 |
| Medicaid`s Challenge: Improving Health |
October 17, 2003 |
| |
Dear Friends,
Last summer I was asked to head a Congressional task force on Medicaid. Medicaid is the largest health care program in the country, covering low income mothers and children, the disabled, and low income seniors. It provides health coverage to 48 million Americans and costs about $280 billion a year. It represents 7% of the federal budget and between 15 and 20 percent of most state budgets.
After a series of task force meetings this summer, in the last two weeks, we have held the first two of what will be many hearings over the coming year on Medicaid. We have a long way to go to formulate solutions, but much needs to be done.
Medicaid was set up to pay claims, not to improve people’s health. Astoundingly, there is no state that we have found yet that routinely gathers the information to be able to tell whether the health status has been improved for people covered by Medicaid. They can tell us how much money was spent for what services, but not much more.
Medicaid funds about 70% of the nursing home beds in America. Most people do not want to go into nursing homes; they would rather age in place if at all possible. We should make that easier to do.
In general, Medicaid does a lousy job helping people manage their chronic diseases like diabetes, heart disease, chronic obstructive pulmonary disease and asthma. In fact, states need to say “mother may I” and get a waiver from the federal rules to operate disease management programs. With 60% of the cost of health care in America attributable to a dozen or so chronic diseases, you would think systematically reducing the impact of these diseases on people’s lives would be a priority, but it is not.
Medicaid does not address prevention, either, and many health problems are related to diet, exercise and smoking.
Medicaid is one of the most complex federal programs there is, and one of the most important. I look forward to continuing to work on this challenge.
Wish you were here,
 |
|
|
|