Another article that doesn't mention how much these programs cost - how the costs are exploding every year and taking more and more of state and federal budgets.
Of course people are going to approve of these programs, they think they're free.
Once again Dems have a policy problem, Reps help ease with their lousy messaging. Medicaid and Obamacare are popular, because they are free or heavily subsidized. If DC handed out free cars based on income, those cars would also be popular.
Increasingly, healthcare is a game of 3 card monty, with vast costs being moved around the table in a manner that precludes Americans from knowing what their healthcare actually costs. The system appears to purposefully camouflage costs, so Americans have no idea what part of their payments provide their own healthcare, and what part provides healthcare for someone else, paying nothing. When people need an oil change, they can call 3 businesses and know the least expensive. That is not possible for most routine healthcare.
Moreover, imagine the cost of oil changes, if they were free for 1/3 of drivers, and the remaining 2/3rds had to cover their own oil changes, and the cost of the 1/3 who pay nothing. 40% of Californians and 36% New York residents, our 1rst and 4th most populace states, are enrolled in Medicaid.
In less the last 25 years, US Medicaid enrollment has more than doubled. In the not too distant future, Medicaid enrollment is expected to hit 100 million. There are only 335 million people in the US. If nearly 1/3 of the US pays nothing for healthcare, the other 2/3rds have to pay much more. It is simple Math.
The focus of American healthcare, as of late, has little to do with improving anyone's health. Most effort is directed at stealthily reallocating costs, as increasingly, large swaths of of people pay little to nothing, which means fewer Americans are left to pick up the ever increasing tab.
We have morphed from providing healthcare for truly needy Americans, to paying the healthcare of people simply good at manipulating their incomes and the world's needy, who have recently arrived in the US, unable to afford our expensive American healthcare system, no matter how hard they toil. The names of particular programs have increasingly little relevance. At the end of the day, all healthcare bills must be paid by someone.
All, as overall costs grow at an unsustainable clip, aided by the DC 3 card monty game. Problems must be quantified to be fixed. Both Dems and Reps understand the problem, they are simply loathe to admit it. Nor can it be corrected, without destroying much of the current system, while introducing competition and demanding absolutely everyone, but the truly neediest Americans, have some skin in the game.
I'm surprised the Republicans haven't revived a policy from Trump's first term, expanding short term health insurance contracts. These are health insurance plans that don't require all of the bells and whistles (and cost) in a typical Obamacare plan. They were also about 60% cheaper. This type of plan was always in Obamacare; Biden sharply restricted them. The interesting thing is they were expanded by executive order, which survived the courts. Yet the Trump administration has shown no interest in action.
One could dare to dream that it’s because he wants Congress to make them long term by adding the expansion to any deal. Low cost catastrophic coverage with a HSA is probably the best option for most people. Especially if we can get price transparency into the system.
I think healthcare is to many Republicans what border control is to many Democrats--voters by and large want the party to exhibit better stewardship over the issue, and too many in the party have instead brushed it aside, usually with bad reasoning. (i.e. "people who want any kind of border control at all are racist" or "people who want the government to do anything at all to improve the administration of health care are leeches/socialists/welfare queens/etc.")
Republicans may well have to be shellacked at the ballot box, like the Democrats were, before they realize voters don't like their concerns being brushed aside. And honestly, if both parties cooperated on getting Obamacare working as smoothly as possible, you could have what Mitt Romney successfully implemented in Massachussets, which is an unusually good compromise between state- and market-based healthcare solutions. (something which is hard to pull off, because health care and health insurance are the top items on that slim but important list of things markets oftentimes aren't terribly efficient at allocating)
If you want public healthcare you need to get serious about controlling the border including deportations from the interior of every non-citizen who uses any social services. Next you need to get the country on board with a massive broad based tax increase. Something along the lines of a 20-25% national VAT. Anything else is simply promising free stuff for votes with no regard to the long term consequences.
