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The surprising U.S. state that is quietly revolutionizing healthcare, Maryland.

KSweeley

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May 7, 2014
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Baltimore, MD, USA
This is so awesome I live in Maryland, according to this, Maryland has the groundwork already laid out that could lead to healthcare for all: https://theintercept.com/2017/07/24...e-that-is-quietly-revolutionizing-healthcare/

There is one state, however, where a combination of fewer institutional barriers and existing health care structures could make health-care-for-all an achievable reality: Maryland.

It will take a grassroots groundswell and electoral victories, especially in next year’s governor’s race. One prominent gubernatorial candidate, former NAACP president Ben Jealous, has ardently endorsed single payer. “We have the opportunity in this state to make sure that we don’t have any more neighbors burying loved ones because they didn’t have access to health care,” Jealous said at an event where Sen. Bernie Sanders endorsed him for governor.

If elected, Jealous would face fewer procedural obstacles than those that have dogged California in its long battle to establish a single-payer system. While Maryland, like California, has robust Democratic supermajorities in the legislature, there is no two-thirds requirement to raise taxes, and no budgeting straitjacket mandating certain percentages of state spending to education or other priorities.

And while states do need federal waivers to incorporate programs like Medicare into a state-run program, Maryland is the only state to already hold a Medicare waiver. It enables a unique system known as all-payer rate setting, which serves as the basis for universal health care in several industrialized nations. In other words, while other states would have to begin from scratch to overhaul their health care systems, Maryland has a head start.
 

Media

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May 6, 2016
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This would be amazing but I fear that because ultimately the health care industry controls our insanely high prices, it would quickly bankrupt the state. Until the industry is put on a leash, I can't see single payer working, and god damn do I want it to work.
 

KSweeley

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May 7, 2014
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Baltimore, MD, USA
This would be amazing but I fear that because ultimately the health care industry controls our insanely high prices, it would quickly bankrupt the state. Until the industry is put on a leash, I can't see single payer working, and god damn do I want it to work.

Here in Maryland, hospital costs are already controlled:

MARYLAND IS THE only state in America where all hospitals must charge the same rate for services to patients, regardless of what insurance they carry. There’s some variance between hospitals, but every patient in a particular hospital pays the same. Other states experience huge, seemingly random differences in hospital costs, depending on the insurer (or lack thereof).

Maryland’s Health Services Cost Review Commission has set hospital reimbursement rates for over 40 years. The state obtained a federal waiver to include Medicaid and Medicare in its all-payer system, with the goal of keeping cost increases below Medicare growth. And it’s worked, creating the lowest rate of growth in hospital costs in America.

In 2014, to prevent hospitals from making up profit margins through volume, Maryland tweaked the system, adding global budgeting. “The traditional way it worked, every hospital got a rate card,” said Joshua Sharfstein, an associate dean at Johns Hopkins’s Bloomberg School of Public Health, and a former head of Maryland’s Health Department. “Now you get a number, which is the total revenue for the year.”

Because the global budget doesn’t change based on the number of admissions, this creates hospital incentives toward better outcomes. “It makes the health system focused on keeping people healthy rather than just treating illnesses,” said Vincent DeMarco, president of the Maryland Citizen’s Health Initiative, a state advocacy group. That includes increased preventive treatment, using case managers to connect patients to primary care, eliminating unnecessary tests, and encouraging good health outside the hospital walls.

Three years into global budgeting, the state is “meeting or exceeding” its goals, according to a January Health Affairs study. Hospital revenue growth is well below counterparts nationwide, or the growth of Maryland’s economy. Plus, state hospitals have saved $429 million for Medicare, more in three years than it targeted for five. Most important, every state hospital (all of which are nonprofit) and every insurer in Maryland are on board with the system.

If a centralized rate-setter bands every insurer together to negotiate prices, all payer can functionally act like single payer in terms of bringing down costs. All payer reduces hospital and insurer overhead, since billing costs are known in advance. And because the Affordable Care Act caps the amounts insurers can take in as profits, lower hospital costs should flow back to the individual in the form of smaller premiums.

This is why five countries — France, Germany, Japan, Switzerland, and The Netherlands — use all-payer rate setting as the basis for their universal health care systems. These countries have been found to control costs far better than America’s fragmented system.

