So much of the practice of medicine in this country has become so regulated that it has taken on the aspects of government ownership (and universality; anyone who argues America need “universal” health care does not know what he is talking about because it already is universal in the U.S.). Unfortunately, that means it becomes less and less efficient in its delivery, at greater and greater waste to taxpayers.
Wheelchair provision to the indigent in Louisiana provides a prime example. Incentives simply were absent to control costs. My own experience confirms this. When my wife got her latest, most powerful wheelchair, the firm we dealt with (through private insurance, not Louisiana Medicaid) promised one set of things but when the delivery was made it lacked some features. To our chagrin, we found the company already had billed the insurer who had paid for things we didn’t get (and consequently, reduced my wife’s lifetime benefits as a result). A couple of years later, we learned from another source that the company owner had been convicted of Medicaid fraud for similar practices.
Most Medicaid wheelchair recipients in Louisiana, because of the state’s archaic laws that push the disabled into nursing homes, are nursing home residents, so the idea of making nursing home monitors of these devices, and in fact paying for them first before they can receive reimbursement, is an outstanding one. Might as well make them work a little harder for the generous reimbursement schedule under which they operate, plus they do get a bonus for each successful reimbursement. More stringent requirements, better monitoring, and the ability to “recycle” chairs alone could save the state millions of dollars that can be plowed into home-based care for the disabled.
This is an example of the efficiencies Louisiana needs to pursue to bring down the cost of health care in the state which runs about $6 billion yearly, or about 30 percent of operating expenses of state government. The resulting savings may only be 0.2 percent of this total but it’s a start. Maybe the federal government prompted this, but now it’s up to state officials to keep looking for greater and more efficiencies.
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