Tag Archives: health care

A New Welfare Trap

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This one is in the offing at the State level, and comes as a result of the punitive tax for not buying health coverage was repealed last December.

At least nine states are considering their own versions of a requirement that residents must have health insurance….

And

Maryland lawmakers are pursuing a plan to replace the ACA mandate, which requires most people to pay a penalty if they don’t have coverage. California, Connecticut, Hawaii, Minnesota, New Jersey, Rhode Island, Vermont, and Washington, as well as the District of Columbia, are publicly considering similar ideas.

Notice that.  These are Progressive-Democrat-run states.

The less well off who couldn’t afford either the penalty or the remaining costs—high deductibles, low per centage of plan provider payments even after “coverage” kicked in—under Obamacare still won’t be able to afford mandated coverage in these States.

Beyond that, they won’t be able to leave the State and relocate to one that doesn’t inflict these costs.  Their already limited economic resources are a barrier to such relocation.  Added to that, though, will be the lack of portability of the mandated coverage plans: having been dragooned into one by, say California or DC, they won’t be able to take it with them, even to Connecticut or Minnesota.  Or to a State that doesn’t require them to buy something they don’t want.

Progressive-Democrats really are that desperate to keep their welfare “recipients” trapped in welfare cages. Aside from that bit of self-serving…nonsense…the move also demonstrates the Progressive-Democrats’ utter contempt for us Americans.  We are, their behavior and policies say, just too mind-numbingly stupid to be entrusted with our own choices.  We have to be led by our Betters, forced for our own good, to do certain things.

Working for a Living

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Indiana has joined Kentucky in getting approval to add a work requirement to its Medicaid program (separately: Federal approval should not be a requirement; the program should be a State-run and -funded program only).

Of course, there are objections.

Democrats and consumer groups are decrying the GOP push, saying it is antithetical to Medicaid’s goal of expanding health care.

That’s plainly not true, though (I’ll ignore the conflation of health care with health care coverage).  The push is exactly what’s needed to make health care coverage available to all who want it.  The plan, even as minimal as this one is (the work-related requirement would apply only to a small segment of Indiana’s Medicaid enrollees), will facilitate availability, not limit it.  By making it possible for folks to get off this welfare program and into jobs that can enable them to buy their own coverage—if they want it—it will allow the State’s Medicaid dollars be committed to those who truly need Medicaid because they’re too old, too young, and/or too infirm to get desired coverage on their own.

It’s a Start

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The Centers for Medicare & Medicaid Services has been instructed by President Donald Trump to adjust its rules to allow the States to adjust their own rules to require work for Medicaid payments.

This is a very good start.  There are two remaining steps, though.  The funds transferred to the States in support of Medicaid need to be converted to block grants with no strings attached.  Each State knows its own medical support needs far better than does the Federal government.

The last step is to begin reducing, over a short number of years, the size of those block grants until no funds at all are being sent to the States.  This will get the Feds out of the States’ business, remove an extortion tool from the Feds’ kit which the Feds use to push the States into doing (or not doing) things the Feds demand be done or not done, and it will greatly reduce Federal spending.  In 2016, the Federal government sent almost $350 billion to the States in Medicaid transfers.

The Veteran’s Choice Program

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This is a program that would give veterans the option of going to a private sector doctor in lieu of playing the delay wait game at a Veterans Administration facility, after the veteran has jumped through the requisite VA hoops.  After a political tussle in Congress over increasing/renewing its funding, some additional money was provided.  That additional funding was necessitated because

its popularity depleted the allocated funds more quickly than anticipated. Patient visits through the program increased more than 30% in the first quarter of fiscal year 2017, according to the VA.

Extra points for those of you who can say why the program is so popular.

Despite the success of this limited program, the Progressive-Democrats in Congress want to get rid of it.  Congressman Mark Takano (D, CA), for instance,

argued on the House floor in July that it’s a “mistaken belief that the private sector is better equipped to care for our nation’s veterans than specialized VA doctors.” But while the VA provides high-quality specialized care in certain areas, for the most part veterans’ needs are similar to everyone else’s.

Indeed.  Takano and his fellow Progressive-Democrats just want to maintain control over OPM. It’s a mistaken belief that the private sector cannot care for our nation’s veterans better than specialized VA doctors. As Burgess and Cleland (authors of the piece at the link) note, mostly our veterans’ needs are similar to everyone else’s.

Those few specialized needs unique to a veteran’s particular military history? The VA’s specialists, functioning in the private sector, can deal with those at least as well as they do now, and probably better and faster without the VA’s bureaucratic impediments.

Make the Veteran’s Choice Program functionally universal: privatize the VA, and use its current and what would have been its future budgets for veterans’ vouchers.

Veteranos Administratio delende est.

Death Panels?

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The Affordable Care Act required Medicare to penalize hospitals with high numbers of heart failure patients who returned for treatment shortly after discharge. New research shows that penalty was associated with fewer readmissions, but also higher rates of death among that patient group.

Because sometimes readmission is necessary for quality care—whether that readmission was driven by later complications, by too-soon original discharge in the Medicare (which is to say Government) pressure to hold down costs first, or by some other factor—but that Government pressure to push the patient out the door also pushes against the patient’s return.  Even when necessary.

Here are a couple of numbers from a study soon to be published in JAMA Cardiology:

One in five heart failure patients returned to the hospital within 30 days before the ACA passed. That dropped to 18.4% after the penalties. Mortality rates increased from 7.2% before the ACA to 8.6% after the penalties….

In other words, an 8% drop in readmissions is associated with a 19% rise in death rates for heart patients.  That’s not a favorable trade-off.

There is a legitimate interest in improving the quality of care for all patients, including those for whose care us taxpayers are paying, but readmission rate is not an accurate measure of that quality.  Readmission rate can only measure…readmission rate.  That metric addresses neither the reasons for readmission nor the reasons for the prior discharge.

Government pressure to hold down readmissions doesn’t quite amount to death panels, but the outcomes seem dismayingly similar.  To be clear, the results of the study do not establish a causal relationship, for heart patients, between the lowered readmission rate and the higher death rate.  However, the magnitude of the apparent association between the two desperately wants further investigation.