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  • Blogo-Care

    Posted by Carl from Chicago on January 31st, 2009 (All posts by )

    During Blogo’s numerous press conferences prior to his impeachment, he hammered on a few themes that I started to think may be a precedent for the nation as a whole.

    From his impeachment speech (whole text here):

    And then I would say to all of you, think about the things we’ve been able to do together. Health care for all of our kids, first in the nation

    In speech after speech and interview after interview he hammered home the “fact” that he had granted insurance coverage to so many in Illinois, through various means.

    How has this actually been implemented in Illinois? State payments to medical providers has been dramatically slowed. From this article titled “State Owes Area Health Care Providers Millions

    “This is the worst it’s ever been it’s historically been this way, nursing home providers have had to in this kind of environment in Illinois for quite a long time”

    I have personal experience with the State of Illinois delaying payments (I used to be an auditor) but apparently the situation is worse than ever for health care providers. When watching the local PBS news program “Chicago Tonight” (which I have been following during the impeachment process) I noted many legislators from the State of Illinois house and senate saying that they had to intervene with the State of Illinois to expedite payments to some of their local hospitals that were on the verge of major financial distress since they hadn’t been paid.

    Note that delaying payments is “net” the same as reducing reimbursements since the state doesn’t really catch up for a long time. Thus if the state moves from a 60 day payment cycle to a 90 day payment cycle that is essentially a permanent reduction to health care providers. Also, the variable nature of the payment delays ensures that rational health care providers need to hold a big “rainy day” fund since ostensibly their employees want to be paid cash rather than IOU’s (like the State of California recently did with tax returns).

    There is little that these medical providers can do except complain to their local legislator. You can’t “sue” the State to make payments happen faster, and if you do the state doesn’t care. Unlike insurance, which may be (popularly) perceived as unfair, there are no avenues of appeal if you feel the state is killing your business.

    In this way the US will likely move to some sort of backwards medical socialism program – by increasing coverage under existing programs and then squeezing providers with reduced and slowed reimbursements, or by not increasing Federal transfers to states to make up the difference on the unfunded mandates.

    You will watch a version of this unfold in Illinois and other states that increased insurance coverage at state expense, as medical providers begin to financially crumble and move away from treating state and Federally insured patients, or do it in the most bare-bones and cheap manner possible.

    The parallel process will occur as people with means move out of the state and Federally controlled medical industry where possible and necessary to preserve their health, with ultimately a two-tiered system emerging with failing public facilities and walled-off private facilities. Unlike Canada, where it is illegal to practice private medicine, in the US those types of laws won’t get widely passed, and a backwards two-tiered process will stumble into being.

    Watch it first in Illinois, then the nation. Sadly enough we are the bellwether.

    Cross posted at LITGM

     

    7 Responses to “Blogo-Care”

    1. Shannon Love Says:

      I really wonder why people think we can have national health care when we can’t get it work on the small scale in the states.

    2. Jonathan Says:

      Great post. I wish your predictions didn’t make so much sense.

    3. td Says:

      I doubt sincerely Blagojevich’s going to be much of a bellwether on health care or anything else.

      Some less delusional and more competent examples:

      http://www.newyorker.com/reporting/2009/01/26/090126fa_fact_gawande

    4. Carl from Chicago Says:

      Hmmm…. TD I tried to read that New Yorker post you linked to but didn’t get past the reference to the 1940′s in Australia and the UK and didn’t have the time to stumble through the rest of that article. Also saw the links to Paul Krugman on your blog, and well, ’nuff said.

      You are welcome to visit the City of Chicago and watch Blogo-care in action. Stop by the Stroger hospital… they don’t even know what a paying customer is. When Stroger got sick he didn’t even go to the hospital that was named after him, which was absolutely classic.

    5. onparkstreet Says:

      Shannon Love: seriously, right? It’s gonna be hard to have everything centralized, even hospitals themselves suffer from being to ‘centralized’ in decision making.

      *One of the residents told me a Chicago hospital story at work the other day – don’t remember the hospital. The health department shut down the cafeteria/food service so they were bringing in Subway for the patients. Oy.

    6. TMLutas Says:

      Td – Anyone who believes that government systems don’t produce their own share of tragedies should watch Dead Meat. I can’t speak about 1950s Australia or turn of the century England but Starla Darling very likely had the right to health coverage under COBRA. Her ignorance of her rights is an indictment of the Archway & Mother’s HR team but that’s hardly a systemic problem with private provision insurance. Once you start talking about tear jerking stories that already have solutions based on current law, this is emotional manipulation and not serious public policy discussion. I stopped reading at that point. If I wanted to be emotionally manipulated, I can talk to my 7 year old. At least all she wants is a puppy.

      The problem with the socialized systems is that they rob the future to pay services today under the theory that the future is a long way away. Haven’t we had enough of that already?

    7. td Says:

      History is rather unkind to the notion that governmental involvement in healthcare is inherently doomed. A more balanced reading would lead one to the ponder the possibility that its an issue of management rather than ideology if one is interested in investing the time.

      Carl thanks so much for the invite but I’ll decline as I’ve been living in Chicago for a number of decades now and remember County well when Thompson and Edgar were our beloved guvs too.
      And btw I also link to this site on my blog so….. nuff said??