The system only applies to hospital payments, not primary care doctors or clinicians. However, last year Maryland submitted a “progression plan” to the Center for Medicare and Medicaid Services, with the goal of expanding the system by January 2019. That would line up with the swearing in of Maryland’s next governor.
 

Media

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May 6, 2016
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Here in Maryland, hospital costs are already controlled:

Holy shit that's awesome. I wish I could move to Maryland. Between having two horrible autoimmune diseases and lots of surgery, even with insurance we are in debt up to our eyeballs. It's insane how much shit costs.
 
Dec 11, 2012
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Oh, man... I hope this happens. This would be amazing.

I really believe that we only need one state to do this. Just ONE. Others will see how great it works and follow along. Third party health insurance middle men companies know this and will try to kill it every way possible. But if we can get one state to do this, it's all over.

Hopefully Maryland can be for us what Saskatchewan was for Canada.
 

KSweeley

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May 7, 2014
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Holy shit that's awesome. I wish I could move to Maryland. Between having two horrible autoimmune diseases and lots of surgery, even with insurance we are in debt up to our eyeballs. It's insane how much shit costs.

:( I hear ya, health insurance is ridiculous here in the U.S. in that there's absolutely no cost controls built-in at all and the lack of cost controls completely fuck over the American people as a result with loading people who has serious conditions with huge amounts of debt.

I'm glad that I live in Maryland where Maryland managed to become the only state in the U.S. to mandate a universal charge that all hospitals must charge that amount to all their patients.
 

Saint Gregory

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Jan 4, 2006
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I just moved from MD to FL. I actually really liked living there but the taxes in the area where I lived (Hyattsville) were insane. I hope they can implement this without making the tax burden significantly worse.
 

Byakuya769

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Jul 31, 2007
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Honestly, depending on the tax increase, I'd have to consider moving to VA as my wife and I both work in VA and D.C. respectively.
 

Horns

I drop hot takes hoping you'll argue with me. Just ignore me.
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We just need to give Larry Hogan the boot and this could happen. Hoping Trump gives all Republicans a bad name even those who distance themselves from him.
 

ahoyhoy

Unconfirmed Member
Mar 25, 2008
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Legal weed and single payer in a single year? Gawd damn. Now Dems just gotta nominate a not shitty candidate.

That's fantastic.

Too bad Maryland's Cost of Living is through the ROOF...would move back...

Taxes are super high but there are plenty of affordable places around Baltimore.
 

KSweeley

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May 7, 2014
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Baltimore, MD, USA
We just need to give Larry Hogan the boot and this could happen. Hoping Trump gives all Republicans a bad name even those who distance themselves from him.

Well look at this: http://www.neogaf.com/forum/showthread.php?t=1410756

Hogan plans to speak at an event in York, Pa., on behalf of Scott Wagner, a state senator from York County who is one of two announced candidates vying for the Republican nomination to challenge Democratic Gov. Tom Wolf. More Republican candidates are expected to enter the race before the primary next spring.

Hogan's appearance could play into one of Maryland Democrats’ attack lines against him — that the real Larry Hogan is far to the right of the moderate positions he’s adopted as governor.

It also raises questions about why he would wade into a neighboring state’s intra-party battle at a time when he is seeking re-election. Polls show Hogan’s approval ratings are sky-high, but Democrats hope to bring those down by tying Hogan to Trump.

They were quick to pounce on news of Hogan's plans.

"Governor Larry Hogan is headed to an exclusive fundraiser to stump for a Republican who wants to gut the Affordable Care Act, opposes a woman’s right to choose, and denies climate change," said party Chair Kathleen Matthews. "Like a typical politician, Governor Hogan claims to be a moderate but he secretly supports his ultra-conservative friends who have nothing in common with Maryland values."

Mileah Kromer, director of the Sarah T. Hughes Field Politics Center at Goucher College, said she finds it surprising that Hogan would align himself with a “Trump-like” candidate. She said it gives state Democrats something to use against him.

“To me it seems out of character for such a cautious politician,” Kromer said. “What Hogan needs to do is rebuild that Hogan coalition and run as an affable moderate

Wagner has staked out a conservative set of policies that include climate change skepticism, enthusiastic support for fracking, and opposition to Obamacare and abortion rights.

