Medicaid keeps on growing like kudzu vine in a forest. Kudzu grows like a wildfire out of control and the Biden government has no interest in stopping it. They actually want it to take over everything.

This process began with the Affordable Care Act of 2010, better known as ObamaCare, which the Obama Administration pushed through Congress without a single Republican vote. Medicaid eligibility was originally defined by the federal government as 133% of the Federal Poverty Level (FPL) for pregnant women and children six years and under, 100% of FPL for children seven to eighteen, 75% of FPL for the elderly and disabled and 25% of FPL for working parents. Childless adults were ineligible. Individual states could increase these levels but could not decrease them.

ObamaCare changed all that by establishing one federal definition of eligibility at 133% of FPL. It also enticed states to increase their Medicaid rolls by offering to increase the federal subsidy from a then current average of 57% of the costs to 100% of the costs for “newly eligible” people in 2014 for three years. Thereafter the subsidies would gradually decline to 90% in 2020, but none beyond that. Many states were sucked in by this incentive only to have buyer’s remorse when the rolls of their Medicaid population ballooned past expectations and they were left with huge debts in their state’s budgets. But the federal government was only too delighted to have more people on the rolls of Medicaid.

Then the Covid pandemic hit in 2020. This gave the new Biden Administration just the excuse they needed in 2021 to expand the rolls of Medicaid further. They extended the temporary expanded eligibility guidelines of the Trump Administration well beyond the pandemic crisis to allow millions of Americans to enroll in Medicaid who did not meet the economic eligibility guidelines.

Fast forward to today and now we see the Biden, or should I say Harris, Administration going further in their quest to expand Medicaid. Here is how the Wall Street Journal editorial board described it: “Kamala Harris this week praised North Carolina’s new plan to wipe out medical debt. What the Vice President didn’t say is that the Biden Administration is making taxpayers in the rest of America pay for it. Behold how the Administration is turning Medicaid into an entitlement for progressive policies far beyond healthcare for the poor.”

The Centers for Medicare and Medicaid Services last week approved North Carolina Democratic Gov. Roy Cooper’s plan to increase federal Medicaid reimbursements for hospitals that agree to forgive medical debt and discount future bills for low- and middle-income patients. Urging other states to follow, Ms. Harris promised to continue “to relieve the burden of medical debt.”

This could be an expensive proposition. Americans owe more than $220 billion in medical debt, though perhaps Ms. Harris considers it a pittance relative to the more than $800 billion in student debt the Administration has written down. Enter Mr. Cooper, who is dangling more Medicaid money for hospitals that waive debt accrued over the last decade by patients earning less than 350% of the poverty line—$109,200 for a family of four—or whose unpaid bills exceed 5% of their annual income. Hospitals will also have to provide large discounts for patients earning less than 300% of the poverty line.

Larger federal Medicaid payments would exceed the amount of potential debt relief. But this may still be a Faustian bargain for hospitals since debt relief could cause patients to skip out on future bills. Reducing patient payments for emergency visits could also spur more to go without insurance, resulting in more uncompensated care.

Why is this government so eager to enroll more Americans in Medicaid?

This is all about expanding the welfare state to make more Americans dependent on the government. It is one more step toward socialized medicine, the complete government control of your healthcare. Don’t be fooled! When they are in complete control of your healthcare, they are in complete control of who gets treatment and who does not.

The fate of our medical system in the future lies in the hands of medical students being trained today. Unfortunately, there is cause for alarm when examining the training and medical ethics of our current batch of medical students.

The evidence for this concern comes from many sources I have written about in the past.     (See Woke Medical Education, Woke Medical Education Update, Woke Medical Education Update 2024.) These posts mostly concerned training and speculated on the impact of such training. But now we have a real-life example of how this trend is influencing our world today.

Dr. Travis J. Morrell is an Ob-Gyn physician practicing in Grand Junction, Colorado. In an Op-ed entitled Ideology in Medical School Threatens Everyone’s Health, he tells us what happened in his state when he tried to protect children from radical transgender ideology. Here is his story: “Beware the rising generation of physicians. In June, an army of medical students defeated my attempt to protect children from radical transgender ideology. My fellow physicians in the Colorado Medical Society overwhelmingly stood with me in defense of basic medical ethics and evidence, yet students from Colorado’s premier medical school overruled us. Americans should worry that when today’s trainees become tomorrow’s doctors, they’ll put political activism ahead of patient health.”

Dr. Morrell filed a resolution with the Colorado Medical Society in March which was intended to protect children from transgender medical interventions that can ruin healthy sexual function and damage reproductive ability, potentially leading to a lifetime of physical and mental ailments. He built his resolution around the Colorado Medical Society’s existing policy on female genital mutilation. Passed in 1998 and reaffirmed in 2014, that policy opposes the practice, which is also a federal crime. Yet transgender surgeries often involve mutilation, which activists deem medically necessary. Earlier treatments, such as puberty blockers and cross-sex hormones, are typically prescribed in preparation for mutilating surgeries on teenagers.

Dr, Morrel tells us what happened: “Under Colorado Medical Society rules, my resolution came before the general membership in mid-May. My fellow physicians were given four weeks to vote, and within days passage looked likely. After more than three weeks, more than 60% of participating physicians supported the resolution. But by June 12—the day before voting ended—the tide had dramatically turned, thanks to a sudden influx of votes by medical students.

At first, I didn’t understand why so many medical students chimed in, but a website called the Publica has since reported that Frank Merritt, an assistant professor at the University of Colorado School of Medicine, emailed the student body shortly before the vote ended. “I don’t usually use this position for things like this,” Dr. Merritt’s email began. He then asked the medical students to vote against my resolution. He told the students that all of them are “automatically members of the Colorado Medical Society, though I imagine most of you have not registered accounts.” He provided instructions for registering and implored them to act fast as voting was closing soon.

