no pain no gain

[kent nickell]

I was just reading this op-ed piece in the Minneapolis Star-Tribune and it seems emblematic of the pervasive problems of trying to deal with a public budget such as kicking the can down the road, using accounting tricks, nobody wanting to make tough choices and political gridlock.. It has to do with a late night session last night trying to balance the Minnesota budget...

""It increased the school payment delay imposed last year from $1.7 billion to $1.9 billion and offered only a claim against any future state surpluses to put the payments back on schedule""

By doing the above they claim they didn't cut school funding.. But how are these schools supposed to deal with in reality coming up $2 billion dollars short? Are they supposed to tell teachers that we'd like you to work for us and if the state happens to do well over the next few years maybe we can even pay you??

""The agreements most disappointing omission was its failure to seize an opportunity presented by the new federal health reform law to bring $1.4 billion in new money to Minnesota in the next three years.

That much was available for moving 100,000 of the state's poorest citizens from state-funded health care programs to Medicaid, a 43-year old program financed with a 50-50 state-federal match. The move had much to recommend it: the creation or preservation of 21,000 private-sector health care jobs; improved access to health care services for a needy population; a reduction in the uncompensated care costs that are often passed on to people with private insurance, and an ability to apply cost-containment strategies to a bigger share of the health care market.

To make the switch to Medicaid, Minnesota's costs for the affected population would have increased $188 million over three years.

The offer ought to have been seen as too good to pass up. But in the words of one gubernatorial candidate this would imply "opting into Obamacare" ""

 

[sharon sanders]

Re: no pain no gain

California too:


Cuts seen as costly to San Bernardino County

<!--subtitle-->$24M would be lost if CalWORKS is killed
<!--byline-->James Rufus Koren, Staff Writer
<!--date-->Posted: 05/17/2010 09:28:29 PM PDT
<!--secondary date-->
<script language="JavaScript"> var requestedWidth = 0; </script>
<script language="JavaScript"> if(requestedWidth > 0){ document.getElementById('articleViewerGroup').style.width = requestedWidth + "px"; document.getElementById('articleViewerGroup').style.margin = "0px 0px 10px 10px"; } </script>Gov. Arnold Schwarzenegger's proposal to eliminate the state's main welfare program, CalWORKs, could mean big losses for businesses in California, especially in high-poverty areas such as San Bernardino. CalWORKs, the California Work Opportunities and Responsibility to Kids program, gives cash benefits averaging about $500 per month to more than 47,000 families - about $24 million per month total - in San Bernardino County.


snip

Ross, though, said eliminating CalWORKs seems especially foolish given that the program is only partly funded with state money. Cutting the program, Schwarzenegger said, will save about $1.1 billion, but Ross said it will cost the state $2.8 billion in federal funding.

Read more: http://www.sbsun.com/business/ci_15106785#ixzz0oHbAQYCp
​

Trouble in California is trouble for the US:

California's economy is the largest of any state in the US, and is the eighth largest economy in the world.<sup id="cite_ref-Largest_state_GDPs_in_the_United_States_-_California_Texas_New_York_Florida_0-0" class="reference">[1]</sup><sup id="cite_ref-California_economy_ranking_among_world_economies_1-0" class="reference">[2]</sup>As of 2008, the gross state product (GSP) is about $1.85 trillion, which is 13% of the United States gross domestic product (GDP).<sup id="cite_ref-BEA_2-0" class="reference">[3]



http://en.wikipedia.org/wiki/Economy_of_California

</sup>

 

[kent nickell]

Re: no pain no gain

As an additional example of political gridlock and the difficulty in healthcare reform, the American Medical Assn weekly newsletter this week had an article dealing with Wellpoint Blue Cross's recent 40% rate increase coming just when it looked like health care reform may pass. The state of California found numerous errors in Wellpoint's justification for this increase.

About half of the states do not require regulatory approval of health care plan premium increases. Health and Human Services Secretary Kathleen Sebelius is encouraging states that do not require this to do so.

The reply from the governor of Indiana "When we feel the need for advice about health care costs, we won't start with the people who just passed this disastrously expensive and backward federal legislation."

As of Sept. 23, under the health system reform law, federal regulators would be allowed to reject rate increases deemed unreasonable, and insurers' individual plans must spend at least 80% of the money they take in on actual medical care.

 

[mixin]

Re: no pain no gain

I had hoped that health care reform would be a good thing; but if other places are having the same problems my area is, I think treatment is going to be really poor.

My current experience is the medical field is stretched pretty tight as it is. It's taking 3 weeks to obain Medicaid approval for a procedure and 2+ weeks for some test results to come back. For more urgent results, it's taking about that long from test to procedure.

Medical things, in general, seem to be unorganized. Scheduling problems, communication problems. specialists having offices in several towns, everyone seems to be very hurried. Multiple tests are scheduled one right after the other... and if they start running behind, then they hurry to get back on schedule.

I wonder how it will be when all our unemployed/non-insured, all those who have delayed treatment, etc, join the medically covered?

 

[kent nickell]

Re: no pain no gain

I agree that the medical field is stretched tight and has much disorganization. I think eventually we might see more primary care being given out by nurse practitioners, leaving more complicated problems for physicians.

The insurance field is a total mess. We have a country that combines top of the line medicine for some with 3rd world conditions for others. Uninsured patients can often pay double for a procedure that insurance companies have negotiated special rates for. And many people are just a job loss away from being uninsured. Hospitals often provide emergency and other care for people who can't pay and this is often made up by higher insurance premiums for those who can.

I see health care reform as trying to get a grip on some of these problems. If more people become insured through various mechanisms this helps level out the playing field, provides a degree of security, and helps avoid transfers of payments which can obscure true costs.

Having blocs of insured patients empowers them to negotiate for reasonable medical reimbursements. Also the reform bill requires the insurance companies themselves to be more transparent as to what portion of their revenues they are using for medical care.

Medical care is a complicated subject as it involves choices as to what is a persons right to basic care and should it be solely on their ability to pay. Also what is reasonable compensation to motivate the varying level of training necessary to provide medical care. These are societal choices but I think they can be more easily made where there is greater transparency in the overall process allowing for more informed discussions.

 

[Laidback Al]

Re: no pain no gain

I agree that the medical field is stretched tight and has much disorganization. I think eventually we might see more primary care being given out by nurse practitioners, leaving more complicated problems for physicians.

The insurance field is a total mess. We have a country that combines top of the line medicine for some with 3rd world conditions for others. Uninsured patients can often pay double for a procedure that insurance companies have negotiated special rates for. And many people are just a job loss away from being uninsured. Hospitals often provide emergency and other care for people who can't pay and this is often made up by higher insurance premiums for those who can.

I see health care reform as trying to get a grip on some of these problems. If more people become insured through various mechanisms this helps level out the playing field, provides a degree of security, and helps avoid transfers of payments which can obscure true costs.

Having blocs of insured patients empowers them to negotiate for reasonable medical reimbursements. Also the reform bill requires the insurance companies themselves to be more transparent as to what portion of their revenues they are using for medical care.

Medical care is a complicated subject as it involves choices as to what is a persons right to basic care and should it be solely on their ability to pay. Also what is reasonable compensation to motivate the varying level of training necessary to provide medical care. These are societal choices but I think they can be more easily made where there is greater transparency in the overall process allowing for more informed discussions.

These are excellent comments Kent. If there were not such disparities and inequities in the health care system, and if the greed was not the primary motivation for the current heath care insurance structure, there would not be a need for health care reform.