Tag Archives: Medicaid

North Carolina Medicaid Reform


The new governor of North Carolina is out reform how Medicaid is paid for in the state:

 RALEIGH, N.C. — North Carolina’s $13 billion Medicaid program needs a big dose of private competition that will come from paying a handful of statewide managed-care providers to deliver medical, mental, and dental care to the elderly and disabled for a stable cost, Gov. Pat McCrory said Wednesday.

McCrory and state Health and Human Services Secretary Aldona Wos unveiled a proposal that would largely privatize management of Medicaid while keeping ultimate responsibility in state hands.

McCrory said reshaping Medicaid was the first and most pressing long-term task his three-month-old administration was tackling.

The problem today is that the program continually runs over budget and programs that had money allocated to them have to be adjusted to accommodate the overrun.

The idea is to remove the risk from the state and give it to the private sector in exchange for the chance to earn profits in the space.

We’re Gonna Ration

The allocation of scare resources: Rationing.

There are a lot of ways of doing it; time, money, connections even luck.

Some of us think that rationing by money optimizes quality and supply.  Others think that rationing by time does the same thing.  I disagree:

SACRAMENTO — As the state moves to expand healthcare coverage to millions of Californians under President Obama’s healthcare law, it faces a major obstacle: There aren’t enough doctors to treat a crush of newly insured patients.

So, California is going to ration on time.  And one of the metrics that time based rationing optimizes is – low quality:

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

Now, to be sure, allowing non-doctor health care providers could very well be positive; after all – why do we need an MD to refill a prescription for blood pressure medication?  However, I’m sure that California isn’t embracing this is an open-market mindset.  Rather, docs are just fleeing the medicaid business.  In fact, in California, only 57% of doctors are accepting new medicaid patients.


Where I’d Start Cutting Budgets

Look, I get it.  The new popularity of the conservative movement is that we have to reduce the size of the government.  We have to Spend Less, Tax Tess.  Reduce spending and reduce taxes.

I get it.  I do.

But we can NOT reduce taxes right now UNLESS we reduce spending.

Now, I AM a proponent of the idea that when taxes are raised it acts as an economic inhibitor.  That businesses will grow slower or even shrink.  That as taxes rise, the amount of money we bring in is actually less than the amount we could have brought in.

But there is a limit.

So, where would you cut?

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