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Gov. Mike Beebe met with reporters Monday and said no one had been doing a good enough job explaining the Medicaid issue.
So he commenced explaining it and took a breath maybe a quarter-hour later.
He was mildly Clintonian in his professorial instruction and in his contextual connecting of the dots.
If everyone could hear this explanation, then public opinion would change. If all legislators could hear it — and he said that he and his staff would share it with them anytime — then a three-fourths majority to appropriate the money for expansion might not seem so implausibly daunting.
So I’m going to take a shot at explaining it as he explained it, availing myself, for that purpose, of this online column so that I might blow through newsprint’s space limitations.
First, the governor said, existing Medicaid (and our deficit thereon) is an entirely separate issue from proposed Medicaid expansion.
While it’s true that Medicaid expansion would solve some of the existing deficit problems, the two issues do not overlap much in terms of service, and not at all in regard to essence.
Existing Medicaid goes overwhelmingly to asset-depleted folks housed in nursing homes — mostly helpless senior citizens — and to children’s health insurance through the ARKids First program. So we need to plug our existing shortfall to keep from having to reduce vital aid to those two needy groups.
Expansion has little to nothing to do with serving more nursing-home residents or children. Instead, it’s about extending Medicaid’s basic health-insurance coverage to a greater number of recipients — about a quarter-million adults who now work and don’t quality for Medicaid but who make so little that they can’t easily afford health insurance.
Their children probably are covered under ARKids First, but they are likely uninsured.
If they get sick now, particularly in some kind of high-dollar emergency, they probably wind up getting treated at the local hospital and are sent bills they never pay, at least in full, because they can’t.
So their costs get written off as uncompensated care, or indigent care, and the hospitals build those costs into their price structures in a way that raises health-insurance rates for all of us.
Beebe will be happy to explain to you that he formerly was on the hospital board at Searcy and knows firsthand what he’s talking about.
The essential point of so-called Obamacare, he said, was to reap long-term efficiencies for the health-care system, and eventually for all of us, by getting those kinds of patients insured.
That would mean the rest of us wouldn’t have to keep paying those costs in ever-rising medical bills and health-insurance rates.
To try to hold down the immediate explosion in the federal budget deficit, President Barack Obama and Democrats included in the Affordable Care Act a reduction in reimbursements to hospitals for Medicare — not Medicaid, but Medicare.
And to compensate hospitals for that lost revenue, the law provided for this expansion of Medicaid at hundred-percent federal funding for three years, and 90 percent federal funding thereafter.
But then the U.S. Supreme Court said states could opt of the Medicaid expansion. Then it all hit the fan.
If we opt out in Arkansas, vital hospitals — from UAMS to your nearest local one — will be in big trouble.
And if we opt out, there will be a lingering and unjust gap in health insurance in this state.
The poorest people will have health insurance on basic Medicaid. Most middle-class and upper-class people will have private insurance. Some in the lower range of middle class will be able to buy insurance through new health-care exchanges and receive some form of subsidy in their premiums. Seniors will have Medicare.
Alone without insurance would be people working and making too much to get basic Medicare, but earning less than 138 percent of poverty and thus ill-equipped to afford even subsidized care through the new exchanges.
So, as Beebe laid it out, we can expand Medicaid at federal expense and help our hospitals and our working poor people.
And we can seek to construct a new health-care culture in which costs might stop rising so much because of uncompensated care.
Beebe acknowledged that some people, understandably, believe the federal government simply can’t afford to be throwing this kind of borrowed money at states.
But, as he said, that money is going to be borrowed and spent regardless of whether Arkansas takes its relative pittance.
For us to decline the expansion would be to close some of our hospitals, conspicuously deny insurance to our working poor people and perpetuate an unsustainable system of uncompensated care.
And it would accomplish diddly in regard to the federal deficit.
If you’re still opposed, then you’re simply stubborn or I need to go back and shorten some of these words and sentences.
It’s not a matter of ideology, which, in this case, only gets in the way of profound logic.
