Wednesday, May 29, 2013

Fiscal Fear-Mongering -- By Tennessee State Treasurer -- On Obamacare's Expanding Coverage Of Tennessee's Poorest Citizens

First, let's get the facts straight. The choice isn't whether Tennessee is shifting money away from college funding, to fund health care for the poor. By every credible estimate, without the advent of the ACA of 2010, Tennessee would be paying far more for its existing health care programs, from 2014 to 2020. So, to blame Obamacare for this is disingenous, at best. Tennessee has been allocating money away from educational subsidies for over three decades. That has absolutely nothing to do with health care reform -- it predates it by over thirty years.

In addition, the single most relevant fact -- one that is omitted by the Tennessee State Treasurer, in the below article -- is that the federal government is providing over 15 times as much as Tennessee itself is, to fund these programs, over the next ten years. This is a boon to Tennessee, from the federal government. It exists because it is immoral to force the poor into the most inefficient, and expensive delivery option -- ER services -- when we have the means to provide basic, cheap, effective preventative care, in Tennessee. [A large part of the problem, locally in Tennessee, is driven by the proliferation of for profit mega hospital chains -- that stridently lobby to avoid covering the poorest Tennessee citizens. But that is another series of posts, for another day.]

This is, in my opinion, the Tennessee State Treasurer simply trying to shift the blame -- for the shocking waste, in his own state health care delivery non-system -- to some mythical federal bogeyman.

Of course, this is all political theatre, to create cover for Tennessee's Republican Governor Haslam, who is still likely to refuse the federal Medicaid expansion from Obamacare -- jeapardizing the lives of hundreds of thousands of Tennessee's sickest and poorest citizens. [Background here, here and here.] Here is the local Jackson Sun, over the long weekend, on the topic -- do go read it all:

. . . .State Treasurer David H. Lillard said on Thursday that expanding health care costs could drive money out of other programs, including higher education programs, which would prompt officials to raise tuition rates.

“In higher education prior to 1990, the state paid greater than 50 percent of all costs and fees of state universities and community colleges,” Lillard said. “What occurred over time was a shifting of new money coming into the state budget system. Today, higher education probably gets something in the area of 38 percent paid by the state. . . .”

“You’re dealing with a situation where you can have a shift in priorities going forward,” he said. . . .

We find it ironic that Tennessee's Treasurer decided to argue that increasing coverage for poor people through the state's TennCare program will somehow mean fewer middle class kids will go to college.

Not only is that factually inaccurate, it is simply finger-pointing -- to deflect attention from the amount that the Tennessee state government wastes every year on ineffectual medicines and treatments -- see graphic at right. Tennessee is No. 2 or No. 3 in the nation, for waste of government medical expenditures -- over $1,440 per person per year. [Once again, the dominance of for profit hospital chains in Tennessee plays a role in this waste.] As the biblical adage suggests -- "take the beam from your own eye, before picking at the mote" -- in mine.

UPDATED | Okay -- let's do some math, here: If we were to set a goal for State Treasurer Lillard -- that Tennessee would end only HALF of the per person waste, per year, in TennCare -- or, $700 saved, per person per year (instead of $1,445) -- by better state fiscal management of the benefit-drug approvals. . . substituting generics for the branded names, etc., what would that look like?

Well, there are 1.2 million people on TennCare now, according to the state's own website. So, the Treasurer would have $820 million in new funds, if he acheived only 50 per cent waste reduction. At full waste elimination, he'd have a new $1.64 billion in available resources.

"Beams and motes," here, people -- the Treasurer estimated that Obamacare would cost an additional $200 million per year, in Tennessee -- we just found four times that amount, or $820 million a year. [Said another way, he only needs to eliminate one-eighth of the current TennCare waste, overall, to "break even," on Obamacare.] Note: it would be $1.44 billion a year, for new education subsidies, if he could eliminate all the waste -- even after he pays for Obamacare, by his own estimates. Q.E.D.

[Of course, all these same figures would (proportionately) appear, on a similar review of Mississippi, Florida and Arkansas, for certain. They would also likely appear in most of the states led by Republican governors who now oppose the expansion. Here endeth the sermon.]

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