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PaperclipPerfector  4d ago (text post)   19777 thread views

Culture War Roundup for the week of July 7, 2025

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Posted this in the comments last week, but was curious to get some more thoughts on a potential path forward on the healthcare front that isn't just single-payer across the board:

I do occasionally wonder if you could get to a decent place via:

  1. Get rid of Medicaid. It maybe made sense at one point, but it's current incarnation is, as far as I can tell, such a disgusting mess for all involved parties that it's better to just kill it with fire.
  2. People who would be on Medicaid can now get insurance via the ACA exchanges - they'll get a 94% CSR plan for 2% of their income. There's some annoyance around how they will enter their income, but much less paperwork than it takes to interface with Medicaid. There would need to be a small legislative tweak to allow this to happen (let <138% FPL income people get subsidies), but in practice they should trade a bunch of annoying documentation and everything is free for a functional network (ie a blues plan) and everything is very cheap + 2% of their income.
  3. Expand Medicare to more disease categories other than just end stage renal disease (in addition to the elderly). In practice I think you want to try to capture an additional several million of the sickest people. Hemophiliacs, organ transplant, some cancers, some rare genetic disease perhaps, that sort of thing. This will dramatically lower premiums in the ACA. However power-law distributed you think healthcare costs are, the reality is they are likely more power law distributed than you think.

That's going to create some winners and losers, hospitals will be upset that more high cost people are on Medicare, but shifting people from Medicaid to commercial reimbursement rates should help out with that. The amount of bureaucratic nonsense saved by getting rid of Medicaid should be huge.

All a bit of pie in the sky dreaming anyways...

The whole situation is a mess, I like to think of healthcare economics like communism - yes you can absolutely up end the system and make it way better than what we have now, but when has that ever happened successfully?

The thing that probably gets the most complaints over in doctor land is that changes to the current medicaid structure is likely going to result in a further decline in safety net and rural hospitals. This trend has been ongoing for some time but loss of medicaid dollars will probably accelerate it greatly and people are expecting to see that with the current wave of budget cuts.

Two specific things off the top of my head that you'd have to watch for:

-It is very easy for the hospital to help you by signing you up for medicaid. Private insurance would likely find ways to block this. Hospitals rely heavily on this.

-Medicare and Medicaid are much lower overhead on the clinical side of things and less paperwork. Private insurance is a lot more work (although Medicare is trying to change that! Yay). Don't expect a reduction in medicaid to reduce bureaucratic costs and middleman costs.

yes you can absolutely up end the system and make it way better than what we have now, but when has that ever happened successfully?

Basically every other western nation manages to spend equivalent or less amounts of healthcare than the USA, and has equivalent or better outcomes. So yes, basically everyone else's system is better than the USA status quo.

Basically every other western nation manages to spend equivalent or less amounts of healthcare than the USA, and has equivalent or better outcomes.

Observably, this statement is (still arguably, but commonly presented as) true if you replace "healthcare" with "education". But the typical solutions presented by the left are in the opposite direction there: few are suggesting we adopt European (or more extreme, Korean or Japanese) norms in education and cut funding. Is education different, or is this just a case of "conveniently, this evidence supports the action I already wanted taken"?

Liberals do not want healthcare costs cut, whatever gave you the impression that they did?

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