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Fill-in-the-blanks reform

Wednesday, October 26, 2005
Chicago Tribune

Cook County runs the largest publicly owned medical network in the nation. Nothing will be more affected by Gov. Rod Blagojevich's push to overhaul the state's rickety and expensive Medicaid system than the county's hospitals and clinics and the hundreds of thousands of patients who rely on them.

Blagojevich formally pitched his program to the Illinois General Assembly on Tuesday. He wants lawmakers to adopt it next week and have it up and running by July 1. But according to a spokesman for Dr. Daniel Winship, who runs the county facilities, no substantive discussions have yet been held with the governor's administration about how this new plan would work.

That's because there's not much of a plan to discuss. Blagojevich wants lightning-fast action on little more than a concept, with details on complex questions of how patients will get treatment and how it will be paid for to be filled in later.

The governor spoke to lawmakers for 24 minutes but spent just 97 seconds talking about the managed care disciplines he wants to impose on Medicaid to wring out savings. His focus was on spending those savings on a new program called All Kids that would underwrite medical coverage for thousands of uninsured children.

In advertising, that's called selling the sizzle and not the steak. All Kids is an intriguing idea that addresses a chronic and emotionally charged problem. But it's only a small part of what Blagojevich is proposing to do.

Medicaid is a vexing problem in every state, where the soaring costs of medical care for the poor are devouring budgets. The $8 billion Illinois program, which covers 1.7 million low-income residents, consumes one-third of the state's entire operating fund.

States are experimenting with all manner of cost-cutting initiatives to rein in Medicaid. Some are cutting benefits, others making it tougher to qualify and virtually all--except, up to now, Illinois--have turned to forms of managed care. Nothing has produced a sure-fire formula for success, and many efforts have flopped. A new Florida reform that would pay privately run health maintenance organizations to care for more than 2 million recipients received a serious blow Monday when the state's largest insurer declined to participate.

Illinois is one of few states trying to grow its program. That can have far-reaching consequences. The Kaiser Commission on Medicaid and the Uninsured says Medicaid cost pressures intensified in the last economic downturn as poverty grew. By intentionally making its program bigger, Illinois could court financial disaster when the inevitable next recession arrives.

The Blagojevich reform model is one professionals nickname "managed care lite." It would steer patients to gatekeeper physicians to coordinate care but contain few of the HMO-style financial carrots and sticks to make doctors and patients adhere to the rules. That could limit its impact as a cost-containment tool.

Whatever the shortcomings of his proposal, Blagojevich deserves credit for launching a long-overdue discussion about reining in Medicaid and helping children. His proposal could be the starting point for a goals-driven deliberation: Illinois does need to reinvent an important safety net to make it patient-friendly and cost-effective.

The state, and the governor's legacy, would be better served if he was more intent on doing it right than on doing it fast.

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