The Health Care We Have: The Case For Medicaid Expansion (Guest Post)
Tuesday, December 8, 2009 at 12:30PM 
By Adeshola Blue
Healthcare reform, insurance reform or whatever it is is really beginning to disturb me. I was under the impression that we already had safetynets in place (Medicaid), and a really popular government run insurance plan (Medicare). So why is it that we need comprehensive reform again?
Being that I have seen the effects of both plans on senior citizens and the poor, I believe that the Congress and the President have both been going about this the wrong way. The simplest solution is usually the best one.
We are currently in an economic downturn and it is obvious that people need help. So how do we handle the high cost of insurance and make sure that everyone is covered? Easy. We go with what we already have. Imagine if you will that the current system is a house. We are currently making payments on the house, but everyone cannot reasonably fit into it. It is not big enough, and it is badly in need of repair. Should we just go out and buy a bigger new house that we will be paying for in perpituity or should we fix up the house that we have, that we can currently pay for?
I say we go with the house that we have. We should expand Medicaid and keep Medicare like it is. Have people that can't afford insurance that are employed to pay into medicare on a sliding scale. Make their payments based on their income. This will help out two fold. The insurance companies won't have any other choice than to be more competitive because they will lose customers. Ultimately the rates would have to come down because if they raise the rates Medicaid would become the better option. This may be a bit difficult at first, but since the infrastructure is already in place, the federal government can give the states more money to pay for more medicaid casemanagers. The sliding scale pay for services would help pay for the increase in manpower and state costs. Medical providers would also be put on notice to reduce costs. If there is a large volume of patients, this shouldn't be an issue.
The only positives I see in this reform bill is the lifting of the pre-existing condition clause, hopefully a lifting on the cap on the maximum dollar amount you can incur over the lifetime of your insurance and the lifting of the anti-trust exemption. Those are changes the American people understand. No one wants to be grandfathered out of their insurance because they have met their maximum, no one wants to be exempted from insurance because of pre-existing conditons, and everyone would like some competition in their choices of insurance.
We are in a recession. No one wants to pay for anything new. Trust me on this. The people would be able to get behind something that we already know and understand. Don't give me anything new. The last new program agency we had was Homeland Security. We all see how that has worked, more government oversight and less rights.
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Reader Comments (20)
hmmmm.....interesting point of view.
i've always disagreed with the public option.
I know this is probably an oversimplification of the realites of funding and such, but I don't know why they just didn't go with what people know.
Would this approach also open up income guidelines to include people that are not "poor" or old enough to be eligible for Medicare, but also not able to afford their own healthcare? I think if anything the reform is supposed to address the issue of those in the middle.
A lot of this stuff you're suggesting --- like widening the criteria for existing entitlement programs --- was or is already on the table. Early on in the process, one of the big issues being debated was raising the bar on Medicare to XX% of the federal poverty line, as part of the mandate-subsidize-regulate approach. (The problem isn't the legislation, it's the legislature.)
And the public option would be far less expensive than absorbing millions of new people into programs that are already going to be hard to pay for; someone has to pay for all those new Medicare/Medicaid recipients.
Also, I think you're really oversimplifying how hard this is:
1) No one has figured out how to reduce costs. The obvious way would be to move away from fee-for-service and tell people that there's a limit to how much treatment they could get, but Americans aren't exactly keen on that idea. Good luck with that.
2) The large volume of patients is itself a problem. A lot of people have pointed out that we don't have enough doctors now, and we'd have even less if there's an influx of millions of new patients into the healthcare system.
the problem with this country is a lack of personal responsibility. the majority of the ailments that people have are self-inflicted (be it smoking, drinking, over-eating, lack of exercise). i don't see a point in the government becoming the insurance company to give these people health care when they don't even know how to take care of themselves.
swiv: Jesus, where to start?
the way it works now is that if you suffered from a prolonged illness, you can be denied care. The proprietor of this blog has written thoughtfully and eloquently about her own battles with mental illness. On the individual market --- that is, not insured through her job --- she would be uninsurable. that's not her fault, and that's how our health care system works now. Indeed, if she were to be insured on the private market, and her insurance company found out later that she suffered from depression in the past and didn't disclose it, they could summarily rescind her insurance coverage. PBS's Frontline had an excellent episode about the way our healthcare system works. In it, the CEO of CIGNA --- one of the biggest insurers in the country --- said that his own company would not have offered him insurance on the private market because he'd had open-heart surgery. Are either of these issues their fault? Or is it a fundamental flaw in the way our insurance model works?
