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kirkydu (93.89)

We should all be Nebraskans

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December 26, 2009 – Comments (14) | RELATED TICKERS: HUM , AET

With the healthcare plan getting through the Senate, the somewhat good but clearly flawed plan heads for committee.  Here's what we should all hope.  That the whole nation gets the same deal as Nebraska.

For those not paying attention, Nebraska's sweet deal (or maybe suite deal, I don't know where they were when they cut it) basically covers all of Nebraska's increase in Medicaid expenses going forward.  At the moment, Senators Lindsey Graham and Jim DeMint of South Carolina, among others, are crying foul at the deal. 

Now, I'm not going to get too into the rhetoric of it all or even the politics, but for Graham and DeMint to cry about this is so over the top it's funny.  I have read the Congressional record from time to time.  Those two guys are the last ones, well at least in well populated Congressional company, to complain about getting deals for their state.  To try to rile people up with bogus Constitutional issues- I asked a Constitutional law professor I know and he laughed- is so blatant I can only marvel at how warped politics (not just them, because I think fully 3/4 of pols are warped) is an act of grandstanding that is funny to those not glomming onto their dysfunctional proclamations (I was going to say retarded but I didn't think that I should drag the challenged down to the level of politicians). 

In any case, here's why we should all be Nebraskans.  In the not too distant future, 2010 most likely, there are going to be a lot of states teetering even nearer to insolvency.  Unlike California, most of those states are going to have massive problems refinancing their debts.  Instead of the Federal gov'ment helping them then, the Feds ought to simply cover the cost of Medicaid nationally.  Completely take that cost off the books of the states, as the program was originally intended. 

Now, we can debate whether this healthcare plan should be done or not (I'll take the yes side, see my previous blog), or we can solve a couple huge problems.  The first problem we can solve is getting low income people health insurance that keeps them out of the ER (the uninsured using ERs is BY FAR the largest aggregate cost inflator in the health system), that is by further opening up Medicaid based on a sliding scale program (like what is in the healthcare plan).  Next, we can alleviate the need for small employers to provide healthcare until they have moved a little further up the "S" curve (like the current healthcare plan does with its opening up of Medicaid and banning underwriting discrimination which is antithesis to risk pooling anyway), which will make them much more competitive and able to hire.  [Fool's Brian Orelli touches on the risk pooling a bit yesterday and how it will lower costs.] Finally, we can help all the states with their budgets, without discrimination against states minding their business well (all 4 or 5 of them) by putting Medicaid on the Federal dime where it belongs. 

Here's to Nebraska and a great idea.

14 Comments – Post Your Own

#1) On December 26, 2009 at 7:34 AM, dbjella (< 20) wrote:

What do you thing about having the Federal Reserve print more money and  give it to the states?  We can take the Federal Gov't right out of the Medicaid funding process.   Then the states can expand their programs more to cover everything they need.

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#2) On December 26, 2009 at 7:35 AM, dbjella (< 20) wrote:

thing = think

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#3) On December 26, 2009 at 9:54 AM, IIcx (< 20) wrote:

Big No from me.

As currently written, it doesn't appear to reform anything and may contain a provision that, if passed, will not allow it to be amended or repealed in the future. If it was any good, why would that provision need to be in the Bill?

I did read this and your previous blog. You make some excellent points.

Related to the previous blog, Public Service Educational Loan Forgiveness for Medical students along will funding for Hospital run Clinics might overcome the concern about attracting talent to NFP clinics.

I also really like the idea of funding more clinics for the uninsured rather than giving the money or credit to the uninsured. 

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#4) On December 26, 2009 at 10:33 AM, davejh23 (< 20) wrote:

"I asked a Constitutional law professor I know and he laughed..."

Maybe he laughed because the Constitution doesn't grant Congress the authority to do 90% of the things they've done in the past.

