The American system of paying for healthcare is absurd. It\u2019s complex, it\u2019s confusing, it wastes enormous resources on administration, and it doesn\u2019t necessarily get patients the services they need. But it can be be made worse. Republicans in Congress are trying.<\/p>\n
The bill that just passed the US House of Representatives proposes to save money on Medicaid. The Republicans have resurrected old ideas that have already been proven not to work by claiming they are bold new solutions.<\/p>\n
This is what the so-called work requirement sounds like. The proposal is that anybody who wants to be on Medicaid, is able-bodied and not working ought to get a job, do volunteer work or go to school.<\/p>\n
Most able-bodied people on Medicaid already meet those qualifications. Enforcing the requirement would require the program to hire large numbers of bureaucrats. Where\u2019s Elon when they need him?<\/p>\n
And there is a far more important reason for not imposing such restrictions: simply, the health of Americans. Under our system of paying for healthcare, the ideal is to have everybody possible covered by some form of insurance. Medicaid is an inadequate payer, often doesn\u2019t pay enough to cover the cost of the services provided, but it\u2019s better than nothing.<\/p>\n
In a recent talk, Chris Ramirez, communications director for UNM Hospital, explained why. When people have coverage, they are much more likely to seek medical care when they need it. So they don\u2019t wait until they\u2019re seriously ill before they receive medical care, their care costs less, and the provider gets paid.<\/p>\n
When people have no coverage, Ramirez explained, they don\u2019t seek preventive care, they are likely to postpone healthcare until they\u2019re sicker, they suffer more, and their care costs more. They probably go to a public facility like UNM Hospital, and the taxpayers end up paying the costs.<\/p>\n
We\u2019ve also been reminded, as New Mexico policy makers have debated family and medical leave, that when people get sick their life is interrupted, which imposes costs on their families and commmunities, including workplaces, school and other institutions. Ideally, we are all better off if everybody has coverage.<\/p>\n
I recall long-ago past debates about how to contain the costs of government funded healthcare.<\/p>\n
One topic was how to limit which services were covered — limiting coverage to \u201cessential\u201d services. The discussion involved words like \u201cbasic.\u201d Eventually, it became clear that such limitations don\u2019t work in healthcare, because individuals\u2019 needs depend on their individual circumstances. Some people are sick.\u00a0 Others will benefit from preventive care, which will save money.<\/p>\n
Another topic was the one being revived now, imposing work requirements.<\/p>\n
What policy makers do is, first, identify and understand problems, and second, try to develop solutions. Like Medicaid, the solutions may be government programs. I often think our policymakers are very good at defining problems, but creating solutions that work is difficult, and the programs are often less than perfect. They may also be expensive, so the next round of policymakers may try to make them less expensive by ignoring part of the original problem.<\/p>\n
In Medicaid, the adaptation that has worked for years has been to underpay the providers. That weakens the program, because lots of providers choose not to take Medicaid patients and those who do put their business at risk. But if this ignorant legislation passes the Senate, the new limitations on access will weaken it more and shift more costs to the taxpayers.<\/p>\n
I wonder what it feels like to be a so-called budget cutter and have to ignore the fact that the most cost-effective way to run the program is the way it\u2019s already being run and your changes will make it more expensive.<\/p>\n
\u00a9 2025 by Merilee Dannemann<\/p>\n","protected":false},"excerpt":{"rendered":"
The American system of paying for healthcare is absurd. It\u2019s complex, it\u2019s confusing, it wastes enormous resources on administration, and it doesn\u2019t necessarily get patients the services they need. But it can be be made worse. Republicans in Congress are … Continue reading