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So Rick has been gone for a month on a medical mission to Tanzania, which shows his really lousy timing. And I don’t feel qualified (enough) to analyze the Senate’s new-ish health insurance bill without my doctor-expert. But he found connectivity a few days ago and sent me his thoughts on the subject.

It’s disappointing that big places of Obamacare are left in place and Rick believes the current “repeal” legislation will merely slow the death spiral and not arrest it, but he notes that, for the most part, this is really a Medicaid reformation bill and that is definitely much needed. Block granting Medicaid to the states would improve quality of care and reduce overall costs. We’ve had 20 years of welfare reform to bolster the idea that states do it better than the federal government does.

Critics are savaging this idea, implying that “deep cuts” will hurt the quality of care. Some of them are even engaging in inflamatory and highly inaccurate rhetoric about people dying because of cutbacks. The problem with this is that nobody is proposing to cut Medicaid. Republicans are merely proposing to limit annual spending increases. But just like when Sarah Palin refused to allow the Alaska budget to grow chasing higher oil prices, in the upside-down world of Washington DC budgeting, this counts a “cut”.

The Washington Post contributes to this falsehood with a column explicitly designed to argue that the program is being cut.

…the Senate proposal includes significant cuts to Medaid spending…the Senate bill is more reliant on Medicaid cuts than even the House bill…spending on the program would decline in 2026 by 26 percent…That’s a decrease of over $770 billion on Medicaid over the next 10 years. …By 2026, the federal government would cut 1 of every 4 dollars it spends on Medicaid.

A New York Timesarticle even had a remarkably inaccurate headline as it shares out the dishonest rhetoric, especially in the first few paragraphs.

Senate Republicans…took a major step…, unveiling a bill to make deep cuts in Medicaid… The Senate measure…would also slice billions of dollars from Medicaid, a program that serves one in five Americans… The Senate bill would also cap overall federal spending on Medicaid: States would receive a per-beneficiary allotment of money. …State officials and health policy experts predict that many people would be dropped from Medicaid because states would not fill the fiscal hole left by the loss of federal money.

Here’s a chart showing the truth. The data come directly from the Congressional Budget Office.

At the risk of pointing out the obvious, it’s not a cut if spending rises from $393 billion to $464 billion.

Federal outlays on the program will climb by about 2 percent annually.

If opponents of reform want the program to grow faster in order to achieve different goals, that’s fine (everybody is allowed an opinion), but they should be honest about the numbers.

Of course, there is more than math involved here. There’s also policy.

The Wall Street Journal recently opined on the important goal of giving state policymakers the power and responsibility to manage the program. The bottom line is that recent waivers have been highly successful.

…center-right and even liberal states have spent more than a decade improving a program originally meant for poor women and children and the disabled. Even as ObamaCare changed Medicaid and exploded enrollment, these reforms are working… The modern era of Medicaid reform began in 2007, when Governor Mitch Daniels signed the Healthy Indiana Plan that introduced consumer-directed insurance options, including Health Savings Accounts (HSAs). Two years later, Rhode Island Governor Donald Carcieri applied for a Medicaid block grant that gives states a fixed sum of money in return for Washington’s regulatory forbearance. Both programs were designed to improve the incentives to manage costs and increase upward mobility so fewer people need Medicaid. Over the first three years, the Rhode Island waiver saved some $100 million in local funds and overall spending fell about $3 billion below the $12 billion cap. The fixed federal spending limit encouraged the state to innovate, such as reducing hospital admissions for chronic diseases or transitioning the frail elderly to community care from nursing homes. The waiver has continued to pay dividends under Democratic Governor Gina Raimondo. …This reform honor roll could continue: the 21 states that have moved more than 75% of all beneficiaries to managed care, Colorado’s pediatric “medical homes” program, Texas’s Medicaid waiver to devolve control to localities from the Austin bureaucracy.

By contrast, the current system in states that have not moved toward block granting is not successful. It doesn’t even generate better health, notwithstanding hundreds of billions of dollars of annual spending. Both Rick and I have worked in the medical field intersecting Medicaid and we’ve both seen how badly it works. Medicaid is what single-payer health insurance looks like and it isn’t pretty.

Avik Roy explained this perverse result in Forbes back in 2013.

Piles of studies have shown that people on Medicaid have health outcomes that are no better, and often worse, than those with no insurance at all. …authors of the Oregon study published their updated, two-year results, finding that Medicaid “generated no significant improvement in measured physical health outcomes.” The result calls into question the $450 billion a year we spend on Medicaid… And all of that, despite the fact that the study had many biasing factors working in Medicaid’s favor: most notably, the fact that Oregon’s Medicaid program pays doctors better; and also that the Medicaid enrollees were sicker, and therefore more likely to benefit from medical care than the control arm.

First, there are no Medicaid cuts, as the left is asserting, and second, Medicaid as currently operating, does such a poor job that it doesn’t have any effect on health outcomes. If the GOP actually did cut the program, it is entirely likely that people would actually get better care with no insurance at all. But that is not what is being proposed. The administration of Medicaid would move to the states, which was a highly successful improvement to welfare programs in the 1990s and is now working in a handful of states for Medicaid.

So whatever you’re hearing in the news is not news … it’s propaganda, created by those who don’t want to lose their power to control the lives of others.

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