The army of medical students swung into action. More than 150 voted against my resolution, with the final vote being about 75% opposed. Six medical students voted in favor—an act of bravery considering their names were made visible to other society members, including fellow students, during the voting process. Following the vote, on June 14, the Colorado Medical Society’s board formally rejected my resolution. It’s possible the board would have made the same move had the resolution passed, but it would have been much harder to justify.”

This real-world example of the impact of woke medical education has frightening ramifications for our country’s medical future. Combine this with the increasing call for socialized medicine like Medicare for All and our medical future is indeed alarming.

 

This blog is not intended as a political commentary. But it is intended as a healthcare information site and one that will inform you on healthcare issues being debated by our politicians.

Now that it appears Vice President Kamala Harris is the intended nominee of the Democratic Party for President, her views on healthcare should be known. Harris is a supporter of Senator Bernie Sanders’ views on socialized medicine. When Sanders promoted changes in our healthcare system he called Medicare for All, Harris supported his bill in the Senate. She has called for the elimination of private health insurance in favor of a socialized system where government controls all healthcare. What would that mean?

When Senator Sanders promoted Medicare for All, in 2018, I wrote a two-part series on the subject. Since this subject is sure to be discussed in the election campaign soon, In Part I of this series I re-published Understanding Medicare for All – Part I. Today I am re-publishing Part II.

Understanding Medicare For All – Part II

Robert S. Roberts, M.D.

9/10/18

Today we continue an explanation of the proposed legislation of socialist Senator Bernie Sanders entitled Medicare For All. Healthcare economist John C. Goodman gives us ten fundamentals you need to understand about Medicare and what it means if it were the only healthcare system available to everyone, as Senator Sanders promotes. Last post we looked at the first seven and today we pick up again with number eight.

8. The real cost of Medicare includes hidden costs imposed on doctors and taxpayers.

In number seven, we learned that Medicare For All would be costly. Charles Blahous of the Mercatus Center has estimated the cost at $32.6 Trillion over the first ten years – and probably more thereafter. Blahous also estimates that the administrative cost of private insurance is 13%, more than twice the 6% it costs to administer Medicare.

Single-payer advocates often use this administrative cost comparison to argue that universal Medicare would reduce healthcare costs. But this estimate ignores the hidden costs Medicare shifts to the providers of care, doctors and hospitals, including the enormous amount of paperwork required in order to get paid.

The Obama administration forced doctors and hospitals to implement electronic medical record system – a costly change that appears to have failed to deliver promised increases in quality or reduction in costs or medical errors. In fact, it has made it easier for doctors to “up code” and bill the government for more money. Also to be considered are the costs of collecting more taxes to fund Medicare. Some estimates put these costs as high as 25 cents on every dollar.

A Milliman  & Robertson study estimates that when all these costs are included, Medicare and Medicaid spend two-thirds more on administration than private insurance spends. Using the most conservative estimate of the social cost of collecting taxes, economist Benjamin Zycher calculates that the excess burden of a universal Medicare program would be twice as high as the administrative costs of universal private coverage.

9. Not a single problem in ObamaCare would go away under Medicare For All.

All of the difficult questions posed by ObamaCare would remain. Who would pay what? Would the premiums be actuarially fair? Would there be subsidies? Would the premiums vary by age? By health status? By income level? By health living choices?

How would employers be affected? Economists tell us that employee benefits are substitutes for wages and are therefore “paid for” by the employees. Under Medicare For All, would employers get off scot free?

Would there be an exchange? There is one now for Medicare – that’s how people enroll in Medicare Advantage plans. Like the ObamaCare exchanges, the Medicare Advantage exchange has subsidies for private insurance, mandated benefits, annual open enrollment and no discrimination based on health status.

The ObamaCare exchanges, by contrast, have been a disaster. Premiums and deductibles are skyrocketing, there are higher charges for chronic patients who need specialty drugs, and plans exclude more and more of the best doctors and hospitals. Expect more of the same with Medicare For All.

10. Medicare is already on a path to healthcare rationing.

Medicare is already in trouble. It is already on an unsustainable path with future promises made that far exceed expected revenues. When the Affordable Care Act (ObamaCare) was passed in 2010, the Medicare Trustees estimated the unfunded liability at $89 Trillion! Yet at the next trustees’ report that figure had dropped to $37 Trillion. How could that happen?

Passage of the ACA theoretically put the government’s healthcare spending on a budget. Goodman says that for the past 40 years, per capita healthcare spending has been growing at twice the rate of growth of real per capita income. At that rate it won’t take long to run out of money.

The Obama administration tried to “solve” this problem by creating an enforcement mechanism to control spending It was called the Independent Payment Advisory Board (IPAB). It was to be tasked with reducing fees for doctors and hospitals to cap spending. This unelected and unaccountable board would be able to restrict what treatments your doctor could provide with the stroke of a pen! Fortunately, IPAB was abolished this year in a bipartisan budget deal.

Goodman says expect Medicare fees to providers to continue to fall behind private sector fees in the future. This means one of two things must happen:

• Providers will respond to lower fees by providing less care to seniors
• Providers will shift costs to non-seniors in the form of higher fees, higher insurance premiums and higher state and local taxes.

The first of these options means Medicare will become more like Medicaid. Doctors will restrict access by offering fewer appointment options for Medicare patients just like they currently do for Medicaid patients. Hospitals may respond by reverting to the use of open wards instead of providing private rooms. Expensive treatments will be unavailable as cost-reducing takes precedence over patient care.

Medicare For All is socialized medicine and similar healthcare systems in other parts of the world, including Canada, Great Britain and Sweden always are plagued by restricted access and declining quality of care. Expect the same in this country.