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Medicaid for All: Bold Rx for What Ails the US Healthcare System?

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By    |   Wednesday, 21 Jun 2017 11:46 PM

The bruising congressional debate over what to do about Obamacare has prompted Jim DeMint, the president of the Heritage Foundation, to call the 2010 law a “cancer” on the nation’s healthcare system that must be excised.

“We don’t need to replace the healthcare system — we need to remove the cancer,” said the former U.S. senator at the 2017 Conservative Political Action Conference. “Once we get rid of Obamacare, we can begin to improve our healthcare system so that it works for every American.”

Whether you agree or not, DeMint’s analogy suggests a bold Rx may be needed to fix what ails the nation’s healthcare system: A radical treatment that — like chemotherapy — is not designed to merely treat the symptoms, but remove the tumor, which has spread to the point that more moderate measures won’t work.

That radical fix: Medicaid for all.

A controversial idea? No doubt. A tough pill for some GOP leaders to swallow? You bet. But workable? Without question, many experts and some political pundits say.

In fact, for a growing number of moderate and conservative voices, Medicaid for all may be the only true antidote for the healthcare crisis the Republican Party has inherited. In the minds of many, it is the only way to significantly lower premiums, increase competition and choice, and make sure every American has coverage and care. Three states — Nevada, New York, and California — are considering adopting such a program.

Politically, Medicaid for all could be seen as the health policy equivalent of chemotherapy — a last-resort option often used only when all other possibilities have been exhausted.

For the moment, let’s set aside all the rancor and debate over Obamacare's individual and employer mandates, safeguards for people with pre-existing conditions, essential health benefits, insurance subsidies and the like. Instead, let’s start with this basic premise:

Most Americans believe everyone should have access to some standard level of healthcare in the U.S., at the lowest possible cost — so it doesn’t bankrupt individuals, businesses, insurers, doctors, hospitals, drug companies, or the government.

If you agree — as polls show most Americans do, as well as members of Congress, and the current occupant of the White House — the only reasonable follow-up question is: How do we do that?

The answer, by many accounts, is Medicaid.

Congress and the White House have been gridlocked over minor Band-Aid Obamacare fixes that essentially keep the Affordable Care Act alive, while choking off funding and enforcement of many of the law’s provisions.

But even those modest prescriptions for reform have been stymied — and not just by the Democrats who oppose significant changes to Obamacare. Deep divisions within the Republican Party have also led to a standoff, with conservatives demanding full ACA repeal and moderates pushing to keep safeguards for people with pre-existing conditions and insurance subsidies for middle class voters.

Congressional leaders and the president could sidestep all of this by turning to Medicaid to cover the 7 percent of Americans who don’t now get insurance through the workplace, Medicare, the Veterans Administration, or Medicaid.

Here’s why: Medicaid is the nation’s federally funded, state-administered healthcare program for the poor. It is not “socialized medicine,” as some have falsely argued, but relies on the nation’s free-enterprise network of doctors, hospitals, providers, and clinics to (literally) provide cradle-to-grave care. Recipients are provided everything from maternity to nursing home coverage, and everything in between — at a nominal cost.

In fact, federal stats also show it costs half as much, on average, to insure a Medicaid recipient (under $5,000 per year, on average) as it does a typical American who is covered through the Obamacare exchanges, the private market, or employer-sponsored health plans (more than $10,300, on average, last year, according to Obama Administration estimates).

Allowing Americans who now make too much money to qualify for Medicaid — or even buy into the plan by paying a nominal premium — would create a safety net that makes sure everyond is covered at half the cost of a typically insured individual in the U.S.

That would bring the nation’s average per-capita costs in line with most other Western nations. (Americans now pay twice as much per capita for healthcare than any other country on Earth, yet trail all other Western nations when it comes to the death rate from preventable conditions, according to the nonpartisan Commonwealth Fund).

Another option worth a look: Allowing Americans to buy into Medicare before they turn 65, the age of eligibility. Letting middle-aged Americans to pay two, three, or even four times as much as the average Medicare recipient pays ($109 monthly) would provide adequate insurance coverage at a significant savings to younger, healthier individuals.

It would also produce an infusion of cash to Medicare, and keep it solvent. (Federal stats show that Americans over 65 use roughly twice as many healthcare services as those under 65).

Both options — perhaps offered in tandem, on a voluntary basis — would meet President Donald Trump’s core campaign promises to make sure “everyone will be covered” and “healthcare costs will come down.”

There are details and difficulties that would need to be ironed out, of course. For one thing, only two out of three American doctors accept Medicaid, which has already lead some patient advocates to argue reimbursement rates for Medicare and Medicaid should be the same.

But such details are minor, compared to some of the major divisions that have stymied Congress in trying to move forward on an Obamacare alternative.

At the very least, it doesn’t take a medical degree to see that, without decisive action in Washington, another round of insurance price hikes and limited choices will greet Americans in November when they start searching for 2018 insurance coverage.

Big insurers like Aetna and Humana have been dropping out of the Obamacare exchanges, citing financial losses. In fact, more than 40 percent of U.S. counties are projected to have only one insurer selling coverage on their marketplaces for next year, according to data compiled by the consulting firm Avalere.

In the meantime, regulators in Virginia, Maryland, and other states have reported early price hike requests ranging from just under 10 percent to more than 50 percent for 2018 — on top of premium rate increases that averaged 22 percent this year.

The only question now: Whether congressional leaders are willing to embrace bold prescription for a new way forward that could address what truly ails the U.S. healthcare system.

Building on Medicaid and/or Medicare could be just what the doctor ordered for American consumers.

At the very least, the idea deserves a closer examination.

© 2017 NewsmaxHealth. All rights reserved.

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Could Medicaid for all could offer an antidote for Obamacare? Some experts believe such a plan could sidestep the fractious political debate over repealing and replacing Obamacare, significantly lower premiums, increase competition and choice, and make sure every American has coverage.
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Wednesday, 21 Jun 2017 11:46 PM
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