Consequences of Cutting Medicaid
http://thedianerehmshow.org/shows/2011-05-31/consequences-cutting-medicaid
It appears Medicare will remain a divisive issue into the 2012 election. While Republican lawmakers continue to embrace plans to overhaul the program, results of a recent special house election made it clear that task won’t be easy. Some worry Medicaid will suffer as a result of public resistance to Medicare reform. Congress recently introduced legislation that would help states cut existing eligibility for the program that serves children and the poor. But many low and middle income families rely on Medicaid to pay for long-term care. Diane and her guests talk about the consequences of cutting Medicaid.
Guests
Norman Ornstein
resident scholar at the American Enterprise Institute and coauthor of "The Broken Branch: How Congress Is Failing America and How to Get It Back on Track."
Julie Rovner
health policy correspondent for NPR, author of "Health Care Policy and Politics A-Z," and contributing editor for National Journal Daily.
Congressman Michael Burgess
Republican,Texas, 26th District
Joy Johnson Wilson
Health Policy Director and Senior Federal Affairs Counsel,
National Conference of State Legislatures
Ron Pollack
executive director of Families USA, a national non-profit organization for health care consumers.
Comments
Please familiarize yourself with our Code of Conduct and Terms of Use before posting your comments.
Ryan's plan is pretty much DOA. So why waste time discussing it. Something more important, FOX News! I know devotes of the D.R. show just love fox news because they cannot stop writing about it. They do have a very good line up of prime time shows. I like Freedom Watch with the judge, if you get tired of that you can flip over to Bill O'Reilly. One thing I think even pancake can appreciate is the revolving cadre of female commentators, the next is more beautiful than the last. Caroline Helmond could make just about any conservative loosen his grip on "guns and religion" in the right situation. Krystal Ball if you can believe that ain't no toothless cousin either. Stossel does a nice job putting things in perspective. Glenn Beck is gone but if your lucky might stop by with an interesting twist on things. Hannity, well he is what he is. You have Follow the Money, Americas Nightly Scoreboard and Greta, nice lady! Anyway, take a little time out from your boiling cauldron of hate and check it out.
I will interested to see if the discussion today acknowledges the "elephant in the room" -- that the present course of medicare and medicaid is UNSUSTAINABLE!
Without referring back to that monster reality, everything the guests say today is actually a moot point! Of course, the cuts in the Ryan plan are tough -- but that must be analyzed in light of the alternative -- which is the total collapse of the entire system UNLESS the cuts are made.
I'm sure your guests, Diane, will say that raising taxes will solve the problem. But that is actually an entirely different topic which deserves a separate show.
One seventh of the cognitively functional people in my nearby retirement home are men. The percentage drops in the high care wards. Yesterday I went over there to watch the Indy 500 with some of the women and nearly all the men. I don't got no TV at home anymore because the last one is now a computer monitor. I provided the facility a giant flat screen because money is short there and they need it all for staffing. My Danica Patrick cut-out looked tiny beside me and the nurses. More than half the residents exist on a combination of Medicare/ Medicaid/supplemental Medicaid. Now if North Carolina has much less Medicaid money under a grant system and no way to raise the shortfall in hard times my nearby retirement home will not be able to accept any more Medicaid residents , may have to mothball some beds, may even have to close. This is because most older North Carolinians were non-union wage slaves with little or no retirement money. They paid for the big fortunes of some Oligarchs. To say a program is going broke is another way of saying we've lost our resolve to meet our humane responsibilities. All this is happening at a time of systematic Medicare fraud by for-profit care companies and providers, while they overload undereducated, underpaid staff with impossible loads of responsibility. It'll be a disaster. We coulda shoulda made medical services universal and comprehensive under one system, but sadists like to play games with tax money while they wallow in profits. Politicians fail to enforce the laws or provide compulsory funding, all because the medical industry bribes them.
The poor, disabled, and agéd constitute an inherently expensive pool. If we put everyone under the same national insurance scheme, the whole plan would become more sustainable. If we don't want a directly governmental plan, we could do as the Swiss do, where private companies can't profit from it but can use it as a sales tool---we might even be able to get the insurance companies to let it pass. (The current plan, which is not so much health-care reform as a guarantied customers scheme with no immediate, strong, limits on profits, was of course to their liking.)
What goes around comes around. The GOP would not allow any intelligent conversation continually demonizing and giving the American public nothing but misinformation. Until the politicians grow up and start acting like real elected representatives I don't know if the country can have any real discussions on major issues.
(1) Many high net worth families transfer assets of wealthy elderly member to their kids for the sole purpose of qualifying for Medicaid for long term care. LTC providers actually help families do this in order to ensure payment and occupancy in their facilities. (2) If it is not the responsibility of adult kids to take care of their elderly parents and we believe it is the taxpayers' responsibility, why not provide the same benefit at early age. Let's allow parents of newborns to qualify for tax dollars to care for their kids for the first 18 years of their lives too!
I'm glad that people with disabilities were mentioned in this conversation. So often only elderly people are discussed, but both Medicare and Medicaid are extremely important for people with disabilities of a variety of ages.
I want to mention two issues that are connected:
-Nursing homes are increasingly for profit, resulting in more costly and less patient-centered care.
-There is very little wheelchair accessible housing available. So, some people who would be able to return home or stay home in the first place if they had accessible housing are unable to do so.
I think that we need to move towards universal health care, but not by expanding Medicare. It should be obvious that we need to increase taxes. When one looks to European health care, out-of-pocket costs are low for actual procedures but they pay for it is taxes. We can't keep giving the rich tax cuts and taking away from the programs (entitlement and based upon low income) for many who have no other way to meet basic needs.
We the people must be an ignorant lot, according to these guests.
I should have started counting the times the phrase "the average voter doesn't know" or "the average (fill in the blank) has no idea."
Who are they calling average?
What are the consequences of letting Medicaid continue to grow? How much of our budget should it be allowed to consume?
What reasons are there for not mentioning the military budget? A comment was made saying that legislators are looking everywhere to cut budgets, and yet they apparently are unwilling to look at the military budget. I am confident that it is possible to cut back on this budget without harm to the soldiers on the ground.
There's a simple solution to this problem - tax cuts and cuts to social programs! If that doesn't work, well, more tax cuts & more cuts to social programs. It's a Republican law, as certain as creationism, which is how life came about on Earth. Doncha know?
Is there a better way to handle the problem?
Yes, a single-payer plan. This is the only way to bring down health care costs for everyone including the indigent, disabled, poor and working poor. We keep putting band-aids on a broken health care insurance system.
Orstein made an interesting comment: The majority of births in the US are under medicaid". Given that consider the following: Having childer and the number of children one or a family has is a PRIVATE decision. Yet the funding of that PRIVATE decision is with PUBLIC dollars. Since that is the case, why not LIMIT the benefit to TWO births per family (notice this allows for twins, ects) The limit is # of live births - not # of children - so if a family has twins that would be one birth. Regardless the point is that we need to place limits. My child never got to have every item in the store. He/She had to make a choice. So too must the beneficiary. They can have TWO PRIVATE births paid for with PUBLIC dollars but that is all. If they wish to expand their family they are free to do so at their own expense. I cannot understand why legislators will not put forward legislation that says the above. As a tax payer I want my representative and Senator to put forward such legislation. I hope that readers will contact their reps and demand that they put forward legislation that limits the number of PRIVATE births that are paid with PUBLIC dollars. Maybe if we all start asking they will use their common sense and limit the behefits so that all families that do need it will have the dollars and those families and individuals that over use the benefits will have to stop. We need to distinguish between the truly needy and the irresponsible.
Long-term care is a grossly misunderstood issue. The cost is extraordinary, but most of us won’t need it. As my wife and I became seniors we reviewed our own situation and found the current mantra - if you are poor you depend on charity, if you are rich you self-insure, but if you have modest savings and income you should buy long-term care insurance - to make sense. We make annual payments for insurance.
