Medicare isn’t an entitlement … Medicaid likewise isn’t an entitlement (to qualify you have to spend down your assets to $2,000) … we who work and have income, pay for it through social security and income taxes and this gives us individually the right to be covered after we have exhausted our resources down to $2,000.  Medicaid is typically used for medical care in a hospital or nursing home … physicians don’t usually take Medicaid patients due to low payments.  Those that do are usually scamming the system to make ends meet.  It likewise, doesn’t pay for specific services but usually for a limited per day charge for a physician, hospital or nursing home.  Quality of care or quality of life aren’t factored into the daily payment.

Under Obama care Medicaid was expanded to cover 20 to 30 million more recipients who are within a range of the poverty line.  Their coverage was not limited to preexisting conditions and had escalating deductibles to cover the high costs of covering all Americans and aliens.  This is why the program is failing because it takes millions of healthy Americans signing up through their companies or state insurance exchanges to fund this true entitlement program.  Due to its structure the national health insurance and single payer system was what the Obama Care design was to write into law as a tax program not an insurance program … that’s why the Supreme Court approved it.  What we have ended up with is a socialized medicine debacle requiring small businesses and individuals that can’t afford to, carrying unhealthy peoples at high utilization cost for preventable medical services.

The quandary is how to cover people who don’t work or are not registered aliens and expect the right to medical care regardless of the cost.  Most of these people are unhealthy by nature and their costs exceed a deductible they can’t pay.  Then the taxpaying American pays twice … once for theire care and twice for the deductible of those that don’t care.  Under the Republican proposals (and there are many) the cost would be shared by all working Americans either by medical savings accounts or increased taxation (retain the Obama taxes) and managed care that only pays a share by block granting the rest of the funding responsibility to the States.  This has been labeled Trump Care due to the Republicans taking on Obama Care without the participation of the Democrats.

Rather than share the responsibility for fixing Obama Care the Republican controlled Congress is attempting to stick it to the Democrats as Obama Care did to them … its shuts them out of the legislative process and they shifts the blame to the Trump administration.  What would work is to amend Obama Care by taking out the pork and leaving in the solutions that include medical savings accounts and adding accountability for the providers to control cost and quality.  The pork being the grants to universities, the enforcement being assigned to the IRS that cost $2 trillion dollars over ten years and the taxes on provider equipment and puts in the solutions for the lack of provider accountability for excessive prices and control over provider cost of services with no standards for outcomes.  In Obama Care there were innovations for allowing the beneficiaries to get tax deductions for being healthy and medical savings accounts but no controls on Medicaid spending and Medicare denials.

As I have proposed in my books on the topic, health care needs to be founded on an enterprise model platform paying for outcomes replacing the institutional medical model of paying for provider incomes.  Hospitals, physicians, nursing homes, pharmacies would be paid more for prevention then for mediations and  treatment.  The quality of care would be based on outcome models not income codes.  The waste of trillions of dollars due to over utilization and fraudulent billings amount to $600 billion per year minimum or $6 trillion over the next decade while Americans health is declining due to them not internalizing the necessity to pursue better lifestyles and habits.

Read “Restore Elderpride”, the Boomers Are Coming”, “America in the Red Zone”, “Life Styles for Aging”, “The American Enterprise Manifesto” , “Failing Government Taketh Away” and “Never Too Late to Live”