Food stamp benefits to end tomorrow

[kan...@aol.com]

https://www.cbsnews.com/news/food-stamps-snap-benefits-november-2025-government-shutdown/

The crime here is not the gov't shutdown, although that's not so good, but instead that Trump won't allow the release of emergency funds designed for this kind of event. 

So it's a conscious decision by one person to permit this cruelty. 

[Brian Kegerreis]

Oh well if the democrat senators would pass the clean cr then the food stamp money would flow.

Not that the federal government has any constitutional authority to do it.

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[kan...@aol.com]

Actually, you're way off base, again. The CR as proposed would massively increase health care costs for millions of Americans. There's plenty of good reasons to continue to negotiate this issue. But Republicans think that they finally have a way to start killing the ACA. That's been a goal of theirs since it passed 15 years ago. They've advance dozens of bills trying to kill it. The current changes will raise premiums by about 16-25%, depending on what state is being looked at. BUT, with subsidies ending, many people will have increases in their premiums by over 100%, up to 175%. 

So it's worth the effort to refuse this bill as currently configured. And millions of Americans agree. In fact, by a 2:1 margin they blame the Republicans. And that ratio applies to the INDEPENDENTS being polled. You're one of them, right? 

[Brian Kegerreis]

No the clean CR doesn't end subsidies for the ACA. Those are ended by already agreed upon measures. 

Besides which the ACA doesn't need subsidies. After all, it's affordable.

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[kan...@aol.com]

Not affordable enough for millions. Cute show of stupid asshole-ness though. 

No reason for the subsidies to expire now. They've done exactly what they set out to do. 

The fight is worth it. 

[Brian Kegerreis]

Ass-holeness nice way to try to avoid discussing why health care is unaffordable...

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[kan...@aol.com]

That wasn't the topic, BK. If you'd like to discuss health care costs, open a thread. 

But this conversation isn't about the cost; it's about how it's paid for. Different issue to be sure. 

John Oliver did a show that my wife got on You Tube, by way of HBO. It was about Medicare Advantage health plans. 

These plans are mis-named. First, they have NOTHING to do with Medicare. And they definitely don't confer any advantage to the users. 

They soak the gov't and the users out of billions of dollars. They were created basically to keep private insurance companies in the game of insuring the elderly. 

This is something that I was not aware of. I just think of these plans as a horrible way to get insured. Didn't know that they are a form of scam. 

They do some very "creative" billing and coding practices. One that is really cool is that if you are given a diagnosis. you SPOUSE automatically is given the same one too. Hence one diabetic becomes two. And yes, women can carry a diagnosis of prostate cancer. 

Good place to look for all kinds of fraud. 

And then there's HCA, which by itself defrauded Medicare out of 1.6 billion dollars. It's CEO at the time has been rewarded with the governor's office in Florida and now the Senator's seat. Way to go Rick. Not a day in jail. 

Remember, corporations are people, at least until the blame is apportioned. 

So maybe we can look at the various companies that find ways to monetize shady practices. 

The stats are clear though. Private companies have a profit margin of like 22%, perhaps more. Medicare is about 2%. So with the stroke of a pen, I can shave health care costs by quite a bit. But when it's proposed, you can see who benefits by a robust private industry. They're the ones lining up to object vehemently to the single payer model. And the ones throwing MILLIONS of dollars at politicians by way of lobbyists. 

Medicare isn't the best thing since sliced bread; it's just better than anything else out there. And WTP can at least theoretically control how it does its job.

There, I didn't discuss health care costs. Now where were we? 

[Brian Kegerreis]

This is another great example of why you shouldnt let the government control your food supply. 

[kan...@aol.com]

Brian, that's a leap of ill-logic that defies explanation. I just presented a reasonable argument that for health care, the gov't does it better and cheaper than the privates. 

Don't know how that pertains to the food industry. Don't care either; since I don't advocate for gov't control of the economy in general. But health care is clearly a one-off beast. And the private sector doesn't really have incentive to control costs. They just pass them on to the consumers by way of higher premiums. Reference the auto insurance, which has the same problems. 

If US citizens want lower cost health care, they can get it. Every other first world country does it. Their results are pretty darn good. 

