HEALTH CARE/Joan Retsinas

Send in the Wedding Planners: Health Care

Enough of those PhDs forcing the bloated government bureaucracy into complex programs that nobody understands. Enough with the spreadsheets, the algorithms, the position-papers. Enough with unhappy clients, angry taxpayers, acronym fiefdoms of waste.

Let’s turn our government over to wedding planners. They have experience perfect for solving those thorny social problems that bedevil the eggheads. This president has ceded a major HUD fiefdom to the planner who orchestrated a truly fabulous really great wedding for son Eric). Lynne Patton, whose resume didn’t include experience in anything related to housing or urban planning before her appointment, will shape up Region II of the US Department of Housing and Urban Development, which includes New York and New Jersey, reforming those fiefdoms according to the logic of wedding planning.

Why not enlist that same expertise for healthcare?

The Budget Straitjacket

The straitjacket of a budget hovers over both weddings and the healthcare budget. Every bride and groom (except maybe the Trump children) has struggled with one. How to accommodate the zillion relatives, friends and “business associates” so that nobody feels slighted? This same challenge stymies federal programs. How to extend “benefits” to as many people as want them? If you don’t cut your invitation list, you must cut elsewhere.

Wedding planners know how to cut: chicken for lobster, a DJ for a band, daisies for centerpieces, modest favors (most are soon discarded) … and always negotiate for better deals. Only dummies pay retail. Aunt Laura and Uncle Harry won’t see the cuts, if they are subtle.

We can do the same with health benefits. Pare payments (Medicare and Medicaid) to nursing homes by 5%. Better yet, threaten an 8% cut. The lobbyists for the nursing home industry will claim victory with a 5% cut. Tighten the “filmy vision” criteria for reimbursement for cataract surgery. Exclude some drugs from the formulary; if that arouses anger, simply tighten the criteria. We’ve moved many procedures, including mastectomies, from inpatient to outpatient stays. Move more – why not same-day obstetric deliveries for women on Medicaid? Mental health advocates considered insurance requirements for “parity” in mental health treatment a victory: roll back that victory. Get ride of those subsidies that the Affordable Care Act promised to people buying insurance on the “individual” market. Those people can still buy insurance; it will be their responsibility to pay for it without the debilitating help of government. Under the Clinton Administration, Congress passed Supplemental Children’s Health Insurance, covering mothers and children with incomes above Medicaid. Drop it – leaving states to pick up the tab. After all, this Administration wants to shrink Washington, sending power back to the states. Take the programs that consume a sliver of the federal healthcare budget, like oxygen, home care, durable medical equipment, and hospice. Highlight the abuses (you can always find abuses in government programs) as you pare their budgets. Seize any evidence that suggests a diagnostic test may not be necessary. Currently the literature questions the need to screen for prostate cancer. Under the cover of “evidence,” stop paying.

The secret to scrunching the wedding budget lies in barely perceptible cuts, coupled with price-negotiations. A lesson for the wonks in Washington.

The Invitation List

Must Uncle Harry come? He hates your family. What about the cousins you rarely see? Your neighbors – must you invite all of them? Eventually the happy couple may need to pare the list. Who will feel offended until the end of time, or the end of the marriage?

Enter the wedding planner, to salvage harmony. The ruses: Pick a venue difficult for the octogenarians on the list, like a mountaintop retreat. Better yet: a destination wedding. Holding it in the Seychelles will exclude everybody who can’t pay the airfare, or thinks the wedding isn’t worth the time or expense. Exclude children. Some parents will be unable to find babysitters. Schedule it mid-week, or Dec. 26. The list will shrink.

The same ruses will work with health insurance. Uncle Sam can discourage people from using the services. Limited networks of hospitals, physicians, specialists, and rehab centers, especially in rural areas, will decrease utilization. So will high co-payments and deductibles. (In the long run, those people deterred from basic services may end up costing more in hospitals, but you can take that risk.) “Red tape” makes it hard for people to sign up in the first place. Hospitals (which will be financially hemorrhaging in this new world order) will be hard-pressed to hire enough social workers to help people navigate the maze of rules. Reinstate exclusions for coverage of pre-existing conditions.

Finally, as any wedding planner will advise, categorical reasons for excluding people – no third cousins, no ex-spouses – will not signal out any one person. The rancor may die down. So exclude non-citizens, or at least undocumented immigrants, from healthcare. That will complement the “America First” rhetoric. Require Medicaid recipients to work (though you might need to give disabled and elderly a pass) – another politically popular stratagem. Ratchet down the income-eligibility threshold for Medicaid – serve only the poorest of the poor.

This President has made clear his scorn for the poor, the disabled, those dependent on government (ironically, government housing subsidies buttressed his father’s fortune), and, as a corollary, his esteem for the wealthy. With the installation of a wedding planner in a high office, he has made clear his scorn for the government bureaucrats who have been laboring for decades to serve Americans. Their expertise under-girds genuine progress. Only a simple person would consider the process of government simple.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email

From The Progressive Populist, August 1, 2017

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