Lets just say they do that and take on all the cost of Medicaid...Where is that tax money going to come from...The taxpayer will be force to pay a higher state tax..The only good thing is then maybe the burden with be had by all ,instead of on the backs of the property owner................
Medicaid is a program that is not solely funded at the federal level. States provide up to half of the funding for the Medicaid program. In some states, counties also contribute funds. Unlike the Medicare entitlement program, Medicaid is a means-tested, needs-based social welfare or social protection program rather than a social insurance program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare, mostly in preventative medicine.
In that sense it would be better to be paying for our locals in need, rather than the entire state. The true question is, if Genesee county assumes our share, does that obsolve us from medicare payments accross the state, or is this in lieu of our state's contribution to the Federal government?
Also, when Obamacare starts to kick in in 2014, the plan is to increase eligibilty of medicaid to 133% of the poverty line,with intent of insuring more people, will that create a situation locally where the increase in medicaid recipients places undo burden on local taxpayers. I don't know the exact demographics, but I see it as a valid question.
All in all, if it means keeping our locals covered first, I would be for it.
Perhaps we should, when it comes to Medicaid, stop emphasizing managed care and go back to having health clinics for the poor (typically non-profits aided by the government). Doctors will be hired by clinics (part time or many would probably just volunteer) so private practices will have more space, Medicaid patients would receive better and more direct care as billing Medicaid is such a nightmare that many doctors do not participate and it will save piles of money. It probably would also cut down dramatically on emergency room visits, which end up hurting everyone.
Dan, why is it that the Federal Government should do anything?
One of the major cost drivers in health care now is that the Federal government only pays 57 cents on the dollar for the true expenditures of medicaid, This forces hospitals and Doctors to increase cost to insured or cash paying patients to cover thier own cost.
I do not believe in top down government myself, and I can find no example anywhere, where the Federal government has done anything but increase health care cost in general.
I like your county clinic idea, as long as it is funded and controlled locally. Tha still leads to my question, if the county assumes it's share of medicaid, does that absolve us from contributing to overall medicaid cost statewide. If it in fact does, it may turn out to be a better deal for tax payers in Genesee County, if not, then what would be the point?
Mark - I think that moving away from horrendously costly managed care would be a big cost saver, the current system as is makes it impossible for doctors to be compensated fairly for treating medicaid patients and means that we have to have an entire bureaucracy to administer the program. All of that would be gone. Moving to a clinic based model would give local governments control of how to provide services, and doctors (and other staff) would just bill the clinic for their services or work for it directly. As is, many doctors just end up treating medicaid patients pro bono because medicaid billing is so complicated that it's easier for them to just take care of them without doing so.....but that comes at a cost to their practice and they obviously can't serve the entire population of Medicaid patients that way. This way, those doctors could just care for those patients directly, and many would probably end up just volunteering their time. Medicaid patients also could actually get the care they need and not have to be punished because of the inefficiency of the way the program is currently set up.
I like to think of it as an idea that's non-ideological, it combines the best of the left and the right instead of the worst. It provides people the care they need, except in a local and cost efficient way.
I don't see it as exactly ideological, just logical.
UMMC has had several clinics around the county and in Attica for years, the intent was convience for senior citizens and promoting preventative care, unfortunately one is closing do to less than optimal use. I don't remember off had whether it was in Byron or Bergen, As that one closes the clinic in the Jerome center is going to increase a bit.
These clinics are used primarily, not entirely by Medicaid and medicare patients, I just see our dollars better spent on our community rather than accross the the state for other communities.
Maybe I shopuld rephrase my question, is genesee counties share, based on what citizens using medicaid use or is it medicaid usage for the entire state divided up
Funny you should bring that up Daniel, and we are very close in thought I believe.
I have been reading quite a bit by Dr Lee Hieb from AZ, she is a spinal surgeon in the phoenix area and a renowned one that. She came out as an outspoken critic of Government health care not from a political point of view, but from a purely pragmatic approach. She is the daughter of a doctor, who is the son and grandson of a doctor, pretty much health care in the blood.
She uses the 3 C's of medicine argument
1) Cash- For preventative and day to day health care using cash reduces the price for those that can pay.
2) Catostrophic Insurance - for injury, serious and longterm illness, by limiting insurance to the Catostrophic, Prices would be dramatically reduced.
3) Charity, not in the sense of fundraisers, but in the sense of communities taking care of thier own.
I could make a case for health care being a local issue -- locally funded and locally controlled.
My complaint about medicare as constructed now is an irrational amount of local taxes go to the program with zero local control.
If it really cost us as a community $9 million annually to ensure all of our neighbors had adequate medical coverage, at least the money is staying local.
