Fixing Medicaid one state at a time

Sometimes it seems the motto in Congress should be, "Don't just do something, stand there!" Lawmakers debated a flurry of measures throughout December, but ended up punting many issues into 2006. That includes Medicaid reform.Luckily, two states decided not to wait for Washington to do something. Florida and South Carolina are both proposing reforms of their own Medicaid programs.

Most states recognize they can't afford their current Medicaid programs. Over the long haul, spiraling Medicaid costs will eventually squeeze out spending on other priorities - such as education, transportation and homeland security.

In Florida, for example, 24 percent of the state's 2005 budget went to Medicaid. South Carolina's Medicaid program is expected to demand 24 percent of the state's budget by 2010. So both states are using existing waiver authority to test new approaches for Medicaid.

The specifics of each plan are different, but that's really the point. Both states aim to use different methods to make the Medicaid program more patient-centered rather than system-centered. They intend to introduce choice for beneficiaries, competition among providers and insurers and stability to the program. Similar principles are already found in the highly popular Federal Employees' Health Benefits Program, the system that provides health coverage to federal workers and members of Congress.

Choice is always good for consumers, in health care as in retail sales. Medicaid enrollees would be better off if they could select a plan that best suits their needs instead of depending on a one-size-fits-all system that leaves much to be desired. Choice will spur competition, as insurance plans and other providers of services will have to compete for enrollees based on value. By trusting in the free-market forces of choice and competition, states will reap the benefits of greater stability in the program.

To accomplish these goals, Florida and South Carolina want to establish a fair and equitable financing system based on individual needs and costs. Enrollees would be able to apply their Medicaid contribution to the plan they choose. The states also would focus on enhancing and improving coverage options. o promote choice and competition, these states allow for flexibility in benefit structure. That sounds complex, but it really means allowing insurers and provider groups to design packages that enrollees actually want. Some plans may focus on diabetes while others may focus on pediatric care. In the end, most patients will probably get a plan that addresses their specific concerns. Finally, these states will invest in educating Medicaid patients so they can make smart choices about their own health. Enrollees will be given the tools and information they need to make informed decisions about their health care and their health care services.

These states aren't the only ones looking for change. Governors from across the country and political spectrum stress the need for Medicaid reform. This puts them - Democrats and Republicans alike - at odds with many of their party's elected officials in Washington, who seem to want to maintain the failing status quo. Gov. Mark Warner, Virginia Democrat, and Gov. Mike Huckabee, Arkansas Republican tried to set Congress straight. As former and current heads of the National Governors Association, respectively, they testified about the need for change and supported the House of Representatives in its efforts to give more control over Medicaid to the states.

The urgency for change in Medicaid is evident to those at the state level who are dealing with the program on a pragmatic level. Reform efforts like those in Florida and South Carolina are only the start. As with welfare reform, it appears that the states - not Washington - will lead the way to reform.

State governments, unlike Congress, are required to balance their budgets every year. They know they can't afford to just stand there and let an unreformed Medicaid program gobble up an ever-growing share of their budgets year after year. So while Congress dithers along with deficit spending, the real reform action is in states like Florida and South Carolina, where leaders are working to save and improve Medicaid.

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Staff shortage shuts emergency ward at a major Australian public hospital

An unbelievably incompetent health bureaucracy -- despite (or because of) the fact that they have got 3 times as many paper-shufflers as medical staff

The emergency ward of a major Queensland hospital will shut on Monday - probably for months - because of a doctor shortage. The Caboolture Hospital emergency ward was to be closed amid community fear and anger, Liberal health spokesman Dr Bruce Flegg said. "This community has been treated appallingly, they still haven't had any official word from the Government on what they are supposed to do in an emergency," he said. "People in Caboolture want an emergency department in Caboolture, they don't want to be told they've got to go a long distance to an already overcrowded hospital." It was only a matter of time until someone dies because of the closure, he said.

A health spokesman said this would be the only emergency ward closure in Queensland and no one would be turned away if they presented at Caboolture Hospital in a serious condition. "If you have a life threatening emergency, ring 000, if you've got non life threatening situations, we have set up a 1300 number where you will get an experienced emergency department nurse who will advise you about where to go for the most appropriate treatment. "About 60 per cent of people who turn up to the emergency department of a hospital are there for minor conditions that could be treated by their local GP."

The spokesman said the small number of bulk billing doctors in the area meant patients would need to travel to the next closest hospital - in Redcliffe - to receive free medical attention, for which they would receive a "patient travel subsidy scheme reimbursement". The Queensland Ambulance Service also would provide extra services to transport patients between Caboolture and Redcliffe hospitals, he said. The spokesman said the Caboolture emergency ward may be reopened in a couple of months and blamed the doctor shortage on medicos not wanting to work in Caboolture.

The Australian Medical Association has urged the Queensland Government to further improve the pay and conditions of the state's doctors, despite a pay rise awarded to senior doctors late last year.

Source

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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?

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