Off Topic USA 2012 Elections Thread

[SkiBumGymMom]

Would like to take this opportunity to give a shout out to what I think is the best socialized Medical program in the world - the US Military Health care system. My father and husband where both career military, so I grew up going to military hospitals and my children where born in them. And while they have their flaws (I din't see the same doctor twice until I was 25 years old), the care was great. Since my husband retired, we have lived in an area for the past 10 that is far enough from a military base that we use civilian care, through TRICARE.

Was away from home recently and had a chance to need to visit an ER and happened to be close to an Air Force Base, so got to go down memory lane. Amazing. So good, that if anyone in my family had any kind of health issue, I was seriously consider moving close to a military hospital, just to avoid having to deal with insurance issues. Went to the ER to have my daughter checked out for a concussion. Spoke to the check-in nurse(with a sorry to make you wait ma'am for a 3 minute wait), saw the triage nurse, saw the doctor, CT ordered, wheeled to CT, CT results given to doctor,saw doctor again, all clear,walked out the door. This took about 90 minutes.

I truely don't know how much we could apply on a National scale. I know the issue is far more complex. But it does make me cringe when I hear some say "socialized medicine" like it is a dirty word, and talk like the federal government can't do anything right. I have personal experience with these federally funded hospitals, run by federal employees, and my experience has been positive.

My husband's family was military (his dad), so when they were growing up they were covered through that (CHAMPUS at the time). He always talked about how wonderful it was. Glad to hear more support for it.

 

[Andersonortho]

You bring up Medicaid... what about Medicare? What's the difference as a service provider? Both are government health care programs. What about Tricare? (US military health insurance) Another government run program. What makes Medicaid unique as abused, misguided and bad for doctors? I'm curious.

QUOTE]

Info from my small part of the health care world...

Medicare is for people aged 65 or over, people under 65 with certain disabilities or people in end-stage renal disease.

Medicaid is for low income adults and children. The services vary per state as do eligibility req's. CHIP is for chidlren under age 19 from families who make too much to qualify for Medicaid. For many, CHIP is free; for those with high incomes a low premium may apply. In my state a family of 4 can make up to $69,000 and qualify for CHIP.
My experience is with Medicaid and CHIP as Medicare does not cover any of my services.

How does it affect doctors? Services (often rationed by Medicaid by requiring per-authorization) are billed by the doctor to the state Medicaid entity at the usual and customary rate (i.e.- $500.00). The state reimburses the provider a fixed, non-negotiable rate (i.e.- $200.00) The balance ($300.00) cannot be billed to the patient and must be "absorbed" by the doctor. Imagine providing a service that costs the doctor $250.00 (not including any 'profit') yet he/she is reimbursed only $200.00. That results in a loss of $50.00. How would a doctor continue to remain "in business"? How would he/she pay the assistants? Purchase supplies? Pay rent? Pay back student loans? PAY FOR GYM TUITION?

Sidenote: Health care as a basic human right. Hummm. Needs more definition. "Health care" including... what? Organ transplantation, cosmetic surgery, infertility treatment, eyeglasses vs. lasix surgery? Access to health care also needs definition. Does access mean a local doctor within 10 minutes? 45 minutes? Two hours? What about transportation to/from health care appointments? Medicaid already reimburses approx. $0.32 per mile for non-emergency transportation. Someone somewhere has to set guidelines and make the "yes or no" decisions. Each of these services carry a real cost. How can everyone have every service they choose AND all costs be covered?

No problems in Canada? Really? I know a dozen practitioners who have left Canada or GB for the US due to complications with health service.

I understand that this is more complicated. But sometimes the simplest questions are the most significant... I know.. I work with children everyday.

 

[wandrewsjr]

"Sidenote: Health care as a basic human right. Hummm. Needs more definition. "Health care" including... what? Organ transplantation, cosmetic surgery, infertility treatment, eyeglasses vs. lasix surgery? Access to health care also needs definition. Does access mean a local doctor within 10 minutes? 45 minutes? Two hours? What about transportation to/from health care appointments? Medicaid already reimburses approx. $0.32 per mile for non-emergency transportation. Someone somewhere has to set guidelines and make the "yes or no" decisions. Each of these services carry a real cost. How can everyone have every service they choose AND all costs be covered?"

