Why are Medicare and Medicaid less efficient and more costly than private plans?

What incentive does the government have to fight fraud?

 

Maxine Waters (D) is also under investigation for government fraud.

Here is another very liberal Democrat a lot of people would like to slap some good, common sense into!



"My name is Representative Maxine Waters and I am a flaming liberal. And as a flaming liberal and a Democratic Socialist I must tell you the money in your savings and checking accounts does not actually belong to you. Instead, your money, the money you have worked so hard for, collectively, belongs to the federal government! This is why I support increasing our income tax rate to 70 percent like it was in the good old days before the Republicans were in charge of tax policy!”

 

IF a person cannot afford medical insurance, and cannot afford proactive medical care, and that person needs some medical attention, if their only two choices are to use an emergency room or have no treatment at all...what's wrong with choosing the emergency room?

Ignoring your embellished examples of acne and a cough, when a person needs critical care, if they don't get it, they will die or their ailment will worsen, both of which are burdens on society as well.

None of us can change the FACT that millions of people simply DO NOT have the financial means to afford any medical care. So do we punish these people by refusing critical medical care? Maybe we should just kill them and be done with it...

 

Then you didn't understand the poster's point. He was referring to people covered by medicaid who go to the ER for routine issues rather than to their own physicians or the county health clinic.

 

That is true whether or not people have Medicaid. It has nothing to do with it.

At least, if someone has medicaid, they can get the drugs and care the ER recommends they get that they WILL NOT get at the ER. Diabetes care meds, testers, blood pressure meds, heart care meds, depression meds, dilations, catheters, routine surgeries for things like hemorroids, cysts, eye problems, so much more.

 

Not all poor people qualify for Medicaid...its mostly for pregnant women, children and some people with disabilities...

There's a lot of discrepancy in how States award Medicaid benefits...

From the Rational Arguments Healthcare Blog:

Basically, Medicaid is supposed to provide health care coverage for the poorest among us. There are some minimal federal guidelines that are set for Medicaid. Then, each state gets to implement it as it sees fit. Some states are more generous, and some less. Generally, Medicaid is meant to cover those at the low end of the socioeconomic spectrum.

The government defines poor this way:

Persons in Family 2009 Poverty Level
1 $10,830
2 $14,570
3 $18,310
4 $22,050
5 $25,790
6 $29,530
7 $33,270
8 $37,010


While you consider the table, remember this amazing fact – a single parent, with a child, who makes minimum wage earns MORE than the poverty level. That’s how low the line is.

Regardless, Medicaid must cover:

Kids under 6 years of age to 133% FPL
Kids 6-18 to 100% FPL
SCHIP upps these to 300% FPL in most states
Pregnant women up to 133% FPL
Parents to 1996 welfare levels
The elderly and those with disabilities who receive SSI
Now, states get to implement things above that as they see fit. But the first important thing to note is that adults without children aren’t mentioned at all. And in most states, they can’t get Medicaid.

Let me say that again – in most states even the poorest adults without children don’t get Medicaid.

And it gets worse. Those 1996 welfare levels can be super low. So low that, for instance, in Alabama a couple with two children making $2500 a year don’t qualify for Medicaid. Granted, some states are more generous. But in many, parents have to be insanely poor in order to get Medicaid:



Remember, these are percentages of the table above. In many states, parents, if they work at all, can’t get Medicaid.

One of the overlooked benefits of health care reform is that it sets guidelines that vastly increase Medicaid coverage nationally. The federal rules will change such that everyone, even those without children, making 133% FPL (Senate version) or 150% FPL (House version) would get Medicaid. In some states, that might not be a big deal. But for those in the states on the left side of the chart, this would result in millions of the poorest among us getting the coverage that many of us already assume they get.

They don’t right now. And they desperately need it. And if we fail to pass any reform, they will get nothing.

 

There only choices are not an ER or not treatment, you DO realize that there are doctor's offices that accept medicaid? That pretty much makes that rest of your post null and void. Next time, please re-read my post before you respond. I was referring to medicaid recipients being able to use ER rooms for non ER reasons at the tax payers expense.

 

Thats acutally a good point.
The politicians also tries to save money and resources, ending up doing everything half-assed. They want power, but they are not willing to pay the price when they got it

 

Here's a comparison in terms of cost between private health care in relation to Medicare:

http://krugman.blogs.nytimes.com/2011/06/12/medicare-versus-private-insurance-the-data/

Please refer to table 13 of the report:

https://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf

 

Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance.

This report was written by a health policy analyst, not and economic moron or the self protecting government.

 

No, the poster I replied to made those statements. Do try to keep up.

 

With my insurance hat on:
One major reason SS and Meicade is not good, it is a massive beurocracy and there is a lot more fraud. In private insurace it is simple, just pay your little premium every month, and get approval and treatment services for anything. For government systems, you need to quaify, fill out applications, await approval, and some drugs and treatments are not covered, and they have limits on what they will cover and what they will pay for. Hence the government insurance plans are slow and costly, while the private isurance is cheaper and more efficient.

