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Ideas to reform medicaid

ClarindaA's

ClarindaA's

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Jun 3, 2002
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1) Any ER visit will cost $50 out of pocket for those on then government tit. This would hopefully keep people from abusing their government paid for insurance, as well as ER departments

2) Every visit to a healthcare provider costs $15. Again, have some skin in the game.

3) Double the taxes on cigarettes, alcohol, pop, junk food, add a tax to fast food. Self explanatory.

4) Revisit Michelle Obama’s lunch program, tweak it a bit to add more protein.
5) Teach fitness and nutrition for 2 periods a day, starting in 1st grade. Maybe the kids can guilt thief parents into actually giving a damn about those two subjects.
 
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ClarindaA's said:
1) Any ER visit will cost $50 out of pocket. This would hopefully keep people from abusing their government paid for insurance, as well as ER departments

2) Every visit to a healthcare provider costs $15. Again, have some skin in the game.

3) Double the taxes on cigarettes, alcohol, pop, junk food, add a tax to fast food. Self explanatory.

4) Revisit Michelle Obama’s lunch program, tweak it a bit to add more protein.
5) Teach fitness and nutrition for 2 periods a day, starting in 1st grade. Maybe the kids can guilt thief parents into actually giving a damn about those two subjects.
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@The Tradition was getting hard until you raised point three.

For the record, I agree with you on everything but point three.
 
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My biggest issue with Michelle Obama’s changes to school lunch was the amount of food given. Make the food healthy and plentiful. And for gods sake if you are trying to encourage them to eat healthy make it appealing. Have schools build gardens and greenhouses where they can grow fruits and vegetables that are served in the cafeteria. Utilize culinary programs to design menus and prepare foods. The goal shouldn’t be forcing “healthy” foods on kids. It should be teaching them that eating healthy doesn’t mean being hungry or unsatisfied.
 
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3boysmom said:
My biggest issue with Michelle Obama’s changes to school lunch was the amount of food given. Make the food healthy and plentiful. And for gods sake if you are trying to encourage them to eat healthy make it appealing. Have schools build gardens and greenhouses where they can grow fruits and vegetables that are served in the cafeteria. Utilize culinary programs to design menus and prepare foods. The goal shouldn’t be forcing “healthy” foods on kids. It should be teaching them that eating healthy doesn’t mean being hungry or unsatisfied.
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Clarinda and you are correct it needs tweaked. Michelle was on the right track, though.
 
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Encode into the emtala laws the ability of hospitals to refuse ED treatment to a patient not in an emergency condition.
 
I could go for most of this if we make similar adjustments to regular healthcare. I have a prescription now that I pay less than $1 for - there is no reason I shouldn't be paying $15 as well. I'm not sure about the Emergency room price as that may encourage people to go there. I think having more urgent care centers available and marketing them as alternatives to the ER would be helpful as well.

And let Medicare negotiate with the pharmaceutical companies to get the best prices.
 
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RileyHawk said:
I could go for most of this if we make similar adjustments to regular healthcare. I have a prescription now that I pay less than $1 for - there is no reason I shouldn't be paying $15 as well. I'm not sure about the Emergency room price as that may encourage people to go there. I think having more urgent care centers available and marketing them as alternatives to the ER would be helpful as well.

And let Medicare negotiate with the pharmaceutical companies to get the best prices.
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Riley, you are confused, ER visits don’t cost much for Medicaid now, I’m stating it needs to cost them more, they abuse it. I agree on urgent care. As far as meds, we could agree on 10 dollars
 
BlackNGoldBleeder said:
I don’t believe what would ostensibly be a tax on poor people would be that beneficial. What should happen is marijuana should be legalized at the federal level and the tax revenue from that could be put into healthcare.
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I agree about weed, but raise the taxes on cigs enough that it’s truly unavailable to people who aren’t well off. I’m helping take care of my brother in law( by all accounts a useless eater) he knows everything, never able to keep a job, still drinks and smokes, he won’t quit smoking despite our attempts….yet I have to help pay his rent….eff that
 
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ClarindaA's said:
I agree about weed, but raise the taxes on cigs enough that it’s truly unavailable to people who aren’t well off. I’m helping take care of my brother in law( by all accounts a useless eater) he knows everything, never able to keep a job, still drinks and smokes, he won’t quit smoking despite our attempts….yet I have to help pay his rent….eff that
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I’m fine with more taxes on cigs.
 
