I hope the images will load….
they won’t
So go view this post at Substackhttps://danjschmidt.substack.com/p/look-at-it. they seem to be more friendly to my poor skills.
Look at It
Our legislature is wringing their hands and has their undies in a twist about our Idaho Medicaid costs. Or are they just still stinging from their folly?
I think they are still pissed that the voters overrode their negligence to expand Medicaid. It was a wise move, they passed on it, the voters didn’t, and the legislature is still pissed. We elect them, don’t we? These petulant people serve us.
I must applaud their bravery. Examining the costs of healthcare in this country takes patience, discipline and, yes courage. It sometimes takes the courage to admit you are wrong.
The map in white and green above these words shows the Medicaid expenditures per enrollee per year by county in these United (we hope still) States.
Examining our colossal boondoggle of health care in this country should unite us. Or we could go the other way.
Back to the map. Dark green is high cost per capita, white is low. Look at the map.
It is from a wonderful study out of the University of Washington we are soon to kick to the curb. The Idaho legislature no longer wants to be affiliated with such institutions.
Do you see Idaho on the map?
That’s where my eye went.
We are a vast state of white. There are a couple counties that are light green, and a couple others that are darker green. Hey Canyon and Twin Falls, what’s up?
But the takeaway here is that Idaho spends a lot less than most states on Medicaid health care costs.
So, just what is the legislature trying to solve here?
If they still are just butt hurt about the Medicaid expansion initiative, that’s not a very mature attitude.
But if they really think throwing Idaho Medicaid to the managed care wolves will assuage their pain, I am here to argue they are spending your dime to salve their crotches.
Well, it has been done. They voted for it, and our Governor signed it. Idaho Medicaid will be contracted out to some for-profit company in your portfolio. Maybe you’ll retire more comfortably. But will we all, us taxpayers, us citizens be better served?
This second map might help you.
This shows the states that have sent their Medicaid money down the managed care rabbit hole. Dark blue is all in, light blue less so, grey not at all, and Idaho, green, is trying managed care only in primary care settings. Idaho has been trying to incentivize primary care doctors to give good, quality care at low cost. This program has only had a couple of years to roll out.
Look at the maps. Compare both.
Look at South and North Dakota. Green and Blue/ costs pretty different. Maybe this primary care model works. But maybe not.
I think that’s why the Idaho legislative work group that was tasked with this conundrum made no recommendation. They honestly looked at maps like this and threw up their hands. That was a wise reaction. It will take more work.
Managing health care costs will be tough. There is no easy solution.
Just like looking at a map and deciding Twin Falls and Canyon County are slackers is not wise. Wisdom takes more effort.
And trust.
But now the die has been cast. Idaho will jump into contracting Medicaid through some big health care company. Will we be better served? Will the people on these services get better care? Do you even care?
Moving Medicaid to managed care has not saved most states money. Just look at the maps.
But that is what our legislature and our governor has decided is what’s best “for us”.
I believe we had a good plan. I believe managing primary care doctors was a wise move made by the legislature five years ago. It was based on good study and good advice. It was unwise to jump sideways this soon. But then, we elect them, don’t we?