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States, first and foremost, have a responsibility to be fiscally responsible. If a Medicaid expansion is deemed by the states to be an irresponsible fiscal policy that leaves them holding the bag, then why should they sign on? Why are State government's responsible for the healthcare needs of its citizens? No doubt about it, healthcare access is a noble cause. But States' focus should be on economic prosperity for all.
The cost of Medicaid is an issue but how will the people living above the threshold for Medicaid but below the income threshold for ACA get health care not presently available. Meanwhile almost all republican controlled states refused Medicaid Expansion to cover this segment of the uninsured poor.
This gives Democrats another issue to use against the GOP. The GOP is more concerned with ideology than with governing. Voters will have to knock them around for a while before they get the hint.
Single payer will likely happen regardless of hiliary because the ACA is designed to fail.
People will get fed up with the ACA. It not cheap. Millions will still end up without insurance.
The only real issue with single payer and it's a huge issue is how to pay for it. Germany is facing huge pressures trying to control its own health care cost. It recently had to raise individual taxes for health care to I believe 8.5%? And employers still need to kick in 7%. That's a total of 15.5% of taxes from employer and employee to pay for single payer.
So many confuse single payer with free. Instead of paying insurance premiums/subsidies, employers and employees are taxed.
No two nations with single payer do it the same way. In Germany, their single payer more closely resembles Medicare insurance and the masses encouraged to carry supplemental policies to help with the out of pocket costs. In Germany, prices are negotiated with hospitals and big pharm.
The Swiss mandate everyone to buy defined private insurance. The concept of group health insurance subsidized by employers does not exist. Neither does the concept of Medicare/Medicaid. About 40% of the people receive government subsidies.
Premiums are more affordable because most hospitals are owned and operated by government.
In contrast, we now have a mandate similar to the Swiss but no control over the costs.
Without a 500 pound gorilla in the room, there is no reasonable way to mitigate costs.
Health care eats 16% of GDP in the US. It really is going to take a LOT of money to have single payer, insurance or whatever. Germany has admin costs that are a fraction of what they are in the US and most people are in non-profits lowering the cost more. But anyone who thinks there is going to be a free lunch, now in the exchanges, or later if we go true universal is in for a shock.
Absolutely.
One is not going to find non MD Sr. hospital administrators making $ 1-5 million salaries, exclusive of incentive comp.
One is not going to find senior management earning incentive comp by holding the line on the rank and file.
One is not going to find hospitals and Cancer Treatment Centers with huge budgets to build and market the brand.
One is not going to find hospitals and Cancer Treatment Centers with business plans to kill or acquire the competition to dominate the market.
One is not going to find incentive plans for MDs to refer X amount of business and prescribe Y amount of certain medications.
One is not going to find hospital and medical equipment manufacturer trade associations and Big Pharma lobbying the legislator to make decisions in their best interests.
No real surprise - there have always been foot-draggers.
Recall that Medicaid was established by law in 1965. When it went into effect in 1967, 24 states initially did not participate. Four years later, in 1969, there were still 9 holdouts. Alaska was obstinate until 1972, and Arizona until 1982. http://kaiserfamilyfoundation.files....13/01/8349.pdf
There are always those who need to be dragged kicking and screaming into the future. So it is today with the Affordable Care Act.
If your idea of "the future" includes having the government force you to buy a product you do not want, the loss of liberty and a giant leap towards communism, then you can keep that future. I want no part of that future. No true American would.
This is where you and your communist buddies start rounding up people for concentration... Oops! I meant "reeducation" camps. I hope you are prepared for a lot of death.
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