editorial (2005-30)

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TennCare Cuts: People,

We’re leaving a lot of desperate people to fend for themselves

Making Good ‘Cents’ Sense

TennCare Cuts: People,

The WATE-TV Town Meeting on the TennCare Crisis last week at the Tennessee Theatre was a jarring experience. No matter how much you think you know about the reform of the state’s health care program and the cutbacks that are set to eliminate or put new limits on health insurance coverage for nearly 300,000 Tennesseans, the anticipated effects are not felt up close and personal unless you are right there among TennCare reform’s benefit-losers and their families.

The forum, carried live in prime time and moderated by Channel 6’s veteran news anchor, Gene Patterson, got off to a stunning beginning with the announcement that a UT study estimates that the governor’s recommended cuts in the program will cost 3,300 lives across the state over the next 15 years. If that doesn’t sound like too many lives to you, you weren’t there to see the reaction from those who expect to be the “victims” of those cuts.

The assemblage at the theater included such “victims” and their caregivers and some of the smaller providers, individual doctors and pharmacists who have been serving them.

The personal accounts were heart-wrenching. The questions of what to do now were mostly specific, and the panel—made up of legislators, executives and leaders in the health care industry, County Mayor Mike Ragsdale and TennCare’s director of public affairs, Michael Drescher—had mostly general answers. The most specific recommendations included calling a list of information numbers.

The stories the panel heard would be hair-raisingto those who aren’t used to hearing them, but panel members handled them with aplomb and made level-headed attempts to assure the questioners that help was still available.

The anxious audience was told that there is a tradition in East Tennessee of providing physician and hospital care to all those who need it, regardless of their ability to pay. That may be true. There was compassion for the medically indigent in the past, but there was nothing so comprehensive as TennCare.

It seemed odd that the question of why the state “can’t afford” to maintain the TennCare program at its current levels wasn’t asked. There were state legislators on the panel—Sens. Tim Burchett and Jamie Hagood and Reps. Joe Armstrong and Harry Tindell—who could have answered that question.

As Drescher, the TennCare specialist, described it, the state’s $8 billion annual program serving 1.3 million persons has just gotten too big and cumbersome. Maybe so. It cost $8.6 billion last year, and the cuts would bring it back down by about $600 million. But to take for granted that we can’t afford it without the cuts means just one thing: We won’t raise the taxes to support it.

There are more reasons we can’t pay for TennCare, including some abuses we’ve never been able to run down and correct. But the overriding reason is that we haven’t been able to reform our tax system to reduce the regressive sales tax and spread the tax burden more equitably through a graduated income tax.

If we had, and if we’d passed the proposed cigarette tax increase this year by 50 cents a pack, leaving it still below the national average, to raise $200 million or so, we’d still be worrying about reforming TennCare from the inside out. We’d be hoping to curb abuses and trim benefits slightly, rather than hacking at it from the top down, leaving our uninsurable medical cases to fend for themselves as if those cases were just files and not the people who are living them out in despair.

It’s never been a bad idea, as a merger of the entire government structure that serves the city and county has never been a bad idea.

It has yet to appeal to enough of the voters, who have turned it down four times in the last half-century, but it must eventually happen if we ever expect efficiency from our local government.

Meanwhile, the two mayors have asked for recommendations from a study committee that they’ve named to review services that could be easily combined to save money and promote efficient service.

The parks & recreation areas, tax collections and motor vehicle service areas have been tossed out as examples where a joint city-county effort would be easy to mount.

Any reasonable suggestions for such combined service agencies should be explored while we have mayors intent on working together for the public good. We’ll get around to real government consolidation when the time is right—again.

© 2005 MetroPulse. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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