If we in Arkansas could solve the federal deficit by sacrificing our hospitals and working poor people, then maybe there’d be some argument.
But to sacrifice them to nothing at all — that’s just wrong.
John Brummett’s column appears regularly in the Arkansas Democrat-Gazette. E-mail him at jbrummett@arkansasonline.com. Read his blog at brummett.arkansasonline.com.
Comments on: A worthless sacrifice
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johnparrish says... January 9, 2013 at 7:54 a.m.
Good explanation, its not right but good explanation. If everything were fair, there wouldnt be any crippled children or handicapped adults. Wish we could keep our Gov another 4 years......
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Jackabbott says... January 9, 2013 at 9:03 a.m.
Good story. Existing Medicad should be saved and bolstered. But taking money from Medicare for people who paid Medicare premiums while working and retired and shifting it to others is morally wrong. This is one of the fundamental reasons older people lost favor with Obama, it is a sleigh of hand to pay for something that should have been set up in a way to pay for itself.
Social Security and Medicare are popular programs not only because they work but also because they are self-financing. Once Reagan and the other presidents and their lackeys in Congress started using SS as a giant piggy bank was ok until we traded our economy to China and Mexico and now find ourselves short.
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Pobucker says... January 9, 2013 at 10:01 a.m.
*blink*
There is always tomfoolery, let's see if we can find it.
~
ah! Here it is-
In the rape you now or rape you later catagory:
Hospital writeoffs for freeloaders = higher hospital healthcare costs for all
Moving freeloaders to exchange insurance = higher insurance healthcare costs for all
the tomfoolery? You working people are going to pay for the freeloaders any way you look at it.
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Molly44 says... January 9, 2013 at 10:51 a.m.
It's not taking any money from old people or reducing their services. Instead of paying $35 for some medical service, Medicare will pay $30. Why? Because the ER and the hospital will start receiving money for those services they used to perform for free to the uninsured sick and injured.
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Whippersnapper says... January 9, 2013 at 10:59 a.m.
Yes, in liberal world, providing more services to more people will miraculously cost less overall. Whether the tax dollars to pay for it come out of the left pocket or the right pocket, they still come out of the same pair of pants. If there is not enough money to pay for all the services today, there isn't enough money to pay for even more services for even more people tomorrow.
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JakeTidmore says... January 9, 2013 at 11:39 a.m.
And in the conservative world, they continually offer the old excuse "Am I my brother's keeper?"
Blessed are the poor because the conservatives will do everything in their power to shaft them, blame them, and demonize them. Anything other than care for them.
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Pobucker says... January 9, 2013 at 11:57 a.m.
Jake, you say all that like it is wrong. the poor you will have with you always. MY version - its like pouring money down a rat hole OR throwing good money after bad.
Freeloaders should starve to death. don't work, don't eat.
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Populist says... January 9, 2013 at 12:44 p.m.
Pobucker,
You need to read Jeffrey Sachs "The End of Poverty" and other books which discuss ways to end poverty. Some areas have much less poverty because they have higher levels of education. We can enable people to avoid poverty by making better choices in life. Birth control can allow people to plan their children so that they can adequately take care of them. Education allows people to be more skilled and produce better services or more goods more efficiently.
When emergency rooms are treating colds, we are wasting resources. Emergency rooms operate with a fear of litigation, and it costs too much to treat minor injuries there. Some people should just see a nurse at a health clinic. Indeed, medical expenses in this country could be decreased dramatically with more public recreation, exercise, and weight loss programs. We need to regulate and label lard and sugar. Supersized meals should be called "lard ass sized." We just are obese and out-of-shape as a nation.... I am going to get up and exercise.
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Whippersnapper says... January 9, 2013 at 12:56 p.m.