And yes, I know the stories about people coming here for health care. I also know about ex-pat US citizens moving to Europe, often so they can afford health care. And people going to Mexico, Columbia, Brazil for certain procedures, usually cosmetic. Etc. Nobody has it perfect, certainly not  us. 

[Brian Kegerreis]

I had a pvc ablation last year in February. I was in the hospital about 23 hours. 

It cost 229000 dollars. 

Why did it cost so much?

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[kan...@aol.com]

It didn't. The hospital BILLED that much. They never intended to collect that amount. The billing/payment system is broken. Its' sort of like auto sticker prices; they mean little. But instead of taking a car's sticker price and chopping off 10-20%, insurance companies chop off 50-70%. So hospitals factor that into their "retail" pricing. 

The only people that pay "retail" are rich people with no insurance. Think wealthy Arab royalty. 

When I worked with my new billing service we had to agree on a "multiplier" amount. Basically that meant that if I wanted to collect a dollar for services, I billed three. Others use an even higher multiple. Three was chosen because that's about what Medicare uses to discount their payout. I could have used Medicaid's discount and billed about 12 times my "fair" rate. But that would be unethical. You can imagine that doctors and hospitals and other providers see this differently. Hence the VERY uneven prices seen. 

I work to  be fair; I'm sure that doesn't apply across the field. 

Billing is so messed  up that you can't even price out an admission is advance. If you call a hospital and ask them how much it will cost to get a procedure done, they'll either 1) laugh until they pass out, 2) hang up on you, or 3) tell you that they can't do that. 

I'll go with #4; don't blame me. I'm just a foot soldier. The only thing I can do about it is pass along what I know (not really inside information) and behave ethically. 

And for the snipy assholes who complain that I don't volunteer my services, that's your answer. I've forgone hundreds of thousands of dollars over my career that I could have likely gotten by gaming the system better. Not my style. Oh, and I spent many hours at Truman Med Center teaching my craft to residents while collecting 50 cents on the dollar in salary. So there's that. Do we know any truckers who delivered, say, food for free or at a discount so that needy people could EAT? 

A single payer system would end ALL of this. Medicare will tell you what they intend to pay for a given service. And it will be essentially the same everywhere, with COL taken into account. So if you live in New York City you can lower your bill by going to bumfuck Wyoming for your procedure. Of course the level of expertise might not be the same. 

I've offered and explained my instant fix for over 20% of the medical costs in the US. See if any of you can do better. 

[B Keg]

Government subsidies are a significant part of why health care costs have outpaced inflation for many years. 

Be nice, even when you don't want to!

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[kan...@aol.com]

You're right, BK. End all subsidies. End all health insurance. Just let people die of treatable illnesses. 

The ghost of Ayn Rand rises. 

Of course, DF will explain to us that health insurance can't really be ended. People will ban together and create private systems to cover each other's costs. Presto, health insurance. 

Some large companies do this already; it's called self-insurance. But the companies need to be large enough to handle the inevitable statistical outliers. OR, OR, they can just let the really expensive diseases run their course. 

But the govt's role here isn't responsible for rising costs. It's multifactorial. One is Big Pharma. They really do jack up prices, dramatically. Another is the lack of billing transparency. Also massive inefficiencies built into the system. And there's a lack of willingness on the parts of physicians to adopt reasonable  protocols. Now I'll admit that some of the "protocols" that have been put forth are really just a series of hoops to jump through. And if not jumped carefully, it allows Medicare and other insurances to deny payment. I'm not familiar with a lot of these; but I do know about protocols for treating pneumonia in inpatients. Lots of hoops of dubious purpose. 

But the idea could be implemented with good results. Follow accepted guidelines, get better outcomes. And avoid malpractice, Win-win

There is a protocol for avoiding ankle x-rays. It's called the Ottawa Ankle Rules. A simple exam taking less than one minute rules out fracture with accuracy of about almost 100%. That little protocol, so simple, would save a few hundred million dollars per year. There are similar "rules" for knees, also very accurate. There are similar rules for brain C-T scans; but they are more controversial. Etc. But physicians as a group are hesitant. 

I've employed the ankle rules when a patient asks, "Do I really need an x-ray?" I've used it a couple of times in pregnant women who wanted to avoid an x-ray. 

Such protocols could be developed all over the medical field. Savings would be dramatic. 

