Who Said This?

By John Ballard

This isn't  exactly  HCR but Medicaid adjustments will be important to PPACA.
Here is the link to the following but it's no fun to find out who said it (and when) before guessing.

The fundamental problem with the Medicaid system is that its beneficiaries are distinct and separate groups of individuals with radically different needs and characteristics: people with disabilities, the poor and the elderly poor. A 21st Century Responsible Citizen Medicaid Act would divide Medicaid into three distinct areas, each administered separately with its own rules and structures.

First, the act should establish a Capabilities Program to help both Americans with disabilities and those with work-related or other injuries lead the fullest possible lives. The program should provide incentives to people with disabilities to be productive, rather than threatening them with a loss in benefits if they get a job. The program should also allow participants to capitalize on technologies and therapies that maximize their abilities, and that emphasize integration into social, family and work life. This philosophy closely resembles the government's successful approach to rehabilitating and reintegrating amputees and other wounded veterans from the Iraq campaign.

The second area would address the needs of the relatively healthy poor, who have much different needs than people with disabilities or the elderly. Poor individuals should be offered vouchers for health savings accounts that sensitize them to the benefits of prevention, wellness and early detection. This would also encourage a more rational use of health care; prenatal care, for example, is far cheaper than neonatal intensive care. Similarly, a visit to a health clinic or doctor's office rather than to an emergency room will save a significant amount of money. But the rules currently allow for payment for expensive emergency room visits despite the lack of an urgent health care need. Government leaders need to rethink the part of Medicaid serving the healthy poor in the same way we rethought welfare in the 1990s.

Third, the legislation would create a program to serve the elderly that reintegrates the family back into their care. The current system, for example, prevents a daughter whose mother is in an assisted-living facility from contributing financially to her mother's care without losing all Medicaid coverage. This either-or mentality is anti-family and leaves the recipient with a lower quality of life.

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America's Medicaid program isn't working. A "money only" debate would be an exercise in futility and -- more tragically -- would trap the most vulnerable people in our society in a hopelessly broken system. Transforming Medicaid is a moral imperative.