posted on:  7/6/2006    revised: 3/10/2010

Illinois is now implementing major changes to the medical programs that cover the state's two million Medicaid recipients. The strategy is designed to reduce payments on behalf of chronically ill people representing about 16% of the sickest recipients and use the money to cover more of the state's uninsured kids.  Hardest hit will likely be diabetics and others in similar situations that require long term expensive treatments and who have no other medical care options.  In the past, the medical community said "we have new treatment technology that will save your life, so let's get the state to pay for it".  Now the state is clearly saying "If the care is too expensive and we really do not think that you will get better, we will not pay for it".  This is rationing of health care in its most severe form.

The changes received relatively little press coverage except from the Illinois State Medical Society that said that the state's poor track record for making payments to doctors will discourage them from accepting new patients under the program.  (I have always believed that the way to cover more kids was to give kids "regular insurance" for free or at little cost rather than a separate brand of "poor kids' insurance" that brands then from the start when seeking medical care.   But that is another topic).

The biggest problem of this program and many others like it that operate independently in many other states is that it does nothing to address the 'big picture' of our medical care crisis.  The total cost of medical care remains unchanged and the money we have available for medical care is the same.  We are simply shuffling available funds from one place to another without addressing any of the real economic problems.

In a sense, I give Illinois credits for having the guts to say "sorry, you are too sick, so we will not pay for your care".  This is not a job that I would want to have yet appears to be an economic necessity in our future.  State officials are now literally put into a decision of determining who lives and who dies.  Of course, this is just the beginning of what is to come in health plans across the country; we have predicted this for years.  A scary future awaits.

keywords:   managed care, rationing, Medicaid

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health-care-vs-health-insurance.htm

Copyright 2010 by Tony Novak. Originally produced and published for the "AskTony" column syndication prior to 2007. Edited and independently republished by the author in March 2010. All rights reserved.