Sunday, August 25, 2002


As usual, Dave Kushma has an editorial in Sunday's Commercial Appeal. And, as usual, he's wading in deeper waters than he oughta.

His subject is TennCare and the positions of the two front-runners in the Governor's race--Bredesen and Hilleary. He both tries to pillory them for not having firm solutions to the problems of TennCare and tries to argue that there aren't any problems that more money won't fix. It's not a pretty sight.

The next governor of Tennessee, either Democrat Phil
Bredesen or Republican Van Hilleary, has taken state tax
reform off the table. Dead issue, both nominees say.
Time to move on, they insist.

OK. Assume the income tax debate is over for at least
the next four years, whoever is elected governor. So
between now and Election Day, can we hear more from
the candidates about the next biggest issue of the campaign: fixing
Notice the conflation of "reform" with "income tax." The new Legislature will be working on reform and spending reform this year. It has to, as the one cent sales tax increase will expire next year. But Kushma won't mention that here, as it confuses the point he want to make

But TC reform requires in-depth information and numbers, something woefully missing in the public debate. The document most use, the audit of TennCare done last year, lists a lot of opportunities for tweaking TC, but the CA pretends that information doesn't exist. And when folks try to talk about cutting the swollen enrollment of TC, you get swats like this. Neat tricks!
Paradoxically, TennCare remains one of state government's greatest
strengths, most glaring weaknesses and handiest political scapegoats. It
insures one of every four Tennesseans - people who are poor, disabled
or chronically ill, and who cannot afford or obtain health coverage at
work or from a private insurer.
That's the strength? Wildly out of control socialism? There's no paradox--it's failing and flailing. It's past time to get rid of it.
Because of the special federal aid it gets as an experimental program,
TennCare provides this essential care at less cost to state taxpayers
than the fee-for-service Medicaid plan it replaced eight years ago. Its
model - using market competition to expand access to care while
controlling its cost and preserving its quality - remains sound.
This is incoherent! An experiment? Let's terminate it or roll it out, then. "Less cost?" Not according to the audit. And "market competition?" Where? Companies are bailing out, not being paid, being underpaid. The pool of companies was limited; then half of the behavioral side disappeared in a welter of debt and several on the health care side wanted out or went under.

Access was expanded under the assumption that companies could handle the load. The number of enrollees far exceeded anyone's estimate and the companies started not getting paid, and either bailed or went bust. Now the one's left are staggering, and the State can't afford to let them out.

Quality? Talk to the ones whose health care providers went away. Or the ones who must make endless calls, visit multiple clinics and doctors, and navigate the endless maze of bureaucracy.
Now the bad news: TennCare consumes one of every four dollars of
state revenue. Despite cutbacks, the program's $5.7 billion budget this
year is $256 million out of balance.
He doesn't even blink as he says that. What does that tell you? "Out of balance...."
Several of the private managed care organizations the state has hired
to run the program have failed, leaving behind a mountain of debts.
Some MCOs have made themselves better known for the lavish salaries
they pay their executives, and the political influence they wield on
Capitol Hill, than for the efficiency of their operations.
So this is their fault? And doesn't this contradict Kushma's assertion of market competition?
It remains an article of faith - if not necessarily fact - among TennCare
detractors that its eligibility is too easy and too casually enforced, and
its benefits too generous, encouraging private insurers and employers
to dump their poorest, sickest workers and customers on the state.
Doctors, hospitals and other providers still complain of late or
inadequate payment, or no payment at all, for the services they
perform for TennCare patients.
Nice try at dismissing this all as a point of view, but the audit backs all this up. Clearly. And business studies have shown that companies did dump workers. I know mine did. No "faith" here, just facts. Face 'em, Dave.

Kushma then laments that both candidates sound alike in their talk of "reform." Gee, Dave, think they see someone you don't? Maybe it's you who needs to drop his "faith" in socialism and recognize the reality?
Both candidates offer the requisite horror stories of people moving to
Tennessee merely to qualify for TennCare, or even enrolling in the
program while living out of state. But once you get past such argument
by anecdote, what do you have to do to restrict eligibility?
Sigh.... Dismiss fact as anecdote. How can you even debate someone who doesn't want to recognize the truth? Meanwhile, the CA offers the "requisite horror stories of people" who will be cut from TennCare, happily provided by advocates who benefit under the current mess. But no conflict there!
Among other things, it's culling the TennCare rolls by at least 159,000
people - more than one of every 10 recipients - and, some patient
advocates fear, potentially twice that number. It's doing so, advocates
assert, by forcing a lot of people who are severely physically or
mentally ill to jump through hoops they can't reasonably negotiate
under the state's tight deadlines to get or keep TennCare eligibility.
Hey, how about that. Paula Wade reports it, and he parrots it. Good trick, Dave. He even uses the party line, "culling." Good boy.
The new rules demand of recipients a bunch of new paperwork and
often a detailed personal interview with an overworked bureaucrat at a
state office. In some cases, the revised eligibility standards don't take
into account pre-existing conditions or lack of ability to get or pay for
commercial insurance.
Hey, ever been to a government office before? That's what bureaucracy is! I've gone to the Food Stamp office many times (not for myself, but in a job) and that describes the procedures there to a T. Why should TC be any different?
Similarly, when they talk about curbing benefits, what do they want to
limit or eliminate? Which services? Which drug prescriptions? Some
specifics, please?
But when these guys assert that you have to pick up the tab, do they tell you what parts of your budget you'll have to cut? Of course not. Government leaders are wise; editorialists and journalists are impartial; bureaucrats are selfless; the poor would never try to take advantage of you! Shut up and pay.

Until next time,
Your Working Boy

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