There is generalized agreement in Alabama that Medicaid is broke. The governor, through an appointed commission, has established a blueprint (details found here) that is being made into legislation allowing care to transition into “regional care organizations” that would allow better, coordinated care to occur at with grass-roots input.
This legislation is modeled on a program already established in Oregon. The New York Time has helpfully (?) provided a story so that Alabamians can see what they are potentially getting into:
Oregon and the federal government have wagered $1.9 billion that — through a hyper-local focus on Medicaid — the state can show both improved health outcomes for low-income Medicaid populations and a lower rate of spending growth than the rest of the nation.
How does this work, you might ask. A common component takes on the reality that our health care system is unusable by the people who need it the most, those who are chronically ill:
Hands-on work with patients is common to all the efforts, including one that is using “patient guides,” to talk through care options with people who stack up in emergency rooms with often routine medical problems.
Whats not to like about that, you say? The devil is in the details:
Fifteen Community Advisory Councils have been established across the state, charged with setting local goals. One of them, around the college town of Eugene, will take aim starting July 1 at smoking by pregnant women, hoping to cut neonatal costs through a system of rewards, like gift cards at the doctor’s office for women who go tobacco free.
This is getting into slippery slope territory. What about personal responsibility? Don’t choices have consequences? Reading on, you can see where this approach might not sit well with the typical Alabama voter who seems to believe (based on comments to blogs and sign held up a rallies) that recipients of “charity” should be grateful for any crumbs sent their way. Oregon has put the recipients in the driver’s seat:
“One thing unique about the C.C.O. process is the degree to which it focuses on all the elements of an Oregon Health Plan recipient’s life,” said Steve Weiss, the chairman of the advisory board at Health Share of Oregon, a Coordinated Care Organization in Portland. Mr. Weiss, 70, is disabled and gets by, he said, on $864 a month.
Oregon’s governor, as an emergency room physician, sees the potential for this approach:
Mr. Kitzhaber, in an interview in his office at the Capitol, said the anecdotal interventionist health care story he imagines is that of a poor 92-year-old woman who develops congestive heart failure in a heat wave because she has no air-conditioner.
“Under the current system, Medicaid will pay for an ambulance and $50,000 in the hospital,” he said. “What it won’t pay for is a $200 window air-conditioner, which is all she needs to stay in her home and out of the acute medical system.”
Contrast this to a comment I received upon writing about our efforts for the local paper:
The current reshuffling of the Medicaid system will do nothing to change the financial dynamics of indigent care funding. The state will have the same amount of money to provide care for an ever increasing population to be covered, and a continued abuse and overuse of medical services by a increasingly unrestrained, unappreciative, irresponsible, and entitled population.
I only hope our governor, also a physician, and legislator will continue down this path, looking beyond the “common sense” of the people, and do what is right for Alabamians.