Medicaid Benefit Plans - State Of Michigan: Fill & Download for Free

The idea of national health insurance goes back to Teddy Roosevelt. Bismark created the basis of the German system back in the 19th Century. So the idea isn’t anything “new”. Opposition came from the AMA who opposed anything that might reduce the freedom of physicians to charge what they wanted for their services. I have access to the State of Michigan public library system and anyone who wants to learn why the US doesn’t have national health insurance can likely access their state public library system to learn why things are as they are. Interestingly enough, opposition to national health insurance appeared during the First World War because the Germans had it. Then when the Russian Revolution occurred in 1917, the idea was opposed because it was a part of “Russian Communism”. It was also seen as a “socialist” idea which didn’t help either. There was actually opposition too to the idea of medical insurance to help pay for hospitalizations when Blue Cross started up. Fear again of control over prices. There was also opposition to the idea that Black people would get the same benefits as white people got there in the South. Racism was an issue in the early part of the 20th Century as it related to health care.FDR considered the idea of national health insurance similar to the idea of Social Security, but ran into enough opposition from Congress that he dropped the idea. Harry Truman advocated national health insurance in 1948, but got nowhere with the idea. Again the idea was seen as “socialist” and the Cold War with Russia, later China pretty put “paid” to the idea. The European adoption of national health insurance was seen as “European socialism”, something that Americans certainly didn’t want.Medicare and Medicaid didn’t come into existence until 1965, and only because the Republicans lacked the necessary number to prevent it due their losses from running Barry Goldwater for President in 1964. LBJ also passed civil rights laws that moved the South from Democratic to Republican in reply.The Clinton Plan of 1993 was designed from studies made of European systems. Effectively the federal government would collect taxes (progressive payroll tax) and private insurance companies would bid to provide coverage (community rating) in return. The basic system was an HMO with an “option” of “fee for service” at extra cost. One problem was that you didn’t have a choice of what health insurance company would be covering you. Or whether or not you’d be able to keep the doctor of your choice since the basic system was an HMO.Obamacare was a copy of the Romneycare plan which in turn was based upon a plan by the Heritage Foundation. Again the major problem was you were not given a choice as to the level of coverage you wanted and were willing to pay for. To meet the requirements of Obamacare, a plan had to provide a level of coverage that made the plans quite expensive, which meant to hold down the cost of the premiums, large co-pays and deductibles were necessary.Currently, the best plan now under study by the Republicans is the one created by Senator Rand Paul, MD. It allows people to set aside money for health savings accounts which can pay for both medical treatment and drugs (including those that are OTC). It allows people to decide upon the level of coverage they want to buy and can afford. It’s biggest problem is that it does little to actually reduce health care costs which seem to be now politically “untouchable”. If Dr. Paul had be willing to consider things like repeal of prescription laws, the plan might be adequate for most people. For those with serious and expensive conditions, some sort “assistance” is necessary, but that is a problem that is unlikely to be resolved given our current administration.

