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Trump Wants to get rid of Medicaid
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water_bear88




 
 
    
 

Post Wed, Mar 15 2017, 1:36 pm
SixOfWands wrote:
A co-pay penalty for non-emergency treatment in an ER, leaving real emergency care free? Certainly making urgent care centers more available to Medicaid patients would be helpful.


I think that should work. I live in a country with socialized healthcare and I will get penalized if I go to the ER without justified cause. Of course, my primary care visits are free (medication is not, but what my family needs is reasonably priced- for example, recent replacement 2 inhalers with asthma medication was something like 30 shekels). It's only a major issue for the middle class if you get sick with something less common and the drug you need isn't subsidized by the government.

The ER penalty is waived in a specific list of cases, which includes being hospitalized as a result of the visit, having a referral from a primary care physician, being delivered there by an ambulance that picked you up in a public location, or being 40+ weeks pregnant and showing up at the maternity emergency room. It's somewhat lower thought not entirely waived nights and weekends when primary care is unavailable.

To all those on this thread who think they shouldn't be paying so much, how many are paying even partial tuition to private schools? You're prioritizing that over dental care. That is a choice you are free to make, but don't blame the poor.
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youngishbear




 
 
    
 

Post Wed, Mar 15 2017, 1:39 pm
I don't think it's fair to start labeling certain necessities as choices, lest we end up saying nonsense like "Americans can choose to get healthcare instead of an iphone".

Americans should not go hungry or without healthcare. Long-term goal: neither should anyone.
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sourstix




 
 
    
 

Post Wed, Mar 15 2017, 1:53 pm
[quote="Jeanette"]It's all very nice to argue against social service programs and how the poor are living large on the backs of the rich (poor them!). That's been the Republican agenda since forever. But people seem to be forgetting that DT ran on the opposite platform. He did not run as the Republican who would cut social services programs. He ran as the champion of the poor blue collar/middle class workers that everyone forgot about. He ran to replace Obamacare with something bigger, better that would cover more people at less cost. Now he's seeing that "nobody knew healthcare could be so complicated." Huh, who knew??[/quote]

Yes, he's being shrewd here and people are not getting it. He says, I'll take care of underprivedged and then just cuts them out. Making the rich richer and the poor poorer.

so u watched john Oliver? Hysterically funny yet to the point
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33055




 
 
    
 

Post Wed, Mar 15 2017, 2:38 pm
When 93% of a population are on Medicaid, that is not a safety net for the poor. That is standard operating procedure. That population has plenty of luxury items, so it is not a question of doing without and ending up on the street dead. Perhaps there should be tzeducah for jewelry if the same money went for health care.

I became friendly with ladies at my gym. When Obama care decided to cover gym membership, they got their Drs to write the appropriate documentation for free gym memberships going forward. Also, they were asking me to sell their free breast pumps over the internet for them. They also sell the free formula provided by WIC.

The abuse of the taxis is systematic. People cut private deals with the taxi company and take a bus. Yes, they take the bus that picks them up on their corner and drops them off near their dr. Taxis should only be provided when there is no public transportation available for routine checkups. Rufuah health center provides a free busing loop. This loop takes people to the gym and back. It did it before Obamacare.

Maybe cutting out this abuse will save a small percentage, but it adds up when the other abuse is cut.

I have posted about medical tourism. Foreign residents claim they live here and get free medical care before they fly home. I know of one lady who was given a $2000 hearing aid for a mild hearing lose in one ear. Someone pays for this.

My premiums went up 150% monthly under Obamacare.

I understand the incentive to get paid under the table and have the opportunity to make money by going to the Dr.

ITA that poor people need healthcare. But there should be a residency requirement before non-emergency care is provided.

My property taxes are the second highest in the nation due to Medicaid.
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sky




 
 
    
 

Post Wed, Mar 15 2017, 2:52 pm
I know people with many kids - if one child has a sore throat they take all the kids for strep tests it is free. If you pay $25 you think twice before testing 6 children.
If you can get free orthopedics for every child then why not try and get for every eligible child. If 6 children in a family need then there is something wrong. If there was even a small co-pay people would not be doing it.
If you get free tylenol, bactriban, diaper rash cream at every sick visit dr appt then of course you will ask
When there is no cost it will be abused.
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Amarante




 
 
    
 

Post Wed, Mar 15 2017, 3:09 pm
Squishy wrote:
When 93% of a population are on Medicaid, that is not a safety net for the poor. That is standard operating procedure. That population has plenty of luxury items, so it is not a question of doing without and ending up on the street dead. Perhaps there should be tzeducah for jewelry if the same money went for health care.

