One metric is that USA spends more per capita on health care than any other country, but life expectancy is below Japan, Australia and most European countries.
The reason? We don't have a healthcare system. We have a revenue generating system that does healthcare. In it Income>Outcomes (i.e. Income is more important than outconmes)
Yep Paul G, 100%. We have many great doctors, and if one is lucky enough to have good health care coverage and access to those docs, fantastic. but overall our for-profit health care system driven by private insurers and medical group CEOs listening more to CFOs and consultants than to care providers - leads to some awful outcomes. It probably won't happen in my lifetime, but please bring on Medicare for All (if there is still Medicare when Rs get doen with safety net).
And the Big Barbaric Boondoggle is also going to shut down a ton of hospitals. Mainly in rural counties. What good is having health insurance if there's no hospitals to get care?
Also, when you cut 17 million from the insurance rolls, they'll put off care--then show up at a local ER when they have an acute crisis. That costs thousands, or tens of thousands, instead of hundreds. And force the local hospital to eat the bill. Which drives up health insurance premiums for EVERYBODY else.
👆🎯As a retired health care worker I have seen this, the very poor show up only when they are in a health crisis. And they absolutely are paying more for the much sicker, and uninsured. This will kill rural hospitals, who will get bought up by religious orgs, compromising health care even further.
Actually only the overpayments to Medicare "advantage". That Medicare Advantage was invented by R's relentless quest to destroy Medicare. They worked in tandem with their insurance company buddies and the fraud there is mind boggling
"In 2024, the improper payment rate in Medicare Advantage was 5.61%, amounting to $19.07 billion in federal payments that were not properly made. Improper payments include both fraud and other errors, but fraud is a major component."
The vast majority of costs for healthcare are for labor of all kinds - but primarily for doctors and nurses. The costs per unit are so high due to constraints on supply - the AMA acts as a super powerful union to limit the supply - along with friends in government who control the number of residency positions available. The traditional argument for throttling the supply is that if there are more doctors it will be easier to see your doctors and you will go to the doctor and use more care- increasing the costs overall - but this pendulum has swung too far and we are not making enough doctors to meet minimal demand today, forget luxury medicine. Also note that a very small percentage of high use patients drive much of the costs for hospitals and social workers / programs to manage external factors that often drive these patients’ hospital visits are the cure, not less access to care.
im a free enterprise believer, not a Democratic Socialist, but maybe, in a Single Payer system, our really good doctors can make do on $700k-$800k comp instead of $1M+ that specialists and surgeons in our local and regional system often make. They are great doctors, but it is all about tradeoffs and reasonableness, and there are multiple ways to address costs
I remember that Michael Moore documentary Sicko where they followed around an English doctor. He was basically an employee who complained that maybe he should be paid more but he lived in a nice house and drove a BMW.
We need more physician "employees"-so much of those fees go to paying staff including one DEDICATED to filling out paperwork.
Yeah. As somebody said back in the ACA debates, spending more money for worse outcomes is the literal definition of inefficiency, and yet we're all supposed to be terrified of how "inefficient" the system would get if it worked like (pick literally any European country).
Most tellingly: Taiwan - decided to go compulsory, single payer in 1995; Korea - moved to single payer in 2005. These are hardly "socialist" countries by any rational measure.
Of course, if it is because of the educational system then not only won't it "take decades to turn the US into a world-class country again," it won't ever happen. Our educational system is also under assault by Republicans, who not only benefit, but survive on voter stupidity and ignorance. They need poorly educated voters so they have no incentive to try to improve education in the US.
But the problem is far worse than that. Americans, for the most part, don't care if they are well-educated. I have long made a distinction between education and training. The attitudes in this country regarding the two are now overwhelmingly in favor of training whose goal is to provide better higher paying jobs. Even Obama emphasized schooling as training. What is not important in the US is the idea of citizenship that balances rights and responsibilities. Among the most important responsibilities are knowledge about and understanding of our system and what it needs.
Increasingly, the kinds of college courses and majors that help make people better citizens and more complete human beings are subjected to disrespect and regarded as a waste of time. There is a huge empathy deficit in this country and training to be a doctor, lawyer, scientist, or technologist is not going to contribute to people having the kind of understanding that contributes to a more humane society. Making money has become the overwhelming justification for going to college. Schooling for students in the El-Hi system is important, but far too few young people understand or have any interest in learning. There are far too many distractions and virtually no emphasis on going to school to learn things that will make you be a better citizen and human being.
I could go on, but there is no point, since going to school to do anything other than make as much money as possible is no longer a part of this country's belief system. From a young age and from across the political spectrum young people are told that "education" is about making money.
" . . . going to school to do anything other than make as much money as possible is no longer a part of this country's belief system . . . " Sadly, I think you are right. I am old now. When I was working while going to college I valued my education as something of value apart from the income it might one day bring me.
But the Faux Snooze people will be claiming (again) that the US has the best medical system in the world. And they may be right - if all you look at is the one for Congress.
The congressional healthcare plan should be opened up for all Americans. The healthcare afforded congress should be the minimum that all Americans get.
Ah yes the old "demonize the poor so we can crap on them" spiel, only the gullible idiots buy that, but we seem to have so many more here in this country, than I ever imagined. The repubs defunding education has succeeded beyond measure.
"which always also benefits the 1%).." but they cannot stand that it doesn't actively hurt the 99%...how can they enjoy thir billions, if they cannot gaze out on the suffering masses to tickle their sociopathic souls.
I read an article on a European mainstream media website today, mentioning statistics where rich Americans have a shorter life expectancy than poor people in Germany.
Well, if if life expectancy is lower than the countries you mentioned, then it only follows that the US will spend more per capita, because with lower life expectancy Is a result of more illnesses, evidently.
Medicaid sounds a lot like the Canadian system, except that everyone is covered, and most provinces don't have any health insurance fees. Those that do are required to provide the same coverage, free or reduced fee, to all lower income people.
Coverage is not yet quite as good as western & northern Europe, but we have a much better life expectancy than most US states.
Truer than almost anyone who hasn't experienced it would believe. Sometimes it does not matter how smart or educated you are, or how much money you have, or how well-meaning and competent your doctors are, the complexity itself can still create absurd and dangerous situations where you're not allowed to take any actions that would resolve them. Don't ask me how I know, we'll be here for days, and I'm healthy, in my 30s, and have been continuously insured with significantly-better-than-average insurance my entire life.
“What this suggests is that Republicans who consider Medicaid a soft target, a program that only benefits inner-city rats, are going to be shocked by the blowback if they do manage to eviscerate this key piece of American health care. “
Except that’s not what will happen. The funding cuts will make Medicare function poorly without literally saying to very many people that they no longer qualify. Recipients will simply get horrible coverage and after that’s had a few years to work its way through Medicaid won’t be popular anymore. People will of course clamour for a replacement but the GOP will say “whatever we replace it with we’ve seen that government running it doesn’t work”
Remember, it’s low information voters who voted these guys in. They won’t understand the import of the funding cuts, they won’t even be aware of them, they’ll only know it no longer works.
Addendum: I posted this response to someone below in the thread but it seems to be roughly how I’d respond to a lot of the replies so…
Well yes but will they be told all of this is because of this bill or will they be told, and believe, that it’s because many previous Democratic, liberal, woke, communist governments spent too much and crushed the economy and that’s the reason the government has no choice but to kick them out of their nursing home or impose a work requirement for their coverage…it’s to prevent the system going bankrupt didn’t you know?!?
I can tell you exactly which story they’ll hear from Fox News or, in a lot of places, their local media.
The GOP is literally beneath contempt. But they're probably right, their voters will blame Biden, or "those people", or someone else, when their health insurance disappears.
Well now, all they have to do is remember what they had in 2024 and what they now no longer have in 2025! But they’re so thickheaded. I guess someone will have to show that to them.
But then that’s up to the opposition to get off their butts and get out there with a bull horn and explain in simple language why the system isn’t working and who is the blame because of what changes. If you want people to believe you then tell them the facts in the language they understand. No academic BS with graphs and charts. Tell them stories of real suffering. Just not sure the Democrats understand that.
I'm not sure it would make a difference because the media will just ignore what the Democrats are trying to say. Consider that the news coverage of yesterday's Senate voting--at least all the new coverage I saw, heard, or read that wasn't on Left-leaning blogs and Substacks--all the coverage interviewed REPUBLICANS about "will the Senate pass this?" All cast in classic horse-race style coverage.
