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Healthcare open thread

As many at FDL are aware, Medicaid, including the Medicaid expansion, while trickling down some much needed healthcare to those at the lower end of the economic scale, is, like most seemingly government-run public programs, increasingly a vehicle for privatization and the upward transfer of wealth.

In the case of Medicaid, this is occurring through Medicaid managed care. Some previously provided links:

Increased opportunities for states to use managed care companies

Moving dual-eligibles (low-income seniors eligible for both Medicare and Medicaid) off Medicare and into Medicaid managed care

Most states have no mandated medical loss ratio for Medicaid managed care

This recent story identifies some of the specific problems

Medicaid, once considered one of the crowning achievements of The Great Society, is now being dismantled by those entrusted with its care. Plagued by a poorly designed medical reimbursement process that rewards health care professionals for providing medically unnecessary care and yet doesn’t pay enough for many specialists or small providers to deal with burdensome administration, the popular program has been a target of reform for decades. With state budgets hollowed out by the perfidy of the mortgage industry and a budget regime that cuts investments in health to fund tax breaks for corporations, legislators across the nation are now looking to find ways to cut costs—and if there’s time, improve the quality of care…

Here enters managed care, seen by some elected officials as a panacea to their fiscal woes. Under this system, private insurance companies, or Managed Care Organizations (MCO), receive a fixed monthly payment from the state per Medicaid patient. In exchange, they agree to work with hospitals to strike deals and lower costs.

One obvious flaw in the system is that MCOs can increase their profits by erecting roadblocks to care. If you’re one of the aforementioned 60 patients put on a diet and exercise regime, you may find it more difficult to get access to a cardiologist. Worse still, if MCOs make a patient drive three hours to see an “in-network” specialist he or she needs, chances are lessened that the patient will make it to that professional at all—and the MCO can keep the funds it receives from the state without paying for that person’s care.

Another problem with managed care as an upward transfer of wealth is that in conjunction with Medicaid Estate Recovery people enrolled in managed care may have their estates charged for the premiums, even if they never receive any actual care.

Like so many other institutions and programs that ought to serve the common good, Medicaid is being dismantled before our eyes through privatization. Wherever we go from here, if we’re able to find our way, we need a narrative and policy proposals directed toward expanding and protecting the commons, not an approach built on the false trickle-down narrative of neoliberal public/private-for-profit partnerships.

(Note: As someone who never wrote a diary, I didn’t expect or receive diary access when recent changes went into effect. However, in the course of correspondence with FDL about my concern for other regular diarists who seemed to be missing from the revised scene, there was some miscommunication and access was added to my profile. I didn’t intend to use it unless the missing regulars returned, but with the hiatus in effect, maybe we can add a few more voices to myFDL to keep things lively. To that end, here’s a thread on a subject that may get less attention during the hiatus, if people care to use it as a place to discuss related issues. Missing folks – hope you’ll stop by again!)

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