Trump and GOP Fail: 'Obamacare Repeal/Replace'
The Market Ticker - Commentary on The Capital Markets
2017-03-07 06:00 by Karl Denninger
in Health Reform , 1476 references Ignore this thread
Trump and GOP Fail: 'Obamacare Repeal/Replace'
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So it's out..... well, at least sort-of-out.

And let me point out a few things about this bill, at least as far as I can determine from reading and cross-referencing it:

  • Idoes not repeal the "penalty."  It instead moves it to the back end; if you don't have insurance (by choice) and then buy it, you get hammered with a 30% penalty for a year.  For most people that's far more than the ACA penalty for not having insurance -- it could easily be $3,000 or more!  This is outright fraud on the part of the GOP which said it was repealing the penalty.  Paul Ryan, Donald Trump and the rest are all ****ing liars.

  • Medicaid expansion is essentially ended and cost-pickup for the states is capped to CPI-U's medical expenditures inflation index on a forward basis.  This will detonate State budgets within about 10 years as the current spend is expanding at ~9% a year but the CPI-U index is less than half that.

  • It does not repeal the prohibition on discrimination in price (or denial) for pre-existing conditions, but it does increase the multiplier for age to 5 (from 3.)

  • IT IS NOT A REPEAL OF THE ACA -- not even close.  The vast majority of the ACA remains intact.  The "mandate" is gone but the penalty remains, just shifted to the back side and for many will be far worse than the penalty would have been.  The restriction on what plans you can sell is gone, subsidies are cut, indexed only to age and paid to HSAs instead of directly to insurers. It does repeal many of the "add-on" taxes that paid for the program previously as well.

Repeal and replace? More like bend over, grab your ankles and bite down on a big stick so you don't chomp your tongue off.

When it comes to the media and their "lead-in" to the bill you have pieces like this, which sound awfully good when you read them until you realize there's exactly zero being said about the how.

Remember, it's who, what, when, where, why and how (sometimes stated as "with what?")

These are the 5 Ws (and one H, or sometimes 6 Ws) that form the basis of journalism.

Well?

Where's the examination of that last one: How?

Not in that oped and not in the "new bill" either IN WHICH THERE IS NOT ONE WORD ABOUT ANTI-TRUST, COLLUSION, OR ANY OF THE OTHER PRACTICES THAT MAKE MEDICAL CARE SO DAMNED EXPENSIVE, NEVER MIND THAT MANY OF THESE PRACTICES AND COLLUSIVE ACTS WERE RULED ILLEGAL IN 1979 BY THE SUPREME COURT YET THOSE LAWS ARE NOT ENFORCED AND THE COLLUDING PARTIES ARE NOT INDICTED, PROSECUTED OR BROKEN UP.

As an example you have laments like this from a physician:

Republicans ran on a platform of repealing and replacing a failing ObamaCare system. 

Democrats touted ObamaCare as an overwhelming success.  Neither party has really addressed the issues surrounding the law—patients are experiencing higher costs, diminished access and poorer quality care.

....

I have seen my patients go without medicines, miss important preventative care milestones and struggle to find access to high quality care. Copayments continue to increase—deductibles are rising (more than $12,000 in some cases) to the point where an average family simply cannot utilize insurance except in catastrophic circumstances.

There's a hell of a screed in that article but as I read it what kept going through my head is that this is a physician who's complaining that Washington has failed to fix this and that, lawmakers are putting "their own interests" ahead of the public and so on.  Complaint after complaint after complaint leveled against both political parties.

But nowhere in that article is found any discussion about the how -- that is, how is this individual physician prevented from putting a stop to that crap for his customers right damn now!

In other words how is it that he can't charge $100/hour (a quite-reasonable wage, all things considered -- that would be $200,000 for 50, 5-day-a-week 40 hour weeks of work in a year with 2 weeks off) in cash for his patients and given that most patients actually see said doctor for about 15 to 30 minutes per visit you then get to explain why someone who has a $12,000 deductible shouldn't just pay $50 for 30 minutes of said doctor's time with said physician seeing said person under his terms (and none of the nonsense being complained about.)

Is the problem that you can't just pay the $50 because said doctor has been prohibited from holding out his hand for you to stuff a Grant into it?  What law prevents him from doing that?  Why is that all of these "escalating costs" and "administrators" have resulted in actual physicians kneeling before Zod instead of them telling everyone trying to mandate that crap to stick it up their ass?