Yep, lots of complicated decisions to make, lots of choices/limitations to be set. But in my experience with the military health care system, they seem to have figured it out. Remimbersement for mileage? No. Distance to doctor? Think they have set this as 60 miles as the crow flies. Preventative medicine? Yes. Lasix surgery? No. Eyeglasses? Yes, one pair every 2 years. Cosmetic surgery? Yeah, right.

Yes, lots of complex decisions to be made. Insurance companies currently do this. No, you don't cover everything.

 

[SkiBumGymMom]

You bring up Medicaid... what about Medicare? What's the difference as a service provider? Both are government health care programs. What about Tricare? (US military health insurance) Another government run program. What makes Medicaid unique as abused, misguided and bad for doctors? I'm curious.

QUOTE]

Info from my small part of the health care world...

Medicare is for people aged 65 or over, people under 65 with certain disabilities or people in end-stage renal disease.

Medicaid is for low income adults and children. The services vary per state as do eligibility req's.
My experience is with Medicaid as Medicare does not cover any of my services.

How does it affect doctors? Services (often rationed by Medicaid by requiring per-authorization) are billed by the doctor to the state Medicaid entity at the usual and customary rate (i.e.- $500.00). The state reimburses the provider a fixed, non-negotiable rate (i.e.- $200.00) The balance ($300.00) cannot be billed to the patient and must be "absorbed" by the doctor. Imagine providing a service that costs the doctor $250.00 (not including any 'profit') yet he/she is reimbursed only $200.00. That results in a loss of $50.00. How would a doctor continue to remain "in business"? How would he/she pay the assistants? Purchase supplies? Pay rent? Pay back student loans? PAY FOR GYM TUITION?

Sidenote: Health care as a basic human right. Hummm. Needs more definition. "Health care" including... what? Organ transplantation, cosmetic surgery, infertility treatment, eyeglasses vs. lasix surgery? Access to health care also needs definition. Does access mean a local doctor within 10 minutes? 45 minutes? Two hours? What about transportation to/from health care appointments? Medicaid already reimburses approx. $0.32 per mile for non-emergency transportation. Someone somewhere has to set guidelines and make the "yes or no" decisions. Each of these services carry a real cost. How can everyone have every service they choose AND all costs be covered?

No problems in Canada? Really? I know a dozen practitioners who have left Canada or GB for the US due to complications with health service.

I undertstand that this is more complicated. But sometimes the simplest questions are the most significant... I know.. I work with children everyday.

I know the difference between the programs (what qualifies for Medicare/Medicaid), but thank you for the explanation as to how it affects doctors. (LOL at the gym tuition part! I think we can all agree on that). Would this problem not be addressed if the reimbursement was raised?

Good point about the definition of health care. Maybe if that were defined there would be less resistance? Organ transplants? Yes. Cosmetic surgery? Depends. Is it breast implants for cosmetic gain or breast reduction because of chronic back pain? Is it fixing cleft plates or burn scars? Does it cover infertility and Viagra but not abortions and birth control? It's definitely a valid discussion that should be brought up. In my personal opinion the basics are human rights, prenatal care, OB/GYN care, primary care physician for illness, injury care (be it a broken bone or a spinal cord injury), cancer treatments. Should prescription drugs be out of reach of people because of cost (which happens especially when companies still have patent rights, you see it with many HIV and cancer meds). I've heard the answer that without the profits there would be no drive to create these drugs. Pump more resources into research at the government level? Money can't be the only motivation to people (a different discussion, I'm digressing). Beyond the care medical items that add to quality of life, glasses, wheelchairs, ventilators, hearing aids. I'm pretty familiar with the last part, knowing the astounding amount of items a paraplegic needs just to live a "normal" daily life. Also familiar with what is covered for things like hearing aids vs. cochlear implants and the type.

