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09-09-2012, 08:04 AM   #1
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THE elephant in the room Medicaid

funny how this gets so little play from both sides....
Personally Medicaid should be wrapped into Medicare and free the states from the burden...

Guess their voice is not important:
QuoteQuote:

In fact, the issue of long-term supports and services for the frail elderly and people with disabilities was almost entirely ignored by both parties. The importance of expanding home and community-based care got a quick nod from the Republicans. The Democrats were effectively silent.

Republicans have, of course, proposed to turn Medicaid as a whole into a block grant. That would cap the federal contribution to the joint state/federal program. According to the Congressional Budget Office, the 2012 version proposed by GOP vice presidential candidate Paul Ryan would reduce projected Medicaid spending by $800 billion over 10 years.

You might think this is a good idea, and that with increased flexibility governors can run the program more efficiently. You may think is a bad idea. But if we are going to have a debate over the future of Medicaid, we should not forget that one-third of the program’s entire budget–almost $120 billion last year–was spent on long-term care services for the frail elderly and younger people with disabilities. And two-thirds of the program’s budget was spent on all services including health care) for this population.

Medicaid spends almost five times as much per enrollee for the elderly as it does for young adults or kids. And it spends more than five times as much for people with disabilities.

It is true that most Medicaid enrollees are mom with kids. But most of the money is spent on the elderly and disabled. Much as those people are ignored in the policy debate over Medicaid, they are not going away. And it is a scandal when the politicians who argue over the program pretend they don’t exist.

I suspect that few may have valid "picture ID" anymore...

Clinton: What Medicaid Cuts Would Mean For The Elderly And Disabled - Forbes

more:
http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/09/08/medicaid-as-a-m...s-entitlement/


09-11-2012, 12:52 PM   #2
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This elephant has a brother...
The Silent Robber of Middle Class Income? It's Still Health Care - Derek Thompson - The Atlantic



QuoteQuote:
Who stole the middle class's raise? Cheap foreign workers did it. Software did it. The decline of unions and manufacturing did it, too. But don't forget health care.


Between 1999 and 2012, workers' health care costs grew four times faster than their earnings, according to a new report from the Kaiser Family Foundation.

And, pulling back the lens, we see the 50-year story. Workers compensation -- which includes health care, pension benefits, and employer contributions to Social Security, Medicare and other government programs -- has increased from about 4.5 percent of the economy in 1960 to 11 percent of the economy is 2009. Even after globalization and technology trends held down wages in the last few decades, middle class raises transmorphed into benefits. Essentially, we traded income for insurance.
09-11-2012, 02:26 PM   #3
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QuoteOriginally posted by jeffkrol Quote
funny how this gets so little play from both sides....
Personally Medicaid should be wrapped into Medicare and free the states from the burden...

Guess their voice is not important:


I suspect that few may have valid "picture ID" anymore...



more:
Medicaid as a middle-class entitlement
I am not sure what the point is. The reason why it doesn't make sense to wrap long term nursing home care into Medicare, is because the states pay way under what Medicare does for nursing home care. Also, Medicaid requires you to give up your assets (including anything you gave to your kids in the last five years) in order to go on it.

Most nursing homes actually limit the number of Medicaid beds that they have because they would lose money if they had too many of those type of patients.
09-11-2012, 03:02 PM   #4
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QuoteOriginally posted by Rondec Quote
I am not sure what the point is. The reason why it doesn't make sense to wrap long term nursing home care into Medicare, is because the states pay way under what Medicare does for nursing home care. Also, Medicaid requires you to give up your assets (including anything you gave to your kids in the last five years) in order to go on it.

Most nursing homes actually limit the number of Medicaid beds that they have because they would lose money if they had too many of those type of patients.
Other nursing homes specialize in Medicaid beds. It's all cost plus, you just order as many unnecessary tests as possible. In Deer Hunting With Jesus Joe Bageant relates a story of one nursing home resuscitating a man twice on the way to the MRI machine so they could get that one last billing in.

