Medicaid Expansion

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DisPas
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Medicaid Expansion

Hi everyone! I'm a new member, but I've been engaged in Maine politics for years.

So, I assume nearly everyone here is opposed to Medicaid expansion on the ballot in November. The Maine Heritage Policy Center put out a white paper basically summarizing, I think, the conservative stance on the topic: 1) it's too expensive and 2) we'd be helping people who can help themselves.

I'm conflicted on this issue. I think MHPC brought up some good arguments, but it ignored some opposing evidence. First, we pretty much end up paying for the uninsured anyway. Why not offer them some primary care services to try to prevent more expensive emergency room costs? Second, I think it's unfair to demonize the potential beneficiaries of expansion. Are there some lazy, entitled assholes among them? Of course, but policymaking shouldn't be guided by the exceptions to the rule. Most of them work or have a debilitating condition or injury. Many are caregivers for their parents or young children. Some are working their way up to self-sufficiency, but haven't yet pulled themselves out of minimum wage territory.

So what say you? Where am I going wrong?

Thanks, and I look forward to the discussion!

Dr. Wordsmith
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I'll bite.

I'll bite.

I'm conflicted as well about expanding Mainecare but "why not offer them some primary care" is a really bad idea. Insurance or government payers are really inefficient ways to buy primary care. That's like using auto insurance to get your oil changed.

Buying routine primary care the same way you buy a week in the ICU or chemotherapy has made previously affordable primary care too expensive.

Ugenetoo
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Rand Paul and the

Rand Paul and the libertarians are right to question this whole mess.
A government in charge of taxation that targets certain non profit organizations because they aren't the right flavor for the current administration has absolutely no business dabbling in the dispensing of healthcare, IMO.

Watcher
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I don't believe our

I don't believe our government has the right to stick a gun in my face and tell me I must give it money so they can give it to my neighbor for his health insurance. Health insurance is not a right. If I am forced to kick in bucks involuntarily, I want the gubbmint to be sure my neighbor does not conduct his life in such a way as to increase and abuse his use of the medical services the cost of which they are forcing me to pay. My neighbor must stop smoking now; he must quit abuse of all drugs...including alcohol; he must exercise regularly and loss the massive gut he is hauling around; give up or seriously reduce his glutinous consumption of sugar, carbohydrates, soda, chips, french fries and all such death or illness causing foods and, must get annual physicals et al. All of the foregoing cause illness and, since I am paying for his treatment, it is my call.

johnw
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Under the current "free

Under the current "free market" configuration......most middle income workers are subsidizing low or no income workers for medical care either through higher premiums or taxes.... either way we pay. Insurance companies are not in this for the exercise so I have no trust when they tell us that they are making no money....ditto for pharmaceutical robber barons and for profit medical monopolies .
I'll just throw this out there .What IF we did have a single payer system that everyone was paying into instead of the select few , no free ride. And the government administered it, you go to the doctor ,they submit the bill the government pays it( I know it's not quite simple but this is a hypothetical exercise).... how is that any more complicated or painful than what is currently happening for most of us?
BUT here is the real what if , what if the government didn't give any "work" to the insurance companies , there was no need for insurance companies to offer health insurance at all. Do you want to wager that the insurance companies would suddenly find a way to make health insurance more affordable???? Of course this will never happen because the congress is to busy kneeling and licking the insurance companies boots.....

Toolsmith
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@Watcher

@Watcher
This is what single-payer does. Since they're paying, they control everything. Your life decisions become their business, and Big Brother starts demanding that you live life how they think you should. No more freedom of choice.

Add government to health care? All decisions become political. You get expensive care if there's a political benefit (politically connected group), you don't if there isn't. The masses of poor get free primary care to buy their votes - but not expensive care, because that would be too expensive. And you get the bill since they don't pay taxes.

Roger S
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I have two main objections to

I have two main objections to expanding Medicaid. First, there's the phenomenon of people overusing services when they are free. I know it's anecdotal and drawn from a small sample, but the MaineCare recipients I have known run to the doctor or the ER for the most minor things, things that someone who has a deductible or co-pay that they have to pay aren't going to bother seeing a doctor for. Second, there's the cost transfer to the paying customers. Medicaid reimburses providers at such a low rate that they shift the cost of providing services to those who have insurance, making insurance more costly for those of us who pay for it ourselves.

Combine Medicaid patient's overuse of services with the cost shifting and I think you will find that expanding Medicaid is a much more expensive solution.

Bruce Libby
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That would be only more so

That would be only more so ,as the schedule of fed. contribution increases no matter the time table.
That small sample Roger is bad enough but gets even worse when they use a rescue to facilitate the
treatment.

anonymous_coward
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Welcome DisPas!

Welcome DisPas!

The study to look at is the Oregon Medicaid experiment. At the time, they had enough money to offer Medicaid to a portion of a chunk of the poor population, but not all of them, so what they did was randomly offer Medicaid to a subset of that population.

At the same time, researchers tracked those who received and didn't receive Medicaid to see how they fared.

This is pretty much the dream conditions for understanding how people respond to government offered insurance.

The results, like most things in the real world, didn't really play into the conservative or the liberal narratives on government offered health care.

On one hand, it didn't reduce the number of ER visits - people were more likely to visit hospitals, get medication, receive treatment. On the other hand, it reduced the incidence of certain kinds of issues (for example, more people were diagnosed and treated for diabetes). It also reduced the incidence of depression and the chance that people would have unpaid medical bills (unsurprisingly).

There were no significant changes in mortality, but the study didn't really last long enough to measure the long term impact on health.

(for more details, see this: https://en.wikipedia.org/wiki/Oregon_Medicaid_health_experiment)

Also it's worth noting that while people do get treated for broken bones at the ER, you can't show up with cancer and get chemotherapy from the ER. Or get a knee replaced. Or get a tumor removed.

FWIW, one thing that bothers me (even as a liberal) is that medicaid seems to be really pretty good. It should suck. It should cover preventative and bare bones coverage of extreme things (childhood diseases) but that's it. You should have an incentive to move up, but not have to worry about your kid dying because you're poor.

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