Health Care, the TennCare Experience

[CDarwin]

Now, I doubt most of you have ever heard of TennCare, and it's nothing particularly special that you should have heard of. It's a state program in Tennessee to augment Medicaid by contracting with managed care companies that is most famous for going crazy and almost bankrupting the state a few years ago before being pared down considerably. Well, Frank Cagle (former editor of the Knoxville News Sentinel, if that means anything to anyone) wrote in his column in a local weekly about how Tennessee's experience with TennCare might and should reflect on the national health insurance reform proposals currently bobbing about Congress, and I thought I would share.

 

TennCare No Model: We learned some lessons that would be helpful for national health plan

 

Ok, three questions: First, do you think Tennessee's experience, or the experiences of other states (you may substitute your own), with more limited experiments in state-provided care for the very poorest are relevant at all to the more ambitious proposals before Congress? And, assuming you answer the first question with a "yes," what do you think of Cagle's points?

 

To summarize his basic "lessons of TennCare":

1. TennCare suffered from its isolation from a nation-wide comprehensive solution.

2. "[P]rivate insurance companies dumped the sickest among us onto the taxpayers.The 'pool' of the chronically ill, with pre-existing medical conditions, were shifted from private plans to TennCare."

3. "[M]any businesses stopped offering health insurance and threw their employees onto the TennCare rolls."

4. "[P]rescription drugs with no co-pay and no limit was a prescription for disaster. The per capita rate of prescriptions per patients was almost twice the national average. Reports of widespread prescription fraud angered the populace, reduced support for the plan, and enraged legislators."

5. Reports of non-taxpayers- illegal immigrants and people from other states- receiving benefits on the plan further undermined its popularity.

 

So, the third question. Assuming you respond to my second question somewhat positively, what are we to do about ameliorating these problems in a national health care bill?

Edited August 12, 2009 by CDarwin

[DJBruce]

It would be ridiculous to consider the problems of TennCare when trying to reform healthcare as it helps show exactly what might need to be reformed. Although there are many differences from a state program and a national program, their is much that TennCare could show us.

 

2. "[P]rivate insurance companies dumped the sickest among us onto the taxpayers.The 'pool' of the chronically ill, with pre-existing medical conditions, were shifted from private plans to TennCare."

 

Although this seems reasonable from the stand point of the insurance company- it increases profit- it will greatly expand the size of the public plan. I cannot seem an appropriate way to stop this as, I am against the government interfering with the health insurance companies themselves.

 

3. "[M]any businesses stopped offering health insurance and threw their employees onto the TennCare rolls."

 

This was one of my major concerns when I first considered the idea of a national plan, but from what I have heard- Senator Specter's townhall, although please don't quote me on this- the current plan will tax companies which do not provide health insurance. This would fix the problem granted the tax was slightly greater than the amount a company would spend on healthcare.

 

5. Reports of non-taxpayers- illegal immigrants and people from other states- receiving benefits on the plan further undermined its popularity.

 

If the program is national the problem with citizens from other states would be non-existence. The problem with illegal immigrants is a different matter; personally I do not feel they should be granted healthcare as they are not legal US citizens, but I feel that their will be differing opinions on this.

[iNow]

When I read the article, my conclusion is that we should remove private insurers from the equation almost completely. However, I am quick to stipulate that my views have become more extreme in response to the idiocy we've seen from the opposition these past several weeks.