In short did someone make the current model something he's forced into rather than chooses and if so who did it with what law(s) (specifically) and why is doing so legal especially when every doctor in a given area has the same "problem"?  If there's no competition due to collusive behavior in a place where competition would obviously make someone richer at the other competitor's expense then you have a very solid case that felony violation of the law is taking place among all those who are doing the colluding!  If extortion (that is, some sort of threat) is involved then it's even worse.  I remind you that in 1979 insurance companies and pharmacies tried to claim that their collusion was exempt from anti-trust law and lost at the Supreme Court.

There are only two possibilities: This physician is part of the scam voluntarily or he is being forced involuntarily.  He's either a protagonist and thus willingly engaged in the offense or he's a victim of it.

Which is it and why isn't that the center of the a whole lot of journalistic attention?

You know.... the old "How" question that is supposed to be central to journalism?

Start asking that question and you will find yourself in two places at once.  The first is here, where we can remove $400 billion a year from the federal budget alone by cutting the crap on just one disease -- by putting sufferers of same first and prescribing health instead of expensive drugs that do not resolve anything.  The second is found in making The Surgery Center of Oklahoma the model for all medical practice exactly as it is for a car repair shop; that is, mandatory posting of prices and charging of the same price for the same product or service to all who come in the door for same.

Neither Democrat or Republican members of Congress will do either, and neither will Trump -- and journalists will not poke at why physicians have not revolted en-masse and destroyed this demonic system from within by simply putting out their hand and demanding a Grant to see them for 30 minutes of their time, ending the rampjob on the front end, at the local medical office, with finality while demonstrating that obtaining medical advice need not bankrupt you or be complicated.

As a result of all these actors serving those who are colluding to jack up the price by a factor of five to ten over what it should be for medical care in this country and the complete unwillingness of both Congress and the press to call those parties out and put a stop to it the federal budget is on a path to implosion along with all of the pension systems in the United States within the current President's term.

In 2009 I gave you a fairly simple "how" in these very pages, and have followed through with far more since, including more-complex ideas, all centered on the rule of law -- specifically, law that has existed for more than 100 years and does apply to health care.

You might want to go back and read that piece again. Then read this one.

Make sure you note the dates on both....

As for Trump, Price and the GOP?

smiley

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User Info Trump and GOP Fail: 'Obamacare Repeal/Replace' in forum [Market-Ticker]
James56287
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Agreed with all the parts about level pricing, but the example given about the doctor's 200K salary is a little off. Assuming he's an employee and not the owner of the practice, pricing him out at a 200K salary, adding taxes, fees, benefits, reasonable amounts of vacation, cost of technology, administration, and a reasonable profit for the firm would probably have his charge rate in the area of $300 per hour. The more middle men you add, with additional line items being added to the cost of sales calculation, the higher the number goes. I guess all I'm saying is that in the above example where someone is throwing down a Grant for thirty minutes, the doctor is probably only making ~60-70K per year.
Tickerguy
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Why should he be an employee? For what reason and purpose?

The point is this: If you are a VOLUNTARY part of the scam that FORCES prices higher, AND you collude so nobody decides to be the guy who takes the Grant according to the Sherman Act you are a FELON.

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James56287
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This gets to the hospital, group practice, clinic, or other care provider model where the doctor isn't the owner. None of which removes the need for level posted pricing, they just force the necessary price higher to generate the salary level desired for the employee. I'm sure there are doctors that'd accept 60-70k, but maybe not as many as we'd like.
Tickerguy
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Sigh.... do I need an upper-body workout this morning again?

There is no need for any of the following:
Quote:
Assuming he's an employee and not the owner of the practice, pricing him out at a 200K salary, adding taxes, fees, benefits, reasonable amounts of vacation, cost of technology, administration, and a reasonable profit for the firm

Nothing prevents said cash-accepting doctor (ONLY cash!) from having NO administration, doing records his way (in other words his only expense is a copy of Quickbooks for finance) and ALL of the gross, minus his voluntarily assumed expenses drops directly to the MAGI line on his 1040.

Does he HAVE expenses? Sure does, and every one of them is deductible. But all the other bull**** is gone. Note that I already left in "reasonable vacation" in my numbers, just like any other white-collar employee (FIFTY weeks of work, but there are FIFTY TWO in a year.)

This is called COMPETITION and conspiring to prevent it is a felony.

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Eli
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It is time for this sign, yet again.

