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There is a
fundamental
health care
question that
every candidate
for office,
whether at the
state or federal
level, should
answer this
fall: How are we
going to address
growing Medicaid
challenges that
threaten state
budgets and
increasingly
leaves gaps in
care for
vulnerable
families?
Medicaid, the
health care
program that
treats 53
million
Americans, is in
need of
fundamental and
comprehensive
reform to ensure
that it meets
the very
different needs
of very
different
populations it
serves,
including poor
and uninsured
children, people
with
disabilities and
the elderly.
Medicaid has not
been
significantly
updated since
its creation in
the mid-1960s.
Like many relics
of that era,
Medicaid has
become
increasingly
inefficient,
prone to fraud
and abuse, and
out of step with
advancements in
modern health
care.
Past attempts at
reform have been
mostly
ineffective,
largely due to
lack of
political will
and entrenched
interest groups.
There simply
hasn’t been the
commitment to
trying new and
better ways of
administering
the program as a
whole.
Therefore, too
many efforts
have forced
cashstrapped
states to limit
services without
improving care.
The financial
challenge is
real. Simply
saying “spend
more money”
isn’t going to
get it done.
Medicaid will
cost taxpayers
nearly $5
trillion over
the next 10
years. That is
why we have a
vested interest
in making sure
this program is
as strong as
possible.
Already,
Medicaid exceeds
more than 20
percent of state
appropriations
in half of the
states, and
those numbers
will only grow
in the coming
decade – forcing
governors and
state
legislatures to
raise taxes,
reduce benefits
or make painful
choices about
limiting other
state services
to pay for
Medicaid.
This summer, I
convened summits
nationwide with
Medicaid
experts, health
advocates and
government
leaders to
develop a
roadmap for the
future of the
Medicaid
program. Those
efforts have led
to a report
entitled,
Medicaid
Makeover: Four
Challenges and
Potential
Solutions on the
Road to Reform.
The report lays
out the four
central problems
plaguing
Medicaid and
what
policymakers
must do to
confront these
challenges:
First,
Medicaid does
not adequately
meet the health
care needs of
the diverse
populations
served by the
program. We must
realign
responsibility
for Medicaid so
that the federal
government
assumes a larger
role in
planning,
delivering and
paying for
services for the
elderly while
allowing the
states to take
on greater
responsibility
for those under
65.
Second,
Payment
structures and
technologies are
outdated. States
must be
encouraged to
recognize and
reward
high-quality
care and
improved
outcomes and to
deploy health
information
technologies.
How badly is
advanced health
IT needed in
health care? In
August, the
Institutes of
Medicine (IOM)
issued a report
that found that
at least 1.5
million
Americans are
sickened,
injured or
killed each year
by medication
errors. In other
words, the wrong
patients are
getting the
wrong drugs in
the wrong
dosages at the
wrong time. The
IOM estimates
the extra
expense for
treating
illnesses caused
by medication
errors to be at
least $3.5
billion.
Medicaid
programs can be
leaders in this
field.
Third,
Medicaid must do
more to address
the problem of
the uninsured.
States must be
encouraged to
expand Medicaid
coverage to
lessen the
strain on our
health care
safety net.
Fourth,
Medicaid does
not efficiently
encourage
individuals to
play an active
role. We must
identify and
overcome
barriers so
individuals can
take control of
their own
health.
To expand on
this last point,
Medicaid
Makeover
calls for
shifting
emphasis from
treating
sickness to
managing
wellness.
Individuals
should be
empowered to
take charge of
their own health
– an absolutely
necessary
component of any
health reforms.
In Medicaid and
through the
health care
system, the
first and best
way to reduce
health care
costs – and
improve people’s
health – is to
keep them from
getting sick in
the first place.
As a matter of
economic, health
and personal
policy, we must
do all that we
can to promote
the cause of
prevention –
living healthier
lifestyles by
eating right,
exercising more
and stopping
smoking.
What does this
mean for the
health care
system? Just
look at the
facts:
• Obesity costs
the American
economy $117
billion a year.
• About 75
percent of our
health care
dollars are
spent treating
chronic diseases
such as heart
disease, cancer,
and diabetes.
And $75 billion
of that treats
obesity alone.
• These chronic
illnesses – many
of which can be
prevented by
healthy
lifestyles –
cause seven out
of every 10
deaths.
These preventive
health issues –
as well as the
other three
noted earlier –
are severely
impacting
Medicaid.
Addressing these
fundamental
challenges is
key to
redesigning
Medicaid. We
also must stop
looking at the
old model that
worked in 1965
but is now
clearly and
painfully
outmoded and
instead figure
what works best
in 2006 and
beyond. We must
identify the
best way to
bring quality
health care to
those in need
and not hide
behind an
antiquated
system.
Innovation needs
to be encouraged
and more
importantly
rewarded.
When I was
governor of
Wisconsin and
overhauled an
outmoded welfare
system, many
told me it
couldn’t be
done. I didn’t
listen to them.
Instead, I
listened to
welfare mothers
and found out
how government
could help them
get back to
work. With the
help of many
others, we
achieved our
goal.
I am confident
that we can
succeed again
with making over
Medicaid – if
Governors,
Members of
Congress and
state lawmakers
make it a
priority this
election season
and throughout
their terms in
office.
RF
Tommy G.
Thompson served
as Secretary of
Health and Human
Services from
2001-2005.
Previously, he
served as
Governor of
Wisconsin from
1987-2001. He is
currently a
partner at Akin,
Gump, Strauss,
Hauer and Feld
LLC. |
