Nevada just passed legislature that will give medicaid to all. Here's a link if you folks are curious

 

 

It would have been better had there been more details about the plan and its funding.

 

However, a move toward greater government involvement in ensuring health insurance access is likely in the United States, despite the fact that the GOP-majorities in congress and the President claim they want to repeal Obamacare and replace it with a more free-market-friendly solution.

I say the above based on polling on the subject, that has Americans saying "Yes, the government should be responsible for ensuring health care coverage for all Americans" by a 60% to 38% margin.  Although Republican voters were opposed (only 32% agreeing with the above statement), the poorest Republicans did agree (52% saying yes), and support for government ensuring health care coverage has risen in all age, income, and political groups over the prior year.

It is nice to see that we are finally starting to adopt better ideas.

I have always been in favor of anyone to buy-in to Medicaid. Medicaid is Government supplied healthcare for the poor, and no one ever pays into it. This would grant everyone an affordable means to get basic care. Now the only problem would be having enough doctors that accept Medicaid to take care of the mass influx of patients wanting to pay them with Medicaid.

 

Doctors don't like taking Medicaid.

I have always been in favor of anyone to buy-in to Medicaid. Medicaid is Government supplied healthcare for the poor, and no one ever pays into it. This would grant everyone an affordable means to get basic care. Now the only problem would be having enough doctors that accept Medicaid to take care of the mass influx of patients wanting to pay them with Medicaid.

 

Doctors don't like taking Medicaid.

In case you don't know why the medical community dislikes taking Medicaid:

 

When you take Medicaid you and your patients must agree to allow the government to audit your records including treatment notes. If the government funds that you did not dot every single i and cross every single t, they can force you refund payment of your services. This can happen months and months after the date of service. You can appeal, but ultimately you have little recourse.

 

To top that off, in my field, if someone does not show up for a session and doesn't call to cancel, they may be charged for the missed session. If you take Medicaid you cannot do this. It truly sucks to turn away a paying patient who genuinely needs help because the appointment slot is already taken, only to have the person who had that slot blow you off! The charge for missed appointments drastically reduces no show incidents.

 

In my state Medicaid pays as well as most insurance companies, but even when I used to accept insurance I refused Medicaid for the above reasons.

And insurance company's don't do this "dot all i's, cross all t's" melarky?

 

I have always been in favor of anyone to buy-in to Medicaid. Medicaid is Government supplied healthcare for the poor, and no one ever pays into it. This would grant everyone an affordable means to get basic care. Now the only problem would be having enough doctors that accept Medicaid to take care of the mass influx of patients wanting to pay them with Medicaid.

 

Doctors don't like taking Medicaid.

In case you don't know why the medical community dislikes taking Medicaid:

 

When you take Medicaid you and your patients must agree to allow the government to audit your records including treatment notes. If the government funds that you did not dot every single i and cross every single t, they can force you refund payment of your services. This can happen months and months after the date of service. You can appeal, but ultimately you have little recourse.

 

To top that off, in my field, if someone does not show up for a session and doesn't call to cancel, they may be charged for the missed session. If you take Medicaid you cannot do this. It truly sucks to turn away a paying patient who genuinely needs help because the appointment slot is already taken, only to have the person who had that slot blow you off! The charge for missed appointments drastically reduces no show incidents.

 

In my state Medicaid pays as well as most insurance companies, but even when I used to accept insurance I refused Medicaid for the above reasons.

 

Glad to have someone with first hand experience here to explain it. Thanks SM

And insurance company's don't do this "dot all i's, cross all t's" melarky?

No. They do not audit in the same way. With both Medicaid and commercial insurance both there can be plenty of roadblocks to getting paid. For example some policies require preapproval for treatment, which must be renewed, so every few weeks you have to apply for permission to keep treating a sick person, this may mean spending hours on the phone or doing paperwork for one patient. Also, most insurance companies make inexcusable mistakes processing claims on an alarmingly frequent basis, including sending payments and private info to the wrong person. But private insurance generally won't read all your progress notes and then demand their money back after paying you because you did not explain how each session applied to the specific goals on the treatment plan to their arbitrary satisfaction, or because you updated the treatment plan one day late. At least I haven't heard of that happening, anyway.

 

I could tell you stories about insurance companies and/or Medicaid that would blow your mind.

So it just beaurocracy doing the best at what it does the worst, beaurcratic oversight. No surprise there. Atleast here even the governmental insurance company is still run very independently from the beaurcracy itself and works just as fine as the private sector at keeping the paperwork between insurance and gov.

 

Guess it is mainly thus an issue of splitting the law-oversight from the law-enforcer, I'd guess the VA is run slightly better in that regard (ignoring the $$ issues in general)?

So it just beaurocracy doing the best at what it does the worst, beaurcratic oversight. No surprise there. Atleast here even the governmental insurance company is still run very independently from the beaurcracy itself and works just as fine as the private sector at keeping the paperwork between insurance and gov.

 

Guess it is mainly thus an issue of splitting the law-oversight from the law-enforcer, I'd guess the VA is run slightly better in that regard (ignoring the $$ issues in general)?

The VA is famously mismanaged, IDK the details about that, though.

 

As for beauracracy, well yes, that is part of the problem. I think the insurance companies make it hard to get paid in hopes that people will just give up and cut their losses. I think the goal is to not pay for anything they can avoid paying.

As for beauracracy, well yes, that is part of the problem. I think the insurance companies make it hard to get paid in hopes that people will just give up and cut their losses. I think the goal is to not pay for anything they can avoid paying.

 

 

This is true, but I don't think the government would be much better in that regard.

Hence you need a kind of middle ground, the mentality of a beaurocracy but no desire to make personal profit. Our healthcare insurancers are rooted (but not all) in the unions (of various "ideologies") and they do a brilliant job of understabbing eachother (yay lots of bonus stuff) and herassing the government in being allowed to repay everything.

So it just beaurocracy doing the best at what it does the worst, beaurcratic oversight. No surprise there. Atleast here even the governmental insurance company is still run very independently from the beaurcracy itself and works just as fine as the private sector at keeping the paperwork between insurance and gov.

 

Guess it is mainly thus an issue of splitting the law-oversight from the law-enforcer, I'd guess the VA is run slightly better in that regard (ignoring the $$ issues in general)?

There's a whole industry in USA whose job is to manage paperwork between the doc and insurances and follow up on those claims. I assume it's bit better now as most insurances have transferred to exchange the information electronically, as opposed to actual paper forms with 50+ fields being sent by mail, what's it called? HCFAs? 

pffft, no bureacracy works unless a dozen forms have been processed in triplicate, don't you know that?