Not a single Democrat interviewed or even shown in the background.
There seems to be quite a number of organizations in America that supposedly also represent the certain interests of Medicaid recipients. However, no single umbrella organization to fight for Medicaid rights. And until now I have not heard public comments from any of these organizations protesting what is taking place in the Big Beautiful Bill Baloney.
The Republicans view Medicaid recipients as simply a loose mass of unorganized, powerless, ignorant and lazy parasites. Until the recipients get organized under one roof with strong leadership and speak with the voice of millions, they will not have much influence. A few demonstrations and a few letters to senators are basically meaningless.
if DEMOCRATS wait for media to get their message out. they might just as well continue to yell at clouds like schumar does. get off your butts and do the work!
I fully agree. Tired, old, Democratic congressional leadership proclaiming tired, old slogans to the press in DC do not make the news. Everyone wants to know what Trump said today, what Trump is doing, what BS is spreading.
No, when I mentioned that we should be telling the people the truth about this bill, then we should be doing it at the community or state level in straight language, placing the blame where it belongs with examples that hurt to hear. Bring actual victims to tell their stories.
The only way to convince the common man is with old-fashioned, belly-button to belly-button, face-to-face convincing dialogue. Shake hands, kiss baby behinds, mixed with a crowd, whatever it takes. Weren’t the primary elections in NYC last week a good example of how to get under peoples’ skins?
Leave the aged, so-called “leadership” in DC perform lip service to the media. More they will not accomplish.
Here in Michigan, Bridge Magazine is cutting through the BS and my little local paper is picking up the Coverage. Also, my Senator Elissa Slotkin is putting out a short and to the point Intel. Briefing to her constituents like me.
The opposition has been fighting hard for health care coverage since LBJ passed Medicare and Medicaid, Republicans have been fighting hard to dismantle all of it, a millions of voters have been conned into voting for them, often helped in the lies they tell by the mainstream “liberal” media who got their fee-fees hurt because the Clinton administration didn’t kowtow enough to them.
“A Triumph of Misinformation:
Most of what everyone "knows" about the demise of health-care reform is probably wrong--and, more important, so are the vague impressions people have of what was really in the Clinton plan”
Democrats lost the midterms becuause they supported healthcare reform as other did when they voted for the ACA. I’m not a huge fan of Kathy Hochul but she, like other Democrats, voted for the ACA knowing it would almost certainly cost them their seats in Congress. It did. In contrast today’s Republicans refuse to risk being primaried for voting in their constituent's’ best interests.
yes! go into communities and KNOW what people are having issues with; otherwise, you have no idea what you are talking about. wth! trumpf doesn't even know what 'grocery'means.@@
Oh, this is so unfair. Democrats HAVE been out there with a bullhorn, but since voters don't find the stories about it exciting, they don't click. And so the stories go down the tubes in the algorithms. Democrats can't make explanations about how they are the ones protecting health care or any other social program exciting. Because it really isn't exciting by the standards of today's media ecosystem.
No. Once this brave new world of democratized media came about, where people could pick an excitement bubble over a well-informed bubble in which to live, new responsibilities devolved down to the consumers of the media who are also the voters in democracies. These people, the low information voters, are going to have to step up before democracy becomes viable in political systems again. All are under threat from this phenomenon, and it isn't the fault of the political parties except, slightly, when parties take advantage of the entertainment as news system. But, the responsibility to fix it falls squarely on the voters. Ultimately, where else COULD it fall if we believe democracy can work? Democracy operates on the premise that voters are worthy of having the right to vote.
Voters from across the political spectrum are looking more and more toward being entertained from the political "news" media they consume. Some are just more like this than others; but real, high value, information is suffering across the board. Everyone needs to become more responsible for the type of political news they consume. Until they do, the news media will not respond with higher quality information.
And no, neither Democrats nor anyone else will save democracy in America by becoming like MAGA. The people need to move toward the relative quality of Democrats. Democrats do not need to more toward the relative low quality of MAGA, which as I said wouldn't work to save democracy anyway.
You are right. Aren't these cuts supposed to be implemented over the next ten years? So things will slowly get worse! People won't see the full impacts for years.
this country can afford to build and blow up,BIG BEAUTIFUL BOMBS, but refuses to pay for a peanut butter sandwich on white bread, for a kid going to school...and the kid is forced to go to school by that same government. there i somethng really weird about this picture
I see what you're pointing towards, but please reconsider the scare quotes. There are lots of people with lots of reasons for not sending their kids to public school or any other traditional school, many of them quite good.
And they know that, which is why most who homeschool their kids are not trying to teach them everything themselves. The field of available options has changed and expanded quite a lot.
In many places, they won't even know that what they have today is Medicaid. The money goes to the States, and the States use it for their own medical support systems. In Tennessee, it's called "TennCare."
One way the Republicans are cutting Medicaid is through work requirements. The states will be required to administer these requirements at a big cost. The people who are on Medicaid will need to provide their work history which will be difficult. These people will know it’s the BBB that made this change.
Also, people living in nursing homes will be thrown out. This bill is cruel, it will be obvious.
Well yes but will they be told all of this is because of this bill or will they be told, and believe, that it’s because many previous Democratic, liberal, woke, communist governments spent too much and crushed the economy and that’s the reason the government has no choice but to kick them out of their nursing home or impose a work requirement for their coverage…it’s to prevent the system going bankrupt didn’t you know?!?
I can tell you exactly which story they’ll hear from Fox News or, in a lot of places, their local media.
They’re not changing how Medicaid works—it will still deliver benefits that far exceed whatever for profit health insurance offers. It just cuts funding by reducing enrollment. I think it’s an open question as to whether this will live on as an issue until it’s fixed. There’s a good chance people who lose coverage will see others keeping theirs, which will make the cuts even more deeply unpopular.
Hospital and medical professional association lobbyists will remind everybody of what they lost. They will continue to hound state and federal legislators, and they do know how to use media. They will lobby middle class voters, explaining why their insurance premiums have risen at a faster rate thanks to those premiums also covering care for the uninsured. It’s how The Affordable Care Act got a hearing in Congress back in 2009, and that dynamic isn’t going away regardless of Republican wishes. La plus ca change, plus c’est la meme chose.
Of course, low info voters identify with low info politicians. We have way too many of those. Governing is not taken seriously. It's more about the 15 minutes of fame.
To your point..... Democrats should force immediate adoption of the republican plan. Stop with the good government transition periods and trying to make it less sonorous. . Cause and effect must be timely! The last time a piece of legislation like this was passed and then repealed was the Democrats long term health care for seniors. A probably good long term policy was rejected by seniors because the bill was due immediately. Political consequences for Democrats was Meh.. Probably because they folded the program so quikcly! (So you won't get rid of the MAGA BS easily)
'THEY'need to see exactly what they voted for, immediately..DEMOCRATS , PLEASE! just stop trying to save these people, let tham wallow in what they want and get.
This is the correct answer. If all low info voters get is right-wing propaganda (at worst) or nothing (at best) - they'll have nobody to blame. And as long as they continue winning culture wars with the same voters - they'll pay no political price. Does anyone truly think Dems shouting from the rooftops to MAGA voters is going to result in accountability?
These people are the ones who managed to survive Covid, despite refusing vaccines and masks. They didn't blame Trump then, and they won't blame Trump for this.
No, not really. Those people won't get lousy coverage. They won't be covered at all by anything. That's what the GOP's work requirements are for. So people no longer eligible for Medicaid will just end up getting sick, staying sick and going to die in hospital emergency rooms when they are in extremis (assuming, of course, that they can get to a hospital).
But hey, as Joni Ernsts said "We're all going to die" anyway. So why worry?
But what happens when grandma gets kicked out of the nursing home, or cannot find a bed in the first place- Medicaid is the way long term nursing care is paid for in the U.S.
No, they literally are going to take it away from folks who cannot complete the paperwork twice a year. They will find out when they go to the pharmacy to pick up their medications or at the ER during an emergency. We need to band together to devise groups who will help these folks prove they are working & complete the paperwork.
Rural places like Alabama will be forced to close hospitals. Even people who have "gold plan" insurance will have trouble using it if the closest hospital is over 100 miles away. Meanwhile most New York residents will continue to live within 5 miles of a hospital.
