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Medicaid will break the bank of state government if we don’t do something. And it has been interesting to watch the two political parties in Arkansas as they react to that largely undisputed assertion.

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Editorial, Pages 15 on 03/20/2012

Print Headline: Medicaid and consequences

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Archived Comments

  • jericho77
    March 20, 2012 at 6:57 a.m.

    Let's be clear that Beebe's and other policymakers' approach is about accountability for coordinated, efficient, and quality care; it's not about reducing pay to providers. Costs are benchmarked (looking retrospectively, I might add, such that providers are paid the same as they are now), and if a certain percentage of episodes do not meet the benchmark (with an evidence base of historical costs), then those costs are disallowed. If you look at the numbers, there are high cost providers with poor outcomes; there are low cost providers with great outcomes. This means, of course, there are inefficiencies that when disincentivized can be corrected with the right incentives. The episode-based piece is the more lightning rod piece of the reform, but there is a population-based piece of all of this reform as well, incentivizing primary care providers to proactively manage the preventive care and chronic diseases of patients in their population. The idea is to prevent those acute episodes from happening. Perhaps the most consistently ignored piece of this burgeoning political discussion is that private insurers are bought into this approach. How conveniently that has been ignored! So sure, let's instead cut services and the rolls and go to a fully-capitated managed care system. I'll be anxious to know how Sen. "ridiculous" Irvin's husband's practice will survive in that system, when ALL the risk of his patient panel is transferred to him.

  • Whippersnapper
    March 20, 2012 at 7:20 a.m.

    Democratic solution = government price controls. How does that ALWAYS end up? Oh yeah, it reduces the supply of whatever is being controlled and folks face shortages. Mike Beebe is going to do for health care what Jimmy Carter did for gasoline in the 70s. (and for anyone who thinks we ought to impose a "windfall profits tax" on "big oil", that's another wonderful Jimmy Carter idea)

  • suffernofools
    March 20, 2012 at 7:29 a.m.

    John, won't some ARKids families, sooner than later, qualify for the subsidized insurance pools via the Obama-cares legislation? I don't see that factor mentioned in news stories.

  • Whippersnapper
    March 20, 2012 at 8:57 a.m.

    suffernofools says... March 20, 2012 at 7:29 a.m.
    "John, won't some ARKids families, sooner than later, qualify for the subsidized insurance pools via the Obama-cares legislation? I don't see that factor mentioned in news stories."
    Everybody with a clue knows that Obamacare will be thrown out by the courts. The government themselves have stated in court filings that the "individual mandate" is the key to making the whole thing work and when that is tossed, the whole thing will go with it. No state is going to pin their hopes on that fatally flawed piece of work - folks like Beebe will propose their own fatally flawed pieces of work.

  • johnnyray1004sbcglobalnet
    March 20, 2012 at 9:21 a.m.

    jericho77: i appreciate your obviously well-informed input, but i must admit to you that, after all these decades of covering government and politics, there are some basic programmatic things i still do not grasp. how are we saving money on medicaid through bundling for episodic care if providers are held harmless and still getting the same amount of money? i hate to be a simpleton that way. really. i'm serious. i get the emphasis on prevention and outcomes. i think what you are saying is that there are benchmarks at least equal to today's reimbursements, but, if you exceed them, you'll not be fully reimbursed. right? in other words, get the care delivered without waste and with an expeditously achieved favorable outcome, and get your usual money, right? ok. still my short answer -- the basic truth applicable to readers -- is that we would be reducing medicaid payments by reducing what we send to providers, macro speaking. or not? maybe i should have mastered this before i wrote a column.

  • suffernofools
    March 20, 2012 at 10:50 a.m.

    Whipper, I agree that it will be a hard call for the justices. However, there are other government mandates that come close to what Obama-cares demands, such as paying taxes, getting drivers licenses, auto insurance etc. Now I know the difference, you don't have to get a license and insurance if you don't drive. However, I think the court will be persuaded by this argument: That everyone, eventually needs health care, and that they generally get it when beset by disease or accident, but that others have to pay when others willfully go uninsured. We'll see. Should be tremendously interesting court debate. John, I wasn't being facetious. Should not many ARKids families end up in the insurance pool and off Medicaid, or am I missing something?

  • Whippersnapper
    March 20, 2012 at 12:03 p.m.

    I think the court will be persuaded by this argument: If the government is permitted to force every American to buy Health Insurance, there is no limit to what the government can force citizens to do. Government attorneys who were asked that question in hearings couldn't come up with the answer to what the limit would then be. I think that will doom the bill.

  • suffernofools
    March 20, 2012 at 12:35 p.m.

    Well, when we had the draft, the government could force people to run uphill into machine-gun fire. Even with a volunteer force, some servicemen are forced to re-up and do more war tours. They have a name for it, Stop-loss. Ever read Catch-22? If you haven't it's a great novel.

  • Lifelonglearner
    March 20, 2012 at 1:01 p.m.

    Well, John, you have again done a good job stirring up intelligent discussion. Like most political questions, such as taxes and benefits, it is all goes back to who really pays and who really gets the most money/benefits. As far as being mandated to have insurance, the selectively conservatives have not problem with forcing a woman who has been raped being mandated to keep and raise the child without any assistance from them. How about a mandatory adoption program for all married couples? There are almost 200 Arkansas children in foster care. How about a mandatory DNA registry for males to determine responsibility for pregnancy? There would be mandatory options of (1) Marriage (2) Child support, income replacement and medical care (3) Vasectomy. Oh, wait, that would infringe on male privacy rights.

  • Jackabbott
    March 20, 2012 at 1:28 p.m.

    This is a tough situation. Beebe is probably headed in the right direction. But the program needs to be analyzed to determine who is really benefiting from the current system. The disabled and minors belong in the program but able bodied persons who do not have a work history should be placed in a separate category with a partial loan program that they will re-pay once employed and a term limit. Also the program was never intended for the children of illegals and if the current immigration racket continues it will eat this program alive. Many of these policies are inter-related and have adverse consequences for the rest of society.
    Providers should be required to competitively bid on the services and required to be auditited annually for over-runs, scams and outright fraud.
    More broadly, the Reagan era pustch of trickle down-voo doo economics continues to have negative consequences for the USA. All of the recent Presidents have continued to push these failed economic policies that have profundly transformed the USA from a creditor nation to a debtor one, from a manufacturing and productive one to a service, consumer oriented one, from an fairly equal and stable distribution of income to one that directs most of the loot to the 1% or to China, Mexico and other foreign countries and entities. From one where immigrants came to look for opportunity and freedom to ones that sneak across the border or whatever and become adept in navigating our welfare, charitable and legal institutions.
    Want some examples: Arkansas has lost control of its natural energy sources, production and distribution to either Texas based companies or foreign countries, getting over-priced and gouged in the "exchange". Manufacturing companies like Whirpool move their operations to Mexico and we open the doors and our tax revenue base to illegals.

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