The Medicare/Medicaid Fiasco
By Steve_in_KC on December 4, 2008 at 7:55 AM in Current Affairs, Health Care
This is the last of three installments in a series. The other two, Healthcare Programs Need Immunization and The Bad Old Days ran here on NQ within the last week or so. The opinions expressed here are strictly my own, drawn from my own experiences and research. If I got any facts wrong, feel free to correct me. I know… like you’d hesitate!
George W. Bush seems to have always had a thing for Medicare. I don’t know why he can’t seem to leave it alone. Sure, it needs fixing, along with Medicaid and Social Security. But it’s too important to people’s everyday lives to be monkeying around with it – and worse, using it as a tool to shovel government money into the insatiable mouths of insurance and pharmaceutical conglomerates.
I lay the blame for the problems described in this article completely on him. It was his doing. Just add it to his list of blunders.
Medicare began offering a Prescription Drug Benefit in early 2004, called Medicare Part D. GW Bush signed it into law in December of 2003. One month later, it was revealed that the bill would cost around $139 Billion more annually than White House estimates during Congressional debate on the program. There is evidence that this budget discrepancy was deliberately hidden, in order to get the votes of fiscal conservatives.
The actual benefit didn’t start until 2006, but in 2004, Medicare rolled out a phase-in of the benefit. They needed an ocean of temporary customer service reps to absorb the tsunami of calls. I was one of thousands of temps who were hired to provide “Beneficiary Assistance.” They hired us by the hundreds each week, put us through a 2-day cram training class, and turned us loose on the phones. More on that in a bit.
A Little Background:
The two most expensive programs that states administer are Education at #1, and Medicaid at #2. Medicaid is for people with low incomes, of any age. It used to be fairly easy to qualify for it, but as medical costs rose, the income ceiling to qualify rose with them. Medicaid is fraught with abuse, thus making it almost as wasteful as it is beneficial, as entitlement programs go.
Medicaid varies a lot from one state to another in what it covers and who qualifies for it. States with a lot of money, like California, have generous Medicaid benefits. Poor states, like Mississippi, not so much. They also vary in what they cover. Prescription drugs are the biggest medical expense for most people, and that coverage also varies from state to state.
By contrast, Medicare is a health insurance program for the elderly and disabled, with low-cost premiums and co-pays. Low income people can often get assistance from their state programs if they can’t afford to pay. Those with low income who also qualify for Medicare due to age or disability are called “Dual Qualifiers.”
Ooh, it almost sounds like a good thing, doesn’t it?
“Woohoo! Look at me! I’m a Dual Qualifier!”
In 2003, there was a wave of reform fever going around in the state and federal governments, aiming to reel in these expensive entitlement programs. But there were also a lot of calls for more assistance, especially for the elderly. In Washington, Congress debated cutting benefits for Medicaid, but the states rightfully howled in protest. Nobody wanted to cut benefits, but they didn’t want to raise taxes to keep up with the rising medical costs.
Therefore, Congress decided to divide the pie a little differently. By adding a prescription benefit to Medicare, they were able to take some of the burden of eldercare off the states. They took the money to pay for it from Medicaid. Oh, they didn’t phrase it like that publicly, but that’s what we were told in training.
The sales pitch to the public was this:
“The elderly will now be able to buy this new inexpensive Prescription Drug Benefit through Medicare! This will save taxpayers a lot of money by reducing Medicaid funding!”
State legislatures across the country saw it as an opportunity to slash Medicaid, thus avoiding having to risk their political careers by voting for tax increases. They could say, “We’re taking care of our elderly first, through Medicare’s Prescription Drug Program, so only the Welfare cheats will be affected by decreasing Medicaid funding.”
Some states lowered the Medicaid income limit to below the poverty line. Some dropped prescription coverage completely!
Shortly after I started working for Medicare, 13,000 people in Mississippi, including the elderly and disabled, got letters informing them they no longer had prescription drug coverage under Medicaid. They were advised to call Medicare to sign up for the prescription drug discount cards.