And then there's the RVRB, This a system for helping to level the reimbursement field. As it stands, people that do PROCEDURES get paid way more than people that do thinking. 

You get a colonoscopy, taking less than an hour, and doc gets anywhere from 200 to 1500 dollars. Total cost ranges from about 1800 to 4500 dollars. So why the extreme variance? 

Anyway, if you have a very complex problem that you present to your internist, and she has to do some reading on the subject, she gets paid for the office visit. 

And the ophthalmologist gets like $600 dollars for a cataract removal. That low amount surprises me. But the procedure takes like 15 minutes. So there's that. 

The orthopedist who does a hip replacement. gets about $1300; but this procedure takes a lot longer than a cataract and involves daily hospital rounds and office follow up. Now you imagine how well doctors cooperate in adjusting these inequalities. NOT. 

But nowhere does the gov't play a role here. They just help even out the costs for the haves and have nots. 

AND, without the gov't obliging it, rural hospitals would vanish. They don't make money, period. And they're suffering right now, thanks to Trump. A little more Trump and they'll be as rare as Bigfoot. 

[kan...@aol.com]

But  since this is my bailiwick, I'll persist. 

Let's do the Dave F. Libertarian health system. Insurance companies exist; but without that nasty gov't oversight. 

So I'm Mr, CEO of Big Insurance. I get to run the company as I see fit. So, the first thing I'll do is reject for coverage, BK, for being overweight. I reject anyone over 70 (subject to change) for being too old. I'll reject about 25% of adults because they smoke. I'll reject another large percentage because they drink too much. And so on. No gov't mandates. I get to run things as I see fit. And since the gov't isn't in the game, I'll have the same restrictions even if I choose to cover large corporations. Sure GM and Ford offer a huge clientele; but I'll still get to cover each person individually based on various screening criteria. I'll also demand that children get vaccinated according to CDC recommendations. Or, if JFK keeps his ugly mitts on things, or a successor is equally stupid, I'll establish my own criteria for a vaccination schedule, based on DECADES of good research. Adults will need yearly flu shots. And no religious exemptions. They're really bullshit. Among us we have plenty of knowledge about Judeo/Christiaan theology. Not much that suggests that vaccines go against typical religious teachings. Of course I don't need to worry about Christian Scientists; they don't seek medical care anyway. 

So basically I'll run my company like an auto insurance company does. Insure qualified people, demand compliance, cancel anyone who strays. This  appears to be in close keeping with non-government interference, a model of Libertarian thought. I suppose that I might choose to insure some of the fat/smoker/drinkers; but at a huge markup. And if they start to cost too much based on claims.......hasta la vista. 

Phew; health care is now greatly reduced in cost. Taxpayers are relieved of obligation. The Koch Bros are happy as clams. 

And 100 million or more Americans are shit out of luck. 

Of course doctors are free to accept/refuse patients based on ability to pay. And primary care docs can  pick and choose who they want in their practice. Hospitals the same. No more COBRA/EMTALA laws that demand emergency stabilization of any/all patients who present for care. Back to the practice of performing "wallet biopsies" before initiating treatment. 

And pregnant non-payers will deliver babies while driving through West Texas trying to find a charity hospital (this was the ACTUAL scenario that resulted in the creation of EMTALA laws. Of course that was the action of that pesky gov't; which is now sidelined). The number of doctors will diminish in this scenario, hospitals as well. Not knowing how the Law of Unintended Consequences will play out, but I suspect that alternative sources of care will emerge. More chiropractors, homeopaths, naturopaths, psychopaths, etc. It will be like the Wild West (again). These alternative practices exist today; but they've been out-competed by "traditional medicine", mostly because they don't work.

IMO, a civil and wealthy society can do a lot better than that. We have, and we should continue. Can the gov't do better? Yes. Can the system function without them? See above. Do the majority of Americans want that? I don't think so. So fix what needs fixing. But don't throw the baby out with the bathwater. Or, go ahead. 

We'll finally have a situation that impacts the FWT's among us. Maybe they'll finally come around to a more reasonable way of looking at things. 

[David Fairchild]

Ken,

We have been down this road before, but again healthcare cost are simply on an unsustainable path. Healthcare is now ~18% of GDP up from ~6% in 1960. Compare that to housing that accounts for ~12% of GDP and food that accounts for ~6%of GDP, according to the BEA.