Americans' hatred for 'Government' means they pay about twice per capita for rather mediocre healthcare with a lot of people simply uncovered, than if we just instituted programs like The UK, Europe, Canada, etc have. But no, they don't want some mindless Government Bureaucrat making healthcare decisions for them. No siree Bob - they want an overworked, mindless insurance company bureaucrat making life or death decisions for them. 'Rational' is not a word which belongs in the same sentence with 'average American Voter'.
As somebody I read on the Internet once put it about his own home of West Virginia, Americans will pay several thousand dollars a year in repairs to their car so they don't have to spend several hundred a year in taxes to fix the potholes.
I read in the past few years that the US Government already pays for over 60% of total health care costs now. Yes, if we simply eliminated private insurers (whose overhead approaches or is even more than, 20% of their cost) with their high executive compensation and other overhead, transferred the costs of "private", employer sponsored plans, in addition to dividend payments, the excessive payments we give to Big Pharma and medical device companies, and the mandate that hospitals are built to provide healthcare, not as wasteful showpieces, I think we'd have it covered. And then some.
I have seen the system from the inside out. It is shot through with special-interest carve outs. We know how to make the system more efficient and in doing that, it would be better for the patients. But then someone's over-generous profit margin would decline.
I think you are right. I have long been puzzled about how Great Britain delivers longer life expectancies than we do. That implies that their healthcare "socialism" delivers better outcomes than our "for profit" capitalism.
Americans hatred for "Government" all started with Ronald Reagan. Yet, many people considered him a saint! He might have been someone you would want to ride a horse with, but in many ways he was as detrimental to our social fabric and the social safety net as is DOGE and Trump today.
No. I think Oregon does the same. Lots of people are on Oregon Health Plan, which is Medicaid. I bet half of the people on Medicaid don't think of it as Medicaid.
Not every state, but many have alternative names (Health First Colorado, for example here in Colorado). Gonna be some surprised people when funding begins to disappear, especially in geographically large states, like Colorado, with vulnerable rural hospitals and long distances to major health facilities.
I am always amazed how we all seem to want to ignore the impact of nursing home patient enrollment in Medicaid. I know its not currently on the line in this abomination of a bill, but will certainly be identified as cost and "addressed" next. This will affect most families in America - including the well off prior to nursing home costs, and the GOP answer - that women will stop clogging up the job world, surrender their shoes and remain pregnant homemakers attending to grandma, doesn't seem to be backed up in their financial plans.
As far as I know there is no other realistic option for financing long-term care. Burning all your assets to pay for it then going on Medicaid is the norm.
People trying to do amateur memory-care will be a disaster, both for the patients and the caregivers. People do try it (trying to preserve independence, preserve assets, or while on Medicaid wait lists) and it's just way more than a family member can handle, even if they don't work.
I agree. Paying for nursing home care is an issue consuming many of my friends who are desperately working to get their parents to qualify for Medicaid. Without Medicaid they simply can’t afford that care.
Absolutely. The fact that our population is only getting older means those programs are actually more important than ever. Cutting Medicaid at a trillion dollars will have consequences for all Medicaid recipients and will indirectly impact Medicare because for many patients they draw from both programs.
In Canada (in BC) long term care costs 80% of your income, with no obligation to sell assets. The institutions are also run by the provincial government. There are private ones for the wealthy but there’s nothing wrong with the public ones
The US health care "industry" is an extortion racket. If US health care costs were about the same as the average in EU countries, with no other changes, the Federal government would save something like $900 Billion/yr. This isn't hypothetical savings, this is from direct comparisons with real countries. It's equivalent to about a $10k/year raise for every US household. It would eliminate about half the annual federal deficit. The solution is something like Medicare for all. "Everybody" knows this, but the lobbyists for the health insurance industry, and their ilk, prevent this from every happening, by paying off politicians to make sure it never comes to a vote. The US is probably doomed, and this chronic inability to stop the looting of the public coffers is why.
"The US health care "industry" is an extortion racket."
When I was dealing with health insurance before I had a relatively decent employer-provided plan, it was hard to miss that every single bureaucratic fuckup the private insurers made was one that, if not caught, would just happen to cost me money.
"Oh, sorry - our records show that you still owe us one monthly payment. ... Oh yes, I see here that you've called about this and gotten it straightened out a dozen times over the last seven months. But, um... well, I guess somehow the error in the system was never corrected! Who can say how. It's a mystery, really."
"Oh, sorry - we have to charge you the full cost for your visit because you have no referral from your primary care doctor. Oh, you do? Well, we don't see it in the system. Oh, you brought us a physical copy? Well... we don't have it. Sometimes they just don't get uploaded into the system. Wonder how that happens."
"Oh, sorry - our hospital is not in your network, so insurance won't pay for anything. Oh, you say you asked us when you arrived whether we took Blue Cross Blue Shield and we said yes? Oh well yeah but um... that just means that we'll accept you and treat you if you have Blue Cross Blue Shield. It doesn't mean we're set up for them to pay for anything!"
"Oh sorry - the lab that we sent your blood work to isn't in network. Oh yes, I see here that we told you this and that you specifically told us to make sure it was sent to the OTHER lab which IS in network. And that we told you we would, and that you called several times to make absolutely sure that was what was happening. But um... we just didn't do it. Oops?"
It couldn't possibly be honest mistakes and pure bureaucratic incompetence, because if it was, there would at *some* point have been mistakes that favored me, or at least mistakes that didn't have any bearing on my money. There never were. It was always an issue that somehow, totally inexplicably, would just *happen* to cost me money.
It was never ambiguous in any way either. It was about as subtle as a Mafia tax-collector coming back and saying "it's true, you did give me your weekly money, but then I tripped on a skateboard and slipped on a banana peel and dropped it down the gutter and now it's gone, so I need the same amount again. You wouldn't want there to be any misunderstandings between you and Big Al, would you?"
And most noticeably, it never happened on the government end of things. I never had a moment where the government failed to send me my Medicaid card, or accidentally purged me from the Medicaid rolls, or tried to weasel out of any of the payments they were responsible for. I'm sure it does happen, but the fact that it's so rare I never experienced it once, when compared with the absolutely endless and universal "incompetence" of literally every private actor in the system, pretty much tells you all you need to know.
TL/DR yes, it is an extortion racket. Quite honestly, while there are many ways of providing universal health care, I lean heavily towards single-payer or a British-style NHS system for exactly this reason. It's true that it's possible for a private market to provide a decent service if heavily regulated and subsidized enough, in the sense that some countries do it successfully. But the American market is just not that market: it's run on corruption and extortion for so long that unless you're willing to literally post an armed Marine in every single boardroom with orders to shoot the CEO the first time his company denies coverage that was due, regulating it can only do so much; it's as much a contradiction in terms as the idea that you can regulate the Mafia. Like the Mafia, we don't need these people regulated. We need them gone.
Let’s hope the wheel turns away from the empathy haters and toward a day when healthcare for can be realized as a human right not just another profits over everything.
A lot of it is hidden in profits for middlemen, monopoly practices and the cut the wealthy get by buying up what used to be independent businesses. Private equity.
The health insurance industry neither provides health care, nor makes people healthier. Nor does it reduce costs, spur medical innovations or contribute to public health. It's a deadweight loss on the system. It's serves, functionally, merely as a parasitic mechanism to funnel money to wealthy shareholders. The US system is an accident of history. Corporate provision of health care was introduced in WW2 to get around wage controls. It's demonstrably the worst option of all the ones in use in other countries.
I don't see the act as actually targeting medicaid. The Republicans are just scamming their own fiscal hawks.
All the tax cuts hit immediately (even retroactively!!) while the medicated cuts are delayed for 4 years or more.
So the impact on the deficit for the next 4 years will be MUCH WORSE than advertised while the medicaid cuts are something for the NEXT administration to deal with.
The aging of baby boomers needing nursing home care has be a driving reason why participation in Medicaid has gone up over the last 15 years. Medicaid is the public program that provides 24/7 care for those who need it and can't afford the outrageous costs. My dad's care was $13K/month until Medicaid kicked in. And Medicaid only kicked in after my mom spent down almost all her assets. And that means testing was the most rigorous process. We had to account (provide photocopies) for every single expense of $100 or more for the previous 5 years. There's not much fraud in MA Medicaid!