In private insurance we have Risk Managers, to assure you will get the best service because we are competing with other insurance companies, so we must offer the best service to attract new clients.

LOL.
You Dig?

 

It seems like you are doubling down on not understanding.

Good for you.

 

Then this is not a Medicaid problem. It is a problem at the emergency room level. There are NO LAWS that say an emergency room must attend to every person that walks in the door...none! The ONLY law which applies is that they must tend to EMERGENCY medical situations! A cough and acne ARE NOT emergency situations...

 

IF Medicaid is paying for the procedure, then the costs are identical to Medicaid and taxpayers no matter if the procedure was done in an ER or a doctor's office.

The ONLY issue is whether or not ER's want to accept or reject non-emergency patients...and this is 100% their choice...their choice!

BTW; I'm not going to re-read anything. If I misunderstood something, then let me know, and that's the end of it. Your condescending comments serve no purpose...

 

Medical emergency rooms, no matter if patients have zero insurance and zero money, or have insurance and million$, have Medicaid or Medicare, are required to tend to EMERGENCY medical situations. They are not required to deal with acne and coughs and non-emergency situations. They can accept these patients, but they do so at their own choice...not mandated by anyone...

 

The ER cannot legally turn them away, so once again, you don't understand how this works. And yes, the treatment is far more costly than if it were done at a physician's office. And yes, it is your responsibility to understand what you are responding to, not mine.

 

Get this through your head; a medical emergency room ONLY is required to treat those with critical medical situations...NOT acne, NOT coughs, nothing except for EMERGENCY medical care. All other care required they can send the people elsewhere.

If you are naive to believe anyone can walk into an emergency room anytime for anything, then please explain why would anyone have insurance?

If you don't believe the above, then YOU show your proof in which YOU believe emergency rooms are required to treat anyone for anything anytime??

If you would read my posts, you would know that I said the 'cost to Medicaid and taxpayers is the same'. Of course it costs more to treat people in an emergency room than a neighborhood clinic, but so what, the cost to Medicaid and the taxpayer is the same no matter where the procedure is done! Why, because Medicaid is going to only pay X$ for a procedure...period!

 

I don't need to get anything through my thick head. You had misread and misunderstood posts and rambled and babbled about things that are not even being discussed. Now, for the last time, the ER cannot refuse treatment to anyone!!!

 

Any patient who comes into the emergency room complaining of chest pains or any female coming into the emergency room complaining of abdominal pain must be considered to be an emergency and it is mandatory that the ER diagnose and treat as necessary.

People who want free treatment tack one of the above on their list of complaints to ensure that they get seen and treated. The staff knows that the chest or abdominal pain will magically disappear when they treat the other issue, whatever it is (usually a cold, or surprisingly often a pregnancy test.)

For the chest pains, they still end up doing a basic heart workup just to make sure that there isn't a real problem (which adds to the cost for the hospital.)

As for the question of why people have insurance, hospitals can and do turn to collection agencies and sometimes even sue for unpaid hospital bills. If a person has financial resources yet chooses not to pay a hospital bill, they will experience damage to their credit rating, harassment from bill collectors and eventually a negative court judgement against them. This is a good reason for insurance.

Naturally this doesn't apply to people who have no financial resources to take and no credit rating to protect.

 

You are correct, OldManOnFire.

This is one reason our health care costs in America are so expensive. When the hospitals treat the indigent in their emergency rooms, they have to raise the rates for the people who have insurance so the hospital will not lose money and go out of business.

When the indigent go to the emergency rooms for routine health care, they drive up the costs for all of us.

 

You are indeed correct, Louisiana75.

 

Too much conspiracy stuff for me!

 

An emergency room is not required to perform 'routine health care'. They are ONLY required to respond to emergency and critical medical situations, to stabilize the patient, then transport them to another facility. If emergency rooms are doing routine health care, tending to acne, or coughs, etc. then that facility is at fault for incurring those costs. As you point out for any medical services that are not paid, this loss is either written off against income or added into the overhead and charged to everyone...and must be minimized...therefore these medical institutions cannot possibly treat every person for every ailment for free...

 

#1, insurance in itself is a social service. Those that receive more care than they pay are being covered by those that pay more than the medical care they receive, i.e., actuaries perform all the math on this.
Ref: http://actuarialgrads.com/actuaries - US Dept of Labor Occupational Handbook Information.htm

For myself being in general healthy, for my cholesterol, I eat right and exercise, others take prescription drugs. Guess what, prescription drugs are subsidized through ones insurance policy, of course everyones plans vary but most people's medical insurance has covered for prescriptions.


Now here is the kicker, pay attention, private is not more efficient, any large organization will have their beauracratic bottlenecks, either private or public. The private is for profit, so any losses or "inefficencies" are just written off. If you ever worked for a mega corporation you will too run into some procedures that are very inefficienct, because it all has to do with auditing. Even large corporations need to audit their programs for a variety of reasons, i.e., theft, poor management, this happens in private industry too. Yet in private industry, it does not have to be revealed and hence no one sees it.