New York Times
Business Day
Following the Money, Doctors Ration Care
By TYLER COWEN
Published: December 11, 2010
Doctors are already rationing health care and are likely to further discriminate based on whether a patient has private insurance, Medicare or Medicaid.
Showing posts with label Medicaid. Show all posts
Showing posts with label Medicaid. Show all posts
Monday, January 10, 2011
Thursday, April 29, 2010
Understanding Insurance: Will a Public Option or Co-op Get US Where We Want?
Today's commentary comes from an article I'd written for the Journal of the American Osteopathic Association and published today. Please click here.
Monday, March 22, 2010
House Passes Sentate Health Bill
Last evening the House passed the Senate's health bill, H.R. 3590, the Patient Protection and Affordable Care Act. Over 38 states are now stating they are in process and will file suit regarding the procedures and processes, as well as substance and constitutionality issues once the bill is signed into law. This law, along with H.R. 4872, the Health Care and Education Affordability Reconciliation Act which follows, will greatly expand Medicaid. Unlike Medicare, Medicaid requires states to chip in a percentage of the costs as well as administer the program. As mentioned in the January 4th posting, 43 states are facing financial deficits. Not every state was fortunate enough to get the nearly $600 million each in supplemental Medicaid deals to which Vermont and Massachusetts were privy, let alone the cornhusker kickback that Nebraska did which covered the state's required Medicaid contributions in perpetuity. (This provision for Nebraska will supposedly be eliminated in the yet to be passed by the Senate reconciliation bill.)
Last Thursday, Arizona's new budget signed by the governor dropped coverage for childless adults and the child health insurance program (CHIP) instate, leaving 357,000 Arizonans without coverage. The governor stated the "budget is a vivid reflection of how the fiscal crisis affecting state governments is cutting deeply into healthcare."
Politicians may choose to ignore the will of the people and pass legislation, but ultimately someone must pay for it. Given the present economic crisis, tax revenues are falling for both state and federal governments. It seems Washington has forgotten the fiscal realities of those outside of the Beltway. If the checks and balances built into our Constitution do not cause this legislation to be rethought, the financial realities will.
Last Thursday, Arizona's new budget signed by the governor dropped coverage for childless adults and the child health insurance program (CHIP) instate, leaving 357,000 Arizonans without coverage. The governor stated the "budget is a vivid reflection of how the fiscal crisis affecting state governments is cutting deeply into healthcare."
Politicians may choose to ignore the will of the people and pass legislation, but ultimately someone must pay for it. Given the present economic crisis, tax revenues are falling for both state and federal governments. It seems Washington has forgotten the fiscal realities of those outside of the Beltway. If the checks and balances built into our Constitution do not cause this legislation to be rethought, the financial realities will.
Monday, January 4, 2010
States AGs revolt as House and Senate Bills expand Medicaid
Expect more states to join the 13 AGs who threatened to sue if either health bill is enacted by Congress claiming certain Senators and Representatives were given sweetheart deals to get them passed.
Forty-three states are facing financial deficits given the down turn in the economy. According to a CNN report December 10, "As states attempt to get their budgets in line for the new fiscal year, ...budget constraints are causing 25 states to reduce services to their residences. So far 17 states have already made cuts or are considering cuts to programs that affect low-income children's and family's access to health insurance and health care services." In the last House vote of 2009, it passed the "Jobs for Main Street Act" by a 217-212 vote along party lines, which provided states with some funding mostly for current operations, including $53 Billion for extending benefits/health insurance subsidies for the unemployed and $23 Billion for Medicaid.
Given that Medicaid is a program jointly funded by federal and state governments and administered by the states, it is easy to see why states are financially unable to expand benefits programs. It seems Congress is out of touch with the reality of the severity of the economic crisis and continuing politics as usual, in these are anything but usual times. Unlike the federal government states cannot just print money. Despite claims to the contrary by our politicians, neither bill seriously does anything to bend the proverbial cost curve downward. However, as mentioned before in this blog, both do an extensive amount of cost-shifting.
No one wants to see anyone without healthcare, but it's time we take the politics and politicians out of it. The reason why became clear in talking with a friend who is an Indiana State Representative. He said, "So much of what we do with regard to legistlation is in response to some horrific hardship case we hear about. We feel compelled to right a wrong, and so we pass legistlation. But we don't take the time to look circumspectly at the issue to understand the potential unintended
consequences of what we pass."
