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Doctors, Patients Need to Talk About Care Costs

In a time of high deductibles, medical debt is rising.

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Photo by Adam Berry/Getty Images

No matter how great your physician is, there is one question he or she is unlikely to answer: “How much will that cost?”

It is not really their fault. Medical schools and residency training programs have traditionally shied away from teaching costs. For the most part, costs remain hidden even from many practicing physicians. Some would argue this is for good reason, since doctors should be making decisions based on medical need without clouding that judgment with considerations of potential costs. That intention is noble, but in practice, it often leads to doctors inadvertently saddling patients with expensive medical bills. Doctors and patients both need to better communicate about this problem and work together to find solutions if the financial burden would be too much.

A Monmouth University poll recently found that paying for health care is the top concern of American families, beating out job security and other household bills. Similarly, when Gallup asks Americans “what is the most urgent health problem facing this country,” cost consistently tops the list.

One reason for this concern is more Americans than ever are on high-deductible health plans. This means even seemingly simple medical decisions could result in substantial out-of-pocket costs for patients. With increased price sensitivity comes new requests.

Nobody knows exactly what the current administration will do to change health care coverage, but based on current Republican proposals it seems likely the number of high-deductible plans—and “consumer-driven health plans” such as health savings accounts—will continue to grow.

As the responsibility shifts more to patients covering the cost, the result is that more than a quarter of Americans say that someone in their household is currently struggling to pay medical debts. This leads to Americans putting off needed care.

When faced with a tragedy, too many Americans have their lives saved but their life savings decimated. Oncologists have begun to understand this problem, coining it “financial toxicity” and considering it an unintended consequence of their treatments. Just like other side effects of chemotherapy, such as losing one’s hair, this does not mean it is always avoidable, but at least by recognizing the issue, these doctors and patients can be more aware of the situation and can work on trying to navigate the problem together. Knowledge is power.

More doctors should care about the costs that patients need to pay, and help with ensuring that the recommendations they make are the best options for the patient sitting in front of them. For example, there are a wide array of choices for many medication classes, such as statins or oral contraceptives. Physicians can help identify the option that will be the most cost-effective for a given patient. Health care professionals also can learn and share specific “tips” with patients, such as informing them about the $4 generic medication lists or drug price lists.

A number of new tools are also emerging to make this easier for patients and physicians. One free website and application provides local searches to find the lowest-cost pharmacy for your specific prescriptions. When considering medical tests or procedures such as an MRI or knee surgery, there are a handful of options currently available for the public to research prices. Healthcare Bluebook and Guroo are two websites that claim to provide a search of prices within your area and to help you determine a “fair price.”

Physicians should go further and take responsibility for helping patients understand the complex world of medical financing. Oftentimes, it does not even have to be the physician, but rather a designated person within the practice who can give patients more in-depth answers.

Research studies show that patients often do not bring up their troubles with paying for their medications or medical care with their doctors. It is likely that this has created the illusion for physicians that their patients do not want to talk about costs, or that all is fine. Your doctors went to medical school because they committed to helping patients with their needs. If you need help with understanding the financial ramifications of their care, then you should start by asking about it.

Christopher Moriates, M.D., is the assistant dean for health care value in the Dell Medical School at The University of Texas at Austin. He will  lead a session called “Hey Doc, How Much Will That Cost?” on March 12 at the 2017 South by Southwest festival.

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  • Fantasy Maker

    We have way too many fat, out of shape, junk food eating and soft drink swigging idiots to ever bend the cost curve of healthcare. Modern day medicine is keeping older people alive but I cannot say their quality of life is much better.
    The medical community is more than happy to grow and profit from fat, lazy and ignorant people.

    • BCinBCS

      Fantasy Maker, I just don’t have words to describe your bullshit.

      • Fantasy Maker
        • BCinBCS

          I’m not questioning the data, I’m questioning your use of it as an excuse for dissing the health care community and your blanket condemnation of the overweight as lazy and ignorant.

          • Sam Jacinto

            One of the overweight (the guy in the White House) really is ignorant.

          • SpiritofPearl

            He eats junk food and exercises rarely.

          • WUSRPH

            He hits a golf ball every chance he gets….He’s on his way to setting the record for golf games by sitting president,

          • SpiritofPearl

            His hours on the golf course far surpass those of his predecessor.

            “I’ll never play golf! I’ll never take a vacation!”

