Posted on 08/01/2005 12:42:18 AM PDT by FairOpinion
Critics say Gov. Schwarzenegger's proposal to move over a half-million patients into managed care won't save money.
Gov. Arnold Schwarzenegger's complex deal with the federal government over Medi-Cal funding includes a move the state Legislature rejected once before -- moving more than a half-million aged, blind and disabled people into managed care.
The administration sees putting those people into HMOs as a crucial piece of an overhaul aimed at curbing soaring costs of the program, known as Medicaid in other states. The groups to be moved account for a quarter of Medi-Cal beneficiaries but 53 percent of expenditures.
Critics, however, fear the huge number of patients involved in the switch will create widespread disruption of health care without any savings.
"If you have a wholesale moving ... we're going to have people fall through the cracks, not get care and die because of the sheer numbers," said Patricia Yeager, executive director of the California Foundation for Independent Living Centers.
At least 14 other states have managed care for some Medicaid recipients.
Michigan's decade-old program is considered a success, even though costs keep rising because of increasing health expenses and enrollment, officials said. Most of the 1.45 million Medicaid recipients in the state are in managed care.
"We've still been able to ensure adequate care ... but we've been able to do it in a cost-conscious way," said T.J. Bucholz, spokesman for the Michigan Department of Community Health.
Washington state tried in the late 1990s to move its disabled population into managed care but ended the effort after a year.
"Clients said they weren't getting enough money and providers, and advocates said there weren't enough services," said Doug Porter of the state Department of Social and Health Services.
In California, Medi-Cal currently provides a mix of managed care and fee-for-service. Under managed care, the state government pays HMOs and eight county-run systems to provide health services in much the same way privately insured people obtain it, with similar limitations on whom patients can see.
Fee-for-service involves government reimbursement of hospitals and doctors who bill on a case-by-case basis. There are no restrictions on whom patients can see, but they often must locate specialists themselves.
George Sharp, 32, a quadriplegic and paid activist for the nonprofit Disability Resource Agency for Independent Living of Modesto, is now under the fee-for-service plan. He's concerned that managed care won't provide access to the neurologist he has seen for nearly 20 years.
"That's my fear," he said. "I probably wouldn't go see another doctor. I am very comfortable with my doctor that I'm seeing right now. He knows what I need. He knows my situation."
Sharp also worries that he might have to wait longer for medical equipment, such as his $20,000 wheelchair.
"Without my wheelchair, I'm stuck in bed," he said.
Blue Cross of California, which currently has 35,000 aged, blind and disabled Medi-Cal members, is confident it could handle more patients.
"All of our programs are based on our members' needs. So if we needed to ramp up more services ... we would do that," spokeswoman Kellie Bernell said.
The federal government wants the state Legislature to accept the new Medi-Cal program by Sept. 7 or risk losing as much as $180 million in funding, said Stan Rosenstein, deputy director of medical care services for the Department of Health Services.
The actual switch to managed care wouldn't begin until January 2007. Three of the largest counties -- Los Angeles, San Bernardino and Riverside -- would make the shift over the course of a year. Other counties would follow.
State health officials said that would be enough time to make the changes properly, and no one would have to leave their current doctor until the state has contracted with an HMO in their area.
"It will be a challenge, but it's a well planned-out challenge," Rosenstein said. "There's not going to be a rushed effort."
Some legislators have their doubts. In May, worries about planning and availability of specialists led lawmakers to reject the first switchover proposed by Schwarzenegger.
"It wouldn't be wise to rush into a proposal that isn't going to work," said Wilma Chan, D-Oakland, who chairs the Assembly Committee on Health.
A change to managed care in Orange County a decade ago led to a budget deficit for the agency that administers the Medi-Cal plan. Known as CalOptima, the agency said it now spends a monthly average of about $400 a person on its 85,000 elderly and disabled patients while receiving only $375 for each member in monthly Medi-Cal payments. Reserve funds are used to make up the deficit.
1. They should eliminate the BILLIONs of fraud that is in the system FIRST.
2. Pushing people into HMO-s does NOT save money, it's just a different set of people make money at the expense of the patients.
