Schweitzer: "Medicaid is a system that isn't working . . . one of the least effective programs

[geek tragedy]

in terms of health care, in the history of our country."

http://www.huffingtonpost.com/2009/07/19/obama-ally-throws-cold-wa_n_239869.html#

But he's in favor of Single Payer!!!!!

Full quote:

The second problem we have is that one of the least effective programs in terms of health care, in the history of this country, is something called Medicaid," the Montana Democrat added. "About 20 percent of America is on a Medicaid program and they would like to shift it and grow it to somewhere around 25 or 30 percent. In Montana's case alone it would add 115 million dollars to our costs in our state, as our match. Now Medicaid is a system that isn't working, almost everyone agrees. But what Congress intends to do is increase the number [of people] on Medicaid so they could do it for the cheap. It is not working for anybody."

[hobbit709]

1. I wonder what inspired this rush of Schweitzer bashing threads today.

[geek tragedy]

4. The article from MSNBC quoting his anti-Obama rhetoric, including plenty of stuff

he's borrowed from the Tea Party.,

[ProudToBeBlueInRhody]

9. MSNBC is trying to gin up excitement for a primary that's pretty much over already....

....by calling a populist "Anti-Obama" while the noted "centrist" runs to Obama's right.

[SidDithers]

11. Probably this thread...

http://www.democraticunderground.com/10024333473

Sid

[DesMoinesDem]

19. The talking points were handed out.

[Cali_Democrat]

2. But....but...but....Barry Schweitzer is a liberal hero!

Last edited Wed Jan 15, 2014, 04:08 PM - Edit history (1)

Stop your hippie punching!

Actually, the only reason why some DUers like him is because he attacks Obama. It's painfully obvious.

He's not even liberal.

[Tarheel_Dem]

3. DU's Libertarian wing has already lined up behind him. Election Over!

[Laelth]

5. He's right about that. Medicaid stinks by comparison to Medicare.

The problem is that Medicaid is run by the states. In many cases, it's run very poorly. Medicare, on the other hand, is run by the Federal Government, and it works very well. Medicare, not Medicaid, would be the better model for a single-payer system.

-Laelth

[geek tragedy]

6. Except that Medicaid actually controls costs and is a real single payer program

administered by the government. Medicare is in practice administered by insurance companies, and its coverage sucks so much that most people need to buy a private supplement.

[joeglow3]

23. Define "controls costs"

My wife's office has quit accepting medicaid. Many procedures have a remibursment rate less than the materials involved. Thus, not only is the Doctor working for free, he is paying his staff out of his own pocket and is subsidizing the rest of the drug/material cost. Doesn't take a brain surgeon to realize this is a quick path to bankruptcy. Offices have 2 choices: either refuse to accept it, or jack up the costs to privately insured patients.

Sorry, but Congress cutting reimbursement rates to the point that a stealth tax gets passed on to people through increased costs is NOT "cost controls." It is an attempt to dupe an ignorant public into thinking they are "saving money."

[geek tragedy]

25. it controls costs as much as possible on the coverage end.

If you want more cost controls, you need to regulate the providers.

[ProSense]

7. No,

"He's right about that. Medicaid stinks by comparison to Medicare."

...in fact, it doesn't.

Krugman: The Medicaid Cure
http://www.democraticunderground.com/10024309532

Medicare could benefit from a drug program similar to Medicaid's

Medicaid Drug Rebate Program

<...>

The Medicaid Drug Rebate Program is a partnership between CMS, State Medicaid Agencies, and participating drug manufacturers that helps to offset the Federal and State costs of most outpatient prescription drugs dispensed to Medicaid patients. Approximately 600 drug manufacturers currently participate in this program. All fifty States and the District of Columbia cover prescription drugs under the Medicaid Drug Rebate Program, which is authorized by Section 1927 of the Social Security Act.

The program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for State Medicaid coverage of most of the manufacturer’s drugs. When a manufacturers markets a new drug and electronically lists it with the FDA, they must also submit the drug to the Drug Data Reporting (DDR) system. This ensures that states are aware of the newly marketed drug. In addition, Section II(g) of the Rebate Agreement explains that labelers are responsible for notifying states of a new drug’s coverage. Labelers are required to report all covered outpatient drugs under their labeler code to the Medicaid Drug Rebate Program. They may not be selective in reporting their NDC's to the program. Manufacturers are then responsible for paying a rebate on those drugs each time that they are dispensed to Medicaid patients. These rebates are paid by drug manufacturers on a quarterly basis and are shared between the States and the Federal government to offset the overall cost of prescription drugs under the Medicaid Program.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Medicaid-Drug-Rebate-Program.html

The ACA increased the Medicaid rebate percentage.
http://www.medicaid.gov/AffordableCareAct/Timeline/Timeline.html

Issue Brief - Medicare Drug Negotiation and Rebates

<...>

Medicare Part D is a voluntary prescription drug benefit for Medicare beneficiaries, established in 2003 under the Medicare Modernization Act (MMA). Prior to this law, Medicare did not offer a prescription drug benefit. In 2012, almost 65 percent (over 30 million) of Medicare beneficiaries were enrolled in a Part D plan (MedPAC, 2013).