“On virtually every issue, he’s pretty consistently conservative,” said Stephen Medvic, a political scientist at Franklin & Marshall College in Lancaster, Pa. “He’s going to position himself very much as a Trump-style [candidate]
 

vegohead

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Sep 9, 2016
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Legal weed and single payer in a single year? Gawd damn. Now Dems just gotta nominate a not shitty candidate.



Taxes are super high but there are plenty of affordable places around Baltimore.

I guess, but one downside of that is the commute if you work in DC or NOVA. Can be 2-3 hours each way. And you don't get the luxury of having the metro at your doorstep.

But yea, goo Maryland. Excited for that 10 minimum wage price increase next year. Hopefully it does more good than harm for businesses.
 

Lazy vs Crazy

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Apr 29, 2005
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Who would have thought that preventing hospitals from charging whatever they want so they can make massive profits would lead to lower costs.
 

n00bsauce87

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Sep 26, 2013
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Maryland
I guess, but one downside of that is the commute if you work in DC or NOVA. Can be 2-3 hours each way. And you don't get the luxury of having the metro at your doorstep.

But yea, goo Maryland. Excited for that 10 minimum wage price increase next year. Hopefully it does more good than harm for businesses.

I currently live in Laurel (which is arguably the biggest city or top 3 not named Baltimore) and the cost of living is fair for having access to DC and Baltimore. Depends on where you live, but in the middle of rush hour it takes me an hour to drive into downtown DC. And even then, WMATA buses run to Laurel.

I'd have to ask where are you talking about to not get access to WMATA. To travel from Baltimore to DC either from I-95 or the BW Pkwy might be 2 hours, but then it'll be better to just take the Marc train into Union Station for a fraction of the time.

So that leaves the Princess Anne/Eastern Shore area where you can take the Bay Bridge or just work in Annapolis or West MD near Hagerstown/Fredrick. Then I can see the 2/3 hour drive with no public transport into DC. You must be talking about a very unlucky spot with no options.

On-Topic: Soooooooooooooooo proud of my state. I love it. The only thing I'm worried about is if Jealous gets elected is the taxes. We are already have a progressive state tax. I just hope if it were to go up, that it's continued to be reflected in higher minimums and REALLY instituting this version of single-payer. Right now in my life, healthcare is very important to me.
 

Xe4

Banned
Aug 1, 2014
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I do think Maryland is moving towards UHC in the correct direction, and is something I think states like Vermont and California should try to do. Both made the mistake of trying to jump directly into single payer, which would be disastrous for both the economy of the state and for the movement for UHC as a whole. A system like Maryland with an all payer system is much easier to get into and works nearly as well. Combine that with a public option and better pricing controls and you have yourself a workable universal healthcare system. At the very least, it would be easier to achieve than some huge leap of a healthcare bill.
 
Jun 13, 2005
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Taxes are super high but there are plenty of affordable places around Baltimore.

The direct taxes aren't that high. Its the fees that are crazy. Cost of living isn't bad either unless you want to live in an upper class all white area. There are a few areas of extreme racisim in Maryland.


Yeah right. I had to have surgery in MD - and I had a good, top of the line PPO - and the amount of money I had to pay out of pocket was ridiculously high. I kept getting bills for months until I met my deductible.

I have a fairly good idea on the cost of open heart surgery in most of the US and Maryland is one of the cheapest states. Flordia, Texas, North Carolina, and Tennessee are crazy expensive and have the worst sucess rate. It depends.I think elective surgery is really expensive in Maryland but its something i don't concern myself with.
 
Feb 18, 2009
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New York
This would be amazing but I fear that because ultimately the health care industry controls our insanely high prices, it would quickly bankrupt the state. Until the industry is put on a leash, I can't see single payer working, and god damn do I want it to work.
It would be great if the healthcare industry would get fucked over, they’re criminals holding so many people hostage all for profit.
 

HaakonHaakonsen

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May 2, 2016
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Awesome! Proud Marylander!

Even though hospital costs are controlled, they're still crazy expensive. My wife and I just had twin boys. She was in the hospital for 4 days, and they were in the nicu for 2 weeks. Between the 3 of them it cost $60,000. I'm fortunate enough to have some of the best health insurance around so I didn't have to pay anything, but that would cripple someone without insurance.
 

