Medicaid is a horrible system. You are as likely to die on medicaid as with no insurance at all and adding 19 million people as an unfunded mandate
will make it that much worse.
As with any of the social programs, if people treated them as a temporary handout to help them through hard times they'd be worthwhile and
probably not too ineffective. But instead there's no compunction to getting aid simply because you qualify for it, and stay on it in perpetuity
because you can. And that lack of personal responsibility is bankrupting all of us.
We've already seen private insurers drop programs for kids in response to the ACA because of the inability to deny the sick. Rather than lose
money, they drop the program and now the state systems are the only option. We're already seeing what Ryan described as a lack of choice.
The simple problem is that we have a screwed up notion of health and health care. If we mandated that insurers paid for a yearly complete teardown of
your car and replacement of all defective parts but stopped funding road repair and allowed anyone to sell gas with no oversight, would we have safer
roads? Of course not. But we pay billions to treat symptoms without regard to the shit we eat, the stress we endure, the pollution we breathe, and the
lack of ergonomics in our lives.
As to how to address those? Beats me. I just know from my observation that the less people have to pay for health care, the less healthy they are. But
we have to care for "the least of these" and I don't know how to do that without getting some leaching bastards sneaking in.
The Ryan plan offers the only serious hope of reducing fraud in Medicare and Medicaid. Its Medicare reforms, especially if they were expanded
later, would make it easier for the federal government to police the program, and its Medicaid reforms would increase each state's incentive to
To see how the Ryan plan would reduce Medicare fraud, imagine that the proposal really were what its critics claim it is: a full-blown voucher
program, with each enrollee receiving a chunk of cash to spend on medical care, apply toward health-insurance premiums, or save for the future.
Instead of processing 1.2 billion claims, Medicare would hand out just 50 million vouchers, with sick and low-income enrollees receiving larger ones.
The number of transactions Medicare would have to monitor each year would fall by more than 1 billion.
We need a system where people ask "do I really need this?" and then if they refuse the test the doctor isn't on the hook for malpractice but
anything that shifts financial responsibility to the patient hurts the poorest and sickest. There's a way, I'm sure, just not in an era of
soundbites and billion dollar election campaigns.
[Edited on 6-28-2011 by doctorb]