Here’s a NY Times pick from comments on their article about students rioting at Middlebury College when Charles Murray was there to speak (boldfacing mine):
Michjas Phoenix 15 hours ago
I am a very liberal Democrat. Often I find myself correcting obvious errors among the black and white crowd. Today my mission has been to argue that Medicaid coverage often stinks and that those who champion the ACA need to be critical about those added to the Medicaid rolls. I have always been a critic of Medicaid and I have always been seen as very liberal. But now, expressing the same ideas, I have been taken for a defender of Trump. It is incumbent upon all to distinguish their enemies from their constructive critics. Too many have lost the ability to recognize constructive criticism. The temper of the time is important. But we are all individually responsible for how we think, and those who can’t tell their friends from their enemies have themselves to blame. Ignorance is ignorance, and it doesn’t matter if your intentions are good.
Here are my questions and my answers in response to Michjas’s comment:
Q: Why does Medicaid coverage often stink?
A: Because it pays only fractions on the dollar, thus many doctors refuse to accept Medicaid patients.
Q: Why exactly do doctors refuse to accept such patients?
A: Because they are not willing to incur losses of profits, or even actual financial losses, by taking on such patients.
Q: Why might doctors incur losses?
A: Because of the very high costs of relatively ordinary treatments and procedures in American medicine. For example, the electrocardiogram I got in a Spanish clinic in early 2014 after having struggled on Napoleon’s route over the Pyrenees cost me out-of-pocket something like $190 as a foreigner not covered in any way by Spanish healthcare – the same simple procedure in the US costs 5 to 10 times as much.
Q: Why are American healthcare costs so high compared to most of the rest of the world?
A: In part because so much of healthcare in America is privatized and for-profit in large companies that, with Citizens United, are legally entitled to influence, or even control, politics and law-making by pouring cash on politicians, who then create or modify laws to enable enormous and still-growing profits in medicine and pharmaceuticals. This is a disastrous feedback loop for everyone except the highly wealthy. Contributing to the loop is unlimited liability for medical enterprises, from which lawyers profit greatly. Early evening television has been flooded by ads for drugs, debt consolidation/relief, and legal help related to healthcare (cars and beer have always been there, and cigarettes used to be).
Q: Why do Americans put up with this destructive cycle?
A: Because not enough of us have put our minds and resources together to stop it. Maybe we’re scared and galvanized enough now to get on with it. One place to attack it is in Trump’s planned expansion of privatized prisons. Privatization of fundamental community matters is the true underlying problem. Yes, government can be wasteful. But that’s better than the hellholes of our healthcare system, our prisons and our overall infrastructure, all of which have been looted by large corporate interests.
Another line of questioning – and one should carry out several or many lines to triangulate the whole truth – would inquire into why Medicaid pays only fractions on the dollar. I think the answer comes out the same, though: high costs of ordinary healthcare, which have been exacerbated in recent years by private physician practices getting folded into large private hospital chains that are inexorable on profitability across the board. Most doctors now report to accountants, not to senior medical people (but I’d have to fact check that assertion – it’s certainly true in Concord MA – I’m aware of only one private practice left in town).
Well, we can take Michjas’s self-description as a liberal who hates Medicaid at face value. Of course, Medicaid can be improved, but contrary to what he (I assume) says, Medicaid is much better than the alternative of no health insurance for those poor people. And that is the only alternative presently on the table for consideration. We know this because of all the Republican legislators and governors who refused Obamacare’s expansion of Medicaid and because of the provisions of the Republican alternative to Obamacare now under consideration. So, just what does Mr. Phoenix propose? The comment doesn’t say.