• The Heritage Network
    • Resize:
    • A
    • A
    • A
  • Donate
  • For Patients in Both Medicare and Medicaid, Care Is Inefficient and Costly

    The Wall Street Journal recently reported on bureaucratic barriers for patients covered by both Medicare and Medicaid. These two programs serve the elderly and the poor, respectively, and people who fall into both categories—the “dual-eligibles”—should get better-quality care with more efficient taxpayer spending.

    According to the WSJ, an estimated 9.7 million Americans fall under the dually eligible criteria. They account for 16 percent of the Medicare population but 27 percent of Medicare spending, and 15 percent of Medicaid’s population but 39 percent of its spending. More efficient financing for this group is essential to reining in spending on both entitlement programs.

    Not surprisingly, dual-eligible costs are high mainly because the two government programs do a poor job of working together. In her recent testimony before the House Energy and Commerce Committee, Director of the Medicare–Medicaid Coordination Office of the Centers for Medicare and Medicaid Services Melanie Bella said, “Too often, the care journey for these individuals is fragmented and uncoordinated…Over the years, a lack of coordination for this population has led to fragmented and episodic care, which can lead to lower quality and higher costs for this population.”

    Take Victor Maceyra, for example. After recovering from a shoulder injury, he was kept at a government-funded rehabilitation center for six months. The reason? Medicare and Medicaid each tried to force the other to pay for his home care. Examples of this kind of lack of coordination abound, and dually eligible patients frequently receive treatment at hospitals that they could obtain elsewhere. According to the Medicare Payment Advisory Commission, the panel that advises Congress on Medicare reimbursement, up to 40 percent of all dual-eligible hospital admissions are unnecessary, and care would be more appropriately addressed in a different setting. This is bad news for the patients affected—and it also means significantly higher costs for taxpayers.

    Adding more layers of bureaucracy to government-run health care programs will only make them more clumsy and inefficient. Obamacare dramatically expands Medicaid and depends on draconian cuts to Medicare that will result in less access to care for already vulnerable populations. This approach to health policy is chock full of bureaucracy-based solutions, and you can bet it will worsen existing problems and make real reform more difficult.

    The Heritage Foundation’s Saving the American Dream proposal includes a better plan. It addresses the needs of dually eligible seniors by expanding their access to private coverage, promoting coordination of their care, and making financing more efficient, benefiting patients and taxpayers alike. The Heritage plan would replace the current “defined benefit” structure of Medicare with a defined contribution for seniors to offset their costs, whether they choose to enroll in traditional Medicare’s fee-for-service program, keep their existing private health insurance and bring it with them into retirement, or purchase another private plan that better suits their personal needs. Dually eligible beneficiaries would receive the maximum contribution from the federal government, and in place of traditional Medicaid, states would “top off” the federal contribution to provide further financial assistance if they enrolled in private coverage. The low-income elderly would thus be better served by receiving coverage from one single health plan.

    There is no question that Congress could do a much better job to secure care for the most vulnerable members of society. By rooting out the staggering waste and inefficiency in Medicare and Medicaid through structural transformation of these programs, the Heritage plan would improve the quality of care for low-income seniors and increase the sustainability of both programs.

    This post was co-authored by Kyle Rusciano, a member of the Young Leaders Program at The Heritage Foundation. For more information on interning at Heritage, please visit: http://www.heritage.org/about/departments/ylp.cfm

    Posted in Obamacare [slideshow_deploy]

    5 Responses to For Patients in Both Medicare and Medicaid, Care Is Inefficient and Costly

    1. George Colgrove, VA says:

      This whole system should be sent to the private sector. The private sector – through competition has proven over and over again that they can keep prices low, quality high and provide full coverage of healthcare options. The most successful healthcare enterprises can have large profits at the same time provide low prices and high quality health care options. Of all the vilification by the left and by the federal workforce, government supplied healthcare has proven to be very costly and limited and of low quality.
      Competition encourages innovation and advancement in technology. Government – as expensive as it is, limits healthcare to what has been proven. Because of it's desire to manage a large workforce, inovation is crushed – if it means loosing workers. Obama vilified ATM's because they put tellers out of work. This is all we need to know when it comes to government healthcare.