I dislike the Republican word game with the idea of "waste". Please understand that "Privatize" means "Create waste". In value stream analysis any diversion of cash flow from its intended purpose is identified as waste. Here's how that plays out:
Before
budget - overhead = intended purpose
After
budget - overhead - profit = less intended purpose
The diversion into profit is waste by definition. When Republicans say they are looking for waste, what they are looking for is a way to divert resources from the intended recipients to the wealthy.
Private insurance is a for profit business. It's first responsibility under SEC regulation and Sarbanes-Oxley is to make profit for its investors.
Word games is what the GOP does best. Their claim that private industry is more "efficient" than government is pure BS. Private industry is most "efficient" at profiteering.
Back in the nineties when everybody was going crazy for privatization all over the world, its apostles were claiming that if you just took those bloated and inefficient state-run companies that had existed under communism or similar systems, and give them to the private sector, they'd revitalize them and make them efficient.
Somebody at some point did a study and found that in fact, the private sector had no interest in taking over state-run companies except in two scenarios:
1) They were going to break up the company and sell off everything it owned for parts.
2) The company was already turning a profit anyway.
In other words, only when the stated rationale didn't apply.
"A decade later, George W. Bush tried to privatize Social Security. But he, too, failed, because Social Security is also immensely popular."
As I recall it, the W Bush plan was to replace Social Security with private accounts invested in the stock market, which -- their backward look at stock market returns showed -- would result in everyone getting much higher retirement income.
Then the dot com bust happened.
But they never tire of coming back to the same trough to try to feed.
My cynical side gets the impression that the One Big Beautiful You-Betcha Bill might be taking the effort to end entitlement programs to an unprecedented level: crash the government and blow up the deficit so completely that even restoring the highest past income tax rates on the wealthy won't save us.
Then face the public with the choice of either drastically cutting Social Security, Medicare, and Medicaid ... or doing without functional roads, the military, etc.
They've been trying to privatize everything since St. Reagan got that snowball rolling. We've been suffering the results ever since. Remember Blackwater?
Much longer than that. My father came out of WW II and landed a job with the Atomic Energy Commission. That was privatized in the Eisenhower administration and contracted out to Union Carbide. For those of you unfamiliar with the AEC, they built nuclear bombs and power plants and produced radioactive isotopes for medical purposes.
Union Carbide ran Oak Ridge. That's where the uranium enrichment programs and plutonium manufacturing ran (X-10, Y-12, and K-25). It was also the site of Oak Ridge National Labs, which did research projects. There was also a heavily guarded set of experimental nuclear reactors that was simply referred to as "reactor row." The contract went to Lockheed Marietta much later.
How? Because the evil ones are too old. Like old wine beyond its best – before drinking age, their conservatism, however well meant, has turned sour as vinegar
Their minds are living in the previous century. And the younger ones following in their footsteps, are their disciples who fear losing their perks and having to go out into the competitive world and find a real job.
Once again, one of the biggest points about Medicaid is missing. Yes, the personal tragedy of people losing their medical coverage is the worst thing. But the point that is missing is the impact on the health care delivery system. Medicaid, in most cases, pays the least of any health insurance program, which may be why the cost of Medicaid is lower than others. But, it still pays something, which is better than nothing. So, now those former Medicaid covered patients who show up in the hospital emergency department will still get treated. The hospital is legally and morally obligated to treat, regardless of ability to pay. So, now there is no payment for those services: how does the hospital get paid? They can eat the costs (not very sustainable). They can reduce or cut services. The result will be loss of reasonable access or no services at all. Or even, hospitals closing. They can try renegotiate commercial contracts to include these costs ("cost shifting"), which means premiums go up on commercial insurance. They will charge self pay patients more, but those are people without insurance, many of whom can't afford it (except the ultra-rich who can afford it with their tax break).
So, bottomline: cuts to Medicaid will adversely impact all of us. These cuts are cruel. republicans in congress are no longer loyal to their constituencies and their oath, but are subservient and loyal to trump and his masked henchmen. Keeping their soon to be meaningless jobs is more important than doing the job they swore to do.
Thank you for making this clear and to the point...even with charts. The words that stood out as true: The do not care. It's a psychological problem. But by making the point that it could bring personal blowback to the GOP and the individual senators and the Speaker of the House...all I can think is they are counting on the piece of the bill that allows the unitary government to cancel elections. We must be in the streets in even greater numbers. I was on Medicaid. It is the very best. It is like Universal Healthcare. I've never liked the Medicare for All slogan. Medicaid for all makes far more sense to me. Medicare is so complex and riddled with rules. Medicaid is simple. It may be means tested but it doesn't have all the hoops and hurdles.
When I was walking into the grocery store the other day I overheard a woman on her phone screeching “ Of course they’re saying it’s all Trumps’ fault.” It doesn’t matter what she was talking about. It’s the “they” and the denial of accountability that is troubling. I think the “low information” folks, as they have been so politely labeled, are just plain ignorant and too lacking in imagination to consider any point of view that is not MAGA. Tragic, really.
One metric is that USA spends more per capita on health care than any other country, but life expectancy is below Japan, Australia and most European countries.
The reason? We don't have a healthcare system. We have a revenue generating system that does healthcare. In it Income>Outcomes (i.e. Income is more important than outconmes)
Yep Paul G, 100%. We have many great doctors, and if one is lucky enough to have good health care coverage and access to those docs, fantastic. but overall our for-profit health care system driven by private insurers and medical group CEOs listening more to CFOs and consultants than to care providers - leads to some awful outcomes. It probably won't happen in my lifetime, but please bring on Medicare for All (if there is still Medicare when Rs get doen with safety net).
Not talked about much, but the Big Very Ugly Bill is going to take a chunk out of Medicare too.
This. As per Congressional budget rules.
And the Big Barbaric Boondoggle is also going to shut down a ton of hospitals. Mainly in rural counties. What good is having health insurance if there's no hospitals to get care?
Also, when you cut 17 million from the insurance rolls, they'll put off care--then show up at a local ER when they have an acute crisis. That costs thousands, or tens of thousands, instead of hundreds. And force the local hospital to eat the bill. Which drives up health insurance premiums for EVERYBODY else.
👆🎯As a retired health care worker I have seen this, the very poor show up only when they are in a health crisis. And they absolutely are paying more for the much sicker, and uninsured. This will kill rural hospitals, who will get bought up by religious orgs, compromising health care even further.
Actually only the overpayments to Medicare "advantage". That Medicare Advantage was invented by R's relentless quest to destroy Medicare. They worked in tandem with their insurance company buddies and the fraud there is mind boggling
"In 2024, the improper payment rate in Medicare Advantage was 5.61%, amounting to $19.07 billion in federal payments that were not properly made. Improper payments include both fraud and other errors, but fraud is a major component."
The vast majority of costs for healthcare are for labor of all kinds - but primarily for doctors and nurses. The costs per unit are so high due to constraints on supply - the AMA acts as a super powerful union to limit the supply - along with friends in government who control the number of residency positions available. The traditional argument for throttling the supply is that if there are more doctors it will be easier to see your doctors and you will go to the doctor and use more care- increasing the costs overall - but this pendulum has swung too far and we are not making enough doctors to meet minimal demand today, forget luxury medicine. Also note that a very small percentage of high use patients drive much of the costs for hospitals and social workers / programs to manage external factors that often drive these patients’ hospital visits are the cure, not less access to care.
im a free enterprise believer, not a Democratic Socialist, but maybe, in a Single Payer system, our really good doctors can make do on $700k-$800k comp instead of $1M+ that specialists and surgeons in our local and regional system often make. They are great doctors, but it is all about tradeoffs and reasonableness, and there are multiple ways to address costs
I remember that Michael Moore documentary Sicko where they followed around an English doctor. He was basically an employee who complained that maybe he should be paid more but he lived in a nice house and drove a BMW.
We need more physician "employees"-so much of those fees go to paying staff including one DEDICATED to filling out paperwork.
100% correct
With insurance companies getting rich.
Yeah. As somebody said back in the ACA debates, spending more money for worse outcomes is the literal definition of inefficiency, and yet we're all supposed to be terrified of how "inefficient" the system would get if it worked like (pick literally any European country).
I confirm your statement.
