|Leading policy-makers and scholars explain how market forces, deregulation, and consumer choice can work to improve health care for all Americans.||
In Control of My Health
Gratzer, a senior fellow at the Manhattan Institute, argues that what Medicaid needs is not a tune-up but a comprehensive overhaul. Thankfully, there are promising state initiatives in places like Colorado, Florida, and South Carolina that are doing just this.
Colorado has started Consumer-Directed Attendant Support, or CDAS, to give severely disabled Medicaid recipients more control over their care, literally putting them in charge of their own health dollars. Participants are able to hire and fire their own caregivers, and use money for life-enhancing equipment. Patient satisfaction is high, as is quality of care — but not costs. Whereas Medicaid state budgets skyrocket, CDAS spending is 20% under budget. “Choice works,” declares Governor Bill Owens. ...
Faced with rising Medicaid spending — up 13% annually for the past six years — the governor of Florida, Jeb Bush, proposes to get his state out of the business of micromanaging Medicaid. Under his plan, those eligible for Medicaid would qualify for a set, need-based amount of money (an AIDS patient, say, receiving more funding than a healthy young woman). With this money, recipients select a plan from a menu of competing insurance company offerings. For those who select a less comprehensive insurance (at a lower premium), part of the money saved goes to a flexible spending account for out-of-pocket medical expenses.
The governor of South Carolina, Mark Sanford, envisions a reform under which most Medicaid recipients would receive a debit card for health services — and the choice and empowerment that go with it.
Gratzer thinks that the President can energize more states to reform Medicaid through “block grants with the bonus of new funding for a decade to come.” This approach would sweeten the pot for state legislators as well as “end Medicaid as we know it,” to the great advantage of patients and policymakers alike.
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