Tuesday, March 08, 2005

Medicaid: it's the Alzheimer's and the strokes

Economist.com | Medicaid reform

The Economist thinks that Bush's social security redesign will fail and that attention will turn to Medicaid. They helpfully illustrate the article with a picture of a Hispanic family. Idiots. The article is mostly worthless, save for one prize paragraph:
Set up in 1965 to provide health care for the poor, Medicaid, with a total cost of over $320 billion, is now, alongside Medicare, America's biggest government health-care programme. Uncle Sam pays between 50% and 77% of the tab, depending on how poor a state is: on average, 57 cents out of every dollar Medicaid spends. Over 50m Americans rely on the programme for their health care. Most of those who enroll are poor families with children, but most of Medicaid's money is spent on old and disabled people, particularly on nursing-home care. (Medicare, the federally-funded programme for the old, covers only doctor visits, hospital visits and, from next year, prescription drugs.) Medicaid pays for two-thirds of all nursing-home residents in America.
Idiots and cowards. They ought to have featured a picture of an elderly middle class person in a nursing home bed. The medicaid fight is really about nursing home care, most nursing home care is for demented persons, and the vast majority of long term nursing home residents are white middle and upper-middle class adults. The latter group most often managed an informed divestiture of assets that allowed them to pass wealth to their children and transfer their ongoing expenses to medicaid.

To put it mildly, this problem has been predicted for while. We've known for decades that unless we came up with way to slow the onset of Alzheimer's (stroke reduction we may be able to do) there was no solution short of Soylent Green that was going to prevent an explosive increase in nursing home costs. The future is now.

I'll make the bold and radical prediction that the Bush administration will cut costs by denying benefits to the family in the Economist's photo. This will advance the cause of the "ownership agenda" but it will do nothing about Medicaid's costs. (Sound familiar?) True cost reforms will come only by preventing asset transfers from demented adults, encouraging euthenasia, preventing Alzheimer's, setting up nursing homes in low wage nations, or developing fully automated nursing homes (preferably with virtual reality entertainment for the residents).

Of this list I like the Alzheimer's prevention part. Make me president and I'll match 10% of the yearly federal medicaid bill ($32 billion or so) with research funding. (Not likely! :-)

Otherwise I've long considered the other two options (Guatemalan nursing homes and robotic care facilities with virtual reality entertainment) to be great investments.

Now you can completely ignore the Bush medicaid kerfuffle to come.

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