During the first two years, as they rolled out this new benefit, it was chaotic for everybody involved: beneficiaries, pharmacies, organizations that help the elderly, and even for Medicare employees.
This phase-in period was poorly designed, poorly funded, and poorly executed. Hundreds of thousands of elderly and disabled people suddenly lost access to their prescription medications, due to loss of Medicaid coverage. They couldn’t afford them anymore.
In those first two years, Medicare’s plan provided a mere $600 annual credit, and only to very low-income people, to replace their Medicaid coverage.
Whereas they had been getting prescriptions filled for a co-pay of about $10 a drug under Medicaid, they now got a piffling average of 10-15% off the retail prices. Many had $500 a month in prescription needs, and lived on less than $1000 a month from Social Security. It wasn’t just in Mississippi. I got calls like these from all over the country.
The Prescription Drug Discount Plan offered through Medicare is one of the most confusing programs ever launched by the government – kind of like the Tax Code. Here’s the gist of it:
The benefit is offered in conjunction with private-sector companies that sell “discount card” plans and are reimbursed by Medicare. Plans have an annual fee and/or monthly premiums, along with deductibles and co-pays.
The discount cards are administered by over 50 different companies in any given area, comprised of partnerships formed between insurance companies, drug manufacturers, medical providers, and pharmacies.
According to Wikipedia, “As of 2008 there were 1,824 stand-alone Part D plans available. The number of available plans varied by region.”
Each partnership is free to set its own prices. Since the discount package they offer is their primary selling point, the idea is that they will be competitive and economical — but like any commercial market, that sea is full of sharks.
When beneficiaries enroll in one of these prescription plans, they cannot switch until the end of the year!! That’s still the way it is.
From the beginning, it was clear who was benefitting most from this new benefit. The Discount Plan partnerships.
What we were trained to do was to take calls from beneficiaries, and ask them to tell us in detail all of the prescription medications they were taking, including dosages and how many pills per month. Then we would use our internal Internet to wade through the various discount plans, with the help of built-in search engines (thankfully!), and give them the choice of at least three plans.
We couldn’t tell them outright which plan was the cheapest or the best for them; we had to give them three choices to pick from. The price differences from the best to the third-best could be dramatic, but we couldn’t “show favoritism.”
We would give them the names and contact information for the three plans, and tell them they needed to call each one and compare prices. Many of these people were barely able to cope with the one phone call to Medicare, let alone calling three insurance companies, and then making wise choices.
Many of them would begin weeping as the call progressed, as the reality set in that they would no longer have their prescription medications because they could no longer afford them.
After two months, they gave me the option to become a permanent employee of Medicare. It only took me my lunch hour to decide against it. Why? I have a heart, and it was getting broken daily, to the point that I would drive home from work fighting back tears.
I had to listen to caller after caller tell me all their miseries, their medical histories, their financial details, and their doctor’s orders — and all I could do was steer them to businesses that would offer them savings of about 10-15% off retail, knowing in my heart that prices would likely increase by 20% in the next year. I just couldn’t handle it.
Epilogue
Although I’ve presented this story in the past tense, know this: it’s still basically the same. The Medicare Prescription Drug Plan has stabilized somewhat, and it’s more affordable now, but it’s still a mess.
Only the most impoverished can qualify for Medicaid now, which is why so many elderly people allow themselves to go broke, so they can get Medicaid to pay for their old-age needs. Most of us will have to figure out the Medicare Maze before too long. Some of us are already there. Woe is us.
We’ve heard a lot of political campaign talk about Universal Health Insurance for America this year. Please don’t bet on it coming to pass in our lifetimes. I’m not saying that to be cynical — I’m strongly urging you to hang on to any insurance you have, unless or until you can get something better without a gap in coverage. It only takes one illness or accident to wipe out a family’s finances, even with insurance. Without insurance, it can be devastating.