I became friendly with ladies at my gym. When Obama care decided to cover gym membership, they got their Drs to write the appropriate documentation for free gym memberships going forward. Also, they were asking me to sell their free breast pumps over the internet for them. They also sell the free formula provided by WIC.

The abuse of the taxis is systematic. People cut private deals with the taxi company and take a bus. Yes, they take the bus that picks them up on their corner and drops them off near their dr. Taxis should only be provided when there is no public transportation available for routine checkups. Rufuah health center provides a free busing loop. This loop takes people to the gym and back. It did it before Obamacare.

Maybe cutting out this abuse will save a small percentage, but it adds up when the other abuse is cut.

I have posted about medical tourism. Foreign residents claim they live here and get free medical care before they fly home. I know of one lady who was given a $2000 hearing aid for a mild hearing lose in one ear. Someone pays for this.

My premiums went up 150% monthly under Obamacare.

I understand the incentive to get paid under the table and have the opportunity to make money by going to the Dr.

ITA that poor people need healthcare. But there should be a residency requirement before non-emergency care is provided.

My property taxes are the second highest in the nation due to Medicaid.


Medicaid is not available to non-residents except for emergencies. I believe that it is not available until one has lived in the country for a good amount of years - I believe it is five. So there is no ability to fly in and get Medicaid unless one is really hooked into a criminal network that is supplying fake Visas and naturalization papers.

How does Medicaid have anything to do with property taxes. Property taxes are a local tax and in general they support local services like schools or police, street cleaning or whatever local services are provided by a municipality.

Medicaid is funded mostly by Federal taxes and I would imagine in liberal states like New York which provide generous Medicaid, also supplemented by state income tax. But certainly not by property taxes. The only medical care that might be provided by property taxes would be ambulances or perhaps a free clinic if a town wanted to fund it.

If people are cheating the system, that's disgusting but the vast majority of people on Medicaid are not scamming the system like the frum Jews you know. I think Monsey and KJ are very special places where you have a system in place where the institutions provide advice on how to best cheat the system. It also is a place in which there is rampant fraud for all government programs like woman not getting married civilly or completely cash payments for both tax fraud and to quality for government programs. It's disgusting. However, that culture of cheating does not exist in places like Appalachia where people are receiving medical care for the first time because of expanded Medicaid.

FWIW, the zip codes with the HIGHEST percentage of Medicare and Medicaid fraud are in Brighton Beach because the Russian Jews are well schooled in bilking the system having grown up in the Soviet Union where it was a necessity to cheat to survive.

If you know people are cheating, blow the whistle. I would if I were aware of all of the cheating frauds that you seem to be aware of. I don't mean this in a snarky way but I completely agree that it's disgusting morally reprehensible behavior and seems to be condoned by a community that is using its "smarts" to bilk the system instead of using its talents to earn an honest living. What a horrendous hypocritical culture has been devised in which all manner of chicanery seems to be justified in the name of Torah.


Last edited by Amarante on Wed, Mar 15 2017, 3:11 pm; edited 1 time in total
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33055




 
 
    
 

Post Wed, Mar 15 2017, 3:10 pm
sky wrote:
I know people with many kids - if one child has a sore throat they take all the kids for strep tests it is free. If you pay $25 you think twice before testing 6 children.
If you can get free orthopedics for every child then why not try and get for every eligible child. If 6 children in a family need then there is something wrong. If there was even a small co-pay people would not be doing it.
If you get free tylenol, bactriban, diaper rash cream at every sick visit dr appt then of course you will ask
When there is no cost it will be abused.


Oh yeah, I forgot about the free designer shoes yearly. That is so ridiculous. The lines for the free shoes are out the door. Everyone qualifies for free shoes. And the free glasses yearly.

Don't forget the free phones once you get for Medicaid. You can call internationally with them. (I know Obama didn't start the program, but they were pushed heavy under his admin. )
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MagentaYenta




 
 
    
 

Post Wed, Mar 15 2017, 3:18 pm
Medicaid copays and deductibles are a function of the states and how they administer their programs. Some states build in copays others don't.

I was on medicaid expansion for a year before my medicare began. My Dr. visits had a $25 copay and ER 50 (depending on the medical issue this could be waived). Medication copays were a function of a state formulary (just like most private ins. uses a formulary).

