Wednesday, June 9, 2010

Post Number LXX

This past Wednesday I had the pleasure of attending a Boulder Economic Council event: The Boulder Economic Summit. The focus of the event, subtitled Boulder in 2035: Opportunities and Insights, was to look at the future from a variety of perspectives and to provide a insightful analysis of the trends, developments, competition, challenges, and opportunities that will impact Boulder and those who live and work there.

The event was tremendous, and the quality of the speakers was top-notch. I was especially impressed with the keynote speaker, Thomas Frey, Senior Futurist and Executive Director at the DaVinci Institute. In example after example, he demonstrated how the world in 2035 will be in many ways unrecognizable to those of us living in the here and now.

Ironically, despite all the future talk, what really struck me was the part of his presentation when he discussed Roman numerals.

In a nutshell, he talked about despite the many deficiencies of that numeral system (such as how the unwieldiness of the numerals made advanced math difficult, if not impossible), the system stuck around for a longer time than its usefulness would indicate because the Roman Empire was so big no other ideas or systems were able to emerge.

While Mr. Frey was speaking, it hit me. Medicaid is like the Roman numeral system. The system isn’t capable of meeting the current needs we are facing. At the same time, the system is so big we feel like we can’t change it. I recently read this guest blog post by Harold Pollack, Associate Professor of Public Health at the University of Chicago, in Ezra Klein’s blog. I think the post sums up the issue well:

Slapped together 45 years ago as a relatively small program that mainly financed healthcare to welfare recipients and their children, Medicaid has evolved into a huge and diverse program that finances almost half of American nursing home and long-term care, bears large responsibilities for the care of disabled adults and children, and is the major vehicle to cover millions of poor and near-poor Americans who would otherwise be uninsured.
Discussing the flawed nature of this federal/state partnership, Pollack continued:

Rising Medicaid expenditures undermine states’ ability to address other pressing needs. Saddled with balanced-budget requirements and constrained tax bases, dozens of states are cutting or constraining services at precisely the moment when these services are most needed to meet human needs and to stabilize local economies.
Medicaid has grown far beyond what it was originally designed to do, and its many flaws are jeopardizing the ability of states to meet some of the basic needs of their citizenry. And yet, the system is so big now that change or adaptation seems so daunting that few are willing to undertake the challenge. Furthermore, any attempt at change seems to come from the outside in, and there doesn’t appear to be a lot of inclination on the part of those who are “in” to look for solutions from the outside.

Eventually, the Roman numeral system was replaced by a superior decimal system. And I believe that eventually we as a society will be forced to examine the efficacy of using Medicaid as the funding mechanism for long-term services for people with cognitive, developmental, and intellectual disabilities. I just hope we don’t wait too long.

Then again, what do I know?

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