Here in Missouri, Governor Blunt has instituted some of the most brutal cuts to medicaid in the nation. Having cut medicaid to almost the federal minimum, Blunt now has a vision for how to "reform" Missouri Medicaid. It would start by eliminating Medicaid altogether, and replace it with a whole new system. Here is the governing idea behind Blunt's health policy:
Tentatively dubbed Missouri Healthnet, the new system would use both carrots and sticks to place more emphasis on prevention and personal responsibility.
Under the working draft, residents would apply for the program over the Internet, use a state rating system to pick their doctor, receive benefits tailored to their health status and reap rewards for good habits.
I cringe whenever "personal responsibility" is invoked when discussing healthcare or the poor. For a great discussion (even if the writing and argument is occasionally questionable), see Mark Rank's One Nation, Underprivileged. As someone who's disabled, I have spent a fair amount of my life on medicaid, in two states. I can state that my supposed lack of "personal responsibility" is not what has at times jeopardized my health. Being on medicaid, I have a limited pool of doctors and specialists that I can see. So, instead of having a consistent primary care physician, or instead of seeing the right specialist that I need, I often have to visit over-packed clinics staffed by Residents. (No disrespect to Residents, but they are over-worked in these clinics, and are thus not always able to give the best care.) The real contradiction in the theory of "personal responsibility" is that programs like medicaid for the disabled and poor provide inadequate healthcare, and so people on medicaid become more of a drain on state budgets because of compounded illnesses that are not attended to properly. Then, the rules of being on medicaid make it so that you can hardly earn any money lest you get kicked off. Not everyone, be they disabled or poor, can find a job that offers health insurance, or enough of an income to buy an individual policy (this option is not open to the disabled most of the time). If someone who is on medicaid tries to save money, or build up a work record and resume, they run the risk of making too much money, and by too much money, I mean approximately $700 a month for a single person in Missouri, or a little over $900 for a couple (combined).
I am also wary of applying over the Internet, for the obvious reason that the poor do not always have internet access. Aside from that, I am most disturbed by the following lines--"receive benefits tailored to their health status" and "reap rewards for good habits." Yes, that's it conservatives, the poor and disabled have poor health only because of bad habits. Never mind that they have such low incomes that they can only eat horrible, high-fat food. Never mind that the conditions of governmental help for the poor seeks to punish them rather than truly help them.
As for "tailored to their health status," I think that is just vague enough to justify shorting people on coverage. You score x number on the health scale, which means y amount of benefits. Such a healthcare program cannot be preventative as Blunt claims, but can only be on the cheap.
During the next two years, and if the Democrats can win the White House, healthcare needs to be an urgent issue. An exploratory team of doctors, hospital administrators, economists, and lawyers needs to be set up to develop a plan for universal healthcare in this nation. In Britain, everyone pays a certain percentage of their income toward National Healthcare. I do not know why we cannot do that here, with some exceptions made for those living below the poverty line.
I think that for universal healthcare to become a reality, the following needs to happen:
1.) There needs to be a netroots, grassroots, and popular movement to declare that healthcare should be a right and not a privilege in this country. FDR knew this, and stated it in his Economic Bill of Rights.
2.) There needs to be a leader in the Democratic party who can firmly, and eloquently advocate the need for such reform to healthcare. There needs to be a paradigm shift in this country concerning social responsibility.
3.) Business and Industry needs to be convinced to get on board with this. If everyone is contributing to healthcare, then they don't need to.
If we have universal healthcare, then I truly believe that we can improve general health in this country, and over time decrease the cost of healthcare. It's so expensive right now mainly because of lawsuits and mostly because of the inadequate coverage for the poor and the disabled, which exacerbates underlying health problems, and then puts a burden on programs like medicaid.
I'm not an expert on this. I'm only someone who is suffered under the poor coverage of medicaid because I have a disability. I invite comments and suggestions for how to lobby for universal healthcare (I'm using this term loosely, and am not suggesting it has to look like what Clinton introduced in the early 90's.) When it comes down to it, is there anyone here who hasn't felt victimized by either a program like medicaid or their own insurance policy? The business of health insurance in this country has made victims of us all by turning good health into a consumer good.