I’ll bet you have been riveted to the goings on of the interim Idaho legislative committee looking into whether adopting a managed care contract for Idaho Medicaid would solve all our problems.

What? You don’t know about this?

 It’s more important for you than who will be the next Republican sacrifice for Speaker of the House of Representatives.

Idaho Republican legislators seem to have decided the best way to rid themselves of the cost of health care for the poor, disabled and uninsured is to somehow involve private enterprise. This is even though the Idaho Freedom Foundation is cool to the proposal.

Shucks, we all know corporate business runs things so much better than any guvmint outfit, don’t we?

Well, I guess maybe not prisons. Idaho tried that for a while. We all know paying for incarceration is a drag on the economy. So, let’s just farm out the prisons and running them to corporations and we’ll sign a taxpayer funded contract. Win-win.

Well, it didn’t work out so well, if you choose to remember.

But healthcare should be easier, right? It’s just keeping all those people from wasting our money. Why can’t corporations figure out the way to stop that waste? Jeff Bezos gets us what we want real cheap with free delivery, doesn’t he? My next day delivery comes next week.

I don’t know if our legislators have looked hard at others who had this fantasy. It is telling.

I vote for people who are willing to acknowledge they might be wrong about something. Maybe you like the ones who are sure they are always right. But then, I’m an Idaho Democrat, and you’re probably not.

I think it was the second President Bush (the Iraq invasion, WMD guy) who instituted Medicare Advantage programs. Well, he had congress approve it. Back when the House had a Speaker…

Some of you folks my age might be enrolled in such. As it turns out, about 160K over 65 Idahoans are so enrolled. This number has grown four-fold in the last ten years. I’m sure you’ve seen ads somewhere.

Once you hit the magic 65, you can get health insurance through regular Medicare (guvmint plan), or you can choose from a Medicare Advantage plan. These are private insurance corporations who contract with Medicare to provide insurance for their enrollees, then they get paid from the guvmint based on complicated formulas and calculations.

The theory was, since private enterprise is so damn efficient, they would be able to provide health insurance at a lower cost, and still make a profit, thus saving the taxpayer money AND rewarding their investors. Win-win, high fives all around.

Shucks, I wish it was that easy.

It turns out, Medicare Advantage plans cost the taxpayer about $7 Billion more than if the enrollees had been in regular Medicare in the year 2019. Add up the years, add up the numbers and the growth in enrollment, and then look at your retirement portfolio. Maybe you have invested in some healthcare stocks. Maybe you like the way this is spinning.

Medicare Advantage plans make a profit for their investors by finding the cheapest providers. That’s what managed care does. Enroll the cheapest, most cost-efficient programs in your panel, and only allow your enrollees to use your panel.

Small town hospitals and providers won’t make the grade. You guys provide care locally. Local doesn’t always make the balance sheet look good.

Idaho, beyond Boise, can be pretty rural. Does such a model serve us?

Idaho legislators need to be focused on making Idaho communities healthy. Their worry about the Medicaid budget is wise, but too narrow.

Good schools, good jobs, good housing makes people healthy.

But shucks, I’m an Idaho Democrat.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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