The unique medical needs of Floridians
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Thread: The unique medical needs of Floridians

  1. #1
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    Default The unique medical needs of Floridians

    Mike Pence spoke in Florida to rally support for the AHCA. He said that giving Medicaid block grants to the states would allow Floridians to craft programs to meet the unique needs of Floridians.

    This is not the first time we've heard this meme. It was used as an argument by Republicans when Romney was running against Obama, when they had to justify opposition to a program that was so very similar to "Romneycare", his own successful Massachusetts program.

    I'm still waiting for someone to give me an example of how the practice of medicine differs wildly from state to state. Or of how the needs of a sick Floridian differ substantially from the needs of a sick Arkansan. Or any example of any condition, economic or medical, that supports this asinine sound bite.

    But then, I'm also waiting for a sign of humility, intellectual curiosity, civic knowledge or empathy from our new president.

    I should live so long. Or, maybe I shouldn't.




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    Marc Speer

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    There is no difference in the treatment phase of illness between any healthcare insurance program, be it socialized medicine or our unique and failed free market approach. What most people don't seem to grasp is that the only area of healthcare affected is how the healthcare providers are compensated. I have received healthcare in countries with socialized medicine and found them comparable to US healthcare, and in one instance, superior.

    What you heard is just more Republican bullshit, right up there with the concept of how the ACA is failing, which is also not true.
    Who am I? Why am I here? -Admiral James Stockdale-

  3. #3
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    Quote Originally Posted by mspeer View Post
    Mike Pence spoke in Florida to rally support for the AHCA. He said that giving Medicaid block grants to the states would allow Floridians to craft programs to meet the unique needs of Floridians.

    This is not the first time we've heard this meme. It was used as an argument by Republicans when Romney was running against Obama, when they had to justify opposition to a program that was so very similar to "Romneycare", his own successful Massachusetts program.

    I'm still waiting for someone to give me an example of how the practice of medicine differs wildly from state to state. Or of how the needs of a sick Floridian differ substantially from the needs of a sick Arkansan. Or any example of any condition, economic or medical, that supports this asinine sound bite.
    This argument is not about results. It's ideological. "Local control" arguments are not far removed from states rights arguments. States rights arguments are not far removed from discriminatory instincts. It's all part of the Republican toolkit.

    Block grant ideas go clear back to at least the Nixon administration. A law and order fright wave resulted in the Law Enforcement Assistance Administration (LEAA). The LEAA spilled mammoth doles to the states to control lawlessness and pot smoking hippies.

    States were required to form LEAA "planning agencies" to write a state plan detailing expenditures. As opposed to creating any consistency or momentum, the state plan contained wish lists from new "county crime commissions."

    In some counties, the money became slush funds to underwrite personal wet dreams. Not everywhere. But there was local control. There was financial accountability but no philosophical accountability. Some counties set up treatment programs. Other counties bought new guns and shiny new police cars.

    All of the money got spent. Local politicians loved the windfall. Press releases and ribbon cuttings increased. Politicians got re-elected and named buildings after themselves. Thus, bloc grants.

    There is some medical difference between states. Obesity. Propensity to exercise. Coal mines. Violence. Bad water. They COULD be accommodated through broader programs. Or we could just throw the money in a pot and have a free-for-all.

    Your medical care could run that way. Medical cost inflation stems at least partially from competition among providers. Who has the newest facility? Who has the best cath lab? Who has the newest cat scan? That exists where multiple hospitals co-exist near each other. Do they each need a competing orthopedic program? Competing cancer program? Competing psychiatric program?

    Sending your health money to some farmer or plumber elected as a rural county commissioner does not assure excellence. Without fools arguing that both political parties produce the same results, we might not have Trump.
    Last edited by local lurker; 03-19-2017 at 07:15 AM.

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    I had to look back because it had been too long since I was directly involved. This interested me on the National Council On Disability website. It indirectly speaks to the chaos that ensues when huge amounts of federal money go into play. Linking block grants to healthcare should terrify us. Add it to the stack.


    "What can we learn from examining past experience with federal block grants? First, the real value or purchasing power of block grant funding tends to decline over time after adjustments are made for inflation.

    "In a study of five Reagan-era block grant programs, Peterson and Nightingale found that the real dollar value of four of the programs declined between 1986 and 1995.20

    "A later study of 11 federal block grant programs concluded that the current value of federal funding fell by an average of 11 percent over the study period.

    "The factors leading to reductions in federal support are difficult to untangle, but one possible explanation is that the consolidation of separate program authorities disrupts the targeted advocacy that previously existed for programs rolled into the block grant.

    "It is harder to rally Congressional support for your particular cause if you know that the ultimate decision on how funds will be used rests with state or local officials.

    "Second, once block grants are authorized, the degree of flexibility afforded to state and local officials tends to erode over time. In a process sometimes referred to as "creeping categorization," Congress adds new restrictions, set-asides for particular purposes, or new categorical programs with similar or overlapping aims.

    "As Feingold and colleagues point out, "[a] common explanation traces this phenomenon to members of Congress, who seem to reap greater electoral benefits from narrowly targeted categorical programs or set-asides than from wide-ranging block grants."22

    "Illustrations of these recategorization patterns can be found in the first two block grant programs created by Congress.

    "The Partnership for Health Act retained its original flexibility, but its impact waned when Congress, concerned about state administrative performance, created more than 20 new categorical grants for health services outside the block grant.

    "Dissatisfied with state administration of the Safe Streets program, Congress added mandatory set-asides and other requirements that reduced state flexibility and later terminated funding for the program.24

    "Third, implementation of new block grant programs tends to be smoother when states administered the categorical programs replaced by the block grant.

    "When an administrative structure is already in place and recipient and provider relationships have been established, state officials have an easier time incorporating new responsibilities into existing management systems. Conversely, problems are more likely to arise when state governments assume responsibility for administering programs where the Federal Government previously awarded grants directly to local governmental units or nonprofit organizations.

    "The Community Services Block Grant, created by Congress in 1981, is a case in point. Here state governments had to establish administrative structures, fill new staff positions, and develop new relations with service providers in a policy area where states previously had little or no role."

    http://www.ncd.gov/publications/2013...13/05222013Ch2
    Last edited by local lurker; 03-19-2017 at 12:31 PM.

  5. #5
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    The Community Service Block Gant of 1981 was ironically a Trojan Horse to slash the very generous Block Grants of the seventies and did indeed also diminish the bang for the far fewer funds and allow States to steer funds away from targeted areas of need for which cities, towns and counties literally applied directly for grants awarded on merit under the guidelines to whatever the powers that be in the State desired.
    "They tried to bury us, but did not know we were seeds." Mexican proverb

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