Dear Carol, I hope this blog finds you well. 😉
The question was asked, “how would you fix medicaid”?
My short answer is “I don’t really know, and my gut response would be to root out any fraud to not waste money.”
My responses will only be high level with one example I know of when dealing with Medicaid. I apologize if my thoughts are half baked and come off ignorant. They are. Simply put, these are my thoughts and have not been “in the system” to give clear examples.
We’ve seen enough 60 minutes, 20/20 to know that there are examples of fraud in the system. We hear stories of people “who has a brother in law” who collects public assistance but earns good money under the table. Either way, fraud is not good. I also understand that there is a cost to policing the fraud and that factors into how much an agency will explore and spend on the matter. Some Fraud is accepted if the cost of policing it outweighs it.
With that said… As a conservative (some might call me libertarian) I believe our society should uphold public assistance. We DO have needy in this country. The system should understand that public assistance for the truly needy which I believe it does but with any government agency there is inefficiency. Therein lies the debate… how does our society define the needy.
“Fixing” Medicaid probably starts with identifying why people come to need the assistance. Aside from disabilities (mental and physical), what we have remaining is mostly low income from a variety of factors. Why the low income? It is lack of employment right? Why the lack of employment? Downturn in the economy or unskilled/uneducated to the point of no opportunities. This leaves the answer to be jobs.
But I don’t want jobs to be the answer. Because it is not. When able bodied people are employed, they want off the public assistance and this largely happens. This is the Utopia of public assistance… people only temporarily using the assistance.
OK…. next component. Accountability of individuals. Children are not part of this discussion but they are a potential negative side effect. Children who grow up on assistance mostly likely continue on assistance. This is not a golden rule, but a potential hazard. From the start, children are not to be blamed for receiving Medicaid.
Accountability of adults is important. Medicaid should have mechanisms built in for people to work to move out of the public assistance realm. Job Training, home economic education (balancing their money, etc). These may exist. I don’t know for sure. If they do, great. If a recipient shows up at the Medicaid office holding a smartphone and drove up in a new car, an eyebrow should be raised. I only speculate this happens. I would hope this type of fraud is discovered and eliminated.
My only example of how Medicaid is taken advantage of deals with the elderly. When someone is to the elderly point in life when nursing care is necessary, the elderly couple can be divorced with all assets moved to the healthier spouse leaving the other spouse under the income/asset level to qualify for medicaid and have all nursing care paid for. Yes, this is a real life example that has been used. It is unfortunate, but real.
Medicaid is a facet of our government that is fiscal in nature but is at the crossroads of social issues. Back to able bodied people on public assistance. Some who receive Medicaid most likely receive food stamps. If an individual is a high health risk due to behavioral factors (smoking, drinking, poor diet, lack of exercise) they should engage in programs to reverse those negative factors. If on food stamps, we can track what people purchase and help guide them. This is not a sure fire tool, but you get my point.
I know this sounds intrusive to individuals, but when you receive public money and engage in something not healthy for you then you should receive some scrutiny.
Whew… I hope this does not come off as a right wing kook. My short answer is, public assistance for those who need it, find and eliminate fraud, help those able bodied people move off of Medicaid.