How Not to Limit Medicaid Spending

Starting tomorrow, proof of citizenship is required for Medicaid benefits. The Washington Post reports:

The new provision is part of last year's Deficit Reduction Act, which President Bush signed into law in February. Despite a federal inspector general's report concluding that there was little fraud by noncitizens, supporters said the measure would ensure that Medicaid dollars go only to citizens or eligible immigrants. [Empasis mine]

You have to give the Republicans credit, it's not too often that you can combine zenophobia with an illusion of healthcare reform.

The simple fact is, this mesaure is bad for the poor. As if the health care system isn't already too difficult to navigate, many Medicaid eligable forgo care becuase they fail to navigate the Medicaid beauracacy. While the healthy need not register for Medicaid, there is a class of Medicaid eligable who need healthcare. Proof of citizenship only adds another barrier.

Anti-competition in Pharma

The Health Business Blog notes that big pharma has a number of ways of squeezing out generics:

Branded pharmaceutical companies have pioneered a number of clever techniques to repel generic competition: lawsuits that ensure delay of generic entry and threaten financial ruin for generic makers, next generation products (think Nexium) that are subtle variations of products losing protection, and authorized generics that effectively cut the market in half during the traditional period of exclusivity enjoyed by the first generic entrant.

Well, add to that list undercutting, since Merck is apparently exhibiting that classic oligopolistic behavior. The patent on the satin drug Zocor is running out, and Merck is pricing it at the lowest level possible. Meanwhile, the generic from Teva will be on the highest tier.

I wonder how a company with as few resources as Merck will be able to absorb this cost...

Coming Soon: National Patient Identification

When I first read HIPAA, I must of totally missed the identification requirements. Here's the money sentence (emphasis mine):

The Secretary shall adopt standards providing for a standard unique health identifier for each individual, employer, health plan, and health care provider for use in the health care system.

Holy crap, we're going to be assigned a number just to get healthcare. Nobody should need a number to receive healthcare.

I presume they'll use SSNs. SSNs were not supposed to be used for identification, yet they're used for tax identification, obtaining IDs (REAL ID Act) and for eligibility for other entitlement programs: HUD and Medicare/aid.

National Provider Identification

The Health Insurance Portability and Accountability Act (HIPAA) was a law passed by congress with the intention of protecting patient privacy. However, it has been routinely criticized for being overly vague and requiring more medical bureaucracy where there is already excess.

One of the lesser know provisions of HIPAA requires doctors to receive a National Provider Identifier (NPI). The NPI is administrated by Centers for Medicare and Medicaid Services (CMS), as this identifier will be required for all Medicare/aid payments. Although HIPAA is supposed to be simplified, the "simplified" version of the NPI is 36 pages.

Clearly, this is an unnecessary intrusion. There is no need for the federal government to keep tabs on doctors in such a systematic fashion. While I can see how this may reduce fraud, the responsibility for fraud reduction should lie with the states who administer the distribution of Medicare/aid funds anyway.