Saturday, June 24, 2017

Bill Crawford: Consensus needed on Medicaid

"It is the obvious which is so difficult to see most of the time," wrote Isaac Asimov. "People say 'It's as plain as the nose on your face.' But how much of the nose on your face can you see, unless someone holds a mirror up to you?"


A conservative Republican legislator, speaking about Medicaid cuts, shared this perspective with Mississippi Hospital Association members, "some don't think government should be involved in health care at all."

Prominent social conservatives like Gary Bauer also reflect this notion. While "liberals have traditionally been seen as standing up for the weak and the vulnerable," said Bauer, "conservatives can be just as empathetic. But they believe that, in most cases, it's not government's role to be the primary dispenser of empathy."

Other conservative mirrors, however, reflect a different perspective. As C. S. Lewis wrote, “For what you see and hear depends a good deal on where you are standing: it also depends on what sort of person you are.”

Even Mississippi's old 1890 Constitution reflects a role for government in caring for the insane, indigent, and "those persons who, by reason of age, infirmity, or misfortune, may have claims upon the sympathy and aid of society." (See Sections 86 and 262).

Sen. Roger Wicker appears to support an active role rather than no role. Last week he told MSNBC, the Senate is working to give the 50 states greater say in how Medicaid works, "while also preserving the system that was meant to protect poor children and disabled people."

Wicker's perspective no doubt reflects that of most Mississippi conservatives. Turns out lots of them have elderly relatives in Medicaid funded long-term care facilities. This includes many not-so-poor conservatives who pragmatically move nursing home costs to Medicaid by transferring their elders' assets to other family members.

"Our country is great because it is built on principles of self-reliance, opportunity, innovation, and compassion for others," reflected Ronald Reagan.

It was Reagan who, in 1986, created one of the most intrusive roles of government in health care. He signed the Emergency Medical Treatment and Active Labor Act (EMTALA) that requires all hospitals that accept Medicare and Medicaid payments to provide people emergency room care "regardless of ability to pay."

Missing in action are social conservatives willing to undo the government's intrusive EMTALA dictates, despite the abusive and costly use of emergency rooms by patients with no emergency medical conditions.

Also missing in action are conservatives willing to have government pay for the free care EMTALA requires hospitals to provide, which puts many Mississippi hospitals in financial jeopardy.

This was particularly evident last week when Gov. Phil Bryant's Division of Medicaid ignored Mississippi hospitals' proposal to provide managed care for Medicaid recipients, a proposal designed to keep money in Mississippi to help offset losses from uncompensated care. Instead, millions in fees for Mississippi Medicaid managed care will continue to flow to out-of-state vendors.

While most may join with Reagan and Wicker in seeing an active role for government in health care, our state and nation are far from a consensus perspective, especially regarding Medicaid.

Crawford is a syndicated columnist from Meridian (crawfolk@gmail.com)

25 comments:

Anonymous said...

As I was reading along, I knew full well that, before long, I'd come to your snarky comments about 'transferring assets to qualify an elderly person for medicaid'. And I was right.

But, let me ask: If the government can write regulations that allow it to seize my assets through taxation for the transfer to others who do not work....why should I not take advantage of the regulation that allows me to transfer my mother's $75,000 house to me to keep the government from seizing it?

I guarantee you she and I have paid way more in taxes (that wind up being transferred to the slothful) than the value of a few assets she might transfer to me.

Anonymous said...

All liberals, all progressives, most independents, most columnists and even a few conservatives fail to realize that neither the constitution, the Bible nor Ronald Reagan require that we provide for the slothful, those unwilling to pull the wagon or the able bodied who stand with their hands out.

I recognize rain, so, quit pissing on my leg and find yourself a fire hydrant.

Anonymous said...

It seems to be a common argument that medicaid is stealing money from taxpayers pockets and giving it to lazy dead beats. I think most people fail to realize a large portion of beneficiaries are children and those with disabilities. I'm a working taxpayer with private insurance through my work but my 1 year old son is a medicaid recipient, not based on income but based on disability. The private insurance picks up the bills first but there are many expenses and therapies that private insurance doesn't cover. These treatments and therapies are expensive and even though I have a well paying job I would struggle to afford them without medicaid. The significant cuts to medicaid being proposed by congress will certainly harm health care for my son and those in similar or worse situations. I just wish people would really understand what cutting medicaid means.

Anonymous said...

3:19, I along with I am sure many others, are sorry about your son's situation. But on the other side of the scale, I just received my personal diagnosis of a disease that will require significant, long-term treatment, most of which will not be covered by my Medicare - Medicare for which I paid into the system for 46 years. Is there a difference for why I should have to pay for these expenses, therapies and treatments that are beyond what my current insurance (Medicare) covers while you get the benefit of my helping pay for your son's?

