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6/24/2008
Lance Burri: I'm shocked. BadgerCare is over budget.

BadgerCare Plus is so successful, it's over budget. From the Wisconsin State Journal this weekend:

As of May, the Medicaid health program BadgerCare Plus has already tripled the number of new patients that state officials expected to sign up for the coverage by June 2009. In its first five months, the health plan for families added more enrollees than the state has done in any similar period in at least a decade, officials said. That influx is adding more stress to a Medicaid budget that state officials acknowledge is already in the red by $78 million.

…it will be a mixed blessing for taxpayers and the already strapped state budget, as state officials acknowledged it will likely raise costs significantly for the program expansion, which they previously said could be covered without new money from state taxpayers.

Let this be the last time we are surprised by something like this. That is, if any of us were surprised in the first place.

Doesn’t this always happen?

Remember the Medicare prescription drug program? Originally, the Bush administration said it would cost about $400 billion over 10 years. The program passed into law on that assumption. Just over a year later, that estimate was up to $532 billion. Not long after that, it was at least $720 billion, and maybe over a trillion.
In Massachusetts, the costs of their government health care program are expected to grow by 85% - about $400 million – next year. Far more than originally estimated, because far more people than estimated are signing up. Imagine that.

And now BadgerCare Plus is doing the same thing. And notice the story says Medicaid is already in deficit.

It doesn't matter why the estimates were low. Well, it does: Proponents might have lowballed costs deliberately to limit opposition. Being honestly wrong would be bad, but deliberate deception would be worse.

And yet, it doesn't matter, because either way, we still have to deal with it.

Those who support government-run health care can't demand tax increases to pay for the unexpected costs, because they're the ones who tell us universal health care will save money.

Unfortunately, lowering taxes – making Wisconsin more business and, thus, more tax-revenue-friendly – isn't in the cards, either.

So cost increases mean service cuts. For example, it wasn't so long ago that Congress was debating whether or not to cut reimbursements to Medicare doctors by 10%. Doing that will result in doctors reducing the number of Medicare patients they see – something we've already experienced with dental care here in Wisconsin, because Medicaid reimbursements for dentists are too low (among other problems).

Canada has its famous waiting lists – rationing, which means there's not enough to go around – and not long ago sent women with complicated pregnancies to the U.S. because they couldn't provide care in Canada. In Britain, doctors are debating whether they should continue treating smokers and the obese.

This hasn't happened to BadgerCare Plus…yet. Some of us will be surprised if it does. Others of us won't be surprised when it does.

Backers of government health care have no end of horror stories: anecdotes about people unable to fully access health care due to its cost, or health insurance due to its cost. Because when your access to care is limited by your own ability to pay, well, that's a problem. It's outrageous. A scandal.

When your access to care is limited by the government's ability to pay, though, that's all right. That's different.

That's Universal!

Lance Burri is a contributor to the Badger Blog Alliance and occasionally blogs at his own site as well.

COMMENTS

Well said! It's not surprising that they're in the red, when you have people with "Forward" cards using the ER for pregnancy tests or sore throats, "because it's more convenient".

At least, in Britain, they (gasp) KICK PEOPLE OUT of the ER for such frivolous visits. But WE can't because the law makes us see every waster that turns up.

But, as expected, Britain is running into serious problems with their system, the NHS.

They have neither the time nor the money to see all the people that come to them, thus are sending patients to the private hospitals--like my cousin, who had a ligament rupture. This is a SERIOUS injury requiring IMMEDIATE attention.

But she was put on a waiting list for SIX MONTHS, after which time the NHS sent her to a private hospital because they STILL "couldn't get to her"!

No wonder private health care is one of Britain's fastest-growng industries.

emily matthews (Tue Jun 24 10:01:00 2008)

The only thing the Badger Care experience proves is that there are a many many people who need health care and who never got it or could never afford it. Now they're using Badger Care. Great! Think of the savings we will have in the private health care market when these previously under insured people don't clog the emergency room at tremendous cost. Think of the fact that they can now have health care!. As far as the waiting rooms, ask Canadian and Brit (who pay less than half of what we do for health care and have better results)if they would trade their system for ours. Hell no they won't because they know better. Our system is broken and the Badger Care cost overrun is a symptom of how broken. Tear the whole thing down and start from scratch. Oh, Emily , as far as your "sore throat" statement. The only reason anyone in their right mind goes to E room for a sore throat is because they don't have access to normal health care avenues. The frivolous use of health care you insinuate is simply not the case. I suggest you go to an emergency room and visit with the people there who. Instead of the apparent scorn you have for the people there you may learn something about the system and compassion.

dave allen (Tue Jun 24 19:12:48 2008)

Hmmmm, funny--ALL the Brits I know would never EVER want to go back to their system! And I DO know more of them than you, Dave.