More people probably should buy such coverage, but it seems such a waste to pay for a service that seems so unnecessary when one is still healthy. Besides, if one needs long-term care, the state is likely to pick up the cost when one goes broke. So, the incentive becomes even less.
This leads to more demand for public funding than the resources available. Either care will be denied or care will be rather poor. Woe to those who expect private or public charity as a solution to everyday problems. With a large aging population, the traditional public role of providing long-term care to a very small number of people is no longer viable. Too many of us will need it.
The answer may be fore the government to get out of the a few public service announcements proclaiming that if one does not protect oneself with savings or insurance, long-term care may not be there if you need it. Better include that in your retirement plans!
Americans are great givers, but Medicaid has become a monster. Some have come to believe that the poor should be “entitled” to the same medical care as those who can pay for it. This leads to an impossible burden on the health care system and our economy.
Dear M/s Diane,
Kindly ask the pannel about the GOP claim of deficit/debt reduction when in 2000, the surplus they inherited was never ever considered as some kind of down payment to the country;s deficit/debt?
Great job you do for all of us M/s Diane!
Your guest(s) mention using block grants to achieve the 'flexibility' to deal better with Medicare/Medicare costs. Just how does this flexibility affect individuals? Does it give us reasonable choices or just take away benefits?
Diane,
I am a medical review nurse and I have worked with private insurance, Medicare and Medicaid populations. From what I have seen the Medicaid patients are sicker than any of the others. There are tiny babies with birth defects who require huge amounts of care, people with multiple mental and physical disabilities, people with severe infections who require many days in the hospital. It is no wonder that Medicaid consumes large amounts of cash!
Theresa Rolle, RN
Why are we so afraid to discuss euthanasia? After seeing several of our elderly relatives live, with Medicaid's help, like vegetables in nursing homes, my siblings and I vow to never let that happen to us.
Why are we spending so much money on 85+ers who are barely alive, while so many of our young children, with their whole lives ahead of them, are going hungry and being poorly educated. They are the ones on whom we baby boomers will depend when we are in long term care some day.
Regarding the proposed "vouchers for vultures" Medicare program, I cannot see how one can expect aged individuals to even begin to navigate the health care system. I am currently assisting my friend, an widowed 82 year old with age related mental changes, navigate through a diagnostic work up. She has no living children and no close relatives. I have the advantage of being an RN who has worked throughout the health care continuum, including a number of years working for insurance companies. At 53, I am tech savvy and mentally competent enough to do this. However, everyday that I hear the arguments about the future of Medicare, I wonder what will I do when I am in my friend's position and who will help me? No one who is ill can be expected to effectively navigate the current health care system without assistance and the thought of evaluating insurance alternatives while in the midst of life-threatening illness is unimaginable.
Additionally I want to emphasize that Medicare for my generation is not an entitlement: it is a program that we have paid into all of our working lives. Somehow expecting to get back benefits in return for taxes we have paid is in no way to be considered an "entitlement."
What a well informed panel!
Several thoughts:
1. I hate that the whole Medicare/Medicaid issue is caught up in partisan politics. No one wins-not even the party, and clearly the families in need lose big time.
2. The long term care problem needs fewer politicians and more people like your panel to be creative in how to care for those in need. What about in home care instead of the "feared" nursing home? My mother on Medicaid had an aide for 5 hours daily and the family filled in the remainder so that they could continue working. Much cheaper than the $3000 +- for NH stay. Cost of an Aide vs. RN care: a no brainer.
3. Poor people get the worst care-we all know that. When a pregnant woman does not get adequate care and has a premature baby, rather than paying for a normal delivery and discharge several days later, the baby ends up costing the Medicaid program literally millions.
Clearly this is a very complicated issue, but the solutions which lack creative thinking seem to punish those with the greatest need.
Spoken like a true social worker!
What a well informed panel!
