They say the devil is in the details, and strangely enough we aren’t getting to see those details.
Florida Governor Jeb Bush is fed up with the rapid increases in state Medicaid expenses. Medicaid, you may recall, is supposed to be a safety net for the health care of Americans near and below the poverty level. The number of Floridians in this system has quadrupled over the last 20 years. The state portion of these expenses have increased 88% since 1998, while tax revenues have only risen 24%. It is not known how much of this increase is due to the Federal government shifting expenses to the states. In which case, Mr. Bush has his esteemed brother to thank.
Having much the same philosophy as his brother, Mr. Bush feels that this problem can be solved by getting private insurance companies involved. Poor people can theoretically choose from a variety of programs, with coverage and limits suiting their individual needs, and the state will pay the insurance company. Policies will pretty much work like any other health insurance policy, paying negotiated rates to doctors and hospitals.
A number of people are wary of this proposal, and for good reason. They fear this will limit the types of services available, since specialized services cost money, and money spent cuts profits. Of course the insurance companies want to make a profit if they are going to get involved in this thing. And certainly providers have a right to make a living from services they provide. From the TBO link above:
Hospitals are wary that the plan may leave them with more unreimbursed costs for indigent care, but representatives at facilities such as Tampa General Hospital said they were reluctant to comment until Bush’s plan is evaluated further.
There’s the problem. Nobody really knows how this program is supposed to work. Nobody knows how it will be paid for. Nobody knows how much it will cost. Nobody even knows if, in the end, it will be a proposal that insurance companies will want to participate in.
I have long felt that health insurance in particular drove up costs. It inserts a profit-driven middleman. It insulates people from insurance costs, and from actual healthcare costs. It drives up the overhead costs of doctors and hospitals. This proposal does nothing to mitigate these concerns. If Mr. Bush really wants to get the free markets involved in healthcare, he should consider giving the poor a stipend with which to pay for healthcare and/or healthcare insurance. They should get to keep what doesn’t get spent — maybe in one of those nifty Health Savings Accounts his brother is so keen on — but once it’s gone, it’s gone.
But since Medicaid is a safety net, that almost certainly will not work either.
In closing, why does American Airlines want to know who you might be visiting, and is it really a secret TSA regulation?