Obamacare is useless to me now.

[Mr. Shaman]

[Professor]

Again, nothing to do with my point. You're saying that HC companies are sending fewer and fewer dollars to providers. That is true (and there are good reasons for it - namely, more regulations and compliance - those cost centers for HI companies have increased 300% since 2005).

However, when a person goes through the exchanges (a good part of the law, BTW), they buy HI from a private company among a pool of companies. When an employer provides HI, they buy it from one in that same pool.

[Professor]

[spacemonkey]

The middleman needs to be out of HC completely. People already pay into a HC plan their entire working life, but have no access to it. And there is no part A, B d, or whatever in the pay in to a plan they can't access. That's just more added BS by the middleman. I'm all for a national plan, but what they actually have is nothing but coercion/extortion.

[Professor]

If you don't want a middleman, then let's get rid of Medicare and Medicaid altogether. Those are RIFE with middlemen. Imagine, if you will, a single dollar bill in the following scenario.

Here's a quick primer on Medicare and Medicaid, focused on those middlemen. You go to a hospital and show your Medicare card. Medicare then pays the hospital. But, Medicare doesn't pay the hospital quite enough to cover their costs. So the hospital eats some of it. At the end of the year, the hospital certifies a sum of all this lost revenue on MCare patients, and sends that to the Dept of Health and Hospitals in their state. That DHH compiles all the numbers, and sends it to DHHS (Federal). Now, Medicare cannot reimburse hospitals for this directly, but they realize that hospitals need to be able to at least cover their costs. So, they authorize something called an Upper Payment Limit for these hospitals (typically rural and community hospitals). This UPL contains a Federal match of other Medicaid dollars (compiled by the states separately and sent to DHHS), which is then sent back to the states. The state then pays the hospitals for Medicaid services, with a UPL match.

How's that for a middleman? Were you able to keep track of that dollar bill? It went from you to the Fed (taxes), was broken in 2 with part going to the hospital and part being held at the Fed. That part then waits on numbers from the state. It's sent back to the state, and then on to the hospital.

Nice, huh?

[spacemonkey]

[Mr. Shaman]

[Mr. Shaman]