You’ve asked a complicated, but logical question. The answer lies in understanding healthcare costing and pricing, the area in which my PhD is focused.When healthcare prices are calculated and modeled, the cost to transact business from marketing,contracting with payors for each contract with each payer,enforcing each contract’s with each payer’s contractual terms and conditions,appealing wrongly denied claims according to the rules of each contract with each payer,following up on slow paid claims for each contract with each payer,verifying coverage prior to service for each contract with each payer,verifying benefits (completely different than verifying if the policy is indeed in effect),negotiating maximum allowable fee schedules for each contract with each payerfollowing the rules, playbooks, website updates and amendments for each contract with each payerand moreEach activity has a “cost tag” in addition to simply rendering medical care that’s needed by the patient, covered or not covered. The fact that something is not covered is an insurer, underwriter and actuarial decision, not a medical decision. The fact that these things are deemed “not medically necessary” is overturned all the time by regulators as a different matter altogether.When I teach seminars on contracting I review no fewer than 21 different “types” of insurers and payers, namely:UnionsEmployers who self-fund claims trust fundsEmployers who purchase insurance rather than self-fundMedicareMedicare Advantage plansMedicaidGovernment “metals” plans from the exchangesWorkers compMotor vehicleProperty and casualty (liability)Prison HealthVA/TriCareAssociation plansChurch plans’HMOsPPOsEPOsASOsTPAsIndependent NetworksIndemnity insurers (sickness and accident)Travel accident and illness insuranceDisease specific policies (cancer, long term care, etc.)FULLY INSUREDThe premiums include an incremental charge to operate the plan - in each state. There’s no CIGNA or AETNA or BLUE CROSS national. They must replicate in each state, with subscribers and insureds bearing the brunt of the cost of the redundancy.50+ CEOs50+ VPs50+ Medical directors50+ Case Management teams50+ marketing and sales teams and their managers and support teams50+ sets of regulatory fees to be paid50+ audits to be carried out to fill in state reports and federal reportsSELF FUNDED UNDER ERISAThen on the self insured side there are some 300K individual company self funded health benefit plans operated and maintained by insurers, all with their federal reporting and regulatory compliance. They must maintain reserves, purchase or underwrite reinsurance (for excess claims losses - like from COVID). They must also verify and manage pre-existing risks, review medical records, sort out primary and co-insurance positioning.So now imagine there was only one plan, one carrier, one insurer.How many people would that affect and put out of work? What about their unemployment compensation and insurance? What about their roles, their work space, their desks, their computers, software licenses, phones, and so forth? What about the insurance they had for their families and dependents?What about the staff model HMOs like Kaiser, Harvard Pilgrim, HAP of Michigan, Henry Ford Gundersen, and others?? These are brick and mortar health plans, clinics, hospitals, all operated by an insurer. Who would maintain them and own them and operate them?What about capitalism and free enterprise? How would the investors react if we went to one plan, one single payer?So in one way, single payer may create efficiencies, but in the other way if will impact the economy heavily. Just something to ponder before making a decision as to which you’ll support.

I really don't understand this notion that the American dream is dead. It really isn't.The American dream means different things to different people, but this is probably what it means to most people:Owning a decent carBeing a homeownerEarning a middle class household income of $70K–100KHaving decent health insurance (typically employer covered)Being married and sending your kids to above average schoolsSaving for your kids college educationHaving enough income and wealth for a comfortable retirementBeing able to go on vacation a couple of times every yearAll these things are achievable to the average American today. I know several people who grew up in poverty stricken or working class families and easily achieved this and even went beyond to become successful professionals and even millionaires.However, there are a few issues that make it difficult for people to achieve their American dream.A college education is becoming more and more expensive each yearThe cost of health insurance has become relatively expensiveThe cost of living in certain places is artificially high (SF Bay Area, certain areas of NYC, etc.)There is a savings crisis in AmericaMany people on the conventional left and right agree that most of these issues are problems, however solutions each side puts forward are radically different. People like me who are on the right, prefer solutions that involve changing incentives, free markets, and individual responsibility. On the other hand, people on the left prefer to expand the size and scope of government.Below are summaries of my solutions to each problem:Government interference into the higher education industry is precisely why the cost of a college education has risen much faster than inflation. Governmental interference with subsidized loans and excessive college support programs have incentivized colleges to raise tuitions rapidly and the number of unprepared Americans entering colleges is at historic highs. Approximately 54% of American students who enter college are unable to graduate