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ClarindaA's said:
Riley, you are confused, ER visits don’t cost much for Medicaid now, I’m stating it needs to cost them more, they abuse it. I agree on urgent care. As far as meds, we could agree on 10 dollars
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I understand that. I think making it a flat $50 will encourage some who aren't using the ER today to do so.
 
RileyHawk said:
I understand that. I think making it a flat $50 will encourage some who aren't using the ER today to do so.
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They don’t pay as is. I’m not talking everyone gets $50!visits, I’m saying Medicaid patients need to pay and have some pain financially
 
ClarindaA's said:
They don’t pay as is. I’m not talking everyone gets $50!visits, I’m saying Medicaid patients need to pay and have some pain financially
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Ok. I do understand. I'm simply saying there may be a lot of people on Medicaid who don't use the ER unless necessary who, for $50, might do so instead of waiting for their doctor. Maybe not. The premise is sound on the face of it, but there are also a lot of Medicaid patients who don't have $50 or a reasonable alternative to the ER. I think the first thing would be to make more care facilities available that can handle emergencies and also preventative care. Along with a campaign to make these resources widely known. Too many people who go to the ER don't know of anyplace else to go.

Again, overall I agree with your ideas.
 
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RileyHawk said:
Ok. I do understand. I'm simply saying there may be a lot of people on Medicaid who don't use the ER unless necessary who, for $50, might do so instead of waiting for their doctor. Maybe not. The premise is sound on the face of it, but there are also a lot of Medicaid patients who don't have $50 or a reasonable alternative to the ER. I think the first thing would be to make more care facilities available that can handle emergencies and also preventative care. Along with a campaign to make these resources widely known. Too many people who go to the ER don't know of anyplace else to go.

Again, overall I agree with your ideas.
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I feel like a lot of people who don’t have any skin in the game abuse the ER with non emergencies. Talking with providers, they get frustrated with mom’s bringing in kids with colds, when they could have made an appointment with their primary care provider, they do steer them to walk in often, but it’s still overkill. Urgent care is still not the place for a kid with a 99.3 fever and mild symptoms
 
3boysmom said:
My biggest issue with Michelle Obama’s changes to school lunch was the amount of food given. Make the food healthy and plentiful. And for gods sake if you are trying to encourage them to eat healthy make it appealing. Have schools build gardens and greenhouses where they can grow fruits and vegetables that are served in the cafeteria. Utilize culinary programs to design menus and prepare foods. The goal shouldn’t be forcing “healthy” foods on kids. It should be teaching them that eating healthy doesn’t mean being hungry or unsatisfied.
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I largely agree with you, but with most schools not in session over the summer, gardens are a tough thing to accomplish. My wife is a teacher and we have sort of attempted this and it just didn't get off the ground due to summer schedules, etc.

I totally agreed with Michelle's focus on healthy eating, but the details were quite problematic and I heard from MANY affected students that they couldn't get enough to eat under that program. Causing kids to be hungry is NOT a winning strategy, FWIW. But...hopefully there can be a refocus and improvement on the details so it can be successful.

I
 
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ClarindaA's said:
Riley, you are confused, ER visits don’t cost much for Medicaid now, I’m stating it needs to cost them more, they abuse it. I agree on urgent care. As far as meds, we could agree on 10 dollars
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Clarinda.....come to an ED sometime and observe for a metro 24 hr. period and you will quickly see how unreasonable and how unworkable your proposal becomes. I understand your frustration....but imagine the frustration this will create for the providers and staff of most EDs/clinics.
 
joelbc1 said:
Clarinda.....come to an ED sometime and observe for a metro 24 hr. period and you will quickly see how unreasonable and how unworkable your proposal becomes. I understand your frustration....but imagine the frustration this will create for the providers and staff of most EDs/clinics.
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Why is it unreasonable, it means less people they have to see
 
ClarindaA's said:
I feel like a lot of people who don’t have any skin in the game abuse the ER with non emergencies. Talking with providers, they get frustrated with mom’s bringing in kids with colds, when they could have made an appointment with their primary care provider, they do steer them to walk in often, but it’s still overkill. Urgent care is still not the place for a kid with a 99.3 fever and mild symptoms
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I'm sure there are those cases. Medicaid suggests the patients have little money to begin with so I'm not confident adding a charge will be the answer. It may be that many of those who go to ERs don't have or don't know of a walk-in or urgent care that they can go to that accepts Medicaid. More facilities that have lower overhead need to be available to Medicaid patients.
 