There are lots of reasons for the increase in healthcare spending per capita. But if it takes an end to the Enhanced Premium ACA tax credits now (which is what the current fight in D.C. is all about) to restart SNAP,  then I vote we end the Enhanced Premium tax credits. And FWIW, if we do end the Enhanced Premium tax credits, then I will probably need to work two to three more years, at least, rather than retire next year.

https://commons.wikimedia.org/wiki/File:US_healthcare_cost_over_time_as_percent_of_GDP.svg

[kan...@aol.com]

So DF, that suggests that you are benefitting from the tax credits? 

Glad that you can live without them, even with some inconvenience. But there are millions who won't be able to cope. 

My son lives with me and Mom; so he'll do okay. But his premiums will increase to the point that they will just about eat up his yearly salary. True he works part time. But a $6000 increase is a serious hardship that a lot of people can't handle.

But you'll agree that ending tax credits is a separate problem from the COST of health care. One deals with WHO pays; the other deals with HOW MUCH gets paid. 

I believe the tax credits are  appropriate for millions of people. It will make a big difference in their ability to get along.

 I think I made it clear that we're discussing two issues here. The tax credit issue is straightforward enough. It's a yes/no question. I vote yes. 

The cost of health care is a much tougher nut to crack. I've offered plenty of options. Nobody else here has offered much that sounds any better. 

Iterating: single payer lops off about 20% in an instant. 

Various efficiencies can lop off a lot more. I've shown some samples. 

I even went with the Ayn Rand/Libertarian model. Costs may plummet;  but at the cost of a lot of increased illness

Actually, I'm going to add to what I think is more of the Law of UC's. There are already hospitals opening up that don't take insurance or Medicare. They have transparent pricing. Of course CASH/credit care only. This model may well expand to fill some gaps. But again, many will be frozen out. 

The auto insurance model, as applied to health care, is problematic. Not everyone drives; not everyone is allowed to drive. But health care is/ should be available to all. As such, the gov't needs to play a role. Otherwise, providers will freeze out people/places that are less profitable. Think FWT's and rural areas, as well as others I mentioned. The gov't already does plenty to make rural health care available. Absent those incentives it would become much less prevalent. 

And YES, it costs too much. I would suggest that some of the increased costs come from significant advances in what's available. Also, many of the costly advances are too widely available. Everyone wants to have the latest toys at their facility. And docs want to use the latest toys, even when not necessarily called for. Now, in truth, insurance companies often set up barriers to using these toys, requiring "prior authorization" to get coverage. But do we really want an insurance company's low level functionary to decide what I can/cannot do for my patient? Not a great idea. So how do we incentivize docs to use tools reasonably? I'm big on saving dollars whenever I can. But I'm a unicorn. I see reports of ER visits; the amount of lab/x-rays etc ordered seem really excessive. It looks like the younger docs are doing a lot of CYA or maybe just have become too reliable on toys/tools instead of their diagnostic acumen. 

I only see this trend in ER reports; but I wouldn't be surprised if it were found to be wide spread. 

If it's CYA, then malpractice reform would help a lot. I pay about 12K a year for my malpractice; but some specialists pay 5-10 times more. Like any overhead cost, it gets passed on. 

Need more ideas? I can provide. But my notions have already offered saving above 20%. And care isn't impacted in the least. 

BTW, Medicare does NOT ask for prior auth. I can do what I think is necessary. However, they do perform RAC audits. I think RAC means "Return All Cash" or some such thing. I does mean that they can audit your work and claw back money. Doesn't worry me; I only bill for work actually done. I document well. Others? Maybe yes, maybe not so much. 

[David Fairchild]

Ken, the fight in D.C. isn't about the standard tax credits/subsidies that are permanent under the ACA. It's about the additional tier of enhanced tax credits/subsidies that were due to expire at the end of this year. My guess is that if your son is working PT, then he will likely continue to qualify for the standard tax credits.

The enhanced credits are what allowed several million middle and upper middle class folks retire early during the COVID shutdown or in the years since. They provided substantial credits to folks making well over 4X the poverty line. If the enhanced tax credits go away, then there become a cliff function at 400% the federal poverty where those above that amount get no subsidies. 