in 6 years. The best way to solve this crisis is to eliminate the Department of Education, end federal interference in the higher education market, and end federal control of student loans. Additionally, state and local governments need to stop incentivizing higher education institutions to spend millions of dollars on lavish athletic and extracurricular facilities that have precisely nothing to do with completing a college education program that will help students get relevant and well compensating jobs. The overhead that universities currently have is notorious for being expensive and having no benefit. For example, why does the University of Michigan have 80 diversity administrators? Bureaucracy kills.Health insurance and America’s healthcare system are incredibly complex systems where solutions will not be easy or simple. However, the answer is absolutely not transitioning to a European style single payer national healthcare system. Health insurance has become expensive primarily because of government interference and the third party payer system it created. Prices are signals and there is literally 0 price transparency in the healthcare delivery market. The solution will involve scaling back government spending and regulation on healthcare while phasing out Medicare, Medicaid, and the third party payer system in general. Transitioning to a system of catastrophic insurance coverage combined with Health Savings Accounts is probably the best direction for the country.This is also because of state and primarily local government housing policies that make it prohibitively expensive to build middle income housing. The left’s misguided ideas on rent control, affordable housing, and so-called “smart building” policies are the primary reason that certain places have become too expensive for middle class and even upper middle class Americans. Leftist policies combined with supply and demand, rampant NIMBYism, and lobbying by HOA’s have artificially increased the cost of living in many places.The U.S. once had a culture of personal saving and investment. That still exists to some extent, but it has largely dropped off the map for many working and middle class Americans due to the excessive tax burden that payroll taxes place on them. Eliminating payroll taxes and transitioning to a retirement system of universal privately funded retirement accounts with a required savings percentage would be preferable to the current inadequate and redistributive social security system. Australia successfully transitioned from an American style pay as you social security system to a privately funded system over 10–15 years and we can do it too. Social Security is bankrupting the country and is a terrible deal for workers because of the piss poor returns and anti-saving mentality it creates. Combine that dependency on government programs and you have the makings of a catastrophically bad piece of public policy.Sources and further reading:Article, Essays, and Researchhttp://www.aei.org/publication/chart-of-the-day-century-price-changes-1997-to-2017/‘there has been a severe contraction in the quality of higher education’Are Sports the Reason Why College Costs So Much? | Generation OpportunityHow College Costs Lie to Us | Hayden PadgettWhy College Costs Are Rising | John HoodThe death of the healthcare marketAfter the ACASeven Social Security Myths | Charles BlahousThe Numbers Are in: Social Security Robs the Working Poor | Tom EddlemThe Case for Privatizing Social Security Just Got Stronger | Daniel J. MitchellWhy No One Is Even Talking about Raising Payroll Taxes to Fund Social Security | Brenton SmithWhy Social Security Must Fail | Dean RussellSocial Security: Just End It | Brenton Smith"Medicare for All" Isn't Medicare at All | James PethokoukisNo, 'Medicare for All' Is Still Not Plausible | Brian RiedlWhat It’s Like to be a Medicare Enrollee: 4 Economic Lessons from My Last Doctor's Visit | Warren C. GibsonAmerica’s Most Libertarian State Is…?More Evidence for Private Social SecurityThe Second Social Security CrisisThe Ever-Expanding Fiscal Burden of Social SecuritySocial Security’s Creeping Fiscal CrisisBooksHealthy Competition: What's Holding Back Health Care and How to Free It, : Michael F. Cannon, Michael D. Tanner: 9781933995106: Amazon.com: BooksRestoring Quality Health Care: A Six-Point Plan for Comprehensive Reform at Lower Cost (Hoover Institution Press Publication): 9780817919443: Medicine & Health Science Books @ Amazon.comIn Excellent Health: Setting the Record Straight on America's Health Care (Hoover Institution Press Publication): 9780817914448: Medicine & Health Science Books @ Amazon.comThe False Promise of Single-Payer Health Care (Encounter Broadsides): Sally C. Pipes: 9781641770033: Amazon.com: BooksThe Case against Education: Why the Education System Is a Waste of Time and Money: Bryan Caplan: 9780691174655: Amazon.com: BooksInside American Education: Thomas Sowell: 9780743254083: Amazon.com: BooksGoing Broke by Degree: Why College Costs Too Much: Richard Vedder: 9780844741970: Amazon.com: BooksThe High Cost of Good Intentions: A History of U.S. Federal Entitlement Programs: John F. Cogan: 9781503603547: Amazon.com: BooksFalling Short: The Coming Retirement Crisis and What to Do About It - Kindle edition by Charles D. Ellis, Alicia H. Munnell, Andrew D. Eschtruth. Politics & Social Sciences Kindle eBooks @ Amazon.com.Going for Broke: Deficits, Debt, and the Entitlement Crisis: Michael D. Tanner: 9781939709745: Amazon.com: BooksRent Control: Myths and Realities--International Evidence of the Effects of Rent Control in Six Countries: Milton Friedman, Walter Block, Friedrich A. Von Hayek, Basil Kalymon, Edgar O. Olsen: 9780889750333: Amazon.com: Books