I do agree with some of your ideas for reforming healthcare...it just seems that the current plan will either lead to a complete government takeover of healthcare, or it will increase the cost of private insurance much faster than costs have been rising to date.  I also like the idea of funding clinics for the uninsured...many such clinics that didn't receive gov't funding were put out of business by malpractice claims or threats...with appropriate malpractice reform, clinics like this would probably start popping up again even without federal funding.  I'm afraid that incomplete reform now will lead to complacency and no real reform will get done until it's too late.

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#5) On December 26, 2009 at 12:11 PM, kirkydu (93.89) wrote:

While I am no fan of gov'ment meddling in general, the fact is we got it and there is still no will to slow it down.  While we, and indeed I, voted for "change" I am not so sure I like exactly where things are changing to.  That doesn't mean I don't want change, but I, like many before me, am finally turning cynical.  While I like President Obama, I can not muster enough criticism to say what I actually feel about our pathetic Congress today, and the previous ones back to the 1980s which is about as far as I remember.  I simply pray (yeah, moderate libs do that, especially the Catholic ones) for term limits.

So, I try to figure out what things gov'ment can do to help the golden goose rather than kill it.  With regard to healthcare reform, in my mind the number one issue is get people out of the ERs who shouldn't be there.  I am not sure why that isn't front and center in the debate- I take that back, I am sure, it's because it is a basic issue that could be fixed pretty easily with a minor expansion of Medicaid, underwriting rules (eliminate pre-existing exclusions) and the clinics one fool discussed, and gov'ment doesn't do anything easily when they can make a big show of it.

Issue two is help businesses with healthcare expenses so they can hire more and expand.  I am no fan of direct subsidy to business as the money usually doesn't find its way to where it was intended, but helping reduce an expense such as healthcare makes a lot of sense in my economist mind.

As for first comment by dbjella, which I presume was a modest attempt at satire and smartassery, no, I don't think we should just print more money.  But, putting Medicaid on the Federal dime would alleviate a lot of budget pressure for states, which otherwise are going to have to be bailed out soon.  Since we ARE going to expand Medicaid and have subsidies for private coverage, thereby alleviating a major strain on small business, which we need to pick up desperately, helping the states without giving them money to burn makes sense to me (again, relief v giving cash).  Maybe we could cut our military commitments by 5% to 10% to pay for the whole healthcare issue in this country.  Then again, we like our wars, so maybe not.

davejh23 you said "the Constitution doesn't grant Congress the authority to do 90% of the things they've done in the past."  I don't even know what to say, you might be right, you may be wrong, but why bother?  Re healthcare, malpractice litigation just isn't that big of a deal, it's about 5% of healthcare costs.  The last round of tort reform was pretty good.  Is there a little more to do?  Sure, but the numbers scream tweak, not overhaul.

llcx, turn off the huckster trio Hannity, Beck and Limpbaugh.  Understand that although imperfect, the plan going through is better than doing nothing.  Hopefully they tweak it over the next few years to make it better.  The item you demagogue doesn't prevent that.

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#6) On December 26, 2009 at 2:43 PM, ikkyu2 (99.38) wrote:

Medicaid is garbage.  No decent doctor wants to take Medicaid; to make a profit off Medicaid patients you have to double book 40 patients a day for 5 minute visits, and schedule them for all manner of bogus procedures; and you could make more money in that time seeing Medicare or insured patients.  

So who takes that job?  The doc who couldn't get any other job.  We talk about supply-side pressures in medicine; this is the real supply side problem, Medicaid basically enforces subpar medical care for poor people.  Often they'd be better off with no doctor.

Expanding Medicaid would be a dumb idea, except that as you point out, states borrow against their future Medicaid payments as a way of expanding state spending today at the cost of depleting their general fund tomorrow, knowing the Feds will have to make up the slack.  States' righters need to take some time to pore over these money transfers, which show that the Federal government is propping up the general fund of most states to the tune of hundreds of billions a year, and has been doing so since the mid-90's.

