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April 03, 2006

Patchwork Care

Kate's penned a terrific post on the elemental confusion and complexity-of-use currently handicapping various low-income government health care programs. For instance, most folks thing Medicaid simply covers the poor. It does not. It covers certain categories of low-income mothers, all low-income pregnant women, some low-income men with families, etc, etc. It relies on more than 28 different categories of people, 21 of whom states have the option to cover (or not), and most of whom are never able to figure out where they fit or if they're eligible. It's a mess of a program that, while fairly efficient as a delivery structure, is poorly designed as a safety net.

But that's because Medicaid wasn't originally supposed to be a health system for low-income folks -- it was for widows, and the disabled, and other categories were added in piecemeal, inconsistent fashion. As for some of the other programs, check out the Healthy Families income chart. If you think that'd make sense to recent immigrants lacking a high school education, well, I applaud your belief in the mutability and adaptability of the human mind.

So yeah, yeah, you know I don't like our health structure. What to do about it? Well, basically, I agree with Kate's conclusions, so you should probably just read her whole thing.

April 3, 2006 | Permalink


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Tracked on Apr 3, 2006 4:23:22 PM


I never hear about ways to cut costs, only how to get others to pay for it. Well, here's a start.


Posted by: Fred Jones | Apr 3, 2006 3:50:35 PM

Since Medicare does not provide for the final year(s) of those many seniors who must enter long-term care facilities near the end of their lives, it is crucial to recognize that Medicaid is the support vehicle that makes long-term care financially viable for these seniors. It is a very substantial part of the total cost of Medicaid to the states and federal government.

Medicaid is a mess, particularly since the feds began allowing the states to 'innovate' in many directions. Now it is impossible to prescribe a general fix for Medicaid issues, since each state's programs are unique in some way - some depending on private insurance companies to administer the programs in a HMO-like fashion. The real error in the progression of Medicaid over the years is the thought that states should run their own programs. The states cannot afford Medicaid as it is, and they are proceeding to redefine it back to No-Medicaid.

It will be very difficult to untangle this mess, even with good faith and strong desire to rationalize the programs. Maybe the right answer is to offer all Medicaid eligibles the chance to join Medicare. The alternative of allowing entry into a FEHBP-like program won't work unless the government supplies the premiums to the various insurance plans that compose FEHBP.

I'm becoming a believer that our patchwork system of finance and administration of health care may not be reformable. Sins of the fathers....

Posted by: JimPortlandOR | Apr 3, 2006 5:12:43 PM

Complete the quote, Jim. You sure you want to wait that long ? (....are visited unto the third and fourth generation)

Posted by: opit | Apr 3, 2006 7:28:36 PM

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