Posted by
John R. LaPlante on Thursday, October 12, 2006 3:42:24 PM
Note: This is one of a series of observations from the Education Reform Summit / Annual Meeting of the State Policy Network, held in Milwaukee during the week of October 2.
It’s easy to get discouraged when thinking about health care policy. The expansion of government programs, while perhaps well meaning, crowds out the private sector. Programs meant for the needy have become thought of as a middle-class entitlement, and sizable budgets are growing even larger.
Yet there are some interesting and even worthwhile experiments going on in the states, which could have significant benefits for taxpayers, service providers, and people in need of care.
Kentucky, for example, is moving towards demanding co-pays for emergency room visits, something that one panelist called “an excellent idea.” Does that sound harsh? Consider that when people use ER visits as a substitute for ordinary office visits, the extra and unnecessary costs are borne by everyone. The idea behind co-pays is not to reap extra revenue—the amount is likely to be insignificant compared with the state budget for Medicaid—but to get people to become smarter users of what is, admittedly, someone else’s money.
South Carolina, meanwhile, is introducing health savings accounts for some groups of Medicaid beneficiaries. (Now might be a good time to point out that Medicaid serves four very different group of people: the mentally retarded and developmentally disabled; those in need of long term care such as nursing home residence; S-CHIP, or children; and the general population. Reforms that work for one group won’t necessarily work for another.)
South Carolina will also use a bidding system for long-term care beds in nursing homes, rather than using a “cost-plus” formula.
Florida will be offering some people in Medicaid 13 different plans to choose from—more than many people with employer-based coverage have. Health care providers will be given risk-adjusted payments, meaning that managed care organizations will get more money for taking on AIDS patients or children with difficult-to-treat diseases than they would for nearly healthy individuals. The state also will pay people for healthy behavior, on the theory that doing so will save taxpayer funds and result in healthier lives.
One panelist said that changes to public programs is like welfare reform: the innovations are coming from a few states, and are percolating up to the federal government, and to other states. There is still too much that is too wrong about Medicaid and other state programs, and advocates of less government and more freedom will have legitimate differences in opinion on strategy and even philosophy. But change is inevitable, and it’s happening already.