66 Comments - wordslinger - Tuesday, Oct 18, 11 @ 6:25 am: So it’s fiscally irresponsible to go to the market to borrow at lower rates to catch up on bills, but it’s conservative business values to borrow $3.3 million from a nursing home at higher rates? Got it. - Allen Skillicorn - Tuesday, Oct 18, 11 @ 6:36 am: Looks like a spending problem to me. Just like a child in a candy store with big eyes, the state needs to learn what it can and cannot afford. See what I did there, I compared the legislators to children… - dave - Tuesday, Oct 18, 11 @ 7:38 am: **Looks like a spending problem to me.** But what you don’t understand is that they have already “spent” the money, but haven’t paid the money yet. And they are paying much higher interest rates by essentially borrowing from the providers rather than banks. - MikeMacD - Tuesday, Oct 18, 11 @ 8:13 am: Just letting my imagination run loose. Comptroller issues warrant anticipation certificates to the Treasurer. Essentially, these represent that the Comptroller has done everything necessary to validate payment but just doesn’t see the cash available at this time. Treasurer “invests” in these certificates by issuing a check to the anticipated payee. When the actual warrant is issued by the Comptroller, the Treasurer doesn’t issue a check for the principle but just sends along the difference in interest between what the state is paying and what the Tresurer is taking per the “investment”. Yes, the devil is in the details, such as, do these two offices have the authority to do such a thing, system set up, limits on cash etc. Like I say, just imagining. - Aldyth - Tuesday, Oct 18, 11 @ 8:23 am: These vendors are stuck with doing business with the state. They are paying interest on loans to make payroll, while Illinois benefits from getting an interest-free loan from the vendors. Why would anyone become a vendor for the state in the future? No one in their right mind would agree to be abused this way. - wordslinger - Tuesday, Oct 18, 11 @ 8:26 am: –Why would anyone become a vendor for the state in the future? No one in their right mind would agree to be abused this way.– I’m sure many well-off docs and “non-profit” hospitals don’t mind the arrangement. Once the pump is primed, they may be getting paid late, but they’re getting paid regularly with a lot of extra juice. If I recall, last session the docs said they didn’t want a lower reimbursement rate to cut down on the payment cycle. If you can carry the loan, it’s good money. - Realist - Tuesday, Oct 18, 11 @ 8:59 am: I might get tarred and feathered for saying this, but Sen. Cultra makes a good point. We do need to find ways to have low income families avoid the Emergency Room, which is far more expensive than a regular doctor. I don’t think Sen Cultra was suggesting that people shouldn’t receive emergency services, but they don’t need to go to the ER for a cold or the flu, which happens all too often. - Bill - Tuesday, Oct 18, 11 @ 9:01 am: It is not interest free. The state is paying a point a month. At least they are supposed to pay that. They are also supposed to make their full pension payment which they aren’t paying. Illinois would get a better deal on juice from the local shark. - TwoFeetThick - Tuesday, Oct 18, 11 @ 9:14 am: =They are paying interest on loans to make payroll, while Illinois benefits from getting an interest-free loan from the vendors.= Only half true. Yes, vendors are paying interest to borrow money while they wait for state reimbursement. But the state is not borrowing money from them interest free. The Prompt Payment Act (30 ILCS 540) requires the state to pay interest on overdue bills. If you check the wonderful database put together by the AP and available on the SJR’s website, you will see that for the time period covered, the state owes $17.3 million in interest on those late bills. Nope, not interest free at all. - really - Tuesday, Oct 18, 11 @ 9:19 am: Why is the comparison always between eating and health care? Why isn’t the comparison between cell phone/HBO/xbox live and health care? - Retired Non-Union Guy - Tuesday, Oct 18, 11 @ 9:22 am: I agree with Realist. Maybe the bill could be structured in such a way there is a (relatively speaking) high co-pay of $10-$25 for using the emergency room, which could be waived if it was a true emergency, and a small co-pay of $3-$5 for going to the doctor’s office. And since some would quibble over the definition of emergency, let’s use the same one the HMO’s use to decide whether to waive the ER co-pay. I’ve seen both sides of it, having given my kids & grand kids the co-pays for their prescriptions even though they have Medicaid cards. We’ve tried to encourage them to see their doctors more and use the ER less to help hold down the costs and they do some of that. But when it is “free”, they don’t see a reason to wait until the doctor can see them the next day when the ER is open all night. - Colossus - Tuesday, Oct 18, 11 @ 9:46 am: @Really - Because most people who rely on Link and