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June 30, 2006

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It occurs to me that I should probably have said something about what procedures are now in place to protect against fraud. If one applies as a legal immigrant, one must provide papers. If one applies as a citizen, every state other than Montana, New Hampshire, New York and Texas allows one to swear, under penalty of perjury, that one is a citizen. (As of a July 2005 report by the HHS Inspector General.) Of the 47 states that allow this, 44 reported having "a written or informal 'prudent person policy' requiring documentation if the statements of the applicant seem questionable" (p. 9). About half of these states also do follow-up assessments on the quality of their screening, to check for fraud. This number should (imho) plainly be increased. It's a lot better than requiring people with dementia to find their possibly nonexistent birth certificates.

Hil,
People with dementia don't vote (at least dementia stemming from Alzheimer's) Why should the current Republican leadership worry about groups that either don't vote or aren't reliably Republican? ;^)

According to the article this is supposed to save Medicaid $735 million over the next ten years. That's about a quarter per US resident per year.

Will it even save that? At an administrative cost of $1.50 per recipient per year the policy will cost about $750 million over that period.

Maybe it won't cost $1.50, but even without the legal proceedings there are going to be extra employees, time spent on administrative procedures and mixups, etc., so the net savings will be even less than that quarter.

All so a few sick illegal immigrants can't get care.

Lovely.

It could save a lot if almost nobody can actually collect Medicaid benefits.

LJ: People with dementia don't vote (at least dementia stemming from Alzheimer's) Why should the current Republican leadership worry about groups that either don't vote or aren't reliably Republican? ;^)

And on what do you base your conclusion that people with dementia aren't reliably Republican?

I was trying to snarkily suggest that the dementia brought on by Alzheimer's shouldn't be confused with the symptom of being a reliable Republican and this was the closest I could get.

It could save a lot if almost nobody can actually collect Medicaid benefits.

Sad to say, it wouldn't surprise me if some of the people supporting this felt just that way.

Remember that, as Malcolm Gladwell documented well for New Yorker, the Bush administration buys into the moral-hazard criticism of US health care, which says that most people are getting too much health care.

This is probably a step towards a UK-style National Database. The next step will be offering to build a giant biometric database so that people who can't get medical care because they can't "prove who they are" can get it.

OT: but this is a must-read.

This seems like a dumb implementation of a reasonable idea.

Since the problem of illegal use of the system is relatively minor, it would be far more sensible to start requiring identification/proof of citizenship for NEW enrollees. This would give people coming up on the enrollment age plenty of time to get their documentation in order in a leisurely fashion, without inconveniencing the existing population at all.

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