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["clanSkeen" <sgian AT planetc.com>]

> If memory serves, you're in TN. Can you give James' synopsis of the recent
> stories in the press about "Tenncare"? If you're not in TN, then, 
> nevermind.


Certainly.  TennCare came about in 1993 because of the large number of 
uninsured in Tennessee was causing hospitals and clinics and even private 
practice doctors to raise fees on a weekly basis to cover the cost of 
medical services they were providing but for which they could not and did 
not collect fees.  Since the 'average and customary'   fees kept going up, 
insurance premiums kept going up.  For example a pretty good medical policy 
with a very low deductible cost $18 in 1986 but by 1992  poorer coverage 
with a $5000 deductible was more than $600 a month (rates in both cases for 
healthy non-smoker).  TennCare was created so that when services were 
provided for the poor uninsured, the hospitals and doctors would at least 
get something.

But the benefits were unrealistic.  No copays, no premiums or fees, 
unlimited doctor visits, unlimited prescriptions, unlimited transportation 
costs, etc.  As the decade of TennCare waxed on, the vast majority of its 
resources were being spent on a very few of the enrollees.  I have to be 
realistic here and describe what everyone was observing.  As prescription 
drug use became a legal way of getting a fix people headed for doctors to 
prescribe all sorts of debilitating drugs instead of heading for the pusher. 
Some people who were lonely and had no other say to entertain themselves 
called the ambulance to take them to the hospital  three times a week and 
everyone had a fine old time over it.   The costs became a very major 
portion of the state's budget.

The current governor ran on a platform of reforming and saving TennCare. 
And, as good luck would have it, he was as good as his word.  He proposed 
ONLY for those who were older than 18 and who where not eligible for 
MedicAid that they pay a small monthly premium (average $10), pay a copay 
for a doctor visit (average $10), and a copay for prescriptions (average 
$1).  Further they would be limited to ten paid doctor visits a year, 45 
days of hospital stays, and no more than six (6!) prescription drugs at the 
same time.  That's still a pretty good deal.

Enter one Gordon Bonnyman who founded the "Tennessee Justice Center".  Every 
proposal to contain the costs of TennCare were challenged in court by 
Bonnyman and the courts blocked them.   Some needed to be blocked but many 
were absurd such as a provision that if a doctor and the hospital said a 
person no longer needed medical treatment (ie they were a hypochondriac), 
the patient could declare themselves in need of whatever treatment they 
decided and TennCare had to pay for it.

This fall when the governor tried to get concessions from the standing court 
orders and could not, he announced that TennCare would be scrapped and 
Tennessee would go back to the old standard Medicaid system.  To understand 
the impact of this, nearly 1/4 of the population of Tennessee is on 
TennCare, some 1.3 million people.  About 890,000 of them would be eligible 
for Medicaid but 400,000 of them would become completely uninsured.

At the showdown at high noon, Bonnyman blinked and the negotiations are back 
on the table.   As much as I am not in favor of such programs but would much 
prefer to see the government get completely out of anything to do with 
medicine whatever, yet I have to say that examining the numbers, the state 
could easily afford the governor's modified TennCare system ... much more 
easily than it could afford to go back to having doctors and hospitals pick 
up the tab for the uninsured who could not pay for medical services.

James