It seems Congress is using the same rationale my friend described. Poorly, reasoned laws are worse than none at all. Let's be financially responsible and fair to all our citizens. Perhaps the States can succeed in getting Congress to appreciate we need to be writing good bills rather than paying people off to pass any bill.
Forty-three states are facing financial deficits given the down turn in the economy. According to a CNN report December 10, "As states attempt to get their budgets in line for the new fiscal year, ...budget constraints are causing 25 states to reduce services to their residences. So far 17 states have already made cuts or are considering cuts to programs that affect low-income children's and family's access to health insurance and health care services." In the last House vote of 2009, it passed the "Jobs for Main Street Act" by a 217-212 vote along party lines, which provided states with some funding mostly for current operations, including $53 Billion for extending benefits/health insurance subsidies for the unemployed and $23 Billion for Medicaid.
Given that Medicaid is a program jointly funded by federal and state governments and administered by the states, it is easy to see why states are financially unable to expand benefits programs. It seems Congress is out of touch with the reality of the severity of the economic crisis and continuing politics as usual, in these are anything but usual times. Unlike the federal government states cannot just print money. Despite claims to the contrary by our politicians, neither bill seriously does anything to bend the proverbial cost curve downward. However, as mentioned before in this blog, both do an extensive amount of cost-shifting.
No one wants to see anyone without healthcare, but it's time we take the politics and politicians out of it. The reason why became clear in talking with a friend who is an Indiana State Representative. He said, "So much of what we do with regard to legistlation is in response to some horrific hardship case we hear about. We feel compelled to right a wrong, and so we pass legistlation. But we don't take the time to look circumspectly at the issue to understand the potential unintended
consequences of what we pass."
It seems Congress is using the same rationale my friend described. Poorly, reasoned laws are worse than none at all. Let's be financially responsible and fair to all our citizens. Perhaps the States can succeed in getting Congress to appreciate we need to be writing good bills rather than paying people off to pass any bill.
Friday, January 1, 2010
Social Safety Nets with Growing Holes
After much hoopla, Congress finally began its Christmas vacation last week.
House or Senate plan, public or private, it really doesn't matter - what the politicians seem to have forgotten is that any plan must be underwritten correctly and with the appropriate safeguards or it won't be solvent. For some reason, beneficiaries tend to get upset there is no money to pay claims.
The CBO takes a snapshot in time approach to financial analysis. This static accounting approach does not account for the way human beings react in the real world, a fact they readily admit with multiple disclaimer footnotes in all their reports. Rather, what is needed is an underwriting analysis of the proposals. Underwriters try to predict the future given past behavior, human nature, changing market conditions and nature of the risk pool. The fact that accountants rather than underwriters are determining the feasibility of our social welfare programs may explain why Medicare, Medicaid and Social Security are projected to have a combined deficit of well over $100 Trillion into the future.
Underwriting isn't sexy enough for the politicians, which is no doubt why they ignore it entirely. Underwriting is risk assessment, and sometimes risk management; the very words convey dullness and boredom. No, it's much more exciting for Democrats to accuse Republicans of wanting you to die, and die quickly, and for Republicans to say that Democrats want to kill Granny. But where does this leave the American people? Don't we deserve better?
House or Senate plan, public or private, it really doesn't matter - what the politicians seem to have forgotten is that any plan must be underwritten correctly and with the appropriate safeguards or it won't be solvent. For some reason, beneficiaries tend to get upset there is no money to pay claims.
The CBO takes a snapshot in time approach to financial analysis. This static accounting approach does not account for the way human beings react in the real world, a fact they readily admit with multiple disclaimer footnotes in all their reports. Rather, what is needed is an underwriting analysis of the proposals. Underwriters try to predict the future given past behavior, human nature, changing market conditions and nature of the risk pool. The fact that accountants rather than underwriters are determining the feasibility of our social welfare programs may explain why Medicare, Medicaid and Social Security are projected to have a combined deficit of well over $100 Trillion into the future.
Underwriting isn't sexy enough for the politicians, which is no doubt why they ignore it entirely. Underwriting is risk assessment, and sometimes risk management; the very words convey dullness and boredom. No, it's much more exciting for Democrats to accuse Republicans of wanting you to die, and die quickly, and for Republicans to say that Democrats want to kill Granny. But where does this leave the American people? Don't we deserve better?
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