MEDICAID HAS GIVEN AMERICA SOCIALIZED MEDICINE

The nation has so vastly extended taxpayer-funded Medicaid to the working poor this decade that it has produced the biggest expansion of a government entitlement since the Great Society was launched in the 1960s, a USA TODAY analysis has found. With little notice, the medical care program paid by federal and state taxpayers has grown from covering 34 million people in 1999 to 47 million in 2004, an examination of government data shows. The expansion has cemented government's role as the nation's primary health insurer. About 100 million people - 1 in 3 - now have government coverage through Medicaid, Medicare, the military and federal employee health plans. More than 10 million others are eligible for Medicaid but have not signed up.

The expansion has won bipartisan support in Washington and state capitals, as a consensus has emerged to provide medical care for the poor, especially children. President Bush has proposed spending $1 billion over two years to encourage eligible families to sign up for Medicaid. Medicaid's growth has continued despite debates about spiraling costs and controversial efforts in Tennessee and Missouri to scale it back. The growth is an aftershock of welfare reform, which since 1997 has pushed individuals off welfare and into the workforce. To support low-wage workers, Congress and state legislatures expanded coverage to low-income working families. Medicaid previously had gone primarily to welfare recipients. Today, a family of four can earn as much as $40,000 a year in most states and get government health insurance for children. The nation's median household income was $43,318 in 2003, the Census Bureau says.

The expansion has had far-reaching consequences: More children insured. The portion of children without insurance fell from 14.8% in 1997 to 11.7% in 2004, the Health and Human Services Department reports. The rate of young children being vaccinated has increased from 72% in 2000 to a record 81% in 2004. Higher costs. Medicaid spending grew from $159 billion in 1997 to $295 billion in 2004. That 85% increase is nearly twice the rise in Medicare, which insures seniors. Washington pays 59% of Medicaid's cost; states pay the rest. Reduced private insurance. Many low-income workers are choosing Medicaid over employer insurance because it is less expensive and often covers more. Medicaid is free or nearly free for recipients. Out-of-pocket costs and the range of services covered vary by state. The percentage of children covered by private insurance fell from 65% in 1999 to 59% in 2004, while those on Medicaid rose from 22% to 29%.

Critics of Medicaid's expansion say it is adding to the federal budget deficit - $412 billion in 2004 - and luring people from employer-offered insurance. "Shame on us for creating perverse incentives that cause people to give up private coverage for Medicaid," says Michael Cannon, director of health care studies at the libertarian Cato Institute in Washington.

But supporters say most Medicaid recipients have no other option and need coverage to keep working. John Begala, a member of the Ohio Commission to Reform Medicaid, says Medicaid's expansion "is one of the great policy success stories of the decade."

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HO HUM! THE BAD NEWS FROM THE BRITISH NHS NEVER CEASES

The patient British have had such bad service for so long that most know no better. Note: "A&E" is British for what Americans call "ER" and Australians call "Casualty"

Only half of all children and elderly patients with broken limbs receive adequate pain relief within an hour of arriving at accident and emergency departments. Research by the Healthcare Commission, the health inspectorate, revealed that few A&E departments come close to achieving the government target of providing pain relief within 20 minutes. Even after an hour, only 53 per cent of children and 42 per cent of elderly patients in moderate or severe pain had been given pain-relieving drugs. However, the researchers found that 71 per cent of A&E patients rated their overall standard of care as excellent or very good. There were "disconcerting" variations between hospitals, the commission found. Staffing is not the reason, it concluded. Many departments have acquired extra staff without any improvement, suggesting that investment in services has been wasted. "Extra staff are only likely to yield beneficial results when the purpose of the extra staff is very tightly focused - for example where a problem or bottleneck has been identified," the commission concludes.

The report was based on information about three conditions: children in pain from a broken elbow or wrist, elderly patients with a hip fracture and also patients who had taken an overdose of paracetamol. Standards for treatment were laid down by the British Association of Emergency Medicine. So few met the standards that the commission had to modify them to make a meaningful comparison. But even when A&E departments were allowed an hour to provide pain relief, many failed. In some hospitals only a fifth of children and a seventh of elderly patients had been given painkillers within an hour. Some managed to treat 100 per cent of patients within an hour.

Anna Walker, Chief Executive of the Healthcare Commission, said: "A&E departments have overall made great strides in improving services, in particular on waiting times, which are very important to patients. "They now have to go the extra mile if they are to deliver the care their patients need, and that means focusing on quality as well as waiting."

For patients with a broken hip, X-rays should be taken within an hour. Only a third of patients were treated within the target. Only about 65 per cent of patients who arrived at A&E within eight hours of a paracetamol overdose were treated within the stipulated eight-hour target. The results of the December 2003 audit were shown to hospitals which were then audited again in February 2005. Only 50 out of more than 200 were able to respond in the time given, and these hospitals showed some improvements.

The commission also carried out patient surveys, which showed that the great majority were satisfied, saying that their care had been excellent or very good. Waiting time was the main key to patient satisfaction. The report found no clear correlation between staffing levels and performance of A&E departments. Since 2000 the average department has 20 per cent more nurses, 27 per cent more doctors and 37 per cent more consultants.....

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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