Several thoughts:
1. I hate that the whole Medicare/Medicaid issue is caught up in partisan politics. No one wins-not even the party, and clearly the families in need lose big time.
2. The long term care problem needs fewer politicians and more people like your panel to be creative in how to care for those in need. What about in home care instead of the "feared" nursing home? My mother on Medicaid had an aide for 5 hours daily and the family filled in the remainder so that they could continue working. Much cheaper than the $3000 +- for NH stay. Cost of an Aide vs. RN care: a no brainer.
3. Poor people get the worst care-we all know that. When a pregnant woman does not get adequate care and has a premature baby, rather than paying for a normal delivery and discharge several days later, the baby ends up costing the Medicaid program literally millions.
Clearly this is a very complicated issue, but the solutions which lack creative thinking seem to punish those with the greatest need.
Spoken like a true social worker!
(Pancake, you've hit it on the head again...)
Single-payer is a solution to this and other (e.g. moral) deficiencies in the system. There seems to be no disagreement other countries surpass the U.S. in this - every caller and individual I know attested to it. But even when there are topics devoted to it, its chief opposition seems to be the "core American value" of protecting immoral profiteers. Get em off the teat already, stop their dictating to doctors, be ethical and improve the poor (and costly) care the poor receive.
All the same, those who profit most from the system should be asked to share fairly, when many of those who do work don't have health care and don't qualify.
The Ryan plan seems to be getting all the attention and sucking up a lot of NPR airtime. Let's devote a week or so to the Democrat's plan. How about next week? Everyone will be back from vacation by then. Thanks.
Interesting comment that was made about the large percentage of child births that are paid for by Medicaid.
If these women cannot afford to give birth, can they afford to raise the child? If you cannot afford the associated costs of a child, you should not be getting pregnant
.
What the republican legislators don't understand is that many middle class and downward are living paycheck to paycheck. They don't have enough money to save for long term care.
It boggles me to see how stingy and miserly they are, if it doesn't hurt them, they don't care. I am on disability and am on both Medicare and Medicaid, otherwise I wouldn't get the health care I get and appreciate.
My income on disability is $460 a month. and my total SS income is under $700. a year, total.
I know quite a few people who just don't get any health care because Medicaid guidelines are so low and the make make $10-$25 too much to qualify. I have a friend on disability also who is in that category. He is just above the federal guidelines for poverty.
Most people don't know that the income to be below poverty is at about $8,000 a year but it will be RAISED next year so that you can make $10,000 a year and not be considered poor.
This is something that nobody in government understands.
What the cuts will do, will end up with a huge numbers of unemployed, sick, malnurished citizens.
This is what they call PLANNED MISERY. A sick, poor, hungry population is easy to control.
You are right hainc, and also NPR is supposed to be National news, but much of it is world news. Of course we have to consider that too, but I would like to see more national news, like what happened in Wisconsin, And in Detroit, " the emergency managers" and that the Fa. governor was head of a company that was fined for 14 felonies.
"If you cannot afford the associated costs of a child, you should not be getting pregnant"
Delivery is free in Australia.
Seems to me the worker was referring to premature births (the well-insured will have the company paying it) and cost of poor care (in Medicare)...I don't see especially related to the cost of raising a child.
Considering the ever-increasing percentage of Americans working harder than ever and getting less for it - I think, rather, some others should not be getting rich.
I have been involved.in healthcare for 40 years. One of todays guest spoke of coordinated care and its projection to save costs. Two points , first that is a political based statement, Diane should not allow that. Two, coordinated care happens now and it will never reduce costs as the guest implied. How can tests ordered by an oncologist cover those ordered by a neurologist? The sharing of medical record data happens now and all it saves if a few basic duplicate tests .
Better administration of current spending is needed not more programs.
Thank you for a thoughtful discussion on the impact that state-level cuts to Medicaid are having on the nation.
For a state-by-state analysis of Medicaid and its importance to children, visit http://www.childrenshospitals.net/AM/Template.cfm?Section=N_A_C_H_News_a....