Last Monday afternoon, I heard U. S. Representative Joe Barton (Republican from the 6th Congressional District here in Texas) speak to a group of health care providers and advocates. We assembled at Parkland Memorial Hospital at the invitation of Dr. Ron Anderson, President and CEO for our public hospital system.
Congressman Barton is a powerful fellow. He chairs the Energy and Commerce Committee in the U. S. House of Representatives and this year he is chair of the conference committee made up of Representatives and Senators who must come up with reconciliation plans for matching legislation with budget by the end of September.
I have no idea why this is true, but the good Congressman's committee is in charge of Medicaid legislation and funding. He was in town to listen to our ideas on how the health insurance product for the poorest Americans ought to be managed, funded and reformed.
In the course of his presentation, he mentioned that 85% of the costs associated with Medicaid have to do with elderly Americans who use the program to provide long-term, end-of-life care.
Medicaid was originally conceived as a program to serve the health care needs of the poor. It has morphed into a plan to pay for the end-of-life care for many Americans who really aren't poor. More on that in a moment.
Mr. Barton began by telling us that his committee needed to shave several billion dollars off of Medicaid appropriations over the next decade. He was looking for solutions and invited us to offer our ideas.
I think I have at least a partial solution. I think I know where to find the savings he is looking for. It won't be popular, but it would be fair.
Here's how my idea would work.
Close the loop holes on all of the middle class people, like me, and families, like mine, who abuse the system by shifting the wealth of elderly parents to their children before they die. By making this wealth transfer, prosperous aging adults can currently qualify for Medicaid as a long-term care strategy when they should be using a portion of their accumulated wealth to pay the bill themselves.
What is saved for middle class families is lost for the poor, the ones for whom the program was designed in the first place.
Rather than cutting back on care for those who are really poor, Congress should shut out those who aren't. If the nation wants a long-term care program for middle class people, then it should build one, but not on the backs of or at the expense of our poorest citizens.
I know Mr. Barton could find his $15 billion, or whatever the number actually is--he wasn't too clear on that himself.
The Medicaid mess is a good example of how those at the very bottom "take it on the chin" again and again.
It is not right.
In fact, in my book it is immoral.
9 comments:
It seems unfair to me that all those who paid into the system aren't able to take anything out of the system.
Todd, maybe I can clarify. My parents, and I expect your parents, have not paid into Medicaid. Medicaid is a program for very low-income persons who cannot afford insurance or medical care. My parents, and I expect yours, and the two of us are paying into Medicare--the national health insurance program for retired persons. At retirement we are able to transition to Medicare for our health insurance. That is how we "take out" from what we have paid in.
My point in this post is that people, like my parents who are not poor, more and more often are transfering their wealth to their children so that they can be classified as poor or "destitute" and thus qualify for Medicaid long-term nursing care. This is a deception--a sort of artificial and technical destitution, if you will.
If the American people want a government plan for long-term care at the end of life for working people who earn a decent living, that would be something to consider outside the private sector. That is a political and policy matter.
My point is we shouldn't be cannibalizing a program designed for the poor and we shouldn't be trying to cut it back because of rising costs at least in part caused by the actions of people who really aren't eligible to use it.
This is a justice issue and people of faith who cherish values, as we all seem to be saying that we do, should stand up for the value of economic morality.
That's not a very generous attitude, Todd. Your primary concern is for yourself, not the least among us.
No, you misunderstand my intention. I would rather choose to whom my money goes, rather than the government doing it for me. I do believe that we have a responsibility to those less fortunate than us, but I don't believe that the government is the best way to fulfill our responsibility.
Todd, your heart is great! I love your spirit.
What you need to look at more carefully is the scale of the problems we are discussing here, as well as the limits of volunteer actions, strategies and donations.
Sometimes the collective will of the larger community has to make decisions for us, else many of us are crushed by the bad decisions we are also capable of making.
We are living at a time in our history when there is more room for volunteer actions and the result is simply growing need. Hard cold truth.
My fear is that the "will of the larger community" is incapable of making decisions for us. Also, it's not their responsibility to make decisions for us. Bad decisions are ours to make. Not once did Jesus talk about creating a "new world order" that prohibited people from making bad decisions. We have been blessed (cursed as well?) with free will, and I don't want to lose that free will to the "will of the larger community."
Todd, how far are you willing to take your Libertarian ideology? No speed limits? No taxes? No system of public education? How about civil rights? We are doomed if all we are is a nation of individuals unwilling to surrender some of our individual power and authority to persons, whom we select, to take care of many issues beyond our capacity to address due to sheer scale. The church cannot do it. Private charity cannot do it. Government is an institution every bit as divinely appointed by the Creator as is your individual freedom.
Anon, how far are you willing to take your socialist ideology? Complete distribution of wealth? Universal health care? Moral legislation? We are doomed as well if we are a nation that removes personal choice from daily life. I'm not a radical, Anon, I recognize that there is a balance between libertarianism and socialism. I choose to err on the libertarian side, not because I'm selfish, but because I believe that I have the responsibility to make decisions for my family AND provide for those less fortunate, not the government.
I strongly disagree with your estimation that government is as divinely appointed as free will. Free will is at the center of God's creation, Jesus' mission on earth and our response to God as his children; government is not.
Todd,
While I agree with you as to the track record of most governments we've seen, doesn't Scripture tell us that God has placed the government over us, and that we are to surrender to the government what it has claim to? (Sorry for the vagueness of the reference - I'm on vacation and don't have a Bible to look it up in.) Our money still bears our Caesars.
My main reason for government intervention is that so many people, whether for economic or other reasons, don't have choices to make for themselves. It'd be nice to say everyone can achieve that for themselves, but that's never been the case in human history, and none of our advancements have changed that fact.
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