09-11-2012, 06:05 PM   #5
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QuoteOriginally posted by Rondec Quote
I am not sure what the point is. The reason why it doesn't make sense to wrap long term nursing home care into Medicare, is because the states pay way under what Medicare does for nursing home care.
Medicare only does 90ish days.. and you need to show progress..

QuoteOriginally posted by Rondec Quote
Also, Medicaid requires you to give up your assets (including anything you gave to your kids in the last five years) in order to go on it.
Most nursing homes actually limit the number of Medicaid beds that they have because they would lose money if they had too many of those type of patients.
Actually shows some of the brokenness of the system.. most people know the drill and
"Spend down" just fine..
09-12-2012, 03:14 AM   #6
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QuoteOriginally posted by boriscleto Quote
Other nursing homes specialize in Medicaid beds. It's all cost plus, you just order as many unnecessary tests as possible. In Deer Hunting With Jesus Joe Bageant relates a story of one nursing home resuscitating a man twice on the way to the MRI machine so they could get that one last billing in.
That maybe true in New York, but there isn't a single nursing home facility in Indiana that owns an MRI machine or laboratory. They send people out to do these tests. The patient's physician is the one who orders the test and ethically should make certain that it is needed.

Medicaid generally requires pre-authorization for all expensive tests, like MRIs and CT Scans and if a patient has had one recently, they will deny the test. Finally, they under pay for such tests as well, paying roughly fifty percent of cost. All in all, a pretty dysfunctional system, designed to shift the cost of caring for the elderly to others who have better paying insurance, or those doing rehab with Medicare.
09-12-2012, 03:19 AM   #7
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QuoteOriginally posted by jeffkrol Quote
Medicare only does 90ish days.. and you need to show progress..



..
Medicare only pays for rehabilitiation, not long term placement. There may be facilities that fudge a little to get an extra week out of Medicare, but in the end, if someone does not rehabilitate enough to go home, then they have to make decisions about what they are willing to do. Nursing homes would love it Medicare would get in the business of long term care, because they would get paid at least fifty percent better than they are with current Medicaid beds.

However, there is no stomach to start paying for long term nursing home coverage with Medicare. Those with finances will buy additional long term care insurance and those without, will go on Medicaid.
09-12-2012, 04:31 AM   #8
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QuoteOriginally posted by Rondec Quote
That maybe true in New York, but there isn't a single nursing home facility in Indiana that owns an MRI machine or laboratory. They send people out to do these tests. The patient's physician is the one who orders the test and ethically should make certain that it is needed.

Medicaid generally requires pre-authorization for all expensive tests, like MRIs and CT Scans and if a patient has had one recently, they will deny the test. Finally, they under pay for such tests as well, paying roughly fifty percent of cost. All in all, a pretty dysfunctional system, designed to shift the cost of caring for the elderly to others who have better paying insurance, or those doing rehab with Medicare.
I'll just quote the relevant passages from the book...keep in mind he is writing about western Virginia an West Vriginia.

QuoteQuote:
It cracks us up to hear the well-off baby boomers on NPR talking about “selecting the right care facility for elderly parents.” Our family’s choice, like Dot’s, was either the Hallmont in Winchester, which smells like shit and Pine-Sol, or the one in Romney, which smells like shit and piss. We chose the closer one, and I push Mom around in her wheelchair while she puffs Camel filters. Like Dot’s mom, mine seldom sees a doctor unless something goes very wrong.
Like a slumlord’s rentals, such nursing homes are merely spaces that allow the proprietors, doctors, and health administrators to generate money for themselves through our government’s approach to care. Most, if not all, of the money at these middle-grade establishments now comes from the government in the form of Medicaid and Medicare payments for services—everything from medical procedures to toenail clipping and special diets. The dependency is greater in rural and working-class urban areas, less in affluent places, many of which manage to receive a disproportionately high share of government reimbursements. Medicaid was designed during the sixties to meet the needs of Americans under age sixty-five without health insurance, after which age Medicare would kick in protecting all Americans over sixty-five. But the new jobless economy that drove Wall Street to new heights somehow left us with 45 million uninsured Americans, pushing Medicaid enrollment from 33 million to 56 million between 2001 and 2005 alone. This was accompanied by the nearly complete destruction of the public hospital system and health clinics by HMOs and Bush administration funding cuts, and by the rise of false nonprofit hospital networks. Meanwhile, although Medicare and Medicaid serve some 87 million people one way or another, a 2007 budget proposal calls for a $10.6 billion slash in funding for Medicaid and Medicare in order to preserve their “solvency.”*True, these programs consumed $417 billion of the nation’s $2.338 trillion 2006 budget. But Pentagon programs consumed $419 billion, yet nobody seems to be inquiring about the Pentagon's solvency.

