Medicaid (was RE: Walzer on the Left)

Jim Westrich westrich at miser.umass.edu
Wed Mar 27 11:07:45 PST 2002


At 01:34 PM 3/26/02 -0800, Marta Russell wrote:
>Maybe it is on solid foundation politically but look at what is happening.
>Most are aware of the cutbacks in Medicare payments to docs - and the
>physicians now saying they will no longer take Medicare. Well many have
>not for years.

Private payers (managed care organizations) are much more flexible and fluid in changing and adjusting rates than Medicaid and Medicare. There are lags and while it is important that people fight for adequate reimbursement (because unfortunately too many providers respond only to pecuniary incentives), I personally don't think it is a Medicaid/Medicare problem per se. It is a systemic problem with health care delivery and financing.

You point out many of the problems with cutting corners in prescription reimbursement but when private payers do the same thing where is the outrage? Well, the outrage is very diffuse because private payers have generally avoided people with regular and expensive pharmacy needs (most of whom are people classified as disabled--I have data on this for Massachusetts). New Hampshire changed their insurance regulations to allow "waiting periods" for "preexisting conditions" of 18 months! (In other words, people with disabilities stay the hell out).


> As a result some states are just outright slashing health care funding,
> while other states are looking for more flexibility to make tradeoffs in
> benefits and overage. What they mean is RATIONING health care to those
> already on the program. While some states are expanding the numbers of
> people who can qualify for Medicaid they are also planning to cut
> services and benefits to make room for the additional people to be added on.

This is an excellent point. Expanding services for children make the liberals get all warm and fuzzy (don't worry I think it is a good thing) but there is no comparable interest in getting people with disabilities better and more varied services. Getting kids on the rolls means there are lower uninsurance rates without many changes in costs. What is worrisome to me that long-term Medicaid policy for people with disabilities seems to be largely divide and conquer. The divide is largely around work; as states are providing more health care options for those that work (subsidized and public care that is really a break for the employer) and as you mention curtailing options for people with disabilities on "traditional" Medicaid. I am for positive work incentives for people with disabilities up to a point. I am against a "carrot-shaped stick" that leads some to work while clubbing those who do not.

Peace,

Jim

"i write in red ink that turns blue when the book closes"

-Saul WIlliams



More information about the lbo-talk mailing list