Texas Plan For Reducing Health Care Costs: Don't Offer It

The CBO should run the numbers:

Some [Texas] Republican lawmakers — still reveling in Tuesday’s statewide election sweep — are proposing an unprecedented solution to the state’s estimated $25 billion budget shortfall: dropping out of the federal Medicaid program.

It would certainly "save" money for Texas (I suppose the "folks dying" thing may have a cost.) But it would save the federal government even more:

The Heritage Foundation, a conservative research organization, estimates Texas could save $60 billion from 2013 to 2019 by opting out of Medicaid and the Children’s Health Insurance Program. [. . .] State Representative John M. Zerwas, Republican of Simonton, an anesthesiologist who wrote the bill authorizing the health commission’s Medicaid study, said [. . .] “Because of the substantial amount of matching money that comes from the federal government,” Mr. Zerwas said, “there’s an economic impact that comes from that. If we start to look at what that impact is, we have to consider whether it’s feasible to not participate.” State Senator Jane Nelson, Republican of Flower Mound, who heads the Senate Public Health Committee, said dropping out of Medicaid was worth considering — but only if it made fiscal sense without jeopardizing care. Currently, the Texas program costs $40 billion for a period of two years, with the federal government paying 60 percent of the bill.

(Emphasis supplied.) Sooo, Texas can save $60 billion and the federal government could save $90 billion. What's not to like? Except of course, all the people dying. But other than that, sounds great.

Speaking for me only

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    Dr. Zerwas, meet Dr. (5.00 / 0) (#1)
    by oculus on Sun Nov 07, 2010 at 11:06:30 AM EST
    Kervorkian. Except the latter had consent.

    Sounds like the republicans (5.00 / 1) (#2)
    by robotalk on Sun Nov 07, 2010 at 11:32:25 AM EST
    and Texas want their own sort of rendezvous with destiny.  The election results also seem to say "hurry sundown."  I'm sad to say that it looks like policy over the next two years will be "let's see what happens, if . . . ."  

    Welfare for billionaires paid for by cutting (5.00 / 2) (#3)
    by MO Blue on Sun Nov 07, 2010 at 11:32:56 AM EST
    services to the poor.

    The Census Bureau study released Thursday said that Texas' poverty rate last year was 17.3 percent, once again the nation's sixth-highest. The rate among Texas children also has increased since 2008.

    Poverty now affects almost 1.8 million Texans younger than 18. That's just more than one of every four. Dallas News

    More good Republican ideas recycled in Texas:

    Appearing on CNN's Parker/Spitzer this past week, occasionally secessionist Texas Gov. Rick Perry (R) proposed allowing states to opt-out of Social Security:

    "Here's what I think would be a very wise thing," he began. "In 1981, Matagorda, Brazoria, and Galveston Counties all opted out of the Social Security program for their employees. Today, their program is very, very well-funded and there is no question about whether it's going to be funded in the out years. It's there. That's an option out there." Think Progress

    The CRS said,   "By examining the actual system in place in Texas, this study shows that Americans are worse off with privatized accounts -- not in theory, but in reality."   And remember, this was in 2005.   You can imagine what those private accounts look like after the recession took trillions of dollars in investments out of the stock market starting around the end of 2007.   I'll bet those county employees wish they'd been allowed to stay in the Social Security program. link

    Why doesn't Texas just opt out of (5.00 / 3) (#4)
    by Anne on Sun Nov 07, 2010 at 11:46:29 AM EST
    the Union altogether?

    Or, perhaps people like Rick Perry and Doctor Kill Medicaid would like put their money where their mouths are and strip their assets down to Medicaid-qualifying levels - and not by transferring them to family members - get a minimum wage, part-time job, and contemplate life in "retirement" with only whatever pennies and nickels they can manage to save and "invest" - assuming they live anywhere near long enough to reach retirement age - and then they can report on what it's like to live when you have nothing.

    Honestly, I'm not sure people like this can even be called human, and that doctor? I guess he thinks, "first, do no harm" means "first, do no harm to my bottom line."

    Truly disgusting that anyone would even give people like this a forum.


    Texas (5.00 / 3) (#7)
    by Ga6thDem on Sun Nov 07, 2010 at 12:00:33 PM EST
    just dropping out of the country would be fine with me. Maybe they should unite back with Mexico.