I'm starting to ramble there, but like I said, you bring up a good discussion point. A discussion I think people need to have, because while some people are using more extraneous things and consider it medical care (certain cosmetic surgery) many people are suffering or even dying because of lack of access to things like the most up to date cancer treatments.

I didn't mean to say Canada has no problems, just not the problems I've had with my family. No system is perfect but from personal experience the others seem to be working better for the country as a whole.

I work with children everyday too, I understand. If you don't mind my asking, what kind of medicine do you practice?

 

[Andersonortho]

I posted this article earlier, but here's some states with much lower standards. Anti-Medicaid states: Earning $11,000 is too much - The Denver Post

What about the Colorado Child Health Plan Plus (similar to CHIP)? It is low-cost (low premium) health care for uninsured children or children whose families make too much to qualify for Medicaid. It should cover a family of 3 with an income of $47,000 or less.

From what I understand, those who make too much for Medicaid should qualify for CHIP or a similar program. Those who make too much for CHIP (or similar program) are the ones who have to make decisions about paying out-of-pocket for health insurance or going without.

FYI- In my state, children of divorced/ non-married parents may be coverd by a private insurance like Blue Cross Blue Shield from one parent AND be covered by Medicaid as well. These kids have more insurance than most privately insured children.

 

[SkiBumGymMom]

What about the Colorado Child Health Plan Plus (similar to CHIP)? It is low-cost (low premium) health care for uninsured children or children whose families make too much to qualify for Medicaid. It should cover a family of 3 with an income of $47,000 or less.

From what I understand, those who make too much for Medicaid should qualify for CHIP or a similar program. Those who make too much for CHIP (or similar program) are the ones who have to make decisions about paying out-of-pocket for health insurance or going without.

FYI- In my state, children of divorced/ non-married parents may be coverd by a private insurance like Blue Cross Blue Shield from one parent AND be covered by Medicaid as well. These kids have more insurance than most privately insured children.

That's the situation I was in. My son was covered by CHP+ (CO CHIP) for a short time. At the time for a 1 person household is was an income of under $350 a week. Now it's $538 a week. Then I started making more money, with a higher paying hourly job without benefits he no longer qualified (I was making $8.50 an hour, this was the mid 80s). His father lived in a different state... well not even a state really, DC. He was a student with only college health care covered through his scholarship until I was finally receiving insurance via my employer (the school district when I became a certified teacher). It was that time in between that was the toughest. And even with CHP+ not everything was covered.

 

[Andersonortho]

If you don't mind my asking, what kind of medicine do you practice?

For privacy reasons, I think it is best that I not disclose my speciality. It's a small world...."

Have enjoyed learning and sharing on this thread.

Raise reimbursement rates? Good luck. Blood from a turnip. States are cutting funding to balance budgets since Medicaid funds come from states (and are matched by fed). My state reimburses me at ALMOST 50% of my usual and customary fees... sometimes it is a negative rate (-10%)... meaning it costs me money to provide the service. Most people are not aware of that. I have fixed costs, too. Some docs choose not to participate with certain insurances including Medicaid/ CHIP. May not be fair but is legal. Their practices are "private" businesses.

My biggest hang up (so far) with universal care is that it does not have a bottomless funding resource. Is it possible that one day the system could be upsidedown like social security (in the future)? Could it be possible that the pay-out costs could exceed the "income" sources? How is it funded? Taxes? Individual purchases it? Mixture?


Who makes the big decisions? How are they connected to the health care world? Who is padding whose pockets? Who "lives" or "dies"? Who gets the procedure and who doesn't? Pre-authorization panels already exist (in private and public health care systems) for the purpose of rationing. Someone will always be on the "losing" end of the decision.


Sorry for ranting. I do enjoy my "job". I consider it my hobby b/c I love what I do. After all.... in the end it will not matter how much money we made or what titles we had. It will matter that we made a difference to someone.

