Tuesday, October 02, 2007

Reverse Robin Hood: Congress' Regressive SCHIP Expansion Would Tax Poor to Fund Health Insurance for Middle and Upper-Middle Class

A successful effort by Congress to expand the State Children's Health Insurance Program (SCHIP) by $35 billion over five years over White House protests would require low-income Americans to subsidize health insurance for children and young adults in the middle and upper-middle classes, says a September 2007 paper by David Hogberg, Ph.D. published by the National Center for Public Policy Research.

If SCHIP is expanded as Congress now proposes, says the paper, people making under 200 percent of the poverty line will subsidize health insurance for children and young adults in families over 200 percent, perhaps as high as 400 percent, over the poverty line:

Both SCHIP bills passed by Congress take the tax revenues from those under 200 percent of the poverty level and give it to those children who live in families above 200 percent of poverty, likely all the way up to 400 percent of the poverty level... It is not inconceivable that a parent with one child with an income of $13,690 will be funding benefits for two children in a family of four with an income of $82,600. In short, SCHIP expansion would result in families whose income puts them in the bottom 15 percent of households funding benefits for children who are in families close to the top 25 percent of households.

The paper also notes that Congress supports reimbursing states for SCHIP expenses for middle and upper income children and young adults at a higher rate than it reimburses Medicaid expenses spent on the poor:

SCHIP is supposed to insure children for families that make too much money to qualify for Medicaid. Presumably, then, children on Medicaid are in families that are poorer than are children on SCHIP. Yet the federal government matches the dollars states spend on SCHIP at a proportionally higher rate than it does Medicaid. In 2006, states spent a total of about $132 billion on Medicaid, while the federal government matched that with $165 billion. That means, on average, the federal government spends 1.2 dollars on Medicaid for every one dollar the states spend. For that same year, states spent almost $2.4 billion on SCHIP and the federal government sent the states $4.8 billion in matching funds.20 Thus, the federal government spends two dollars on SCHIP for every one dollar the states spend. In short, the federal government spends proportionally more on the children in SCHIP than it does on the poorer children in Medicaid.

The paper, "SCHIP Expansion: Socialized Medicine on the Installment Plan," by David Hogberg, Ph.D., is available online at www.nationalcenter.org/NPA560.html.


Australia: Government hospitals crisis is Statewide

Sacking half the bureaucrats and employing medical staff instead would transform the situation rapidly but Leftist governments regard bureaucrats as sacrosanct -- far more important than healthcare for the peasants. Bureaucrats = CONTROL in their sick thinking

DOCTORS in charge warn that every emergency unit in the state public health system is plagued with chronic management problems that jeopardise patient care. Valerie Malka, head of trauma at Westmead Hospital, said the situation was so critical that lives were at risk. "My philosophy is that patients should get the care I would want my mum and dad and family to get, and there is no way that would happen, certainly not at Westmead," she said. "You cannot get anything done for patient care at Westmead because everything you try to do is an obstacle." The head of the trauma unit since 2000, Dr Malka said she was at the "end of her tether" and ready to quit.

Sally McCarthy, head of emergency at Prince of Wales Hospital, and Tony Joseph, head of trauma at Royal North Shore Hospital, have also warned of systemic problems across NSW. "They just don't listen to anyone at the clinical coalface," Dr McCarthy said.

Dr Malka said some toilets in the wards at Westmead were so filthy that patients refused to use them. Misdiagnosis was common because junior and inexperienced doctors were left alone after hours and at weekends. "Patients are at the mercy of the system and its failures," said Dr Malka, a surgeon. Her comments followed a wave of complaints about lack of staff and resources in emergency departments after Jana Horska, 32, miscarried in the toilets of Royal North Shore last week after waiting two hours to be seen.

Dr McCarthy, who is vice-president of the Australasian College for Emergency Medicine, said every emergency department was under intense pressure. She said the problems at Royal North Shore were "the tip of the iceberg" and all emergency departments had similar issues.

The Health Minister, Reba Meagher, has launched an inquiry into Ms Horska's treatment but has refused to broaden it to include all emergency departments. Instead, she announced a new "model of care" for pregnant women.

The Opposition health spokeswoman, Jillian Skinner, said the announcement was a knee-jerk reaction, while Dr McCarthy described it as "absolute rubbish" because it was devised by bureaucrats who were not emergency specialists.

Ms Meagher's spokeswoman said the minister had also established a taskforce to examine workforce issues, but doctors say the system is in crisis and will only improve when the Government's attitude changes.

Dr McCarthy said that two weeks ago an elderly woman was made to wait on an ambulance stretcher at Prince of Wales for almost six hours, with 12 ambulances in the bay, because there were no emergency beds. "There needs to be a change in attitude because out-of-date bureaucrats in NSW Health think that emergency departments are meant to be chaotic but fail to acknowledge that we are treating the most critically ill people there are, people who are often much sicker than anyone that turns up in an ambulance," Dr McCarthy said.

Dubbed the "invisible minister", Ms Meagher has been accused of refusing to meet doctors and health groups in the six months since taking on the health portfolio. Her spokesman rejected the claim, saying she had made more than 50 visits to hospitals since March.


No comments: