Disappointing Medicaid Advisory Report
In "Million Dollar Baby," Hilary Swank's character offers her mother a free house. But the mother angrily rejects the offer, requesting cash under the table instead. The reason: a house would disqualify her for welfare and Medicaid benefits.
Reform of at least one of those problems is well under way, thanks to Pete du Pont and then Bill Clinton and then (mostly Republican) members of Congress – all of whom promised to "end welfare as we know it." What is now needed is to end Medicaid as we know it.
Imagine that tomorrow's newspaper carries the headline: "Supreme Court Declares Medicaid nconstitutional." After much hand wringing, Congress would almost certainly give the Medicaid funds to the states as an unrestricted cash grant and hope for the best. We would then get 50 different experiments – almost all of which would significantly improve the current system.
Why? Because today states only have to pay for 33 cents of every Medicaid dollar they waste, on the average. Federal taxpayers pay the other 67 cents. Conversely, the states get to keep only 33 cents of every dollar of waste they eliminate.
If the states had to pay the full costs of their bad decisions and if they got to reap the full benefits of their good ones, they almost certainly would make better decisions.
With this in mind, The New York Times description of a federal advisory panel's recommendations is disappointing – especially considering that this is a Republican panel appointed by an administration dedicated to consumer directed health care.
Far from calling for an end to Medicaid as we know it, the panel called for enrolling the disabled in managed care, encouraging home care over nursing care, and giving the biggest subsides to those with the lowest incomes.
Reporter Robert Pear called these recommended changes "sweeping." Perhaps inside the Beltway they will be viewed as such.
For the rest of the country, they are not nearly sweeping enough.
If people would change their focus from how to get people more care (no matter what kind of care that is)…to how to get people the right care … we might begin to get somewhere. Thank you Larry Lawrence M. Becker Director, Benefits and Policies Xerox Corporation – Corporate Human Resources
John: I was disappointed to read your Alert about our Medicaid Commission report. I would have expected you to refer to original source material for your information rather than to preliminary news reports. When you see the final report, which will be issued by December 31, you will see that the recommendations are indeed visionary and would go a long way toward meeting the goals that you outlined. To your specific points, our recommendations would accelerate the move toward much greater state experimentation. We heard numerous testimonies during our many commission meetings over the last 17 months which convinced us that the states could do a much better job than the federal government of matching their resources to the needs of their populations. A number of our recommendations are designed to give the states much greater flexibility and control. To that end, Bob Helms and I worked very hard in developing a proposal to provide better coordinated care for dual eligibles — patients who cost the most and who are often caught in the maze of the Medicare and Medicaid payment systems that lead to fragmented care. Here is a link to our paper which provides much more detail on our idea for a "Medicaid Advantage" program, which was included in the commission's recommendations. Medicaid Advantage would lead to better coordinated care and better managed care — a big difference from the typical understanding of "managed care" — through a program primarily run by the states. Our recommendations also would create new incentives for the states to better manage Medicaid funds and to stop gaming the system by creating new payment mechanisms. Bob Helms also developed an excellent paper on the many problems with the current Federal Medical Assistance Percentage (FMAP) payment system. Unfortunately, addressing FMAP was outside the charter of our commission, and we were prohibited from including specific recommendations for FMAP reform in the report. But the report does acknowledge the urgent need for this issue to be addressed. Bob is finishing his own paper on FMAP, which AEI will publish soon. Developing consensus on a commission that includes 30 people is not easy. But I think we did remarkably well in offering recommendations that create new incentives and ideas for the specific Medicaid issues we were charged with addressing. Our report calls for promoting individual responsibility and contains many other ideas that would move toward a better set of incentives to govern the Medicaid program. I would be happy to provide you with more detailed information on the commission's work. Grace-Marie Turner President Galen Institute
Limo Divers Protest Medicare Mediciad Reform Cuts, It’s rumored this issue could become part of the Tea Party movement. AmeriChoice Health is also rumored to take a position on this reform. Recirculate those tax dollars? Help keep limo drivers working, benefits flowing and overpaid tax dollars remain in abuse.
Medicare.gov as well as other Federal agency’s encourage you to report any fraudulent activities, yet, the same government agencys were notified the way this company does business yet did nothing. Three years ago they were reported to these Federal agency’s and as of todays date not only were they allowed to continue doing business but were never charged once. Protected vendor status sure, politics sure,limited government budgets sure, Federal and State officals looking the other way sure, and rather then stop these activities a strong desire not to rock the boat existed. Even with the vast changes in the laws and budgets,a hands off policy remains, you tell me what’s wrong with this picture? The Government created this monster and now they don’t know what to do about it, like shooting yourself in your own foot etc. Tons of money to advance their national growth, its market positions, tons of money for political donations, tons of money to send 75 millon back to its home office from New York state alone, tons of money to suppot National TV shows, tons of money to pay hugh State fines, tons of money to hire the very best law firms, tons of money to pay for bribes and kickbacks, tons of money for hugh salarys and bonuses, all done on the back of the American taxpayor, you see this company receives all its money from the Federal government. Should your tax dollars be held to a higher standard? Should the government agencys responsible for there review be held to that same standard?Should the IRS audit their corruption? Why has this company not been charged? How long can the buck be passed here in more ways then one? Hey, it’s your tax dollars don’t complain now.. then don’t complain later on…
ps… I know times are tough for a lot us, but it would be great to have a free limo to go to the Doctors, Pharmacy, Movies, Grocery shopping, and given free tickets for the movies. Offered soda, pop corn and hotdogs, as well as have them receive free coupons for Grocery items……Kind of makes you wish you also had Medicare and Mediciad right?