HCBS Reductions? What Advocates Can Do.

HCBS Reductions? What Advocates Can Do. Information Bulletin # 324 (9/2010).

Has your State threatened to cut back or reduce Medicaid-funded home and community-based services ? Has your State actually reduced HCBS Medicaid services? What impact will these reductions have on people remaining in the community?

What can advocates do about these reductions? What should CMS do?

In addition to how the ADA and integration will be impacted if the reductions are implemented, another handle is the Medicaid statute itself?

To receive federal Medicaid funds, a State must have a written state plan that has been submitted to and approved by the Secretary of the U.S. Dept of Health and Human Services. CMS posts state MA plans and amendments at www.cms.gov/medicaid/stateplans/

State MA plans must be amended to reflect changes in federal policy, Court decisions, and “material changes” in policy, state law, or operation of the program. 42 Code of Federal Regulations § 430.12. Proposed State plan amendments must be submitted to the CMS regional office which must “consult with central office staff on questions regarding application of Federal policy.” 42 C.F.R § 430.14. CMS must make a “determination as to whether State plans (including plan amendments and administrative practice under the plans) originally meet or continue to meet the requirements for approval are based on relevant Federal statutes [including the ADA] and regulations.” 42 C.F.R § 430.15.

Hmmm. The United States Supreme Court in 1999 in the Olmstead decision found that unnecessary segregation in institutions violated the ADA - sure sounds like a Court decision. CMS has issued several “Dear State Medicaid Director” letters telling states that their State plans must comply with both the Medicaid and the ADA statutes, and these letters sure look like federal policy.
Therefore, when your State proposes reductions in HCBS, advocates must analyze what impact the reductions will have on causing or preventing unnecessary segregation. Advocates must ensure that CMS will disapprove the amendments based on Olmstead and its own policy requiring compliance with the ADA.

Advocates for older and younger Americans with disabilities should:

1. Find out if your Governor has reviewed the proposed amendments, a Medicaid requirement for State plan amendments?
2. Contact your regional CMS officials and obtain copies of documents between your State and CMS regarding the amendment.
3. Unbelievably, there is no requirement for public hearing or even an opportunity for public comment. Nevertheless, each State has a Medical Care Advisory Committee that reviews and comments on proposed changes. Get to them and make your voices heard.
4. Send your comments to the CMS regional office AND to the Secretary of HHS. Tell them how the amendments will impact on people unnecessarily being institutionalized.

Thanks very much to the National Health Law Program for their invaluable suggestions and observations, many of which are the basis for and incorporated in this Information Bulletin.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Rebalancing MA FY09 - How Is Your State Doing?

Rebalancing Medicaid’s Long-Term Care Expenditures: How Is Your State Doing? Information Bulletin #323 (9/2010).

In the Affordable Health Care Act in 2010, Congress provided that States would receive an increased federal match IF they “rebalance” their Medicaid expenditures from institutional expenditures to community expenditures. This was Section 10202 - “Incentives for States to Offer Home and Community-Based Services as a Long-Term Care Alternative to Nursing Homes”. States that spend less than 25% on community service could receive a 5% enhanced match and states that spend less than 50% could receive a 2% enhanced match.

In this Information Bulletin, we focus on why this section is important and how best it should be implemented to get the funding to the most states and to the states most out of balance regarding institutional and HCBS community spending.

Last Bulletin highlighted how well the DD Community has done in most states to reverse the institutional bias in Medicaid spending in relationship to the aging and physical disability community. Section 10202 could be used to make both the NF and ICF-MR funding streams more community based in states with the most inequitable systems.

Rebalancing of Medicaid’s long-term care expenditures is critical for older and younger people with disabilities eligible for nursing home services as well as persons with developmental disabilities. If your State shifts expenditures from the more expensive nursing home budget to the less expensive community budget, there will be more Medicaid funds available to serve more people in the community. By offering a larger federal match to move money from nursing homes to the community (HCBS), there will be a financial incentive for states to confront the lobby of the nursing home industry and increase funding for community services (HCBS).

This would be an opportunity for advocates in aging and disability organizations to join together to push for this new HCBS opportunity that begins October 1, 2011.

We decided to look at how state expenditures were made in FY 2009. Remember the Supreme Court ruled in Olmstead in 1999 over 10 years ago.

We use the state data compiled by Thompson Rueters under CMS contract. www.hcbs.org/browse.php/sby/Date/source/150/ThomsonReuters

From that data, we computed what follows.

