A POOR SOLUTION

I would call attention to the  extremely thoughtful commentaries  relating to my past 2 blogs. Many, if you have not read them, are worth going back and reviewing.


That said, I had intended to opine on the role of unions, in both the private and government sectors, in today's economic world. Suffice to say, there should be a place and that must be addressed later. For the present my attention has been focused on the Medicaid issue especially in New Jersey, as one of the two main causes of our state monetary crisis. Health care and pension funding along with wages  represent the biggest expenditures in municipality's budgets.


This quote is from the CNJGM posting to which Bernice provided a link  Saturday:.
 '"At the state level, the largest cost drivers in the budget are school aid, public employee pensions  and health benefits, and Medicaid. For the past two years, the Medicaid program has benefited from 
the availability of federal stimulus funds to support New Jersey‟s obligations. Continuation of federal stimulus funds for Medicaid is not an option as they have been eliminated. The state‟s widely documented unfunded liabilities – underfunding of the public
employee pension and health benefits systems – represents perhaps the most significant fiscalchallenge to our future". CNJGM

The  proposed Medicaid reforms impact on an issue that deeply concerns me; "The Affordable Health Care Act". The well intentioned pen pushers "do-gooders" have substituted quantity  for quality. There is no way  this nation or any nation can afford what is promised in the act without strictly limiting accessibility to certain treatments, medications, or facilities. No where is that in greater evidence than in the Medicaid program.

The fact is that Medicaid is a program that is not solely funded at the federal level. States provide up to half of the funding for the Medicaid program. In some states, counties also contribute funds. The States decide the benefit programs other than Federally mandated. Up to now States do not have to participate. 


From what I can gather the State wishes to farm its program out to a "Managed Care Provider". Money is expected to be saved by giving "Medicaid" more direct control over spending:.  From the CN article (Bold Face mine);"Seek federal approval to create programs with wellness and prevention incentives and give people in Medicaid more direct control over health spending" That in  essence is allowing the payer not the professional to decide what type care or diagnostic studies are to be done.

Equivalency does not denote equality. Thus an older therapy or outdated diagnostic study may be allowed rather than "the state of the art".  Use of generic drugs means that they are older and the term "equivalent therapeutic value) does not mean that are as effective as newer proprietary medications. By the time it is found that there is a poor response irreparable damage may have occurred.


Some of the suggested reforms as quoted from the CN article: (Bold Face mine)
  "Move roughly 121,000 aged, blind and disabled Medicare recipients into managed care for both medical visits and prescription coverage, saving $41 million by requiring the use of less expensive drugs and treatments." That in is stating that these individuals have less value than the rest of society and should be treated accordingly. A slow version of the Nazi's solution


"Cut state reimbursements to nursing homes by 3 percent, saving $25 million."
and "Eliminate $7.5 million in payments to nursing homes for holding patients' beds open for 10 days when they leave a facility, as required, in case they return."  Consider the effect of these two reforms; The "nursing homes" already have trouble surviving when dependent on Medicaid with out cutting corners on services. With less funding they will reduce staff to a  bare minimum and all other services including dietary will suffer. The second measure means that if a patient is admitted to a hospital the nursing home will use the b ed for a new patient to prevent  a ten day loss of revenue. The patient may then  go to another less desirable facility. 

"Increase anti-fraud enforcement efforts by the Comptroller's Office, including buying new equipment and hiring more auditors, saving $35 million." This is essential and part of the problem lies in the fact that unless fraud is gross little attention is paid to the small dollar siphoning of funds. To many dollars  have been lost to Medicaid and Medicare from actions  of unscrupulous vendors. This includes as noted in recent articles charges by units of the University of New Jersey Medical units, other hospitals,  nursing homes , pharmacists, physicians etc. If one is without conscience any thing goes.

The Medicaid program is truly "Between a rock and a hard place, a dilemma; a situation offering at least two possibilities, none of which are acceptable"(Wikipedia). It would be nice to include every even the undocumented who fall below a certain income level into a universal heath care plan. However it is economically untenable without sever rationing of services. There is going to have to be some unfortunate compromises made. Inferior quality for quantity's sake is not acceptable.