          • WUSRPH

            9 times in 7 weeks.

          • SpiritofPearl

            All on the taxpayers’ buck . . .

      • donuthin2

        FM, “Grow and profit from fat, lazy and ignorant people”. If so, more than a few will do very well with the likes of you.

        • BCinBCS

          Yea, donuthin, it’s a shame that fat people are too lazy to grocery shop at Whole Foods and take advantage of their country club gym membership.

  • BCinBCS

    Here’s the latest on the repeal and replacement of Obamacare courtesy of WaPo:

    The GOP drive to destroy Obamacare took another hit Thursday morning, when conservative Sen. Tom Cotton tweeted that the House GOP repeal-and-replace bill is probably dead on arrival in the Senate. Cotton even called on his House colleagues to “start over.” The Arkansas Republican is an ally of Trump — who favors the GOP bill — so this is somewhat significant.

    But fear not: If the GOP repeal drive does fail in Congress, Trump has a secret, backup plan to kill the Affordable Care Act. And it’s actually a pretty good plan, if you view it from the point of view of Trump and many Republicans.

    CNN reports on Trump’s clever new scheme:

    In an Oval Office meeting featuring several leaders of conservative groups already lining up against the House Republican plan to repeal and replace Obamacare, President Donald Trump revealed his plan in the event the GOP effort fails: Allow Obamcare to fail and let Democrats take the blame, sources at the gathering told CNN.

    I’m not sure how far the second plan will get because, despite certainty on the part of Republicans that the ACA survives merely by a tiny unraveling thread, it can putter along assuming that they do not cut off funding for the subsidies and other costs. And, of course, the Medicaid expansion is in very little danger (unless funding is eliminated) because its costs are below what were expected since many red states, such as Texas, refused to participate in the program.

    https://www.washingtonpost.com/blogs/plum-line/wp/2017/03/09/trump-has-a-secret-backup-plan-to-kill-obamacare-its-actually-brilliant/?hpid=hp_no-name_opinion-card-f%3Ahomepage%2Fstory

    • José

      It’s strange bedfellows, all right. But I will gladly ally myself with Sen. Cotton and Rep. Jordan right now to defeat TrumpCare. The GOP is acting like they have one shot to undo the ACA if they can move quickly and decisively. It’s a good strategy but can fizzle rather quickly too. Remember how Jed! was going to lock up the Presidential nomination last year?

  • BCinBCS

    Ah-ha, I’ve finally discovered why Republicans, especially Paul Ryan, keep touting their Obamacare replacement plan as offering more coverage, better coverage and at cheaper prices. In my mind, this made no sense – its like saying that Obamacare is a Ford and Trumpcare is a Cadillac but Trumpcare costs less.

    It turns out that it’s all politics (duh, who da thunk it?). In poll after poll, Americans prefer Obamacare over straight repeal and over the Republican replacement plan. By a two to one margin, Americans want to keep the ACA or have it do more. Only seven percent want it changed to do less.

    Knowing that the majority of people want more and better health insurance, it is only logical that, in order to sell their stinking pile, they must attack Obamacare as doing little and Trumpcare as much more generous coverage – and this is despite the fact that, in reality, it does far less.

    • Sam Jacinto

      Trumpcare is built on a Yugo frame

      • BCinBCS

        😉

    • pwt7925

      Since republicans have been running on eliminating the ACA since it was enacted, why the shock over their actually doing it?

      • BCinBCS

        I’m not shocked, at all.

        Am I disappointed in the actions of these “Christians”? Yes. After all, there belief is “I’ve got mine, eff you”.

      • José

        Of course they haven’t actually done it, “done” meaning “eliminating the ACA”. Filing a bill is nothing. Remember that ever since the ACA became law they voted to repeal it about once a month, knowing full well that President Obama and Democrats would protect them from having to suffer the consequences of the bill succeeding.

        It wouldn’t surprise me if the GOP eventually passes some kind of legislation but they have a long way to go. Right now it wouldn’t pass the Senate and may not even pass the House. And any final version will be quite different from what they’ve been blustering about for years.

  • BCinBCS

    Besides health care and science, which includes global warming, I like to keep up with economics. I am a believer in Keynesianism and have a standing monetary bet for proof that “trickle-down” works.

