6 ms·

Cheaper, and more terrible. Medicaid is not something anybody wants and in many ways is worse than the ER as a measure of last resort for acquiring care. Medic

by sidlls 9y ago

Cheaper, and more terrible. Medicaid is not something anybody wants and in many ways is worse than the ER as a measure of last resort for acquiring care. Medicare on the other hand is much better, though still not all that great (it's better than private insurance in many if not most cases). It is universal coverage for folks over a certain age in this country. There aren't any good reasons I've seen to not lower that age to 0 (i.e. covered from birth).

jonknee 9y ago
> Medicaid is not something anybody wants Tell that to the people in states with Republican governors who won't expand Medicaid to cover them... > in many ways is worse than the ER as a measure of last resort for acquiring care What are you talking about? If you are in an emergency and on Medicaid you can go to the ER[1]. ERs give great care, they are just expensive. Medicaid is not expensive, so if their patients are getting ER quality care that is an amazing deal. [1] https://www.medicaid.gov/medicaid/cost-sharing/out-of-pocket-costs/index.html https://www.medicaid.gov/medicaid/cost-sharing/out-of-pocket... Not only can you go, you won't be charged unlike almost all private insurance plans. > Out of pocket costs cannot be imposed for emergency services, family planning services, pregnancy-related services, or preventive services for children.
- zanny 9y ago
  The partial medicaid expansion coverage of the ACA isn't actually putting people on medicaid, it is subsidizing private insurance at a percentage of cost. If you hit 100% of the ACA subsidy you are in medicaid territory, if you are up to 4x poverty you get a diminishing % of your insurance bill paid by the state. My Dad has a $750/month plan but only pays $150 because of the medicaid subsidy in PA from the ACA for his income bracket.
  - jonknee 9y ago
    How it works depends on the state because a lot of Republican governors wanted to stick it to Obama and poor people by not expanding Medicaid as intended under the ACA. That said, the Medicaid expansion definitely puts people on Medicaid! That's a big part of the reason why it's politically suicidal to repeal the ACA. http://www.kff.org/medicaid/issue-brief/what-coverage-and-financing-at-risk-under-repeal-of-aca-medicaid-expansion/ http://www.kff.org/medicaid/issue-brief/what-coverage-and-fi... > Between Summer 2013, just prior to the ACA, and September 2016, there was a net increase in Medicaid and CHIP enrollment of 15.7 million people.
the_mitsuhiko 9y ago
> Cheaper, and more terrible. Medicaid is not something anybody wants and in many ways is worse than the ER as a measure of last resort for acquiring care. So here is what I do not understand. Why does the US not do what many European nations do and split healthcare into two problems? You have a few large insurance pools (single payer for lack of a better term) that is government run, mandatory participation and that covers emergency care and basic health services. And then separately to that you run a free market private healthcare system that sits on top of that governmental system and covers the better care? It's absurd that insurance companies in the US pay for everything. The cost do not add up for me as a customer. I do want choice in the non life threatening cases but I sure as hell do not want to ever have money concerns when it's really critical.
- fatbird 9y ago
  The problem in the U.S. isn't that costs are hidden--in Canada, with fully socialized insurance, health care consumers are actually much less wasteful of resources because they pursue health care in the degree they feel they need it, irrespective of money. Some are constant complainers craving attention, some are tough-as-nails cowboys who don't need a doctor to pull the bullet out; overall, Canadians are pretty reasonable about their as-needed consumption, as demonstrated by per-capita health care spending. The problem in the U.S. is that health care costs are directly tied to your employer, mostly, because the employer is the cost-savings insurance pool you join. This creates a lot of terrible situations where people are stuck in jobs they can't afford to leave for medical reasons; or are stuck with medical problems that prevent them from getting hired. What was originally supposed to be a social contract where you work hard to have a good career, and your boss takes care of the ugly bits of life like cancer, has turned into a tight coupling of disjoint life issues that usually creates the worst possible outcome in both cases. Medicaid is terrible largely because it's legislatively hobbled to prevent it exercising market power (like negotiating bulk pricing for pharmaceuticals, because doing so would embarrass capitalism somehow), and otherwise regulation driven for political purposes, like capping payments for procedures at below market rates, causing them to be excluded from a large number of health care providers who don't need to submit to price controls. The U.S. health care system is like a graduate thesis in perverse incentives.
dragonwriter 9y ago
> Medicaid is not something anybody wants and in many ways is worse than the ER as a measure of last resort for acquiring care. Medicaid is almost entirely state run and varies radically from state to state, but in all cases subsumes and goes beyond ER care, so in no way is it "worse than the ER". > Medicare on the other hand is much better, though still not all that great (it's better than private insurance in many if not most cases). Basic Medicare is worse than private insurance (and even, in some ways, most state Medicaid plans) in a number of ways (especially in the way that it is segmented, particularly the separate prescription drug portion), and deliberately kept worse to promote publicly-subsidized, privately-run (often for-profit) “Medicare Advantage” plans, which (unlike basic Medicare) are comprehensive and integrated, rather than segmented.
deleted 9y ago
[deleted]
opo 9y ago
>...There aren't any good reasons I've seen to not lower that age to 0 (i.e. covered from birth). It isn’t that simple. Medicare saves lots of money because of their lower reimbursement rates and many of the smaller medical practices near me won’t accept any more medicare patients. Even with that, the Part A trust fund (covers hospital costs) is expected to be completely depleted in roughly 10 years.

