When spending less costs more
Thursday, Feb 19, 2015 - Posted by Rich Miller
* Tribune…
Gov. Bruce Rauner’s proposed $1.47 billion in Medicaid cuts includes reductions in dental services, mental health care and other coverage. But some legislators and patient advocates say the targeted services don’t just help keep people healthy — they also save the state money. […]
“We found, for example, that if you cut people’s dental services and then they don’t go to a dentist, they end up going to an emergency room and it costs us more money,” Cullerton said. “So we went back and examined that and made a change.”
“People will not miraculously get better if they’re denied care for services,” said Rep. Greg Harris, D-Chicago. “They’ll just end up at a higher level of care in an acute care setting at the most expensive end of their disease.”
Other legislators responded that the added costs of emergency room services have not been well-documented.
“It’s theory,” said Sen. Dale Righter, R-Mattoon.
No, it’s not a theory. This does happen.
* From a 2012 New York Times story…
In a report this year, [the Pew Center on the States] estimated that preventable dental problems were the primary diagnosis in 830,590 emergency room visits in 2009 — up 16 percent from 2006.
“It’s penny-wise and pound-foolish,” said Shelly Gehshan, the director of the Pew Children’s Dental Campaign. “Rather than an $80 extraction or a $300 filling, states are spending much more on emergency room visits that can’t fix the problem.”
* Also, this…
(M)any Medicaid enrollees continue to live with the pain and discomfort of tooth decay and gum disease, which can exacerbate other health problems, such as heart disease, diabetes and rheumatoid arthritis. Eventually, some go to costly emergency rooms, which can do little but provide short-term pain relief.
…Adding… More on this general topic from the Treatment Alternatives for Safe Communities group…
Governor Bruce Rauner’s $27 million cuts to drug treatment services undermine the very criminal justice reforms that he has been publicly championing.
Criminal justice reforms and cost savings simply cannot happen without drug treatment and coordinated case management upon which Illinois courts rely.
Last year alone, working with judges and community-based treatment providers, TASC diverted 2,080 people from prison and immediately saved Illinois $35 million. Under the governor’s proposed budget for next year, millions of those savings would be wiped out.
- Wordslinger - Thursday, Feb 19, 15 @ 11:40 am:
Just a theory. Like gravity. And heliocentrism. And plate tectonics.
Can’t draw any conclusions based on those.
- MrJM - Thursday, Feb 19, 15 @ 11:40 am:
“No, it’s not a theory. This does happen.”
Anti-government fundamentalism can’t be refuted by mere “facts”.
– MrJM
- A guy - Thursday, Feb 19, 15 @ 11:44 am:
I’m a little surprised Righter said this.
- Cheryl44 - Thursday, Feb 19, 15 @ 11:45 am:
Are any of you who voted for this guy surprised by any of this?
- MikeMacD - Thursday, Feb 19, 15 @ 11:46 am:
The notion that you can reduce overall Medicaid spending by eliminating basic dental coverage is just a hypothesis.
- William j Kelly - Thursday, Feb 19, 15 @ 11:46 am:
Yes, it is true middle class workers will suffer with Rahm and Rauner’s plan, but we should all be happy to know that Rahm and Rauner’s wall-street friends will be handsomely compensated.
- uptown progressive - Thursday, Feb 19, 15 @ 11:50 am:
As always, thank you, Rich, for some fact based analysis.
- VanillaMan - Thursday, Feb 19, 15 @ 11:51 am:
As a CapFax anti-government fundamentalist, I respect facts actually. So let me explain how this theory works to demonstrate.
Dental emergencies are not the same as medical emergencies, but are as painful. If a citizen does not get proper dental care in time, they will end up in an emergency room. Providing dental care for citizens saves money and while a lot of us anti-government fundamentalists have been pointing out that preventative medical care isn’t the money-savings panacea sold over the past five years, preventative DENTAL care IS.
So, anyone writing off preventative health care as being not-cost-effective due to the latest studies regarding preventative medical care, is making the mistake of understanding the types of preventative health care which have different savings.
And who thinks it is OK to let their fellow citizen get no dental care? Who thinks is it OK for their neighbors to have tooth pain? For crying out loud, even this anti-government fundamentalist isn’t stupid.
