Vital Information about Medicaid and Long-Term Care

Please read this crucial explanation of the importance of Medicaid to long-term care residents and their families from the Long Term Community Coalition:  ltccc-medicaid-middle-class

Repealing the Affordable Care Act

Without spin or editorializing on the issue, here are some facts from The Center for Medicare Advocacy,, about the program Congress plans to repeal:

  • The uninsured percentage of Americans under 65 is the currently the lowest in decades. Beginning in 2014, the rate dropped from 16.6% to 10.5%.
  • As of March 31, 2016, 11.1 million people have coverage through the ACA Marketplace.
  • As of 2015, 11 million people in 31 states and the District of Columbia had coverage through Medicaid expansion under ACA, out of a total of 81 million on Medicaid.
  • There are 19 states that did not expand Medicaid: Alabama, Florida, Georgia, Kansas, Idaho, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Texas, Tennessee, Utah, Virginia, Wisconsin and Wyoming.
  • However, the ACA resulted in 16,748,000 people becoming eligible for Medicaid as of September 2016.

Congress says it will replace the ACA with something better. Dare we hope?

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200

©2017 John B. Payne, Attorney

Afford It? We Must!

It is incredible that TEA Partiers and others against universal health care for Americans should claim that we cannot “afford” it. No responsible individual or family would fail to purchase health insurance unless so financially pressed that it came down to a choice between paying for health insurance and paying rent. Health care, like food and shelter, is a necessity for individuals and families and should be a necessity for the government. Everyone needs access to medical care–particularly children. The government cannot budget for defense and transportation and education and other government responsibilities and then say, “Whoops; no money for health care!” President Obama has finally accomplished meaningful health care reform and should be praised, not insulted.

Neo-Cons derogatorily refer to the health care reform act as “Obamacare.” If I were the President I would be proud to have my name associated with the most significant improvement in the nation’s health care system since Medicaid was enacted in 1965. The Patient Protection and Affordable Care Act of 2010 is not perfect, but calls to repeal it are the bleatings of vicious negativists. We cannot call ourselves a civilized society while more than a third of our citizens lack access to health care.

I was talking to a client a couple of years ago. I told him that we need a program of universal health care. He said, “No, that’s socialized medicine. That would be awful.”

“Gary,” I told him, “You are 42 years old, out of work and living with your parents. You have no health insurance. How much worse would socialized medicine be for you?”

Too many people like Gary are swayed by neo-Con and TEA Party rhetoric. We cannot ignore the needs of the uninsured any longer. The health care reform act is a step in the right direction. Neo-Cons and TEA Partiers who say they have a better plan are lying. They just want to leave the uninsured as they are. They have insurance and they have no concern for anyone else’s needs. The United States can afford to ensure that everyone has an affordable health plan. Anything less is uncivilized and ultimately more costly because ailments and injuries that are not treated become more serious and expensive to treat. Without insurance, patients end up visiting the emergency room, the least cost-effective venue to seek medical attention.


John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
©2010 John B. Payne, Attorney

We Can’t Wait Until We Can Afford It

It looks as if health care reform is going to cost $1.6 trillion over the next ten years. If that is not enough to scare the pants off you, think about all of the government programs that run hugely over budget. However, this cost does not mean we should not implement a public health care plan that ensures that everyone–that is, everyone, EVERYONE, not just most people–has an adequate health care plan. This is something we need to do, as much as we needed to invade Afghanistan and Iraq. When something must be done, you start doing it.

How many families would get started if women waited until they could afford to raise children to get pregnant? Nobody, except the very rich, can afford to have children. Parents do not wait until they can afford children; they have children and stretch their means to raise them.

This is what the United States must do, now. We must implement a universal health care system and then go about finding the means to support it.


John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
©2009 John B. Payne, Attorney

World’s Best Health Care System

It is really aggravating when people claim, without stating their basis, that the United States has the World’s Best Health Care System. In the first place, this is just cheerleading. No matter what school it is, the coach and the student council president will proclaim “We’re number one” at the Friday night pep rally. It doesn’t make any difference if the school is U.S.C. or Eastern West Virginia Polytechnical Institute, which hasn’t won a game in any sport since an opponent was disqualified during the Carter Administration. Depending on how the different countries’ health care is measured, the United States’ is undoubtedly better that Zimbabwe’s, but whether it is better than Sweden’s or Canada’s or France’s is less sure. Furthermore, the quality of the care is beside the point for 100 million uninsured and underinsured U.S. residents. They don’t get it.

Secondly, the United States does not have a “health care system.” We have a medical service industry. Then we have a health insurance industry that rations medical services based on insured status and rakes off 15 or 20 per cent. If we really had a system, one third of the nation would not lack adequate health care.

We need a public health care system like Medicare that everyone can buy into at a reasonable price. Medicare has been a wonderful success, despite all the criticism from the political right, the American Medical Association, and the health insurance industry. There are problems, but they are manageable and susceptible to reform.