Medicaid don’t in fact have HBO and XBox live. And while they might have cell phoen plans, they don’t have smart phone data plans or a home phone. And if they do, then they probably have been recently knocked down the ladder and are stuck with multi year contract even though their job disappeared. The vast majority of people who need this assistance would, in fact, have to choose between eating and getting medical care. Hell, I had an ER trip this weekend that is going to take a bite out of my discretionary food budget and I have good SoI insurance. If you lost your job today, how would you get health care and put food on the table? It’s much easier to paint every recipient of public aid as a generaltional leech than it is to admit that every one of us a job loss away from being there. - Generation X - Tuesday, Oct 18, 11 @ 9:50 am: -Why is the comparison always between eating and health care? Why isn’t the comparison between cell phone/HBO/xbox live and health care? - Because it doesn’t make as good a drive by slogan. The public face of this argument does not meet the reality - dupage dan - Tuesday, Oct 18, 11 @ 9:53 am: What is the purpose of the co-pay? Why is it there? Is it there so that folks have a sense for paying out of pocket for a visit to the Dr or ER? Some have suggested that the co-pay be raised enough so that people look at a medical visit as something to be done when absolutely needed, rather than for the sniffles. We hear about people sitting in ERs for hours only to be seen by a Dr and complaining about something relatively minor - or going to their PCP because they have a cold. Not a good use of medical resources, in my view. When you don’t have to pay for a service - and don’t have any skin in the game - that service can be overused. One suggestion for helping lower medical costs was to use an incentive - you get a balance placed into a medical account. The more you access medical care the more comes out of the acct. Any left over at the end of the year you get to keep. The theory is that less pressure on the system, especially in the ER can lower overall costs. Those who have insurance/Medicaid are so removed from the realities of the cost of medical care we see no reason to alter our habits. When we do see those costs we balk at paying for them. That doesn’t mean we don’t get the care - it means the providers seek ways to lower the costs to attract more customers. A good example of that is Lasix eye surgery. When 1st introduced, the cost was very high. Since insurance rarely pays for this “luxury” folks were reluctant to use it. Over time, providers developed ways to provide the service more efficiently while maintaining quality and safety. Costs were lowered and more folk could get the treatment. Capitalism can work in the medical field. - dupage dan - Tuesday, Oct 18, 11 @ 9:56 am: =Hell, I had an ER trip this weekend that is going to take a bite out of my discretionary food budget and I have good SoI insurance= discretionary food budget? Wow, man, that hurts. I have one word for you - budgeting. We all do it. We all incur unforeseen costs in our lives. Deal with it. - 47th ward progressive - Tuesday, Oct 18, 11 @ 10:05 am: Beyond the fact that deducting Medicaid benefits(which the feds reimburse at 50%) from Food Stamp benefits (which is a 100% federally funded Dept. of Agriculture program) thereby creating problems for Medicaid reimbursement from the feds, what we are talking about here is more cuts to the poor and middle class. Can’t we stop talking about that for a minute? In the last few years, the state and local governments have cutback on K-12 education meaning fewer teachers, higher class sizes and lower test scores in non-high property tax producing schools. Higher education has also been cut meaning higher tuition rates and lower state aid which means fewer of our kids get to go to college. We all cut aid to libraries, interlibrary loan, and community colleges which mean lower access to other educational tools for poor and middle class kids. Beyond that we cut Mediciad, funding for public health clinics, and other health/wellness programs which assist the poor and middle class obtaining access to care. Do any of you know exactly how long it takes to get an appointment with a doctor that accepts Medicaid? If there is even one in your county. We also cut aid to public safety meaning our children are less safe. We cut aid to seniors meaning fewer of them have access to prescription drugs and in-home care. These are all programs from which we, the middle class and poor, benefit. We in the middle class consistently hear that we must share in the sacrifice. Well, quite frankly, I’m tired of being the one sacrificing. At a time when our incomes are dropping and the the rich, those who make over $250,000 year, incomes are growing. We all paid the income tax increase because Illinois is burdened with the arcane Flat Tax. But, this means that the poor and middle class sacrificed again by paying a larger portion of their income in