Karl smiley

The biggest issue facing our nation and they are going to do nothing about it but change the wrapper on the box of dog turds.

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Supertruckertom
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Decent ROI on the cost of education.
Live on half of that for a few years and you have the degree and maybe even a small building paid off.
Live at the median income level and it gets paid back even faster.

That could help prevent a costly divorce later.
If they stick with you when you are poor or of modest means, they might be worth having around when times get better.

People change though.
They rarely like going back to average or less.

Here in GA we have an Anti CON law in the legislature.
There is also a Law working it's way through that will allow Doctors to offer treatment plans similar to a monthly membership subscription without being saddled with the Insurance Company financial laws.

This is going to only be handled at the State level if it is handled at all.



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Acebarefoot
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James,

I get what you are saying, but don't miss the forest for the trees, here. I am not bagging on you, just noticing that somehow we end up arguing about each individual tree instead of focusing on the issue of the forest. This Repeal and Replace is fighting over each individual tree at the expense of the forest.

The bottom line is there is a monopoly on medical pricing for drugs, dr's visits and hospital care here in the U.S. Point out it is collusion, call it preferential pricing(walk ins pay a different amount than certain insurance company's for the EXACT same service or good) or something else, but don't loose focus on the fact that we have LAWS in this country to stem this type of behavior, a behavior that can be ruinous to an economy and it's individuals over time.

If allowed unchecked long enough this kind of ILLEGAL behavior will bring a country to it's knees. That is where we are at. This is also what Karl has been arguing for quite some time as well.

"WITHOUT RULE OF LAW WE ALL GO DOWN"


I agree we need to have our facts down, but don't lose focus on the over all fact that our medical industry is BREAKING the Sherman Act and that there is NO law that excludes them from said act. The penalties for doing such needs to be applied to those committing said actions and it needs to be applied NOW!

If the penalties were EVEN to be rumored to being applied in the future to said actions, there would an immediate change in behavior.

It won't be easy as things reset from the "cancer" that is being rooted from our economy, but the sooner we address it, the easier it will be work through.

This Repeal/Replace POS isn't even worth the paper it is written on, as it completely misses the point.

Go back to the "Rule of Law" for the good of the country and quit letting individuals hi-jack the argument to distract us so they can keep leeching off of the system to the detriment of the rest of us. (Again, James....this is not directed at you)

Reason: spelun!
Jfms99
Posts: 170
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Msumelle, Ar
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So Karl the analysis here is that this plan not only does nothing to materially change the Health Care Model it still keeps us on the path to total Fiscal Destruction. My question is are we still looking at the four or five year time frame you have been talking about?

Given that that may be the case and now we see The Fed chopping to raise interest rates I would say the Road to the Fiscal Train Wreck is full speed ahead with no stops along the way.

I agree with your analysis that we are screwed and then some. I also look for reduced benefits of Social Security, Medicare, and Medicaid. With the Baby Boomer group hitting the system, the strain on it will be great.
Vernonb
Posts: 1742
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East of Sheol
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I've seen the hospital health care systems literally suck up the physicians in my local area. My previous physician charged what I thought was reasonable rates as long as he and his partners were running their own firm.

As time went on insurance and government filings got more complex and the overhead more expensive as the paperwork became more complex. He had enough of some insurance doctors telling him how he was to give treatment to his patients.

He finally reached a '**** it' moment with ACA. Of course the nearby hospital bought out the firm. My previous physician gave up his private practice to become a staff ER physician.

Of course there was nothing to stop him from taking cash as Karl prescribed but that means a change on the behalf of patients too. If he refuses insurance/government payments then a majority of his business goes away. The question is how much could he have saved on overhead by dismissal of internal claims adjusters?

With people (patients) being penalized for NOT having insurance it essentially forces them to NOT pay cash due the penalties to not carry insurance. The penalty is meant to destroy the "cash only" economy so the pigs and unneeded piggy middlemen can further feed at the trough of induced human misery.

This penalty is more than a 'tax'. It is a direct and collusive interference on those that would choose to pay cash and for those that would choose to directly accept cash as payment. This penalty is designed to restrict free trade with businesses as the Surgery Center in Oklahoma by siphoning off cash reserves. It is even more insidious than it appears on the surface. Firstly it restricts those with lower incomes and more limited cash reserves. Secondly, by matching that penalty to a percent of income it now ensnares the more wealthy that might have PREVIOUSLY afforded such options!