Populist, "poor" is and always will be a relative term. Every person in the United States today would be wealthy if the standard of 1st century palestine was applied. Numerous studies have established that the average "poor" household in the United States has a higher standard of living than many "middle class" families in Western Europe. When Jeffrey Sachs says we can eliminate poverty and Jesus Christ says we can't, I know who I am more likely to believe. "Am I my brother's keeper?" is a distinctly different question from "Is the government my keeper?" or "Is the government my brother's keeper?" Note that two of those three questions abdicate responsibility for your choices and turn liberals into Ebenezer Scrooge from "A Christmas Carol." If you believe that it is the government's responsibility, then you ask the question "Are there no prisons, no poor houses?" If you believe it is an individual responsibility, you wish you had more of your money so you could help more folks yourself. Speaking as somebody who is a conservative and gives time and money to several charitable organizations, I know who I would trust to help and act responsibly, and it's not the government.
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Reason says... January 9, 2013 at 2:01 p.m.
John explained it well.
.
Medicare and Medicaid are separate.
Medicare is payed by a payroll tax, premiums pay one-fourth and the general funds pay "the rest". "The rest" (the part that comes from the general fund) is what is saved from Medicare and used on Medicaid in Obamacare. Therefore, what was and is being paid into to Medicare is still being used for Medicare. Get it?
.
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cdawg says... January 9, 2013 at 2:29 p.m.
Now that we've heard from the "Let them Eat Cake" crowd not a soul has posed what good it would do by refusing Medicaid Expansion.
As explained, we'll be paying for it whether we take advantage of it or not. Taxes collected under Affordable Care Act will continue to be collected.
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cliffcarson says... January 9, 2013 at 3:05 p.m.
Wrong Pobucker
It is just the excuse for raising rates and there is a difference when compared to reality. The Hospital can write off the cost of fixing a broke finger for a poor person who didn't pay because the poor person didn't have insurance although he was working and making money it was only enough to survive on so he didn't purchase insurance while at the same time he made too much to quality for Medicaid and was too young to get Medicare.
The Hospital or Doctor gains from this: They can write off as a bad debt the cost that they charged the uninsured patient. That will be two or three times what they would have accepted as full payment from a Medicare or Medicaid patient. Oh yes they do that. This reduces any tax they would have to pay.
As an example, my wife was a patient at the El Dorado Hospital. I always take her medicines to be sure the Hospital Staff knows what drugs she is taking. The gave her a pill to take, one of the very same kind of pills that I had in her prescription drugs. But they refused to give one of her pills to her because their policy is to use only pills from the Hospital Pharmacy. My insurance company wouldn't pay for the pill because she had a supply of the pills in her prescription bottle that I had taken to the Hospital. I wouldn't have made an issue of it except the Hospital charged me $32 for the pill.
I asked the Hospital Administrator how much they would accept from Blue Cross as payment for the pill if Blue Cross had agreed to pay it. They said three dollars. They made an adjustment and I paid $10. I will bet my last nickel that the Hospital took a $22 write off as a charitable issue.
Pobuckers statement that "Freeloaders should starve to death. don't work, don't eat." is seriously flawed.
Medicare and Medicaid are two separate programs but Congress - not Obama, approved the raiding of Medicare funds to make payments for Medicaid
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Reason says... January 9, 2013 at 3:07 p.m.
Unless Arkansas plans on sending out the National Guard to prevent the so called "freeloads" from having access to the emergency rooms and to empty the nursing homes and foster homes.... What has Arkansas saved?
.
I suppose that the hospitals could go into a lock-down police state, like our schools, and we can all call it "freedom'. Or we can give freeloaders a free flu shot at the clinic instead of hospitalizing them for pneumonia.
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JDEATON40 says... January 9, 2013 at 3:32 p.m.
So the previous threat to kick people out of nursing homes won't fly now. Just believe everything I say now and forget what I said a few weeks ago. If we can't afford what we have already obligated ourselves to pay for, why should we add to our obligations? And add by a huge factor, also.
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Pobucker says... January 9, 2013 at 3:33 p.m.
Wow.
I am obviously flawed because I hate being robbed so moochers can live. Note I don't hate the moochers, just being robbed to give them the handout.
