White House officials strongly object to the notion that they’re going to sign on to a deficit deal that makes its main cuts in Medicaid. But they don’t deny, and in fact endorse the idea, that Medicaid will come in for some cuts. So I spent much of a day asking health-policy experts the same question: If you need to cut Medicaid, how would you do it?
One way is to simply cut spending on the program. That’s the approach you see in the Republican budget. Currently, the federal government contributes to Medicaid based on need. That means spending goes up if there’s, say, a massive financial crisis that knocks millions out of work. But Republicans want the federal government to tie those contributions to a formula that’s unrelated to need and, in fact, grows more slowly than health-care costs. And that would work. You can spend less by spending less. But it’d mean the program either needs to cut benefits for children, the very poor and the very old and disabled, or kick some of those people off Medicaid entirely. That is to say, it shifts costs rather than controlling them. And we need a better solution to Medicaid than simply “less of it.”
Ezra Klein
Ezra Klein is the editor of Wonkblog and a columnist at the Washington Post, as well as a contributor to MSNBC and Bloomberg. His work focuses on domestic and economic policymaking, as well as the political system that’s constantly screwing it up. He really likes graphs, and is on Twitter, Google+ and Facebook. E-mail him here.
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Indeed, one of Medicaid’s problems is that it is, if anything, too cheap. It pays doctors much less than private insurance or Medicare. The result? Doctors don’t like to take Medicaid patients. The New York Times reported Thursday on a study in which researchers called doctor’s offices to schedule appointments for children with conditions like “diabetes, seizures, uncontrolled asthma, a broken bone or severe depression.” When the researchers said the children were covered by private insurance, all but 11 percent got an appointment. When they said the children were covered by Medicaid, two-thirds didn’t get an appointment.
“In some cases,” says Len Nichols, director of the health-care policy program at George Mason University, “we would do better if Medicaid paid more. If we could get more doctors to treat the expectant mothers on the program and give them better care, that’d reduce the really expensive stuff from the neonatal intensive-care units. And when you look at that study in the Times, notice that the kids were waiting for specialists. That’s a disaster. If the primary care doctor has sent you to a specialist, that means you’ve got a problem they can’t solve. And if you have to wait, it festers.”
You don’t need to be a deficit hawk to worry when an 11-year-old’s seizures go untreated. But if you are a deficit hawk, you should be particularly worried. Continually sending the paramedics out is really, really expensive. Worse, it’s wasted money: A dollar spent keeping a kid healthy and learning is worth a lot more to our economy than a dollar spent stabilizing kids after they become unnecessarily sick.
Though sometimes better care costs more, at least upfront, sometimes it costs less. And the various experts I consulted believed there was one big opportunity for saving money in both Medicare and Medicaid: the “dual eligibles.”
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