the answer is because the Insurance companies, who's lobbyists have a lot of power in Washington, wouldn't let him.

Do you not remember all the discussion about a "public option"?

That too.



(sorta the same thing,though)

That’s pretty much it: not politically feasible.

The irony is no one likes the ACA.

Its ‘supporters’ do so only because they understand it’s a first step to an eventual single payer system. They see it as a ‘foot in the door,’ as it were.

Basically yeah.

But, in fact, HMOs were all for it until they discovered they would actually have to pay for treatment and couldn't just siphon off endless profit without investing some of that cash back into improving the process. And big pharma was aghast that the government would no longer be locked into buying their expensive brand name drugs over generics.

That's basically the root of all the hubbub.

So they came up with "Death Panels" and "Forcing" people to buy "private" policies.

And the conservatives fell for it.

Hook line and sinker.

 

[Sunshine]

If you're asking why Obama didn't expand medicare to cover everyone, the answer is because the Insurance companies, who's lobbyists have a lot of power in Washington, wouldn't let him.

Do you not remember all the discussion about a "public option"?

That too.



(sorta the same thing,though)

That’s pretty much it: not politically feasible.

The irony is no one likes the ACA.

Its ‘supporters’ do so only because they understand it’s a first step to an eventual single payer system. They see it as a ‘foot in the door,’ as it were.

"Mostly Single payer" is going to become a reality with the baby boomer generation simply due to their being on Medicare and the numbers of people involved. Medicare dictates what it will and will not pay. I saw providers in TN try to avoid Tenncare by not participating in it, then the TN government told them that if they wanted to be on the state employee BCBS panels they would have to take Tenncare.

Private and employer provided insurance companies contract with providers for discounts, so in effect, they, too, dictate what they will pay. I don't think the government is vying for single payer simply because many large employers completely underwrite their insurance claims. That means that they pay every dime contracted for those claims and merely hire a company like BCBS to administer the program according to the rules. I certainly hope the government isn't stupid enough to take over paying claims when there is a private company or employer out there willing to do so as part of their employee benefit program. Based on the way claims are underwritten in the health care market, taking over corporate paid claims and pushing through single payer is absolutely stupid. I would certainly hope that is not the government agenda.

 

[Greenbeard]

Yea why didnt he just expand it more and not have to come up with obama care?

Expand on that thought. "Obamacare" as a term has become so useless as to convey nothing--if by "Obamacare" you mean the coverage expansions that give tens of millions of people access to health insurance, then the Medicaid expansion is Obamacare. Or roughly half of it.

So how much more should he have expanded it? To everyone under 150% of the poverty line (as some of the bills at the time did)? Or some higher cutoff? Or to eliminate the entire individual market for folks who don't get health insurance through a job? Or to everyone period?

What is it you're suggesting should have been done? It's hard to debate the question when you haven't clearly articulated what it is.

 

[itfitzme]

Does anyone know why?
Because I dont.
Medicaid | HealthCare.gov

Medicaid A state and federal partnership, Medicaid provides coverage for people with lower incomes, older people, people with disabilities, and some families and children.

Is it because Congress is the branch of gov't that passes laws, not the executive branch? Maybe that's it.

 

[Mertex]

The Affordable Health Care Act is going to be better for people than what we have before because Insurance companies will not be able to play games with people. Already many parents are enjoying the fact that they can carry their college kids on their policy - anybody who has kids in College has got to agree that this is better than knowing your kid doesn't have health insurance because he can't afford it, or doesn't think he'll need it. It is peace of mind for parents and something that was not there before.

How the Health Care Law Benefits You | HealthCare.gov

 

[PaulS1950]

The problem with Medicaid and medicare are that private practitioners do not have to accept their payments. Even the government sponsored clinics don't have to accept the payment from medicaid/medicare as the final price for services. All they do is charge the patient for the remaining amount. What they do cover is paid up to 80% of the federally accepted fee for the service - they do not pay at that level for the fees from private practitioners.
In rural USA it is very hard to find doctors who are accepting medicare patients and are worth having as doctors. There are four doctors in the county accepting new patients and only two of them are worth having - one of them wouldn't even make a satisfactory vet and I told him so.

The idea behind the AHCA is to limit what the doctors can charge for their services - and that my friends will ruin health care in this country. When a doctor is allocated 10 to 15 minutes with each patient you do not get quality health care.

 

[Wyatt earp]

Yea why didnt he just expand it more and not have to come up with obama care?

Expand on that thought. "Obamacare" as a term has become so useless as to convey nothing--if by "Obamacare" you mean the coverage expansions that give tens of millions of people access to health insurance, then the Medicaid expansion is Obamacare. Or roughly half of it.

So how much more should he have expanded it? To everyone under 150% of the poverty line (as some of the bills at the time did)? Or some higher cutoff? Or to eliminate the entire individual market for folks who don't get health insurance through a job? Or to everyone period?

What is it you're suggesting should have been done? It's hard to debate the question when you haven't clearly articulated what it is.

