Hasn't worked in Tennessee
The National Center for Policy Analysis is wondering why more people don’t look at what happened in Tennessee when they tried to have the state manage their healthcare.
In 1993, Tennessee received a Medicaid waiver that allowed the state to leave Medicaid but use the same federal funds for its own managed care plan. Their plan pulled in nearly 800,000 Medicaid recipients and 300,000 more deemed uninsured or uninsurable.
It was originally set up as a budget measure and just like Obama; they promised more care for less money.
The results of the Tennessee program:
***By 1998, enrollment had grown by 100,000, as employers moved employees into the TennCare system.
***In 1999, a review by Pricewaterhouse-Coopers found that TennCare paid health care providers 10 percent below what would be considered actuarially sound, most hospitals had between 10 and 14 percent of their care delivered as charity care, indigent care or nonreimbursed care and the state's hospitals were being paid about 40 cents on the dollar for TennCare patients, which eventually rose to 64 cents on the dollar.
***Also in 1999, a state audit showed Tennessee was spending $6 million to insure 14,000 dead people, that 16,500 enrollees lived outside the state and that 20 percent were not eligible for the program.
Now, their current governor Phil Bredesen (D) has tried to fix it by limiting prescriptions to five per person per month and limiting the number of doctor visits and days in the hospital. When this didn’t work, by November 2004, he scaled the program down even further with the hope of realizing savings. (Sounds a lot like rationing to me)
Bredesen has called Obamacare the "mother of all unfunded mandates."
Hopefully, the four Blue Dog Democrats from Tennessee, congressmen Bart Gordon, Jim Cooper, Lincoln Davis, and John Tanner, who have already expressed skepticism about the Obama health plan, will speak up about the disastrous system and the rationing of care they have experienced in Tennessee.
More on this can be found from Fred Lucas in the Weekly Standard, August 3, 2009.
In 1993, Tennessee received a Medicaid waiver that allowed the state to leave Medicaid but use the same federal funds for its own managed care plan. Their plan pulled in nearly 800,000 Medicaid recipients and 300,000 more deemed uninsured or uninsurable.
It was originally set up as a budget measure and just like Obama; they promised more care for less money.
The results of the Tennessee program:
***By 1998, enrollment had grown by 100,000, as employers moved employees into the TennCare system.
***In 1999, a review by Pricewaterhouse-Coopers found that TennCare paid health care providers 10 percent below what would be considered actuarially sound, most hospitals had between 10 and 14 percent of their care delivered as charity care, indigent care or nonreimbursed care and the state's hospitals were being paid about 40 cents on the dollar for TennCare patients, which eventually rose to 64 cents on the dollar.
***Also in 1999, a state audit showed Tennessee was spending $6 million to insure 14,000 dead people, that 16,500 enrollees lived outside the state and that 20 percent were not eligible for the program.
Now, their current governor Phil Bredesen (D) has tried to fix it by limiting prescriptions to five per person per month and limiting the number of doctor visits and days in the hospital. When this didn’t work, by November 2004, he scaled the program down even further with the hope of realizing savings. (Sounds a lot like rationing to me)
Bredesen has called Obamacare the "mother of all unfunded mandates."
Hopefully, the four Blue Dog Democrats from Tennessee, congressmen Bart Gordon, Jim Cooper, Lincoln Davis, and John Tanner, who have already expressed skepticism about the Obama health plan, will speak up about the disastrous system and the rationing of care they have experienced in Tennessee.
More on this can be found from Fred Lucas in the Weekly Standard, August 3, 2009.
Labels: healthcare, Obama, tennessee
posted by Anonymous at 5:49 AM
16 Comments:
Do the math. 50 million more insured and "eligible for health care" with no additional doctors has to lead to rationing. Rationing is what is the most scary for senior citizens combined with the "end of life counseling" requirement. Another group that is very frightened by Obamacare are the handicapped and disabled. When rationing occurs, it follows that the government bureaucrats will decide that the elderly and the handicap are "too expensive" and thus health care will be denied to those who most need it.
Why do the Liberals demand this so called "Health Care Reform" when there are so many examples of its failure in Tennessee, Massachusetts, Canada, Europe? I think there are two answers to this question. 1) Liberals are arrogant. They think they can make it work even when it has failed every time it has been tried. 2) This "Health Care Reform" is not a reform movement at all. It is a power grab for the Socialist minded left wing liberals. They want to control everyone's life, spread the wealth around and make everyone dependent on the Democrat Party. The result - the Democrats are in power forever. I, for one, am praying for a Republican Revolution in 2010 and I am praying for this country and that all of the basic freedoms guaranteed by the constitution remain in place.
As is evident in your post, the program in Tennessee was never properly funded. Rather than deal with that directly, however, Bredesen has tried to apply private market rationing strategies, the same ones he used as CEO of HealthCare America, the HMO network he founded.
To indict his strategies is to indict private market health care management. Likewise, as has been pointed out many times over, Medicaid and Medicaid related plans are not an accurate reflection on the public option the government is now discussing, which is much more similar to Medicare.
Medicare has consistently provided higher levels of patient satisfaction than their private market counterparts while spending less per enrollee. This has been accomplished while serving the oldest, sickest portion of our society while not having the advantage of cherry-picking plan participants that private insurers enjoy.
AHEFT shows African American health care has long been rationed by breeding us to limit our lives, so why should we pay for all those boomer pensions we will never benefit from? Afater all, it was the boomer pensions which caused the market to crash.
Medicare is going bankrupt and not properly funded. If they were a private business, they would already be doomed and out of business.
The only reason it isn't is because the government is allowed to spend more than it brings in.