RileyHawk said:
I'm sure there are those cases. Medicaid suggests the patients have little money to begin with so I'm not confident adding a charge will be the answer. It may be that many of those who go to ERs don't have or don't know of a walk-in or urgent care that they can go to that accepts Medicaid. More facilities that have lower overhead need to be available to Medicaid patients.
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I’m trying to steer them there by charging them for the ER. Trust me, in rural iowa, it’s dumb redneck moms bringing non ER cases in, then bitching when nothing is done for their kid who has a cough, meanwhile she’s a pack a day smoker.
 
RileyHawk said:
I'm sure there are those cases. Medicaid suggests the patients have little money to begin with so I'm not confident adding a charge will be the answer. It may be that many of those who go to ERs don't have or don't know of a walk-in or urgent care that they can go to that accepts Medicaid. More facilities that have lower overhead need to be available to Medicaid patients.
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But they aren't. That is but on part of the problem. Also, if you are on MedicAid, you are POOR....really POOR. You probably don't have 2 stones to rub together on a good day. Much less $50! Hellsbells, if you are on MedicAid, you probably do not have access to an ED other than police or ambulance....Police are not a "taxi service" and ambulance services charge $$$$! Life on the street.....life as a real POOR (for whatever reason) is something that 99% of the folks here cannot imagine. Poverty is a bitch. Being broke is bad enough but a temporary condition in most cases.....but living in poverty with no way to turn is far worse.
 
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ClarindaA's said:
I’m trying to steer them there by charging them for the ER. Trust me, in rural iowa, it’s dumb redneck moms bringing non ER cases in, then bitching when nothing is done for their kid who has a cough, meanwhile she’s a pack a day smoker.
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If they have no place else to go in a timely fashion many are going to the ER anyway and will ignore the bill. If they had an equally convenient place to go instead of the ER it would be pretty easy to have them go there and be a lot less costly.

I'm sure your idea would work for some, I just don't think it would be enough to make it worthwhile.
 
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joelbc1 said:
But they aren't. That is but on part of the problem. Also, if you are on MedicAid, you are POOR....really POOR. You probably don't have 2 stones to rub together on a good day. Much less $50! Hellsbells, if you are on MedicAid, you probably do not have access to an ED other than police or ambulance....Police are not a "taxi service" and ambulance services charge $$$$! Life on the street.....life as a real POOR (for whatever reason) is something that 99% of the folks here cannot imagine. Poverty is a bitch. Being broke is bad enough but a temporary condition in most cases.....but living in poverty with no way to turn is far worse.
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That's why we're talking about potential solutions.
 
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joelbc1 said:
But they aren't. That is but on part of the problem. Also, if you are on MedicAid, you are POOR....really POOR. You probably don't have 2 stones to rub together on a good day. Much less $50! Hellsbells, if you are on MedicAid, you probably do not have access to an ED other than police or ambulance....Police are not a "taxi service" and ambulance services charge $$$$! Life on the street.....life as a real POOR (for whatever reason) is something that 99% of the folks here cannot imagine. Poverty is a bitch. Being broke is bad enough but a temporary condition in most cases.....but living in poverty with no way to turn is far worse.
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They are available, many towns have urgent or walk in care, it’s a misuse of both hospital resources and taxes for people to abuse the the ER.
 
ClarindaA's said:
They are available, many towns have urgent or walk in care, it’s a misuse of both hospital resources and taxes for people to abuse the the ER.
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Many of those do not accept Medicaid. That's another big issue.
 