    I regularly monitor the fortunes of the state of Kansas where Governor Sam Brownback and a plethora of legislators decided to try a strict real world experiment on trickle-down economics. After massive tax cuts that were supposed to release the hounds of economic prosperity, Kansas began to founder. What did they do? Doubled down, of course. Now that Kansas has lost its treasure, many of its businesses and untold numbers of its population the ultra-conservative voters of the state threw out most of the tea party legislators that were supporting the governor’s experiment. Even as Brownback objects and resists (after all, supply side economics cannot fail – it can only be failed), they began reversing aspects of trickle-down.

    Well, good news for Kansas. Rumor has it that Comrade Trump/Bannon will appoint Governor Sam Brownback as the ambassador to the United Nations for food and agriculture and Kansas’ long, dark nightmare may be over.

    As our legislature sits in session it would be nice if they took to heart the experience of the state of Kansas as they contemplate what Texas should do economically.

    • Sam Jacinto

      As bad as our own Guv is, I implore Trump never to appoint him to anything during his term, Please.

      • WUSRPH

        I tend to agree….but I doubt that Patrick could do as much harm as governor as he can as Lt. governor.

        • Sam Jacinto

          There is that. I think a promotion for him could be useful.

  • WUSRPH

    The situation will not get any better if the GOP enacts its new plan (sic) complete with multi-state policies and a very limited number of coverage requirements. The result will be policies sold SOLELY on their cost which means minimum coverage and high deductibles often issued by a company with less stability and reserves….The policy holder will think they are covered but will find out how devastating this kind of limited coverage will be when a series illness or injury occurs. The ACA tried to deal with this by providing subsidies to help keep down the cost of a policy that provided almost full protection at a lower cost than would otherwise by the case and with the mandate. The new GOP plan provides much less of a subsidy and no mandate…..both of which mean that it Is going to cost more for less.

  • Sam Jacinto

    $4 generics are gone – as is Target’s own pharmacy

  • Sam Jacinto

    Why are the drugmaker prices for generics rising so rapidly? Advertising costs? Nope. Development costs? Nope. Clinical trials cost? Nope. Regulatory costs? Nope. Manufacturing cost increases? Nope. Because they can? That’s it.

    • SpiritofPearl

      Bingo! Bacteria are becoming resistant to our traditional antibiotics, but Big Pharma concentrates on treatments for ED, plaque psoriasis, IBS, and restless leg syndrome because they’re more profitable. We are one pandemic away from destruction.

      • WUSRPH

        So what is your solution? Set price controls on drugs? Limit the profits a drug company can make (and thus funds it might have to pay for other research)? Order the drug companies to spend their money on programs designated by the government? Nationalize the drug companies? Give tax credits for R&D for research areas approved by the government? Increase the funding (which has been greatly reduced over the past decade or two) for medical research including basic research? This is at least for now still something of a free market system……

        • BCinBCS

          I’d return competition to government drug purchases. Barring that, I’d allow the importation of drugs from other (approved) countries.

          • WUSRPH

            Opening the ACA to drug price negotiations (or doing the same on its replace and repair version) is something that you, Trump and I all agree on. But, as with all tiny fixes, it still does not solve the entire problem. Either we find some way to “encourage” drug companies to lower their prices AND spend the time and money on exotic drugs and treatments or we run government drug companies or pay researches to do it. I’d be careful about importing drugs from other even “approved” countries, especially when one of the Trump proposals is to reduce the safety testing we already do. We got thalidomide from England, remember.

          • Sam Jacinto

            Another big part of the cost problem is the enormous amount spent on advertising and courting doctors. The point of the advertising is to make patients pressure their doctors to give them the “latest thing”. The point of the courting is to get the doctors to prescribe their latest ED drug, or whatever. Look around next time you are in your doc’s office. You will likely find numerous items emblazoned with advertising. Doctors sometimes give in when their patients are insistent. If the expensive stuff is not clinically worse than alternatives, what’s the harm?

          • Jed

            “or we run government drug companies or pay researches to do it.”

            ding ding ding.

            healthcare should not be at the mercy of the profit-motive.

          • José

            The idea of lowering pharmaceutical costs by allowing foreign imports, that seems rather dubious. I’ve always suspected that companies can sell for lower prices outside the US because they’ve already recovered their R&D costs with big markups here. If we pay the same low price as everyone else then who underwrites the development? Has anyone studied this question?