Insurance may cost an arm and a leg, but there are diabetics who will actually lose limbs due to inadequate health care caused by lack of insurance coverage. Women who can’t afford expensive preventive drugs like Fosomax will risk osteoporosis. Stoical men will forego check-ups altogether, letting treatable prostate cancer go undetected until it’s too late.
Because cowardly politicians are afraid of losing their jobs, they will avoid voting for tax increases, even in the best of times. It’s going to be a long time before the current financial crisis allows us to have a healthy debate about Universal Health Insurance in America. If it ever comes, it won’t be cheap. The tax burden will be heavy.
Finally, I beg of you, if you care about the Universal Health Insurance that first brought Hillary Clinton to the world stage, don’t let her “our” dream die without a fight. She tried to get it for us in 1993. She tried to make it her primary platform in 2008. I hope she keeps trying. At this point, I don’t even care who gets credit for it, if it comes to pass.
As for myself, I now have a good job and good insurance, but I often think of The Beatles song title, “Tomorrow Never Knows.”
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Thank you for your heart felt story. Wow- opened my eyes.
Thank you for your kind comment, Kristen.
Stoical men will forego check-ups altogether
Women too, Steve in KC. I have no health insurance. If I get really sick…….I just die. I have made my peace with it.
I have made my peace as well.
When government shoves money into something you have one of two results.
Post Office like service because we want economical services from our government.
Or if it is a “free market” government solution prices will rise to cover the government subsidy.
There ain’t no such thing as a free lunch.
Agreed. Government involvement usually results in inefficiency, increased paperwork, and delays. I have no confidence that the federal govt will improve health care. None.
I object to the “Post Office like service” reference because the government does NOT “shove money” into the USPS.
The Postal Service is NOT funded or subsidized by the Federal Government. All Postal Service funding comes strictly from sales of services.
Bear that in mind when you complain about long lines when you mail your Christmas packages and your Christmas cards. The Government is obliged by the Constitution to provide postal service, but the USPS does not get money from tax dollars.
And, given the way that I’ve been treated at places which (in theory) have “marketplace competition”–department stores, grocery stores, fast-food places–I can’t say that any of them are any better in providing service.
(And, for the record, the USPS is the only service which offers package delivery ON holidays–even Thanksgiving and Christmas. Yes, you may have to pay more for it but UPS does not deliver on those days at all.)
The USPS is probably one of the BEST run delivery organizations in the US right now. They deliver a higher quality product for less money than any other company. My only complaint is lines at the retail branches, but then you end up waiting at most stores as well. I do everything online where possible, cheaper, faster, better. Don’t believe me, compare pricing on any package under 10lbs. USPS beats all other services hands down.
The last 20 years have seen the Republicans destroying government in any way they can. They think that private enterprise is always more efficient, but USPS disproves this notion in every way. Private companies have as much or more waste built into them. Plus there is the profit tax that siphons off 10% or more of the income. USPS does not have this issue and uses 100% of it’s income to make it’s service better.
I agree. If I get sick I will just die. I’ve accepted that and, you know, as they say “life goes on”.
My daughter, who is 19 and has had 6 surgeries during our better (i.e. insured) years, is living on the edge. If she has another mastoid breech, which is always a possiblity for her, she will have to have surgery to repair it. She works, but has no insurance.
She got really ticked off once when a lady came into Macy’s and somehow started ranting about universal healthcare and why should she pay for lazy people who won’t get a job… my daughter held her tongue, but of course wanted to scream at her “I work!! I am in college, too – and I don’t have any health care”!
Steve, I am one of the people who is thankful for the Part D Medicare program. I am paying much less out of pocket for my medications. Before this I was getting free meds. from Drug Companys but not all my scripts was I able to get. So this program has helped me, but I am younger and I wouldn’t wish the choosing of which company, on anyone. It is just too hard and confusing for elderly people. I just guess I would feel better if the Gov. was able to barter down the prices of these med. so it wouldn’t cost so much to the taxpayers.
