May 19, 2006


They'd Sooner Fix Medicaid: Can market incentives save the system? (TOM COBURN AND REGINA HERZLINGER, May 18, 2006, Opinion Journal)

OKLAHOMA CITY--The state Legislature here is working to finalize an agreement for Medicaid reform legislation creating personal health accounts (PHAs) for Medicaid enrollees. This comes hard on the heels of similar innovations in South Carolina and Florida. Reform is in the air--much the way it was when Wisconsin revolutionized its welfare system in the early 1990s, forerunning a stunning national success. Are we on the verge of consumer revolution in health care?

It is of course too soon to tell, but the Oklahoma case study is auspicious. The state's antiquated Medicaid bureaucracy has fostered, by turns, a lack of patient choice, provider dissatisfaction, a 9.5% payment error rate, and an escalating price tag of some $3.5 billion. Against these discouraging trends, state leaders spent six months last year formulating stopgap measures with state agencies, policy innovators, providers and beneficiaries.

Instead of assuming the indigent are incapable of decision-making, Oklahoma legislators proposed that Medicaid beneficiaries be given a risk-adjusted allowance to purchase private health insurance. A PHA would be established for annual out-of-pocket expenses without a "use it or lose it" penalty--that is, the unspent balance could be used for future health-care needs. They state would not mandate a homogenous set of benefits; instead, it would provide financial assistance and patient counseling.

The reform passed the Oklahoma State House in March and recently won Oklahoma State Senate approval. The bill's sponsors, Republican Rep. Kris Steele, and Democratic Sen. Tom Adelson, are working to craft a durable bill to send to the governor by the end of this year.

Oklahoma is simply coming to grips with reality--Medicaid needs fundamental change.

Posted by Orrin Judd at May 19, 2006 8:00 AM

Thirty years later, it's about time to declare deinstitutionalization a tragic failure and start rounding up the mentally ill and the mentally retarded (sorry I can't keep up with the PC nomenclature) and putting them in facilities designed to care for them. Taking this hapless population off the streets and giving them the care they need will go a long way to solving the long-term abuses of Medicaid as well as the huge (huge at least when there's a Republican in the White House) homeless problem.

Posted by: erp at May 19, 2006 8:18 AM

Amen. The Grandfather Judd and Geraldo Rivera started it:

The former, at least, would be scandalized by the results.

Posted by: oj at May 19, 2006 8:23 AM

Well, at least Geraldo's legacy helped get Rudy Giuliani elected mayor.

As for the Medicare reforms, to Democrats, until it's tried and works in a (Light( Blue State like Wisconsin, they'll try to hammer any efforts at change as being heartless towards the poor and seniors. Hopefully, there will be a governor and legislature in one of those states that will soon take the plunge and shut the naysayers up.

Posted by: John at May 19, 2006 9:37 AM