Here in Europe, we have always been struck by stories of US citizens ruined by health problems or dying when the cash-flow dries.
Our social solidarity (ever perfectible) results from many past fights in and between our countries.
May you struggle the least possible before reaching the same point. No gloating here, but a strong empathy for those bound to suffer.
Yes, inequality is a "natural thing". But as Socrates said: "The main human virtue is the sense of the right measure in all things".
Canada, the EU, Japan, Australia, New Zealand... 🙄
Most tellingly: Taiwan - decided to go compulsory, single payer in 1995; Korea - moved to single payer in 2005. These are hardly "socialist" countries by any rational measure.
While our outcomes are worse!
It's called "American Exceptionalism?"
lol ,right.. some americans ARE exceptionally stupid!
Of course, if it is because of the educational system then not only won't it "take decades to turn the US into a world-class country again," it won't ever happen. Our educational system is also under assault by Republicans, who not only benefit, but survive on voter stupidity and ignorance. They need poorly educated voters so they have no incentive to try to improve education in the US.
But the problem is far worse than that. Americans, for the most part, don't care if they are well-educated. I have long made a distinction between education and training. The attitudes in this country regarding the two are now overwhelmingly in favor of training whose goal is to provide better higher paying jobs. Even Obama emphasized schooling as training. What is not important in the US is the idea of citizenship that balances rights and responsibilities. Among the most important responsibilities are knowledge about and understanding of our system and what it needs.
Increasingly, the kinds of college courses and majors that help make people better citizens and more complete human beings are subjected to disrespect and regarded as a waste of time. There is a huge empathy deficit in this country and training to be a doctor, lawyer, scientist, or technologist is not going to contribute to people having the kind of understanding that contributes to a more humane society. Making money has become the overwhelming justification for going to college. Schooling for students in the El-Hi system is important, but far too few young people understand or have any interest in learning. There are far too many distractions and virtually no emphasis on going to school to learn things that will make you be a better citizen and human being.
I could go on, but there is no point, since going to school to do anything other than make as much money as possible is no longer a part of this country's belief system. From a young age and from across the political spectrum young people are told that "education" is about making money.
" . . . going to school to do anything other than make as much money as possible is no longer a part of this country's belief system . . . " Sadly, I think you are right. I am old now. When I was working while going to college I valued my education as something of value apart from the income it might one day bring me.
https://www.worldometers.info/demographics/life-expectancy/
US is 48th
Well, at least we rank higher than North Korea. For now.
That ranking won't last if the OBBB passes.
Yeah, we'll be in competition with Nigeria for last place.
But the Faux Snooze people will be claiming (again) that the US has the best medical system in the world. And they may be right - if all you look at is the one for Congress.
The congressional healthcare plan should be opened up for all Americans. The healthcare afforded congress should be the minimum that all Americans get.
The Big Bullshit Bill.
Brutal Bullshit Bill
Oh, but Republicans have a great explanation for this: It's all those minorities and poor people dragging us down.
Ah yes the old "demonize the poor so we can crap on them" spiel, only the gullible idiots buy that, but we seem to have so many more here in this country, than I ever imagined. The repubs defunding education has succeeded beyond measure.
Recall that Ronnie Ray-Gun was excoriating Medicare as Godless Socialism Tyranny back in 1965.
They have ALWAYS preferred that we just die. They literally believe that if we cannot pay for medical care we should be left to die in the gutter.
But look how much better those Trump favorites like Hungary and Russia are doing.....
Oops, they are 73rd and 112th, respectively. As a matter of fact, if I was Russian, I'd likely be dead now.
Another metric is that the USA ranks about 37th in world health outcomes. 2 places above Cuba...
Hey, that’s how toxic capitalism works.
"Hey, that’s how unregulated capitalism works."
FTFY.
Potato, potahto, eh?
Capitalism and socialism can coexist.
Competition and cooperation would make for a good mix.
"which always also benefits the 1%).." but they cannot stand that it doesn't actively hurt the 99%...how can they enjoy thir billions, if they cannot gaze out on the suffering masses to tickle their sociopathic souls.
👆🎯The cruelty is always the point, republicans of the white nationalist variety, are sadists.
Life expectancy is lower in the US than it in Canada. Among the factors is higher infant mortality in the US than Canada.
https://www.worldometers.info/demographics/life-expectancy/
https://www.cia.gov/the-world-factbook/field/infant-mortality-rate/country-comparison/
I read an article on a European mainstream media website today, mentioning statistics where rich Americans have a shorter life expectancy than poor people in Germany.
Well, if if life expectancy is lower than the countries you mentioned, then it only follows that the US will spend more per capita, because with lower life expectancy Is a result of more illnesses, evidently.
You forgot Canada, right next door to the US.
Medicaid sounds a lot like the Canadian system, except that everyone is covered, and most provinces don't have any health insurance fees. Those that do are required to provide the same coverage, free or reduced fee, to all lower income people.
Coverage is not yet quite as good as western & northern Europe, but we have a much better life expectancy than most US states.
It’s partly due to less bureaucracy. In Canada, it’s paid for from income taxes. Every citizen is eligible.
The US system is unbelievably complicated.
>The US system is unbelievably complicated.
Truer than almost anyone who hasn't experienced it would believe. Sometimes it does not matter how smart or educated you are, or how much money you have, or how well-meaning and competent your doctors are, the complexity itself can still create absurd and dangerous situations where you're not allowed to take any actions that would resolve them. Don't ask me how I know, we'll be here for days, and I'm healthy, in my 30s, and have been continuously insured with significantly-better-than-average insurance my entire life.
“What this suggests is that Republicans who consider Medicaid a soft target, a program that only benefits inner-city rats, are going to be shocked by the blowback if they do manage to eviscerate this key piece of American health care. “
Except that’s not what will happen. The funding cuts will make Medicare function poorly without literally saying to very many people that they no longer qualify. Recipients will simply get horrible coverage and after that’s had a few years to work its way through Medicaid won’t be popular anymore. People will of course clamour for a replacement but the GOP will say “whatever we replace it with we’ve seen that government running it doesn’t work”
Remember, it’s low information voters who voted these guys in. They won’t understand the import of the funding cuts, they won’t even be aware of them, they’ll only know it no longer works.
Addendum: I posted this response to someone below in the thread but it seems to be roughly how I’d respond to a lot of the replies so…
Well yes but will they be told all of this is because of this bill or will they be told, and believe, that it’s because many previous Democratic, liberal, woke, communist governments spent too much and crushed the economy and that’s the reason the government has no choice but to kick them out of their nursing home or impose a work requirement for their coverage…it’s to prevent the system going bankrupt didn’t you know?!?
I can tell you exactly which story they’ll hear from Fox News or, in a lot of places, their local media.
The GOP is literally beneath contempt. But they're probably right, their voters will blame Biden, or "those people", or someone else, when their health insurance disappears.
Maybe, but they'll be dying, or at least chronically ill, so they might have other things on their mind.
Which Republican leader said last month that "we're all going to die anyways"?
Sen. Joni Ernst (R-IA)
https://www.rawstory.com/jonie-ernst-medicaid-horrifying-answer/
Well now, all they have to do is remember what they had in 2024 and what they now no longer have in 2025! But they’re so thickheaded. I guess someone will have to show that to them.
The cuts don’t kick until 2028, to minimize electoral blowback.
But then that’s up to the opposition to get off their butts and get out there with a bull horn and explain in simple language why the system isn’t working and who is the blame because of what changes. If you want people to believe you then tell them the facts in the language they understand. No academic BS with graphs and charts. Tell them stories of real suffering. Just not sure the Democrats understand that.
I'm not sure it would make a difference because the media will just ignore what the Democrats are trying to say. Consider that the news coverage of yesterday's Senate voting--at least all the new coverage I saw, heard, or read that wasn't on Left-leaning blogs and Substacks--all the coverage interviewed REPUBLICANS about "will the Senate pass this?" All cast in classic horse-race style coverage.
Not a single Democrat interviewed or even shown in the background.
There seems to be quite a number of organizations in America that supposedly also represent the certain interests of Medicaid recipients. However, no single umbrella organization to fight for Medicaid rights. And until now I have not heard public comments from any of these organizations protesting what is taking place in the Big Beautiful Bill Baloney.