taxes, because we take fewer deductions, than the rich do. We need to dump the Flat Tax ingrained in the Illinois Constitution and pass a Progressive Income Tax. This would mean a tax cut for the middle class and poor while maintaining or raising the income tax for those making over $150,000 a year. Given all that we have sacrificed in the last few years(detailed above in a quite abbreviated summary) it’s time that we ask the richest 2% in this state to join us and sacrifice a bit more of their income so we don’t have to sacrifice more of the services upon which we rely. - Colossus - Tuesday, Oct 18, 11 @ 10:05 am: Dan - I do in fact budget, contribute to my retirement above the requirement and set aside 10% of take home pay. I can tell you to a penny how much I have in my accounts and how much I have left in each budget line item for my family. But that year of unemployment a while back drained the coffers and you can’t get blood from a stone. When was the last time you applied for a full time job? If yours went away today, how long could you make ends meet without help? We are all a bad day away from the DHS office. - Responsa - Tuesday, Oct 18, 11 @ 10:07 am: ==It’s much easier to paint every recipient of public aid as a generaltional leech..== How is it helpful for you to post that? I haven’t seen anyone who comments here ever say that, nor does Cultra’s bill (flawed or not) suggest that. Retired Non-Union guy has bravely and cogently explained, and offered an example of how even a modest policy change could lower health care costs to the state without impacting the quality of health care service to the poor. - Capital View - Tuesday, Oct 18, 11 @ 10:10 am: so many of these issues mentioned above would disappear if the State of Illinois simply paid its bills. Currently, the biggest drag on the Illinois economy is Illinois State Government. The billions owed are diverting local businesses from hiring and expanding, if not driving them to closure as many pharmacies and human services agencies have closed their doors solely to state underpayment and late payments. The solution is to modernize our revenue systems, by having the state tax more services and changing our income tax to a tiered tax rather than a flat tax. Government at all levels needs to be collecting its expected small share from economic activities, yet we still collect taxes as if we are a 1920s-1950s sales and manufacturing society. - Realist - Tuesday, Oct 18, 11 @ 10:23 am: If paying the backlog of bills was “simple,” it would have been done already. The fact is the public will not stomach any more tax increases and a tiered system would need an amendment to the Illinois Constitution. We are going to have to see more cuts, much deeper cuts, and a lot of people are probably going to get laid off from the State. Some of these businesses, like day care centers, that rely solely on the State for their revenue stream, may have to close their doors (if they haven’t already due to lack of payment). I’m not saying that I like these things, but I really think things are going to get uglier in Illinois, and they may have to in order to bring the State back to solvency. - Anon - Tuesday, Oct 18, 11 @ 10:43 am: The co-pay for drugs on Medicaid was $1. I worked at an Osco pharmacy and if the patient said they couldn’t pay, we’d give them the medicine anyway. Then watch them go to the front and buy smokes or a lottery ticket. Copays are not a bad thing. - Robert - Tuesday, Oct 18, 11 @ 10:44 am: Wow, terrific post, Rich! and good job by the Springfield paper in explaining the real impact of overdue bills. “legislators will have to ignore the howls about borrowing on the markets even though we’re already borrowing from domestic abuse programs in Elgin” is quite accurate. so are there any legislators with the courage to back a borrowing plan to pay these overdue bills? - dupage dan - Tuesday, Oct 18, 11 @ 10:44 am: Colussus, It is been along time since I had to apply for a job, something I am very thankful for. Nonetheless, we all have to make do with what we have. I watch family members who are not as fortunate as I make their way thru the medical system in order to secure care. The really make sure they are not visiting the doctor weekly for minor stuff, review the bill VERY carefully and negotiate with providers with some success in lowering the cost of the procedure. Anecdotal experiences like yours are not as important to the grand scheme of things as are real changes that can be made that can put pressure on the medical provision system in this country to lower costs. The marketplace is a living, vital thing that can do that, if allowed and encouraged to work. The examples of that abound. There will always be tough instances of individuals who struggle thru adversity even with a system that you could wholly support. That’s life. - Irish - Tuesday, Oct 18, 11 @ 10:46 am: The point that needs to be made is that not everyone lives in an area where there are clinics or doctors that will accept public