The worst part is the new batch of physicians coming out of school and out of residence that think this system is somehow 'right' and 'normal'.

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Themortgagedude
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Teddy sheds a tear.
Inline

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Tickerguy
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Quote:
So Karl the analysis here is that this plan not only does nothing to materially change the Health Care Model it still keeps us on the path to total Fiscal Destruction. My question is are we still looking at the four or five year time frame you have been talking about?

Probably. The CBO will "score" this but they're always optimistic. Best guess is that it doesn't change much of anything other than cost-shifting about half of the Medicaid expansion into the State budgets. Will that delay things a bit? Maybe. Might it get Trump another two years (close enough to get to near the end of a second term)? POSSIBLY, but if it does the implosion in states that took the original Medicaid expansion will almost-certainly end that party before that time, simply because their hit comes first.

It's not possible to accurately analyze the fiscal impacts until we have some data, so much of this is a guess. But what I do know is that despite all the claims for the ACA it got exactly TWO YEARS of slowdown in Medicare and Medicaid expenditure and that was with all the taxes, distortions and similar. Note that ALL of the PPACA taxes disappear with this plan, which is likely to make things MUCH worse fiscally -- I don't think the Medicaid cost-shift will be enough to make that neutral, but they HAVE TO GET THERE on a CBO scoring basis for it to go through reconciliation -- so they will.

But again, the CBO is historically crazy-optimistic.

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Azengrcat
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Why does the doctor give in to the scams? It might be related to the non dischargible $250K student loan debt which makes him or her a slave right out of school. Compounding the problem is the government subsidies of grain crops which lead to artificially low carbohydrate prices. And if you think you are going to use my tax money to subsidize your corn syrup Coca Cola habit and diabetes medication, I'll happily support a 50% soda tax. I look forward to computerized medicine and LCHF diets bankrupting the medical scam artists.
Tickerguy
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Well, you know, it seems to me that the Sherman Act has a solution to this problem....... Universities (including Med Schools) are NOT exempt.

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Uraki66
Posts: 16
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Kansas
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There are already Dr's doing this. "Direct Primary Care". You can look here http://www.dpcfrontier.com/ and get an idea.

I use one of these. I pay my Dr $75 month (based on age). All visits are free, I get Rx at wholesale +10% and he contracts for cash labs/MRI/etc so if I need those, they are cheap as well. I have his cell phone # and can email him etc. He dispenses drugs himself at his office (most states allow Dr's to dispense)

This is not insurance, he doesn't take insurance. I can point you to some of his videos on YouTube but each Dr in his practice is 600-800 patients and he sees maybe 6 a day, the rest are text/email/phone. He's figured out a way (and all of the DPC is like this) to work around the system for the benefit of the patient AND the Dr.

Yes, it's not insurance but if you think about it, most people don't need insurance for primary care and it's ridiculously cheap this way when the Dr is focused on you not the insurance. Yes, you probably need some sort of catastrophic plan.

So, to me, the whole "healthcare" plan/discussion is crap. We have a solution today that works & doesn't involve insurance on the front end.

And guess what? If you are paying the Dr directly, you have "skin in the game" because if you need drugs, you can get them very cheap, but it still comes out of your pocket. If you need a referral to a specialist, he can do that, but then you'd be paying the specialist.

If you do this where there is no insurance on the front end (where the care is needed and pretty cheap if you can *USE* the care) I would think that you would reduce the need for more expensive care later.

But even with the success stories about this, could you convince congress & most people to go along with it? Probably not because you'd be killing off some billion dollar "profit center" for some group.

Listen to my Dr (yes, this is an hour long) Contrast what he says against all the congressional crap from both sides.

Imagine a world where all health care works like this.


Mike_g
Posts: 4
Incept: 2016-04-26

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re: universities and insurance: Both examples of 3rd party payment, where "someone else" is paying part- or all-of the bill.

In the case of state-run universities: How much worse would the picture (cost of education) be if we included government funding which no doubt contributes to their budget?

In the case of insurance: I get frustrated trying to explain to folks the fallacy (or trap, if you prefer) of "insuring" against routine medical expenses. Would anyone think it is a good idea to pay "insurance" for daily bread and milk at the store? Once we got used to not seeing the cost of the everyday dr. visit (or prescription) the cost was free to skyrocket without notice...
Zappafan
Posts: 2871
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Atlanta
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Karl, the CBO is smoking a hopium-laced blunt. They'll play the same games they always do, goal-seeking and massaging data to make the plan "deficit neutral" on a 10 year basis.