 

[wandrewsjr]

Agree with you about the reimbursement rates. When my statements come from Tricare, I always look at the billed amount versus the amount paid to the provider, and am often amazed by the difference. We are able to see doctors that don't accept Medicaid. I have talked to our doctors about this, and they say they have considered stopping accepting Tricare, but most have some military connection and feel some loyalty to these patients.

I think most of the most difficult questions are already being answered every day, by insurance companies. Health care is currently rationed. Insurance companies decide which medications to cover, which procedures to approve, we have waiting lists for organ transplants, who decides who gets the life saving organ transplant?

The funding issue is a different one, and like with Social Security, is one our nation is going to have to face head on, whether we have universal healthcare or not. We are going to have a huge percentage of our population on Medicare and Social Security starting in the next few years, and we truly have not seriously even begun to tackle how we are going to pay for it.

 

[gymgal]

In response to gymgirl's post on page 14 saying the problem in education is not budget cuts and that class sizes are small, etc. (CB is being strange with posts)

There is a problem with the teaching. Low income schools have much higher teacher turnover, usually have younger teachers (who get paid far less) and have less access to educational materials. You claim that there are no problems with textbooks and other materials in poor urban school districts. ...... I've seen the 80s era textbooks students use with my own eyes. I've seen students have to pay for copies of worksheets, and those who can't, copy by hand. It exists.

You also claim they get the most money. This isn't the case, at least in Colorado. ...

And also you pointed out an academic study about Head Start isn't non-partisan. If it were done by Head Start I would agree. But it was done by the University of Chicago, a private, well respected university. If this sort of research isn't valid, very little research is, considering high level universities produce most major research and studies.

Like I said and you provide points to - It's not the teaching that is a problem - it's the circumstances that cause the high turnover rate, the reluctance of experienced teachers to come into these districts. Discipline issues, lack of parent involvement, lack of administrative support, lack of teacher mentoring (because the experienced ones leave). Throwing money at this to hire "better" teachers or put more aides in the classes are not going to solve it - it only puts a band-aid on the situation.

And school districts with disadvantaged and special needs children *do* get more money from the federal government for free meal, transportation, special education. For those with an IEP, this can total as much as $8000 more a yr. per student affected, depending on the disability and this does not show up in the per-student expenditure because it does not affect the entire school population.

$20,000 for a full time 9 month position fully credentialed teacher? That's about $13.5 an hour (8hr*185 days - lower if the district has more work days). That's ridiculous. I got paid that back in the late 80's as a teacher assistant. Do these districts significantly increase salary after the first year?

As for Head Start, - The first reference you linked (U of Chicago, Georgetown) was NOT a study. It had no new research in it. It was a report attempting to *interpret* the results of other studies. In that, it has a great potential for subjective bias. Given the amounts of wishy-washy language contained in the report (may, might, could, possibly, perhaps, likely....), it is obvious that the report is clearly attempting to make a case for HS, which is not backed up by the data. It clearly states in several sections that the studies don't show clear cut evidence that the program works and then it continues to attempt to defend it. U of Chicago is a very liberal leaning university, employing far more liberals than conservatives as professors - like most universities and school systems in this nation. 10-1 ratio, in fact for Chicago. So, no - this report was NOT non-partisan. The second link from the DHHS at least had new data in it, though there is more recent data out now from the same dept. clearly showing no sizable long term benefit. And even that report attempts to skirt the data and put a subjective spin on it.

1) I support a national sales tax. Canada has a GST as does Australia and it works fine. It goes back to the people in a variety of social programs.

well, I certainly didn't mean this! LOL I support a national sales tax that would replace our current tax system, not one in addition to it...

2) No one should be denied coverage for pre-existing conditions and everyone should have access to affordable health care. If that means expanding Medicare and Medicaid, so be it.

agreed but we have different ideas as to how this would best be implemented. Having a public option encourages businesses to eliminate their own private options, particularly since the tax they will incur will be cheaper than the health care they pay for. It wouldn't be long before the public option would be the only option. People say that's crazy but it's not. Obama is on record talking about the day when we will have a 1-payer system. Obamacare is only the first step.