    2. Andre says:

      Actually as someone whos disabled and on medicaid their inefficient and costly whether you get one or both theres no real way to fix either program either. Most Doctors wont take medicaid and some wont take mewdicare for example meaning the moneys wasted. Also having talked to plenty doctors just paying cash would be cheaper and better since theirs a lot less paper work they can work with the patient as far as payments go. Also like with California they cancel medical services like dental while keeping the money.
      we could safely add 1 to 2 k to a persons ssi/ssa check ending poverty and at least giving the disabled a chance of saving enough to eventually get off the dole and ending poverty also general welfare should be phased out for able bodied people who are just lazy

    3. Bobbie says:

      I expressed a concern a while ago regarding an elderly who was put in the hospital because of a high blood sugar reading. She was healthy otherwise. It took the hospital days to bring her blood sugar down with tests upon tests showing no other health issues. During her hospital stay she developed a swallowing problem which she obviously didn't have with a 500 count blood sugar reading. My father is a good friend of hers and would've known of any swallowing problems before this government run debacle.

      Neglect of the staff was a feeding tube that the staff knew and informed, clogged if not monitored. The tube wasn't checked for two days and she was sent to the hospital with a clogged feeding tube. She was in the hospital overnight and upon returning to transitional care, she was sent back to the hospital because of low blood pressure? One person doesn't do their job which anyone and more than one applies. Lots of compromising to save face at an expense only to the patient!

      She's been in and out back and forth since April 28! Transitional care is mandated by the state and the hospital follows state regulations not necessarily in favor of the recovery of health. The doctor comes in to ask her what the problem is as if the doctor doesn't go by a chart anymore? Inaccuracy problems? Doesn't make sense to put a patient under anymore stress. He should be telling her what's wrong.

      Could have recovered much more quickly in a place of her own environment and wouldn't be recovering from someone elses neglect outside her control and at her expense. She's required by law and rules of her government run insurance to meet government requirements before she can return to the home she owns. The government does make you pay if you have the money and obviously will nurse you a little longer for that extra $1000.00. This is too much government control over the elderly, what are they going to do to us?
      It's not worth a benefit, let alone at no cost?…

    4. Pingback: Entitlement Facts

    5. edfraser says:

      I smell more progressive blood in the water! This abomination called Obamacare will be over turned by slim majority right down party lines. And I will be first in line to cheer its defeat.

      That said I hear of no Republican alternative, except generalities like "tort reform" or "free-market insurance reform". Third-party payers (all medical insurance fits that label) are the problem. The fix is simple and easily understandable, and yes is a free market oriented. More importantly some medical professionals are discussing it and a few are actively trying to implement it!

      It goes by a couple names that I'm aware of. One is "subscription-based, insurance-free medical clinic." Another is "direct-pay practice."

      Both utilize the subscription based business model and one actual practice charges $65/month subscription payed directly by patient regardless of age or preexisting medical conditions.

      Using this model gives the doctor higher incomes, more control over patient care, little paper work, more time with patients, basically all the reasons they went to medical school.

      The patient receives the obvious benefit of much lower healthcare costs, their own choice of provider, more time with doctor, higher quality service, quicker service, no worries about preexisting conditions, peace of mind.

      Why won't the Republicans back this grass-roots revolution before the Democrats kill it? They could create enabling legislation that clears the way, reduces tort when transaction excludes third-party payer, ensures the survival and rapid growth of this obvious workable solution. Google the names above to research this idea and find medical practices trying to implement this.

    Comments are subject to approval and moderation. We remind everyone that The Heritage Foundation promotes a civil society where ideas and debate flourish. Please be respectful of each other and the subjects of any criticism. While we may not always agree on policy, we should all agree that being appropriately informed is everyone's intention visiting this site. Profanity, lewdness, personal attacks, and other forms of incivility will not be tolerated. Please keep your thoughts brief and avoid ALL CAPS. While we respect your first amendment rights, we are obligated to our readers to maintain these standards. Thanks for joining the conversation.

    Big Government Is NOT the Answer

    Your tax dollars are being spent on programs that we really don't need.

    I Agree I Disagree ×

    Get Heritage In Your Inbox — FREE!

    Heritage Foundation e-mails keep you updated on the ongoing policy battles in Washington and around the country.