We're screwed. Trump had a unique opportunity to focus on medical costs, not the insurance angle which is just a way to hide the problem with financial engineering and fraud. He blew it. Nothing will ever get done until the special interests who benefit from the scams are removed from power, or better yet perp-walked in front of cameras and given 10-20 in a P.M.U.A. prison.

Best case scenario - this doesn't pass, Obamacare stays in place as-is and detonates in your 4-5 year window. Hope we are all in good shape and don't need any medical attention by them. Accidents do happen. Maybe we should all consider getting some basic medical training and start forming co-operatives outside the system. This sucker is going down.

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Karefree
Posts: 1848
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Santa Cruz, CA
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I think there is enough evidence to indicate that most doctors are somehow "trapped" in a broken system. The fact that globally, doctors take their own lives at alarming rates should be a red flag, but add to that the length taken to cover up most of these suicides, well, it's more than just a broken system, it is a completely corrupt one that makes organized crime look like a walk down the yellow brick road.

some doctors seem to find their way to something that meets their original goals for going in to medicine in the first place - to actually help people recover their health without becoming dependent on pharmaceutical drugs for the rest of their life. They do exist, but in my own experience, I have found them very hard to find - maybe I don't know where to look?

In the end, I believe the best place to find "causation" is to follow the money. Who gets rich from this broken healthcare system? Yes, some doctors get very, very rich.... I believe they are part of the problem in 8 out of 10 cases.... but there are a lot of non-doctor types getting very rich from our very broken medical "healthcare" system, too.

K

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And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must do it because Conscience tells him it is right.
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Danimal
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-FREEDOM AINT FREE-
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Simply put this is just more Scamalot by our elected officials. Doesn't matter what party screws us! Where are the price controls? Where is the repeal of the MCCaron-Ferguson provision that protects the Insurance Co. from Anti-Trust. Repealing the mandate and sticking us in the Ass on the backend when we actually would need to use the Healthcare is appalling. Still a welfare racket

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Shannonlk1
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Raleigh
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For what it is worth- "Tuesday, Sen. Rand Paul (R-KY) weighed in on the House Republican health care bill, calling it Obamacare lite.

Paul also said conservatives are not going to pass it.

This is Obamacare lite. It will not pass. Conservatives arent gonna take it, Paul said on Fox & Friends.

He added, Premiums and prices will continue to spiral out of control."

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Aztrader
Posts: 7730
Incept: 2007-09-10

Scottsdale, AZ
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Running a cash business makes so much sense, but am wondering if he/she would be censored by the entire medical profession and black listed for doing so. I know that several flat fee realtors that charge only 1% to list houses have been illegally black listed by several brokerages who refuse to show his listings.
If a specialist tried going to a cash basis, would the hospitals and referring doctors black ball him too? The whole system needs to be exposed for what it is and build a network of the cash doctors that are available. If something like this was started and grew to any size, then the fat cats that are raping the system would be exposed for what they are.
The idea that anyone on government healthcare should be made responsible to improve their own health makes more sense then anything. I would love to see the math on what the average Medicaid/medicare patient uses per year in services. Are we paying six figure sums to keep deadbeats healthy? This needs to change immediately. Limits on doctor visits, higher deductibles, limits on prescriptions and penalized for going to your doctor for no viable reason. This has become one massive welfare program and it needs to be stopped.
Uraki66
Posts: 16
Incept: 2015-12-27

Kansas
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Axtrader, your
Quote:
The whole system needs to be exposed for what it is and build a network of the cash doctors that are available.

is what the Dr in my previous post is already doing and has been doing for a number of years.
Themortgagedude
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saint louis
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I think its time we ask ourselves if we still know the freedoms that our founding fathers intended for us. Ronald Reagan 1964
Hstella
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Colorado
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One of the biggest problems with Medicaid is that providers are not allowed to charge folate for anything, not doctors visits, not prescriptions. Literally I think the visit count would drop by 50% if they actually had to pay a $5 cash copay for each visit and each medication. Also, because they pay nothing to fill a prescription, there are multiple "prescription strength " medications that would go a away, because the cheap OTC version does actually cost money, and Medicaid patients don't want to pay that.
Gable
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Retired in NC Mountains
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Uraki66..Thanks for the link to the network. I will be looking into it.

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In all of history, no government became more honest, less corrupt, or respected its citizens' rights more as it grew in size. E.L. 2016
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