... this [article] does paint a great picture of the major problem with states having control. ....I'm not a big fan of the states deciding a lot of things,

......

OK - this scares me. In general, I am a constitutionalist. I believe in the original plans of our founders, which gave the states sovereign powers and the federal govt was only to have power in the areas of national defense and commerce with foreign countries. You mention very real problems with the states having these powers. And I don't like those either but I do not believe we should limit the states' rights as a result. Let the people speak for themselves about what is best for their own state.

I'm leaning towards the idea states should be required federally to raise more money for public works, such as transportation and education. That would relieve the burden of the federal government and allow it to focus financially on the debt and other national financial issues.

Correct me if I'm wrong, but it sounds like you would want the federal government to still collect that money and use it for other ventures, while at the same time have the states increase their taxes to pay for the programs the federal government is now not paying for? This is exactly how we get ever increasing taxes.

This has to do with the federal government usurping state powers. Essentially, the federal government takes in money (through federal taxes) that should stay in individual states (state taxes) and then redistributes it as it sees fit. But also, in the process, it wastes a lot of money because of the system created to manage the tax revenue. This is not the "fault" of the states - it is the fault of the federal government wanting control of certain areas (education, transportation, healthcare...)

Also stop with the bailouts of dying industries and instead put money into growing industries that will be sustainable into the future (energy, not auto work, that will provide long term, growing jobs for Americans).

Amen to stopping bailouts!! Washington should have never bailed-out the auto companies. They should have gone into bankruptcy and restructured. Instead, the American public now owns these companies (in essence) and are paying dearly for it. The government should NEVER put its money into any industry that is not directly related to our national defense. That is overstepping its powers and just wastes taxpayer dollars.

 

[gymgal]

Whoa! From a health care provider's perspective, this is easier said than done.
It is not easy (and rarely profitable) to be a Medicaid provider. The administrative complexities, patient compliance problems and low fixed reimbursement rates makes treating such patients very challenging. Often my costs to provide the care exceed the reimbursement from Medicaid

(Also... my brothers are ER physicians... I don't have the patience to discuss unnecessary ER visits by Medicaid patients.) .

So true - I am lucky in that my profession actually gets reimbursed fairly well through medicaid. Better than some of the private insurance companies. But their requirements for reimbursement and future auditing are outrageous and cause me to spend 2x the amount of time on paperwork than with other insurers.

People just don't think far enough ahead to realize that eventually, Obamacare will end up as a 1 payer system with no options/choices. Health care providers will be at the mercy of the government (never a good prospect), unless they only want to take private pay patients, which many will begin doing. Then it lies on the patients to get reimbursed from the government

As for the ER - true again. Medicaid patients think nothing of going to the ER for after hours care for ailments that clearly can wait until the morning for their Primary care. Privately insured would never think to do this because they face a sizable co-pay or deductible for using the ER.

 

[gymgal]

It seems like many of the problems you brought up could be addressed with better funding and organization. Also I know many people who want to access the care but can't. It also won't happen overnight. Education on preventative care needs to be given to low-income communities and over time things can change (IMO). Problems aren't fixed over night, years of habits aren't fixed in a day. In the long run, with more people accessing preventative care Medicaid ER visits would be down. You said it yourself there are limited doctors who take Medicaid and the ER becomes the only option. There's no incentive to go to the ER, except it's often the only place that will take the un and under insured. No one wants to wait hours and hours at midnight because they can't afford to go to a regular doctor.

"better funding" seems to be the key with everything. Better funding doesn't fix stupid. (and no, I am not talking about medicaid patients, I am talking about public policy). The patients have primary care physicians. That's not the issue. They are assigned a physician (or given a list of open providers) when they enroll. (medicaid...I don't seal with medicare). The issue is that they do not have a financial stake in their decision. they don't realize (or care) that a simple ER visit costs upwards of $800. ERs routinely err on the cautious side for fear of being sued. So they order unnecessary tests, hiking that bill even higher.

 

[gymgal]

As I've said before, I don't think I will ever understand the mindset that leads people to be morally offended at the idea of taking care of people in need. The dry, callous, lack of compassion required just blows my mind, and yet people seem not only capable of feeling this way, but proud of it.

