Absolutely, seniors should worry about health care reform.

But what they should worry about is what they are already seeing as Arnold the Governator has attempted major cuts to In Home Health Services and other Medi-Cal payments.

What many don't realize about Medi-Cal, or Medicaid, as it is known outside California, is that it is paying a large share of the medical costs for seniors. Medicare doesn't cover nursing home care beyond 100 days or drugs, so many seniors receive both Medicare, which was designed for the elderly, and Medicaid/Medical, which was targeted for the poor.

Double-dippers who get both cost the federal government 200 billion a year. In 2008, Medicaid paid 40 percent of total long term care expenditures, and 43 percent of nursing home expenditures.

Medicaid, which is funded jointly by the state and the federal government, has been consuming an increasingly large share of  state budgets, including California's.

States spent one-third of their money on health by 2005, and within a decade, if present trends continue, the health sector alone will devour one-half of state spending. Similarly, Medicaid and Medicare under current policy would consume one-half of all federal revenues within 15 years.

In Home Health Services, which are funded by Medicaid, have expanded dramatically as an alternative to nursing home care, which is far more expensive. It's one of the programs that the Governator has singled out for hundreds of millions in cuts.

Schwarzenegger and various Republicans also periodically attempt to slash payments for health care under Medicaid, thinking they are attacking poor minority families and children of illegal immigrants. Instead they are harming the disabled and the elderly, who account for the largest share of costs.

A national health care plan, with coordinated benefits, better integration of health care into communities, and real reforms that focus on better care at lower cost are absolutely essential if we are to preserve health care for seniors in the United States.

Otherwise, we'll see more attacks on care for the frailest and weakest in society - the disabled and elderly.  California seniors who have spent down all of their wealth except their home and their monthly Social Security checks will now face finger-printing and humiliation to receive in home services under Medicaid, and may still be denied the care they need to live and die with dignity in their own homes.

Want to know about workable solutions? Read this article by David Osborne.

To develop a workable solution, it helps to understand four basic problems our system faces.

First, the core purpose of our current system is to treat symptoms, not to sustain health. We spend most of our energy and money responding to illness, rather than preventing it.

Second, most medical institutions are designed to provide episodic care for acute illnesses, but the real burden has shifted to chronic problems that need continuing and coordinated care, such as diabetes, asthma, cancer, heart disease, and AIDS.

Third, our system is so fragmented among myriad medical practices, hospitals, and insurance companies that it produces enormous waste. Complex administrative processes consume 25 percent to 30 percent of all health-care dollars.

Fourth, our fee-for-service payment system creates perverse incentives. Providers make more money by performing more services. Indeed, if a hospital makes a mistake or omits something important and the patient has to be treated again, that hospital makes more money than it would have if the procedure had gone well.

Even before the Great Recession, we were moving towards permanent fiscal crisis in state government, largely driven by health care costs that have continued to escalate at 10% per year for 50 years.

Read the whole article by David Osborne for some prescriptions that inform the discussion of what a public plan might look like, and how states, with their differing demographics, problems, and markets can play a tremendous part of the solution.

California is leading the way to fiscal collapse because we have the WORST GOVERNOR EVER and structural problems with our government that allow a minority to control the budget, but the problems in California aren't unique, and they will apply to every state unless we adopt meaningful health care reform immediately.

Originally posted to Aeolus on Wed Aug 12, 2009 at 07:07 AM PDT.

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