Amazingly enough, Bernie Sanders once said the same thing as you do here. He was asked if middle class Americans would have to pay similar amounts of taxes (percentage of gross income) as middle class Europeans do if the U.S. ever has a welfare state as generous as the European social democracies. To his great credit, Sanders said YES. Every other elected Democrat states or strongly implies otherwise, that just taxing "the rich" more can pay for such public generosity.
I don't think either party is really set up to deal with the issue.
Democrats make the out of pocket costs go away while allowing widespread crazy over charging. Republicans want to take health care away from the non rich. Eventually the government is going to have to take over. Already most of the money is coming from the government via taxes without any effective oversight.
Well, take the current conundrum. Huge tax breaks for the wealthy were offset by cuts to people who by definition aren't wealthy, medicaid and income based premium assistance to ACA enrollees. Not sure what else to call it, and the voters probably see it similarly, and without knowing the cuts are to the ACA and Medicaid, now every privately insured person who gets a premium increase at work will blame the GOP, and premiums do go up and employers do shift premiums to employees. Whatever the intent, the GOP will be blamed.
Rarely disagree, but I do not believe most Reps want to take healthcare away from anyone. They want all those able to contribute to do so, and everyone to have some skin in the game.
Per the WSJ, nearly 50% of Medicaid appointments are no shows, without cancellations, because there is no fee, for no shows. That means no one else can use that appointment. Walk in clinics would cure that problem, but Dems refuse, because asking Medicaid enrollees to wait in line at a clinic is demeaning and wasteful of the patient's time. So we continue a program where nearly 1/2 of all appointments are paid, but go unused. It is insanity, but any type of reform is deemed punitive by Dems.
Sorry, my disparaging remarks were perhaps an oversimplification.
I'm aware of the medicaid no shows, nurses hate them with a passion, they shuffle people all day trying to squeeze in patients to doctors that are booked out 2 months only to be left with a empty block of time due to a medicaid no show.
I've been to hospitals in the developing world that function as clinics. We also have large populations here that can't read or write. There's little harm from waiting an hour, there are chairs.
Those of us who do pay taxes will pay one way or another, and it's maybe time to work at making the system more efficiently and less profit driven. Profits paid for with taxes.
Hospitals and clinics lose money on Medicaid patients. The profits come from patients with good employer provided insurance.
I can certainly get on board with requiring insurance companies to operate like non-profits as opposed to publicly traded companies, but the lack of cost transparency in our current system is a major if not the largest driver of costs.
The WSJ ran an editorial a few months ago. Unless I misunderstood, nearly 1/2 of Medicaid appointments are paid by taxpayers, but no one sees a doctor. Because no one bothers to cancel in advance, the appointments are just wasted, because there is not time to fill the slot with someone on a wait list. That is mind blowing.
I do not want anyone taking care of a physically challenged kid to be charged $50 bucks when they can't make their Medicaid appointment last minute for a good reason, but neither am I thrilled about eating the cost of an unemployed 24 year old Medicaid enrolled gamer who misses an appointment ,because he is close to hitting a new high score on his video game. Surely there has to be a better way.
Here is the most salient political point for this issue of health care. A large percentage of Americans justifiably fears that if a serious medical event occurs in their families they will either: (a) Not receive necessary medical care, or (b) They will be financially ruined - medical bankruptcy - if they do receive necessary medical care.
If the private sector can't alleviate this fear - and by itself it can't - then people will demand that government do so. All political debate among realistic people - i.e. not including ideologues of any stripe - recognizes this reality. Just saying that government should get out of the health care space is a political non-starter. The big question is what is the most pragmatic way to achieve what a huge majority of Americans wants: necessary medical care for everyone without anyone being financially ruined.
Another article that doesn't mention how much these programs cost - how the costs are exploding every year and taking more and more of state and federal budgets.
Of course people are going to approve of these programs, they think they're free.