Rookhelm

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Apr 5, 2016
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John Delaney needs to run for Governer or President or something already.


With Hogan in office, not sure this would ever come about. Maryland is getting redder by the day...only Baltimore and Montgomery county keeps it blue.
 

Armaros

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Sep 18, 2013
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John Delaney needs to run for Governor or President or something already.


With Hogan in office, not sure this would ever come about. Maryland is getting redder by the day...only Baltimore and Montgomery county keeps it blue.

MD has a democratic supermajority...and hasent voted for a republican president since 1988.

its not going to even come close to purple state in a long long time.
 
Sep 19, 2015
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The direct taxes aren't that high. Its the fees that are crazy. Cost of living isn't bad either unless you want to live in an upper class all white area. There are a few areas of extreme racisim in Maryland.




I have a fairly good idea on the cost of open heart surgery in most of the US and Maryland is one of the cheapest states. Flordia, Texas, North Carolina, and Tennessee are crazy expensive and have the worst sucess rate. It depends.I think elective surgery is really expensive in Maryland but its something i don't concern myself with.

It wasn't an elective surgery.
 

vegohead

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Sep 9, 2016
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I currently live in Laurel (which is arguably the biggest city or top 3 not named Baltimore) and the cost of living is fair for having access to DC and Baltimore. Depends on where you live, but in the middle of rush hour it takes me an hour to drive into downtown DC. And even then, WMATA buses run to Laurel.

I'd have to ask where are you talking about to not get access to WMATA. To travel from Baltimore to DC either from I-95 or the BW Pkwy might be 2 hours, but then it'll be better to just take the Marc train into Union Station for a fraction of the time.

I'm to the right of Baltimore, near the toll roads that take you north.

I guess I'm just not familiar enough with the trains system yet. Though it still seems like a bitch to get around NOVA via the metro. I visit alot of friends and family in the NOVA suburban area.
 

Eidan

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May 23, 2012
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John Delaney needs to run for Governer or President or something already.


With Hogan in office, not sure this would ever come about. Maryland is getting redder by the day...only Baltimore and Montgomery county keeps it blue.

Montgomery County, Howard County, Prince George's County, Charles County, Baltimore County, and Baltimore City all went decisively blue this past election, and did in previous elections too. Maryland isn't going purple anytime soon.
 

vegohead

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Sep 9, 2016
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It's expensive near DC for sure. But I still think NOVA is worse.

Yea, both of my divorced parents are selling their property and they only feel like it's going to sell to military family's lol. Half a million plus houses are just not worth it for a lotta people.

Alexandria has gotten so much more expensive in the last 15 years.
 

Armaros

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Sep 18, 2013
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Montgomery County, Howard County, Prince George's County, Charles County, Baltimore County, and Baltimore City all went decisively blue this past election, and did in previous elections too. Maryland isn't going purple anytime soon.

MD is one of the few places where the minority majority urban cities, AND rich white suburbs go democratic, and only the outlying rural places on the eastern shore and the far-west mountains that have republican sections. Yeah it isn't going purple unless a radical shift in state politics occurs.
 

Draft

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Mar 30, 2005
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Larry Hogan will be easily reelected to put this one on the back burner for another 6 years.
 

kirblar

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Oct 9, 2010
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MD is not going red lol

Hogan is in office in large part because people hated O'Malley.

Blue-state Rs are constrained in ways the national party is not.
 

Rookhelm

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Apr 5, 2016
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Montgomery County, Howard County, Prince George's County, Charles County, Baltimore County, and Baltimore City all went decisively blue this past election, and did in previous elections too. Maryland isn't going purple anytime soon.



Yeah, you're probably right...just feels that way in Western MD
 

ahoyhoy

Unconfirmed Member
Mar 25, 2008
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Larry Hogan will be easily reelected to put this one on the back burner for another 6 years.

If the ACA repeal goes through the state legislature will likely scramble to put something up in its place. That could get the conversation going and if not force him out on 2018 at least force Hogan to shift left again.

Yeah, you're probably right...just feels that way in Western MD

Western MD is beautiful but full of scary conservatism.