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IMHO, health care in the United States is used as a job project, to provide jobs for all the people who used to build stuff. When I was a taxi driver, one of m

IMHO, health care in the United States is used as a job project, to provide jobs for all the people who used to build stuff. When I was a taxi driver, one of my jobs was to take poor people to their medical appointments. The taxi company I used to drive for has reformed itself around its contracts with the various insurance companies. I never got a number for how much the government paid to get people to their appointments, but I imagine it was on the order of $2/mile (the driver got $1.50/mile, iirc). Some of the people I took to their appointments certainly had transportation charges that were higher than the fee paid to the service providers -- say $100/round trip for transportation, vs. $30 for the counseling session or doctor's appointment...

debatem1 7y ago
Why was the government paying a contract between an insurance company and a taxi company?
- vharuck 7y ago
  State governments typically plan activities by connecting private sector groups and greasing the wheels. A lot of money goes to encouraging regular checkups or screenings, but people are less likely to go if they need to take a bus: routes and schedules mean they need to take off more work, and it's easy to just skip and do one of the million other things that need done now (even just unwinding). But a taxi who comes to you is convenient and hard to say "No" to.
  - kbenson 7y ago
    So is the claim here that the state is paying for the rides to the checkups? The comment even indicates that the taxi companies structures themselves around the insurance company contracts, which unless the state is paying insurers, doesn't seem to have the state in the loop. I'm confused how the state is supposed to be in this too.
    - InvaderFizz 7y ago
      I'm not sure how the insurance fits in, but you can see where this would fit in with state/federal payments if you look into Medicare NEMT. Here is one such example: https://www.npr.org/sections/health-shots/2018/01/27/581055275/no-car-no-care-medicaid-transport-program-faces-cuts-in-some-states https://www.npr.org/sections/health-shots/2018/01/27/5810552...
    - taxicabjesus 7y ago
      Medicaid is the United States' program for providing health care to poor people. Medicare (for people 65 years and older) is administered by the federal government, while Medicaid is separately administered by each state. "In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly." - https://en.wikipedia.org/wiki/Medicaid#State_implementations https://en.wikipedia.org/wiki/Medicaid#State_implementations Arizona is a subcontracting state. The state government pays insurance companies to manage the services provided under the Medicaid program; the insurance companies pay the transportation companies to get people to their appointments. > The comment even indicates that the taxi companies structures themselves around the insurance company contracts It started out as a taxi company... Then "transportation vouchers" came along, so businesses could get people where they needed to go without having to give people cash for taxi fares. Over the decades vouchers became a larger and larger part of the taxi company's business. Paper vouchers for drivers became electronic vouchers; pickups and dropoffs are scheduled electronically. When the Apps came along the taxi company's business of leasing taxis mostly evaporated, so the company got rid of its taxi fleet and now focuses on its transportation contracts ("vouchers"). > I'm confused how the state is supposed to be in this too. In the comment above I mixed up who pays for what, but ultimately the transportation funds come from the state government and federal government, filtered through the state's subcontracted insurance company.
      - debatem1 7y ago
        The reason I asked is because this reads as an indictment of government waste, when actually it was a private company which paid (and presumably selected) transportation vendors. Interestingly, Arizona seems to have recently changed the rules around that to allow Lyft to service these customers. Personally I find the idea of financing transport for Medicaid patients on the back of IPO funny money a darkly humorous take on the capital gains tax.

debatem1 7y ago

Why was the government paying a contract between an insurance company and a taxi company?

vharuck 7y ago
State governments typically plan activities by connecting private sector groups and greasing the wheels. A lot of money goes to encouraging regular checkups or screenings, but people are less likely to go if they need to take a bus: routes and schedules mean they need to take off more work, and it's easy to just skip and do one of the million other things that need done now (even just unwinding). But a taxi who comes to you is convenient and hard to say "No" to.
- kbenson 7y ago
  So is the claim here that the state is paying for the rides to the checkups? The comment even indicates that the taxi companies structures themselves around the insurance company contracts, which unless the state is paying insurers, doesn't seem to have the state in the loop. I'm confused how the state is supposed to be in this too.
  - InvaderFizz 7y ago
    I'm not sure how the insurance fits in, but you can see where this would fit in with state/federal payments if you look into Medicare NEMT. Here is one such example: https://www.npr.org/sections/health-shots/2018/01/27/581055275/no-car-no-care-medicaid-transport-program-faces-cuts-in-some-states https://www.npr.org/sections/health-shots/2018/01/27/5810552...
  - taxicabjesus 7y ago
    Medicaid is the United States' program for providing health care to poor people. Medicare (for people 65 years and older) is administered by the federal government, while Medicaid is separately administered by each state. "In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly." - https://en.wikipedia.org/wiki/Medicaid#State_implementations https://en.wikipedia.org/wiki/Medicaid#State_implementations Arizona is a subcontracting state. The state government pays insurance companies to manage the services provided under the Medicaid program; the insurance companies pay the transportation companies to get people to their appointments. > The comment even indicates that the taxi companies structures themselves around the insurance company contracts It started out as a taxi company... Then "transportation vouchers" came along, so businesses could get people where they needed to go without having to give people cash for taxi fares. Over the decades vouchers became a larger and larger part of the taxi company's business. Paper vouchers for drivers became electronic vouchers; pickups and dropoffs are scheduled electronically. When the Apps came along the taxi company's business of leasing taxis mostly evaporated, so the company got rid of its taxi fleet and now focuses on its transportation contracts ("vouchers"). > I'm confused how the state is supposed to be in this too. In the comment above I mixed up who pays for what, but ultimately the transportation funds come from the state government and federal government, filtered through the state's subcontracted insurance company.
    - debatem1 7y ago
      The reason I asked is because this reads as an indictment of government waste, when actually it was a private company which paid (and presumably selected) transportation vendors. Interestingly, Arizona seems to have recently changed the rules around that to allow Lyft to service these customers. Personally I find the idea of financing transport for Medicaid patients on the back of IPO funny money a darkly humorous take on the capital gains tax.