The Health Care Mess: "Expanding" Medicaid

Over at DU an attorney with some experience with Medicaid explains what it is really about, which really means this stupid health care "reform" bill expanding the number of people going on Medicaid merely expands the numbers of people who have their current and future estates seized:

This post is not intended to argue one way or the other on the Senate HCR bill, just to try to clear up some of I what I think are misunderstandings by many concerning the nature of Medicaid.

First of all, Medicaid is not "insurance". You cannot buy it, pay premiums for it or contract for it. It is medical care established by the federal government and optional for the states (though all states now have it) and is need based, though need, no matter how poor someone may be, is not the sole criteria to be eligible for it. Not all poor people are eligible for it unless they fall into one of the areas specifically covered by Medicaid (treatment for HIV, nursing home care, etc.).

Second, it is not "free". Though you receive medical care if eligible, you by law must promise to repay for Medicaid when and if you are able to do so. You might think those were empty words, because after all, how could poor people repay for costly medical care? Well, I have seen on many occasions people who were in fact forced to repay Medicaid. They list your treatment, render a "bill" at some point (which is really just notification of the amount owed) and file it as a lien against you. Then, if you inherit Mom or Pop's home, or if you win the lottery or if you have an accident and sue and recover damages you find out a lien has been filed against you and you cannot sell the property, collect the judgment or cash the lottery check without paying back Medicaid. This happens quite often with elderly people in nursing homes after they have exhausted their savings and become eligible for Medicaid when $8.000 or more is added to the lien each month. Except in the case of a surviving spouse (or dependent child) in NJ all of that money must be paid back from, for example, the sale of a home.

But it not only negatively impacts those who have been on Medicaid who want to sell or dispose of property. It also prevents them from buying property. Let's say a person is poor but then obtains an education or job training and a few years down the road is in the position to actually buy a home. Well, no, because before buying most lenders require a lien search be done on the buyer and if a Medicaid lien turns up they will reject the buyer for bad credit.

I hope this post doesn't sound patronizing and I realize that most probably know the difference, but Medicare and Medicaid are so different they probably should not be discussed in the same sentence.

And here some Democrats are praising this shit "reform." Extending MEDICARE to those age 55 and older is real health insurance reform; expanding MEDICAID does nothing of the kind but ruin even MORE people financially.

Screw it.

The Health Care Mess

So why IS there a mandate to buy insurance, as if the question really needs to be asked?

It's because the health insurance industry wants to continue with its obscene profits, and more people in the pool means more money.

And Of Course

the public option failed in committee, just as it was going to do all the time.

As long as representatives in both political parties are on the take by the medical industrial complex, there will be NO public option in health care/health insurance "reform." It's just stupid posturing when there are more urgent problems facing this country.

If the GOP's Followers

are following the bullshit rhetoric about health care reform, why in the hell are Democrats kowtowing to them?

Why is anybody taking the mandatory insurance proposal seriously when people can't afford health insurance in the first place if they are not covered by their employers or are not working?

Any bill without a public plan will fail big time.

Failure, Thy Name is Obama

We will NEVER, ever have meaningful health insurance reform in this country.

Without a public option, the whole issue is bullshit.

Thank you, crooks in the Democratic Party, who cower over your fatcat contributors.

The Blue Dogs

of the Democratic Party are the major obstacle to any meaningful health care reform.

If they supported single-payer, for example, these conservative Democrats would not be re-elected or get big bucks from health insurance interests, but their lack of will guarantees we won't get anything worth a crap out of Congress.

The Senate, of course, is much, much worse.

Obama

needs to cut out with the "bipartisanship" nonsense and start all over again on health care reform:

When will Barack Obama and the real leaders in the House and Senate finally come to the realization that the health insurors and pharmaceutical companies are the bitter ENEMIES of health care reform? My guess is never. Barack Obama has become totally mesmerized by the odd and unachievable concept of "bipartisanship," seemingly unable to understand that it requires Republican cooperation to succeed and he will NEVER obtain it. The House and Senate have become so dependent on insurance and pharmaceutical industry campaign contributions that, with only a few exceptions, they are wholly enraptured in the thrall of their lobbyists.

I am now of the firm belief that Barack Obama needs to withdraw his current proposal and start all over. He has fallen into the same trap that ensnared Hillary Clinton back in 1993. His proposal (or more accurately "Congress's proposal;" Obama has misunderstood the nature of her mistake, ascribing it to White House authoring of the bill rather than to its nature itself) is now so complicated and arcane that it is not possible to decipher whether any given individual will find it to be beneficial to his or her own situation. This is exactly what Hillary did, and although the purpose in both cases was to try to make reform palatable to health insurors, pharmaceutical companies and health care providers, it only made easier for the enemies of health care reform to employ their highly sophisticated public relations engines to kill it. Complexifying it made it easy for the enemies of reform to overstate its costs and raise fears of its effectiveness even while explaining what its impact on anyone would be, which takes many more words than any news sound bite or bumpersticker will permit.

In order to sell health care reform, the benefits must be made apparent TO THE PEOPLE. This is not possible if the whole thrust of your argument is that, for most people, things will remain the same. Why, even Republicans falsely assert that they want to change things. But that's what Obama is doing -- touting continuity rather than reform, and heralding Federal budget savings rather than the savings and benefits that individuals would enjoy, and it has no chance whatsoever to succeed.

Indeed, there is now a very real threat that any bill reported out of Congress will contain a mandate for everyone to have health insurance, but no public option. In other words, it will FORCE all of us to become customers of the health insurors, a situation they greatly desire. This will make things much worse, both in the short term and in the long run, but this seems to be all we will be able to get out of the current effort. It is WORSE than nothing, will take money OUT of the pockets of our least privileged and give it to the enemies of health care reform, and will do nothing in any way to reform the practices of insurors, drugmakers and health care providers that have gotten us into this mess.

The "mandatory" coverage ala mandatory auto insurance coverage will fail. Period.