If you have an issue with lack of copays in your state, it is an issue that can be attacked on the state level.
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33055




 
 
    
 

Post Wed, Mar 15 2017, 3:18 pm
Amarante wrote:
Medicaid is not available to non-residents except for emergencies. I believe that it is not available until one has lived in the country for a good amount of years - I believe it is five. So there is no ability to fly in and get Medicaid unless one is really hooked into a criminal network that is supplying fake Visas and naturalization papers.

How does Medicaid have anything to do with property taxes. Property taxes are a local tax and in general they support local services like schools or police, street cleaning or whatever local services are provided by a municipality.

Medicaid is funded mostly by Federal taxes and I would imagine in liberal states like New York which provide generous Medicaid, also supplemented by state income tax. But certainly not by property taxes. The only medical care that might be provided by property taxes would be ambulances or perhaps a free clinic if a town wanted to fund it.

If people are cheating the system, that's disgusting but the vast majority of people on Medicaid are not scamming the system like the frum Jews you know. I think Monsey and KJ are very special places where you have a system in place where the institutions provide advice on how to best cheat the system. It also is a place in which there is rampant fraud for all government programs like woman not getting married civilly or completely cash payments for both tax fraud and to quality for government programs. It's disgusting. However, that culture of cheating does not exist in places like Appalachia where people are receiving medical care for the first time because of expanded Medicaid.

FWIW, the zip codes with the HIGHEST percentage of Medicare and Medicaid fraud are in Brighton Beach because the Russian Jews are well schooled in bilking the system having grown up in the Soviet Union where it was a necessity to cheat to survive.

If you know people are cheating, blow the whistle. I would if I were aware of all of the cheating frauds that you seem to be aware of. I don't mean this in a snarky way but I completely agree that it's disgusting morally reprehensible behavior and seems to be condoned by a community that is using its "smarts" to bilk the system instead of using its talents to earn an honest living. What a horrendous hypocritical culture has been devised in which all manner of chicanery seems to be justified in the name of Torah.


With all due respect, I would never ever ever report a frum Jew or testify against one under any circumstances unless I had permission from a BD. I would only request permission under extreme duress.

Different states fund differently. I get double zonked in N.Y.
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Amarante




 
 
    
 

Post Wed, Mar 15 2017, 3:33 pm
Squishy wrote:
With all due respect, I would never ever ever report a frum Jew or testify against one under any circumstances unless I had permission from a BD. I would only request permission under extreme duress.

.


That's like the omertà code of the Mafia.

If a person is engaging in illegal or unethical activity, why do they deserve my protection just because they engage in certain religious rituals. They certainly don't deserve any respect and are selectively choosing which religious rituals they practice. Stealing is one of the big ten and would seem to cancel out almost any other rote actions of an outwardly frum person. Clearly they have not internalized any ethical or moral code of behavior.

That same thinking protects molestors or historically did.

Do you turn a blind eye to any evil immoral illegal act just because someone who calls himself or herself frum does it?

[note from Yael- asking a rav before turning a jew over to non jewish authorities for doing something illegal is a basic aspect of halacha and must be respected. For certain situations such as molestation there are blanket statements already made by rabbanim that do not require one to ask a rav first]


Last edited by Amarante on Wed, Mar 15 2017, 3:47 pm; edited 1 time in total
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amother
Cyan


 

Post Wed, Mar 15 2017, 3:33 pm
Op here, and to squishy. My intention was not about somepeople that fraud the government.

You say you wouldn't report any Jew then stop what your doing now.

My intention was very different. start a spinoff of Medicaid fraud if you want. But not here. Thank you!
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amother
Blue


 

Post Wed, Mar 15 2017, 3:46 pm
[quote="water_bear88"]I think that should work. I live in a country with socialized healthcare and I will get penalized if I go to the ER without justified cause. Of course, my primary care visits are free (medication is not, but what my family needs is reasonably priced- for example, recent replacement 2 inhalers with asthma medication was something like 30 shekels). It's only a major issue for the middle class if you get sick with something less common and the drug you need isn't subsidized by the government.

The ER penalty is waived in a specific list of cases, which includes being hospitalized as a result of the visit, having a referral from a primary care physician, being delivered there by an ambulance that picked you up in a public location, or being 40+ weeks pregnant and showing up at the maternity emergency room. It's somewhat lower thought not entirely waived nights and weekends when primary care is unavailable.

