"Anything else is beyond their skill level."

So true. The list of things government can do even competently is very short. The list of things they pretend to do - very long indeed!

Congress should get the hell out of the way. What gives them the idea that they should dip their noses into every industry in the country, as if they knew better than the people who built them?!? If that were so, maybe you should have a lawyer do your surgery; tell me how that works out for you. If you won't go for that, what makes 435 lawyers think they can do so? The only proper function of congress is to provide protection for us from predators. That's the best they can possibly do. Anything else is beyond their skill level.

Absolutely correct, go to a private doctor in private practice instead of the hospital medical-factory stuff. There isn't the pressure to bill time on the multi-million dollar imaging machines, so they will actually listen to your description of the symptoms, do some examination, have a conversation, and make a more accurate diagnosis.

Ok, so a few comments.

Medicaid is not "Medicare" as in the title of this article. Medicare is operated by the federal government, Medicaid is largely funded by the federal government (about 90%) but operated by the states. Whatever Maine wants to do, is completely up to them, but the purposes of the two programs is very, very different.

Medicare is the default health insurer for the elderly, without regard for financial circumstance. Basically if you are over 65, you are eligible for Medicare, and even if you think you have Kaiser or Humana or whatever, Medicare is the first-dollar coverage with those other name brands both "operating" the plan and insuring gaps in coverage as a supplemental. Medicare is entirely funded by the tax on the working Americans as part of the FICA payroll taxes, you pay half, your employer pays half of the bill for each worker. At retirement, an additional premium is also paid and deducted from Social Security, but it's not enough to cover the cost of the care - it's a couple of hundred per month. The reason Bernie's "Medicare for All" plan was so laughable, is that Medicare soaks the working Americans pretty good already - it would need an enormous increase to cover "all Americans" instead of just the over-65 crowd. Then the income brackets kick in, some are paying $10, while others are paying $5,000 for the same thing. Medicare and "Cost Control" are never used in the same sentence either.

Medicaid (also called Medi-Cal here in California for example) was low or zero-cost healthcare coverage for the poor and indigent. The federal government specifies eligibility and will cover up to 90% of the cost of coverage and the operating costs of the plan - for example, the staffing costs in state agencies to operate it, or the contracting costs since Xerox provides MMIS fee-for-service adjudication systems in about 23 states, HP does a few, etc. States can "elect" to extend coverage beyond federal guidelines on their own cost. For example, California covers illegal aliens inside of Medi-Cal (despite the BS that they do not), but does so at 100% of the cost to the California state taxpayer, no federal funds are 'supposedly' allowed, but then the state bills the federal government for the cost of the staff and buildings and software, and computers, so it's not "really" all at the cost of the state.

Virtually all of the new "covered" on Obamacare was accomplished through the loosening of eligibility guidelines for Medicaid. For example, where the income threshold may have been $28,000 a year or whatever before, it was moved up considerably. People making as much as $50,000 or $65,000 with a kid or two will be eligible for Medicaid. The rightful criticism of ObamaCare was that it regulated-out the discretion of insurers to provide lower-cost basic plans that were affordable before, so with even a standard ObamaCare plan, the cost is pretty high for someone on $50k a year, so we suddenly provide it for "free". Having a Medicaid card doesn't really mean you have care, most doctors & clinics won't take it because the reimbursement for services is so low (or non-existent). They can do a 2 hour appointment, pay 6 people to prepare invoices, and submit a $3500 bill and they might get $200 in payment (and that would be it). The only way a provider can really make a living doing it is if they only do a Kleenex for the sniffles. To stay in business, they have to only carve out a few (very few) appointment slots for Medicaid, and while preserving the rest for Medicare and private-insurance or private-pay clients.

Naturally, to manage that expansion, has come at other costs - they needed to keep the cost curve down on paper, so they started eliminating Medicaid coverage for services to the elderly. Specifically, Medicare will pay for about 90 days in a skilled nursing facility, after that, zero coverage. Medicaid would then begin paying for care if the elderly person is eligible.