Currently, we have no idea how the money is being spent, if it's being spent wisely, if the best, most cost effective local coverage is really being provided and how much is going to unnecessary overhead.
Setting aside the libertarian argument for no government involvement, if you're going to have a medical program, it should be locally funded and locally controlled. If it's not locally controlled, then it's up to the state and the feds to fund it and let our local money go to local needs. Property tax and sales tax should stay entirely local.
A case can also be made Howard, that as more and more of our day to day lives, especially medical decisions are made in Albany or Washington, the less the charity and the sense of community.
That was my original question, if we are assuming our share of medicaid funding, does that necessarily mean that we are paying for our local folks who are in need or are we just helping the state balance a federally mandated part of it's budget?
I do not believe anyone mentioned skilled nursing facilities. The vast majority of occupied beds at the nursing homes in our county are not self-pay. Most of these people were productive members of society, paid their share of taxes, had health insurance and a regular family doctor for years, and raised families who are now grown and pay their fair share. In their final years, they have found themselves in the unfortunate situation of multiple health issues which require more care than can be provided at home. Who can afford $8k+ per month?
Long-term care insurance purchased by working people when young would greatly reduce the financial burden on our community. No one longs to go to a nursing home, and for most, it is the worst imaginable situation to end up in. Most say that they will never end up in a nursing home or that they would never put a family member in one. Reality is in charge and sometimes what we wish for and what ends up happening are two very different things. Just as with retirement money and the need to plan for ourselves instead of a Social Security net that will be gone, we need to make planning for long-term care move to the forefront.
New York state already has an insurance program in place. http://www.nyspltc.org/ If you have a 401k, Roth IRA, 529, etc. - why not Long Term Care Insurance?
Lets just say they do that
Lets just say they do that and take on all the cost of Medicaid...Where is that tax money going to come from...The taxpayer will be force to pay a higher state tax..The only good thing is then maybe the burden with be had by all ,instead of on the backs of the property owner................
Medicaid is a program that is
Medicaid is a program that is not solely funded at the federal level. States provide up to half of the funding for the Medicaid program. In some states, counties also contribute funds. Unlike the Medicare entitlement program, Medicaid is a means-tested, needs-based social welfare or social protection program rather than a social insurance program. Eligibility is determined largely by income. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare, mostly in preventative medicine.
In that sense it would be better to be paying for our locals in need, rather than the entire state. The true question is, if Genesee county assumes our share, does that obsolve us from medicare payments accross the state, or is this in lieu of our state's contribution to the Federal government?
Also, when Obamacare starts to kick in in 2014, the plan is to increase eligibilty of medicaid to 133% of the poverty line,with intent of insuring more people, will that create a situation locally where the increase in medicaid recipients places undo burden on local taxpayers. I don't know the exact demographics, but I see it as a valid question.
All in all, if it means keeping our locals covered first, I would be for it.
The federal government should
The federal government should pick up the slack for Medicaid, states and counties should not have to eat their crow.
Perhaps we should, when it
Perhaps we should, when it comes to Medicaid, stop emphasizing managed care and go back to having health clinics for the poor (typically non-profits aided by the government). Doctors will be hired by clinics (part time or many would probably just volunteer) so private practices will have more space, Medicaid patients would receive better and more direct care as billing Medicaid is such a nightmare that many doctors do not participate and it will save piles of money. It probably would also cut down dramatically on emergency room visits, which end up hurting everyone.
Mark, Check your guestbook
Mark,
Check your guestbook entries,
Thanks Ron. Got it good luck
Thanks Ron. Got it good luck in your quest .. I mean that , it is a pot worth stirring
Dan, why is it that the
Dan, why is it that the Federal Government should do anything?
One of the major cost drivers in health care now is that the Federal government only pays 57 cents on the dollar for the true expenditures of medicaid, This forces hospitals and Doctors to increase cost to insured or cash paying patients to cover thier own cost.
I do not believe in top down government myself, and I can find no example anywhere, where the Federal government has done anything but increase health care cost in general.
I like your county clinic idea, as long as it is funded and controlled locally. Tha still leads to my question, if the county assumes it's share of medicaid, does that absolve us from contributing to overall medicaid cost statewide. If it in fact does, it may turn out to be a better deal for tax payers in Genesee County, if not, then what would be the point?