3. By SELECTING the group of people to be put into HMO-s, as "the elderly, blind and disabled", who comprise only a quarter of all the people on Medical, they are making a decision based on the "useless eater theory". Why should we be paying for medical care for people who are "better off dead anyway".
4. Why not demand proof of legal status and citizenship and push ILLEGAL aliens into HMO-s?
5. If they want to restructure the program, to have people pay small co-payments, enough so they can afford it, but it may keep them from going to see the doctor unnecessarily, may be one possibility.
But there is just something wrong with limiting medical care based on "useless eaters" approach, while providing unlimited medical care to the illegals.
Medi-Care is hardly unlimited itself. It should not be the job of taxpayers to be the provider of first resort
Not that I disagree with you or anything like that =o)
"It should not be the job of taxpayers to be the provider of first resort"
I agree with you.
The entire system should be overhauled and mostly eliminated and replaced by private insurance.
And as I said, crack down on fraud.
"Local leaders: Crack down on Medicaid fraud
Story text size
N.Y. may be losing up to 40% of what it spends on program, report says
A published report suggests New York state’s Medicaid program may be losing billions of dollars every year to fraud and abuse, and local officials agreed that crackdowns are needed."
http://www.thedailystar.com/news/stories/2005/07/25/medicaid1.html
This is frightening. HMOs stay viable by rationing healthcare. Those who need it most will not get it. This is the first step on the slippery slope to forced euthanasia.
"This is the first step on the slippery slope to forced euthanasia."
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Exactly. First the poor elderly and disabled, then after the "success" they will do the same for ALL elderly and disabled.
Just recently in the UK there was a court ruling that the doctors CAN stop providing food and water to terminally ill patients, who "will not get well" and pretty soon will apply to people with heart disease, diabetes, etc.
People will be treated like horses: break a leg, get sick, they shoot you.
Does anyone remember the show from the late 70s or early 80s named Logan's Run? Lately every day I read the news I think about it.
I didn't see Logan's Run, but I remember a StarTrack episode, where some alien race had a law, that when people reached age 60, they were killed. I forgot what PC word they used, but that was what it was, and of course it was mandatory, no exception. I guess that would take care of social security and medicare spending here too.
To even suggest killing people who reach a certain age is barbaric, how old are you?
STOP giving freebies to illegals first than get the lazy bums off medicaid next who shouldn't be on it to begin with like dope addicts.
The majority on medicaid are preemies who's parents put the newborn on medicaid from the moment they are born, should they be allowed to die as well? Most of these preemies will grow to be disabled the rest of their lives.
Leave the elderly alone they will die off soon enough but preemies live 60-70 years on medicaid so according to all of you they should not be saved at all is that correct?
They're already doing this in MA. Unless you have insurance and cash to pay for expensive procedures, they aren't offered to the elderly. The reason usually given is, well, they're old, and it would only extend life a few more years; besides, we can manage the condition pretty well with meds.
umm, this is more like the first step this month.
I think it depends on the HMO. I am currently in the process of being put on the list for a kidney transplant, and my HMO has been wonderful.
As far as "rationing healthcare", that is technically correct. However, when people view their healthcare coverage as an unlimited resource, then rationing becomes necessary. I don't think it really has anything to do with "forced euthanasia".
"To even suggest killing people who reach a certain age is barbaric, how old are you? "
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I think you misunderstood. I totally agree with you. It is barbaric.
My point was that at the rate we are going in that direction, it may actually happen. It won't be done quite that way, but slowly they are withholding more and more medical care from those "they" deem "useless", then comes euthanesia, and again, our society, tending towards barbaric, will decide whose lives will be worth living or not.
Thanks for the clarification. Sad isn't it when something like that is even suggested by a civilized nation.
I agree something has to be done and the first step is get all illegals off of the program.
Unfortunately, they are taking things away from those who can't fight back, "divide and conquer", they are doing it incrementally, one group at a time, starting with groups that unfortunately most people don't care about, because it never occurs to them, that "only by the grace of God, go I" and it could be them or one of their relatives that this is being done to.
I read somewhere that they found some evidence that cave men were providing food and shelter to those, who were disabled, and weren't able to hunt themselves. It seems like they had compassion, which in today's society we are losing.
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