    Seceding from the union (5.00 / 1) (#14)
    by shoephone on Sun Nov 07, 2010 at 12:46:46 PM EST
    I'd be down with that. But can we please keep SXSW on our side of the border? I'm sure New Mexico could use the revenues.

    Hard to believe that anyone would give a darn (5.00 / 1) (#24)
    by rhbrandon on Sun Nov 07, 2010 at 03:25:35 PM EST
    if Texas left the Union. I sure can't see anyone wanting to declare war on them to make them stay.

    No easy oil, aquifers about gone, land going arid. Texas independence or return to Mexico would be like the Eagles trading McNabb to the Redskins. Sounds crazy at the time, only to prove brilliant over the long haul.

    Set Texas Free.


    Where would they be without federal defense (5.00 / 1) (#11)
    by ruffian on Sun Nov 07, 2010 at 12:25:17 PM EST
    spending? Even the hypocrisy is bigger in Texas.

    I'm down with that (5.00 / 3) (#18)
    by Zorba on Sun Nov 07, 2010 at 02:23:11 PM EST
    Let them secede, removing all US government monies and contracts from them, of course, and then build a very large wall around Texas, maybe with a wide moat filled with alligators outside the wall.  ;-)  

    Did you read the site commenting rules (none / 0) (#37)
    by Inspector Gadget on Sun Nov 07, 2010 at 09:02:25 PM EST
    before you decided to threaten to shoot the liberals?

    that commenter is being zapped (none / 0) (#38)
    by Jeralyn on Sun Nov 07, 2010 at 11:11:53 PM EST
    and all his comments erased

    I think... (5.00 / 1) (#5)
    by desertswine on Sun Nov 07, 2010 at 11:54:00 AM EST
    that rule no. 1 in understanding people like this is that they simply don't give a crap about anyone.

    Compare and contrast: (5.00 / 2) (#6)
    by Anne on Sun Nov 07, 2010 at 11:57:04 AM EST
    Howard County is moving ahead with plans to convert a highly regarded health program for the uninsured into a low-cost regional insurance co-operative, despite the increasing pressure to reverse the national health care law that allows such an initiative.

    County officials are considering the creation of small neighborhood walk-in clinics for co-op members, staffed by a salaried doctor, a nurse, a care coordinator and a clerk. Eliminating the traditional fee-for-service system could deliver care more cheaply, advocates said.

    "I see multiple economies of scale," said Howard County health officer Dr. Peter L. Beilenson, who is pushing the co-op idea.

    Beilenson and other county officials have received praise for the creation of Healthy Howard, a low-cost program for the uninsured in Howard. But the plan is not an insurance program and would cease to exist by 2014, when the federal law requires everyone to be insured or pay a fine. So officials are looking at other options.


    Under the proposed program, salaried specialists in regional centers could consult via computer with the primary-care doctors and their patients, reducing in-person visits by as much as 70 percent, he said.

    For start-up funding, the program could seek some of the $6 billion in funds available through the federal health care law passed earlier this year.

    Sue Walitsky, a spokeswoman for Sen. Benjamin Cardin, a Maryland Democrat and an expert on health care legislation, said while there's been talk from Republicans about repealing the health care legislation or blocking funding for parts of the law, anything said now "is just speculation."

    Beilenson's effort has support from people like Karen Davis, president of the Commonwealth Fund, a private New York group that promotes health care, and from Brad Herring, a health economist and insurance expert at the Johns Hopkins Bloomberg School of Public Health.

    "I think their model is a good one," Davis said, adding that she thinks co-ops are "a relatively non-controversial idea." Herring agreed and said that "it's hard to imagine conservatives would try to limit choices in the private health care market."

    Of course, there are the usual naysayers, and it's not a done deal by any means - but at least people are taking the time and making the effort to explore ways to expand and make more affordable the care people need.

    If the golden arches of McDonalds (none / 0) (#10)
    by MO Blue on Sun Nov 07, 2010 at 12:23:56 PM EST
    can get an exception, I would hope that Howard County would be given one. Also, it was my understanding that Sen. Sanders got something in the legislation for states to experiment with a variety of methods to provide all state residents with health care. My google skills are primitive and there were so many changes. Did that proposal go down in flames before the final passage?  