aid. If the visit cannot be paid for the public aid recipient is turned away. Many times the only option is the emergency room. The other issue that dovetails into this is that many pharmacies will not take public aid so the public aid person cannot get the drugs prescribed by doctors to treat their problem. Howeveer treatment and drugs can be gotten through the emergency room visit. The state has created this problem by not paying doctors and pharmacies and by reducing the amount they will pay. Who wants to get a fraction of what you are owed a year after you are owed it? Not too many businesses would accept that plan. - walkinfool - Tuesday, Oct 18, 11 @ 11:01 am: For many of these social service agencies and businesses, the sad truth right now is either late payments (with interest), or no payments at all, if we continue to cut the budget. It is a rare critic who stands up to this reality publicly. They usually decry late payments to businesses and agencies, and then call for more state budget cuts to solve the problem, — which will cut off some of those same businesses and agencies. - wordslinger - Tuesday, Oct 18, 11 @ 11:10 am: –Anecdotal experiences like yours are not as important to the grand scheme of things as are real changes that can be made that can put pressure on the medical provision system in this country to lower costs. The marketplace is a living, vital thing that can do that, if allowed and encouraged to work.– Lot of homilies there, not sure what they mean in context. How would one “put pressure on the medical provision system to lower costs” in a “living, vital” healthcare marketplace? Lower demand by…. rationing care? You can’t be suggesting that. Is the demand for healthcare a market “choice?” Or is it a constant, and growing, demand necessitated by very existence. You break your leg, you don’t “choose” to go to the doctor. You have a heart attack, you don’t “choose” to call the ambulance. Furthermore, it’s in the interests of healthcare providers to perform the most healthcare on those with the best insurance plans and to provide the least for those who have the worst or none. That’s how they make money, right? - dupage dan - Tuesday, Oct 18, 11 @ 11:21 am: Really, word, c’mon now. You can differentiate between the more routine medical care that a person seeks, like hip replacement or carpal tunnell surgery from emergency medical care, can’t you? Your post only seeks to get the gotcha moment rather than debate the issues. Boring. You are describing the system as it stands now, BTW. Not working very well in some respects because it doesn’t follow a marketplace process. For many who have insurance they have no clue as to the costs of a particular procedure since they never even get a bill unless they specifically ask for it. Where else in the real world does that happen? If you have a home built do you call the builder, show him the plans and then move it when it is completed, after a 3rd party has paid the bill? I didn’t think I would have to start at economics 101 with this crowd but maybe I was wrong. Lots of books on how the free market works, word. You could benefit from reading same. I am no financial wizard, never claimed to be. I didn’t make this stuff up out of thin air. Others, far smarter than I, have proposed such market ideas to be used in the medical industry. It ain’t hard to find out who they are - a little more reading in that area could be enlightening. - Logic not emotion - Tuesday, Oct 18, 11 @ 11:22 am: “… they are paying much higher interest rates by essentially borrowing from the providers rather than banks.” “…an interest-free loan from the vendors.” Does anyone know for certain which it is? Do vendors receive interest on amount owed to them or are they having to absorb interest costs as they borrow to fund operations due to late state payments? - King Louis XVI - Tuesday, Oct 18, 11 @ 11:23 am: “Anecdotal experiences like yours are not as important to the grand scheme of things…” DuPage Dan is fat and happy. Everybody else? Tough. Nice. - wordslinger - Tuesday, Oct 18, 11 @ 11:33 am: –For many who have insurance they have no clue as to the costs of a particular procedure since they never even get a bill unless they specifically ask for it. Where else in the real world does that happen? – Are you kidding? What world do you live in? I pay $16 grand a year to cover a family of five with Blue Cross precisely because I know how much medical care costs. There’s only been one year since my last child was born 13 years ago that I even came close to consuming that much care — and that was $12,000 for my daughters broken arm and surgery to have a pin installed. That’s why they call it insurance. Without it, one really bad sickness, need for surgery, or extended hospital stay, and I’m bankrupt, and my family is getting bottom-of-the-barrel care. By the way, hip replacement might seem routine to you, but it ain’t cheap and has been a lifesaver for seniors. It wasn’t very long ago that a broken hip was a death sentence. But