Per aspera

2 Responses to “It’s that sudden stop at the end”  

1. 1 Tom Oct 23rd, 2007 at 11:54 pm

   Excellent link. A few thoughts:

   -Interestingly enough, initially, Medicaid didn’t learn how to negotiate (no MBA’s) as well as private insurers and, for awhile, there was this surreal 1-2 year window in New York where Medicaid paid better than private insurance and exactly as it was foretold in my commie dream, the poor were given preference.

   -Not only does the author make a good argument, it’s not even necessary to make that point because Bush’s objections are flat out incorrect. He says that it’ll give free healthcare to people making $89K a year. Actually, that’s sort of potentially true, but it’s true today, irrespective of the new bill. SCHIP (created w/money from the gov’t tobacco settlement in the 90’s, which is also why they want to further fund it w/tobacco excise tax money, because that’s how the program started, I do agree that’s a dubious way to fund it and I’d rather see it come from the lifting of the cap on Medicare payroll tax), CAN cover people who make that much, but no state has their SCHIP program active in that area. AND, if any state wanted to, it would have to go through CMS/HHS, and the president (or, more likely, secretary loyal to the president) could deny the state’s request to raise it to that income level (something the president also can do today, and a power that was not to be changed in the bill).

   -the $89K thing, again, remember Medicaid is sorta run on block grants now so remember that all that ceiling does is give the state flexibility in shaping their medicaid program to suit their population and the program they chose to have the $89K income limit could have other eligibility factors at play, like, oh, I don’t know, parent’s of kids with HIV who make less than $89K are eligible, for example. Seriously.

   -Bush kept saying ‘poor kids first’. “Poor” has a very specific definition from a federal standpoint tied to a flawed but very formal formula and the mandate creating SCHIP was specifically NOT for poor, but for ‘low income.’ From a federal perspective, a very different category. Poor puts you below the federal poverty income guidelines, which are, like, dirt-ass poor. Like the Joads. I’m talking less than 10K a year here. SCHIP was created for ‘low-income,’ so, like, those wealthy 11K’ers.

   -70% of the kids who would benefit from the SCHIP bill come from families that make less than half that 80K figure.

   -we get $1 million NICU babies all the time. It’s the going rate. though that’s w/out negotiation, as the author says, as there are babies who somehow made their way to megan’s expensive-ass non-participating hospital. if they’re not participating, we don’t have a contract with them and the hospital usually uses it to make up for the losses they incur with their negotiated rates with the plans they do participate with. somehow, at some point, that became the most logical way to build networks, something like the California energy crisis really.

   I’m actually using this time to write this as a break from my paper on medicaid, to say nothing of my job with medicaid.

2. 2 Steve Oct 25th, 2007 at 6:04 pm

   That was crazy informative; thanks. Do you read Ezra Klein’s blog? He’s made health care a personal intellectual priority, so he blogs a lot about it.

   This:

   -Bush kept saying ‘poor kids first’. “Poor” has a very specific definition from a federal standpoint tied to a flawed but very formal formula and the mandate creating SCHIP was specifically NOT for poor, but for ‘low income.’ From a federal perspective, a very different category. Poor puts you below the federal poverty income guidelines, which are, like, dirt-ass poor. Like the Joads. I’m talking less than 10K a year here. SCHIP was created for ‘low-income,’ so, like, those wealthy 11K’ers.

   made me remember this from Matt Yglesias:

   The right’s main tactic whenever Democrats want to do something that might be helpful to any group of citizens everywhere is to identify some even more desperately poor group and claim that their opposition to helping out is driven by a die-hard commitment to these truly needy types. Try to help the working class, and the underclass are trotted out for moral blackmail. Try to help the middle class, and what about the poor? But then when push comes to shove, these are the same people trying to cut section eight housing programs, trying to cut food stamps, etc. The only people they’re really serious about helping are the extremely wealthy beneficiaries of their tax cuts.

   That’s what I think Bush was getting at when he said “Poor kids first.” I think he had drawn the same distinction in his mind (or, if I’m feeling uncharitable, which I pretty much always am when the President is concerned, had it drawn for him). So what he was unsuccessfully trying to communicate was that we can’t give health care to low-income kids, because Poor Kids First. So there, commies!

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