People on the right tend to rant against the prescription drug benefits that went into Medicare/Medicaid under Bush. Of course, that makes sense if you are blindly against all social programs whatsoever (like education for all funded by all). The fact is, drug treatments are an essential element of reducing costs because drugs are much less expensive in managing and controlling conditions than going into the emergency room when these conditions flare up.

But something else has happened since that legislation. There were significant structural changes made that gave states more freedom to re-structure their programs to be more cost effective. And now we are seeing the results.

After winning greater freedom from federal Medicaid rules, states are moving aggressively to transform the nation’s largest public health insurance program, adding fees, restricting benefits and creating incentives for patients to take responsibility for their health.

The changes are just beginning in several states that are being watched closely by governors nationwide. Those changes are reshaping Medicaid, which covers 55 million poor and disabled Americans, so that the program more closely resembles private insurance, rather than a social welfare system run with a strong, central government hand.

Remember, from the time an idea is proposed to passage of a Bill in Congress can take years. So can the implementation of that Bill once it is passed. That is why anyone who is using recent measures of progress since the legislation passes is not being honest with themselves or anyone else. The Bush and Republican imprint on government continues to unfold before our eyes (for those watching):

Starting July 1, West Virginia will phase in a redesigned form of Medicaid that requires patients to sign a “member agreement,” promising that they will keep doctors’ appointments, take prescribed medicine and not overuse hospital emergency rooms. Patients who refuse to sign or to follow the rules will be eligible for less care.

Patient responsibility. What a concept! Finally we will require people to be serious when taking assistence from others. I am all for providing a helping hand when people are in a bad time or something has happened that makes it difficult to impossible to support themselves. But this assistance must be treated with the respect it deserves since the funding comes from all of us.  Read the article and see American inventiveness and free market forces changing the face of welfare as we know it. This will be as big as the welfare program changes in the 1990’s.