Perfectly on point.
Once again Dems have a policy problem, Reps help ease with their lousy messaging. Medicaid and Obamacare are popular, because they are free or heavily subsidized. If DC handed out free cars based on income, those cars would also be popular.
Increasingly, healthcare is a game of 3 card monty, with vast costs being moved around the table in a manner that precludes Americans from knowing what their healthcare actually costs. The system appears to purposefully camouflage costs, so Americans have no idea what part of their payments provide their own healthcare, and what part provides healthcare for someone else, paying nothing. When people need an oil change, they can call 3 businesses and know the least expensive. That is not possible for most routine healthcare.
Moreover, imagine the cost of oil changes, if they were free for 1/3 of drivers, and the remaining 2/3rds had to cover their own oil changes, and the cost of the 1/3 who pay nothing. 40% of Californians and 36% New York residents, our 1rst and 4th most populace states, are enrolled in Medicaid.
In less the last 25 years, US Medicaid enrollment has more than doubled. In the not too distant future, Medicaid enrollment is expected to hit 100 million. There are only 335 million people in the US. If nearly 1/3 of the US pays nothing for healthcare, the other 2/3rds have to pay much more. It is simple Math.
The focus of American healthcare, as of late, has little to do with improving anyone's health. Most effort is directed at stealthily reallocating costs, as increasingly, large swaths of of people pay little to nothing, which means fewer Americans are left to pick up the ever increasing tab.
We have morphed from providing healthcare for truly needy Americans, to paying the healthcare of people simply good at manipulating their incomes and the world's needy, who have recently arrived in the US, unable to afford our expensive American healthcare system, no matter how hard they toil. The names of particular programs have increasingly little relevance. At the end of the day, all healthcare bills must be paid by someone.
All, as overall costs grow at an unsustainable clip, aided by the DC 3 card monty game. Problems must be quantified to be fixed. Both Dems and Reps understand the problem, they are simply loathe to admit it. Nor can it be corrected, without destroying much of the current system, while introducing competition and demanding absolutely everyone, but the truly neediest Americans, have some skin in the game.
Ronda - could you please apply to be White House spokesperson for healthcare? It's insane how horrible the messaging is.
I'm surprised the Republicans haven't revived a policy from Trump's first term, expanding short term health insurance contracts. These are health insurance plans that don't require all of the bells and whistles (and cost) in a typical Obamacare plan. They were also about 60% cheaper. This type of plan was always in Obamacare; Biden sharply restricted them. The interesting thing is they were expanded by executive order, which survived the courts. Yet the Trump administration has shown no interest in action.
One could dare to dream that it’s because he wants Congress to make them long term by adding the expansion to any deal. Low cost catastrophic coverage with a HSA is probably the best option for most people. Especially if we can get price transparency into the system.
"He who robs Peter to pay Paul can always count on Paul's support."
---Unknown
I think healthcare is to many Republicans what border control is to many Democrats--voters by and large want the party to exhibit better stewardship over the issue, and too many in the party have instead brushed it aside, usually with bad reasoning. (i.e. "people who want any kind of border control at all are racist" or "people who want the government to do anything at all to improve the administration of health care are leeches/socialists/welfare queens/etc.")
Republicans may well have to be shellacked at the ballot box, like the Democrats were, before they realize voters don't like their concerns being brushed aside. And honestly, if both parties cooperated on getting Obamacare working as smoothly as possible, you could have what Mitt Romney successfully implemented in Massachussets, which is an unusually good compromise between state- and market-based healthcare solutions. (something which is hard to pull off, because health care and health insurance are the top items on that slim but important list of things markets oftentimes aren't terribly efficient at allocating)
If you want public healthcare you need to get serious about controlling the border including deportations from the interior of every non-citizen who uses any social services. Next you need to get the country on board with a massive broad based tax increase. Something along the lines of a 20-25% national VAT. Anything else is simply promising free stuff for votes with no regard to the long term consequences.
