"In recent years Washington has taken an obsolete program, which covers health care for low-income Americans, and made it worse through restrictive rule-making that defies common sense. It is biased toward caring for people in nursing homes rather than in their own homes and neighborhoods. It lacks the flexibility to help patients who require some nursing services, but not round-the-clock care."
He is also quite correct in pointing out that:
Time and again states like Wisconsin have blazed the path in Medicaid — from giving individuals greater control over their care to expanding the use of electronic medical records — while the federal bureaucracy has lagged behind. Just now Washington is discovering accountable care organizations (networks of doctors and hospitals that share responsibility for caring for patients and receive incentives to keep costs down) and “medical homes” (a model in which one primary-care doctor takes the main responsibility for a patient).
He is also quite correct in pointing out that (there are a few other things in here I agree with, these are the big things):
We need to modernize not only Medicaid’s benefits and service delivery, but also its financing. In good times, the open-ended federal Medicaid match encourages states to overspend. Amazingly, the program is now viewed by some states as a form of economic development because each state can at least double its money for each dollar spent. That matching feature penalizes efficiency and thrift, since a reduction of $1 in state spending also means forfeiting at least one federal dollar, often more.
I am in complete agreement that these issues are two major flaws in the current Medicaid system. Medicaid's bias towards institutional care is a major issue and something that comes up a lot in the disability field. Institutional care is vastly more expensive than home care and the more we can go towards it the better. I also see cost shifting all the time, the current Medicaid model has different cost share schemes for different services so in many cases the more expensive option is cheaper for the state administering the program. I think most of this is handled well enough in the op-ed that I don't have to go into more detail (though I may pick it up in later posts, if I ever get around to looking at New York's Medicaid reform many of these issues will come up in more detail).