Healthcare Hypocrisy - Medicaid usage opinion - Brief Article

Nursing Homes, Oct, 2001

RICHARD L. PECK

Although the American Health Care Association might disagree, there is an ironically humorous side to its recent announcement that state Medicaid programs across the United States are shortchanging nursing homes by $3.3 billion a year. Nursing homes should be grateful that it's not $60-plus billion a year-the entire cost of the Medicaid program. That's because if you're a healthcare policy "strict constructionist," there's no way that Medicaid should even be involved with nursing homes.

Stephen Moses, of the Center for Long-Term Care Financing, and the closely associated private long-term care insurance industry are absolutely correct: Medicaid was designed, in the mid-1960s, to cover the healthcare needs of the poor-and the "poor" were conceived to be underprivileged urban minorities and residents of rural backwaters like Appalachia. Eighty-year-old, formerly middle-class grandmothers were not, it is safe to say, the beneficiaries envisioned (and even less so, upper middle-class estate planners).

But here we are. Medicaid, or at least one-third of it, has become our defacto long-term care entitlement program. Here's where the irony kicks in.

Some of those middle- (and upper-) class Americans, many of them no doubt after a lifetime of opposing government programs, are striving mightily to get themselves qualified for Medicaid-financed long-term care. Meanwhile, many of their states have created ingenious schemes to qualify their Medicaid programs for "intergovernmental transfers," i.e., more money from Washington to continue to support the Medicaid entitlement program. I would venture to guess that many of the state officials loudly protesting the Bush administration's plan to shut down these transfers would shudder at the thought of a national healthcare plan, which would, of course, smack of "socialism."

Seriously, folks, it's time that we Americans decide what it is we want, and then be upfront about getting it. If we want entitlements, then let's pay for them. If we think private insurance is the key, then let's make sure it's available and affordable to more than the minority of Americans with generous health benefits plans. If we don't like either of these approaches, then let's accept the fact that some of us are just going to have to do without needed assistance in our old age.

But let's decide, because one thing is sure: Healthcare hypocrisy just isn't healthy. NH

RICHARD L. PECK,