by sidlls 9y ago

jonknee 9y ago

> Medicaid is not something anybody wants Tell that to the people in states with Republican governors who won't expand Medicaid to cover them... > in many ways is worse than the ER as a measure of last resort for acquiring care What are you talking about? If you are in an emergency and on Medicaid you can go to the ER[1]. ERs give great care, they are just expensive. Medicaid is not expensive, so if their patients are getting ER quality care that is an amazing deal. [1] https://www.medicaid.gov/medicaid/cost-sharing/out-of-pocket-costs/index.html https://www.medicaid.gov/medicaid/cost-sharing/out-of-pocket... Not only can you go, you won't be charged unlike almost all private insurance plans. > Out of pocket costs cannot be imposed for emergency services, family planning services, pregnancy-related services, or preventive services for children.

zanny 9y ago
The partial medicaid expansion coverage of the ACA isn't actually putting people on medicaid, it is subsidizing private insurance at a percentage of cost. If you hit 100% of the ACA subsidy you are in medicaid territory, if you are up to 4x poverty you get a diminishing % of your insurance bill paid by the state. My Dad has a $750/month plan but only pays $150 because of the medicaid subsidy in PA from the ACA for his income bracket.
- jonknee 9y ago
  How it works depends on the state because a lot of Republican governors wanted to stick it to Obama and poor people by not expanding Medicaid as intended under the ACA. That said, the Medicaid expansion definitely puts people on Medicaid! That's a big part of the reason why it's politically suicidal to repeal the ACA. http://www.kff.org/medicaid/issue-brief/what-coverage-and-financing-at-risk-under-repeal-of-aca-medicaid-expansion/ http://www.kff.org/medicaid/issue-brief/what-coverage-and-fi... > Between Summer 2013, just prior to the ACA, and September 2016, there was a net increase in Medicaid and CHIP enrollment of 15.7 million people.

the_mitsuhiko 9y ago

> Cheaper, and more terrible. Medicaid is not something anybody wants and in many ways is worse than the ER as a measure of last resort for acquiring care. So here is what I do not understand. Why does the US not do what many European nations do and split healthcare into two problems? You have a few large insurance pools (single payer for lack of a better term) that is government run, mandatory participation and that covers emergency care and basic health services. And then separately to that you run a free market private healthcare system that sits on top of that governmental system and covers the better care? It's absurd that insurance companies in the US pay for everything. The cost do not add up for me as a customer. I do want choice in the non life threatening cases but I sure as hell do not want to ever have money concerns when it's really critical.

fatbird 9y ago
The problem in the U.S. isn't that costs are hidden--in Canada, with fully socialized insurance, health care consumers are actually much less wasteful of resources because they pursue health care in the degree they feel they need it, irrespective of money. Some are constant complainers craving attention, some are tough-as-nails cowboys who don't need a doctor to pull the bullet out; overall, Canadians are pretty reasonable about their as-needed consumption, as demonstrated by per-capita health care spending. The problem in the U.S. is that health care costs are directly tied to your employer, mostly, because the employer is the cost-savings insurance pool you join. This creates a lot of terrible situations where people are stuck in jobs they can't afford to leave for medical reasons; or are stuck with medical problems that prevent them from getting hired. What was originally supposed to be a social contract where you work hard to have a good career, and your boss takes care of the ugly bits of life like cancer, has turned into a tight coupling of disjoint life issues that usually creates the worst possible outcome in both cases. Medicaid is terrible largely because it's legislatively hobbled to prevent it exercising market power (like negotiating bulk pricing for pharmaceuticals, because doing so would embarrass capitalism somehow), and otherwise regulation driven for political purposes, like capping payments for procedures at below market rates, causing them to be excluded from a large number of health care providers who don't need to submit to price controls. The U.S. health care system is like a graduate thesis in perverse incentives.

dragonwriter 9y ago

> Medicaid is not something anybody wants and in many ways is worse than the ER as a measure of last resort for acquiring care. Medicaid is almost entirely state run and varies radically from state to state, but in all cases subsumes and goes beyond ER care, so in no way is it "worse than the ER". > Medicare on the other hand is much better, though still not all that great (it's better than private insurance in many if not most cases). Basic Medicare is worse than private insurance (and even, in some ways, most state Medicaid plans) in a number of ways (especially in the way that it is segmented, particularly the separate prescription drug portion), and deliberately kept worse to promote publicly-subsidized, privately-run (often for-profit) “Medicare Advantage” plans, which (unlike basic Medicare) are comprehensive and integrated, rather than segmented.

deleted 9y ago

[deleted]

opo 9y ago

>...There aren't any good reasons I've seen to not lower that age to 0 (i.e. covered from birth). It isn’t that simple. Medicare saves lots of money because of their lower reimbursement rates and many of the smaller medical practices near me won’t accept any more medicare patients. Even with that, the Part A trust fund (covers hospital costs) is expected to be completely depleted in roughly 10 years.