RileyHawk said:
Many of those do not accept Medicaid. That's another big issue.
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If they are hospital affiliated, they do. Look at some point, poors can look at their phone and find the urgent care, or on the back of their Medicaid card it should tell them what isn’t ER appropriate. Also, we should tax them out of the ability to smoke.
 
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ClarindaA's said:
They are available, many towns have urgent or walk in care, it’s a misuse of both hospital resources and taxes for people to abuse the the ER.
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Most "emergent care" or "walk-in clinics" are not 24/7 and not weekend friendly. They miss more patients than they catch. And for women, it is even worse since the war on Planned Parenthood was started by political forces of the right. These are all factors that need to be considered.
 
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ClarindaA's said:
I agree about weed, but raise the taxes on cigs enough that it’s truly unavailable to people who aren’t well off. I’m helping take care of my brother in law( by all accounts a useless eater) he knows everything, never able to keep a job, still drinks and smokes, he won’t quit smoking despite our attempts….yet I have to help pay his rent….eff that
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Wouldn't help, i have neighbors buying smokes $10. a cartoon from the Indian reservations, casinos (0 TAXES). They take turns once a month supplies.
 
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3boysmom said:
My biggest issue with Michelle Obama’s changes to school lunch was the amount of food given. Make the food healthy and plentiful. And for gods sake if you are trying to encourage them to eat healthy make it appealing. Have schools build gardens and greenhouses where they can grow fruits and vegetables that are served in the cafeteria. Utilize culinary programs to design menus and prepare foods. The goal shouldn’t be forcing “healthy” foods on kids. It should be teaching them that eating healthy doesn’t mean being hungry or unsatisfied.
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The problem was we were throwing away hundreds of pounds of food a week. Kids wouldn’t eat it. Parents, and we are guilty in my home, not teaching kids to eat properly. I tried but the 3 women here are picky to extremely picky eaters. We can’t get the 20 year old to try anything outside the box.
 
ClarindaA's said:
If they are hospital affiliated, they do. Look at some point, poors can look at their phone and find the urgent care, or on the back of their Medicaid card it should tell them what isn’t ER appropriate. Also, we should tax them out of the ability to smoke.
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I don't believe that's accurate. Many facilities and doctors don't accept Medicaid, that's a big reason ERs get backed up with non-emergency patients. If your proposal includes making urgent care and walk in facilities take Medicare then I think it's more supportable.

I agree with raising the taxes on vice products but not as a disincentive to poor people. That won't work. We know people will spend $$ on addictions before food or shelter or healthcare. It will raise significant funds from those who are not poor, however.
 
joelbc1 said:
Most "emergent care" or "walk-in clinics" are not 24/7 and not weekend friendly. They miss more patients than they catch. And for women, it is even worse since the war on Planned Parenthood was started by political forces of the right. These are all factors that need to be considered.
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You are missing the point, most of the time the poors are going on with non emergencies
 
ClarindaA's said:
You are missing the point, most of the time the poors are going on with non emergencies
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And you're missing the bigger point that they are doing so because there are few other places for them to go. I just asked my wife, who is an RN and has worked with Medicare and Medicaid reimbursements, about walk-in clinics and they do not take Medicaid generally. Patients have to go to community healthcare or a family doctor who takes Medicaid. The availability of those is quite limited.
 
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Sin taxes sound great at first blush, but you're not going to fund anything that way.

The tax will result in less consumption, and therefore less revenue. And the higher you crank up the tax, the less revenue you'll get as people either stop consuming or look for alternatives, and the black market steps in.

It's a recipe for diminishing returns.

But you holier-than-thou types will be happy.
 
RileyHawk said:
And you're missing the bigger point that they are doing so because there are few other places for them to go. I just asked my wife, who is an RN and has worked with Medicare and Medicaid reimbursements, about walk-in clinics and they do not take Medicaid generally. Patients have to go to community healthcare or a family doctor who takes Medicaid. The availability of those is quite limited.
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If they are affiliated with a hospital, they do. All the urgent care in SW Iowa take medicaid
 
I think it is important to identify and achieve consensus on the compelling problems before starting in on the solutions. I’m not trying to be obtuse, I think it makes for a more meaningful discourse.
 
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