The Republicans view Medicaid recipients as simply a loose mass of unorganized, powerless, ignorant and lazy parasites. Until the recipients get organized under one roof with strong leadership and speak with the voice of millions, they will not have much influence. A few demonstrations and a few letters to senators are basically meaningless.
if DEMOCRATS wait for media to get their message out. they might just as well continue to yell at clouds like schumar does. get off your butts and do the work!
At least Schumer is yelling. I haven’t heard a peep from Jefferies.
I fully agree. Tired, old, Democratic congressional leadership proclaiming tired, old slogans to the press in DC do not make the news. Everyone wants to know what Trump said today, what Trump is doing, what BS is spreading.
No, when I mentioned that we should be telling the people the truth about this bill, then we should be doing it at the community or state level in straight language, placing the blame where it belongs with examples that hurt to hear. Bring actual victims to tell their stories.
The only way to convince the common man is with old-fashioned, belly-button to belly-button, face-to-face convincing dialogue. Shake hands, kiss baby behinds, mixed with a crowd, whatever it takes. Weren’t the primary elections in NYC last week a good example of how to get under peoples’ skins?
Leave the aged, so-called “leadership” in DC perform lip service to the media. More they will not accomplish.
Here in Michigan, Bridge Magazine is cutting through the BS and my little local paper is picking up the Coverage. Also, my Senator Elissa Slotkin is putting out a short and to the point Intel. Briefing to her constituents like me.
Add in the part where rural hospitals start closing and the same voters who put these fascists in power will no longer have access to medical care.
The opposition has been fighting hard for health care coverage since LBJ passed Medicare and Medicaid, Republicans have been fighting hard to dismantle all of it, a millions of voters have been conned into voting for them, often helped in the lies they tell by the mainstream “liberal” media who got their fee-fees hurt because the Clinton administration didn’t kowtow enough to them.
“A Triumph of Misinformation:
Most of what everyone "knows" about the demise of health-care reform is probably wrong--and, more important, so are the vague impressions people have of what was really in the Clinton plan”
by James Fallows
https://www.theatlantic.com/past/politics/healthca/hcfallow.htm
Democrats lost the midterms becuause they supported healthcare reform as other did when they voted for the ACA. I’m not a huge fan of Kathy Hochul but she, like other Democrats, voted for the ACA knowing it would almost certainly cost them their seats in Congress. It did. In contrast today’s Republicans refuse to risk being primaried for voting in their constituent's’ best interests.
yes! go into communities and KNOW what people are having issues with; otherwise, you have no idea what you are talking about. wth! trumpf doesn't even know what 'grocery'means.@@
Oh, this is so unfair. Democrats HAVE been out there with a bullhorn, but since voters don't find the stories about it exciting, they don't click. And so the stories go down the tubes in the algorithms. Democrats can't make explanations about how they are the ones protecting health care or any other social program exciting. Because it really isn't exciting by the standards of today's media ecosystem.
No. Once this brave new world of democratized media came about, where people could pick an excitement bubble over a well-informed bubble in which to live, new responsibilities devolved down to the consumers of the media who are also the voters in democracies. These people, the low information voters, are going to have to step up before democracy becomes viable in political systems again. All are under threat from this phenomenon, and it isn't the fault of the political parties except, slightly, when parties take advantage of the entertainment as news system. But, the responsibility to fix it falls squarely on the voters. Ultimately, where else COULD it fall if we believe democracy can work? Democracy operates on the premise that voters are worthy of having the right to vote.
Voters from across the political spectrum are looking more and more toward being entertained from the political "news" media they consume. Some are just more like this than others; but real, high value, information is suffering across the board. Everyone needs to become more responsible for the type of political news they consume. Until they do, the news media will not respond with higher quality information.
And no, neither Democrats nor anyone else will save democracy in America by becoming like MAGA. The people need to move toward the relative quality of Democrats. Democrats do not need to more toward the relative low quality of MAGA, which as I said wouldn't work to save democracy anyway.
👆🎯
We need to yell that MAGA are planning to drown Medicaid pts in red tape & paperwork!
No, not ordinary citizens, but informed down to earth leadership. And certainly not the senior citizens in Congress.
You are right. Aren't these cuts supposed to be implemented over the next ten years? So things will slowly get worse! People won't see the full impacts for years.
Though cutting food stamps will be immediate..
this country can afford to build and blow up,BIG BEAUTIFUL BOMBS, but refuses to pay for a peanut butter sandwich on white bread, for a kid going to school...and the kid is forced to go to school by that same government. there i somethng really weird about this picture
Some areas are working on eliminating the requirement to attend school, and in many areas parents are allowed to "teach" their kids at home.
or blowing up state budgets by giving the money to wealthy parents to help pay for the private schools they're already sending their kids to.
https://www.propublica.org/article/arizona-school-vouchers-budget-meltdown
I see what you're pointing towards, but please reconsider the scare quotes. There are lots of people with lots of reasons for not sending their kids to public school or any other traditional school, many of them quite good.
Most parents are not qualified to teach children everything they need to know, and it is a huge disservice to the child.
And they know that, which is why most who homeschool their kids are not trying to teach them everything themselves. The field of available options has changed and expanded quite a lot.
Some 300+ rural hospitals are at risk of closing within the next couple of years.
See https://ruralhospitals.chqpr.org/downloads/Rural_Hospitals_at_Risk_of_Closing.pdf
Maybe it will be harder to blame the other guys in these cases?
Yep, and not only for recipients; American farmers are the providers of that food, and they're getting the shaft, too.
And the farmers are heavily MAGA.
Mitch McConnell told senators to vote for the Medicaid cuts. Their constituents would get used to it.
I think he is correct. They will go back to voting on racism and cruelty.
In many places, they won't even know that what they have today is Medicaid. The money goes to the States, and the States use it for their own medical support systems. In Tennessee, it's called "TennCare."
It's going to be about ThreeCare when the dust settles.
One way the Republicans are cutting Medicaid is through work requirements. The states will be required to administer these requirements at a big cost. The people who are on Medicaid will need to provide their work history which will be difficult. These people will know it’s the BBB that made this change.
Also, people living in nursing homes will be thrown out. This bill is cruel, it will be obvious.
Well yes but will they be told all of this is because of this bill or will they be told, and believe, that it’s because many previous Democratic, liberal, woke, communist governments spent too much and crushed the economy and that’s the reason the government has no choice but to kick them out of their nursing home or impose a work requirement for their coverage…it’s to prevent the system going bankrupt didn’t you know?!?
I can tell you exactly which story they’ll hear from Fox News or, in a lot of places, their local media.
They’re not changing how Medicaid works—it will still deliver benefits that far exceed whatever for profit health insurance offers. It just cuts funding by reducing enrollment. I think it’s an open question as to whether this will live on as an issue until it’s fixed. There’s a good chance people who lose coverage will see others keeping theirs, which will make the cuts even more deeply unpopular.
Hospital and medical professional association lobbyists will remind everybody of what they lost. They will continue to hound state and federal legislators, and they do know how to use media. They will lobby middle class voters, explaining why their insurance premiums have risen at a faster rate thanks to those premiums also covering care for the uninsured. It’s how The Affordable Care Act got a hearing in Congress back in 2009, and that dynamic isn’t going away regardless of Republican wishes. La plus ca change, plus c’est la meme chose.
Let's hope you're right about that.
Of course, low info voters identify with low info politicians. We have way too many of those. Governing is not taken seriously. It's more about the 15 minutes of fame.
To your point..... Democrats should force immediate adoption of the republican plan. Stop with the good government transition periods and trying to make it less sonorous. . Cause and effect must be timely! The last time a piece of legislation like this was passed and then repealed was the Democrats long term health care for seniors. A probably good long term policy was rejected by seniors because the bill was due immediately. Political consequences for Democrats was Meh.. Probably because they folded the program so quikcly! (So you won't get rid of the MAGA BS easily)
'THEY'need to see exactly what they voted for, immediately..DEMOCRATS , PLEASE! just stop trying to save these people, let tham wallow in what they want and get.
This is the correct answer. If all low info voters get is right-wing propaganda (at worst) or nothing (at best) - they'll have nobody to blame. And as long as they continue winning culture wars with the same voters - they'll pay no political price. Does anyone truly think Dems shouting from the rooftops to MAGA voters is going to result in accountability?
These people are the ones who managed to survive Covid, despite refusing vaccines and masks. They didn't blame Trump then, and they won't blame Trump for this.