And to your point re personal responsibility: the people most likely to be overweight and to smoke are the people least likely to have insurance. You know, poor people. You don't really think that's a coincidence, do you?
should i really care if they're poor? should i care about what their company's insurance (or lack thereof) company is doing? it's not my problem, nor is it yours. but what i do care about is where my tax payer dollars go.
you're speaking on a small segment of the population who actually deserve the help. why change the ENTIRE system for the minority? like i said, most people's ailments are self-inflicted. most sick people aren't suffering from things that are hereditary, genetic and similar type instances. people don't eat right, people aren't active, smoke, drink, have sex without protection, ect. 3/4 of the US population is overweight, and the overwhelming majority of it has absolutely nothing to do with a thyroid. if they're having heart problems, is it my problem? no. they shouldn't have been double fisting the over sized turkey legs and that 12 oz of coors light.
Swiv when have you ever been allowed to dictate where your tax money goes? Just asking....
not me personally. but just because i don't get to say, doesn't mean i have to like it.
i don't have a problem with health care reform, i have a problem with a public option.
For me, this is nothing new. I've been advocating a similar plan for months. But do they listen to me? Nah. Seriously, this has been my same proposal, although yours has more emphasis on the sliding scale payment.
Lemme slow it down for you, since you're missing both the nuance and the big picture from your high horse. The whole economic argument for expanding health care coverage is that you're paying money to cover the uninsured, anyway.Do you think the uninsured don't go to the doctor? Of course they do. But since they can't pay for those treatments anyway, the hospitals pass those costs off to the paying customers --- that is, insurance companies --- who pass it off to their customers, which is why healthcare premiums have skyrocketed.
Think of it as 10 people going out to dinner at a restaurant and 3 of the people don't have the money to pay. The bill's going to have to get covered somehow, so the people who do have the means to pay are going to pay more out of their pocket than they would if everybody paid. So the more people who are uninsured, the more money the insured have to pay for their insurance, which also means employers spend money on insuring their workers that is not going to wages, which means the amount of money that comes out of your check each week is less than it would be. We are all poorer, in a real, pecuniary sense, because of this. And this is a vicious cycle: the more it costs to insure people, the less likely employers are going to keep doing so, which means more uninsured people, which means higher premiums for the insured. Come on, fam. Even if we're using your selfish, fuck-them-what-about-me argument, it's still better for us individually for the most possible people to be insured.
If you're not going to insure everyone --- which is what you're advocating --- to you need to invest in some kind of preventive care so that when uninsured people do go to the hospital they're getting treated when they feel "kinda sick" and not when they have full-blown pneumonia, which besides the obvious health implications, is way more expensive to treat than a nagging cough. The same goes for obesity-related illnesses. You can argue that people put themselves in those situations by making decisions that lead to obesity in the first place (I wouldn't, because of the obvious structural factors that contribute to personal health) but then you're still not dealing with the fact that we're still going to come out of our pockets to pay for their ill health.
Also, the public option, which you keep deriding, isn't funded by tax dollars. It would be funded by customers' premiums, like any other insurance provider.
I'm starting to think that y'all moralists like to make your tired little arguments ("it's all about personal responsibility!") either in the worst possible faith or because it's easier for you to deal in vague abstraction instead of actually learning about the nuts and bolts about whatever it is your talking about. But even then, your argument is essentially, "they're fat and poor and deserve to be sick and die." Do better.
hmmm, interesting. it's not the public option that's going to drive up our deficit, it's this entire bill.
over 1 trillion dollars over the next 10 years.