    I believe that Sen. Sanders' (none / 0) (#16)
    by christinep on Sun Nov 07, 2010 at 02:01:29 PM EST
    health clinic proposal remained in the law.

    Two different proposals (none / 0) (#21)
    by MO Blue on Sun Nov 07, 2010 at 03:04:46 PM EST
    $10 billion in Community health centers was included in the final legislation. What I was confused about was if this was in the legislation.

    Sanders is also working with Sen. Ron Wyden (D-Ore.) to improve language already in the bill to provide waivers for states that want to provide comprehensive, affordable health care and curb rapidly-rising costs for money-making private health insurance companies. The waivers could clear the way for a state-run, single-payer system.

    About waivers (none / 0) (#25)
    by christinep on Sun Nov 07, 2010 at 04:06:03 PM EST
    I don't know what happened to that one. I'd sure like to know, because how "waivers" are granted would be instructive in the forthcoming regulations.  (E.g., the waiver provision under the Clean Air Act for California's more stringent auto emission standards.)

    THat check didn't cash (none / 0) (#26)
    by Rojas on Sun Nov 07, 2010 at 05:03:30 PM EST
    The ethanol boys were TBTF if I recall correctly and the director of the EPA didn't believe in science.

    HUH? (none / 0) (#30)
    by christinep on Sun Nov 07, 2010 at 07:16:07 PM EST
    ROJAS: I served with EPA for a full 27 years...and, I am not sure what you are saying. While I do understand that the Administrator (Gorsuch) in the first Reagan term was more about politics than science, my code breaking of your sentence seems to be off a bit....

    Not to get personal (none / 0) (#39)
    by Rojas on Sun Nov 07, 2010 at 11:20:54 PM EST
    but did that 27 yrs. precede the modern, fuel injected engine with microprocessor controlled three-way catalyst systems? I guess it's not really pertinent because Browner's term damn sure did not.

    While it may not have been apparent at the end of the carburetter era when Congress passed oxygenate mandate, it was clear by the mid 90s the science said flipping the fleet would get us the cleanest air with drinkable water.

    California's waiver fell flat to the forces of ethanol when attempting to rid themselves of that other oxygenate (MTBE) that has contaminated so much of our water supply nation wide.


    My emphasis was on the waiver application (none / 0) (#45)
    by christinep on Mon Nov 08, 2010 at 04:28:39 PM EST
    process that we might see in the health field. What came to mind for me was whether a "waiver" approach would resemble the CAA Title II provision.

    As for the catalyst-controlled systems, and their evolution, all I can say is that I am not an engineer--so, excuse my inability to carry on a technical discussion of the merits (and controversies) surrounding fuel additives. My CAA involvements mostly concerned stationary sources; and, the period of time included the Browner Administration.  Even with my limited Title II involvement (and the occasional Ann Arbor visit), I can say that it is my recollection that scientists within and outside the Agency did not all fall into line on one position as "the way to go" immediately--because most (and rightly so) wanted to see the evidence develop. One area where I do remember a concerted push from the WH and the Administration involved the encouragement and movement to MTBE during the Bush I years. (In fact, the WH General Counsel C. Boyden Grey, served as a kind of interlocutor in that regard.) And, we all know what troublesome history followed MTBE. There were no magic bullets.


    And my point was that a waiver is worthless (none / 0) (#46)
    by Rojas on Tue Nov 09, 2010 at 02:26:14 AM EST
    if the process can be subverted by power players and incompetent or corrupt administrators. And by incompetent and corrupt I specifically refer to Browner and the actions she took against the people on behalf of the ethanol industry because she has a role in this administration.

    My understanding of the issue comes from living in a region where RFG was mandated. There's a reporter down here who covered the MTBE issue and got it right from the beginning. So it's not about magic bullets.


    Because you don't agree with a decision (none / 0) (#47)
    by christinep on Tue Nov 09, 2010 at 12:34:28 PM EST
    does not mean that it was the result of someone being "corrupt." Without proof, quite frankly, it actually undercuts your point. My POV.  I do agree that every Administration that I witnessed in the bureaucracy has its share of what-you-refer-to as "power players." Certain issues--like the one to which you refer--have built-in "political" supporters in terms of policy...on both sides of the aisle. (And, of course, from the various industries...some representing ethanol and others representing certain chemical additives.) But then, the way of the world is that there are "power players" in every organization...people fight for their points of view.  I take exception to characterizing that give & take as "corrupt."