Owllwoman, I agree that the Medicare Prescription Drug benefit is good,all things considered. My story dealt mostly with the way they yanked the rug out from under Medicaid beneficiaries in order to fund Part D. It was totally mismanaged. It’s still a nightmare to sort through all the options and hope that you’ve made a good choice. And again, those benefitting the most from the current system are the insurance and pharmaceutical companies and their partners in
crimethe healthcare “business.”I’m glad you are getting some benefit from it and I thank you for commenting!
You don’t understand why George won’t leave Medicare alone? He has been indoctrinated by the far right to believe that the market is a magical thing that will solve all of our problems, so he is determined to wreck any successful government run health care program. That was the intent behind banning the government from using its collective bargaining power to get discounts on drugs the way private plans do. This was also the reason that he has supported paying more to private medical plans so that they can “compete” with the governments by providing more benefits, fooling people, with the media’s compliance, into thinking private plans are better run. And let’s not forget that he also wants to reward his wealthy contributers in the pharmaceutical and medical industries.
Watching Bush lately as he is forced to act contrary to his free market fundamentalist ideology, he appears that his defenses are starting to crumble and he is finally coming unglued. He has been able to convince himself that the Iraq war will eventually prove him right, but there is no way he can deny the disaster brought on by radical free market policies. This has to be a huge psychological crisis for him.
BernieO, if I understand your point about the government using its huge collective bargaining power, I agree they are not using that power to help the elderly and disabled. They should have made this plan from an entirely different model, becoming essentially the largest customer of the pharmaceutical companies as the largest insurance pool in the country. If they had done it that way, we’d all be better off, getting our drugs at about the same low prices as Canadian citizens. And you are right, it was put together the way it is in order to benefit the country club pals in the insurance and pharmaceutical businesses instead of the taxpayers.
I appreciate your analysis!
[...] The Medicare/Medicaid Fiasco Finally, I beg of you, if you care about the Universal Health Insurance that first brought Hillary Clinton to the world stage, don’t… [...]
My 89 YO mom has seen her drug costs go from $10 to $20 to $40 in the past two years.
And to think: you see how screwed up Mediacre and Medicaid are and yet you imagine Universal care will be better.
Why?
I guess you can always plead insanity.
I don’t plead insanity, but I don’t deny it either!
To my way of thinking, this program was mismanaged, so one can only hope that working out a Universal Medical program would be better, having learned from mistakes of the past.
Maybe the Hope for Change pres-elect can pull it off. /snark
My primary hope for a Universal coverage plan would be for those who fall through the cracks of the current systems. It only takes a minor change in one’s income, or government regulations, for someone to suddenly lose their Medicaid, for example. My biggest objection to the Medicare Plan D, besides mismanagement, is that it decreased Medicaid funding, leaving many people without coverage that were previously covered. My hope is that a future plan will make sure that families without insurance because of low income will be able to get a modicum of reasonable healthcare without forcing them into living on the streets.
Obviously, there is no way that private sector companies are going to provide any relief for low income people in any meaningful way.
Again, that’s just my opinion, and I may very well be insane, but I’m not stoopid.
It’s things like this that also led me to leave nursing. There’s the rampant abuse of some programs, the out-of-control drug and private insurance costs, the sheer struggle of trying to get all the paperwork together whatever program a patient is under, or not. It is so unfair, so hopeless, so full of fingers pointing. I don’t see it stopping until the whole system is overwhelmed with activists who have a clear goal to break it down and rebuild it.
Finally I’m old enough for Medicare and I love it. $130/month. No drugs, but I don’t use them, I’m basically well and most of my lifetime insurance costs have been for accidental injury or unexpected surgical emergencies. This is a great relief from $650 month for Blue Cross-Blue Shield. If I needed some drug on a regular basis, I’d have to get medigap insurance, and be right back where I started.
Personally I blame the Pharma and insurance companies in the near reach, and the capitalist system that has made these crucial industries dependent on good stock sales in the long run. They should be run more like public utilities in the health area.