So, please don’t lump us all together into some Neanderthal-ist group of Neanderthals. One can be conservative, want a good government which is sustainable - (like any good environmentalist would understand the definition of that word), and also have a heart and respect for their fellow citizen.
yeah - don’t do that.
- Jeff Trigg - Thursday, Feb 19, 15 @ 11:52 am:
How much of that $27 million for drug treatment was for people caught with cannabis and given the choice of jail or drug addiction treatment?
- Macbeth - Thursday, Feb 19, 15 @ 11:54 am:
Anything the GOP doesn’t understand or can’t articulate properly is a ‘theory.’
Of course it’s a theory. It’s a theory because you have no data, Righter — and you don’t know the first place to actually gather data.
The GOP anti-intellectualism crusade continues …
- spi_chi - Thursday, Feb 19, 15 @ 11:57 am:
I would like to know how many dentists in Illinois take adult Medicaid? It can’t be very many. The amount adult medicaid pays for a root canal/crown doesn’t cover the lab fees that the dentist has to pay. I believe that the only places that are taking it are clinics such as UIC or Joliet. Try to get an appointment for an emergency extraction at one of those places and you aren’t going to get in for an appointment anyway. Probably the bulk of the money that is going to be saved is going to come from UICs dental clinic.
- MrJM - Thursday, Feb 19, 15 @ 11:57 am:
Your post is one of the reasons why I wouldn’t describe you as “a CapFax anti-government fundamentalist”, VanillaMan.
– MrJM
- AnalystRet - Thursday, Feb 19, 15 @ 11:59 am:
The Governor must have been watching this week’s version of “The Americans” — http://www.slate.com/blogs/browbeat/2015/02/11/the_americans_creators_on_that_tooth_pulling_scene_video.html
- VanillaMan - Thursday, Feb 19, 15 @ 12:01 pm:
Not only am I an anti-government fundamentalist, you need to be one too.
- How Ironic - Thursday, Feb 19, 15 @ 12:05 pm:
@- MikeMacD - Thursday, Feb 19, 15 @ 11:46 am:
“The notion that you can reduce overall Medicaid spending by eliminating basic dental coverage is just a hypothesis.”
I disagree strongly. As I am in administration in a large, community based (non-profit btw) hospital, I can assure you that we see A LOT of indigent patients in the ED with dental related issues.
Had these been treated in a preventative care setting, the $50 extraction wouldn’t result in a $25,000 hospital stay, complete with sepsis treatment, high powered (and expensive) antibiotic treatment, emergency surgery by an oral surgeon (paid for by the taxpayer!), draining of abscesses, and the list goes on, and on.
This is no more a ‘theory’ than suggesting that it’s only a ‘theory’ that filling your tires with air results in a non-flat tire.
- MrJM - Thursday, Feb 19, 15 @ 12:08 pm:
There’s a lot of political real-estate between you and the Social Darwinism/Randian extremes of anti-government fundamentalism, VanillaMan.
I can’t remember you calling me a “collectivist” or “statist” even once!
– MrJM
- MikeMacD - Thursday, Feb 19, 15 @ 12:22 pm:
How Ironic -
My previous comment was tongue in cheek, i.e. irony.
- How Ironic - Thursday, Feb 19, 15 @ 12:26 pm:
@MikeMac,
Great, thanks for the clarification. Unfortunately, there are many that have that view, and are serious in thinking that cutting preventative care doesn’t result in higher costs down the road.
- Anonymous - Thursday, Feb 19, 15 @ 12:26 pm:
Beyond te costs of providing dental care, it is beneficial to, you know, PROVIDE DENTAL SERVICES TO POOR POPULATIONS. There are things that do not need a fiscal justification to protect, this is one of them. The Rauner budget does not seem to grasp the idea that individual health needs are more important than the financial health of businesses.
- Nearly Normal - Thursday, Feb 19, 15 @ 12:31 pm:
Apple city–Guess what! Union members are taxpayers, too. Plus, I think you are responding to the wrong topic.