And this is going to become a big problem for many retirees with (for a couple) AGI of around $90k (which is more like $135k considering the standard deduction) for instance, an early retired couple with a paid for house living a nice upper middle class existence on $135k taken from their brokerage of qualified investments are about to get hit with an additional $20k to $30k in annual premiums when the enhanced tax credits expire, and that may require many of them to unretire at least part time. This is the camp I am potentially in. I have not retired, and probably won't for a few more years if the enhanced credits go away. Otherwise I was considering next year. Sea la vie.

Meanwhile, the current fight in DC will likely have little impact on relatively lower earning folks (i.e. singles <=$50k, couples <=$100k). These folks will still get heavily subsidize premiums via the standard ACA tax credits either way going forward.

As to "But you'll agree that ending tax credits is a separate problem from the COST of health care. One deals with WHO pays; the other deals with HOW MUCH gets paid." No, I don't think that's quite right. It ignores moral hazard entirely. When the folks using a service aren't the one paying for a service, there is little incentive to conserve the service or even consider price when seeking the service. The rise of employer provided healthcare correlates quite positively with increase of healthcare as share of GDP over time.

[kan...@aol.com]

C'est la vie, says the grammar Nazi. I took French a million years ago.

So you're looking at a serious hit, Wow. Things will improve when you become a senior like me. 

Medicare for all!!!! 

You should be shouting this from the mountain top. 

I get the moral hazard argument. However, even  if one is self insured, there is a disconnect between care and payment. The only way to make a real connection is for patients to pay at time of service, as is the case for any other service. This makes sense; except............a lot of  patients literally don't have two nickels to rub together. In my ER career, and in wound care, I see the "cost" of delayed care. This can range from making a  problem cheap to expensive, or from easy to treat to serious, all the way up to converting a problem from easy to life threatening. And sometimes life ending. There has to be some "moral hazard" or equivalent inherent here. 

My vast, really vast, experience in emergency medicine suggests that not a lot of people seek this form of care (which cannot be prevented for lack of payment) for trivial problems. ER's in general are likely the best example of where people go when they don't have any other choice. And like I said, most don't show up for no good reason. Many are not real "emergencies"; but usually there is something going on. Now (long after I aged out of ER practice) there are all kinds of walk-in facilities, even in pharmacies. But they want to get paid. Dang. 

ER's have sort of established a kind of triage system that eliminates some trivial problems. It's called a monstrous wait time. Lots of people walk out before being seen. It does work; but the triaging isn't very accurate. Some who walk out shouldn't. 

More on the moral hazard thing; Medicare patients with a secondary policy are basically covered for everything. But they aren't notorious for overusing medical care. I think that in the grand scheme of things (there's THAT thing again) people do a fair amount of self-triage. Perhaps this has decreased over the years. Maybe the "greatest generation" were more apt to care for their simple problems. Maybe some younger "snowflakes" are more likely to run off at the first sign of whatever. I don't think we can quantify this metric. 

Maybe schools could teach VERY basic self care, so younger people would at least have a clue as to what requires a doctor's input. 

[kan...@aol.com]

I just clarified with my wife. Every year my son has to apply for his ACA thing. There are the usual questions. When asked about income, they asked for his earnings in a single month. The number given was $1000. Based on that his monthly premium will vary from $400-700/month, depending on policy type The cheap one comes with a large 5 figure deductible. 

So basically the kid would be paying most of his income for health insurance. And if got the cheapest policy his deductibles would amount to like 5 years salary. 

As I said, my kid is taken care of by me and Mom. But millions of Americans will be put in an untenable situation. The likely intent is to funnel people into state Medicaid but that requires serious penury. A lot of people won't qualify for that unless they divest themselves of a LOT of property/wealth. 

Nicely done Republicans. 

Hold your ground Democrats. People depend on your strength. Don't let Reps get away with their continued giveaway to the 1% er's while screwing over the 50% er's. 

Recent article says that something like 600+ billionaires have 95% of the world's wealth. If calling this out make me a commie, then sign me up. Not trying to make everyone equally wealthy; never suggested that. But some rebalancing would be appropriate. And the billionaires wouldn't even notice the hit. They could still afford anything that they could dream of. 

