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Legacy of Health Reform: Fiscal Disaster

John on April 9, 2010 at 9:36 am

This Peter Suderman piece at Reason is a must read primer on the recent history of grandiose health reform plans. A sample:

As spectacular failures go, it’s hard to do worse than Tennessee. This early state attempt to dramatically increase health coverage, dubbed TennCare, started off promisingly. In 1994, the first year of its operation, the system added half a million new individuals to its rolls. Premiums were cheap—just $2.74 per month for people right above the poverty line—and liberal policy wonks loved it. The Urban Institute, for example, gave it good marks for “improving coverage of the uninsurable or high-risk individuals with very limited access to private coverage.” At its peak, the program covered 1.4 million individuals—nearly a quarter of the state’s population and more than any other state’s Medicaid program—leaving just 6 percent of the state’s population uninsured.

But those benefits came at a high price. By 2001, the system’s costs were growing faster than the state budget. The drive to increase coverage had not been matched by the drive to control costs. Vivian Riefberg, a partner at consulting firm McKinsey & Company, described it as having “almost across the board, no limits on scope and duration of coverage.” Spending on drug coverage, in particular, had gone out of control: The state topped the nation in prescription drug use, and the program put no cap on how many prescription drugs a patient could receive. The result was that, by 2004, TennCare’s drug benefits cost the state more than its entire higher education program. Meanwhile, in 1998, the program was opened to individuals at twice the poverty level, even if they had access to employer-provided insurance.

In other words, the program’s costs were uncontrolled and unsustainable. By 2004, the budget had jumped from $2.6 billion to $6.9 billion, and it accounted for a quarter of the state’s appropriations. A McKinsey report projected that the program’s costs could hit $12.8 billion by 2008, consuming 36 percent of state appropriations and 91 percent of new state tax revenues. On the question of the system’s fiscal sustainability, the report concluded that, even if a number of planned reforms were implemented, the program would simply “not be financially viable.”

In a related story, the CBO director says US debt is on an unsustainable path in large part because of Medicare and Medicaid:

“U.S. fiscal policy is unsustainable, and unsustainable to an extent that it can’t be solved through minor changes,” Congressional Budget Office (CBO) Director Douglas Elmendorf told reporters at a Christian Science Monitor breakfast.

Spending on Medicare, Medicaid and Social Security, plus defense programs and debt interest, will exceed the rest of the federal budget in 10 years if most of the 2001 and 2003 tax cuts are extended, as President Barack Obama has proposed, Elmendorf said.

The Daily Caller rightly points out that Elmendorf waited until O-Care had passed to make this little announcement. This would have been good information for the public to have about two months ago.

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Category: Health & Education |

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