Here’s what all the terminology and acronyms mean for this bulletin:

1. Long-term care (LTC) is the total Nursing Home (NH) and

Home and Community-Based Services (HCBS) spending;

2. Institutional is the total Nursing Home spending;

3. Home and Community-Based Services includes the total of Medicaid Waivers, Home Health and Personal Care Option spending.

Here’s what we found:

1. The Overall Picture -

In 2009, 66.2% went to NH and 33.8% went to HCBS.

While percentages are important we should also look at funds spent. In 2009, over $50 billion went to NH and over $25.5 billion went for HCBS.

2. A State Breakdown

In 2009, there were only four States that definitely spent less than 50% of A/D on nursing home institutions [WA, MN, OR, and Alaska]. These four therefore spent more than 50% of their LTC funds in the community for HCBS. It is likely that NM and CA are also in this category, but neither has reported all of its data for 2009. [In DD, only 6 states in FY 2009 spent less than 50% in community! Wow – absolutely opposite the A/D world.]

In 2009, there were 23 States that spent more than 75% of their Medicaid LTC A/D on nursing homes.[NE, ME, CT, OH, WY, AL*, MI, NJ, AZ, FL, UT, HI*, IL*, KY, PA, NH, IN, MS, MD, SD, DE, ND, RI*]. *All data not reported. These 23 States have not “rebalanced” their A/D expenditures and 10 years after Olmstead still are overwhelminingly institutionalized biased.

While the field as a whole is moving in the correct direction by increasing spending in the community for HCBS, these 23 states still lag far behind in overall HCBS expenditures.

Conclusion:

According to the FY 2009 data gathered for the above analysis 44-46 states would be eligible to apply for the 2% enhanced match offered in the Section 10202 HCBS Rebalancing language IF CMS makes the policy decision to have the percentages based on these funding streams.

23 states would be eligible to apply for the 5% enhanced match offered in Section 10202 HCBS Rebalancing language if CMS makes the policy decision to have the percentages based on funding streams.

If the policy goal of Congress was to “Rebalance” the LTC system, using Section 10202 to focus on the states with the most inequitable funding patterns, seems like a simple CMS policy decision to focus on those States with the most egregious unbalanced LTC services.

Tell Cynthia Mann, CMS Medicaid Director this is what you would like to see happen. (Cynthia.mann@cms.hhs.gov)

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com

with a searchable Archive at this site divided into different subjects.

As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/

To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Comparing Olmstead Implementation Among Disabilities. I

Comparing Olmstead Implementation Among Disabilities. Information Bulletin #322 (9/2010).

For years, we have reviewed and compared Medicaid expenditures for people in institutions and in the community. For quite a number of these years, advocates for people who have an Intellectual/Developmental Disabilities have consistently used the Medicaid’s Home and Community-Based systems far better than advocates for older and younger people with physical disabilities, dementia.

To analyze how well the Olmstead's ADA mandate to end unnecessary institutionalization of people with disabilities has been accomplished, it is necessary to separate these two groups, ID/DD (previously MR/DD) vs. A/D(Aged/Disabled) (these are CMS designations). The reason this is necessary is, because depending on the disability label people have affixed to their heads, this label determines the institution into which you may be unnecessarily institutionalized and the funding stream you can access in the community.

Under the federal Medicaid statute, people with a ID/DD label are institutionalized in State Centers and ICF-MR (Intermediate Care Facilities for Mentally Retarded), and older and younger people with, for example, physical disabilities, dementia or anything other than the ID/DD label, are unnecessarily institutionalized in nursing homes.

These institutions, though similar in how they treat people, differ dramatically when measured by per person spending which carries over directly into the Medicaid Home and Community-based Waiver system and therefore into the amount and package of services a person will receive. Therefore, the label triggers the institution which triggers the amount of Medicaid community-based services one receives.

This long-winded explanation is necessary to understand that when one compares Medicaid community vs. institutional expenditures, the label determines both the institutional and community-based expenditures.

With this background information, we can now compare Olmstead's ADA mandate by looking at the Medicaid expenditures for the two groups. Here's what we find:

* In FY 2004, nationally the distribution of Medicaid Long Term Care expenditures for MR/DD services spent 42.4% in the institutions (State Centers and ICF-MRs) and 57.6% of the total LTC in the community. In dollars, $12 billion went to MR/DD institutions and $16 billion for services in the community.