Health insurance executives are whining that they cannot compete with a public health care system. What better argument could you find in favor of establishing it? They cannot compete because a public system would be fairer, more efficient, and less expensive than the private insurance industry. These executives are like muleskinners a century ago whining that the internal combustion engine will put them out of business. True, but is that a reason to outlaw gasoline?

We need an inexpensive public alternative to private health insurance. That it will hurt the insurance industry is no excuse for leaving 100 million Americans without adequate health insurance. A fair health care system is a fundamental part of the social infrastructure. It is time to fill that void in the United States.


John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
©2009 John B. Payne, Attorney

Socialized Medicine–Gotta Have It

Not a Constitutional Right

On the topic of universal health coverage, or, as we diehard liberals like to call it, Socialized Medicine, the Federalist Society crowd and other Neo-Cons make a big production out of trying and failing to find justification for it in the Constitution.  To the extent that we buy into that issue, we are being led astray.  The question is not whether there is a Constitutional right to health care, for there assuredly is not.  The question is whether it is good social policy to establish a program that will ensure a minimum level of access, regardless of means.

Our Conservative comrades compare food, shelter, and education to health care and ask whether those who propose universal health care also propose to provide all of the other necessities of life.  This is intended as ridicule, but the answer is yes; under certain circumstances.

On Food, Shelter & Public Services

Food is certainly a necessity of life, as is shelter.  However, few who say we need universal health care also advocate for free food for all or public housing without regard to need.  What is the difference?  Why aren’t we opening barracks for yuppies and mess halls for the middle class?  Food and shelter, for the most part, are within the financial capacity of most people; even the minimum-wage working class.
It makes sense to establish a government-run program to provide an essential service that is prohibitively expensive for individuals.  This is particularly true when it is relatively inexpensive if provided to the population at large.  It is furthermore sound public policy for the government to provide a service to individuals to protect the public health or welfare.

Almost no one questions the propriety of government programs to provide water and sewerage services to the general population.  A well and a septic system are relatively inexpensive and in most of rural America are quite satisfactory solutions to the problems of acquiring potable water and disposing of waste.  This does not work so well in more built-up areas.  When the population density reaches six or eight households per acre, it becomes both expensive and hazardous from a public health standpoint to allow individual households to remain “off the grid” as to water and sewerage.  In an environment like Manhattan, it would be preposterous.  Even the most conservative ideologues concede the necessity of public service projects to provide water and sewerage.

In a similar fashion, police and fire services are generally accepted as necessarily a governmental responsibility, although at one time property owners had to buy badges for the fronts of their houses to show that they had purchased fire services from for-profit fire brigades.  Why have nearly all communities of more than a few families formed fire departments at community expense?  Infernos like the Chicago Fire.  Your purchase of fire services is of little value if the houses around yours are unprotected.  The point is that a community must establish a fire department for all property in the community to protect itself effectively against fire.

What about the police?  I haven’t heard Limbaugh or O’Reilly calling for abolition of police departments or the FBI.  Although big companies may establish their own security force, communities must have a police department to protect people and property and enforce the law without regard to whether a given individual purchased police services or paid taxes.

Why does it make sense to establish universal health care, but not free food and shelter?  We do provide some subsidies for food and shelter, but there is no widespread lack of ability to purchase those things.  We don’t have a third of the population starving to death the way we have a third of the country starving for health care.  That does not mean it doesn’t happen, though.

The government tried to provide food and shelter in the wake of Katrina.  If there were a nationwide catastrophic failure of the food supply–say along the lines of the Irish Potato Famine–the government would be flying C-130s to other continents to buy food for public distribution.  This, of course, assumes that there is no catastrophic failure of national leadership–say along the lines of the Katrina Aftermath.

Availability, Cost & Fairness

The health care crisis in this country is not an availability, nor a cost, crisis. It is a failure to devise an effective system of pricing and distribution.  If we stopped treating the poor and uninsured in emergency rooms at the expense of those who pay for care either through insurance or out-of-pocket, the rapid escalation of insurance premiums would taper off and we would start paying the true cost of the services we are consuming.  If we require the healthy uninsured to buy into the system, the overall cost to everyone would be further reduced.  Just as we require car insurance, we should require a health care buy-in so that a healthy uninsured person who becomes catastrophically ill or injured does not become a charity case to everyone’s detriment.

Those who have health insurance cringe at the thought of “socialized medicine,” but a third of our population lack health insurance at least episodically.  I am sure they would welcome socialized medicine, as compared with what they have now. If a basic catalog of health benefits is insufficient for others, they could purchase supplemental insurance the way Medicare members purchase medigap insurance today.  It could be the best of all possible worlds for everyone. At least it would be better than what we have now.

Employer Problems

Multinational corporations will ultimately lead the charge to universal state-run health insurance.  U.S. industry is suffering a huge competitive disadvantage because of health care costs “built in” to every product.