~
SO, those of you who don't mind being robbed so moochers can thrive, tell me your secret to happiness.
Is it because it absolves you of responsibility?
Is it because you feel so sorry for the moochers?
Is it some issue of morality from beyond the grasp of my withered consence? Whats the deal?
~
It plays out in my mind like a movie.
See me walk down the street.
See the moocher sitting with their hand out.
See me walk by the moocher, ignoring him.
See governent knock me in the head.
See governent pull out my wallet and give it to the moocher.
See the moocher laugh and vote for more government like that.
See me get up pissed as hell and vote for less government like that.
See the moochers win the election.
~
How does this movie end?
See me give up and join the moochers?
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inquire says... January 9, 2013 at 3:48 p.m.
Isn't the moocher the employer who has no company health insurance plan, yet at the same time pays wages so low that the employee cannot possible pay the open market cost of insurance? The world's largest employer, other than the US military, deliberately keeps many employees hours just below the number which would qualify them for insurance. This means many of them have no choice but to get government help. Seems to me the employer is the moocher. Their business plan is to do this on purpose.
Then we have the kind of customer who buys every single thing at this place, knowing how the help is screwed. And the investors who continue to invest in the company, knowing how they operate, rather than being socially responsible investors and investing in companies who have a more honorable business plan.
Many conservatives who think everyone else is a moocher are guilty of some mooching themselves.
And Cliff, I have seen the drug gouging you speak of. The last time my husband was hospitalized, I demanded an itemized bill. (Curious how you have to ask to get one.) I don't remember the exact figures of all the drugs, but all were billed at several times what we pay the drug store. I do remember that an inhaler that is $27 at the drugstore was $177.
We protect ourselves from most of the medical gouging by being able to pay cash the day of service. If we had to be billed, they would charge us more than they get from the insurance companies of the insured.
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RonalFos says... January 9, 2013 at 3:54 p.m.
Ebenezer Pobucker, may you soon get your three night visitors.
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Reason says... January 9, 2013 at 4:02 p.m.
If you are a "people", you are the government. Government of the people, by the people for the people. And the MAJORITY of the people voted to NOT walk by. The MAJORITY voted a second time, NOT to walk by.
.
The so-called "moocher" that we are talking about is somebody's employee. You know those people that employers profit from the use of their time, skills and labor? When the employee gets sick the employer is without an employee. Before Obamacare, the employee would run to the emergency room and get a pill or shot. It was paid for by others that did have insurance and by tax payers and by driving the medical cost up. The expansion means that they can go to the clinic instead. Which drives down the cost of medial care, insurance premiums and taxes... And helps to prevent the spread of diseases onto the rest of the people.
.
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Whippersnapper says... January 9, 2013 at 4:29 p.m.
Ironic that you would compare Pobucker to Ebenezer Scrooge. When Scrooge was a "bad guy," he advocated using government programs funded by his taxes to "help the poor." When he had reformed, he advocated individual and private charity as the better methodology. I think the message is clear - even 200 years ago Dickens knew that government programs are incapable of providing real relief to those that are struggling. Now, 200 years later, they are simply better at entrenching the culture of poverty than they ever were.
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RonalFos says... January 9, 2013 at 4:44 p.m.
Your reading of Dickens is a bit of a stretch to say the least.
Ebenezer: Are there no prisons?
First Collector: Plenty of prisons.
Ebenezer: And the union workhouses - are they still in operation?
First Collector: They are. I wish I could say they were not.
Ebenezer: Oh, from what you said at first I was afraid that something had happened to stop them in their useful course. I'm very glad to hear it.
These sound exactly like the solutions Pobucker and many conservatives would like to see today.
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cliffcarson says... January 10, 2013 at 6:24 a.m.
Pobucker
You Paraphrased the lesson of the good Samaritan, except your version intimated that you shouldn't be one,
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Delta2 says... January 10, 2013 at 8:01 a.m.
Cliff, about that earlier comment, about hospitals and doctors writing off bed debt...doctors are not allowed that luxury, unless they are a nonprofit, which most are not.