No, not really. Those people won't get lousy coverage. They won't be covered at all by anything. That's what the GOP's work requirements are for. So people no longer eligible for Medicaid will just end up getting sick, staying sick and going to die in hospital emergency rooms when they are in extremis (assuming, of course, that they can get to a hospital).
But hey, as Joni Ernsts said "We're all going to die" anyway. So why worry?
But what happens when grandma gets kicked out of the nursing home, or cannot find a bed in the first place- Medicaid is the way long term nursing care is paid for in the U.S.
Medicaid pays for 60% of births, having a baby is expensive.
No, they literally are going to take it away from folks who cannot complete the paperwork twice a year. They will find out when they go to the pharmacy to pick up their medications or at the ER during an emergency. We need to band together to devise groups who will help these folks prove they are working & complete the paperwork.
Rural places like Alabama will be forced to close hospitals. Even people who have "gold plan" insurance will have trouble using it if the closest hospital is over 100 miles away. Meanwhile most New York residents will continue to live within 5 miles of a hospital.
Americans' hatred for 'Government' means they pay about twice per capita for rather mediocre healthcare with a lot of people simply uncovered, than if we just instituted programs like The UK, Europe, Canada, etc have. But no, they don't want some mindless Government Bureaucrat making healthcare decisions for them. No siree Bob - they want an overworked, mindless insurance company bureaucrat making life or death decisions for them. 'Rational' is not a word which belongs in the same sentence with 'average American Voter'.
As somebody I read on the Internet once put it about his own home of West Virginia, Americans will pay several thousand dollars a year in repairs to their car so they don't have to spend several hundred a year in taxes to fix the potholes.
Good one! Excellent.
I read in the past few years that the US Government already pays for over 60% of total health care costs now. Yes, if we simply eliminated private insurers (whose overhead approaches or is even more than, 20% of their cost) with their high executive compensation and other overhead, transferred the costs of "private", employer sponsored plans, in addition to dividend payments, the excessive payments we give to Big Pharma and medical device companies, and the mandate that hospitals are built to provide healthcare, not as wasteful showpieces, I think we'd have it covered. And then some.
I have seen the system from the inside out. It is shot through with special-interest carve outs. We know how to make the system more efficient and in doing that, it would be better for the patients. But then someone's over-generous profit margin would decline.
I think you are right. I have long been puzzled about how Great Britain delivers longer life expectancies than we do. That implies that their healthcare "socialism" delivers better outcomes than our "for profit" capitalism.
Americans hatred for "Government" all started with Ronald Reagan. Yet, many people considered him a saint! He might have been someone you would want to ride a horse with, but in many ways he was as detrimental to our social fabric and the social safety net as is DOGE and Trump today.
He was a sadist who cared for no one, the AIDS epidemic comes to mind.
Yes. And yet Reagan is still lionized today by many, including moderate Republicans and Democrats. I don't get it.
Superficial people, he looked presidential, so that was enough for them.
I see his statement that the scariest words were “I’m from the government and I’m here trying help” constantly at the WSJ,
But then there are the people who say, "But I'm not on Medicaid, I have Cardinal Care."
Cardinal Care being Virginia's name for its Medicaid program. Every state does that.
Just like the many who say: “I’m not on “ObamaCare”; I have ACA coverage.
I suspect only red states do that. Here in New York, it's called what it is: Medicaid.
No. I think Oregon does the same. Lots of people are on Oregon Health Plan, which is Medicaid. I bet half of the people on Medicaid don't think of it as Medicaid.
Interesting.
Medi-Cal.
Florida Blue.
Not every state, but many have alternative names (Health First Colorado, for example here in Colorado). Gonna be some surprised people when funding begins to disappear, especially in geographically large states, like Colorado, with vulnerable rural hospitals and long distances to major health facilities.
Reminds me of the "San Franciscans for Good Governance PAC" and the "Delaware Valley Political Action Committee", both of which were fronts for AIPAC.
"Healthy Indiana Plan" is another one.
I am always amazed how we all seem to want to ignore the impact of nursing home patient enrollment in Medicaid. I know its not currently on the line in this abomination of a bill, but will certainly be identified as cost and "addressed" next. This will affect most families in America - including the well off prior to nursing home costs, and the GOP answer - that women will stop clogging up the job world, surrender their shoes and remain pregnant homemakers attending to grandma, doesn't seem to be backed up in their financial plans.
As far as I know there is no other realistic option for financing long-term care. Burning all your assets to pay for it then going on Medicaid is the norm.
People trying to do amateur memory-care will be a disaster, both for the patients and the caregivers. People do try it (trying to preserve independence, preserve assets, or while on Medicaid wait lists) and it's just way more than a family member can handle, even if they don't work.
I agree. Paying for nursing home care is an issue consuming many of my friends who are desperately working to get their parents to qualify for Medicaid. Without Medicaid they simply can’t afford that care.
See the NYT series “Dying Broke” about long term care.
Absolutely. The fact that our population is only getting older means those programs are actually more important than ever. Cutting Medicaid at a trillion dollars will have consequences for all Medicaid recipients and will indirectly impact Medicare because for many patients they draw from both programs.
In Canada (in BC) long term care costs 80% of your income, with no obligation to sell assets. The institutions are also run by the provincial government. There are private ones for the wealthy but there’s nothing wrong with the public ones
The US health care "industry" is an extortion racket. If US health care costs were about the same as the average in EU countries, with no other changes, the Federal government would save something like $900 Billion/yr. This isn't hypothetical savings, this is from direct comparisons with real countries. It's equivalent to about a $10k/year raise for every US household. It would eliminate about half the annual federal deficit. The solution is something like Medicare for all. "Everybody" knows this, but the lobbyists for the health insurance industry, and their ilk, prevent this from every happening, by paying off politicians to make sure it never comes to a vote. The US is probably doomed, and this chronic inability to stop the looting of the public coffers is why.
"The US health care "industry" is an extortion racket."
When I was dealing with health insurance before I had a relatively decent employer-provided plan, it was hard to miss that every single bureaucratic fuckup the private insurers made was one that, if not caught, would just happen to cost me money.
"Oh, sorry - our records show that you still owe us one monthly payment. ... Oh yes, I see here that you've called about this and gotten it straightened out a dozen times over the last seven months. But, um... well, I guess somehow the error in the system was never corrected! Who can say how. It's a mystery, really."
"Oh, sorry - we have to charge you the full cost for your visit because you have no referral from your primary care doctor. Oh, you do? Well, we don't see it in the system. Oh, you brought us a physical copy? Well... we don't have it. Sometimes they just don't get uploaded into the system. Wonder how that happens."
"Oh, sorry - our hospital is not in your network, so insurance won't pay for anything. Oh, you say you asked us when you arrived whether we took Blue Cross Blue Shield and we said yes? Oh well yeah but um... that just means that we'll accept you and treat you if you have Blue Cross Blue Shield. It doesn't mean we're set up for them to pay for anything!"
"Oh sorry - the lab that we sent your blood work to isn't in network. Oh yes, I see here that we told you this and that you specifically told us to make sure it was sent to the OTHER lab which IS in network. And that we told you we would, and that you called several times to make absolutely sure that was what was happening. But um... we just didn't do it. Oops?"
It couldn't possibly be honest mistakes and pure bureaucratic incompetence, because if it was, there would at *some* point have been mistakes that favored me, or at least mistakes that didn't have any bearing on my money. There never were. It was always an issue that somehow, totally inexplicably, would just *happen* to cost me money.
It was never ambiguous in any way either. It was about as subtle as a Mafia tax-collector coming back and saying "it's true, you did give me your weekly money, but then I tripped on a skateboard and slipped on a banana peel and dropped it down the gutter and now it's gone, so I need the same amount again. You wouldn't want there to be any misunderstandings between you and Big Al, would you?"
And most noticeably, it never happened on the government end of things. I never had a moment where the government failed to send me my Medicaid card, or accidentally purged me from the Medicaid rolls, or tried to weasel out of any of the payments they were responsible for. I'm sure it does happen, but the fact that it's so rare I never experienced it once, when compared with the absolutely endless and universal "incompetence" of literally every private actor in the system, pretty much tells you all you need to know.