Spiraling health costs are crippling those employers who continue to insure their employees and giving a competitive advantage to the skinflint employers who refuse to do so.  In the ‘60s and ‘70s, even low-level employees of small companies generally had health care coverage with only a small amount of employee contribution.  That is no longer true.  There are approximately 47 million  who are recognized as “uninsured” by the government.  This is nearly twice the number of those considered unemployed, so a large part of this group are the working poor.

Uninsured means that they had no insurance during the previous year.  However, other studies show that if you include persons who had no insurance for part of the previous year, the number is at least twice that, or 94 million who are uninsured or under-insured.

There are approximately 301 million people in the United States, of whom 38 million are 65 or older.  Since almost all of the 65-and-up cohort are covered by Medicare, 38% of those who would be in the market for health insurance are under-insured.  If you factor in all of those  already covered by Medicaid, the under-insured population under 65 is probably close to 50%.

Besides the un- and underinsured, those who have coverage are seeing a serious erosion in their benefits.  I could not be in business were my wife not employed by a major corporation.  However, the employer-paid portion of her health coverage has shrunk while the deductibles and co-pays have increased tremendously in the last ten years.  A simple trip to the emergency room for a laceration or other injury requiring radiology now costs us $2,000 or more.  A hospital admission would cost more than $5,000.  How can a family of four trying to get by on $50,000 a year afford that kind of expense, let alone the “working poor?”

One would think that the majority of us would demand universal health care, but the insurance and health care provider lobbies are very powerful and the uninsured are not.  Furthermore, “socialized medicine” has been stigmatized by its opponents.  The “liberal” press has not been much help, either.
A client became very irate when I made a remark about how this country needs universal health care.  He said, “You are talking about socialized medicine; that would be very bad; no, no, no!”

“Gary,” I replied, “you are in your forties and living with your father; you have no health insurance, at all.  How could socialized medicine be worse that what you have now?”  I explained how much it would cost him if he injured himself or became seriously ill.  He became very thoughtful after our discussion.

We Pay Too Much for Bad Coverage for the Uninsured

Another argument against universal health care is made by libertarians and Neo-Cons who say they do not want to pay for other people’s medical care.  This is ridiculous.  People who are uninsured–and that is mostly people who cannot afford health insurance, not those who decide to forgo health insurance because otherwise they would have to settle for a 525i when they want a 760Li–get medical coverage at public expense now.  However, instead of seeing a physician from time to time to catch developing problems, they go to the emergency room with a crisis.

Unless the plan is to allow hospitals to turn away critically injured or ill people if they cannot prove that they have cash for treatment or that they are insured, the uninsured will continue to be treated at the expense of those of us who have insurance or can afford to pay for care.  If the plan is, in fact, to deny the ill and injured if they cannot pay, this would mean that everyone would have to ensure that they can prove their coverage even in an emergency.

Let’s assume that your daughter is stabbed during a robbery and her purse is stolen.  She is lying on the sidewalk, bleeding to death.  The EMS are called.  Before they will try to stop the bleeding or take her to a hospital, they will demand to see proof of health insurance.

What if you have a heart attack?  If you do not have your health insurance card on you, too bad.  You don’t get helped.

Unless you are an Ayn Rand disciple and are willing to ration health care to only those with high income or assets, universal health care is the only reasonable answer.

In the first place, providing universal health care, so that everyone has a reasonable level of health maintenance, as well as hospitalization coverage, probably would not cost much more than the current hodgepodge of Medicare, Medicaid, health insurance, and indigent care–with millions simply falling through the cracks.  It would cost less in the long run because there would be more healthy, productive citizens.

Furthermore, the per capita cost can be kept low.  One of the problems with health insurance is that too many healthy people under insure or go without insurance.  This means that the insureds with the highest health care costs tend to be concentrated in certain plans that then have very high premiums due to insurer screening or by reason of better coverage.

A universal plan like Medicare that provides basic coverage at a nominal cost would be cheaper and more fair in the long run.  It would cost less than the current expenditures in taxes, health insurance premiums, lost wages, poor performance in school and on the job, and so forth.

The argument I hear all the time, which I find deeply troubling, is that with universal coverage, we will have rationing of health care.  We have rationing now.  The only difference between the way health care is rationed now and how it would be with universal coverage is who has to wait for care.

Under the current system, the poor and working poor get the short end of rationing.  With universal coverage, upper middle class Americans will have to share some of the burden of waiting or limiting care.  This is about the political power of the middle class, not the numbers of people affected, or the cost, or the efficiency or efficacy of the system; it is about an ultimately democratic system for delivering care.  It is apparently deeply un-American to suggest that the health or life of a lawyer or accountant is not more important than the health or life of a cashier or mother on welfare.

Let’s Get Fair

Consider a recent public health study citizens of the U.K.  How often do we hear the British Health Service demonized as all that is wrong with “socialized medicine?”  And yet, by virtually every measure, the British are healthier than are Americans.  They spend half as much of GDP on health care and achieve far better outcomes.  The Germans spend a quarter of what we do and have an excellent system.  It is time for us to wake up and get civilized.


John B. Payne, Attorney

Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
©2008 John B. Payne, Attorney