You see how government has screwed up the Iraq War and yet imagine it can do better with medicine which is more complicated?
Now compare UPS to the Post Office.
Or look at VA hospitals. Vets have Universal Coverage.
Believing in the Government Solution is the triumph of hope over experience.
The USPS started off well and is now in debt, so much for privatization. The VA has been cursed with a lot of “attitude” problems on many levels that have worked against it, yet they keep on and provide an enormous amount of service. What if they weren’t there at all and disabled vets had to rely on BC-BS? You forgot to snark about the CDC, the USPHS, military health service (including dependents)and the Indian medical service. The government is in health care in a big way already. You aren’t going to roll that back, and that wasn’t the point of the post, I think; at least I got the message that it’s screwed up but it’s what a lot of people depend on.
I’m aware that government programs don’t always work efficiently, in fact I have a master’s degree in community health which is basically program planning and figuring out how to fund programs to do the most good. Your sarcasm does not actually propose any solution; it’s the old do nothing because it wasn’t done well in the past so let’s all give up now and sit around and bash the government nihilism. If all the energy that went into saying “the government can’t do it right” was instead diverted to “the government is our servant and we’ll make them work better,” we might get somewhere. You’ll notice I offered a different villain, the “get rich sick,” for-profit by any means because it holds up mutual funds system, that we are enslaved to. If you want to contribute to a better system, get a concrete plan out there.
Tax increases?
Lowering taxes has brought the government more money due to increased business activity. Some economist think the optimum rate is 20%.
In addition we compete with Japan which has a 0% capital gains tax.
Want to stop sending jobs overseas? Lower taxes. State and Federal.
When my husband turned 65 in September we went on Medicare and opted for our company plan as our supplemental.
By the end of the month, we were notified that we would be shuffled into other plans.
These “highly trained assistance” could not answer any of our questions on our first three calls. After printing out several options from the internet, we called to sign up.
Great experience! We were on hold for one and a half hours, the assistant signed my spouse up with GM until corrected, and it went down hill from there.
God help anyone who needs to wade through this crap in any sort of diminished capacity!
Add all the revolving door legislators to the Bush list!
there needs to be some regulation and competent help.
I have been out of the Medicaid field for almost 4 years now. I was an ABD (Aged, Blind, Disabled) case worker for Family and Children’s Services and I left shortly after the implementation of the prescription drug plan.
It was a mess, and it wasn’t helpful to people who needed it. It has been too long for me to remember all of the actual dollar amounts, but it went something like this: Medicare PDP would pay the first 80% of prescription costs up to $1250 (again the actual numbers may not be right) then they paid nothing between $1250 and $2500 (est, again), then they paid 100% after that. Enrollees had to pay an extra PDP premium monthly (out of their Soc. Sec.) and then the co-pay. If their meds were more than the $1250 or whatever, then they had to pay the co-pay and 100% up to $2500! It was ludicris.
But the medicaid funding itself was rediculous. For people who needed it the most, it was very difficult to get coverage, and I’ll give you an example in a minute. There are varying types of Medicaid and, as stated in the article, benefits differ from state to state. I live in GA. In the state of Georgia you cannot get medicaid if you are over 18 unless you are disabled. There are (or were – I left medicaid and ignorantly have not followed up on the massive changes since then but I do plan to) no benefits to people who, lets say, are out of work and on the verge of losing their home who have a heart attack – unless that coronary creates, or is a result of, a disability. Social Security will only disable you if your doctor states that you will be unable to work for a period of 12 months or more. If you file for disability you could get temporary medicaid until Social Security denied you, but that usually happened pretty fast.
Families within certain income limits could obtain medicaid for their children, but not for the adults.
