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FOCUS | ISSUE 1 | 2010


According to government released statistics, the health care spending hit a breathtaking $2.3 trillion in 2008 or 16.2 percent of the nation’s economy.


However, individual spending out-of- pocket was less than one-eighth of the total spending. Government and private insurers split the rest.


Putting these numbers into a more personal perspective, per person expenditures totaled $7,681, with individuals paying roughly $912 of that, according to the report by the Centers for Medicare and Medicaid Services. The government and private insurance companies paid for the remaining costs.


The personal cost of health care per household equaled slightly more than what Americans spent on enter- tainment in 2008, but as a dentist-employer paying for our own insurance premi- ums and part of our staffs, that number is tantamount to misinformation.


Because dentistry is only referred to from the periphery in this bill, is there a subject included in these sources that could be a predictor for dentistry? I decided to use Medicaid as my sample subject and tried to fi nd any infor- mation about the health bill’s affect on it. Because it is the untouted wish of the government to put more people on Medicaid under this new bill (Congress is counting on enrolling 15 to 20 million more people into the program), the handling of Medicaid could be our miner’s canary.


DURING THE FALL of the YANKEE EMPIRE


Consider some other numbers. Recent polls show an approval rating of our beloved con- gressmen to be 27.4 percent. Surveys show that only 34 percent of Americans desire passage of the current health bill. Some 60 percent of the senators voted for the health bill. Do we have a representative democracy anymore?


The MDA does not pay me enough to read the 2,074 page bill, nor do we, apparently, pay our destitute senators enough to read the bill. Neither I nor the senators can tell you what is in this pork barrel bill. We have heard bits and pieces. If you are like me, I have heard enough to know that I am against it, but I wanted to know more.


6


I went to a source I trust—The Heritage Foun- dation. I also obtained a copy of the bill online. I found several articles on analysis of the bill from several perspectives—all from non-blog, recognizable and respected websites. Dentistry was but a wee consideration. We seem to mat- ter little. And as I have cited before, we will be carried along with this movement like a dental tick on a medical dog. The dog’s fate will be our fate.


I did notice that in Section 5304, Alternative dental health care providers demonstration project, there is a provision for fi nancing new educational programs for new healthcare worker models. Remember the MDA leadership has been warning that these developments will come from the feds if we do not have a proac- tive approach—sorry, it’s too late (see page 12).


Naïve me. I thought that federal subsidies for state Medicaid would be equally subsidized to the states via some equi- table marker. In FY2008 and FY2009, California got a fourth of the increase in Medicaid subsidy money while having 12 percent of the population. Michigan and California together got a third of the increase in federal Medicaid funding but has only 15 percent of the population. The Obama administration has given aggregate spending estimates of the bill, but has not given state-by-state projections. So, how will federal Medicaid monies be distributed and with what, if any, equity?


Some attention has been placed on the provision that the feds will increase rates of subsidy of Medicaid, but careful reading shows this will only be for new


eligibles, and families currently eligible will not be eligible for the increase in funding.


The new health bill has a MOE clause (mainte- nance of effort). This, along with other provi- sions, will force states to place Medicaid above other state’s monetary priorities. Missouri, along with 28 percent of the states last year, cut Medicaid expenditures. How will this new bill affect the state’s decision? John Holahan, a widely respected analyst at the Urban Institute, warns that “current fi nancing plans for Medic- aid expansions under health reform proposals will be complex and will set up longer-term fi nancing inequities across states.” (Source: The Heritage Foundation).


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