Talk:TennCare
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[edit] NPOV Issues
Looking through the edit history it appears that there have been two versions of this article on Tenncare. There are many objections to the neutrality of the current article.
Specifically in the fourth (4th) paragraph it is claimed that Tenncare suffered mainly from mismanagement. There is no information supplied within the article to support this claim, and I believe that it would be reasonable to assume that those accused of mismanagement and their supporters would have a quite different view of the matter.
Also, the fifth paragraph is blatantly biased. It reads:
- In 2005, the TennCare program was dealt a devastating blow by Governor Phil Bredesen, who had promised during his campaign to reform the program. Instead of reform that repaired the mismanagement of the program, Bredesen terminated coverage for all the adults enrolled in the TennCare waiver as well as for all the adults in the optional Medicaid categories that most states cover. Nearly 200,000 people in the state have lost health coverage, including people with life-threatening illnesses. Many have died. Their deaths are continually being reported by the media.
- (emphasis added)
The language used therein reflects a clear bias against the actiosn of Bredesen. He and his supporters quite obviously feel differently about the decisions that were made. I would propose that in the interest of representing both sides of debate that the reasons advanced by Bredesen and his supporters be placed back in the article. The final paragraph contains similarly loaded language, particularly within the last paragraph.
Within the state of Tennessee there is still debate among well meaning people over Tenncare. Prior to 10 June there was also considerable information about criticisms against the Tenncare program that may have a place in a neutral article about the program. Yaoibutler
My dad no longer has access to healthcare because of this. He is not "abusing the system;" he is very sick and extremely unemployed.
His story isn't unique or exceptional either. So how is that biased? What would be fair and balanced? Ignoring the poor of Tennessee who now have no way to go to the doctor? Sure, I'll bet Bresden's plan sounds great if you leave all of that stuff out.
How can you be fair and balanced about an atrocity? I'm sure My Lai sounds a lot different if you leave out the civilian massacre and just listen to Calley's reasoning. I'm sure Halabja sounds different if you leave out the dead Kurds and only print Saddam Hussein's rationale.
I'm not saying that the TennCare castration is the same thing or on the same level as My Lai or Halabja, because it's not. The difference in degrees is huge.
I'm just trying to make a point. That Bresden has done is inexcusable. We can talk about the fiscal issues all day long, but that won't make all the sick people in Tennessee any better. Can you really weigh fiscal issues against human life?
-Random Goblin
this is clearly written with a heavy political bias. There is no analysis whatsoever of what TennCare really was and how it really worked and really didn't work. There is no tie-in to Hillary Clinton's failed 1994 national healthcareplan, of which this is clearly a carbon copy on the state level.
how is it inexcusable to terminate a program that the state could no longer afford? Where is the rationale in keeping a programme going if the costs are going to exceed the state's income in the none too distant future?
for example, the article seems to suggest the programme worked and was efficient before it fell into mismanagement. The mismanagement happened from the start.
--82.156.49.1 13:02, 30 April 2006 (UTC)
I understand Yaoibutler's position; it's clear that this article was written by someone who did not sympathize with the governor's position on TennCare. However, after spending the last year learning about TennCare's history in Tennessee, I would argue that this is a factual account of the program. The governor's arguments for reform -- primarily, that Tennessee could no longer afford to pay for TennCare -- have proven to be dubious, as news reports and state budget documents now indicate.
It is certainly a fact that many seriously ill people have been cut from TennCare, and that the reforms have led to deaths across the state of Tennessee. The TennCare program was reformed during the Sundquist administration to only include people in extreme poverty, and those who were considered uninsurable. Therefore, when Gov. Bredesen introduced bills to cut back TennCare enrollment, some of our state's most vulnerable people were indeed the ones to feel the cuts most strongly.
This is my opinion, and I recognize that it will be considered biased. It is troubling to me that in Tennessee right now, there is no general account of the program that could be considered unbiased; everyone has an opinion, and there is little agreement between those on opposite sides of the debate. I wish we Tennesseans could pin down and agree upon the basic facts so that we could all engage openly in a conversation about this. But right now, we are all engaged in answering different questions. Some, like Random Goblin, argue that the fiscal issues should take a backseat to the value of human life. Others make the argument that the cuts are fascilly irresponsible, or that they were fiscally necessary. We can't even agree on what the underlying issues are.
This is a hot topic in Tennessee right now, and I expect that many other states will be forced to address these issues in the coming years as well.
______
What follows is my attempt to contribute to attempts to outline the TennCare program with neutrality. I apologize if I have failed in this task and hope that others will attempt the same. Note that I did not list successes of the program to balance the discussion about it's flaws. This is brought to your attention as a matter for consideration.
TennCare
The TennCare program is a Medicaid funded healthcare insurance program initiated by Governor Ned McWhirter in the state of Tennessee in January 1994. The program was implemented through a waiver granted by the Centers for Medicare and Medicaid Services (formally the Health Care Financing Administration) to reform the state's healthcare program for the poor and uninsured. The reform consisted of privitization of fiscal and utilization management to several Managed Care Organizations and Behavioral Health Organizations and expansion of benefits to include uninsurable citizens and children. The stated goal of the program was to provide a safety net for all Tennesseans, reduce cost and improve healthcare outcomes.
Provider complaints regarding contracting, reduced provider fees, delayed payments, and increased administrative burdens were widely reported during implementation. Aggressive utilization management policies at TennCare MCOs and BHOs were also reported, with frequent complaints from patient advocates about the criteria used to assess medical necessity. Efforts to limit specific utilization management practices and funding cuts are widely documented in both the news media and in legal discourse.
Dissatisfaction with the program appears universal, as both Republican and Democatic gubernatorial administrations have struggled to manage the program effectively. Some commentary likens the program to the state's 'albatross', in reference to the intractible nature of the problems and its failure to deliver promised savings. Others declare that the program has met it's original objective and requires change to keep pace with a changing healthcare environment. Still others charge that the program has been destructive to the healthcare system overall and has done little to improve the quality of life for the citizens it serves. Regardless of the point of view, the TennCare program is credited with making fundamental changes to the healthcare system throughout the state - both positive and negative.
The root causes of the TennCare program's flaws appear to be a mixture of the simple and arcane. Actuarial errors prior to implementation have been identified as one source of the program's fiscal problems. Poor understanding of the complexity of Medicaid funding and the financial managment of healthcare insurance products by policy makers and the general public is another. Poor communication about policy changes and their impact is a third. Poor operational management and the apparent lack of improvement over time appears to perpetuate negative attitudes about the program with providers, members and the general public.
It is clear that there are many points of view about the availability of healthcare funding and its translation to services for the 'safety net' promised in 1994. Regardless, the TennCare program represents a significant reform experiment among Medicaid programs in the United States.
24.125.113.154 02:26, 27 September 2006 (UTC)P. Pearce Sept 26, 2006
[edit] five what?
regarding "At the time, Tennessee was one of less than a half-dozen states in the nation with no limits on pharmacy benefits. The state set the limit at five for most enrollees..."
Five what? Five distinct drugs? Simultaneously? Per Year? Leotohill 02:11, 12 February 2007 (UTC)
