By the time this article hits the streets, New
York’s Democrats will have elected a gubernatorial
candidate. And barring supernatural intervention, it’s Eliot Spitzer.
Challenger Tom Suozzi will fade
into the background and possibly out of the public eye for good.
But by pushing for reform in Albany,
and harping on property taxes during the primary, he’s already influenced
Spitzer’s platform.
One of the functions of long-shot candidates is to inject
important new ideas into the public political dialogue. The best we can hope
for is that when Spitzer’s elected, some of his opponents’ ideas follow him
into the governor’s mansion.
If Suozzi made reform his
particular franchise, the lone Republican left in this race, John Faso, has
gone a long way toward making Medicaid his.
Last week in Rochester
(and at a follow-up press conference in Syracuse),
Faso unveiled his plan to overhaul a program that’s one of the state’s largest
expenses.
While the other candidates have a few paragraphs on their
websites devoted to the topic, Faso’s plan is comprehensive. It runs for nine
pages, and that’s not counting two pages of references and a chart that are
appended.
Of course, some of it is rhetoric that’s as much politics as
it is policy. And Faso hasn’t passed up the low-hanging fruit that Spitzer and Suozzi are talking about — stuff like ramping up the
state’s efforts to root out waste, fraud, and abuse or expanding the use of
generic drugs.
But Faso also has more ideas — and more specific ones — on
how to tame the monster that Medicaid has grown into. Some of them are at least
worthy of the public’s careful attention.
One of the themes Faso emphasized repeatedly during his trip
here was that he would make Medicaid both cheaper and better. That’s what every politician says, but Faso has a
specific set of goals — which make up about a third of his plan — to do
just that. Ironically, although he’s the lone fiscal conservative in the race,
his plans all involve spending more money initially, in hopes that those
targeted investments will preclude more expensive care down the road.
One of the chief drivers of Medicaid costs is Medicaid
recipients’ use of hospital emergency departments for routine care. That costs
more than comparable service at a family doctor’s office or a clinic, and the
bill gets passed on to taxpayers. Faso wants to change that by changing some of
the factors that send Medicaid recipients to the ER in the first place.
For example: many doctors don’t accept Medicaid patients.
That’s at least in part because the state’s reimbursement rates — unlike just
about everything else about New York’s
Medicaid program — lag behind national rates. Kent Gardner, president and
chief economist at Rochester’s
Center for Governmental Research, cites anecdotal evidence of just how low
those rates are:
“I’ve been told that docs who accept Medicaid patients don’t
apply for reimbursement because the cost of the paperwork exceeds the value of
the reimbursement,” he says.
The fewer the doctors who accept Medicaid
patients, the higher the number of patients who wind up in the ER, at higher
costs, reasons Faso. Giving doctors more money — and thereby a higher
incentive to provide cheaper care and preventive care — would save the state
money in the long run, he says.
Faso also wants to tap an intermediate layer of care between
doctors and emergency rooms: community health centers like the JordanHealthCenter
in Rochester. His plan calls for
boosting the number of CHC’s from 60 to 100 over four
years. That would require an upfront investment (Faso skirts the question of
how much), but he thinks it would save money in the long run by reducing
hospital visits. Faso cites an Action Alliance for Children report that
estimated that every dollar invested in a CHC in California
saved $2.70.
Not all of Faso’s plan is as
specific. He wants to improve technology systems to track patients through
Medicaid but says little about how or about what the cost would be. And while
some of his plans might be welcomed by many (incentives to keep people out of nursing
homes, for instance), others may not (he wants to “right-size” the hospital
infrastructure — closing some hospitals or at least reducing the number of
beds statewide).
Still, the plan shows that Faso and his policy wonks have
done their homework and understand the system as well or better than most.
Let’s hope the public — and the politicians — are paying attention.
This article appears in Sep 13-19, 2006.