I guess I am somewhat lucky - many years ago I was talked into buying a Long Term Care Insurance Policy that I have continued even through the disaster economic years when paying the premium was a real bitch. Because of that, I don't have to cheat the system like 2:27 proposes in order to let you pay for my future nursing home costs and I can liquidate my (paid for) house in order to pay my upcoming medical bills.

In retrospect, guess I really messed up. Paid taxes for all those years, paid into Medicare, and bought LTCI. Now I get to pay for the nursing home costs of 2:27's mother and the treatment costs of your son.

Anonymous said...

4:42...I am 2:27. Retrospect my ass! I don't advocate 'cheating any system'. Please explain how you think I do or did.

'The System' clearly allows for a person to transfer his or her assets to others five or more years prior to applying for medicaid to cover a nursing home stay. I'm not sure how you equate this with 'cheating' any system.

Just as you are sorry about the condition of the other poster's son, I am sorry about your medical condition. However, there is no need for you to bitch about the law that allows me to place my mother in a nursing home on Medicaid. She worked forty years as a public school teacher and no doubt covered her expenses and yours through taxes of various sorts during that period. If she did not, I damned sure have. And if you think neither of us did, then consider that my military-retired dad did who paid into the system for many years and never drew a god damned dime prior to his untimely death.

Anonymous said...

I think most people fail to realize a large portion of beneficiaries are children and those with disabilities.

What percentage?

Anonymous said...

60% of the people on Medicaid in Mississippi are children. The second highest category are the permanently disabled and elderly (who need lifetime care). The smallest group are the unemployed.

Anonymous said...

5:51, I'll call your bet and double down. My mother was a public school teacher as well, and my WWII military veteran (Pacific Theater) dad didn't live until retirement but paid plenty into the system up until then. So he didn't collect a penny (without the adjective) either. And my mother - who had the option of transferring her house before she died in her 80's chose not to do so.

I realize that the law provides what you claim it allows, but that doesn't mean that it was designed to be abused in that manner. I'm glad you feel good about having current taxpayers paying the cost of your mother's retirement years - I just grew up with a different ethic.

You are certainly entitled to your opinion, but that doesn't make what you think you are entitled to in the way of government subsidies should be condoned by all.

Anonymous said...

It's amazing that you guys are talking about the perils of medicare. I just wonder how you voted?

Anonymous said...

Hard right-wing republican economic doctrine would turn this place into a 3rd world country (we're half way there). Milton Friedman was evil. His policies were only effective in a Chliean dictatorship where people couldn't vote the bums out.

That's all I have to say about that.

2:33 is a real genius, too. Notice he said slothful instead of the word "sick" or mention the phrase "general welfare".

Anonymous said...

1123 it appears to me they are debating the perils of Medicaid - not Medicare. And although it doesn't matter, I would bet the one that wants to 'gain the system' and 'get all that I'm entitled to' didn't vote. And as long as I'm betting, my money is the other vote was conservative (that does not necessarily in this past election equate to Republican.)

We Deserve Our Fate.. said...

"I realize that the law provides what you claim it allows, but that doesn't mean that it was designed to be abused in that manner."

Oh, I'm sorry. You were about to tell us why the law was written that way but wasn't intended to be used and how following the law, as written, is abuse. Please proceed. And don't you think if not intended, it would have been amended long before now?

To the one who isn't familiar with the word slothful - it has nothing to do with sick or disabled or unable to work. It means lazy, indifferent, somebody who lays around and benefits from the labor of others. Somebody who rides in the wagon and holds onto a paper sack disguising a beer bottle.

If you think medicaid babies have some correlation with inability or sick or unable to provide, visit a medicaid office and look at all the seventeen to twenty two year old able bodies women with a baby on each hip, one in the oven and two on the floor. There's your medicaid statistic. Is this what was intended? Is this where our money-faucet should be directed? This is why Mississippi is a welfare-medicaid state.

I'd rather see the money take care of somebody who worked all her life and is living out her final days in a nursing home. She pulled the wagon.

Anonymous said...

12:36 am Apparently you never read Milton Friedman. He recognized that a percentage of Americans are unable to provide for themselves. He put the figure at 19% initially and suggested a negative income tax .

Some of you should consider the implications of cutting off " the lazy" from access to health care. There are the contagious diseases ( some of you cite this when the discussion is illegal aliens who, despite what you've been told lately, haven't been able to get welfare or Medicaid since 1996). Some of you missed the point of Les Miserables and of course, don't read FBI research or you'd understand that desperate people have resorted to crime. And, some of you apparently haven't noticed what happens in 3rd world countries or you'd understand that squalor can affect the health of an entire community.