Medicare Part D went into effect in 2006, providing prescription drugs through private stand-alone prescription drug plans (PDPs) and Medicare Advantage (MA) plans. Part D drug prices are determined through a negotiation between the private drug plan that administers the benefit and the drug manufacturer. By law, the federal government cannot negotiate for Medicare drug prices...Prior to the implementation of Part D, Medicaid paid the drug costs for individuals who were dually eligible for Medicare and Medicaid. Dually eligible individuals are generally low-income, sicker and expensive to treat. The costliest 20 percent of dual eligible individuals account for 66 percent of Medicare spending (MedPAC, 2012). When Part D went into effect, dually eligible beneficiaries’ drug coverage switched from Medicaid to Medicare and the manufacturer discounts were discontinued.

<...>

Savings. One argument is that billions of dollars of savings would be produced if the federal government negotiated for Medicare drug prices. While there are no current Congressional Budget Office (CBO) cost estimates for federal drug negotiation, a report from the Center for Economic and Policy Research (CEPR) estimates that savings to the U.S. government would range from $230 billion to $541 billion over 10 years (Baker, 2013). CEPR noted that the U.S. pays twice as much as other wealthy countries for prescription drugs because their governments are able to negotiate for lower prices.

<...>

Best Price. A third argument is that it makes sense for Medicare to receive the best price available for prescription drugs, just like Medicaid and the VA. In Medicaid, the drug manufacturer provides the federal government discounts for drugs, which are shared with the states. The discount is either the minimum drug amount or an amount based on the best price paid by private drug purchasers, whichever is less. Current law requires drug companies to charge Medicaid 23 percent less than the average price they receive for the sale of a drug to retail pharmacies. Drug companies also must provide another discount if a drug’s price rises faster than the rate of inflation (Thomas and Pear, 2013)...Medicaid rebates, if applied to Part D, would save the federal government money. According to a 2011 study conducted by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services, Medicaid rebates were three times greater than the discounts negotiated by Part D for 100 brand name drugs. In 68 of these drugs, Medicaid rebates were twice as high as rebates granted by the drug companies for Medicare drugs (OIG HHS, 2011; Hulsey, 2013). Similarly, a 2008 study of drug pricing information by the U.S. House Committee on Oversight and Government Reform found that Part D paid, on average, 30 percent more for drugs than Medicaid (Hulsey, 2013).

- more -

http://www.ncpssm.org/PublicPolicy/Medicare/Documents/ArticleID/1138/Issue-Brief-Medicare-Drug-Negotiation-and-Rebates

The President has proposed the same rate for Medicare (http://www.democraticunderground.com/10022670043 ), which would save even more than the Senate proposal (http://www.democraticunderground.com/10022725266), $164 billion to $141 billion, respectively.

HHS strengthens community living options for older Americans and people with disabilities

The Centers for Medicare & Medicaid Services (CMS) issued a final rule today to ensure that Medicaid’s home and community-based services programs provide full access to the benefits of community living and offer services in the most integrated settings. The rule, as part of the Affordable Care Act, supports the Department of Health and Human Services’ Community Living Initiative. The initiative was launched in 2009 to develop and implement innovative strategies to increase opportunities for Americans with disabilities and older adults to enjoy meaningful community living.

Under the final rule, Medicaid programs will support home and community-based settings that serve as an alternative to institutional care and that take into account the quality of individuals’ experiences. The final rule includes a transitional period for states to ensure that their programs meet the home and community-based services settings requirements. Technical assistance will also be available for states.

“People with disabilities and older adults have a right to live, work, and participate in the greater community. HHS, through its Community Living Initiative, has been expanding and improving the community services necessary to make this a reality,” said HHS Secretary Kathleen Sebelius. “Today’s announcement will help ensure that all people participating in Medicaid home and community-based services programs have full access to the benefits of community living.”

In addition to defining home and community-based settings, the final rule implements the Section 1915(i) home and community-based services State Plan option. This includes new flexibility provided by the Affordable Care Act that gives states additional options for expanding home and community-based services and to target services to specific populations. It also amends the 1915(c) home and community-based services waiver program to add new person-centered planning requirements, allow states to combine multiple target populations in one waiver, and streamlines waiver administration.

For more information about the final rule, please visit: http://cms.gov/Newsroom/Search-Results/index.html?q=&filter=Press%20Releases+Fact%20Sheets&date-from=&date-to=

For more information regarding the Home and Community-Based Services available under Medicaid, please visit: http://www.medicaid.gov/HCBS

For more information regarding the Community Living Initiative, please visit: http://www.hhs.gov/od/community/index.html

http://www.hhs.gov/news/press/2014pres/01/20140110a.html

[Tierra_y_Libertad]

8. Are you in favor of single payer? Is Medicaid working for everybody?

It seems to me that a single payer program for all would be a helluva lot better than medicaid.

[geek tragedy]

14. "Medicaid is actually the piece of the US system that looks most like European health systems

which cost far less than ours while delivering comparable results."

http://krugman.blogs.nytimes.com/2014/01/10/the-medicaid-cure/?_r=0

Now, expanded Medicaid is a key part of Obamacare — and so far, despite GOP obstruction, Medicaid enrollments have outpaced insurance through the exchanges. This is often reported as if it were a bad thing — as if Medicaid were somehow a fake solution, as if only purchases of private insurance count. But Medicaid is good, very cost-effective coverage! And rising Medicaid enrollment is, aside from a huge benefit to the previously uninsured, a step toward better cost control in the system as a whole.

So liberals, don’t apologize for Medicaid growth. In economic and human terms, it’s just what the, um, doctor ordered.

[Tierra_y_Libertad]

16. Apparently, you misread my questions.

Do you, like Schweitzer, favor single payer?

Do you think that medicaid covers everybody?

[geek tragedy]

17. I favor us eventually getting to single payer,

I don't think Schweitzer is serious about it.

Medicaid could cover everyone if Congress mandated it.

[Tierra_y_Libertad]

18. Isn't that what Schweitzer is saying? That he prefers single-payer?

And, why do you think he's "not serious" about single payer?

[geek tragedy]

20. well, dkf said she favored single payer too.

Why is Schweitzer not serious?

1) He's not talking about expanding Obamacare to do more, he's saying it's doomed to failure because it will "collapse of its own weight"--a Republican talking point that means the program is too big and does too much to succeed. People who use that language won't turn around and suggest a much bigger, more expensive, and more disruptive change to single payer.

2) his hostility to Medicaid, the closest thing we have to single payer, that provides health care, not health insurance, and controls costs effectively.

Democrats who bash Medicaid suck.

[Tierra_y_Libertad]

21. So, do Democrats who don't favor implementing single payer.

Or, back lost wars.

[geek tragedy]

22. Single payer is a longer term goal.

We should get the hell out of Afghanistan, and stay the hell out of Iran.

[Tierra_y_Libertad]

24. We agree on both points.

[upaloopa]

10. Bull shit!

I work for a county alcohol, drug and mental health services dept.
Medicaid pays for the largest portion of services to children and older adults in our clinics. The ACA has added millions of older adults to those who can now receive services. We are mandated by law to serve the needs of the mentally ill in our county. Without Medicaid the State would have to pay for 100% of the cost of services. As it is, Medicaid pays 50% and the State pays 50%.
Under the ACA the new Medicaid clients will have the Federal government pay 100% costing the State nothing. In three years the state will pay 10%.
So combining the State and Fed payments makes Medicaid a single payer for poor children and older adults.

[geek tragedy]

15. You speak the truth. nt

[sinkingfeeling]

12. Not working? How? Ask the seniors in Assisted Living/Nursing Homes if

they think it's working. It's their last resort for care in their old age after they have depleted a lifetime of savings and assets.

[ProSense]

13. Well,

"Not working? How? Ask the seniors in Assisted Living/Nursing Homes if they think it's working."

...Medicare doesn't pay for "Assisted Living/Nursing Homes." Medicaid does, and that was strengthened by Obamacare.

HHS strengthens community living options for older Americans and people with disabilities

The Centers for Medicare & Medicaid Services (CMS) issued a final rule today to ensure that Medicaid’s home and community-based services programs provide full access to the benefits of community living and offer services in the most integrated settings. The rule, as part of the Affordable Care Act, supports the Department of Health and Human Services’ Community Living Initiative. The initiative was launched in 2009 to develop and implement innovative strategies to increase opportunities for Americans with disabilities and older adults to enjoy meaningful community living.

Under the final rule, Medicaid programs will support home and community-based settings that serve as an alternative to institutional care and that take into account the quality of individuals’ experiences. The final rule includes a transitional period for states to ensure that their programs meet the home and community-based services settings requirements. Technical assistance will also be available for states.

“People with disabilities and older adults have a right to live, work, and participate in the greater community. HHS, through its Community Living Initiative, has been expanding and improving the community services necessary to make this a reality,” said HHS Secretary Kathleen Sebelius. “Today’s announcement will help ensure that all people participating in Medicaid home and community-based services programs have full access to the benefits of community living.”

In addition to defining home and community-based settings, the final rule implements the Section 1915(i) home and community-based services State Plan option. This includes new flexibility provided by the Affordable Care Act that gives states additional options for expanding home and community-based services and to target services to specific populations. It also amends the 1915(c) home and community-based services waiver program to add new person-centered planning requirements, allow states to combine multiple target populations in one waiver, and streamlines waiver administration.

For more information about the final rule, please visit: http://cms.gov/Newsroom/Search-Results/index.html?q=&filter=Press%20Releases+Fact%20Sheets&date-from=&date-to=

For more information regarding the Home and Community-Based Services available under Medicaid, please visit: http://www.medicaid.gov/HCBS

For more information regarding the Community Living Initiative, please visit: http://www.hhs.gov/od/community/index.html

http://www.hhs.gov/news/press/2014pres/01/20140110a.html

[sinkingfeeling]

26. And the topic of this thread is Medicaid, not Medicare. I'm well

aware that it's Medicaid that pays for ALF and Nursing homes as I have a 94+ year-old mother, who is in the situation.