Bureaucracy Bungles Care Policy

July 14, 2008
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Only in the deliberate isolation of bureaucracies, wherein logic is absent as a result of the inbreeding, does it make sense to spend years creating rules to govern non-existent programs.

Grand Rapids Business Journal this week provides in-depth reporting on retirement living and elder care. The ramifications of trends, health care and public policies are magnified (and multiplied) by the 78 million baby boomers reaching “retirement” age. And it is magnified by the fact that “health care” is almost 17 percent of the GDP.

So it is that a federal program requiring nursing home patients receiving Medicaid stipends to liquidate all assts and spend savings to no more than $2,000 exists at all, and binds states not enforcing the federal rule from providing long-term care planning and insurance. The viciousness of this mindless circle of “policy” becomes so intricate it required three stories to explain.

Why does anyone wonder that “health care” is considered broken?

First, the federal mandate, abhorrent in its simplest definition, is more so when it is revealed to be failed. Miller Johnson Snell & Comminskey elder law and estate planning attorney Laurie Murphy notes that most people on Medicaid don’t have estates to recover; it’s so unpopular (abhorrent), even to politicians, that some states do not pursue enforcement; and finally, it costs states more to run the program than is returned in property possessions by the state. She also notes studies have shown an unintended consequence of neighborhood blight: Families and friends are reluctant to provide upkeep for an invalid’s vacant home certain to be taken by the state. Some of the community’s elderly are reluctant to apply for the help they need as a result of the federal mandate.

Michigan, which until last year refused to implement the federal mandate, is under threat of losing its $5 billion federal Medicaid payments (though national politics have frozen federal Medicaid budget funds). The state program to follow through on failed federal policy is still not in effect.

Worse, the bureaubrat power struggle has delayed Michigan’s ability to offer long-term care insurance partnership policies. Jerry O’Bee, long considered for his community service and expertise in insurance planning, advocates for businesses to provide long-term care insurance, even if voluntary, for employees. Others believe that a public-private split between the state and businesses on the costs would be less of a burden.

Those who defer throw fear mongering into the mix, believing that middle-class families will then elect Medicaid and “save their nest eggs” for their children. Is that bad? That is how the “silent generation” provided wealth for the baby boomers and unprecedented wealth and well-being in this country.

It seems simple to do the right thing — unless one stays isolated in a bureaucracy. 

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