TL/DR yes, it is an extortion racket. Quite honestly, while there are many ways of providing universal health care, I lean heavily towards single-payer or a British-style NHS system for exactly this reason. It's true that it's possible for a private market to provide a decent service if heavily regulated and subsidized enough, in the sense that some countries do it successfully. But the American market is just not that market: it's run on corruption and extortion for so long that unless you're willing to literally post an armed Marine in every single boardroom with orders to shoot the CEO the first time his company denies coverage that was due, regulating it can only do so much; it's as much a contradiction in terms as the idea that you can regulate the Mafia. Like the Mafia, we don't need these people regulated. We need them gone.
Read about it (yes it’s deliberate).
https://www.theatlantic.com/ideas/archive/2025/06/customer-service-sludge/683340/
Archived copy:
https://archive.ph/3w8We
Let’s hope the wheel turns away from the empathy haters and toward a day when healthcare for can be realized as a human right not just another profits over everything.
A lot of it is hidden in profits for middlemen, monopoly practices and the cut the wealthy get by buying up what used to be independent businesses. Private equity.
The health insurance industry neither provides health care, nor makes people healthier. Nor does it reduce costs, spur medical innovations or contribute to public health. It's a deadweight loss on the system. It's serves, functionally, merely as a parasitic mechanism to funnel money to wealthy shareholders. The US system is an accident of history. Corporate provision of health care was introduced in WW2 to get around wage controls. It's demonstrably the worst option of all the ones in use in other countries.
Sounds like the French Revolution Hungry people saw greedy oligarchs and used the guillotine
I think they were Monarchs, but potato potahto.
I don't see the act as actually targeting medicaid. The Republicans are just scamming their own fiscal hawks.
All the tax cuts hit immediately (even retroactively!!) while the medicated cuts are delayed for 4 years or more.
So the impact on the deficit for the next 4 years will be MUCH WORSE than advertised while the medicaid cuts are something for the NEXT administration to deal with.
Republicans are mass murderers who are quite good at killing. I hope the world squashes them like bugs.
Blue Tsunami 2026!
Wake up and smell the stinky roses. Television rigs elections, Trump is a TV actor, and the F.C.C. protects TV.
Well, we'll see what happens, won't we.
Yes, of course, we will see, on TV, and therein lies the problem.
It is a problem, but I don't think an intractable one.
The aging of baby boomers needing nursing home care has be a driving reason why participation in Medicaid has gone up over the last 15 years. Medicaid is the public program that provides 24/7 care for those who need it and can't afford the outrageous costs. My dad's care was $13K/month until Medicaid kicked in. And Medicaid only kicked in after my mom spent down almost all her assets. And that means testing was the most rigorous process. We had to account (provide photocopies) for every single expense of $100 or more for the previous 5 years. There's not much fraud in MA Medicaid!
No. The main driver is the ACA (aka Obamacare).
I dislike the Republican word game with the idea of "waste". Please understand that "Privatize" means "Create waste". In value stream analysis any diversion of cash flow from its intended purpose is identified as waste. Here's how that plays out:
Before
budget - overhead = intended purpose
After
budget - overhead - profit = less intended purpose
The diversion into profit is waste by definition. When Republicans say they are looking for waste, what they are looking for is a way to divert resources from the intended recipients to the wealthy.
Private insurance is a for profit business. It's first responsibility under SEC regulation and Sarbanes-Oxley is to make profit for its investors.
Word games is what the GOP does best. Their claim that private industry is more "efficient" than government is pure BS. Private industry is most "efficient" at profiteering.
Back in the nineties when everybody was going crazy for privatization all over the world, its apostles were claiming that if you just took those bloated and inefficient state-run companies that had existed under communism or similar systems, and give them to the private sector, they'd revitalize them and make them efficient.
Somebody at some point did a study and found that in fact, the private sector had no interest in taking over state-run companies except in two scenarios:
1) They were going to break up the company and sell off everything it owned for parts.
2) The company was already turning a profit anyway.
In other words, only when the stated rationale didn't apply.
"A decade later, George W. Bush tried to privatize Social Security. But he, too, failed, because Social Security is also immensely popular."
As I recall it, the W Bush plan was to replace Social Security with private accounts invested in the stock market, which -- their backward look at stock market returns showed -- would result in everyone getting much higher retirement income.
Then the dot com bust happened.
But they never tire of coming back to the same trough to try to feed.
My cynical side gets the impression that the One Big Beautiful You-Betcha Bill might be taking the effort to end entitlement programs to an unprecedented level: crash the government and blow up the deficit so completely that even restoring the highest past income tax rates on the wealthy won't save us.
Then face the public with the choice of either drastically cutting Social Security, Medicare, and Medicaid ... or doing without functional roads, the military, etc.
They've been trying to privatize everything since St. Reagan got that snowball rolling. We've been suffering the results ever since. Remember Blackwater?
Much longer than that. My father came out of WW II and landed a job with the Atomic Energy Commission. That was privatized in the Eisenhower administration and contracted out to Union Carbide. For those of you unfamiliar with the AEC, they built nuclear bombs and power plants and produced radioactive isotopes for medical purposes.
Union Carbide was contracted to do studies, not control the whole thing.
Union Carbide ran Oak Ridge. That's where the uranium enrichment programs and plutonium manufacturing ran (X-10, Y-12, and K-25). It was also the site of Oak Ridge National Labs, which did research projects. There was also a heavily guarded set of experimental nuclear reactors that was simply referred to as "reactor row." The contract went to Lockheed Marietta much later.
That's most disturbing, but it's still not running the entire Nuclear Regulatory Commission.
They tried to block Social Security when it was originally proposed, and they've been trying to kill it ever since.
👆🎯
But imagine the profit the financial industry could have made...helping...people invest. (Sarcasm)
Sometimes it feels like we are just pisssing into the wind. How did so many legislators get so ugly and mean?
When Obama became President
More like Reagan. Obama was never mean. Or ugly.
In REACTION to Obama. Can't have a Black man in the White House. It sent them round the bend.
It goes back at least to Nixon.
How? Because the evil ones are too old. Like old wine beyond its best – before drinking age, their conservatism, however well meant, has turned sour as vinegar
Their minds are living in the previous century. And the younger ones following in their footsteps, are their disciples who fear losing their perks and having to go out into the competitive world and find a real job.
They were born that way.
Once again, one of the biggest points about Medicaid is missing. Yes, the personal tragedy of people losing their medical coverage is the worst thing. But the point that is missing is the impact on the health care delivery system. Medicaid, in most cases, pays the least of any health insurance program, which may be why the cost of Medicaid is lower than others. But, it still pays something, which is better than nothing. So, now those former Medicaid covered patients who show up in the hospital emergency department will still get treated. The hospital is legally and morally obligated to treat, regardless of ability to pay. So, now there is no payment for those services: how does the hospital get paid? They can eat the costs (not very sustainable). They can reduce or cut services. The result will be loss of reasonable access or no services at all. Or even, hospitals closing. They can try renegotiate commercial contracts to include these costs ("cost shifting"), which means premiums go up on commercial insurance. They will charge self pay patients more, but those are people without insurance, many of whom can't afford it (except the ultra-rich who can afford it with their tax break).
So, bottomline: cuts to Medicaid will adversely impact all of us. These cuts are cruel. republicans in congress are no longer loyal to their constituencies and their oath, but are subservient and loyal to trump and his masked henchmen. Keeping their soon to be meaningless jobs is more important than doing the job they swore to do.
Thank you for making this clear and to the point...even with charts. The words that stood out as true: The do not care. It's a psychological problem. But by making the point that it could bring personal blowback to the GOP and the individual senators and the Speaker of the House...all I can think is they are counting on the piece of the bill that allows the unitary government to cancel elections. We must be in the streets in even greater numbers. I was on Medicaid. It is the very best. It is like Universal Healthcare. I've never liked the Medicare for All slogan. Medicaid for all makes far more sense to me. Medicare is so complex and riddled with rules. Medicaid is simple. It may be means tested but it doesn't have all the hoops and hurdles.
When I was walking into the grocery store the other day I overheard a woman on her phone screeching “ Of course they’re saying it’s all Trumps’ fault.” It doesn’t matter what she was talking about. It’s the “they” and the denial of accountability that is troubling. I think the “low information” folks, as they have been so politely labeled, are just plain ignorant and too lacking in imagination to consider any point of view that is not MAGA. Tragic, really.