* In the same year, FY 2004, nationally the distribution of MA LTC expenditures for A/D services spent 74.9% institutions (nursing homes) and 25.1% in the community. In dollars, $46 billion went to A/D institutions and $15 billion for services in the community.

Let's see what changes occurred in five years. Was there a leveling and how much progress was made?

* In FY 2009, nationally the distribution of Medicaid Long Term Care Expenditures for ID/DD services spent 34.4% in the institutions (State Centers and ICF-MRs) and 65.6% in the community. In dollars, $13 billion went to MR/DD institutions and $26 billion for services in the community.

* In FY 2009, nationally the distribution of expenditures for A/D services spent 66.2% institutions (nursing homes) and 33.81% in the community. In dollars, $50 billion went to A/G institutions and $26 billion for services in the community.

The FY2004 data and statistics were only five years after the Olmstead decision. However, the FY 2009 data is ten years after Olmstead. Though there has been a lot of improvement, there is still a significant institutional bias if one has the A/D label.

Let's compare the two funding groups over the five years:

The good news is that between 2004 and 2009, both groups had increased the distribution of Medicaid expenditures in the community as compared to their respective institutions.

But the inexplicable fact remains: people with a ID/DD label have a significantly better chance of residing in the community than people with an A/D label.

Just the facts!

There were 17 States in FY 2009 that expended more than 80% of their Medicaid funds inthe community for people with ID/DD. Congratulations!
There were only 2 States in FY 2009 that expended more than 60% (that's correct) of their Medicaid funds for people with A/D in the community! Wow.

Here are a few examples: Why in FY 2009 would Michigan spend 99.2% of Medicaid funds for people with ID/DD in the community but only 21.5% in the community for people with A/D? Similarly, New Hampshire spent 98.1% for ID/DD in the community but only 17.7% in the community for A/D; Alabama spent 87.8% for ID/DD in the community but only 14.9% for A/D in the community.

Why are there such marked differences based on a label?

Are the ID/DD advocates better than the A/D advocates?

Do younger and older people with physical disabilities prefer nursing homes over community services?

Why can State administrators (Medicaid Directors) continue to shift Medicaid funds from ID/DD institutions to the community while at the same time increase significantly faster the pace of shifting the A/D Medicaid funds to the community?

If the goal is to rebalance the entire long-term service and support system, then we need to look at how each of the funding streams are faring and develop rebalancing strategies to meet our overall goal of a total community integrated system.

Disability advocates - whether older or younger are people with disabilities. Whether your label is A/D or ID/DD or MI or....... , we all want services in the most integrated setting. The Olmstead decision was about all of us. Isn't it about time we confront the labels and the different funding streams?

The people united will never be defeated. El pueblo unido jamás será vencido!

Thanks to Thompson/Reuters for compiling the above state MA expenditures data.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

FY 2009 Institution vs Community-Based Medicaid Services for Older and Younger Americans with Disabilities,

FY 2009 Institution vs Community-Based Medicaid Services for Older and Younger Americans with Disabilities, Information Bulletin #321 (8/2010)

Each State’s FY 2009 Medicaid expenditures provide extremely helpful information to analyze your State’s distribution of its Long Term Care expenditures between its Institutional versus Community-Based Services.

Follow the Medicaid money and you’ll see how committed your State really is to ending unnecessary institutionalization of older and younger Americans with disabilities. How your state allocates its expenditures demonstrates its commitment to provide the elderly and younger persons with disabilities a real choice between unnecessary institutionalization and living in the community.

Let’s repeat - “show us the money” and where your state spends it, and you can see how much your state respects both the ADA and the Olmstead decision. Remember that the Supreme Court in 1999 - more than ten years ago -told states to end unnecessary institutionalization! The FY 2009 data was just released by Thomson Reuters, an independent contractor which compiles the data submitted by each State to the federal funding agency. Thanks very much.

How much progress has been made? Let’s compare the past five years.

In FY 2004, States spent 74.9% of their total Medicaid LTC funds for “Aged/Disabled” [i.e., older and younger Americans with disabilities] Services in nursing homes, and 25.1% in the community.

In FY 2009, States spent 66.2% of their total Medicaid LTC funds for “Aged/Disabled” Services in nursing homes, and 33.8% in the community.