keep working your theories on pressuring health care providers to lower costs in the “living, vital” — and aging — marketplace. - steve schnorf - Tuesday, Oct 18, 11 @ 11:36 am: What, the peasants have no bread? Then let them eat cake! Oh, and keep your head on your shoulders. - Anonymous - Tuesday, Oct 18, 11 @ 11:48 am: The government needs to borrow to pay back the old bills. Its just the right thing to do. Period. After thats done, then the legislature has to further negotiate the budget to make sure the state gets on the right track moving forward. - wordslinger - Tuesday, Oct 18, 11 @ 11:52 am: Furthermore, DD, you don’t think people with health insurance plans know how much they cost? All they have to do is check that box on their paystub. And I’m sure their employers let them know how much more they’re kicking in for the plan when they explain why they’re not giving raises. But I’m convinced this Medicaid co-pay is the way to go. I mean, why should we let irresponsible people get away with paying nothing for healthcare? Based that logic, I’m sure proponents will agree, that a system should be in place requiring everyone to pay something towards a health insurance plan, right? Is this thing on? I can hear you breathing. - steve schnorf - Tuesday, Oct 18, 11 @ 11:56 am: Unless the rules have changed, you can charge a reasonable co-pay, but you can’t deny recipients care if they can’t (won’t pay it. Past experience in this state is that co-pays are really a rate cut for providers. There is another misconception here, i believe. If a recipient uses an emergency room for a non-emergency purpose, the hospital doesn’t get the emergency room rate paid, they get the rate paid if the recipient had simply gone to his primary care provider instead. - John Galt - Tuesday, Oct 18, 11 @ 12:24 pm: === “… they are paying much higher interest rates by essentially borrowing from the providers rather than banks.” “…an interest-free loan from the vendors.” Does anyone know for certain which it is? Do vendors receive interest on amount owed to them or are they having to absorb interest costs as they borrow to fund operations due to late state payments? === I’m not 100% sure, but I think there’s a provision in state law that says that vendors who are paid late must receive some type of interest payment on top of the principle owed as well. Whether that’s true, and furthermore, whether that interest rate is higher than the interest rate required for borrowing via bonds, etc. I don’t know. I’m a pretty conservative guy, but I’m not opposed to borrowing via bonds if it turns out it’s just to switch some of the debt burden over to a lower interest financial instrument. But at the end of the day the shell games can’t be the solution. The underlying problem is the structural deficit in our annual budgets. - GMatts - Tuesday, Oct 18, 11 @ 12:44 pm: The huge Medicare/Medicaid budgetary problems require many “reforms”, but first make sure you are aggressively attacking the white collar crime. The system is easy pickin’s for the crooks who see it as a good risk - with the millions they rip off, they can affort the best lawyers to get them off. - Left Out - Tuesday, Oct 18, 11 @ 12:47 pm: =Universities cope with chronic late payments= Very true along with many other people in Illinois. The universities, however, keep on spending with cost increases running about double the rate of inflation. It appears to me that they might be able to cope better if they would cut their costs a bit while they wait for Illinois to pay what is due. - Anonymous - Tuesday, Oct 18, 11 @ 12:49 pm: @ Logic not emotion - Tuesday, Oct 18, 11 @ 11:22 am: “Does anyone know for certain which it is? Do vendors receive interest on amount owed to them or are they having to absorb interest costs as they borrow to fund operations due to late state payments?” The state prompt payment act mandates a certain percentage to be paid for bills which are past due by a given amount of time. For providers to be able to stay afloat with not only extended payment cycles, but complete unpredictability of whether they will receive a payment in a given month, they must obtain bridge loans from their lending institutions. Well… they get bridge loans in instances where financial institutions are still willing to look at money owed by the state as a good risk to take. There are less of them every year. Cost of the interest on the bridge loans prety much wipes out the interest that the State is supposed to pay. Another wrinkle to this is the recent move by the state to reduce the percentage of interest paid in negotiating with providers. - Rich Miller - Tuesday, Oct 18, 11 @ 1:04 pm: ===going to take a bite out of my discretionary food budget=== People on food stamps don’t have much of a “discretionary food budget.” - Pot calling kettle - Tuesday, Oct 18, 11 @ 1:05 pm: Lots of assumptions with respect to the poor today: 1) these folks just need to budget properly and they will be fine 2) if an unexpected expense comes up, they