The assumption that everyone in this country is employable is nonsense. Are you going to employ someone who is having hallucinations or who can't tell time or find their way to a job? You don't want to pay for employees health insurance, so is it ok with you for them to come to work sick or to have them die when they can't get treated?

How, pray tell, will you avoid increased exposure to bacterial infections if you are turning away those who can't afford treatment? It's ok with you to be sick more often since you can get treated? That won't affect your productivity?

If we would stop taking the extreme either/or positions that are fermented by our political parties and instead have a pragmatic discussion based on facts, we might come up with solutions. No solution will be perfect, but we can do better than we have done .

And, some things just aren't about money. Doctors who are on the frontlines of basic health care should have been having a say. Getting health care delivery costs down should have been the number one focus. A cost/profit analysis of insurance and pharma should have been second. Have you all forgotten or are you so young as to be ignorant to the fact that we once had non-profit hospitals and non-profit health insurance? Are you ignorant to the fact that we, as a society have since become less healthy in numerous measurable categories evaluated by the World Health Organization and our own National Health Institute? Are you aware that cancer is now the number one cause of death in children and yet we aren't asking " why?".

The world is complex. Demand more than the sound byte propaganda of political parties!

Anonymous said...

@ 5:19 I'm quite well aware of the definition of slothful. I'm also aware that your reasoning on these matters is hypocritical at best.

You assert that the law incentivized you to take certain actions to protect your mothers assets in such a way as to qualify her for a nice government subsidized nursing home and that it can't be considered abuse because no one has amended the inherent incentive as to prevent you and others to keep doing so.

Then, you assert that mothers are having "Medicaid babies" because they have an incentive to do so, but this IS considered abuse because you don't approve of the means in which the money was taken from others forcefully such as yourself--and the recipients simply aren't worthy--while also insinuating that the incentive for "Medicaid babies" should be removed.

Since you seem to think in binary absolutes, should lawful incentives, real or imagined, of welfare abuse be completely removed by amending the current laws or not?

Anonymous said...

I have no idea of the percentage but would guess that the majority of those in Miss nursing homes are on Medicaid. Private pay in a nursing home is $7,000 + per month. How many of us have an extra $85,000 a year. My understanding is that Medicaid pays approximately $2,200 per month for a shared room. My mother will be 100 this year. Until 3 years ago between liquidating all of her assets and her SS we were able to finance her assisted living costs. But because of her longevity we ran out of money. We were able to qualify her for Medicaid. Fortunately her SS was above average (more than the $2,000) and it all goes for Nursing home care. She also has Medicare and a private supplement that we pay for Medical. It's pretty easy when you are younger to be critical of services like Medicaid and Medicare ( I was one) and certainly there is abuse of the system. I see it every day in my own coverages and those of my mother but when real life slaps you in the face it's having a safety net is necessary.

Anonymous said...

Mississippi Medicaid pays nursing homes a little more than $200 per night.

Roll Me To My Table said...

Actually Mississippi Medicaid pays a portion of the total monthly bill after the patients total income resources have, by demand, gone directly to the nursing home.

So, if the bill for a private medicaid approved room comes to six thou per month (just pick a number), the patient's family must send every nickle (save about fifteen dollars per month) of the patient's social security and retirement pay directly to the nursing home. And the family must pay ten or so dollars toward the bill to cover the private room (roughly $325 per month).

It would be rare for a patient to have zero income from retirement or SS, therefore medicaid would never pay $200 per night (or the entire 6K).

In the example cited here, the resident's income would pay, for example, $3000 per month, the family would fork up an additional $310 plus hair care and so forth and medicaid would kick in about $100 per day. Also, upon being approved for medicaid, the patient's drug bill is picked up by that program and the family no longer has to pay a whopping monthly drug bill.

In determining these amounts, the Medicaid office demands proof of monthly resources (income), rules that the family pay all of that to the nursing home, then Medicaid arranges with the Nursing Home to kick in an amount after that is satisfied. If the family falters in this government arrangement, the patient comes off medicaid and must pay the entire amount monthly.

Patient and resident are used interchangeably here.

Plain ol' Catfish said...

I want them to shred it.

Because people that are bashing it assume it will not affect them.

So let's go - let's dump it and sit back and watch the whole damn thing crash.

My popcorn and recliner are waiting for this sh*t show to start.

Anonymous said...

