I remember when Pres Johnson created his “Great Society” in 1965, which brought us Medicare & Medicaid. I was in the second class of Baby Boomers to graduate High School in 1965. The last baby boomer was born in 1964 and so the bureaucrats had a stream of new 76 million new tax payers over the next 18 yrs.
Those born in 1900 By age 65, only about 2% of males and 2.3% of females from the original 1900 birth cohort were still alive
Those born in 1910 47.6% of Males and 34.7% females died before 65 y/o
Those born between 1946 and 1964 (Baby Boomers)
Approximately 25–30% of baby boomers in the United States died before reaching age 65
Approximately 70%-75% will live until 65 y/o
Medicaid plus CHIP: 23% of the population, (78.6 Million) which includes 41% of all U.S. children and 15% of adults
In 2025, about 40% of U.S. households—approximately 76 million “tax units”—will pay no federal individual income tax
roughly 65 million people in 2025 (based on a U.S. population near 330 million) who are not contributing to Social Security or Medicare through payroll taxes
The problem with socialism is that you eventually run out of other peoples’ money.
I see a mass exodus of primary care physicians and most office practices will be “stacked” with mid-levels. PA, NP, APRN, and maybe some PharmD. Currently services provided by mid-levels is reimbursed by insurance at 85% of what a MD would get reimbursed, but mid-levels don’t get paid 85% of MD get paid. We may even seen a fair amount of self-care using a AI systems.
Our healthcare system seems to be on the brink of a major transformation – to what – I am not really sure
Five Ways Trump’s ‘Big Beautiful Bill’ Impacts Doctorshttps://www.medpagetoday.com/washington-watch/washington-watch/116518After President Trump signed the “One Big Beautiful Bill” into law on July 4, the question remained: How would it impact doctors?With more than $1 trillion in cuts to Medicaid and the Affordable Care Act over a decade, the mega-bill “represent[s] the biggest rollback in federal support for health coverage ever” according to Larry Levitt, executive vice president for health policy at KFF, an organization that researches issues in healthcare. Here are five ways physicians will be impacted by the law.Swamped Emergency DepartmentsBetween a decrease in the Medicaid rolls — largely due to the law’s imposition of a federal work requirement — and the expected expiration of the Affordable Care Act’s enhanced premium tax credits, an estimated 17 million people will lose their health insurance between now and 2034, according to KFF. And for emergency departments (EDs), fewer insured patients equals more uncompensated care.Joanne Conroy, MD, president and CEO of Dartmouth Health, which provides primary and specialty care throughout New Hampshire and Vermont, said about 10% of New Hampshire residents and one-third of Vermonters are on Medicaid. When patients lose insurance such as Medicaid, they don’t see a doctor and don’t get their medications. “Their healthcare kind of goes sideways, and they end up in our emergency rooms with healthcare conditions that are much more serious than if they’ve been addressed ahead of time,” Conroy said.Alison Haddock, MD, president of the American College of Emergency Physicians, agreed, telling MedPage Today that the health system isn’t functional if the ED is the only place patients receive care, because patients come to the department potentially much sicker.Looming Hospital Closures, LayoffsOver the last decade, a “huge swath” of small hospitals in central New Hampshire have closed their obstetrics departments, Conroy said, and now, with Medicaid cuts looming, some others are beginning to restrict services and lay off physicians. And if patients don’t have care they can walk to or care they can access with a short ride, they don’t get care, she added.UC San Diego Health recently cut 230 positions, blaming, in part, “federal impacts to healthcare” and “regulatory uncertainty.”A Medicare Payment Bump — But It’s InadequateAmerican Medical Association (AMA) president Bobby Mukkamala, MD, said changes the AMA sought that would have tied Medicare physician payment to the rate of inflation disappeared from the final bill. The law does include a 2.5% 1-year increase in the Medicare Physician Fee Schedule beginning in January, but both Mukkamala and Haddock said that was insufficient.For emergency physicians, seeing more patients with poor or no coverage — and trying to serve them with fewer staff and resources — has consequences. “When you’re trying to do more with less, constantly … It leads to that moral injury, that burnout, that has people saying … ‘This is not a sustainable job,'” Haddock said.Mukkamala, an otolaryngologist in Flint, Michigan, agreed. While he can diagnose a patient’s throat cancer, “Then what?” he asked. “Where are they going to get chemotherapy? Where are they going to get radiation therapy?” Without health insurance, the patient likely can’t get follow-up treatment and their cancer will grow exponentially, he said, adding that continued stress from these types of situations can lead physicians to early retirement.A Shrinking Physician Pipeline Those early retirements are compounded by a provision of the bill that caps unsubsidized federal loans for professional degrees at $200,000 over a lifetime.Medical student debt is on average a quarter of a million dollars, Mukkamala said. Even for those whose passion was to become a physician and help people, “the math” just may not allow them to pursue what they love. That could really hurt subspecialty care, especially in rural areas, according to Manan Trivedi, MD, MPP, a hospitalist in Washington who participated in a webinar hosted by the nonprofit Protect Our Care.“In the middle of the country, there could be two orthopedic surgeons in all of rural Nebraska, and now there might not be any because of this bill,” Trivedi said. “And so the sum of these sorts of hidden things in this bill, like the loan caps, are really going to have a significant impact.”Growing Maternity Care DesertsOne provision of the law — a provision which was temporarily blocked by a federal judge on July 7 — bars Medicaid funding for Planned Parenthood for 1 year. This provision is especially concerning to ob/gyns because Planned Parenthood provides a range of reproductive health services, including preventive care. Many of the clinics expected to close as a result of the provision are located in areas where services were already sparse, according to Sarah Bogdan, director of federal affairs for the American College of Obstetricians and Gynecologists.“Care deserts are likely to grow,” she said in an email to MedPage Today. Since ob/gyns practicing in care deserts are already struggling with large patient volumes, clinic closures will only add to their patient load, said Bogdan.
Filed under: General Problems
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