Dr. Rosen:      Last week we discussed how dangerous “Repeal and Replace” would be. No one has really outlined a simple replacement for the thousands of pages of Obamacare. What changes would you make?

Dr. Sam:         I think our system was actually rather good. We had Medicare for the seniors over 65 and those that are disabled. We have Medicaid for the poor who can’t afford private care.  Everyone else should be working and thus are covered through standard insurance.

Dr. Yancy:      I think we have the level of what constitutes the poor set too high. It should never include  more than the bottom 12% to 15% of society. I’m sure that income follows a bell curve. One could make a case that those that are more than 2 standard deviations out from the mean are truly poor.

Dr. Edwards:  That certainly would make more economic sense than just taking items that a group think are necessities. The cost of food is easily calculated. Clothes are more difficult. Some  will “need” clothes that are twice as expensive as others. There are many factors of taste. Having a committee like approach will exceed what is absolutely necessary. There will never be agreement as to what is necessary.

Dr. Milton:      Drinking, smoking and gambling habits are really variable. I have people of welfare smoking two or three packs per day. Some that drink a fifth of Vodka a week.

Dr. Ruth:        I have one welfare family that spends one entire welfare check a month on a trip to Reno to gamble. I think we have to call that a disease. We had dinner with one couple there and they were dropping quarters in the slots as we were in line for a buffet. When we got to  the food he had won one small handful of coins and bragged about his winnings. He totally discounted the money he lost and chalked that up to pleasure and vacation spending.

Dr. Kaleb:       Remember when President Clinton said welfare should be limited to couple of years. We saw many of our Medicaid patients obtain a job rather quickly rather than wait out the two years.

Dr. Patricia:    I see many of my patients go to the ER rather than come to my office for routine  complaints because of evening conveniences.

Dr. Michelle:   That’s a significant excessive or glutinous cost since ERs are never less than $1500 when office calls are about $150.

Dr. Rosen:      What if we had a $50 ER copay and a $5 office copay? How would that change the equation?

Dr. Milton:      I don’t think any of my Medicaid patients would pay $50 to go to the ER. They would see me the following day.

Dr. Edwards:  I second that.

Dr. Rosen:      It seems like we could save about 80% in this segment of society with just a reasonable  and affordable copayment. If we just keep adding up all these savings, health care costs would plummet. At least in the Medicaid portion of society.

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