To all those on this thread who think they shouldn't be paying so much, how many are paying even partial tuition to private schools? You're prioritizing that over dental care. That is a choice you are free to make, but don't blame the poor.[/quote\]

I don't think anyone has a problem with Medicaid paying for emergency dental visits for those who do their best and still can't afford it. The part that bothers me is that I'm paying taxes for individuals on Medicaid to see the dentist for their 6 month check ups and preventative dental care while I only see the dentist myself for real emergencies and pay for it out of pocket. I don't see the correlation between paying tuition and paying for dental care. For me, dental care is a luxury, because I don't get it for free. Therefore, I manage without it. I pay tuition because I think my child's education is more important than my 6 month dental visit so I prioritized it that way. There is a need for Medicaid for those who are truly poor or truly incapable of work. However, the problem is that Individuals on Medicaid are getting care that those who are contributing to that care are being forced to manage without. It's like if I contribute towards your steak meal from money I need, while I'm eating chicken.
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tigerwife




 
 
    
 

Post Wed, Mar 15 2017, 3:53 pm
Jeanette wrote:

I do not think there should be co-pays for medication or for primary care visits. I would not want people choosing to forgo needed medications to save money, or skipping out on preventive care or follow up appointments.


Well, this is what is happening for many people in my bracket. Is it worth the $50 co-pay to follow up on vision loss yearly? Does the tooth hurt that much? I'm not talking about life- and- death, but on preventative matters that may become so.
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33055




 
 
    
 

Post Wed, Mar 15 2017, 3:53 pm
Amarante wrote:
That's like the omertà code of the Mafia.

If a person is engaging in illegal or unethical activity, why do they deserve my protection just because they engage in certain religious rituals. They certainly don't deserve any respect and are selectively choosing which religious rituals they practice. Stealing is one of the big ten and would seem to cancel out almost any other rote actions of an outwardly frum person. Pearly they have not internalized any ethical or moral code of behavior.

That same thinking protects molestors or historically did.

Do you turn a blind eye to any evil immoral illegal act just because someone who calls himself or herself frum does it?


That's why I left the out that I could go to a BD. The thought of child molestation went through my mind.

Honestly, I don't know what I would do if they refused me permission. I would find some way to help. Perhaps I would consult with Rabbi Horowitz. I simply don't know.
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water_bear88




 
 
    
 

Post Wed, Mar 15 2017, 3:54 pm
[quote="amother"]
water_bear88 wrote:
I think that should work. I live in a country with socialized healthcare and I will get penalized if I go to the ER without justified cause. Of course, my primary care visits are free (medication is not, but what my family needs is reasonably priced- for example, recent replacement 2 inhalers with asthma medication was something like 30 shekels). It's only a major issue for the middle class if you get sick with something less common and the drug you need isn't subsidized by the government.

The ER penalty is waived in a specific list of cases, which includes being hospitalized as a result of the visit, having a referral from a primary care physician, being delivered there by an ambulance that picked you up in a public location, or being 40+ weeks pregnant and showing up at the maternity emergency room. It's somewhat lower thought not entirely waived nights and weekends when primary care is unavailable.

To all those on this thread who think they shouldn't be paying so much, how many are paying even partial tuition to private schools? You're prioritizing that over dental care. That is a choice you are free to make, but don't blame the poor.[/quote\]

I don't think anyone has a problem with Medicaid paying for emergency dental visits for those who do their best and still can't afford it. The part that bothers me is that I'm paying taxes for individuals on Medicaid to see the dentist for their 6 month check ups and preventative dental care while I only see the dentist myself for real emergencies and pay for it out of pocket. I don't see the correlation between paying tuition and paying for dental care. For me, dental care is a luxury, because I don't get it for free. Therefore, I manage without it. I pay tuition because I think my child's education is more important than my 6 month dental visit so I prioritized it that way. There is a need for Medicaid for those who are truly poor or truly incapable of work. However, the problem is that Individuals on Medicaid are getting care that those who are contributing to that care are being forced to manage without. It's like if I contribute towards your steak meal from money I need, while I'm eating chicken.


