A Good Idea That Will Fall on Deaf Ears in Washington
Harold Pollack writes:
In Illinois’ Medicaid program last year, 3.2 percent of patients accounted for half of all spending. The top 0.15 percent ― 4,500 people in a program covering 3.2 million people ― required annual expenditures upward of $285,000 each…
A striking proportion of the patients with the most costly and complex conditions are either homeless or one step away from that in precarious or temporary housing. It stands to reason that providing secure housing to people with chronic illnesses might help.
But as we pointed out in numerous posts (see here, here and here) Washington doesn’t like to pay for anything that isn’t invented there.
Is this Dr. Goodman arguing for a safety net? I never thought I’d see the day.
If it leads to better outcomes then its worth pursuing.
“In Illinois’ Medicaid program last year, 3.2 percent of patients accounted for half of all spending.”
That’s absolutely astonishing.
Most entitlement programs have this as the norm. Very few take the far majority.
And people say there is no need to reform entitlements…
“required annual expenditures upward of $285,000 each…”
Those are some amazingly unwell individuals.
They get sick because of their sub-par living conditions, which lead to chronic sickness.
“It stands to reason that providing secure housing to people with chronic illnesses might help.”
I doubt anyone in the GOP would stand in support of this.
And the Democrats would turn it into a national housing program.
Before you know it, we’re in Russia and we have to get permission to move somewhere.
Of course not. They hate the needy too much.
Wanting fiscal responsibility and hating the needy are two very, very different things.
When we place the money above the needy, it becomes the same thing.
You need money to give in the first place. Splitting a fish leaves both content, giving it whole still leaves one person hungry.
Note that the article was written about, and the small study done, in Chicago, which, last I recall, was not considered a GOP bastion. If Chicago, with its heavily blue citizenry and leadership, cannot fund a program to provide “secure housing to people with chronic illnesses,” why would you immediately target Republicans as obstructive?
I have to wonder if the homeless people mentioned above are actually that sick? I suspect the only institutions that pay then any attention are hospitals that cannot turn them away. If you want a hot meal and a warm bed, walk into the Emergency Room complaining of chest pains. Would subsidized housing really reduce indigent medical costs? If it does, we can assume much of the care delivered to this population is unnecessary.
Dr Goodman, can you provide a citation about the 4500 claims that averaged $285,000 each?
I have done some study of claims data. Claims this large usually involve transplants or end stage cancers or maybe persons like Terri Schaivo who are in intensive care for many months.
If that is the case, I am not sure that better housing would make a difference in Medicaid expenditures. A person whose liver is shot will not get better even if they stay in a luxury hotel. Remember the last sad days of Mickey Mantle.
I remember visiting a dialysis facility a few years ago. I was struck by how many of the patients appeared to come from very poor backgrounds. I kept this thought to myself, but privately I observed that here were people on whom society had probably never spent two cents on their education or job protection or their housing. Now at the end of their lives we were spending $100,000 to prevent their death.
In this respect I do endorse what I sense to be the idea behind this post. Let’s take money away from heroic care and spend some of it on better lives in the years before death.