Sorry, Just a simple guy, but if we had 40 million or so folks with out health care why didnt we just expand them under the medicaid umbralla [spl?] problem solved I would thinik and didnt you post that the penalty dont start to 2015? every thing I keep reading folks with out health care will have to pay in april 2014.. you seem like a smart guy on this. but think you are wrong. sorry for the typos....

 

[itfitzme]

Yea why didnt he just expand it more and not have to come up with obama care?

Expand on that thought. "Obamacare" as a term has become so useless as to convey nothing--if by "Obamacare" you mean the coverage expansions that give tens of millions of people access to health insurance, then the Medicaid expansion is Obamacare. Or roughly half of it.

So how much more should he have expanded it? To everyone under 150% of the poverty line (as some of the bills at the time did)? Or some higher cutoff? Or to eliminate the entire individual market for folks who don't get health insurance through a job? Or to everyone period?

What is it you're suggesting should have been done? It's hard to debate the question when you haven't clearly articulated what it is.

Sorry, Just a simple guy, but if we had 40 million or so folks with out health care why didnt we just expand them under the medicaid umbralla [spl?] problem solved I would thinik and didnt you post that the penalty dont start to 2015? every thing I keep reading folks with out health care will have to pay in april 2014.. you seem like a smart guy on this. but think you are wrong. sorry for the typos....

I believe that a large constraint is the current health care industry that has fo be considered and built upon. It isn't possible to simply ignore and scrap an existing health care system that is ready in place, down to the computer system that manage insurance payments from thousands of insurance providers to tens of thousands of mlservice providers. Medicare and medicaid programs would have to be massively expanded as a single insurance provider while tens of thousands of employees would lose jobs as the remaining insurance providers shut down. That or they would all be changing employers, from Blue Shield etc to Medicare/caid. Or the existing private providers would suddenly become Medicare/caid providers.

Is that what we are considering?

Oh, sorry, just jack up the current Medicare/caid to pick up the extra 40 million.

Not as intense. Still, do you suppose that is part of it, to get the 40 million into an existing system that is already huge and capable of the increased load rather than have the gov't try and try and expand it's capacity. Don't we generally agree that the private market is a bit better at efficiency then the gov't?

Agreed, Medicare isn't no slouch. They use CMS. And the existing Medicade system functions pretty well in many counties. Still, might it be a matter of a) logistics.

Another thought is that the govt, the US way, is to not be in the business of competing with private industry.

I know some folk have problems with medicaid in their counties but I'd be cautious about generalizing that to Medicaid in general. While it is a block grant supported program, it is state and county run. It may be that itnjust sucks in some places. Down the street from here is a county Medicaid facility and it not to bad.

Also, my wife has been on Medicare for decades and has bad excellent care.

 

[Greenbeard]

Sorry, Just a simple guy, but if we had 40 million or so folks with out health care why didnt we just expand them under the medicaid umbralla [spl?] problem solved I would thinik and didnt you post that the penalty dont start to 2015? every thing I keep reading folks with out health care will have to pay in april 2014.. you seem like a smart guy on this. but think you are wrong. sorry for the typos....

You asked for a clean debate, so I'd be interested in hearing it: why are those people better off in their state's Medicaid program than shopping on their own for coverage in the commercial insurance market?

 

[itfitzme]

Sorry, Just a simple guy, but if we had 40 million or so folks with out health care why didnt we just expand them under the medicaid umbralla [spl?] problem solved I would thinik and didnt you post that the penalty dont start to 2015? every thing I keep reading folks with out health care will have to pay in april 2014.. you seem like a smart guy on this. but think you are wrong. sorry for the typos....

You asked for a clean debate, so I'd be interested in hearing it: why are those people better off in their state's Medicaid program than shopping on their own for coverage in the commercial insurance market?

Isn't there more than just whether they are better of? There is the market place, them, and the "gov't". As I see it, the market place splits into two general categories, businesses and consumers. Businesses split to the owner/stockholders and workers. Workers are consumer. And everyone is a taxpayer, so it all wraps around to the general public.

So far as I've seen, no one has a secret formula that can predict it. The market is the American way, when tne market will take care of it. The gov't is basically one really huge business with a membership fee structure. It is a bit unresponsive. Small companies, in the market, adjust much faster, the boss just changes direction and every one moves. Larger companies can take longer to respond, but they aren't the lumbering elephant or ocean liner like the gov't.

All in all, I think that's the thing. Oceanliner vs a bunch of speed boats and yachts. How about a super carrier vs a fleet of cruise ships, yachts and speedboats? You pick your analogy.

 

[itfitzme]

Sorry, Just a simple guy, but if we had 40 million or so folks with out health care why didnt we just expand them under the medicaid umbralla [spl?] problem solved I would thinik and didnt you post that the penalty dont start to 2015? every thing I keep reading folks with out health care will have to pay in april 2014.. you seem like a smart guy on this. but think you are wrong. sorry for the typos....

You asked for a clean debate, so I'd be interested in hearing it: why are those people better off in their state's Medicaid program than shopping on their own for coverage in the commercial insurance market?

Another considerationnis that then medicaid would be supplimenting Walmart like is reportedly the SNAP issue. The markets just don't function well when the incentives are different.

