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Canadian physician warns of Medicaid block-grant effects

 

Roger Chafe,  M.D., an associate professor of medicine at Memorial University of Newfoundland, says  the Trump administration idea of replacing the current state-federal sharing of Medicaid costs with block grants to the states won’t work well. He says a similar system was tried and flopped in Canada. Among his remarks:

“Canada offers an example of some of the potential impacts a move to block-grant funding would have, particularly for state governments. For American advocates of expanding access to healthcare, Canada’s experience should be troubling.”

“Perhaps more concerning for state governments is that block grants offer the federal government an easier and quicker mechanism for reducing its contribution than could occur under any cost-sharing arrangement. Several times since Canada’s federal government moved to block grants, it has unilaterally lowered its contribution, leaving the provinces to deal with the consequences.”

“In the U.S., the burden of covering unexpected cuts in federal contributions would likely be borne by Medicaid recipients, who could face stricter program eligibility, higher co-pays or reductions in benefits; by providers, who could face reductions in reimbursements or increases in their costs for uncompensated care; or by state governments, through increases in taxes, reductions in other expenditures or increases in debt.”

To read his piece in governing.com, please hit this link.


Longevity gap widens between rich and poor

 

This New York Times story discusses the widening longevity gap between high- and low-income Americans.

“The poor are losing ground not only in income, but also in years of life, the most basic measure of well-being. In the early 1970s, a 60-year-old man in the top half of the earnings ladder could expect to live 1.2 years longer than a man of the same age in the bottom half, according to an analysis by the Social Security Administration. Fast-forward to 2001, and he could expect to live 5.8 years longer than his poorer counterpart.”

The Times noted that “The experience of other countries suggests that disparities do not necessarily get worse in contemporary times. Consider Canada, where men in the poorest urban neighborhoods experienced the biggest declines in mortality from heart disease from 1971 to 1996, according to a 2002 study. Over all, the gap in life expectancy at birth between income groups declined in Canada during that period. And a study comparing cancer survival rates found that low-income residents of Toronto had greater survival rates than their counterparts in Detroit. There was no difference for middle- and high-income residents in the two cities.”

How much of this might be explained by the fact that Canada has a  single-payer health system for all its citizens and how by the much more complicated demographics of the United States?

 


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