can cut back on the “extras” in their life 3) they can self diagnose their medical conditions 4) they have access to a variety of health care providers. I could go on, but folks, get a clue. Just because those of us with the time and means to comment on a blog meet these criteria does not mean everyone else does. - PrecinctCaptain - Tuesday, Oct 18, 11 @ 1:07 pm: @Responsa Cultra doesn’t have a bill, he has his mouth. http://ilga.gov/senate/SenatorBills.asp?MemberID=1774&Primary=True @Richie Boy Rich and everyone who comments that pays income taxes to both the state and federal government is already paying for these things. - PrecinctCaptain - Tuesday, Oct 18, 11 @ 1:22 pm: “The universities, however, keep on spending with cost increases running about double the rate of inflation. It appears to me that they might be able to cope better if they would cut their costs a bit while they wait for Illinois to pay what is due.” I’m a UIUC student, and I’m not necessarily sure that cutting costs is what is in the best interests of anyone who works or goes here. First off, there are buildings in structurally deteriorating conditions that need major repairs and/or replacements. Can’t cut capital costs. I had a professor last semester who gave out her home phone number in case we couldn’t get to her by email because the department needed to cut some costs: individual office phones for the professors. It’s a university, there is a lot of crap that could be cut and I wouldn’t give a damn, but that doesn’t mean that other students aren’t using those programs and that those programs aren’t helping those students. The school is continually whacking graduate assistants, and because of the federal debt ceiling deal, those folks are gonna get whacked more with some of the changes to interest on their student loans. The university had furlough days for employees and professors went without raises. There’s been some administrative restructuring designed to save money, the UI President, Mike Hogan, wants to get tens of millions more out of more administrative restructuring combined with procurement restructuring. The state owes hundreds of millions to UIUC and the other colleges in this state, and some of the rising tuition rates are result of schools having to pay bills and get things done. They simply can’t wait around for Illinois to pay them what is owed. - CJ Chicago - Tuesday, Oct 18, 11 @ 1:25 pm: Every health insurance plan that I know of charges more for emergency room visits unless they result in an admission. The ER is hands down the most expensvie place to get care. Turning it into a clinic slows and compromises the care for those who truly do have emergent care. Some sort of disincentive is totally appropriate, regardless of the financial status of the patient. - Rich Miller - Tuesday, Oct 18, 11 @ 1:31 pm: I would refer some of you to the actual quote above… ===if they had to pay a lot more to go to the emergency room=== He said “a lot more.” - Chefjeff - Tuesday, Oct 18, 11 @ 1:55 pm: What would happen if a few vendors simply refused to accept additional charges from the State? Not emergency rooms obviously, but gas stations, food vendors, the guy who services the State airplanes, all said “no more credit - pay COD”. Particularly if vendors were not reliant on State business to stay in business, like a gas station. I’d just like to see the face of a State cop, when told to pay cash, or go elsewhere for gas. - 47th Ward - Tuesday, Oct 18, 11 @ 1:57 pm: ===Lots of books on how the free market works,=== There sure are. Everybody concerned about health care costs should look up “free riders” and understand why Obama’s health care plan asks everyone to buy insurance. Get rid of the free riders and you’ll go a long way to lowering costs for everybody. - Demoralized - Tuesday, Oct 18, 11 @ 2:39 pm: Dupage Dan illustrates exactly what is wrong with the mindset some have about medical care. DD is stuck in the fantasy world that capitalism and the free market are the solution to everything. Wrong. Healthcare is not a commodity that should be subject to the whims of the market. Give everybody insurance and access to the care they need. Make everybody pay for it. Some don’t like that solution because then they can’t make a profit in the so-called free market off of people getting sick. Also DD, someday if you ever have to “deal with” being so poor you have to choose between medical care and food, I will not be as crass as you are with those facing that situation now. I will gladly give you a hand up if you need one. - Curious - Tuesday, Oct 18, 11 @ 2:52 pm: Demoralized, I think the key to much of the emotion is in your last sentence. I would hope DD would not be against a “hand up” for someone. I believe that where many, including myself, start getting “crass” as you put it, is when it comes to the “hand outs” that become the family business. That reminds me of the Disney cartoon from my youth with Goofy singing, “Oh the world owes me a living”. - Generation X - Tuesday, Oct 18, 11 @ 3:10 pm: -Dupage Dan illustrates exactly what is wrong with the mindset some have about medical care. DD is stuck in the fantasy world that capitalism and the free market are the solution to everything. Wrong. Healthcare is not a commodity that should be subject to the whims of the market. Give everybody insurance and access to the care they need. Make everybody pay for it. Some don’t like that solution because then they can’t make a profit in the so-called free market off of people getting sick. Also DD, someday if you ever have to “deal with” being so poor you have to choose between medical care and food, I will not be as crass as you are with those facing that situation now. I will gladly give you a hand up if you need one.