That's why the headline in the "Texas & Southwest" section of Saturday's edition of The Dallas Morning News caught my eye: "State plans Medicaid experiment" (Saturday, January 27, 2007, page 3A).
On Friday, Governor Rick Perry, "key GOP lawmakers," and Albert Hawkins, Texas' health and welfare czar, met with U. S. Health and Human Services Secretary Mike Leavitt. No doubt Medicaid financing poses a formidable challenge to the state, given that 25% of the state budget is earmarked for funding the health care delivery system designed to serve the poorest of our residents.
According to the report, the Governor wants to:
- Offer subsidies to small businesses to fund the purchase of health insurance for their employees.
- Give "customized" benefit plans to certain groups of Medicaid patients.
- Transfer part of the funding to "savings accounts" for the patients.
I will reserve judgment until all of the details are revealed and worked through during this session of the Texas Legislature, but I have noted a trend following the announcement of these kinds of plans.
First, the cost involved is often covered by reducing overall benefits to the poor, and sometimes those who need help the most are cut off.
The last time Medicaid was "reformed" in Texas, benefits were cut, people found it harder to be certified and private industry got involved in trying to administer programs. The result to date has been a disaster, and I happened to be in on one of the original planning groups for Accenture, the private company contracted to "improve service and access" to the poor. Hasn't happened.
Second, whenever government begins suggesting private insurance as a remedy for bulging health care costs, I counsel my low-income friends to head for cover!
President Bush's current plan for a health care overhaul includes inducements in the form of tax breaks to motivate more Americans to buy private insurance. According to Dr. Ron Anderson, President and CEO for the Parkland Health and Hospital System, Dallas' public health care institution, the costs associated with these tax breaks would be covered by cuts in funding to hospitals like Parkland that treat the poor and uninsured. Dr. Anderson estimates that under such a plan the loss in Medicaid revenue to Parkland could be up to $83 million annually.
One note of concern for me, as I read the report, is the fact that our Governor asked Secretary Leavitt for "as much leeway as states can be given to tinker with Medicaid." I'd love to know the definition of "tinker" here. One thing I do know, shifting around already limited Medicaid funds never seems to benefit the poor.
I'll stay tuned, but I'm not optimistic.
5 comments:
Larry this is an interesting post. It seems funny to me that when the government finally starts to try and help the poor they end up doing more harm then good. There are several policies within our laws that tend to perpetuate poverty. Then the government tries to do something that makes it look like they are striving to help the needy, but in the end it is just an illusion to appease the public. I to am concerned with what they mean by tinker. The crazy thing is that while they are tinkering poverty will not be solved and like you pointed out it might indeed end up hurting those in poverty. We don't seem to want to commit more money to this issue, we would rather cut back some where else. To me this is apalling. We must put more effort into solving an epidemic that is affecting over 40 million people in our country alone.
Where is all this extra money going to come from? I mean, we're running a humongous deficit right now, and we aren't spending enough. 25% of Texas's budget is just for medicare for the poor... how much more would it be if there was statewide health care?
I just wanna know where the money is gonna come from?
BTW, the best thing they could do is cut out all medicare, and make it law that everyone must have private insurance. No more insurance through your company, no more government insurance. Give everyone a tax credit (or voucher) for 1000 a year for a single person, 3000 for a family, if they use it to buy health insurance. Competition will drive prices down, and health care costs will go down because there won't be nearly as many people coming in without insurance that end up costing hospitals millions of dollars in unpaid services.
Justin, please hurry! Tell me where I can get individual or family coverage for those prices? I could save a bundle here at my company, if your numbers were correct.
The administrative costs and profit margins from private insurance are a huge part of the problem. We would save a bare minimum of $45 billion a year if we could eliminate the admin overhead from private insurance.
This is why American auto manufacturing companies are crying for single-payer health coverage so that they can regain some competitive edge in going up against European and Japanese auto makers whose nations provide universal coverage. This would be so much more efficient.
By the way, the notion to eliminate Medicare (the plan for seniors of all income levels) is a sure thing to plunge millions of older, retired seniors from the middle class to poverty. Not so smart an idea. Medicaid is the plan for the poor and to cut it would only increase medical costs in emergency rooms, etc., ultimately costing us all and doing so very inefficiently.
Maybe I didn't explain well. When you make it law to have health insurance, and get rid of large plans from corporations, insurance companies will make plans that are affordable to continue making a profit. Right now, there isn't a whole lot of demand for individual coverage. People are forced to get jobs where they have insurance. These plans often aren't very good, and because of co pays, people go to the doctor a lot more than they would if they were paying out of pocket. Health savings accounts are an answer to that. There is a huge plan being developed to do this.
Here's a good read on the subject.
http://www.reason.com/news/show/34854.html
There are quite a few people weary of an insurance career because they think they have to be an aggressive sales person. Of course, sales is a necessary ingredient, however insurance is a service everyone needs. Besides, most positions do not require straight sales.
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