[Brian Kegerreis]

Only a twatwaffle would twist acknowledging that government subsidies play a significant part in the rise of health insurance costs into get rid of health insurance and let people die.

This is why I dont want to even have conversations with you. 

Goodbye. 

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[kan...@aol.com]

Senor Luftwaffe here. The people you refer to so disparagingly are called Libertarians. The Koch Bros are a good example. Ayn Rand wrote of these notions. 

Don't shoot the messenger. If your vision wasn't so clouded by the shit in your asshole, you'd know that I was channeling YOUR notions. Oops. Remember, I'm the commie. YOU are the Libertarian. You want LESS gov't in health care. I want MORE. Get that straight before you post again. 

I want single payer health care. Remember? That's what I want. I was painting a scenario where the gov't was removed from the equation. 

I can see why G has grown tired of you. Your posts are increasingly addled. Maybe too much Trump Kool-aid. 

Don't let the door hit you in the ass on your way out. 

[David Fairchild]

Ah fun with labels...

Perhaps ironically, while I agree with BKK on some matters, I don't consider him a libertarian due to his views on immigration and military interventionism. His POVs on those are decidedly not NAP congruent. So even among us libertarians we go mired down in the BS.

I also don't think you a commie, Ken. And I doubt you do, too. An actual communist would not hold individual ownership to the means of production -- which you do through your investments.

[kan...@aol.com]

Brian, I re-read my posts. You clearly did not read or read and did not understand what I wrote. The  posts were obviously too detailed for your understanding, and too long for sock puppets. 

Too bad; DF and I were hashing out some significant notions. 

I'll go with what G has said recently; you're getting borderline unhinged. Too bad, even a blind squirrel finds an acorn now and then. 

I can refer you to an adult literacy class if you wish. Or you can read my posts REALLY slowly and CAREFULLY. Then you'll understand that I don't advocate for what you suggested. I have ALWAYS advocated for MORE access to health care, with costs shared by all. Basically everyone has the same insurance; that's called the gov't. Paid by the graduated income tax. Therefore the wealth are paying more than the needy. 

And just in case it takes more to scramble your two neurons, I advocate for medical care for anyone, that's ANYONE, who is currently within the US, legally or not. 

That's how the Euros do it. My brother had to pay $2.00 for an ER visit for an asthma attack when in England. They literally laughed when asked about paying the bill. And if the illegals had access to health care, they could go to offices or clinics and stay out of ER's. This small change would probably pay for itself. 

On Tuesday, November 4, 2025 at 5:02:23 PM UTC-6 kan...@aol.com wrote:

[kan...@aol.com]

Of course you're right, Dave. I'm just trying to humor the raving idiot. I'm only a commie in the eyes of MAGA-ites or other similar rightists. Sort of "commie by comparison". Except that it would preclude me from every becoming POTUS, I'd call myself a soft socialist. 

In the health care arena, I have clear views about how to go about things. There might be a different road forward. It would entail allowing health care providers to COMPETE for patients in all 50 states. Many states only allow a few companies to offer insurance. I haven't figured out why that's the case; but I'll guess that companies have lobbied to make the situation non-competitive. Don't know why states allow this. But absent REAL competition, companies won't have incentive to work on lowering costs. Hence Door #1; universal health care. And get people into the decision process who understand what they're doing. 

[kan...@aol.com]

https://manhattan.institute/article/reforming-health-insurance-competition-across-state-lines

This article talks about states restriction competition among insurance companies. It also hints at the problem of coverage access ending at state lines. 

The cost of an ACA plan in eastern Oklahoma is 3 times higher than in the counties in Arkansas immediately across the border. But patient demographics are probably more similar  than compared to western OK. So this is illogical to say the least. 

Not sure how the ACA plays into this; but it needs to be changed. 

States have taken it upon themselves to do some regulation of health policies called short term coverage. These are usually designed for people between jobs, needing temporary coverage. But sometimes these become long term policies; and they are really inadequate in many ways. By regulating them, people are sometimes obliged to get more expensive policies. 

So there are a lot of fingers in the pie here. States, the ACA, etc. But by having costs artificially confined to state lines, things aren't fair or sensible. 

I've got the answer. Everyone but BK knows what it is.