Tuesday, April 24, 2007

Medicaid Reforms

Brian Schwartz, Ph.D., gave me permission to post his following comments about Medicaid. Bear in mind that Medicaid is primarily a federal program, so states are limited in how they can reform it. In his proposal to Colorado's 208 Commission, Schwartz focuses on state-level reform. He writes:

"The Denver Post reports on April 19 that 'Colorado's Medicaid program…is among the worst in the nation.' Indeed. My proposal to Colorado's Commission on Healthcare Reform, FAIR: Free-markets, Affordability, and Individual Rights, shows that by the Commission's own standards, Medicaid fails miserably. It inhibits consumer choice, encourages recipients to forgo higher-paying jobs to maintain eligibility, and increases medical expenses for those not enrolled. Says former Maryland state representative John Adams Hurson: 'I am a Democrat, a liberal Democrat, but we can't sustain the current Medicaid program. It’s fiscal madness. It doesn’t guarantee good care, and it’s a budget buster. We need to instill a greater sense of personal responsibility so people understand that this care is not free.'

"The Colorado legislature should convert Medicaid to a consumer-driven program resembling Colorado's Consumer-Directed Attendant Support (CDAS) program -- with insurance vouchers and Health Opportunity Accounts. It should promote responsible consumption with co-payments and premium-sharing, and prevent people from hiding assets to qualify for Medicaid long-term care. Lastly, it should convert Medicaid from a monopolistic pre-paid health entitlement program to a voluntarily-funded charity that, because it must compete for tax dollars, has incentives to improve care and lower costs."

On pages 39 through 46 of his proposal, Schwartz discusses the many ways that Medicaid fails to meet the Commission's own criteria for proposals.