Just to be clear, I fully support Medicaid expansion, for reasons that you and others have stated. Just know that most doctors are not treated the same way that hospitals are in the eyes of the IRS.
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Pobucker says... January 10, 2013 at 10 a.m.
CC, I was the one beaten and robbed. Nobody helped me. In fact, in my parable, the robber got all the moocher votes and won re-election.
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Pobucker says... January 10, 2013 at 10:02 a.m.
SO, those of you who don't mind being robbed so moochers can thrive, tell me your secret to happiness.
Is it because it absolves you of responsibility?
Is it because you feel so sorry for the moochers?
Is it some issue of morality from beyond the grasp of my withered consence? Whats the deal?
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cliffcarson says... January 10, 2013 at 1:26 p.m.
The deal is Pobucker that you insinuate or leave the impression that you think anyone who needs help is a "moocher". That is a very erroneous assumption. You need to learn how to separate the "moochers" from those who through no fault of their own need help.
I suppose the reason you didn't get any help was because people like you were passing you by. I call that poetic justice.
Thanks for the information Delta2, but I do ask - do you know why a Doctor cannot write off bad debts? I was under the impression that all Self-Employed people ( which I am ) could write off all business expenses of which a bad debt is a business cost.
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Whippersnapper says... January 10, 2013 at 4:04 p.m.
Helping our fellow man is our individual responsibility. You should not abdicate your responsibility to the government, nor should I. The more the government takes from me to re-distribute to those that a bureaucracy determines are needy and deserving, the less I have to share with my fellow man who truly ARE needy and deserving. That is the issue - individual responsibility, which liberals think is nonsense.
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Delta2 says... January 10, 2013 at 7:43 p.m.
Cliff, I only wished I knew the answer. I am in no way insinuating that doctors are starving, but...if the IRS somehow would let physicians have a tax credit for treating patients that can't/won't pay, even 25 cents on a dollar or so, we'd have a lot less trouble with health care access. Just my two cents, or 25 cents I guess.
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inquire says... January 10, 2013 at 9:53 p.m.
I used to manage a chiropractor's office. As a matter of general bookkeeping, we wrote off bad debt and portions of the bills of poor patients, but we were just writing them off the books to balance and get rid of them. The doctor told me that he could not write off any office expenses from his taxes unless he had spent money paying them first. What is written off patient accounts is just a loss to the doctor, which means less profit.
They however, get plenty of other breaks. For instance, he always had a new truck and wrote it off as a business expense. He stayed inside the law on this by occasionally picking up supplies that were heavy for me to lift, such as cases of copier paper, or driving the truck to dinner with another chiropractor, where he wrote off the cost of their meal, where they may have discussed business ten minutes out of an hour or more they were dining. I don't know if just driving it to the office would have been enough or not.
He and most other doctors I knew were invested in rental properties as a way to even out the tax bite. They know all the tricks.
When they agree to write off part of a patient's bill or treat them for a reduced fee, they know they can afford it. The down side of the whole messy game is that you have to judge who is deserving and needs the special deal, and for some well insured patients, you have to charge what you can. It's a stupid system and we all lose. Just today, another study pointed out that we spend more on health care with less results than any other industrialized nation.
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RonalFos says... January 11, 2013 at 6:42 a.m.
I hate to say it but if the poor and downtrodden in this country had to depend solely on the giving nature of Christians in this country we would see a much worse state of affairs than we see now. Most Christians in this country are too busy building their country club mega churches to worry about the starving or homeless in their areas. If they were really following Jesus, there wouldn't be anything for the government to do. It would already be taken care of.
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cliffcarson says... January 11, 2013 at 8:31 a.m.
WHIPPERSNAPPER
I know you mean that our money should not be taken to provide for those who truly want to mooch. And yes I know of some who have chosen that course. But the expense they pile on the taxpayer is miniscule to the overall cost of our Nations Health Care. I think I may have mentioned previously that the cost of the real moocher ( the kind who have nothing and never will have anything) is less than one penny for each thousand dollars spend overall. And although those people are truly undeserving, their contribution to the financial mess is almost invisible. Except in the minds of those who have an agenda.
