About Those Health Care Plans by the Democrats

While Senators Hillary Rodham Clinton and Barack Obama fight over who has the better health plan for the uninsured, they say little about a more immediate challenge that will confront the next administration, whether Democratic or Republican: how to tame the soaring costs of Medicare and Medicaid. The two programs, for older Americans and low-income people, cost $627 billion last year and accounted for 23 percent of all federal spending. With no change in existing law, the Congressional Budget Office says, that cost will double in 10 years and the programs will account for more than 30 percent of the budget.

Medicaid Managed Care Plans Place More Burden On Patients And Families With Severe Mental Illness, AJP Study Shows

Managed care health plans for Medicaid patients with schizophrenia and other severe mental illnesses may result in lower costs to the Medicaid system, but lead to greater personal expenditures and higher caregiver burden for patients and their families, new research indicates. . . . The managed care strategies employed by plans led to savings within the Medicaid budget, but these savings were offset by personal expenditures and the contributions of family and friends of the enrollees in the managed care plans. Managed care was not associated with increased overall costs to non-Medicaid government programs. Despite the Medicaid-specific savings, society's total costs were not reduced by managed care. This wider public health perspective is especially important when considering patients with long-term disabling illnesses, who have multiple needs that cross different types of services and payers. Although an earlier report by the same authors indicated similar clinical outcomes for the patients in the three plans studied, the outcomes may have depended in part on substantial contributions from families and friends. Cost substitution may further impoverish already destitute individuals and result in inefficient treatment.