- Ignoring the sanctimonious tone of your post I will go ahead and assume DD already gives a “hand up” by paying taxes. I’m sure that the search for those evil profits have never resulted in medical advances which save lives right? - Seriously??? - Tuesday, Oct 18, 11 @ 3:28 pm: How come the legislators pay checks aren’t on a 9 month delay? I don’t see any of them going without being paid. - Seriously??? - Tuesday, Oct 18, 11 @ 3:31 pm: CJ Chicago - “The ER is hands down the most expensvie place to get care. Turning it into a clinic slows and compromises the care for those who truly do have emergent care.” Well, there used to be clinics that were there to help patients that couldn’t pay, but many of them are closed or have reduced their capacity to help the people they are supposed to serve because the state hasn’t paid them what they owe in Medicaid payments. See how that works???? - wordslinger - Tuesday, Oct 18, 11 @ 4:29 pm: –What would happen if a few vendors simply refused to accept additional charges from the State?– That already happens. I recall a post here a while back about a bullet manufacturer refusing to take any more business from the state police on credit. Problem is, a lot of these folks waiting on state money went into business specifically because the state shed workers and privatized the services. Again, you don’t here well-heeled docs and hospitals complaining about late payments. They know they’ll get the case and they’ll carry the loan for the juice. - mokenavince - Tuesday, Oct 18, 11 @ 4:31 pm: I agree with Seriously??? hold up payments to the pols for 9 or 10 months, and listen to them howl. We should make them as accountable as the guy who has a Link Card. - Coach - Tuesday, Oct 18, 11 @ 4:36 pm: Not diminishing the AP series on our deadbeat state, but it seems the AP is covering much of the same ground Stateline covered a year ago … http://www.stateline.or g/live/static/Behind_on_Bills https://capitolfax.com/2010/10/20/newt -to-rally-with-brady-plus-our-sorry-budget-mess/ - D.P. Gumby - Tuesday, Oct 18, 11 @ 4:37 pm: God, I love it when the Welfare Cadillac Queens (cell phones, HBO, xbox live) is trotted out to respond to arguments for why it’s wrong for government to help those who need help. This seems so obvious even a caveman could do it (which is why the T-Baggers can’t see it)–borrow the money at lower rates, pay the debts to the vendors who are hurting and move on. This is not just going to disappear. Maybe a credit counselor service could help?? - dupage dan - Tuesday, Oct 18, 11 @ 4:59 pm: Yep, I’m the lightening rod for the single party payor set today. As I said, I am not the expert and don’t always have the luxury of writing long dissertations on the subject. Nonetheless, the information about how to control health care costs without resorting to another large, bloated, inefficient gov’t agency to handle health care (Medicare gonna go bankrupt in how many more minutes? Don’t believe it - you are a fool). There are reasonable, compassionate ways to reduce and control medical costs thru market forces - there are several resources out there easily found and reviewed. Using sarcasm to denigrate my postings won’t change reality. But if it makes you’all feel better to bash these ideas, or the messenger, I am glad to provide that service. Upset that the gov’t has closed clinics? How horrible of them. How uncaring. How will that play out in the future? Let’s face it, if you believe that the gov’t will be more compassionate in the future while it controls your healthcare perhaps you’ve never spent an afternoon in a Public Aid office. The long lines, the waiting, the condescending attitude visible. Yeah, you work on that program, I’ll take my chances with the uncaring/unthinking/monolithic insurance companies. At least I have the chance to choose a different one if I don’t like them. How do you switch over to a different gov’t if you don’t like their insurance program? BTW - I have been poor and had to pay for my medical care out of pocket. Not a pretty picture. However, that remains as anecdotal as any other story I have read here. Basing national healthcare policy on anecdotes is foolish. Makes for good barbs to throw around but has little value in a debate. - wordslinger - Tuesday, Oct 18, 11 @ 5:14 pm: –There are reasonable, compassionate ways to reduce and control medical costs thru market forces - there are several resources out there easily found and reviewed.