In dollar terms, in FY 2004, States spent about $46 billion on institutional care and $15 billion in the community.

In FY 2009, States spent about $50 billion on institutional care and $26 billion in the community

The good news is that there was an 8% shift towards the community in those five years. The bad news is that ten years after the Olmstead decision, States are still spending nearly twice the amount of Medicaid LTC funds on nursing homes than on services in the community, despite the overwhelming survey data showing that people want to stay at home.

There is nothing magical about where your State allocates its Medicaid money. Tomorrow States could turn the FY 2009 upside down and spend 66.2% in the community instead of in nursing homes - IF States wanted to do so. Congress and CMS has given States enormous flexibility during the past five years but most States have not taken advantage of the options.

Why has the change been so slow? State legislatures and Governors seem to be very beholden to the nursing home industry, which definitely knows how to play the political process much better than elderly and disabled advocates.

Until the political pressure from the people with disabilities - regardless of age- increases, the nursing home industry will prevail.

Let’s look at how your State did in FY 2009 with its Medicaid Long-Term Care expenditures for older and younger Americans with Disabilities:

Some States have consistently done very poorly and have been consistently below the national average. Some States conversely been consistently above the national average.

Some States seem ripe for class action Olmstead litigation.

What sanctions are CMS and OCR planning for those States that have both lengthy waiting lists for community-based services and spend disproportionately on nursing homes?

% nursing % community
homes
National .....................66.2% ............ 33.8%

Alabama .....................85.1% ............14.9%
Alaska ....................... 44.3% ............55.7%
Arizona ..................... 78.6%............21.4% *
Arkansas.................... 71.0 ............29.0
California...................44.9 ............55.1*
Colorado.................... 56.4............43.6
Connecticut................75.7............24.3
Delaware....................87.5............12.5
D. C............................54.4............45.6
Florida........................79.5............20.5
Georgia.......................74.0............26.0
Hawaii........................80.8...........19.2*
Idaho...........................56.7............43.3
Illinois.........................80.2 ............19.8
Indiana........................83.8 ............16.2
Iowa............................70.4 ............29.6
Kansas........................60.6............39.4
Kentucky....................80.7 .............19.3
Louisiana....................67.5............32.5
Maine..........................75.5 ............24.5
Maryland.................... 85.1...........14.9
Massachus.................. 64.1............35.9*
Michigan.....................78.5............21.5
Minnesota...................42.5............57.5*
Mississippi..................84.2............15.8
Missouri......................66.3 ............33.7
Montana......................66.1............33.9
Nebraska.....................75.1............24.9
Nevada........................65.9 ............34.1
New Hampshire..........82.3............17.7
New Jersey.................78.8............21.2
New Mexico...............31.2...........68.8
New York ..................61.9...........38.1*
North Carolina............57.2............42.8
North Dakota.............. 89.8............10.2
Ohio............................75.9 ............24.1
Oklahoma................... 67.6............32.4
Oregon....................... 43.8............56.2
Pennsylvania............... 82.1............17.9
Rhode Island............... 95.6............4.4*
South Carolina............ 72.1...........27.9
South Dakota.............. 86.0...........14.0
Tennessee................... 91.1..........8.9*
Texas......................... 55.5..........44.5*
Utah............................80.4............19.6
Vermont.....................67.5............32.5*
Virginia.......................64.9..........35.1
Washington ................38.0 ...........62.0
West Virginia.............. 74.5.............25.5
Wisconsin .................. 74.0 ............ 26.0*
Wyoming ...................76.6............23.4

* Data may not include certain LTC expenditures with managed care or 115 waiver data not available.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects.
As of August, 2010, Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/
To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.

Older Americans and People with Disabilities - Bridging the Disconnect.

Older Americans and People with Disabilities - Bridging the Disconnect. Information Bulletin # 320 (8/2010)

This Information Bulletin is an attempt to bridge and solidify advocates from two communities - older Americans and people with disabilities. For many reasons, there has been a disconnect between them.

More than two years ago, we wrote “The Older Americans Act: Consumer Choice and Control over Long Term Care,” (see February 9, 2007 Information Bulletin). We reviewed how Congress’ amendments to the Older Americans Act and its “Choices for Independence” began to provide services for people to remain in their homes, instead of going into nursing homes. The Older Americans Act was for the first time really focused on community!