Bog, as somebody who has grown up in the US, I am every bit as baffled as you are that there's even any debate on the "question" of whether or not everybody should have access to good healthcare in a first-world country.

Whoa - where did this come from? Who is morally offended by the idea of taking care of people in need? And the debate isn't whether there should be access to affordable health care, but what is the best way to implement this. And who is responsible for it - state or federal....

It's not a simple as you all want to make it "dems want universal health care, republicans want to "throw granny over the cliff" "

What is truly baffling (and amusing) is that folks with a "government should provide all" (and the "rich" should pay for it) attitude, can't see that there are other viable options out there.

 

[ALgymMom]

Coming from two countries with socialised health care I find it astounding that there is even a discussion of not being able to get care/coverage for pre-existing conditions. I also found is nauseating to think of families with no health care as they are low income and not covered by insurance or medicaid.

The whole "medicaid patients" tone is a little ugly.

Tell me more about this "health care" system, in quotation marks as the words do not seem to fit the service provided.

Do you really like your socialized health care? I've never met a Canadian that does. I have a set of cousins that have a Canadian father & when I see that part of their family at weddings they all complain about it. Matter of fact, they all travel to the US for "better" service.
My DH & I are self employed & pay a fortune for an individual policy, have no copay & a huge deductible. Let me tell you, we are sick, sick, sick before we show up at the Dr. BUT at least I don't have to wait 2-3 years for a hip replacement if I need it.
Don't feel so sorry for the "Medicaid patients" They see more doctors than me- TRUST ME! I was a respiratory therapist before a SAHM, Medicaid patients are always in the ER for the slightest ailment that I would treat at home!

 

[wandrewsjr]

Like I said before on this thread, I LOVE my socialized health care, the US Military health care system. The hospitals were built with federal funds, all are fully staffed by federal employees and all health care decisions are made by those on the federal payroll. They do a great job.

 

[bogwoppit]

Do you really like your socialized health care? I've never met a Canadian that does. I have a set of cousins that have a Canadian father & when I see that part of their family at weddings they all complain about it. Matter of fact, they all travel to the US for "better" service.
My DH & I are self employed & pay a fortune for an individual policy, have no copay & a huge deductible. Let me tell you, we are sick, sick, sick before we show up at the Dr. BUT at least I don't have to wait 2-3 years for a hip replacement if I need it.
Don't feel so sorry for the "Medicaid patients" They see more doctors than me- TRUST ME! I was a respiratory therapist before a SAHM, Medicaid patients are always in the ER for the slightest ailment that I would treat at home!

I come from the UK and live in Canada. In neither country is the system perfect or problem free. But everyone is covered and can be treated without bankrupting their families, losing their homes or being turned away due to pre existing issues.. Yes we might wait longer for some surgerys, but everyone can have those surgerys. Major health issues are dealt with rapidly.

Hospitals here do not price gouge either. I have seen childbirth bills from the US where an Advil is billed at $25 and swabs at $30, this doesn't happen here. If you came and gave birth here and paid it would be vastly cheaper as no one is playing the insurance game.

My husbands family are all in health care, we know many people who have moved away for more money. That happens the world over.

Hubby's great uncle was the first dr in our small country village, well before the days of Socialised medicine here. He provided many services for free, for dinner, for a pile of manure for his garden. Those days of charitable beliefs seem to be fleeting.

Basic health care is a basic need that should be provided by society to protect society. I do not know enough about the US system to wade into a debate, but I do know close friends who work low paying jobs who have no health care at all. To me that is a scary way to live, but they have no options.

 

[CoachGoofy]

Do you really like your socialized health care? I've never met a Canadian that does. I have a set of cousins that have a Canadian father & when I see that part of their family at weddings they all complain about it. Matter of fact, they all travel to the US for "better" service.
My DH & I are self employed & pay a fortune for an individual policy, have no copay & a huge deductible. Let me tell you, we are sick, sick, sick before we show up at the Dr. BUT at least I don't have to wait 2-3 years for a hip replacement if I need it.
Don't feel so sorry for the "Medicaid patients" They see more doctors than me- TRUST ME! I was a respiratory therapist before a SAHM, Medicaid patients are always in the ER for the slightest ailment that I would treat at home!