Some things have changed, now the elderly also needs to be indigent, which is usually going to be pretty rare. For most Americans, they have paid off their home by or soon after retirement (or they are not really retired), and when illness comes, there are assets that can be sold and private market options exist. For example, many elderly just need 24 hour care, doesn't need to be skilled care, but they can't really prepare meals or get to the bathroom on their own, etc... so Board & Care facilities are popular - which is basically a residential house with some semi-skilled care givers and 4 or 5 residents. The cost ends up being something that can be paid for with their retirement income and same savings bleed-down every month - if they truly do run out of money, it normally turns into a transfer to a skilled center that Medicaid will pay for (Medicaid doesn't cover semi or unskilled, but hopefully it will be considered in the new legislation).

I can't honestly disagree with your points but I do believe they go hand in hand with mine. For the purpose of avoiding the malpractice suits lots of unnecessary tests are ordered. My doctor used my refusal to submit to the fifth nuclear stress test gave him the scapegoat he and his hospital needed to relieve them of any malpractice claim.

None of these programs can be 'reformed' into freedom of choice. Don't reduce numbers, shift money around to pay for a different scam and call it success. Eliminate the programs. If free people want to create their own associations and use these programs freely to find if they will work, let them. Don't force me to join them!

Many of the tests are mandated because of the abuse of the malpractice system - not because care providers want to do the additional tests. I have several ER friends who have attested to that personally and are aggravated because they have to waste the time and money on the test knowing what the outcome will be but knowing that if they don't do it they open themselves up to a lawsuit. I feel your pain, but the better remedy is revisions to the business of lawsuits based on junk science - pioneered by one Democratic former attorney: John Edwards. What we need are caps on legal fees awarded.

Doctors and particularly those associated with big hospitals are a major source of the high price of medical care. People who have private or employer provided insurance plans that pay are a constant source of income and the hospitals in concert with the doctors practice what I call rape by constantly prescribing very expensive tests. If we all knew how much these tests cost, like Stress tests and nuclear stress tests, EEGs EKGs and questioned the doctors as to why they are needed every 3 months or more it would save millions. Some of the drugs prescribed on a daily basis for the rest of our lives are just out of this world expensive and you must question the real need to even be on them. This is where the republicans should start in their effort to reduce health care costs. I had 4 stress tests in a matter of four months and every one showed I was doing just fine after a stent. I told the doctor to pound salt when he scheduled me for the fifth.

Call it what it is! Medicaid and Not Medicare. Big difference and one that none of us have a choice about once you reach the age of 65.

Medicaid is for the poor while Medicare is for those 65 and older.

Fundamentally transformed the US has been.

Agreed. Well said.

That is not my country. That is not a system that I will fight, bleed or die for. Even though I am an old, fat guy at 75 I would, however, fight, bleed and die for the original. I do not care about borders, races, religions or sexual orientations. I only care that there is a rare instance in the history of humanity of a society based on individual rights going down the drain.

Congress should concentrate on radically lowering costs and increasing competition in the medical marketplace, rather than trying to "repair" the current broken system. We need some Republican congressmen and senators to begin promoting free-market solutions that are easily explainable and will lower costs for everyone - solutions such as ending state licensing of doctors and medical schools, allowing doctors and patients to negotiate limits on doctors' malpractice liability, and repealing "certificate of need" requirements and other artificial barriers to entry for new medical facilities and equipment.

That's what our nation was like only 100 years ago - until fundamental changes to our nation began destroying it from within. The framework that had been so solid for more than 100 years has been replaced bit by bit with parts that are either collapsing under their own weight or were structurally unsound. Now instead of a land of opportunity for all, we are a land of opportunity for some and where immigrants are exploited for both their votes and their labor.

We have created a nation of moochers with our welfare programs. We have arrested their development by destroying their self esteem and desire to better themselves. We have carried this over to also being at the root of our immigration problem. Instead of being a magnet for moochers what if the USA was a country where if one worked hard they could not only survive but grow and prosper? What if those that wished to immigrate here knew that it was a hard road and that they would need to work? What if they knew that if they had an education or valuable skills they would also need to assimilate into the existing society by speaking the language and obeying the laws? What if they knew that lacking education and skills they could still make their way by doing jobs that many don't want to do ( Mining coal, making steel, cleaning hotel rooms, shoveling manure, whatever)? Wait, this sounds like my grandfathers America. Who effed it up?