Nothing for what ills us
It is very difficult for me to understand what possible relevance the article by Reps. Marsha Blackburn and Phil Roe [TennCare Lessons for Health Care Reform, July 27] has to the pending national debate, except for allowing them to experience once again the joy of bashing TennCare.
There is not one positive or constructive suggestion in the entire article, and in fact the only subject that seems to interest them, pro or con, is the possibility of a government-run health care option. The merits or demerits of this part of (some) health reform packages cannot be evaluated without an analysis of the need for reform, and for this particular component, in the context of the total package in which it is included.
Instead, the authors content themselves with a misleading and inaccurate summary of TennCare's sad history, on the apparent assumption that if TennCare was bad, then the new reform proposal (they do not say which one) must be worse even though the two have nothing to do with each other.
Blackburn and Roe characterize TennCare as "universal single payer care" and President Barack Obama's goal as "universal care," thus establishing (in their minds) that if two things sound alike they must be alike. But TennCare was not "universal," even within the small "universe" of Tennessee, and it certainly was not intended to be "single payer." Rather it was intended to lower costs and expand coverage through managed care exercised by various qualified provider organizations in competition with each other.
But many of the providers were not qualified, there was little or no management of the care provided, and by the end any real semblance of competition had been eliminated while virtually all risk was assumed by the State. So of course TennCare didn't work —because it was never properly implemented.
If it is true, as the authors charge, that patients with nothing more than a cold incurred high costs for doctor visits and medication when they should have just taken an over-the counter remedy, then true managed care was not occurring or these unnecessary expenditures would not have been authorized or reimbursed.
On the other hand, of course, if people are really ill, then it is more economical (and patients are better off) if they do see a doctor instead of treating themselves and eventually winding up in an emergency room which is the most expensive option of all.
A final point: TennCare alone simply cannot be blamed for "forcing" the then-Governor into proposing an income tax to bolster the State's chronically inadequate and unfair system for raising needed revenues. I have read articles and papers dating back to at least the 1930s that say Tennessee's revenue structure needed to be revised so that it did not rely so heavily on an ever-increasing sales tax.
Governor Phil Bredesen's unwillingness to acknowledge the obvious need for tax reform — along with his refusal to use the State's "rainy day" and reserve funds to help the poor and ailing — are the things that "forced" him to remove some 200,000 of our most vulnerable citizens from the protection of TennCare, thus eliminating the program in all but name. Tennessee being Tennessee, we will probably never know what happened to these people, but if we did the Governor's actions would forever stain his legacy and the reputation of the entire state.
As it is, the people cast out by Governor Bredesen are a large component of the the group which needs health care reform the most, whether through some sort of government-run plan or otherwise. People with no health coverage probably will not mind if a "government bureaucrat" is involved in the process that provides them with necessary care and treatment.
The bugaboo that the new health care system will put another person "in the exam room" with the patient and his or her doctor should not frighten anyone anyway, since all but the most lavish current plans already place limits on costs and availability of certain procedures and require prior authorization for much if not all of the treatment provided.
Like most opponents of reform, Blackburn and Roe give lip service to "affordable basic health care for all Americans," but they say that "creating a plan like TennCare is not the right answer." It would be more correct to say that creating a plan like TennCare is not the right question. The question is how to meet the health care needs of all Americans, and on this subject Blackburn and Roe have nothing to offer.
Michael S. Lottman, 37082
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