Well don't I feel judged.

Cuz...I am one of those Medicaid patients. Coaching doesn't exactly provide insurance, & I inherited genetic cooties that mean without modern medicine I'd be dead.

In the ER for everything? Nope. I went when I locked my finger in a car door & it wouldn't stop bleeding after 6 hours (adipose tissue: really neat! Unless it's poking out of your finger. Then it's kind of ohgodohgod*faint*). Annnd I went when I passed out from abdominal pain. Not for a number of "why did you not go to the ER???" injuries, not when I got whooping cough from a kid at the gym, nope. Just actual emergencies.

The lumping of a group that's scapegoated so much is distasteful. Like, it's really really bad. A lot of people here are big on "don't judge", but all the statements about the apparent monolith that is "medicaid patients" are incredibly judgey, both in the "making assessments" way and in the "coming to a negative conclusion and talking about it" way.

 

[wandrewsjr]

It would lead to a much more constructive, civilized to discussion to make statements such as - "The medicaid system is flawed, because it does not encourage Medicaid patients to see their primary care physician instead of the ER" - instead of, "Medicaid patients are always in the ER for the slightest ailment."

I think all would agree that not ALL Medicaid patients behave this way, and it is much more productive to discuss how to fix the system. Generalizing can only lead to insulting the individuals who actually use the system in an honorable way, as it was designed to be used.(as CoachGoofy described)

 

[ALgymMom]

It is what it is & I refuse to sugar coat it. Clearly, you have never worked in an ER. Maybe if they charged Medicaid patients a small ER copayment it would weed out the ones going for pregnancy test, diaper rash, hangnails, yeast infections, common cold, skinned knees, belly button lint..... Nope- not making the last one up. Go volunteer to work at your local ER, you will see.
When I quit working, that particular hospital was in the red & laying people off daily.

 

[Andersonortho]

The truth hurts sometimes. The Medicaid system is a broken system and we all know that. It may be used responsibly in some great people but it IS abused in many cases.

Here are my REAL WORLD experiences from yesterday and today:
(1) A mother said she refuses to work because it's easier to just "draw a check" and "get it (my service) for free".
(2) A local (very successful) restaurant owner recently married a woman with 2 kids. She has guardianship of the kids and she does not work. They openly admit that the kids are covered by Medicaid b/c the guardian (mother) has a $0 income.
(3) A person called seeking my services yet they have "no showed"-(--meaning they did not show up for a previous appointment and did not call to cancel) their last 3 appointments. When he was told that we would not schedule due to their past broken appts the person cursed at my receptionist accusing us of descriminiating against Medicaid patients. Yet we are the only office in a 100 miles that accepts Medicaid!

Can you sense my frustration? This is reality.

 

[SkiBumGymMom]

Like I said and you provide points to - It's not the teaching that is a problem - it's the circumstances that cause the high turnover rate, the reluctance of experienced teachers to come into these districts. Discipline issues, lack of parent involvement, lack of administrative support, lack of teacher mentoring (because the experienced ones leave). Throwing money at this to hire "better" teachers or put more aides in the classes are not going to solve it - it only puts a band-aid on the situation.

And school districts with disadvantaged and special needs children *do* get more money from the federal government for free meal, transportation, special education. For those with an IEP, this can total as much as $8000 more a yr. per student affected, depending on the disability and this does not show up in the per-student expenditure because it does not affect the entire school population.

$20,000 for a full time 9 month position fully credentialed teacher? That's about $13.5 an hour (8hr*185 days - lower if the district has more work days). That's ridiculous. I got paid that back in the late 80's as a teacher assistant. Do these districts significantly increase salary after the first year?