There are many other facts that condradict your claims about Medicare costs, satisfaction and spending levels.
Mr. Malcolm,
Are you really saying that the markets failed because of pension plans. It had nothing to do with bank loans of 110% of the value of homes to people only showing an ID and a couple of pay stubs. Nothing to do with personal choices, overspending and Barney Frank pushing for more and more loans to people who couldnt afford them.
Are you saying that blacks are rationed in their healthcare because of their breeding. That sounds extremely racist. Who is forcing them to breed. What opportunities do they not have that any other american has?
Hey Bluegill,
If it was not "properly funded," that means that it was too expensive. In a Liberal's mind, to "properly fund" some project means to raise taxes. A Liberal has never seen a tax that he didn't like.
I would have bluegill look at this Hudson report and as anon stated: there are many other sites that differ with his statements
http://www.hudson.org/index.cfm?fuseaction=publication_details&id=6392
HB,
There is nothing in the Hudson article that contradicts what I said. Have total Medicare expenditures gone up? Yes, partly as a function of the same pricing that's affected private insurers but also, significantly, as a function of the number of people who've become eligible.
A smaller healthcare plan that covers fewer people isn't more efficient than a larger one that covers more just because it spends less in total.
When one compares apples to apples, i.e., PER ENROLLEE SPENDING, Medicare has done a better job of controlling costs than private insurers while ahcieving higher patient satisfaction rates. In recent years, the gap between Medicare and private insurers has increased, with Medicare on the more efficient side.
That said, Medicare's numbers are calculated based on providing services to the oldest and sickest portion of our country. If that risk pool were expanded to include the younger, generally healthier populations that private insurers serve, Medicare's numbers would be even better.
Unless you want this country to be even more socialistic than it already is you must recognize that government funded health care is insanity, either fiscally or having to deal with its shortcomings medically speaking. How will we handle a budget that continues to grow at the current pace in both Medicare and Social Security? By 2035, it alone will equal our current budget. Government in a free country does not owe anything but protection from enemies on our land, not the Middle East or elsewhere, good highways and bridges and that's about it. Let's decrease the size of the juggernaut federal government and let the free market take care of health care. What we have now is not a free market system either, it is a corporatocracy of the insurance companies.
Hey Bluegill, since you refuse to acknowledge that medicare is broke, tens of trillions of unfunded benefits promised, will you answer the question I posed last week? How much should doctors make? Since they will all be employed by the government or approved clinics, what shuold be the pay? Do not duck the question! You have all the answers.
I'll make you a deal:
If and when you give up both your cowardly anonymity and the reckless use of "facts" like "Since they will all be employed by the government or approved clinics..." that have no basis in reality, I'll be willing to attempt a rational conversation with you.
In the meantime, you could attempt to answer your own question: How much should doctors make? Don't duck it. We need a specific annual salary number.
Using your liberal math and not comparing apples to apples, you continually tout the same talking points as the politicians. This is no different than the statements about 46 million uninsured which is also a myth
Medicare is not less expensive as the Heritage organization clearly points out.
http://www.heritage.org/research/healthcare/wm2505.cfm
Sorry bluegill, I asked first. Twice now.
I am offered anonimity by H.B. His blog, his rules. I know that really chafes you that you don't get to make the rules. Maybe if you're nice H.B. will give you a prescription?
I thought you would duck my question. More and more doctors are not in traditional private practices. I do predict doctors will be directly or indirectly salaried by the gov. I just think it is fair to young people about to be going into the profession that they know how much someone like you think they should be paid.
http://krugman.blogs.nytimes.com/2009/07/06/administrative-costs/
Excerpt:
However, the Congressional Budget Office (CBO) has found that administrative costs under the public Medicare plan are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private plans under Medicare Advantage. This is a near perfect “apples to apples” comparison of administrative costs, because the public Medicare plan and Medicare Advantage plans are operating under similar rules and treating the same population.
(And even these numbers may unduly favor private plans: A recent General Accounting Office report found that in 2006 Medicare Advantage plans spent 83.3 percent of their revenue on medical expenses, with 10.1 percent going to non-medical expenses and 6.6 percent to profits—a 16.7 percent administrative share.)
The CBO study suggests that even in the context of basic insurance reforms, such as guaranteed issue and renewability, private plans’ administrative costs are higher than the administrative costs of public insurance. The experience of private plans within FEHBP carries the same conclusion. Under FEHBP, the administrative costs of Preferred Provider Organizations (PPOs) average 7 percent, not counting the costs of federal agencies to administer enrollment of employees. Health Maintenance Organizations (HMOs) participating in FEHBP have administrative costs of 10 to 12 percent.
I believe it was HB who was using CBO numbers recently to augment his argument. If those numbers are valuable, these must be, too.
Come on bluegill
Your liberal biased author even admits in his paper that they are not competing on the same playing field and he specifically states:
Lower administrative costs and the ability to bargain for lower service and drug prices chiefly explain this advantage, as does the obvious lack of a profit margin in public programs. These features of public insurance not only allow it to offer the same coverage for less than private plans. They also, the evidence suggests, allow it to better restrain the increase in costs over time while preserving inclusive coverage.
So he is stating that there isn’t a profit margin, and they “restrain” costs meaning they eliminate free markets and will mandate everything including salaries etc.
This is not apples for apples and he still hasn’t addressed the amount of fraud and abuse costs that plague medicare far in excess of private insurers because of poor oversight. When you continue to add these things in, Medicare is not cheaper by any means.
Fraud impacts the private market just as much as it does Medicare. The difference is that Medicare is legally required to report it while private insurers, when not directly involved in perpetuating the fraud, just pass the costs along to plan enrollees with no opportunity for public scrutiny or input.
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