State Strategies For Controlling Medicaid Costs
http://thedianerehmshow.org/shows/2012-09-19/state-strategies-controlling-medicaid-costs
Medicaid, the nation’s largest public health insurance program, serves nearly 60 million low income Americans. Under the Affordable Care Act another 15 million people with annual incomes below about $15,000 would be eligible to enroll. But last June the Supreme Court ruled that states were not required to expand Medicaid eligibility, and a number of states are now trying to find ways to reduce Medicaid expenses by choosing not to expand the rolls, improving efficiency of care, and making other changes to the system: Please join us to discuss what state Medicaid changes may mean for state budgets, national healthcare costs, and the nation’s poor.
Guests
Ron Pollack
executive director of Families USA, a national non-profit organization for health care consumers.
Gail Wilensky
economist and senior fellow at Project HOPE, former administrator of Medicare and Medicaid, and health policy adviser in the George H.W. Bush administration.
Alan Weil
executive director of the National Academy for State Health Policy.
John Selig
Department of Human Services, Arkansas.
Comments
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Have been exposed to the medicaid system for the first time when my WWII clearly retired teamster father entered nursing home care. My parent went through their savings in three years at 9000.oo per month for three years. After that the system required my parents share their combined pension and social security payments. So now about half goes to the nursing home that my father is in and the rest of the bill is paid by medicaid which is the case for close to the majority of the residents in the nursing home. What I can't understand is why the federal government who is footing most of the majority of these bills does not put a cap on what these private for profit nursing homes can charge the federal government. The average cost of nursing home beds in Ohio is 6000.oo per bed per month. Why is it that Stone Spring the place that my father is in can charge 9ooo.oo per month per bed?
We live in a nation that worships money. Should we be surprised that the select few profit on the misery of the many?
Re: your guest from Arkansas and his example of "cost containment" - so, is anyone else concerned that the doctor DID NOT KNOW how long his patients were staying in the hospital? Why are physicians NOT expected to know more about their patient's TOTAL care program? Who ELSE could be responsible for the total care program?
Two facts:
unless THE PATIENT takes some responsibility (including resisting from lawsuits...) the strategies being discussed are DOOMED.
let me tell you - you are going to witness CHERRY-Picking of patients. I AIN'T goin to look after hi risk (i.e. above) patients.
Where do sick people come from? The findings of multiple studies in the UK by Dr. Marmot, et., al., demonstrate that the primary determinants of health, and therefore healthcare costs, are directly related to social/economic status, i.e. people in the higher economic status have better health vs people in the lower rungs of economic society.
More equal societies have healthier populations, lower health care costs.
We are creating unhealthy people: given the current economic trends in the US that continue to create greater economic disparity between citizens, the strategies and tactics discussed today will have little overall effect on health and costs unless we address economic equality first.
Overall, one must ask what is the purpose of the healthcare system, profit or people?
What about under treatment? When doctor's get a bonus from surplus created by NOT providing health care then the incentive is to deny treatment even if it is necessary care. The problem with the HMOs from the 1990s is that they pocketed the money from premiums and then didn't let people have sufficient health care. People died who didn't have to die. The only way to have high quality health care but control costs is to have single-payer national health insurance because everyone is in the same system and costs can't be shifted. Everyone has incentive to keep costs as low as possible but quality as high as possible. Every other nation has some form of national health insurance where for-profit companies are not allowed to play a dominant role in health care. We spend 31% of every health care dollar on administration because we use a for-profit health insurance based system. Traditional Medicare uses only 3% - 6% administrative costs - if you let for-profit health insurance companies take a medicare pie with the Medicare Advantage programs you increase your administrative costs to 12% - 20% but the quality of care goes way down. Quit blaming patients and doctors. The problem is the greedy for-profit health insurance company middlemen who are only takers and provide nothing of value to our health care system.
I'm not sure how a patient "abuses Medicaid." Primary care physicians are not available at night. Secondly, how many of those primary care physicians shunt off their patients to emergency rooms because they feel they're not being paid enough. Finally, states would cut off eligible people from Medicaid and try to divert those funds to other non-medical or poverty related purposes.
I'd also add that people on Medicaid are part of the 47% of the population that candidate Romney just doesn't care about and never will. He doesn't care if these people die from lack of medical care and his attitude is reflective of the Republican attitude about poor pepole as a whole.
States or the federal government should put a cap on what private for profit nursing homes can charge per month per bed since the federal government is paying for the bulk of these bills
Thank you for airing this show. You have offered a great summary of the Medicaid program and dispelled myths about the composition of the populations served.
kathleen wrote:
" My parent went through their savings in three years at 9000.oo per month for three years. "
All this proves is that you did not plan well, kathleen.
Your parents should have gifted their savings to a trust of which they were not a party - i.e. held by their children, but used for their benefit. Medicare/Medicaid used to have a three year look-back on this, now I believe it is five years. A lawyer could have set this up for you to protect their assets. We did it with my Mom.
This a wonderful program for so many people but the abuse is crazy. I know many people with loads of money who have had their assests moved or hidden so they won't have to pay for nursing home care for a spouse, parent, or child. They have told my elderly mother she is crazy for not doing this. People use to be ashamed to have the government pay for their care now people are ashamed to burn their assests and not have the government pay.
It is not ethical to lump all medicaid recipients into the same category, just like not all republicans are the same or not all Christians are the same. The comment that medicaid recipients use the emergency room more because it's available isn't fair to those who are conscientious.
timV. wrote:
"I know many people with loads of money who have had their assests moved or hidden so they won't have to pay for nursing home care for a spouse, parent, or child. They have told my elderly mother she is crazy for not doing this. "
And they're right. She is. When there is a system to game, people will game it. It's human nature. I know it's nice to think people will do the right thing. But generally, they don't. That's the environment around which programs, if they exist at all, must be structured - not the one that we would like to have.
I have been a Registered Nurse for over 40+ years, working in critical care and management. I have seen multiple tests, referrals, and procedures done for patients. Patients, who have a no-code status, are intubated and admitted to the ICU and have referrals for cardiology, infectious diseases, nephrology, dermatology, pulmonology, etc. It's a culture of "scratch my back and I will scratch yours" ... Hospital administration can do nothing to control the situation as they are dependent upon these physicians for patient admissions !!!
Ultimately it comes down to whether we take care of people or allow them to die. There's little point of arguing whether or not America is a "Christian" nation if we allow people to die when they could be saved. No point whatsoever.
How we treat the elderly speaks volumes about what type of society we REALLY are.
gary k wrote:
"How we treat the elderly speaks volumes about what type of society we REALLY are."
You are partly right, gary. What says EVERYTHING about a society is how they treat their most vulnerable ... at the end of life but also at the BEGINNING of life. You seem to have forgotten that part.