3:31. I don't profess to understand all the twists and turns about Medicaid and nursing home cost but I do know very few Medicaid residents have private rooms so your example isn't typical. Also our arrangement is totally different from your example. In our case Medicaid is not paying anything to the nursing home but is picking up a portion of the drug cost not covered by the Medicare supplement we still pay for. Our cost are around $3,000 per month for a two person room and we are thankful that the program is there.

Anonymous said...

8:32 - "Doctors who are on the frontlines of basic health care should have been having a say. Getting health care delivery costs down should have been the number one focus."

These are contradictory, unfortunately, because America overpays its doctors. Controlling our healthcare costs ultimately has to mean paying doctors less, and because the public loves doctors, that's a hard sell.

(There are other things we could save money on, for example by letting Medicare negotiate drug prices. But ultimately, healthcare comes from doctors.)

Anonymous said...

@ Plain old Catfish - they were warned before the election and they're being warned again. You're right. Let them find out the hard way.

American flavored economic shock therapy is on its way and states like MS have the most to lose. And they think it stops at Medicaid. LOL. It needs to happen anyway. It's the only way this place will ever change.

Plain ol' Catfish said...

@ June 26, 2017 at 5:21 PM

You know what 5:21pm, you are so right. I've just reached a point with this state and say f*ck it - let'em have it.

Because year after year, nothing improves or changes for the better in this sh*t show. They are in love with futility and misery.

Mississippians love to elect stubbornly arrogant ignorant som'itches who can prove that they can stand in front of moving freight train and can stop it. Then when they get ran over by that b*tch they end up crying because no one saved them before it came.

They said they can do clean coal - $7 billion dollars laters Kemper Coal Plant is still not running

House Bill 1523 - still headed to the supreme court and piss poor branding for Mississippi

Billions in tax cuts for foreign company's with no return on investment for Mississippi workers - that leads to cuts in state services, lay offs of state workers, in turn leading to offsetting the public employees retirement system - which will make current state workers having to pay more money into the retirement system, which means less take home pay for the LOWEST paid state workers in the country. Less take home pay means less money spent in their local economy's - because the one thing state workers do for certain is contribute to the state two-fold - by providing services and keeping their money in Mississippi.

Phil Bryant did not expand Medicaid - claiming he didn't know how Mississippi would afford it, but its in plain english - the first 5 years the feds would foot 95% of the costs and the remaining years it would foot 90% - it was a free throw gimme. You don't turn that down. That was new jobs, you would have had 4 to 5 insurance company's competing in a Mississippi market - DESPERATE FOR THAT KIND OF HELP. It would have been an economic boom for us, because of the services that would have been provided and the people who would have needed to fill those roles.

Remember in 2009 when Barry had the stimulus package - states could have used those funds for infrastructure improvements - guess who turned them down!? That little fat face joker, better known as Maximus Tater Thot, that's trying to become our next Governor. As if we don't need any improvements in our infrastructure

So I have reached the point - go ahead - let'em eat cake - give them some Jolt soda while we're at it. Let's go ahead, blow this sh*t up - repeal health care coverage. I have a job with health coverage and I am in decent health. So I am good. But for these ass hats assuming its going to hurt me, they are sadly mistaken. It's going to hurt their Mee Maws, Paw Paws, Granny's, Pappy's, Mammy's, Chappy's, Grandma's, Grandpa's, Nana's, and Papa's.

We warned them with the tax cuts and we are at austerity now. We warned them about the health care cuts, but they say repeal and replace - when they really mean, just don't have the black guys name on the damn stuff. But the powers that be mean to repeal and cut, but they gave them the keys to the hen house. So on that note, let'em feel what they voted for, because they still don't get it.

Anonymous said...

Very enjoyable to watch you Plain ol' Catfish completely wilt under the pressure. Best of luck going forward. You are going to need it.

Plain ol' Catfish said...

@ June 27, 2017 at 8:53 AM

Wilt under pressure? How am I under pressure? I am not an elected official or run a major office in Mississippi. I am not in a position of authority or influence.

The people under pressure are the elected officials who put this state in this predicament and those who gave them the ability to do so.

But I am really enjoying this Jiffy Jiff Popcorn - it is delish. ;-)

And The Pain Meds Leave The Facility.. said...

"3:31. I don't profess to understand all the twists and turns about Medicaid and nursing home cost but I do know very few Medicaid residents have private rooms so your example isn't typical."

It's available if the family requests it. Sorry you don't know that. There's an additional charge of about $310 per month. You actually don't know what you're talking about. Check with your nursing home administrator.

I gave you an example of how medicaid pays and how the family pays and how 'resident resources' kick in. If you don't like the example, I'm real sorry about that. It's been real life for us for four years.

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