according to the CBO, only about 6 million people would actually take part in this plan. in addition, this plan would also charge higher premiums because it's start up costs. and the only people who are eligible for this option are people who are able to buy into the "health care exchange." so are the people who "need to be insured" really going to be insured? considering that the uninsured may be paying penalties because they're uninsured. if they can't afford insurance now, how are they going to afford public insurance? because from what i've read, the insurance premiums that the government will charge may be higher than that of private insurance companies. so in order for them to get into plan, will they receive money to buy into this plan? where do they get the money from? or do they get into it at all? because if they can't pay the premiums, they won't be insured......public or otherwise.
people want to ignore personal responsibility because they want government hand outs to fund their irresponsible lifestyles. people want to live any type of way, and want someone else to cover the consequences of their actions. as if somehow, it's someone else's fault that they've lost in life. how about you ask them to do better, and maybe we wouldn't be in this predicament. but asking them to do better is probably too much for bleeding hearts, because they're feelings will get hurt and they'll make excuses as to why they can't actually BE better.
A component to health reform has to be personal responsibility. I don't know how we can legislate that though. Right now, I believe my MS would be much worse if I didn't adopt an austere diet that completely excludes gluten, dairy, many types of vegetables, legumes, food additives, alcohol, etc. No doctor told me to pursue this course. I bought the books and did the research on my own. I stopped a $2,000 a month drug program--covered by my insurance--that my neurologist had me on because I knew this would cause harm to my body. Most people only depend upon doctors and will not take charge of their own lives, which includes eating healthy and appropriate foods. Unfortunately, there will be a lot of people refusing to adopt healthy lifestyles and they will place burdens on the system, and I don't know how we deal with that.
swiv:
No one wants to talk about personal responsibility and how changing ones lifestyle can improve your health without the need for gov't taking over health care.
Personal Responisblity is one that NO ONE can plan for or try to adapt..
Sticking with the current Status Quo isnt going to work either...Medicare /Social Security runs out of money/funding in 2017 if not before....So the SYSTEM has to be corrected to continue coverage for those on it and those looking to be on it in the Future...
As a patient advocate I have seen families TRY and llive off of Medicare/Medicaid alone and it is not enough along as the got keep contracting with PRIVATE run Health companines...Diabetes plagues almost 37% of the US population but insulin is still the major treatment but it is one of the highest costing medications around...Novolog.Novolin rnns about 130, Humalog (Lilly) runs about 90, Lantus and Apidra almost 175....wheres the savings?
All Premiums have increased by 20-55% this year add up your co-pays for the medications and it could cost a retiree almost 300 a month just for medications alone! Try living off of 900 a month with 300 going towards meds..Not happening even with a partner/roomate!
Astarr:
How many of the folks that are diabetics would not be if they weren't obese to begin with?
Frankly, I don't how we're going to stop people from abusing food, drugs, tobacco, alcohol, etc. Providing money to a problem is only going to help but so far.
Ms Blue
I am a big believer in the public option. The cost structure is currently so high and going to continue on that track until the government is forced to pay for everyone going to the ER because they can't afford healthcare insurance. So we need to take over the system now, decide on a basic program of preventive of care and execute it. Except for the costs of being unable to let a loved one die they will all come down, IMO.
That said your suggestion that everyone be move unto Medicaid, contibute a little more to pay for it and charge by income is a very good alternative. Thank you.
well why aare lyou all ignoring the fact that healthcare has been monopolised.
~Yes, there is a medical monopoly and what ever the system you have is always going to suiit big pharma. I will give you a link to the medical monopoly expose.
http://www.youtube.com/watch?v=8J4JLT05siM&feature=PlayList&p=1F8C759ADE2DB8C9&index=0&playnext=1
The problem is not medical care, although it is. the problem is the constitution, because there is a provision for every american to sign waway their civil rights, if they want the government to look after them. If the state get biggger, the Americans will cease to be citizens of their various states but of a corporation called The United States based in the Washington D.C, area.
Most Americans seem to be unaware that the constitution of America is written to be fragile, it can go to a dictatorship if the people wish to have it that way.
Of course Obama does not care aboutthe constitution, he would not be a socialist otherwise. The Irony of his position is that as a Liberation theologists he claims that black people are oppressed by white people, but have you noticed how many white people voted for him?