When it comes to on-the-ground delivery of nursing care services, it doesn’t matter to the government that many staff members are functionally illiterate. All that matters is that a nursing home is an authorized place in which people can die. A thirty-four-bed facility like Romney’s Hampshire Memorial can easily pull in $2 million or $3 million a year. That may not sound like much these days, but if a business manager skins the cat right, it provides a good living for the doctors and others who work there.
“Ya know, I used to be so proud of the hospital,” Dottie recalls. “I grew up here and I can remember back in 1959 when it opened. I was its fourth patient. And later I had three of my kids here. Oh, this hospital was the most wonderful thing! It was so bright and spotless. People got X-rays who had never had them before. Old farmers got blood tests and tetanus shots for the first time in their lives. We had two doctors, Dr. Brown and Dr. Brown, brothers. They raised their kids here. They knew as much medicine as any doctor did in those days. Now half the hospital has been converted to a profitable shithouse that passes for a nursing home. Everybody avoids coming here unless it is life and death. And sometimes not even then.”
The hospital portion of the building remains, but mostly as an anteroom on the way into the long-term care center. There is no receptionist to be seen. Finally, when I caught an orderly passing through, I asked him a couple of questions about the hospital.
“Oh no, we don’t deliver babies or offer medical services,” said the orderly. “People go to Winchester or Cumberland, Maryland, for that. But if somebody came in from a car crash, we’d take care of them.” Clinic might be the best word to describe the place. So if Dottie’s heart fails, she will be hauled thirty-seven miles to the Winchester Medical Center in an ambulance tended by a couple of volunteers.


09-12-2012, 04:51 AM   #9
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Very nice quotation. I don't feel like it sheds a whole lot of light on the problem as a whole, but more on an unfortunate community's experience with poor medical care.

In every state, there are different rules and regs with regard to nursing home standards and obviously different ways in which Medicaid takes care of patients. I am not familiar with West Virginia and so I won't weigh in on the state of their long term care there.
09-12-2012, 05:21 AM   #10
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The graph that Nesster posted is really the most disturbing, especially in light of recent personal experience.



I just learned yesterday that every employee in my office with children has the children on Medicaid. The eye-opening part of that is finding out that this included an employee making in excess of median income and for which the employer pays 100% of individual coverage. I am told the cost of family coverage would still be something like 20% of the income of a single mother. This is insane.

Anyone who does not believe that health care is a major issue in our competitiveness has a head placed firmly under the soil.
09-12-2012, 05:25 AM   #11
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QuoteOriginally posted by GeneV Quote
The graph that Nesster posted is really the most disturbing, especially in light of recent personal experience.



I just learned yesterday that every employee in my office with children has the children on Medicaid. The eye-opening part of that is finding out that this included an employee making in excess of median income and for which the employer pays 100% of individual coverage. I am told the cost of family coverage would still be something like 20% of the income of a single mother. This is insane.

Anyone who does not believe that health care is a major issue in our competitiveness has a head placed firmly under the soil.
Medicare for all...........................

Now you realize my frustration, and fight..........AND how much better the economy would be (except for ins. companies) without the "burden" for individuals..
sometimes the "collective" is sooooooooooooooo blind.
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