        • SpiritofPearl

          If we all die of a curable infectious disease because the medicines that could have saved us haven’t been developed by the egregiously overpaid pharmaceutical companies because they’re not profitable, we’re doomed. Antibiotics are crucial to our survival.

    • BCinBCS

      Will miracles never cease to happen? As it turns out, Rep. Elijah Cummings and Rep. Pete Welch got Comrade Trump/Bannon to agree to support their efforts to make Medicare drug purchases competitive. Since the Tweeter-in-Chief tends at agree with the last person to flatter him, I’m not holding my breath but who knows? Maybe it is a miracle.

  • BCinBCS

    While I’m venting my health care spleen, let’s opine on what this article by Christopher Moriates is about and what another doctor, Congressman Dr. Roger Marshall (R-Kansas) believes.

    Moriates is correct stating that doctors can help with the costs of medical care. But, doctors can only help around the periphery. He writes about the costs of drugs and some procedures that doctors can advise patients about that will help save money but when it comes to the big items, car crash trauma, cancer, diabetes, heart disease, stroke and other big ticket items health care competition breaks down. No one, no one, comparison shops for the best price when they just fell off of a ladder and broke their arm, they go to the emergency room and get it x-rayed, set and put in a cast. Almost all people with a critical health concern don’t comparison shop for their treatment either. Most people with life threatening cancer want the best oncologist at the best treatment facility. Those having a stroke want to be stabilized and transfered to the nearest stroke treatment center. And so it goes.

    Roger Marshall was quoted as saying: “Letting the government run anything, including health care, what happens is prices go up and competition goes down.” He also said: “Just like Jesus said, ‘The poor will always be with us.’ There is a group of people that just don’t want health care and aren’t going to take care of themselves. Just, like, homeless people. … I think just morally, spiritually, socially, [some people] just don’t want health care,” he said. “The Medicaid population, which is [on] a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising. And I’m not judging, I’m just saying socially that’s where they are. So there’s a group of people that even with unlimited access to health care are only going to use the emergency room when their arm is chopped off or when their pneumonia is so bad they get brought [into] the ER.”

    The logic of Dr. Marshall escapes me. (He’s from Kansas so that logic is no longer shocking.) He would not provide health insurance to poor people because they won’t use it. Well, I’m not a doctor but I can see that if one does not use health insurance then that person does not cost anything. (Health insurance rates are based on costs – the lower the cost to the insurance company, the lower the premiums overall; the higher the costs the higher the premiums.) Even so, it makes absolutely no sense to deny care to all people who cannot afford insurance because a few of them will not utilize it. There is the occasional chance that the non-user, having insurance, might choose to see a doctor rather than wait until they have to utilize the much more expensive emergency room and all of the others who will use insurance will cost society less in the long run.

    Treating the health care business as a normal business is wrong. This is because health care IS NOT A FREE MARKET BUSINESS. As soon as we begin to understand the futility of treating medicine and health care like every other business, the sooner we can move on to the solution – single payer health insurance with or without the presence of insurance companies.

    • WUSRPH

      The French, who from all accounts have fairly good health care system, apparently use the kind of hybrid system where private insurance companies, using government money rather than a policyholders premiums, administer a national health care system. It seems to work. It also makes it possible to sidestep the question of what do you do to make up for all the jobs lost when you cut private insurance companies out of the system, as a pure single paying government system would do. That was one of the reasons why the ACA kept a role for private insurers (in addition, of course, to keeping them for opposing it as violently as they would have a pure government system). Most countries who created a NHS from the get-go didn’t have that problem as there was only a tiny health insurance industry (if any at all) when they did it. We don’t enjoy that political luxury.

      • BCinBCS

        Back before Obama was President I wrote an extensive paper advocating our government do almost the same. I prefer a single payer system but, at the time, realized that conservatives would not allow it so I devised a system that kept insurance companies. Back then, I mentioned the paper as a solution to the health insurance problem here on BB and stated that I would e-mail it to anyone interested. Only John Johnson requested a copy.

        • WUSRPH

          Sorry, I didn’t see it…..I read a number of similar papers developed by an old analyst friend here in Austin, but not yours. Send me one now…it may still be of interest. Of course, your problem is the same as my friend’s—you both assume that the GOP, etc. is interested in a solution. Wrong!

          • BCinBCS

            I sent a copy to both of the e-mail addresses that I have for you.