 

[auditor0007]

Does anyone know why?
Because I dont.
Medicaid | HealthCare.gov

Medicaid A state and federal partnership, Medicaid provides coverage for people with lower incomes, older people, people with disabilities, and some families and children.

First of all, that would not address the problem of those with pre-existing conditions not being able to purchase health insurance unless they got it through an employer. For the self-employed or those who work for companies that do not provide company based health insurance, that was a very big problem. The second reason is that in order to reduce costs long term, everyone, or as close to everyone as possible, needs to be covered and paying into the system.

The way the ACA is currently set up, this will raise the cost of insurance on young people, but it will also keep it more affordable as they get older. Just expanding Medicaid would only have helped a small number of people. While the ACA is not perfect, it is a good start. As it is fully implemented I am sure we will see some adjustments and changes to the law as we actually see how well it is or isn't working. The truth is at this point we have no idea how well it will work and how much it will increase or decrease overall spending on healthcare. As it was, spending on healthcare has spiraled out of control for years and was on a path to eventually eat up a full one third of our GDP, something that is just not sustainable.

 

[JQPublic1]

If you're asking why Obama didn't expand medicare to cover everyone, the answer is because the Insurance companies, who's lobbyists have a lot of power in Washington, wouldn't let him.

Do you not remember all the discussion about a "public option"?

That too.



(sorta the same thing,though)

That’s pretty much it: not politically feasible.

The irony is no one likes the ACA.

Its ‘supporters’ do so only because they understand it’s a first step to an eventual single payer system. They see it as a ‘foot in the door,’ as it were.

I am a supporter and I see the ACA as a "foot in the ass" of all those free loaders who sponged off the system by clogging up the emergency rooms for free treatment after they suffer some unexpected trauma!

Another blessing from the PPACA is there is no "spend down" requirement for the continuation of care. Your life savings do not go up in smoke because you get sick. But the one thing about it that tickles my fancy is that under OBAMACARE the insurance companies cannot drop you because you have a pre existing condition. If MEDICARE/MEDICAID could have been expanded to include all those new benefits... fine. But as some here have noted... the republicans wouldn't have it that way!

 

[PaulS1950]

Why didn't Obama just extend medicare/medicaid ?

in two words:

GOVERNMENT CONTROL

 

[itfitzme]

Critique this.

CPIMEDSL: medical inflation
CPIAUCSL: general inflation
Form: (CPIMEDSL-CPIAUCSL)/CPIAUCSL

Description: The decimal percentage difference of medical compared to general inflation. How much larger medical inflation is compared to overall inflation.[1]

Does this form make sense? Why or why not?
Is there a better way to view the relative increase in medical costs to general costs?

What reason should there be for medical costs to rise more than everything, including med cost? It doesn't strike me that fuel is a big factor in delivering medical. And, if the same as general prices, the effect would be relatively the same. Better quality? More and better meds? Supply shortage relative to demand? The standard basket changed?

----------
[1] *So a pill and bread cost $1. *The price increases to $1.50 for the pill and to $1.20 for the bread. *

In the first year, base year,*

CPI is 100*$2/$2 = 100. *
CPIMED is 100*$1/$1 = 100. *

The second year gives*

CPI=100*$2.70/$2=135 and CPIMED=100*$1.5/$1=150. *

So

(CPIMED-CPI)/CPI =*
(150-135)/135=0.11

 

[Hyrcanus]

What we should have done is simply let Americans buy into Medicare, based on a sliding fee scale based on age and income.

The closer you are to 65, the lower your monthly premiums should be.

 

[itfitzme]

What we should have done is simply let Americans buy into Medicare, based on a sliding fee scale based on age and income.

The closer you are to 65, the lower your monthly premiums should be.

I almost want to agree, then I think, nah. *The problem is the medical market.

*The free market is better than trying to do the old managed resource thing, but it has issues. *The whole lazze-fairre, or whatever, thing is based on a small idealized model. It's odd to because supporters bitch that economists don't know what there doing, models are flawed, yada yada yada. *Then they hold up the free-market as reality. *It's just a model. *Perfect competition is zero profit.

I've talked to business owners and they don't compete with lower prices. *It's bad business. *They are not stupid. They know the other guy knows that they know that they are all watching each others prices and that they can hold prices above the ideal equilibrium. *They all want that swimming pool, or whatever.

And the medical markets get awesome profits. *The medical textbook publishers, the medical schools, nurses, doctors, hospitals, drug manufacturers, insurance companies, pharmacies, and on and on. *It is all above the equilibrium price because markets aren't perfect.

Just adding another insurance company wouldn't necesarily do it. *I don't know what will, except way more supply of all of it

 

[Polk]

OR -- instead of expanding just MEdicaid -- offer an early opt-in to Medicare with controlled premiums?

The game was much like Rozman put it. Along with the kick-back to the insurance companies of FORCING enrollment on the younger folks who elect not to cover.

It's a misguided attempt to REASON with the major insurers and that's not gonna work.

They tried to reduce the eligibility age for Medicare. Republicans blocked it...