Saturday, February 10, 2007

Spock Calls Bush Health Care Strategies “Illogical”?

Should Mister Spock from the Star Trek Enterprise hear a presentation on President Bush’s health care solutions, he might call them "illogical". President Bush clearly proposes using market forces to fix the ills of America’s health care non-system. Increasing supply while controlling demand should bring things back in order.

However many of his main “talking points” are later harmed by the President’s proposals. On the supply side stand numerous contradictions.

When the President talked about OB/GYN’s practicing “their love” with their patients, he noted 1,500 counties without such a primary care physician in the U.S. His point was the supply of physicians is constrained. President Bush plans to eliminate medical education payments for 400 hospitals with the change of a Medicaid regulation, thus placing that mission in those facilities in jeopardy.

What has President Bush proposed to increase doctor supply? With the aging of the population and medical services used at a much greater rate by the elderly, has George W. Bush offered any strategies to grow physician supply? I have seen none. Cutting medical education payments when supply is constrained, iIllogical!

(Note: His tort/liability reform proposals would stem the bleeding from physician’s retiring early due to high malpractice costs, but wouldn’t grow the supply of doctors in any meaningful way.)

Anther group supplying care are hospitals. President Bush wants to cut Medicaid reimbursement to 1,200 county owned hospitals and nursing homes. These publicly owned facilities provide large amounts care for the uninsured. Medicaid previously allowed these hospitals to make some profit, which could be used to upgrade facilities’ technology and information systems. No more with the swipe of a Bush administration regulation. With “no profit money” long enough, comes “no mission”.

The President says he wants to reduce the number of uninsured via tax credits, yet he admits this would only drop the nearly 47 million uninsured by 5 or 10%. If he hits his higher target, that gets us back to the number of people uncovered in 2002. Providers would still carry a heavy burden in caring for the uninsured as far as the Bush-eye can see. Cutting back funds to publicly owned hospitals caring for the uninsured while doing nothing meaningful to solve the problem, illogical!

Medicaid also wants to clarify what mental health services a patient can get in a community setting to save $2.3 billion over 5 years. The administration says the definition of rehabilitation services is so broad there is a risk of abuse.

Yet, they provide no new definition and just how the administration will clarify it is a mystery. The budget provides few clues. Health care providers say they have no idea of what the regulations would say. Medicaid officials declined to elaborate. Changing a definition to save $2.3 billion without sharing the new definition (as it was needed to conduct the savings analysis), illogical!

Actually that one is sneaky, underhanded, & manipulative. Did it come from the captain himself? Not President Bush, Karl Rove…

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