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#7) On December 26, 2009 at 2:50 PM, Teacherman1 (62.19) wrote:

Kirkydu  Just for the record, "retarded" is no longer the proper term to refer to those who have IQs lower than a certain percentage. The proper term is "developmentally challenged".

So you can use that term to refer to politicians without dragging special needs people down to their level.

I am a Special Education teacher.

As for the rest of your post, good points, but I am getting out of the mood to discuss the dysfunctionality of congress. When something is blatantly obvious, it simply belabors the point.

Pork is King, and after all, it is someone else's money, so what does it matter to them how much of it they grab as long as it gets them re-elected.

Hope everyone had a nice Christmas and good luck in the coming year.

 

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#8) On December 26, 2009 at 3:19 PM, IIcx (< 20) wrote:

To be honest, I'm not a conservative and had to look up the first 2 names up to see who you were referring to. I guess I should be more aware of the conservative side but simply haven't had the time which isn't a good excuse.

No, I don't think that selling out to the interest groups to simply get anything on the table after decades of debate is justified. The idea of doing it behind closed doors and then without debate or the opportunity to amend it before a biased vote makes the process a complete hoax.

But, I'm trying to keep an open mind and understand why it was passed when the president's own advisors said it will put 1 in 10 hospitals out of business and the system isn't capable of supporting the increased demand. Demand that is likely to be rejected by most providers. I heard these statements on c-span as I watched the Senate debate -- if you could call it that.

The concern about the inability to amend or repeal the Bill is from this cut. What am I missing?

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#9) On December 27, 2009 at 3:07 PM, oldfashionedway (35.56) wrote:

I seriously doubt that any legislator who voted on this bill actually knows what in the world is in it.  They were told to vote yea (or nay) by their cronies, and promptly rewarded for their obedience with the taxpayers 'dime'.

This is a twenty-first century version of the Trojan Horse.  Who knows what this monstrosity is going to unleash on the unsuspecting citizenry of this once great nation.  But they must hurry up and get 'er done, before the opportunity passes, and the masses realize that they have elected politicians who are mortgaging their future and bankrupting their nation.

Granted, DeMint and Graham crying foul is simply a case of the 'pot calling the kettle black'.  Unfortunately, a Federally 'funded' mandate is not much better than an 'unfunded' one with regard to trampling on individuals' and states' rights.

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#10) On December 28, 2009 at 9:33 PM, IIcx (< 20) wrote:

The more I research and discover in this legislation, the more I'm convinced Congress is treating the American People like we are "Chumps".

This Bill must be debated openly and needs our support or it will fall before it gets a chance.

We need reform but this is crap. 

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#11) On December 28, 2009 at 10:01 PM, IIcx (< 20) wrote:

What am I missing kirkydu? 

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#12) On December 29, 2009 at 5:26 PM, kirkydu (93.89) wrote:

llcx, like I said, this is a first step bill that addresses ER overpayments by getting people covered and insurance company skimming.  It very clearly needs to be improved overtime.  Hopefully by 2014 they clean it up. 

I have my doubts too, but doing something half way was better than doing nothing given that doing nothing was actually more expensive- a point most people miss because they don't know, nor bother to read up on, the massive amounts we spend on passing on costs due 15% or so of the population ending up in ERs instead of primary care.

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#13) On December 29, 2009 at 5:41 PM, kirkydu (93.89) wrote:

re high cost of ER care, about $100b per year for uninsured:

http://www.fixourhealthcare.ca.gov/index.php/facts/more/6771/

http://www3.acep.org/patients.aspx?id=25932

http://www.huffingtonpost.com/marilyn-barrett/the-us-universal-health-c_b_171010.html

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijeicm/vol6n1/trauma.xml

http://www.politifact.com/truth-o-meter/statements/2009/sep/20/barack-obama/uninsured-cost-shifting-debated-experts/

 

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#14) On December 30, 2009 at 12:26 PM, IIcx (< 20) wrote:

Thanks for the links kirkydu  

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