Nathan Newman wrote:
> There are serious issues for the disabled currently served by Medicaid that you
> have raised, which are important and Consumers Union has highlighted for
> concern. But for the non-poor disabled who don't qualify for Medicaid and the
> non-disabled poor, Bradley's plan is a large step forward.
Well the Medicare population could be described as the non poor disabled - it is non means tested and many seniors have saved money over a life time of earnings. Let me explain to you what has just happened to Medicare HMO enrollees. Several years ago govt decided to allow Medicare beneficiaries to buy into Medicare HMOs. It paid the HMO $400 per month which is more that the Bradley voucher. In 1998 the Medicare HMOs decided that the Medicare population of seniors and disabled was costlier, i.e., they weren't making profits off the $400 per month.
This is because "cost containment,” the managed care mantra, has led to a payment paradigm shift. Hospitals and doctors no longer get paid for individual services rendered (fee-for-service), they get paid a flat fee as they would if medicine were socialized. However, unlike a socialization scenario, there are financial incentives for physicians and hospitals to keep costs low. As a consequence of market forces shifting the payment and delivery system from fee-for-service to managed care, those needing the most health care are no longer perceived as an asset (bringing more money in), they are seen as a liability (draining the profits).
HMOs’ desire to sign up only those who would cost them the least to care for clashed with federal Medicare contracts because the government held the HMOs to enrolling ANY Medicare beneficiary wanting to subscribe. But gatekeeper physicians and administrators found other ways to get more costly subscribers out. Studies by the General Accounting Office(GAO), for example, show that one out of every 5 Medicare HMOs had disenrollment rates above 20%. Further, the GAO found “the rates of early disenrollment from HMOs to fee for service were substantially higher among those with chronic conditions.” Why? The GAO (and other studies) found that most subscribers left HMOs due to “problems receiving medical treatment.” Medicare beneficiaries found it necessary to revert to fee for service for vital care. The upshot -- subscribers most needing services were forced out of HMOs by denial of care.
But that was not enough for the Medicare HMOs. They contested government and the end, several large HMOs *abandoned* the Medicare population and did not renew their Medicare contracts. They dumped 400,000 Medicare beneficiaries in 22 states off their plans.
Nathan, you are assuming that what Bradley's plan says it can do, it can. But do you think any health care corporation will sit by and let their profits be eaten up by costly enrollees? They will not. Aside from all my other criticisms of the basis for Bradley's plan, I expect that if Bradley's plan is implemented that the private insurers will be at first greedy for any enrollees they can get, but soon they will start to calculate as the Medicare HMOs did and as they have from the beginning of time that disabled and chronically ill cost them more per capita and they will either trim back services, increase co-payments, insist that government pay more premium per head or do something very similar to what the Medicare HMOs described here did - or invent some new way to get out of providing care.
Perhaps it will do what Ethix corporation did. Ethix Corp., an HMO, announced that they "welcomed broad coverage for assisted suicide in a medical economic system already burdened." Ethix Corp's embrace of such a new "treatment" should be seen as a harbinger. Vice President Barbara Coombs-Lee, was chief petitioner for the assisted suicide Measure which created Oregon's law legalizing physician assisted death. But media reports concerning Coombs-Lee failed to make much of her professional occupation within a health insurance group. She was portrayed as a passionate idealog who cared only for things like "patient autonomy," an end to "intolerable pain," and offering "death with dignity" to those who wished to die on their own time-line. Coombs-Lee's role as a financially motivated health industry hatchet woman was carefully buried throughout the 1994 campaign. A lethal dose in Oregon costs only $35 to $50; compare that to one day's stay in a hospital, about $1,000.
The 9th Circuit (San Francisco) court's decision in support of physician assisted suicide specifically targeted the handicapped as "beneficiaries", and stated that it may be acceptable for "competent, terminally ill adults to take the economic welfare of their families and loved ones into consideration" when deciding whether to live or die, and it defended the use of assisted suicide to control medical costs.
Sorry, you will never get me to support a bourgeios plan like Bradley's.
Marta