Mark - I think that moving
Mark - I think that moving away from horrendously costly managed care would be a big cost saver, the current system as is makes it impossible for doctors to be compensated fairly for treating medicaid patients and means that we have to have an entire bureaucracy to administer the program. All of that would be gone. Moving to a clinic based model would give local governments control of how to provide services, and doctors (and other staff) would just bill the clinic for their services or work for it directly. As is, many doctors just end up treating medicaid patients pro bono because medicaid billing is so complicated that it's easier for them to just take care of them without doing so.....but that comes at a cost to their practice and they obviously can't serve the entire population of Medicaid patients that way. This way, those doctors could just care for those patients directly, and many would probably end up just volunteering their time. Medicaid patients also could actually get the care they need and not have to be punished because of the inefficiency of the way the program is currently set up.
I like to think of it as an
I like to think of it as an idea that's non-ideological, it combines the best of the left and the right instead of the worst. It provides people the care they need, except in a local and cost efficient way.
I don't see it as exactly
I don't see it as exactly ideological, just logical.
UMMC has had several clinics around the county and in Attica for years, the intent was convience for senior citizens and promoting preventative care, unfortunately one is closing do to less than optimal use. I don't remember off had whether it was in Byron or Bergen, As that one closes the clinic in the Jerome center is going to increase a bit.
These clinics are used primarily, not entirely by Medicaid and medicare patients, I just see our dollars better spent on our community rather than accross the the state for other communities.
Maybe I shopuld rephrase my question, is genesee counties share, based on what citizens using medicaid use or is it medicaid usage for the entire state divided up
Mark - I can imagine the
Mark - I can imagine the formula would be some combination of what you described above.
Funny you should bring that
Funny you should bring that up Daniel, and we are very close in thought I believe.
I have been reading quite a bit by Dr Lee Hieb from AZ, she is a spinal surgeon in the phoenix area and a renowned one that. She came out as an outspoken critic of Government health care not from a political point of view, but from a purely pragmatic approach. She is the daughter of a doctor, who is the son and grandson of a doctor, pretty much health care in the blood.
She uses the 3 C's of medicine argument
1) Cash- For preventative and day to day health care using cash reduces the price for those that can pay.
2) Catostrophic Insurance - for injury, serious and longterm illness, by limiting insurance to the Catostrophic, Prices would be dramatically reduced.
3) Charity, not in the sense of fundraisers, but in the sense of communities taking care of thier own.
http://www.youtube.com/watch?v=p0ffif1DTT8
She is quite prolific, and she has some really interesting thoughts about reforming medicaid and medicare
I could make a case for
I could make a case for health care being a local issue -- locally funded and locally controlled.
My complaint about medicare as constructed now is an irrational amount of local taxes go to the program with zero local control.
If it really cost us as a community $9 million annually to ensure all of our neighbors had adequate medical coverage, at least the money is staying local.
Currently, we have no idea how the money is being spent, if it's being spent wisely, if the best, most cost effective local coverage is really being provided and how much is going to unnecessary overhead.
Setting aside the libertarian argument for no government involvement, if you're going to have a medical program, it should be locally funded and locally controlled. If it's not locally controlled, then it's up to the state and the feds to fund it and let our local money go to local needs. Property tax and sales tax should stay entirely local.
A case can also be made
A case can also be made Howard, that as more and more of our day to day lives, especially medical decisions are made in Albany or Washington, the less the charity and the sense of community.
That was my original question, if we are assuming our share of medicaid funding, does that necessarily mean that we are paying for our local folks who are in need or are we just helping the state balance a federally mandated part of it's budget?
Without local control, Mark
Without local control, Mark -- and the sense of local community that goes with it -- we have no way of knowing.
Paying off one credit card
Paying off one credit card with another credit card.
Good Point Howard
Good Point Howard
I do not believe anyone
I do not believe anyone mentioned skilled nursing facilities. The vast majority of occupied beds at the nursing homes in our county are not self-pay. Most of these people were productive members of society, paid their share of taxes, had health insurance and a regular family doctor for years, and raised families who are now grown and pay their fair share. In their final years, they have found themselves in the unfortunate situation of multiple health issues which require more care than can be provided at home. Who can afford $8k+ per month?
Long-term care insurance purchased by working people when young would greatly reduce the financial burden on our community. No one longs to go to a nursing home, and for most, it is the worst imaginable situation to end up in. Most say that they will never end up in a nursing home or that they would never put a family member in one. Reality is in charge and sometimes what we wish for and what ends up happening are two very different things. Just as with retirement money and the need to plan for ourselves instead of a Social Security net that will be gone, we need to make planning for long-term care move to the forefront.
New York state already has an insurance program in place. http://www.nyspltc.org/ If you have a 401k, Roth IRA, 529, etc. - why not Long Term Care Insurance?
Karen, good point. Thanks for
Karen, good point.
Thanks for the information.
Excellent point Kelly!
Excellent point Kelly!