    • BCinBCS
    • pwt7925

      Heath care isn’t free, and what Dr. Moriates is saying is that patients need to be aware of the costs of their care. I also hear you echoing the refrain that single payer is the silver bullet that will solve all the health care problems. What good is replacing insurers with another insurer? What recourse will I have if the single payer chooses not to cover my cancer or other urgent care? Isn’t the VA a single payer? Isn’t a single payer just as incentivized to keep costs down (and deny care) as is an insurer?

      • SpiritofPearl

        Look at Medicare vs. private insurance. By eliminating the for-
        profit middle man, Medicare keeps costs low. Read “Bitter Pill,” by Stephen Brill. It’s a monograph from Time a couple of years ago.

      • BCinBCS

        pwt7925, even if that was true, we would still have a better system than the one that we have now. We are the only first world country with such an inefficient, expensive health care system.
        Also, what Pearl said.

      • SpiritofPearl

        Since different insurance companies have different coverage, it’s hard for doctors to know exactly what each insurance company will cover.

      • José

        There are multiple problems with our current system. Single payer is a good way to fix one problem. It would be easier to have universal coverage with such a system. As for cost containment, compare the efficiencies in Medicare versus the typical for-profit insurance businesses.
        It would be foolish to assert that “single payer is the silver bullet that will solve all the health care problems”, and our friend BC isn’t so foolish.

  • Mark Coopers

    Without getting too deep into politics, there is a natural inclination for both patients and doctors to not discuss what the medical options cost. This does neither side any favors since patients pay more than they probably need to and doctors don’t find out that patients suffer an economic injury to go with their medical malady.
    .
    Personally, I’ve never been shy to ask my doctor if (1) this procedure is truly needed or if they are just trying to get more data and (2) is there a cheaper alternative. Given the increasing share of high-deductible health insurance plans, consumers (e.g. patients) need to get comfortable asking what things cost. If enough of us ask and opt for cheaper treatments, the market will eventually* respond.
    .
    * “Eventually” could mean 1 year, 10 years, or 50 years. Healthcare is a weird beast.

  • WUSRPH

    It sure looks like Trump is buying into the Ryan Plan….which, of course, does virtually nothing Trump repeatedly said he would demand….Of course, his defenders will say this is just to move the process forward. I wonder what they will say if it turns out as bad as this plan….

    • SpiritofPearl

      His flunkies don’t want it to be called “Trumpcare.”

    • José

      Best I can tell there is one reason why 45 is so agreeable to the AHCA monstrosity. It’s something that they might actually be able to pass. That’s the big thing, the perception. They can claim to have repealed the ACA. The fact that it doesn’t provide any of the promised benefits but instead will kill people, that doesn’t matter a bit.

      • WUSRPH

        You have just stated the very First Rule of Politics: Perception is always more important than reality. Of course, the election of Trump should have made that more than clear to everyone.

        • John Johnson

          And you were right in the middle of it…a master obfuscator. How can you now act like you are Lilly White? It floors me.

          • WUSRPH

            NEVER said I was….but my actions were the equivalent of what Catholics term a venial sin….His are mortal sins.

          • John Johnson

            As judged by you. Telling.

  • WUSRPH

    Trump makes his views on drugs clear….When Wall Street says it the appointment is “favorable for the sector” you can stop thinking about lower drug prices.

    “WASHINGTON, March 10 (Reuters) – U.S. President Donald Trump has chosen Dr. Scott Gottlieb, a conservative health policy expert with deep ties to the pharmaceutical industry, to lead the U.S. Food and Drug Administration, a White House official said on Friday.

    If confirmed by the Senate, Gottlieb would be in charge of implementing Trump’s plan to dramatically cut regulations governing food, drugs, cosmetics, dietary supplements and tobacco.

    Gottlieb is well known on Capitol Hill, where he has testified multiple times on hot-button health issues, including complex drug pricing matters, and is viewed favorably by drug companies and pharmaceutical investors. A former FDA official, Gottlieb also sits on the board of pharmaceutical companies.

    “Thank God it’s Gottlieb,” Brian Skorney, an investment analyst at Robert W. Baird, wrote in a research note. “We view this as a favorable development for the sector.”

  • BCinBCS

    I’m slowly shaking my head at the Republican incompetence when it comes to health care.