Amazingly enough, Bernie Sanders once said the same thing as you do here. He was asked if middle class Americans would have to pay similar amounts of taxes (percentage of gross income) as middle class Europeans do if the U.S. ever has a welfare state as generous as the European social democracies. To his great credit, Sanders said YES. Every other elected Democrat states or strongly implies otherwise, that just taxing "the rich" more can pay for such public generosity.
I don't think either party is really set up to deal with the issue.
Democrats make the out of pocket costs go away while allowing widespread crazy over charging. Republicans want to take health care away from the non rich. Eventually the government is going to have to take over. Already most of the money is coming from the government via taxes without any effective oversight.
"Republicans want to take health care away from the non rich."
Attributing evil intent to those you disagree with is always a losing argument.
Well, take the current conundrum. Huge tax breaks for the wealthy were offset by cuts to people who by definition aren't wealthy, medicaid and income based premium assistance to ACA enrollees. Not sure what else to call it, and the voters probably see it similarly, and without knowing the cuts are to the ACA and Medicaid, now every privately insured person who gets a premium increase at work will blame the GOP, and premiums do go up and employers do shift premiums to employees. Whatever the intent, the GOP will be blamed.
Rarely disagree, but I do not believe most Reps want to take healthcare away from anyone. They want all those able to contribute to do so, and everyone to have some skin in the game.
Per the WSJ, nearly 50% of Medicaid appointments are no shows, without cancellations, because there is no fee, for no shows. That means no one else can use that appointment. Walk in clinics would cure that problem, but Dems refuse, because asking Medicaid enrollees to wait in line at a clinic is demeaning and wasteful of the patient's time. So we continue a program where nearly 1/2 of all appointments are paid, but go unused. It is insanity, but any type of reform is deemed punitive by Dems.
Sorry, my disparaging remarks were perhaps an oversimplification.
I'm aware of the medicaid no shows, nurses hate them with a passion, they shuffle people all day trying to squeeze in patients to doctors that are booked out 2 months only to be left with a empty block of time due to a medicaid no show.
I've been to hospitals in the developing world that function as clinics. We also have large populations here that can't read or write. There's little harm from waiting an hour, there are chairs.
Those of us who do pay taxes will pay one way or another, and it's maybe time to work at making the system more efficiently and less profit driven. Profits paid for with taxes.
Hospitals and clinics lose money on Medicaid patients. The profits come from patients with good employer provided insurance.
I can certainly get on board with requiring insurance companies to operate like non-profits as opposed to publicly traded companies, but the lack of cost transparency in our current system is a major if not the largest driver of costs.
The WSJ ran an editorial a few months ago. Unless I misunderstood, nearly 1/2 of Medicaid appointments are paid by taxpayers, but no one sees a doctor. Because no one bothers to cancel in advance, the appointments are just wasted, because there is not time to fill the slot with someone on a wait list. That is mind blowing.
I do not want anyone taking care of a physically challenged kid to be charged $50 bucks when they can't make their Medicaid appointment last minute for a good reason, but neither am I thrilled about eating the cost of an unemployed 24 year old Medicaid enrolled gamer who misses an appointment ,because he is close to hitting a new high score on his video game. Surely there has to be a better way.
Here is the most salient political point for this issue of health care. A large percentage of Americans justifiably fears that if a serious medical event occurs in their families they will either: (a) Not receive necessary medical care, or (b) They will be financially ruined - medical bankruptcy - if they do receive necessary medical care.
If the private sector can't alleviate this fear - and by itself it can't - then people will demand that government do so. All political debate among realistic people - i.e. not including ideologues of any stripe - recognizes this reality. Just saying that government should get out of the health care space is a political non-starter. The big question is what is the most pragmatic way to achieve what a huge majority of Americans wants: necessary medical care for everyone without anyone being financially ruined.