- anon - Thursday, Feb 19, 15 @ 12:38 pm:
== have a heart and respect for their fellow citizens ==
I agree, but it’s what this budget proposal lacks. The most compassionate state in the Union? Puhleese.
- Demise - Thursday, Feb 19, 15 @ 12:58 pm:
The Sen. Kirk & Mrs. Rauner post should be combined with this one. To praise the cost saving benefits of programs that Mrs. Rauner’s organization provides while ignoring the cost saving benefits of programs the governor wants cut is ridiculous.
- Federalist - Thursday, Feb 19, 15 @ 1:01 pm:
If dental services are to be provided there must be (1) government clinics throughout the state that will accept them) (2) some type of co-pay maybe as little as $10-$20 per visit.
If this were done there would be better and more honest services and the public would be supportive.
- Precinct Captain - Thursday, Feb 19, 15 @ 1:59 pm:
==- Federalist - Thursday, Feb 19, 15 @ 1:01 pm:==
There are recent posts on this very site talking about how unproductive it is for the state to chase down small premiums. It’s a net financial negative.
- Federalist - Thursday, Feb 19, 15 @ 2:33 pm:
@Precinct Captain
Why do they chase them down. People should pay up front for these small amounts.
Yes, if you let people out the door who have little money, no credit, maybe even dubious legal status you run a high risk of non-payment.
No easy answer. I am trying to put forward something that will help honest people.
- ZC - Thursday, Feb 19, 15 @ 2:37 pm:
The “it’s a theory” statement deserves all the ridicule it’s receiving. But one stat in that Tribune piece caught my eye, the claim from IHA that around 40% of Illinois’s hospitals are operating in the red.
Maybe, but who can say? Hospital finances and balance sheets are impregnable, from an outsider’s perspective. Worse than universities’.
They could be printing money, and they could easily find a way to say 40% of them are in the red. Hate to say something in Rauner’s favor, but Big Hospital today, along with Big Higher Ed, absolutely deserves more scrutiny and skepticism.
- Walter Reuther's Son - Thursday, Feb 19, 15 @ 3:11 pm:
“Yes, if you let people out the door who have little money, no credit, maybe even dubious legal status you run a high risk of non-payment.”
How about people who are profoundly incapacitated or persons with developmental disabilities? Not all of them are making those high-paying salaries they pay at the neighborhood grocery store. Many of them cannot work (for obvious reasons) and could never pay. Should we really make them pay? Aren’t we making them pay by forcing them to an E.R. for an abscessed tooth, rather than paying for preventive dentistry?
How does that help honest people? And, who are these honest people who would think that is a good idea? Did people really vote for that?
Let’s remember who the Medicaid program serves, OK?
- Demoralized - Thursday, Feb 19, 15 @ 3:13 pm:
== I am trying to put forward something that will help honest people.==
Wait . . . so if they can’t pay something up front they aren’t honest?
You do know these people are on Medicaid for a reason right?
- Emily Booth - Thursday, Feb 19, 15 @ 3:18 pm:
Dental coverage depends on the medicaid program and service. I had a desperate father file an appeal on the denial of a dental service for his little girl’s teeth. All she had to do was open her mouth to win the appeal. I also had a man looking for work who had terrible teeth and needed dental care which he could not get w/ his medical card. Anyone looking for work needs to have dental care.
The only dental clinic I know of in Chicago w/ a sliding scale is at the U of I and their hours are limited. My dentist, who has a huge heart, cares so much about dental care that he will do barter.
- Team Sleep - Thursday, Feb 19, 15 @ 3:41 pm:
I think the Dental Society needs to horse trade. If its members agree to take a percentage of charity cases - similar to what AG Madigan has hammered out with the parochial hospitals - then the state should increase Medicaid reimbursements for dental services. There are worse ideas.
- Federalist - Thursday, Feb 19, 15 @ 4:53 pm:
There seemingly is a problem tacking people down and it seems to be costly. That is what an earlier post stated. Solve the problem. If anyone has a better method of collection than I suggested- go for it.
- comment blanchir les dents jaunes - Wednesday, Feb 25, 15 @ 7:48 am:
Thanks for sharing your thoughts. I really appreciate your efforts and I am waiting for your further post thank you once again.