And oh, Dave HELLO--I WORK in ER! And I SEE what goes on! I well remember the chick who had plenty of money for tattoos and cigarettes, but who could not bother to give her child tylenol for a fever, thus sending the child into a seizure. Who boldly claimed that she "needed her beer money" which was money intended to feed, clothe, and medicate her child. Who said, "You better give me a bottle (tylenol) to take home, because otherwise I'm not giving it to (the child)"

Or the one who came for a "free" taxpayer-funded preg test. Or the one who "decided to skip her ob/gyn appointment" because she was "busy", and later decided to come to ER for a "check-up". Or one who came in pregnant at 13 or 15 years old, saying "We can have all the babies we want, and you folks will have to pay for it!"

Or the SCORES who fake injuries to get narcs to sell on the streets. Or the hundreds who DO INDEED come to ER for sore throats, injuries that happened "two years ago", earaches, sprains, etc.

We do have a walk-in clinic now that takes some of these people--but it is notable, that many DO still come to ER, because in their words, "It's more convenient", or "I wouldn't have to wait"-- NOT BECAUSE THEY DON'T HAVE A FAMILY DR!

We ALWAYS ask who someone's family dr is, for discharge instructions--and MOST people DO have one. If they don't, it's because they failed to follow-up with the MD we REFERRED THEM TO the last time--who would see them IF THEY MADE AN APPOINTMENT. Do you know what some of them say, when asked their dr's name? "Oh, I usually just come here". In other words, ER is NOT their LAST choice, but their FIRST! It's so bad that we know all our "frequent fliers" by name!

And when they come for frivolous reasons, we also ask, "What did your family dr tell you?" Most times, they answer that they "didn't feel like" calling him--or that they already have an appt the next day, but didn't want to wait. "Can't wait" for a cold? C'MON!

Any time someone says "People don't use the ER for frivolous reason", it simply shows their ignorance. I suggest YOU do a job-shadow for a month, and see what REALLY goes on. ER would be an easier place to work if we COULD kick them out, as in Britain. But we can't.

emily matthews (Wed Jun 25 09:28:51 2008)

Emily,
The Brits or Canadians will not take our system. That doesn't mean they think everything is perfect in theirs. But they know the absurd nature, cost and unfair nature of ours. In fact no one in the world would be stupid enough to do what we do. So, your British comments are useless.
As far as your ER comments. The reason why there is ANY abuse of the ER is because we do not have a system. Someone showing up to the ER for a sniffle needs to be seen by law and they don't have a family physician that they can be told to go to. This doesn't happen in other countries. Every other country has a low cost primary provider that they can go to. Emily again, I believe you should go to an ER and hear the stories from the patients and doctors alike it would open your eyes. This country is going broke on medical care and it is not (repeat) not largely caused by people abusing the services that the get in the ER. We are going broke because we have a rube goldberg claptrap cost shifting for profit system (is it even that?). I repeat, find for me a country where people would trade their system for ours! Find some facts not useless anecdotes.

dave allen (Wed Jun 25 13:01:15 2008)

As a health care provider, Dave, I DO indeed hear pt. stories!!! Everything I have said is true--there are an awful lot of wasters, and they DO have a family dr they can go to! (Although sometimes the dr "fires" them if he gets sick of them trying to abuse narcotics--then it's true that they "don't have a dr"). Agreed, the "system" we have is wasteful apart from ER costs--but if we COULD kick them out, as in Britain, we'd save A LOT of our ER costs.

Re. other countries trading "our" system for "theirs"--this is ALREADY HAPPENING in Britain, according to a cousin who just left my house on MONDAY, as well as according to an acquaintance of mine. My cousin said, "The UK is going to be like America (re. health care) very soon."

Did you READ my first post where I said that one of the UKs fastest-growing industries was private health care? This is no idle talk! When it takes a pt 5 HOURS to get to hospital by ambulance, because they were TURNED AWAY from multiple ERs, you bet there's a problem that people will address--by GOING PRIVATE.

As to a "system" stopping frivolous ER visits, you should have heard my cousin's stories! She also worked in ER, and said people would turn up at midnight for stupid things like "I ran out of tylenol" or "I need more tampons"--these are even WORSE excuses than the wasters that come to my ER! The difference is, that she was able to tell them to GO AWAY, and we can't in our ER.

I wonder if you truly read what I previously wrote, or are you so blinded by rhetoric that you think I'm MAKING THIS UP? I assure you, I almost WISH I WAS.

The best "system" would be to remove insurance (3rd party payer)-either private or public- from the scene altogether, except for catastrophic coverage. Which is what some people do on their own--and they pay less for their dr visits, because the dr only charges what he'd actually GET from an insurance co, plus he has no hassle with paperwork. In fact, these people REFUSED insurance because they were so happy with what they'd worked out!

Just think: if people could get a 3rd party to pay for all their car repairs and maintenance, do you think they'd take better--or worse--care of their vehicles? If they could get a 3rd party to pay for house repairs, do you think they'd care as to price? When you pick a plumber, do you go with the most expensive? Yet this happens every day with health care decisions--because it is perceived that SOMEONE ELSE WILL PAY. No wonder we're so wasteful.

emily matthews (Thu Jun 26 12:11:39 2008)

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