    Oh good Lord (none / 0) (#48)
    by Rojas on Wed Nov 10, 2010 at 10:37:22 AM EST
    Incompetent or corrupt, pick yer poison.
    Do you really think no one else has to make decisions about complex technical matters in the face of competing agendas?
    I understand the position Browner was in. On the one hand she had Senator Corn. Senator Corn had his scientists with their data sets.
    On the other hand she had Industry Organization Arsenic. Industry Organization Arsenic had their scientists with their data sets.

    Somewhere else you had Dr. White. Dr. White's group had data that showed Corn and Arsenic would provide some mitigation if we lived in the age of the carburettor. However, the data showed that the carburettor had moved into an area of obsolescence. Dr. Whites data showed that with the advent of the microprocessor the industry had implemented closed loop, adaptive  controled injection and emission systems that diminished the role of oxengenates. Dr. White's group presented a trend analysis that showed the natural progression towards reduced air pollution  simply from natural attrition in the  fleet of vehicles using obsolete induction on the road. They went on to provide a cost vs benefit analysis of providing incentives to speed the fleet changeover as compared to the cost of implementing corn and arsenic.

    Confronted with this dilemma, Administrator Browner, after weighing the options carefully, sided with Senator Corn. It seems Senator Corn, like Administrator Browner was a Democrat and politics trumps science. California and the rest of the country be damned.


    I have some friends (none / 0) (#19)
    by Zorba on Sun Nov 07, 2010 at 02:28:37 PM EST
    in Howard County who keep me informed about this plan.  Sounds good to me (not as good as national single-payer, or even an affordable public option, but we ain't getting those any time soon, more's the pity).

    Beilenson should be my congressman. (none / 0) (#31)
    by honora on Sun Nov 07, 2010 at 07:36:31 PM EST
    Unfortunately, he ran against Sen. Sarbanes' son and lost. My daughter, who worked on his campaign, is still not over it. (Ah, the joys of being a Democrat.) John Sarbanes has done nothing as congressman. Such a waste.  Beilenson is incredibly smart and a true 'liberal'.  Howard County is lucky to have him.

    Anne, where do you live?


    Northern Baltimore County. (none / 0) (#36)
    by Anne on Sun Nov 07, 2010 at 08:21:23 PM EST
    I agree that John Sarbanes has been a non-factor, and quite disappointing; Beilenson would have been a great advocate on health care issues - something we really needed.

    "if it made fiscal sense without jeopardizing (5.00 / 1) (#8)
    by KeysDan on Sun Nov 07, 2010 at 12:04:30 PM EST
    care", is an insane position.  If it were not for the repercussions inflicted on the needy, poor and sick, it would be interesting for these Texans to, once again, get these ideas out of their system, sort of like Gingrich's teaching a lesson with his government shutdown.  Except, to his horror and political demise, it pointed out for all who wanted to see, the important role of government and the damage his train wreck inflicted.

    So, too, a Medicaid withdrawal would bring home the cascading economic devastation it would cause. Economic devastation that would not be compensated for by the upswing in mortuary services.   Of course, the devastation in human health and well-being would not matter so much, unless the unsightly sick and dying cluttered up the roadways.

    My worry for the HCR Medicare expansion has always been  for its political vulnerability. Not to rehash the HCR debate (although the Republicans are certainly doing so), but assurances for stable health care delivery need to jettison "welfare" foundations as well as means testing.  

    Medicaid, not Medicare--my regrets. (none / 0) (#20)
    by KeysDan on Sun Nov 07, 2010 at 02:49:39 PM EST
    Alan Grayson was right (5.00 / 1) (#15)
    by TomStewart on Sun Nov 07, 2010 at 01:12:28 PM EST
    The Republican plan for health care:

    Don't get sick. If you do get sick: Die Quickly.

    With no REAL cost controls (5.00 / 1) (#17)
    by TeresaInSnow2 on Sun Nov 07, 2010 at 02:17:10 PM EST
    built into the health insurance bill, that's the plan for individual insurees too.  

