RE: Chronic Disability

[Lisa Furia <Lfuria@earthlink.net>]

Mr. Mashler's comments arrive at the cross-section of social welfare
debates about SS, Medicare and Medicaid reform.

In this discussion of values, I believe it would be very meaningful
to elaborate on the various programs our society uses to support
its citizens and how those programs interrelate.

It seems to me that "solving" the SS program's solvency and
sustainability issues in a vacuum without consideration of how
those changes might impact other programs such as Medicaid and
Medicare would be short-sighted indeed.  I offer as an example the
State of NH's efforts at Medicaid reform.  They chose at one point
to restrict access for Medicaid recipients to certain drugs.  In
doing so, the drug budget plummetted.  However, in total, the
overall budget increased because admissions to inpatient care
facilities increased. In short, a zero sum game. Perhaps some of
that experiment's problems could have been avoided by anticipating
the balloon effect into other programs when downward pressure is
exerted upon one area.  Coordination with, say, social work and
home care programs, ahead of NH's drug policy implementation could
possibly have prevented the explosion in admissions.

I believe it would be prudent for policymakers to consider how
changes in SS might impact the total "bill" to taxpayers, namely
the Medicare and Medicaid programs as well as pressures in States
that are home to disproportionate shares of elderly (Florida,
Arizona, etc.).

Once again, none of these challenges should mean that something is
"off the table" for reform.

Lisa