Yes, $13.50 an hour before you pay into PERA (Public Employment Retirement Association, you pay into instead of Social Security). And that's for teachers with a bachelors and state certification. lot of teachers aids and paraprofessionals make $8 or $9 an hour without benefits before starting in these districts (and some positions require you to be concurrently in school and it's not paid for or only partially paid for at the community college level). I only made $9 (in the 80s) after getting an associates in interpreting. You eventually do get raises, but still not significantly, but in many of these districts the teachers are fired because of low test scores (which is not necessarily indicative of their employment) within the first 3 years before they're eligible. Then they get stuck bouncing around low-income school districts and some even leave public education.

If the federal government is just throwing money at education it certainty isn't making it to CO. And because of TABOR (the law that essentially makes every tax voted on and doesn't allow cities and counties and the state to hold on to additional revenue in good years to save for bad years, it was passed by a mega-conservative back in the early 90s) there is little funding from the state. (A pro-education funding site from the previous election cycle but it has a good collection of stats I've seen in various government reports, couldn't find the originals all in one place Link Removed) Public education in Colorado is in a major crisis. We import very educated people but then don't compare nationally when educating our children here, we're in for real problems in the very near future. (And don't get me started on higher education funding in CO, we're one of the worst in the country.)

Side note, do you still work in public education? I'm very familiar with IEPs, I'm a district special education coordinator. Disadvantaged doesn't equate to special needs, wealthy school districts with special needs children receive the same federal funding. If the states want their rights so badly, they should work to pick up that tab. (I don't think anyone would make the argument that special needs children don't deserve a quality public education with reasonable accessibility)

OK - this scares me. In general, I am a constitutionalist. I believe in the original plans of our founders, which gave the states sovereign powers and the federal govt was only to have power in the areas of national defense and commerce with foreign countries. You mention very real problems with the states having these powers. And I don't like those either but I do not believe we should limit the states' rights as a result. Let the people speak for themselves about what is best for their own state.

I guess I come from a federalist country originally and lean towards that style of government. I understand there are also problems with it, and don't advocate it completely. I also understand I live in the US and the constitution does grant states rights. There should be some states rights, but the question is where do we draw the line? What can the federal government intervene in and not? What about judicial activism? (most conservatives I know dislike it) But then again, what about cases like Brown v. BOE, Loving v. Virginia, etc.? What I see in certain states scares me.

This has to do with the federal government usurping state powers. Essentially, the federal government takes in money (through federal taxes) that should stay in individual states (state taxes) and then redistributes it as it sees fit. But also, in the process, it wastes a lot of money because of the system created to manage the tax revenue. This is not the "fault" of the states - it is the fault of the federal government wanting control of certain areas (education, transportation, healthcare...)

Correct me if I'm wrong, but it sounds like you would want the federal government to still collect that money and use it for other ventures, while at the same time have the states increase their taxes to pay for the programs the federal government is now not paying for? This is exactly how we get ever increasing taxes.

Right. But like I mentioned, some of the states with the lowest state taxes receive the most federal funding per capita (Montana, Wyoming, Alaska, etc.) If people advocate state rights exclusively, then yes federal funding should be cut. I think there should be a balance, maybe (just throwing ideas out that would combine federal power with states rights for the sake of discussion) a relatively low, flat, federal tax rate and then a proportionate state tax rate. When I referred to federal control I meant more along the lines of legislature than funding, making sure states provide a certain level of services and rights for their citizens (proper roads, education, health care, human rights such as anti-discrimination, etc.)

Amen to stopping bailouts!! Washington should have never bailed-out the auto companies. They should have gone into bankruptcy and restructured. Instead, the American public now owns these companies (in essence) and are paying dearly for it. The government should NEVER put its money into any industry that is not directly related to our national defense. That is overstepping its powers and just wastes taxpayer dollars.

Do you think the states should be investing money in growing and future industries to provide jobs for their citizens? Or should it be a solely private enterprise? On the latter, as it's been discussed before in this thread, in today's world there is very little motivation for US companies to make US jobs, it's much cheaper and more profitable to outsource and consolidate. Should there be government intervention there at all?