Text 23683, 104 rader
Skriven 2006-10-09 16:51:10 av Alan Hess
Ärende: Fix Medicaid
====================
Certainly, Medicaid needs fixing.  
*****


http://www.baltimoresun.com/news/opinion/oped/bal-op.medicaid09oct09,0,4582067
.story?coll=bal-oped-headlines

From the Baltimore Sun
Fight Medicaid monster, not Wal-Mart


By John R. Graham

October 9, 2006

This summer, a federal court overturned Maryland's so-called Fair Share Health
Care law. This law would have forced large employers, primarily Wal-Mart, to
spend at least 8 percent of their payrolls on health care or contribute an
equal amount to Maryland Medicaid. This wrongheaded bill arose from the notion
that Wal-Mart relies on Medicaid to provide health care to many of its
employees, thus forcing other taxpayers to subsidize its labor costs.

Medicaid spending is indeed out of control, but it's not because companies such
as Wal-Mart are abusing it. Rather, it's because the program gives politicians
an incentive to overspend. Medicaid, which is paid out of state and federal
taxes, perversely encourages all states to spend more, regardless of how useful
those dollars may be. That's because the law requires the federal government to
match each state's Medicaid funding. When Maryland spends an extra dollar on
Medicaid, the federal government is required to pitch in a matching dollar -
and there is nothing Congress can do to stop it.

This is profoundly undemocratic. The federal legislature has little control
over how federal taxes are spent on Medicaid, and each state legislature can
effectively tax the 49 other states without their consent. The results are both
predictable and appalling.

National Medicaid spending amounts to more than $300 billion a year, up more
than 50 percent in the last five years. The program now affects more than 50
million Americans - more than one in six. The Congressional Budget Office
projects that without major surgery, the cost of Medicaid will nearly double by
2012.

According to data from the Centers for Medicare and Medicaid Services in
Baltimore, the average American spent (adjusted for inflation) almost five
times as much on private health care in 2004 as in 1967. The amount contributed
to Medicaid, however, shot up by 14 times, even though there has not been a big
increase in the number of poor people. From 1970 to 2003, the number of people
living below the poverty line went from 12.5 percent to 12.6 percent.

Meanwhile, the number of seniors grew from 9.9 percent of the population to 12
percent, a significant jump. Yet Medicaid is even outpacing Medicare, the
health program for senior citizens. While Medicaid spending went up
fourteen-fold, spending on Medicare increased by less than 10 times.

It's easy for states to succumb to the spending bug, because federal law
divides Medicaid recipients and services into "mandatory" and "optional"
groups. So, states have reached out to enroll "optional" patients with
"optional" illnesses. As a result, optional coverage is now the norm. Only 39
percent of Medicaid spending in 2001 was on mandatory coverage.

Indeed, about 12 percent of adults who are enrolled in Medicaid also have
access to employer-sponsored health insurance.

Ironically, Maryland's Fair Share law would have made this worse. For every
Wal-Mart employee earning $20,000 who did not receive health benefits from the
company, Fair Share would have levied a surtax of $1,600, payable to Maryland
Medicaid.

However, this would have automatically pulled in another $1,600 from the
federal government - which would have increased the incentive for employees to
stay on (or move to) Medicaid rather than seek good private health insurance.

As such, bashing Wal-Mart with the Fair Share law would not have made either
individuals or employers more responsible for health care.

The solution to controlling Medicaid costs lies in restructuring how we pay for
it by removing automatic federal matching payments. Instead of matching the
states, no matter what they spend, Washington should give them an annual
Medicaid lump sum based on the number of residents in the state. Calculating
this figure is straightforward arithmetic.

This simple spending reform would eliminate the incentive for states to
increase Medicaid spending, heedless of the cost. Alongside this, the federal
government could greatly increase the freedom of states to innovate in how they
deliver Medicaid.

The current Medicaid bureaucracy is extremely burdensome, because even the
smallest reforms (at the county level) have to be federally approved. This
regulatory nightmare is an attempt to control spending - but it's obviously a
failure.

With spending reform, the need for this bureaucracy would diminish. Once state
politicians were forced to make more fiscally responsible choices about how to
allocate Medicaid money, we could expect a flourishing of Medicaid reforms that
would save taxpayers money and improve individuals' health insurance choices -
without punishing employers such as Wal-Mart.

John R. Graham is director of health care studies at the Pacific Research
Institute. His e-mail is jgraham@pacificresearch.org.

Copyright + 2006, The Baltimore Sun | Get Sun home delivery

--- Msged/2 6.0.1
 * Origin: tncbbs.no-ip.com - Try the CROSSFIRE echo - all welcome (1:261/1000)