The real moochers are the 1%. This is something all of us should realize. When the Government gives Oil Companies Billions of Dollars in Corporate Welfare - and our Government does this day in and day out, our economy gets the blood sucked out of it big time. Think if you will for a minute about this scenario: An Oil Company or International Financial Institution gets a Billion Dollars a quarter ( 4 Billion per year) subsidy and many of them don't even pay taxes, anyway $1,000,000,000 / $20,000 per year =50,000. In this example 50,000 people could divide that subsidy up at $20,000 per quarter giving each person an annual income of $80,000 dollars. And that's just for each One Billion per quarter. Big Oil, when gas was at its highest profit period ever, was raking in total subsidies exceeding 1/2 Trillion ( 500 Billion ) yearly. That total would come to about $80,000 dollars per year for 25 million families.
What I am saying Whippersnapper is that the 1% have you and me fighting over nickels and pennies while they are stuffing their pockets with $100 dollar bills from our tax payments. And they have gotten us to place blame on the poorest among us. That's why I said in an earlier post that they are vampires who are after your last drop of blood. And yet, you seem to be fighting for the right to give them your and my last drop of blood.
Inquire - did your Chiropractor use the estimated bad debt percentage accounting method or the direct write off method? That could make a difference. If Doctors can't write off Bad Debts I am totally amazed-at a loss for words, but I admit I am not sure about this.
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cliffcarson says... January 11, 2013 at 8:51 a.m.
RonalFos
Very well said. The only difference I would have used is that I would have used the phrase "Those who call themselves Christian". The true Christian will be a good Samaritan, the pretend Christian will try to get you to go on by those in need referring to them as "moochers". And they will try to convince you that those in need are the cause of our economic mess as they point their nose skyward in a good pretend Christian pose.
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Delta2 says... January 11, 2013 at 9:24 p.m.
Cliff, and Inquire,
Yes, Inquire has it right. Physicians, chiros, and other professionals learn the rules from their accountants, and learn how to make those rules work for them. But sorry Cliff, physicians are not getting some enormous tax break for treating non paying patients, and I doubt they ever will.
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inquire says... January 11, 2013 at 9:47 p.m.
Cliff, I was not privy to any tax filing info. This was just conversation in the office. But he was pretty clear that to take a tax write off, he had to have first actually paid for something, then he could write off the cost, but that patient write offs were basically a charity for people who otherwise would have gone untreated.
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cliffcarson says... January 12, 2013 at 8:30 a.m.
Thanks Delta2 and Inquire. From what I read you are correct. My first statement about this subject was that a write off of what could be charged vs what Insurance Companies would pay would be a way to write off an expense not incurred, but you have straightened me out concerning that. And I checked out your explanation and found you are right. What really blew my mind was that the way the law is written, a Doctor, Dentist, etc, are not allowed a write off for a bad debt. The reasoning seems that you can't write off a transaction if you have not spent money to provide the service.
How the Doctor could provide the service without spending money to provide the service is beyond comprehension. The facility, the equipment, the personnel are not freebies. And as such should be considered as overhead, a business expense, a charge that could be based on time of use. I still have to assume this can be a business expense, otherwise my tax liability is not being figured correctly.
The percent of accounts receivable estimation method does allow for an accounting method that will allow for addressing Bad Debts, but the direct method of writing off a bad debt seems to me to be a justifiable expense. However not being an expert in Tax Law and not dealing in a profession as a Doctor, etc, I admit that not all things in life are fair.
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cliffcarson says... January 12, 2013 at 8:34 a.m.
I forgot to mention that a good friend of mine is a practicing MD. I will get with him and see if he can shed some light on this. I will let you know.