The OAA provided grants for States to develop a “single point of entry” for long-term care, so people would know what community-based services were available in order to avoid institutionalization. This single point was through the “Aging and Disability Resource Centers” (ADRC). It also adopted the “consumer model” so people could self-direct care and services.

The Older Americans Act is up for reauthorization in 2011. Yes folks, Congress will have to face whether or not the “Aging and Disability” centers will be refunded. This reauthorization will provide a forum and opportunity for these two communities to discuss how well they have worked together, how well the ADRCs are functioning, if they are serving both older Americans with disabilities and younger Americans with disabilities and what changes should occur.

There are a number of issues which we hope both communities understand and address:

1. Medicaid is the same funding stream for long-term community care and nursing homes for all people with disabilities, regardless of age. Cut-backs and reductions of Medicaid services impact every disabled person, and State legislatures’ common attacks on services will hurt people regardless of age.

2. Yes, these two communities do not agree on everything (e.g., assisted living, identifying oneself as having a disability), but there are unequivocally common interests. In an era of reductions and attacks by States on community-based services, it is critical to put aside differences and join to fight what the two communities have in common.

3. There really is power in numbers! Can you imagine a State legislative hearing with twenty-five year old wheelchair uses holding hands with seventy-five year old wheelchair uses demanding their right to live in the community and not being dumped into nursing homes.

4. How about next year, during the Congressional reauthorization hearings, joining forces? Tell Congress that all people with disabilities, regardless of age, want the right to receive services in their own homes.

5. The increased Medicaid funds for Money Follows the Person grants must focus on getting anyone out of nursing homes who wants to live in the community - not just people with disabilities under 60 years old. Older Americans do not enter nursing homes because they want to; they do not have community-based services offered to them. If both communities combined their efforts, they could have a significant impact of enhancing waivers - especially in those 20 States that have not yet received MFP grants but probably will be applying for them very soon.

6. The Independent Living Centers serve many older Americans with disabilities. Yet, the AAAs and ILCs in most states keep each other at some distance. As the under 60s younger Americans with disabilities become the over 60s older Americans with disabilities, yes it really happens, the disability issues and culture will cross the age barrier. Let’s hope that the people take the lead and make these organization really work together.

To not take the 2011 reauthorization as an opportunity to address these issues and to jointly work out strategies is perilous.

POWER concedes nothing without a struggle.

Steve Gold, The Disability Odyssey continues

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com
with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com or call 215-627-7100.




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A Proposal for Preventing Health Care Reform from Burdening Our Country

A Proposal for Preventing Health Care Reform from Burdening Our Country

Every day 14,000 Americans lose their health coverage. More than 46 million people are without health care. But maybe many of these people really do not deserve and should not receive health care. Just because someone is poor or ill or disabled does not mean he or she deserves health care.

Similarly, many of the remaining millions of people who are already paying for private health insurance or are receiving publicly funded health care do not deserve the benefits they take for granted.

We must cut costs and the only fair way is to deny health care to all people who do not deserve to receive it.

Throughout the current health care debate, we have worn blind folds. In darkness, we have each touched a part of the health crisis, like the elephant’s tail, trunk, or ear. Based on what we touched, we thought we understood the problem and had the answers.

But just feeling up part of the animal is not enough. The trick is to figure out how we decide who really should not receive health care. Who is unworthy of receiving it? How we can persuade them not to request or receive health care? Once we figure this, we will significantly reduce our health costs.

The goal: Increase the number of people among us who should not receive health care because they do not worthy.

We have assumed that there is a health care crisis because of the health care insurance companies, the pharmaceutical drug companies, the doctors and hospitals, and the lawyers. But these folks represent only part of the trunk and the elephant’s left front foot.

No, the cause of the health crisis is much bigger. It’s them - those people who do not deserve unlimited health care – for themselves, for their children, for their parents.

Let’s look at some categories of them, where we might be able to increase the number of people who should not receive health care, leaving more for the deserving ones.

The Oldest People

In this category people over 90 and maybe even over 85. But the years are not the crucial criterion. We know that in the last year or two of their lives is when most health care funds are expended per person. Health care in these years is extremely expensive, and for what? A few more years. A few years of what? Visiting doctors and hospitals? Pain, worry and discomfort? Cost?

Most older people want all the health care that exists, and if it doesn’t exist, it should be invented. Don’t discuss costs. Ask this group if they deserve to receive unlimited medical care and bankrupt the rest of the country for their health care and they’d not flinch - “we earned it.” Well, maybe many of them did not pay into the system anywhere near what they’ll get out of it, but why quibble. And anyhow, the deserve equation is not just a money-in/money-out calculus.