Here is a horrible example of one of my clients to show what medicaid did to anyone who otherwise qualified (based on disability) but had income:
My client had juvenile diabetes. His diabetes was so severe that by the time I obtained him on my caseload he had been going blind for about 3 years. When he became totally blind he was granted disability. He had one foot amputated and the other leg below the knee was amputated a few months before he became my client. In his better days, he had worked and made good money. He had a wife and three children. One of his children had Downs Syndrome. His wife was unable to work because he was unable to do much for himself and certainly was unable to watch a disabled child. Their household income was his SSDI of around $1600/mo and the child’s SSI of around $600/mo. They had no other income. He was not Medicare eligible because he had only been determined disabled a year earlier. Medicare required a person be disabled for 2 years before becoming Medicare elgible, if they were under 62. He was 40.
Under medicaid policies in Georgia, he qualified for ABD Medically Needy. Anyone who is disabled can get medicaid under medically needy, regardless of income. In order to receive benefits, however, they must first either pay or incur an amount of medical costs that they are responsible for up to whatever amount is necessary that would leave them with ONLY the “income limit” amount to live on. At the time (I do know that these have increased very slightly and has been spread out to consider different family sizes now, but the limits are still rediculous) the “income limit” was around $365. So this client and his wife and children would save every receipt for aspirin, sinus meds, etc and still the wife had a propensity to go to the hospital emergency room and rack up bills just to meet their monthly “co-pay” of over $1800! Could you imagine having to pay an $1800 co-pay on a $2400 income? But this man needed his medication, dialysis, regular therapy, very regular checks with doctors to prevent further limb loss. His medication costs were extraordinary. Without her emergency room visits, they would not meet the burden of the co-pay and still feed, clothe and educate 3 children. The child with downs had SSI and was fully medicaid covered, but their other children could not get medicaid because the household income limit was too high.
When he qualified for a kidney transplant and a donor was located, the medical facility would not approve the transplant until he had met his medicaid co-pay for the month and they were desperate – so off she goes again to the emergency room.
Who do you think pays for all of those ER visits so that he could get his medicine and dialysis and kidney transplant? Everybody else who pays medical bills. I can’t understand why people don’t see that these costs are always absorbed anyway by the general populace, hence “universal”.
But to create the kind of stressful atmosphere that this family lived in day by day – and intentionally so – was more than I could bear. I had wanted to help people. I argued policy with my supervisors and the director until I finally resigned – completely burned out and defeated. I can’t tell you how many nights I left work and went home and would literally sob for hours over the needs of my clients. My caseload was 300 deep, and 50% of them were in similar situations. Elderly clients who took 1/2 of a pill 2 times a day instead of 1 pill three times a day, and other atrocities.
Then, there is the system abuse, which is prevalent in any program, but the bottom line was that the people who were less needy got more and the people who were more needy got less. I got sick of it and left.
I guess it’s time for me to polish up on my knowledge of current policies and try to be an advocate for change.
Wow, Donna! I would have benefitted from chatting with you while I was writing this piece!
It is so discouraging to want to help people with the programs you represent, but have your hands tied by regulations that often make no sense and too often leave the most vulnerable folks with the least assistance.
It was more than I could handle, and I empathize completely with your experiences.
Thank you very much for adding to this commentary!
My family is living this Medicare/Medi-Cal nightmare every day with my 84-year-old mother diagnosed with Alzheimer’s. Unfortunately, she did not have long-term care insurance (could not afford it) and so is reliant on a Senior HMO program (which sucks, but all we can afford) and basic Medicare (which also sucks!). A few months ago, I spent 3 hours on the phone with a Medicare specialist to see if we should get Medicare supplemental insurance, and at the end of it realized just how f*cked up the system was. Medi-Cal (California’s Medicaid program) isn’t that much better. My mother’s income is below poverty level, but not by enough. She also has a few dollars left in savings, but it seems a few dollars too many. So, we have to wait until she’s pretty much destitute in order to qualify for the low-income drug benefits. And, when she deteriorates to the point that the facility she’s in can no longer care for her, or when the family runs out of money (which won’t be too far in the future) she’ll have no choice but to go into a state-funded facility, of which decent ones are few and far between. We’re all praying she loses her mind completely before that happens, so she’s not aware of where she’s living. Pretty sad, huh? But not uncommon in this richest country in the world.