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lazybar says... January 12, 2013 at 9:20 a.m.
love how inquire thinks all employers should provide benefits for thier employees.thats fine lets force them to provide full insurance and vacations fot all employees but then lets do away with min wage because a great number of businesses would only be able to pay $5 a hour for wages after providing all these benefits.
the problem with the er is not fixing broke fingers for the poor,its the fact some have figured out that they do not have to provide id or varify prove of address for the bill and a er cannot refuse service unless they are a for profit hospital.the first fix to our medical crisses is to allow hospitals to refuse nonemergency services and make clients prove who they are and where they live.
lets go to the barter system,say a young healthy person is own gov assistance and owns a iphone.then the doctor should get the iphone as a form of payment.
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Delta2 says... January 12, 2013 at 9:48 a.m.
Cliff, I spent 12 years in private practice, and a lot of people had the same idea about physicians and bad debt that you did, the difference being that you bothered to open your mind and research it. I'm not asking you to cry me a river, but most people don't care about such issues and prefer to go on thinking physicians catch all these breaks for doing free work.
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cliffcarson says... January 12, 2013 at 10:12 a.m.
Thanks Delta2
I mentioned a friend who is a practicing MD. I have reviewed what he gets paid for some of the services he provides and will say that it should be a crime to allow Insurance companies to pay him such a pittance for his services. But he will not refuse a person, insurance covered or not. He also donates one month per year to those who can't afford to pay for the care he gives. I look upon him as a good Samaritan. He truly lives a Christian life. Unfortunately not all people rise to his standard. Please excuse me if I portrayed a disdain for Doctors. I assumed a write off was there but I didn't intend to disparage Doctors or their calling.
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inquire says... January 12, 2013 at 4:49 p.m.
Cliff,
I believe most doctors are far more charitable than the mammoth institutions that most of them work for now. Those doctors are under pressure as to the volume of patients they see in a day, how much money they bring in, and --in some cases--how many they admit to the hospital. Yet I know two doctors personally who work under those conditions, yet in their private lives, volunteer to do a lot of free medical care both at home and abroad. My dentist also volunteers at a free clinic, and does work abroad.
LAZYBAR, why do you so despise working people? Who are you, a member of the one percent? When a person works hard for a company, he has every right to expect a decent wage and benefits. A man who has good support for his family, including good insurance, and a pension to look forward to, is a loyal long term employee. He doesn't job hop and people don't have to be trained over and over for his job. The decades when this was the norm were also decades of growth and expansion, and the middle class grew and made the US the envy of the world. Now the working person is being bumped backwards down the rungs of the ladder on their way to joining the third world countries, yet corporations have record profits, and the cost of goods and services is rising.
I believe we have had the argument about ID's in hospital ER's before. I have plenty of experience with taking my husband there. There is NO WAY you can be seen without showing ID unless you are in such bad shape that you have to go to treatment immediately. Even then, someone will eventually bring the portable computer and get the information from the patient, or the person who accompanied them. Why do you keep saying you can get into a hospital without an ID?
There are two main reasons why doctors cannot barter today. One, if they work for a large clinic or hospital, their hands are tied by their employers. Two, even in a stand alone private practice, it can get dicey. The contracts they sign with insurance companies to become a contracted provider are strict about charging all insured clients the same. The insurance companies, including medicare, have the right to inspect the books at any time. If a doctor, for instance, forgave one patient's high deductible in return for some bartered compensation, he would be liable to be sued by the insurance company.
Think it can't happen? It can, and does. A well known chiropractor with a huge practice in the city near here was fined thousands of dollars by an insurance company when they found out he was forgiving the deductibles for some patients.
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lazybar says... January 14, 2013 at 9:26 a.m.
inquire,you think there is no way but yes there is.my wife is a er nurse and my fatherinlaw is a retired er doctor so i have a little better idea of how the er works than you.i don`t have anything against the working people,even though i`m a employer i still work but being a employer i know there is only so much you can pay.some jobs are low tech and don`t require a lot of effort with profit margins being low a business can`t afford the benefits like paid insurance on the other hand some jobs require lots of effort and maybe high stress with a great profit margin and those jobs usually come with benefits.i`m not against people getting paid,i`m against people having to pay a union to work.unions driving up labor cost and being one of the factors in companies moving over seas.
my comment about bartering was more about a vast majority of those getting gov help can`t afford insurance but they some how find a way to buy a $500 phone.