    Oh, and add "pay your tax before you die because you can't afford the health insurance...."

    Not exagerating in the least.


    Perry's running for the 2012 nomination. (none / 0) (#9)
    by Angel on Sun Nov 07, 2010 at 12:06:14 PM EST
    He's planning to team up with Romney.  Seriously.  

    Yeah (5.00 / 1) (#12)
    by Ga6thDem on Sun Nov 07, 2010 at 12:27:17 PM EST
    that's what I heard too. These people are just downright creepy. There's no other word for it.

    hair ticket for men (5.00 / 1) (#13)
    by ruffian on Sun Nov 07, 2010 at 12:34:48 PM EST
    Two Ken dolls with their Barbie wives... (5.00 / 2) (#22)
    by Angel on Sun Nov 07, 2010 at 03:19:58 PM EST
    Truly, truly scary.

    i don't think i'm ready (none / 0) (#41)
    by nycstray on Mon Nov 08, 2010 at 01:58:12 AM EST
    for another round and it's already starting :P

    That's not fair (none / 0) (#43)
    by Socraticsilence on Mon Nov 08, 2010 at 02:13:40 PM EST
    I mean sure Romney makes basically all other politicians seem like paragons of idealism and political conviction but he's no where near as dumb as Gov. Goodhair.

    Team crashing and burning (none / 0) (#29)
    by Militarytracy on Sun Nov 07, 2010 at 06:49:07 PM EST
    Only Illegal Immigrants on Texas Medicaid (none / 0) (#23)
    by pluege2 on Sun Nov 07, 2010 at 03:22:37 PM EST
    What's not to like? Except of course, all the people dying.

    yea, but the only people on medicaid and medicare in Texas are illegal immigrants so its OK it they die. In fact its good if they die because they deserve it for being large screen TV watching, Cadillac driving, beer drinking all-day freeloaders sucking the lifeblood from the hard working American plutocrat.

    If China can get by paying workers (5.00 / 1) (#27)
    by Rojas on Sun Nov 07, 2010 at 05:12:40 PM EST
    175 bucks a month why can't Texas? I've been telling people for two decades now not to set the bar so damn low that even a snake would have trouble getting through it. Looks like one just did.

    Holy blankety blank (none / 0) (#28)
    by Militarytracy on Sun Nov 07, 2010 at 06:47:55 PM EST
    Crazy is showing up way ahead of the curve I projected for myself on my bedroom wall chart.  Things are going to be really rough for awhile.  Stressful is going to be changed out for flat nuts.  I console myself my thinking that I didn't get the universal healthcare that I wanted last year, but now that the utter freakshow has come to town I suspect that soon....talking about universal healthcare and shoving that back onto the table in two years is soon not going to be pronounced SO CRAZY by the very serious people.  I might even get it in six.

    If Texas withdraws... (none / 0) (#40)
    by diogenes on Sun Nov 07, 2010 at 11:36:30 PM EST
    Don't people without Medicaid get financial help from the feds to get Obamacare?
    Also, Medicaid has large bureaucratic costs.  The few medicaid patients I see I see for free because it isn't worth the trouble/billing costs/investigation costs to get eight dollars for an office visit.  
    New York City not so long ago had city hospitals where people went.  You didn't have to document up the wazoo due to fear of fraud investigators.  

    This is something (none / 0) (#44)
    by Socraticsilence on Mon Nov 08, 2010 at 02:18:52 PM EST
    that no one wants to address on either side of the aisle- one of the reasons medicaid (and to an extent medicare) are so efficent costwise for the government to administer (besides the obvious efficency gains) is because they put the burdens of billing on the provider in addition to having low rates of reimbursement (which raises the rates insured and out of pocket patients pay)- its why a massive expansion in either is/was frought with peril- medicaid may be tolerable given that 30-50 million people spread over the nation isn't that massive a expansion, but something like Medicare for all would have crushed the existing provider network- you would had either months long waits or a massive number of providers refusing to take medicare patients as doing so would drive them out of business.

    And no Dickens around to chronicle the cruelty (none / 0) (#42)
    by BobTinKY on Mon Nov 08, 2010 at 08:28:29 AM EST