Only Three Ways to Fix Medicaid

I was listening to a newscast discussing Medicaid and the ‘reality’ that politicians must confront in dealing with the situation that it is on critical life support. Without the proper corrective action, the prognosis for Medicaid is it will be economically terminal if it isn’t already. The topic under discussion was how an out-of-pocket cap would impact Medicaid. In addressing the situation the interviewee indicated that there were only three options available to politicians:

1. Cut back on who is eligible
2. Cut back on what is covered
3. Cut back on how much doctors/facilities are paid

The assessment was that changing eligibility is a non-starter because it doesn’t sell well for politicians when they say they’re going to prevent poor people from receiving health care. Not to mention that what will happen anyway is that you will drive more people to emergency rooms which will cost even more and degrade service for those who really need an emergency room. You know those people who might include you. This does come close to being labeled with a ‘death panel’ like tag.

 

The option of cutting back on what is covered is used a little, but it’s really hard to stand-up and say that you want to restrict, limit and prevent the needy; particularly the sick needy from getting the care that they require. It won’t be called a restriction, limit or barring of access; it will be called rationing. And for most politicians the prospect of being the one who wants to ‘ration’ health care is not a banner they want to carry; particularly those who spoke out against any other plan that they insisted was going to ration health care. When you erect a building, you sometimes have to live it its shadow.

 

So this leaves the punting option. If you are to cowardly to step up to either of the first two, you must go with the make someone else do it. It won’t work of course, because it’s the typical solution that politicians come up with. It’s simple: that means that they don’t know what they’re doing. It’s easy: that means that they haven’t considered or figured out the consequences, again they don’t know what they are doing. And, it’s cheap: which means they haven’t added the costs that will be generated because …, you know the rest.

 

But wait! Are there just these three options? Perhaps the politicians and their advisors and policy wonks have missed something. This may seem impossible for the ‘best and brightest’, after all the problems of Medicaid are well understood and have been around for quite a while. They’ve had the time to examine it, to analyze it, and to create any number of solutions to the issue. So these must be the only options; but they’re not.

 

A number of State Governors say they could fix the Medicaid problem in their state if they were given the funding but relieved of the federal restrictions. So they must know the solution. But do you really think they have a solution, or they are just going to mix and match the original three? They’ll do it discreetly of course.

 

But why has no one proposed the competitive option, or the reward option, or the evolutionary option?

 

The answer is that they don’t understand how to solve a problem by using the health care system, they are fixated on the same old “we’re in charge, and we have decided how to fix the problem we caused to start with”. Maybe if the politicians just accepted that they don’t know what to do, how to do it, and why it work then they could turn to solving the one problem that they might, just might, be able to handle. Find someone who can.

 

Well, since it’s not their money; why should they care?