    During the 27 hour debate on Trumpcare (Ryancare) by the House Energy and Commerce Committee Rep. John Shimkus (R-Ill.) asked, in defense of the bill, why men should have to spend their money on prenatal care. He was reminded by the Democrats that no health care plan covered only the personal choices of the insured. Shimkus countered that’s the way that insurance should be. Setting aside that prenatal care directly benefits fathers, it is apparent that Shimkus and his fellow conservatives apparently have no concept of how insurance works.

    Don’t believe me about Republicans and their lack of understanding of insurance?

    Wunderkind Speaker of the House Paul Ryan during his power point presentation on Trumpcare (Ryancare) stated that insurance cannot work if healthy people have to pay more to subsidize the sick. That pronouncement is from one of the authors of the bill. I am not making this up!

    During the long period when they were out of power, it would appear that conservatives elected representatives that were great at public relations, who knew precisely what to say to get elected but had no experience or idea how to govern. Now that they unexpectedly find themselves having to govern, they haven’t a clue what to do. Whereas before, their entire experience was limited to saying “No”, now they must understand issues and relationships and build coalitions. They are discovering that: “Nobody knew that health care could be so complicated” (where nobody = Republicans).

    • donuthin2

      I get it that we have to be concerned about national debt, but the hypocrisy of cutting taxes at the same time as cutting some of the basic programs is absurd.

      When health insurance companies started doing underwriting to determine who was to be insured and or what they would be charged, we started down a slippery slope. Smokers were the first to be segregated out and either charged more or refused, which seemed logical to us all. Then, those with high blood pressure, diabetes, etc were sorted out to be treated differently. For many, it didn’t make much difference as they were on a group plan of their employer. But for self employed or others, it became disastrous and their only relief was reaching the age of 65 and getting on medicare.

      If we are to believe that everyone is entitled to basic health care needs, then a national health care plan is essential. Problem is, politicians believe everyone should have basic health care, but they are not willing to develop a program that achieves it, but instead, leave a large segment out there that just shows up at the emergency room. Hospitals have found a way to absorb that cost by passing it through to those who have insurance. But, employers and insurance companies, in order to control costs, have negotiated most of the “extra” out of what they will pay if you want to be an in network provider.

    • John Johnson

      Yep, both sides have loons that others in their party have to defend. Pelosi comes to mind, as does Waters and Jackson Lee.

      • WUSRPH

        Two blacks and all three women…..does that say something about you?

    • WUSRPH

      Funny you would mention Ayn Rand since Ryan has been trying to run away from his past infatuation with here every since 2012 when the Catholic Church attacked the lack of Christianity in his budget plan. Instead, he has been saying things like:

      “I adored her novels when I was young, and in many ways they gave me an interest in economics. But as a devout, practicing Catholic, I completely reject the philosophy of objectivism.”

      But based on the current Ryan/Trump plan it appears he didn’t really mean it.

  • BCinBCS

    In a lot of cases, Occam’s razor explains a lot. In my reading, I ran across an article by Reihan Salam in Slate that is a simple explanation for the unnatural actions of Speaker Paul Ryan and the Republicans:
    (emphasis is mine)

    This is the right way for Republicans to talk about the cost of the safety net: If there’s a conflict between rich people’s money and the lives of ordinary Americans, we’re going to choose the latter every time. But Ryan couldn’t pitch his plan in these terms, because he needed to demonstrate that he could shrink the size of government. If he wasn’t going to cut Medicare and was going to cut taxes, he had to slash safety-net spending somewhere else. That’s why he proposed wildly unrealistic reductions in the growth of federal Medicaid spending. His message wound up being completely muddled. We need to cut spending because we’re facing a debt crisis … but we’re also going to cut taxes. It is vitally important that we protect the safety net for old people … but we’re going to slash it for poor people.

    What a way to do business, what a trade-off. 🙁

    • WUSRPH

      Remember all that talk by the GOPers about the ACA creating “death panels” that would determine who would live or die or at least what treatments could be offered to a patient? Of course, it was all b.s. and never happened….BUT if the GOP/Trump are able to revise the Medicaid system they way they are proposing, they could be turning a bunch of state legislatures into death panels of a sort. That will be because of the different way they would fund the health care programs administered by the states.