I have no health insurance, either. The choice for me is rent, or insurance. I choose rent. I’m on a monthly medication, and if it wasn’t for the Patient Assistance Program at Merck, where I can apply every year for free meds, I either wouldn’t be able to afford them or I’d have to hop over the border to Tijuana every few months and buy them cheap at the pharmacies there (which I did for many years before I found out about the P.A.P. program!).
I know all this is way more info than anybody needs to hear, but Congress should know that stories like my family’s are not rare or uncommon. Just think, if Ted Kennedy was in my mother’s shoes, he’d be dead now. Too bad none of them really care (well, except for Hillary, and now as SoS, she won’t be able to do much).
And like Bert said, if I get really sick….I die. Like so many others.
Steve, Your comment about “fiscal conservatives” is now nonsense. Conservatives have definitely proven they can not manage a budget other than to borrow and spend, so the term is now an oxymoronic. Try “fiscal responsibility” as a useful term. If it takes raising taxes to balance a budget, that seemed to work well in the 1990’s, the economy grew and grew. But spending has to be tightly controlled. Back to 1990’s there was a very adverserial relationship between the President and Congress so spending was tightly controlled to the benefit of all.
CE415:
Just for reference, here is the only sentence where I referenced fiscal conservatives:
In this context, they were fighting against the new benefit that Bush wanted, so the Bush White House lied to legislators about the cost of the program. The fiscal conservatives were trying to keep the benefit from happening at all. So they were the meanies, in that context. But they were trying to hold the line on expensive entitlement programs, which is to their credit as watchdogs of the budget.
The term was not meant to be perjoritive or accusatory; it was just the best description of what was happening in 2003, IMO.
Thanks for your comments!
Steve, I think studies of this Medicare bill’s passage should be taught in school. The more cynical part of me thinks it was deliberately designed to provide bails of cash to those who least deserve it while helping destroy what little faith is left in the existence of a civic sphere and a common good.
Without the radical concept of universal care all attempts at “fixing” healthcare wind up being corporate welfare. The post Reagan mantra of privatization being the cure for government has been, I believe, demonstrated to be misplaced faith.
The way I see it is that some things cannot be part of a “free market” assuming such a thing exists. Suppose that air had to be purchased. People would pay any price, and therefore any equilibrium between supply and demand is hopeless. Offering to have government subsidize the purchase of air for those who cannot afford is basically the situation with healthcare today.
Making healthcare universal, seeing it as a public utility and not as a profit center, is the only solution even with its faults. I remember public utilities and I don’t think they were that bad as a model. Privatization does not automatically get rid of inefficiency and can make issues like corruption even worse.
Speaking of corruption, a recent PBS show on healthcare was discussing the costs of universal plans in other countries. Their costs are significantly lower than our corporate welfare program, and that doesn’t factor in the costs of the lives destroyed at its expense. We are spending about 22% in the management of our system while some countries expenditures are in the single digits. Now why is that when we are so competitive and competent and free market and all?
Annie Bakley… I can not agree with You more!!!Hope that more of US start screeming”POLITICIANS KEEP YOU DIRTY HANDS FROM OUR MONEY” ” GO AFTER THOSE WHO ARE INTENTIONALLY ARE COMMITING THIS UGLIEST CRIME IN USA HISTORY, GO AFTER THEM AND PUT THEM BEHIND BARS FOREVER. WERE IS THE HIGHEST COURT OF OUR LAND, GET THOSE RESPONSIBLE AND ADD TO UNEMPLOYMENT LIST!!!
Annie, I think the Bush Administration as a whole will be, and in fact is being analyzed in Political Science classes, but I doubt any practical lessons will be learned there. Often, analyses of corruption serve as lessons on how to get away with it more than how to prevent it!
Now that’s cynical… on my part!