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inquire says... January 14, 2013 at 10:11 a.m.
We use the oldest hospital in this state and not ONE single time in thirty seven years in their system has it been possible to get in for very long without showing ID.
Maybe if you are brought in as a prisoner (I wouldn't know about that), but then the police know who the person is.
Without unions, many employers would still be content to pay a few dollars a day with no insurance or pension, just use people up until they couldn't stand up anymore, then toss the aside, as in Upton Sinclair's Jungle. They wouldn't care about safety equipment. People would die early from black lung, asbestos poisoning, or exposure to triclorethylene.
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lazybar says... January 14, 2013 at 11:09 a.m.
thats because you don`t know the system.just because they ask and you gave does not make it that way.
unions are out dated and job killers
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inquire says... January 14, 2013 at 2:33 p.m.
I'm so glad my husband didn't work for you; we would have had a miserable life and a miserable retirement. Of course, he probably would have had better sense than to stay with you for 34 years as he did with his last employer.
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kinggeorge says... January 14, 2013 at 2:45 p.m.
I am surprised that no one brought up the subject about food stampers buying liquor and other non-essential goods and services with their stamps. I work at a free clinic and donate my services. Almost all of the patients own a cell phone, smoke expensive cigarettes, drive vehicles, and very few have jobs. Some of them drink. Some are victims of "bad luck" and others have contributed to their situations. Abuse of the charitable system should carry a penalty, but if it does, it does not seem to be enforced. If the abuse and waste were controlled there would be a lot more to go around.
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lazybar says... January 14, 2013 at 4:28 p.m.
inquire,most of my employees have been with me for a while.i used to provide insurance but my business is like most others,cost of doing business is just like cost of living.although average wages are up it does not match inflation.in the past 10 years we have raised our prices 10% but it cost me about 25% more to do business.in your simple mind i`m sure you think i should just raise my prices and provide more benefits or make my family do without.i expect my employees to give me a days work and they expect me to pay them to best as i can.you complain about walmarts benefits and wages but i doubt you would be willing to pay $8 a gallon for milk if they went union.
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inquire says... January 14, 2013 at 8:22 p.m.
I shop at Walmart as little as possible because I don't approve of the way they do business. When we had chain unionized grocery stores where I lived, we favored them on purpose because they WERE union. Given a choice, we have always supported union labor. When my husband was still working, every check we wrote carried a small caption that read "this payment made possible by union labor", to emphasize to merchants where the money was coming from.
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cliffcarson says... January 14, 2013 at 9:42 p.m.
Actually, the reason workers wages are shrinking, and have been,for several years ( in buying power) can be directly traced to off shoring and Corporate greed.
America needs Wage earner Unions now more than they ever have needed them.
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DontDrinkDatKoolAid says... January 14, 2013 at 10:41 p.m.
Actually, the reason workers wages are shrinking, and have been,for several years ( in buying power) can be directly traced to the government printing more money without any backing (GDP) and putting that money into circulation.
America does not need blood sucking Unions for their cost would be passed on down to the 47 percent.
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cliffcarson says... January 15, 2013 at 5:35 a.m.
1934Cartoon
Seems you are saying that the reason workers wages are going down is because of those "blood sucking Unions". Is that correct? Do you have anyway to prove that?
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DontDrinkDatKoolAid says... January 15, 2013 at 8:30 a.m.
CC or should I say Dumb A$$, reread the post. Thanks.
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BillSmith says... January 16, 2013 at 8:40 a.m.
Arizonia Governor Jan Brewer just accepted Medicaid Expansion for her state. You people need to read what she said.
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DontDrinkDatKoolAid says... January 16, 2013 at 11:16 a.m.
So?
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