But you're actively deciding to forego preventative dental care. You absolutely could afford it with your salary- you spend your money on luxury schools instead. It's your choice to get sick and need a root canal every few years, since you'll pay for it yourself. When Medicaid is paying, though, it's a lot cheaper to get people in every 6 months for simple care than give them root canals less often. This is about math, not emotion.
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tigerwife




 
 
    
 

Post Wed, Mar 15 2017, 4:01 pm
Water Bear, I feel like the issue is incomparable in Israel. Basic care is available to everyone. However, if you need advance care or private services it isn't as out of reach. I paid something like 1000-1600 shekel to see one of the top doctors in a specific field which is a joke compared to the US. I wish they can work out a similar program here. But a big factor is that Israeli doctors are getting paid way less than they would in the US.
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water_bear88




 
 
    
 

Post Wed, Mar 15 2017, 4:10 pm
tigerwife wrote:
Water Bear, I feel like the issue is incomparable in Israel. Basic care is available to everyone. However, if you need advance care or private services it isn't as out of reach. I paid something like 1000-1600 shekel to see one of the top doctors in a specific field which is a joke compared to the US. I wish they can work out a similar program here. But a big factor is that Israeli doctors are getting paid way less than they would in the US.


But I think basic care should be available to everyone in the US. They could afford it if they budgeted right. Just start with medications and needing generics more available so there's competition on drugs that have been on the market for years (epinephrine shots, e.g.). It is complex with doctors' salaries- you're right- Israeli doctors don't graduate with anything like the student debt their American colleagues accumulate.

But if you're going to pay for others' Medicaid anyway, you will pay less overall if they get preventative care. Root canals involve anesthesia and heavy involvement of a dentist. A twice-yearly visit, as I recall, is mostly with a dental hygienist and maybe a 2-minute lookover by a dentist. No expensive drugs. Mathwise, you the tax-payer come out ahead when the poor get preventative care. Your insurance should be incentivized to do the same.
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33055




 
 
    
 

Post Wed, Mar 15 2017, 4:22 pm
water_bear88 wrote:
But I think basic care should be available to everyone in the US. They could afford it if they budgeted right. Just start with medications and needing generics more available so there's competition on drugs that have been on the market for years (epinephrine shots, e.g.). It is complex with doctors' salaries- you're right- Israeli doctors don't graduate with anything like the student debt their American colleagues accumulate.

But if you're going to pay for others' Medicaid anyway, you will pay less overall if they get preventative care. Root canals involve anesthesia and heavy involvement of a dentist. A twice-yearly visit, as I recall, is mostly with a dental hygienist and maybe a 2-minute lookover by a dentist. No expensive drugs. Mathwise, you the tax-payer come out ahead when the poor get preventative care. Your insurance should be incentivized to do the same.


Twice yearly checkups are $380 plus 4 taxis. Anyway, I think they yank certain teeth instead of doing root canals to be fair.

Medicaid recipients should not get routine cabs if there are closer providers. It is an invitation for abuse. Also, it should be required that families coordinate appointments.
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tigerwife




 
 
    
 

Post Wed, Mar 15 2017, 4:26 pm
water_bear88 wrote:
But I think basic care should be available to everyone in the US. They could afford it if they budgeted right. Just start with medications and needing generics more available so there's competition on drugs that have been on the market for years (epinephrine shots, e.g.). It is complex with doctors' salaries- you're right- Israeli doctors don't graduate with anything like the student debt their American colleagues accumulate.

But if you're going to pay for others' Medicaid anyway, you will pay less overall if they get preventative care. Root canals involve anesthesia and heavy involvement of a dentist. A twice-yearly visit, as I recall, is mostly with a dental hygienist and maybe a 2-minute lookover by a dentist. No expensive drugs. Mathwise, you the tax-payer come out ahead when the poor get preventative care. Your insurance should be incentivized to do the same.


I agree with you that everyone should get basic care! But beyond that the pricing is incomparable. I wonder if it's possible to make it work.
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amother
Blue


 

Post Wed, Mar 15 2017, 4:29 pm
water_bear88 wrote:
But you're actively deciding to forego preventative dental care. You absolutely could afford it with your salary- you spend your money on luxury schools instead. It's your choice to get sick and need a root canal every few years, since you'll pay for it yourself. When Medicaid is paying, though, it's a lot cheaper to get people in every 6 months for simple care than give them root canals less often. This is about math, not emotion.


I understand your argument and I agree with it for individuals who do what they are capable of and are truly poor and can't afford the basics. This is under the premise that Medicaid is only covering medical necessities (which is debatable). I also know that there are people on Medicaid sending to similar luxury schools as I am.
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