I agree that healthcare administration classes should include teaching how good programs were crafted in such a political way that the rich get richer, and the poor get screwed.
Health administrators should be educated in how the system is gamed by corruption, and what kind of political corrections need to be made for it to work as it should, in my opinion.
I appreciate your contribution to the comments here.
first; Government must keep their dirty corrupted politicians from Medicare/Medicaid and Social Security. ALL our life we are paying for, and POLITICIANS AND SOME PRESIDENTS ARE SPENDING OUR MONEY FOR WARS AND OTHER CRAP!!! THOSE MONEY SHOULD NEVER BE TOUCH, BY ANY ONE.
JUST TO KNOW WHAT AND WHEN AND HOW OUR PRESIDENTS, LIKE CARTER, SCREW UP US SO BADLY. THE SAD PART IS, THAT DEMOCRATS ARE MOSTLY RESPONSIBLE FOR. IKE AND CARTER ARE THE MOST TO BLAME FOR.ILLEGALS GOT THEIR RIGHT TO RECEIVE SOCIAL SECURITY AND OTHER SOCIAL SERVICES DOURING CARTER, IKE CHANGE UNTOCHABLE SOCIAL SECURITY TO TOUCHABLE. Bush must stay away from, LIVE US ALONE, and hope that Obama wont use AND AGAINCHANGE LAW PERMANENTLY(CHANGE BY IKE). Now we are paying of Bail out all those crooks, and GM,Chrisler,Forc CEOs are treating US ECONOMY DISASTER IF THEY DON GET WHAT THEY ARE ASKING FOR. !!!! My only answer is!!! FIRE THEM, BANKRUPT THEM AND START ALL OVER.
iNVESTIGATE, WERE ALL BAIL OUT MONEY WENT, GET BACK AND START FIREING ALL CEOS, AND POLITICIANS CONGRESMAN AND SENATORS ALL OF THEM WHO ARE RESPONSIBLE FOR TODAY MESS, AND START WITH NEW PEOPLE FROM BUTTOM UP!!!!!!!!!!!
No ONE is talking, that PROPERTY TAXES, ARE SO HIGH, THAT ON TOP OF LOAN WE HAVE TO PAY PROPERTY TAXES, AND THIS ADDS FROM 150 AND TO OUR PAYMENT. PROPERTY TAXES ARE UNAXEPTABLE AND ADDING JUST MORE AND TO MUCH TO OUR MORTGAGE.sO, it is not just the lown,but property taxes on top of the loan!!!
i NEVER BELIEVE IN gOVERNMENT pROGRAMS. i NEVER INVETED MONEY IN STOCKS, 401k AND i WAS SO RIGHT. i DIDNT APPLY FOR PRESCRIPTION DRUG ROGRAM. i KNEW THAT pdp WAS A ANOTHER SCREW UP FOR RETIRED AND DISABLE AND OLD, AND I WAS RIGHT. SO MANY OF MY FRIENDS LOST THOUSANDS OF MONEY INVESTING IN 401K, AND NOW I BELIEVE, THAT WE WERE INTENTIONALY ROBBED BY OUR POLITICIANS.NOW WE ARE PAYING CORRUPTED CEO’S AND NANCY PELOSI IS SO EAGER TO GIVE THEM ALL, INCL. TO HER HUSBAND BUSSINESS OVER 150 THOUSANDS FROM PORK PROGRAMS!!!
my own Doctor advise me not to apply for PRESCRIPTION DRUG PROGRAM, and thanks to GOD and my Doctor for watching over me.
Thanks for such a full look at this situation. Yuo really help us understand what is going on!
Thank you, Tricia! That makes me feel good!
[...] The Medicare/Medicaid Fiasco Finally, I beg of you, if you care about the Universal Health Insurance that first brought Hillary Clinton to the world stage, don’t… [...]
Sooooo confusing. I thought if you declined part D & years later tried to pick it up you paid an outrageous penalty, like 1% a day for life