These older geezers sound like they’re against any change. So what would they accept?

Here’s a deal that many seniors might accept, and will save trillions in medical costs. When your doctor thinks your last few years have arrived, you become eligible for a month or maybe two of free room, board and transportation to anywhere in the continental USA. If your doctor believes that these last few years could be especially expensive medically, then we’ll consider Alaska, Hawaii, and Puerto Rico. If the old person will agree to a three year program, then we’ll provide a free two month cruise and funeral expenses. In exchange, the senior must agree to forego any non-routine medical care for the number of years bargained for. Pain medications will be provided gratis.

The “Preventable Chronic Disease” People

The following people should be denied health care because their diseases are their own fault. Given modern medicine’s advances in genetics, if a person can genetically establish “no fault,” then we’d give them a pass.

The Obese People

Now we all know that anyone who really wants to control their weight can do so. There is no excuse for people stuffing their faces with greasy hamburgers and french fries, or drinking soda with all the added sugars. If they eat like that, why should they expect our health care system will cover them? Stuffing oneself should have consequences.

Isn’t it time we stopped blaming the food industries that just want to make money? Attempts to change consumer eating patterns have failed. Therefore, let them eat whatever and however much they want, as long as they agree to live with the consequences and we don’t have to pay their health care.

OK. Obese People have heard of the deal we made with our grandparents and even though they might not deserve it, let’s see if we can make a deal, so we can save medical costs. We agree to pay for one year in a gym of your choice. In return, unless you lose by the end of the year an agreed on number of pounds, you will receive no medical care for the next two years that can be related in any way to obesity.

Shouldn’t the same principle apply to children who are obese? It’s never too early too deny health care to a kid who keeps eating and does not exercise. Let them learn early in life that there is no free health ride; suffering will benefit them later in life, if they survive.

But since parents are in control of what their children eat, or at least are supposed to be, then parents of obese children should also be punished and denied health care for themselves. It’s also never too early to make parents act like adults.

The Smoking People

Smoking has been a recognizable cause of “preventable chronic diseases” for many decades. Since this has been known for many years, we should “just say no.” Sorry. You smoked knowing the potential adverse effects and now you want us to pay for your choices? You’ve got to be kidding. No deals.

The No Immunizations People

These parents are a real problem because their choice not to have their children receive immunizations affects their kids, who have no say in the matter. If their children come down with a preventable disease, maybe the only option is to take their children from them, involuntary relinquishment of parenthood, and then we treat the children. Harsh, .sure, but what are the options?

The Avoidable and Unnecessary Hospital People

Hospital costs make up the bulk of the health care system. Sure, many people need and deserve to receive care in a hospital, and the present proposal will not impact them. But what about people who do not manage routine conditions that with minimal proper care will avoid hospitalizations? For example, people with asthma or bacterial pneumonia often just don’t follow their doctors’ rules. They don’t use their asthma inhalers, don’t refill prescriptions on time. Then why pay for their hospitalizations? In this group, let’s not forgot those No Helmet People and the Car Drivers Above Speed Limit People. No medical care for their follies.

The Hypocrite People

Let’s not forget those federally elected officials (and other federal employees and their families) who use and accept a publicly funded, single payer health system that they agree is the best. Yet, among them are elected officials who fight against any public option for the rest of us. Have they forgotten the Golden Rule? These officials should either entirely relinquish their and their family’s public option health benefits, or let the rest of us share the benefits.

Our senior citizens, who have worked so hard and long, receive Medicare health insurance, another public option. They want to keep their public health care and are afraid that if non-seniors had a similar option, then their Medicare benefits might be reduced. They want to keep what they have. The seniors should be told that they taught us as children to share our toys with other children, and yet now they forget their teachings. They too should be reminded of the Golden Rule.

The Oldest People, The “Preventable Chronic Disease” People, The Obese People, The Smoking People, The No Immunization People, the Avoidable and Unnecessary Hospital People, and especially the Hypocrite People, under my plan these folks will do fine without health care, and anyway, they don’t deserve it.

Stephen F. Gold, Esq.

An attorney who specializes in disability

Phila., Pa.

W-215-627-7100

C -215-498-0689

H – 215-232-2228

stevegoldada@cs.com