– How about a link or a google search phrase? - 47th Ward - Tuesday, Oct 18, 11 @ 5:26 pm: ===There are reasonable, compassionate ways to reduce and control medical costs thru market forces - there are several resources out there easily found and reviewed=== Yes, one of the best ideas is for the government to require that all Americans purchase private health insurance. Those that cannot afford it get a subsidy, those who have luxury plans pay a premium on top of thier premiums. Pick your plan, choose your doctor, etc. Eliminate free riders on our health care system and the costs will go down. Ask any economist. But this very plan, a compassionate market approach that works in Massachussets, has been vilified by Republicans all across the country, who also despise Medicare and especially Medicaid. More states are filing suit to block the health care bill than the number of states making progress on setting up insurance exchanges. It’s weird, isn’t it? - wordslinger - Tuesday, Oct 18, 11 @ 5:42 pm: 47, you don’t get it, man. It’s all about freedom, not responsibility to your community. It’s an affront to liberty to require that yuppie deadbeats carry health insurance like most working stiffs. So in the name of freedom, a guy like uninsured Kent Snyder, Ron Paul’s guy, can die of pneumonia leaving $400,000 in medical bills for everyone else to eat. He didn’t invest a penny of his healthy earnings to insure his health. But when he got sick, of course, he went to get the care. We’re a compassionate nation. We’re going to do everything we can to keep people alive, money be damned, no matter who you are. But it’s galling that people who call themselves conservatives can promote individual irresponsibility in the name of freedom at the expense of the community. - Retired Non-Union Guy - Tuesday, Oct 18, 11 @ 7:01 pm: 47th, hate to burst your bubble, but they are talking about raising taxes in Mass. because of the health costs they can’t cover … heard the story on the radio today while I was driving home. - Rich Miller - Tuesday, Oct 18, 11 @ 7:10 pm: RNUG, hate to burst yours, but try the Google instead of listening to radio. The proposal is to revamp the way the state pays its costs, not to raise taxes. - Retired Non-Union Guy - Tuesday, Oct 18, 11 @ 7:38 pm: Rich, You’re right, I didn’t Google that first. Gee, imagine the MSM getting things wrong. The NYT story I just found said that Mass. is trying to to avoid a cost increase by changing to a flat payment system, which I read as being somewhat similar an HMO, a flat per person rate per year. I tried to make some sense of the linked doctor survey but it’s going to take more than a few minutes to digest it. The NYT did say the could be problems getting the docs to go along with the program if it is voluntary; if they don’t, then their costs will go up and require additional funding from somewhere. - Retired Non-Union Guy - Tuesday, Oct 18, 11 @ 7:42 pm: BTW, I’m not opposed to a true single payer system similar to Mass. … but (to digress a bit) I don’t think much of the ACA; seems like they picked some of the worst features of every proposal to cobble together something when it was passed. I’m actually disappointed the CLASS portion won’t be implemented because I can’t get LTC for the Mrs. due to pre-existing conditions. - Pot calling kettle - Tuesday, Oct 18, 11 @ 8:40 pm: ==BTW, I’m not opposed to a true single payer system similar to Mass.== Except, of course, that MA has no such system. They require everyone to get insurance, on their own, primarily from private insurers. In some cases, the state acts as a broker to help folks find insurance, and the poor are covered by Medicade. This over-simplifies the program, but it is not a single-payer system. - Emily Booth - Tuesday, Oct 18, 11 @ 8:57 pm: “You cannot get into heaven without a permission slip from the poor”. Michael Moore You cannot use your Link card for non-food items. It is a nutrition program. If you are really interested in creating a nation that is healthy, prosperous and thriving, do 3 things: raise the minimum wage, provide subsidized child care and provide national health insurance. “This is my two cents, my ten cents is free.” Eminem - PrecinctCaptain - Wednesday, Oct 19, 11 @ 2:16 am: @wordslinger And to think, that Edmund Burke’s conservatism was all about the responsibilities of the individual to the social contract with the community. “Society is indeed a contract. … it becomes a partnership not only between those who are living, but between those who are living, those who are dead, and those who are to be born.” http://books.google.com/books?id=-NeDta2yzxkC Interesting use of Burke here: http://delong.typepad.com/sdj/2009/11/hoisted-from-the-archives-burkean-conservatism-and-the-burden-of-the-past-on-white-america.html Sorry, comments for this post are now closed.