Medicare is privatized for HMO's today

[donhakman]

First the accounting for the USA was privatized, then the move on education to privatize with vouchers for religious schooling and now Medicare is privatized.

All it really means is that these programs cost 4 times as much and friends of the administration get rich.

It also means these programs will run out of any budget given them in a hurry.

[caledesi]

1. Great graphic! nt

[sandnsea]

2. Dean led the way

Dick Gephardt had the foresight back in the 1990's to oppose putting Medicare into HMO's. Not Howard Dean. He jumped right on it and had Vermont's Medicaid plan run by HMO's. Until they pulled out of Vermont, just like Gephardt said would happen with Medicare. This interview was the year Civil Unions was signed, 2000? Not so long ago. Dean has a horrible position and record on HMO's, Medicare & Medicaid; just like every other Republican idea he's supported.

Healthplan: You've called yourself a fan of HMOs. What are the three best aspects of managed care from your viewpoint?
Dean: The best aspects I can see are not having hassles over billing payments, since you have capitated payments up front. The other positive aspect is the notion that there is a single payment, and doctors-at least in the better health plans-are left to their best judgment.

Healthplan: Vermont, like other states recently, has seen bigger national players exit the local Medicaid market. At the same time, Vermont is expanding its earlier version of managed care-the primary care case management program (PCCM), where the state pays doctors extra to manage the care of their Medicaid patients. What do you see as the future of managed care in Medicaid?
Dean: I think that is going to depend from state to state, and individual states will make that choice. But I think health plans were not able to make enough money from those systems. The primary care case management program (which we're expanding) is very much modeled after some of the good things we found in having a managed care system. And in our case, we felt we were able to administer the (Medicaid) plans for less administrative cost. (Medicaid HMOs) is something I'm glad we tried, but it didn't seem to work.

Healthplan: Do you think consumers should be able to sue their HMO?
Dean: No, I don't think that is helpful. I think lawsuits in general aren't helpful. I favor arbitration. But we do need external review. In Vermont, we have a panel that works with the state government where someone who feels they are not getting proper care from their HMO can appeal. Ultimately, an ombudsman is called in and (where appropriate) the banking and insurance commissioner enforces the HMO to grant the care. I think that is fine. I think that is good. I think that system is much better than lawsuits. The reason is that system takes care of a problem before it gets out of hand. In order to file a lawsuit you have to show damages. Well what's the point of waiting until the patient is damaged so that you can file a lawsuit? I prefer arbitration up front before damage is caused, rather than lawsuits afterward. It certainly has been used in our state and it seems to be used successfully.

http://www.medscape.com/viewarticle/405541