For the inconvenient elderly: let them die

The way to save Medicare, some TV pundit said recently, is to cut Medicaid. Lots of people will die before they reach Medicare age.

It was said only about half in jest.

If low-income people can’t afford health care, some will get sick, and the sick will get sicker. When they reach 65, their health care under Medicare will be more expensive. But some will die and save the program the cost of their care.

Medicaid itself will also save money because Medicaid, not Medicare, pays for nursing homes for low-income elderly. Two thirds of Medicaid spending nationally is reportedly spent on low income patients who are elderly or disabled or both.

Future funding for Medicaid hangs in the balance if Congress passes the proposed replacement for the Affordable Care Act or the proposed Trump budget. The health care law would cap federal contributions to Medicaid and the state would have to make up the rest of the cost. As you know, New Mexico is already in the midst of a budget crisis.

New Mexico total Medicaid spending is more than than $5 billion a year, according to the Kaiser Family Foundation. It’s roughly $4 billion federal, less than $1 billion from the state. Much of the spending is on the elderly in nursing homes.

According to an October 2016 report by the Legislative Finance Committee, New Mexico has 74 nursing homes certified by the national Center for Medicare Services (CMS) with a total of 7,130 nursing home beds as of June 2016. If those facilities can’t afford to stay open, some of them will close.

The LFC report raises concerns about the quality of care in nursing homes, using a number of standard measures. Not surprisingly, the report also says costs are increasing and Medicaid is not keeping up. (The full report is on the LFC web site.)

The frail elderly are also targeted in other portions of the recently released Trump budget proposal. Meals on Wheels is one that’s been mentioned.

According to Meals on Wheels of America, almost 41,000 New Mexico seniors annually receive meals. At last count, 9,543 were homebound seniors – – the same seniors who are saving Medicaid a lot of money by staying out of nursing homes. Almost 3 million meals were served in total, including both home delivery and group settings such as senior centers. The total cost was about $20 million, of which $3.3 million was federal funds.

Meals on Wheels points out that the home visits by its volunteer deliverers are, for many isolated seniors, the only human contact they have all day. The volunteers (who even pay for their own gas) not only deliver a meal but also check on the welfare of those seniors, including making sure they have not fallen. Falls among the elderly are getting increasing notice as a source of injury, hospitalization, death and costs. Meals on Wheels of America claims the home visits help to decrease the rate of falls, which nationally cost $34 billion a year. I surmise those costs would involve medical care and therefore be shifted to both Medicare and Medicaid.

Without programs like this, some of those elderly folks will die, reducing the cost of both their Medicare and Social Security.

President Trump promised seniors he would not cut Medicare or Social Security. Those programs are a big part of the federal budget and therefore the federal deficit and the extremely scary national debt, which nobody is talking about and which will continue to increase as this administration increases the defense budget and cuts taxes for people who don’t need the money. So how do you get to a balanced budget?

If you can’t cut the entitlement to Medicare or Social Security, cut the number of people who receive them.

Triple Spaced Again, © New Mexico News Services 2017

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