Yeah, You Were Good In Your Day, But We Don't Need You Now

I think one of the things that infuriates me most about the Bush administration is how they always, always go shooting for the most vulnerable Americans. You know the elderly, poor, injured vetrans, gays, immigrants. They really are the cruelest of the cruel.

A federal advisory panel says that long-term care for aging baby boomers threatens to bankrupt Medicaid, and it recommends sweeping changes to rein in costs, including greater use of managed care for the sickest Medicaid recipients.

The proposals set up a likely clash between the new Democratic Congress and the Bush administration, which has sent strong signals that it will seek big savings in Medicaid next year.

Panel members adopted the recommendations last week, by a vote of 11 to 1, and are drafting a report to be submitted next month to Michael O. Leavitt, the secretary of health and human services. Mr. Leavitt created the panel in May 2005 and is receptive to many of its proposals.

The panel, known as the Medicaid Commission, said states should have more freedom to alter benefits and eligibility for the program, which serves more than 50 million low-income people.

Moreover, it said states should be allowed to enroll some of the sickest Medicaid recipients, including nursing home residents and people with disabilities, in managed care plans.

All that said, I have to admit I was in an HMO for a while. My experience was nowhere near the horror stories others have to tell, but I know very poor HMOs do exist and the elderly won't know which they're getting. In my case there were no long waits for an appointment nor at the doctor's office and I was treated by the same doctor each time. It was not unlike a private, non-HMO clinic I later used.

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