      Under the current law, there is no cap on the amount a state can receive from the federal government for Medicaid. Instead, the states are reimbursed for what they actually spend. The Ryan/Trump plan would change this to set an annual cap on the amount the state will receive (which, by all accounts, will turn out to be less than they are receiving now). This means that, should there be a special demand on the system for higher priced care or a increase in the number covered (say as the result of a recession), the state could run out of money with persons still needing care. The result would be to force local hospitals, etc. to “eat” the extra costs or, more likely, have the Legislature set limits on how much can be spent on either an individual in a year or determining which treatments it will pay for, or maybe both and perhaps even other curbs on spending. This could well mean that someone who would have received treatment under the existing system may be denied that care (or that quality of care) under the new….but that’s apparently just what Ryan/Trump intends.

      • BCinBCS

        In case anyone is interested and hasn’t the time or the inclination to study the matter, here is information on “death panels”.

        There is a Republican pollster and opinion shaper who I admire as one of the most brilliant minds yet is someone that I hate with a passion because of how he uses his brilliance – Frank Luntz. He can take mom, baseball, hot dogs and apple pie and convince you that they will cause the downfall of the American Way. He’s that good. He’s the man who took taxation of the filthy rich, a policy that, among other things, helps prevent the establishment of overlord families who sequester wealth generation after generation from the rest of society turning a societal good into evil by rebranding that inheritance tax as the “death tax”.

        Despite the fact that it occurs to everyone, few people take the time to inform themselves and their loved ones about what they want if they become terminally ill. I suppose that most people hope that when they are 101 years old, they will go to bed one night and peacefully never wake up. Unfortunately, many many people spend their last months, days or weeks in the hospital dying of an incurable problem. If the dying person in the hospital is lucid they are counseled on their end of life options. If they are not, their spouse or other relative is presented with those options. The doctor, nurse or social worker who details end of life options and determines the wishes of the patient or the patient’s relatives concerning those options is an employee. One of the many great features of Obamacare is the provision for payment to those people who provide this information.

        The Republican party, a party that hated Obamacare with a burning intensity, put Frank Luntz to work on the act. It was about this payment for end of life counseling services that he developed one of his most brilliant emotional counters by describing the counseling as “death panels”. The rest is history.

        Besides “death tax” to describe estate taxes he is the person who took global warming and rebranded it “climate change. All of those descriptors that now proceed your opponents name such as “liberal” Democrats, “corrupt” Hillary, “lyin’ Ted (Cruz) and “little” Marco (Rubio) are direct results of Frank Luntz inspirations.

  • WUSRPH

    It is often hard for a legislator/congressman/solon of any sort to stand up to the pressure from the president or his equivalent as you move down the ladder of offices. In the next few days we will see how well the 40 members of the US House of Representatives’ “Liberty Caucus” will do when pressured by Trump “to go along” with Speaker Ryan’s plans to gut/reform/repeal/replace or whatever the ACA and Medicaid. It will be interesting to see if these self-proclaimed “super conservatives” will resist Trump…

    Just how many will “stand up for their principles” against Trump’s veiled threats of them getting “primaried” next year will depend on several things. First, whether they think they can explain a change in their positions as “moving the process along” and “honoring our promise to the voters” while “reserving” the right to vote against the final package, if there ever is one. Second, how frightened they may be of Trump.. More might be willing to oppose the president if it were farther along in Trump’s term and he had screwed up more than he has to date….But it is probably too early to see how strong he will be next year and discretion is always the better course for survival even if not of valor. And, third, whether they think enough of their colleagues will stay with them to defeat the bill when it comes to the House Floor. (It is easier to be a hero if you have others standing with you.)

    If I had to guess right now, I’d say about 20 will stand firm…But I could be surprised.

    During my years around the State Capitol I have seen a few members willing to stand up to the pressure…and the threat that by doing so they were risking their political future, .but not that many….Despite that, when the subject comes up, I like to point to the fate of the so-called “Gang of Four” who opposed former Texas House Speaker Bill Clayton so forcefully back in the late 1970s. I do so because, although everyone told them they were finished in Texas politics, it didn’t turn out that way. In fact, two of them went on to the U.S. Congress and the another is now the Dean of the Texas Senate. But, then maybe they were exceptions to the rule.

  • WUSRPH

    CBO says 24 million more without health insurance over the next decade….but it saves money. Funny that Trump used CBO figures in his attacks during the campaign…but now his aides say you cannot trust its numbers. Funny how you see things differently when it is you who are affected.