Monday, December 23, 2013

Et tu, Brute? Not exactly.

Moise Brutus.
Here's an inspirational tale being pushed by the rightwing wind machine, in today's Morning Bell from the Heritage Foundation: the story of Floridian Moise Brutus, who was 20 years old when a 2010 motorcycle accident left him a triple amputee and is now a college student and competitive cyclist in training for the 2016 Paralympics. The improbable villain of the story? Wicked big-government Medicaid! That is...

The inspirational part of the story seems to be completely true, as seen in the less tendentious accounts of venues like WSVN Fort Lauderdale; this is one gutsy young man, and the doctors and therapists and social workers who have helped him get where he is have done a terrific job, but Medicaid?

The Heritage hacks explain:
Medicaid wasn’t working for Moise. His extremely difficult injuries meant that he had specific challenges and needs. But as he says, the old government program was a “one-size-fits-all” model.
Thankfully, Moise lived in Florida, which was trying out some reforms to Medicaid. He was able to switch out of the old Medicaid program into a private plan—and that changed his life.
The private plan gave Moise an individually tailored approach to his needs.
“That’s when everything started to get better for me,” he says. He was able to get “the best care, the best prosthetics, the best of everything.”
Not quite, hacks. Brutus was forced out of traditional Medicaid by Florida law, which requires Medicaid recipients to join a private plan within 30 days of qualifying, and arbitrarily assigns them to one if they fail to do it, and this is what happened to Brutus; he was too depressed to follow through with the bureaucracy and got assigned to a company called WellCare Health Plans. He was depressed, ironically, because thanks to those "reforms" traditional Medicaid was unable to provide him with the stump revision surgery he needed to begin his rehabilitation, and he refused to speak to the WellCare caseworker who would have explained it to him.
Haitian dancer Fabienne Jean. Didn't have to join a managed care plan, I don't think.
Luckily, his mother talked to the caseworker, and the two of them pushed him to cooperate, and the story has a happy ending. But you can't blame Medicaid for the fact that it almost didn't; the guilty party here is the crazed Florida legislature which unnecessarily complicated his situation in their unslakable desire to shovel more money into the coffers of rent-seekers like Governor Rick Scott.

I mean, not Scott in this case—WellCare only had to pay $217 million in fines for their Medicaid fraud case, while Scott's company, Columbia/HCA, went for the big one, Medicare fraud, and paid more than $1.7 billion.

And WellCare seems to have handled this pretty well, but as Brutus himself says*,
“Would I actually recommend (Medicaid managed care) to anyone? From my experience I would, but speaking logically I'm sure not every story has as happy an ending as mine...”
*That is, as he has really said, in his own words, unlike referring to Medicaid as a "'one-size-fits-all' model", a rightwing cliché that the Heritage hacks, with characteristic dishonesty, casually stuck in his mouth for their own propaganda purposes.

Indeed, New York state authorities found WellCare's performance in running a managed care Medicaid program for 75,000 patients so faulty in 2012 that they put the company on probation. They emerged, successfully, last January, but with a
Cautionary Statement Regarding Forward-Looking Statements
This news release contains "forward-looking" statements that are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995.... Forward-looking statements involve known and unknown risks and uncertainties that may cause WellCare's actual future results to differ materially from those projected or contemplated in the forward-looking statements. These risks and uncertainties include, but are not limited to, WellCare's progress on top priorities such as improving health care quality and access...
I'm sure that's just mandatory boilerplate but doesn't it, in this context, have a certain poignancy?

So four or five cheers to Moise Brutus and his team—you guys are the best—but no cigar to Heritage and the other pushers of the story trying to exploit it for the purpose of spreading their anti-government falsehoods, and no thanks to the Florida state legislature, which has only hampered Medicaid from doing what it does so well. Here, on that subject, a public service message:

Limbs Are Essential

Make a Difference: Take a Stand for Our Amputees
Yes, in some states, amputees who are Medicaid beneficiaries are being denied access to the artificial limbs and customized bracing. They are entitled to their mobility.
The best thing that you can do to help is communicate to your state and federal legislators, and ask them to make sure this doesn't happen in your state.
Visit the AOPA Limbs Are Essentialwebpage for more information and the opportunity to contact your legislator.
New Jersey: Montclair State University tap dancer Evan Ruggiero, second from right. Photo by John Munson for the Star-Ledger.

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