This morning's plenary was hosted by Tom Scully, currently wearing so many hats I couldn't report them all. He was, however, head of CMS during the George H.W. Bush administration. His talk, although a bit on the pessimistic side, involved primarily the prohibitive challenges to affecting any practical change to Medicaid within the foreseeable future. He described it not as a single, uniformly administered program such as Medicare but more as a patchwork quilt with 55 panels -- 55 different programs administered differently by 55 states and territories, all with different eligibility criteria, 55 different provider payment structures/processes, 55 different needs and assessment priorities, etc., et. al.
Another point made -- and this is turning out to be one of the other predominant threads of discussion at the conference -- is that long term care will put Medicaid into even more of a crisis than it already is. Currently 70% of all nursing home residents are Medicaid recipients.
The further graying of America will overburden the system in the next 10 years as more and more Boomers require not only traditional LTC but, even more taxing, the recuperative care -- recovery from broken bones, transplants, traumatic surgeries -- that hospitals longer provide.
Ironically, the substance of his talk in and of itself was a great argument for the immediate passage and implementation of a Universal Healthcare Plan to replace the "mess" that is Medicaid. He then stated, however, that he never expected to see it in his lifetime. The odds, he said, were 70% against any substantive health care reform in the next ten years.
Of course, no one has a crystal ball but -- first and foremost -- much of whatever happens will be dependant upon the administration that will be in place come January 2009.