The “intelligent design” trial - over a Pennsylvania school board’s mandate that science students must be encouraged to study “intelligent design” as a scientific alternative to evolution theory - is underway. Michael Behe, by all accounts, made a priceless ass of himself on the stand today - to absolutely no effect on the school board members who share his religious inclinations.
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The Bush administration has rewritten the benefit rules for Medicaid in the state of Florida, as the beginning of a program to limit benefits across the nation. The benefit-provision aspects of the program have been completely redefined, from a “defined benefit” program in which members were told what benefits the program provided, and were then entitled to receive them, to a “defined contribution” program in which the government provides a modified per capita fee for the year and then encourages private healthcare providers to limit benefits to members to earn a profit from the total fee pool. Under the new plan, benefit levels are not matched to actual patient need but to an estimate of the overall need set at the beginning of the year; with most care provided by for-profit private entities, the only way for them to make a profit is to make sure their expenditures for the year are less than the capitated fees they have received from the state, by limiting the care they provide to members. The administration states that this is their plan for the rest of the country as well.

he Bush administration approved a sweeping Medicaid plan for Florida on Wednesday that limits spending for many of the 2.2 million beneficiaries there and gives private health plans new freedom to limit benefits.

The Florida program, likely to be a model for many other states, shifts from the traditional Medicaid “defined benefit” plan to a “defined contribution” plan, under which the state sets a ceiling on spending for each recipient.

Children under the age of 21 and pregnant women will be exempt from the limits.

The Florida plan says, “The state will set aside a specific amount of money for each person enrolled in Medicaid,” based on the person’s medical condition and historic use of health care.

Joan C. Alker, a senior researcher at the Health Policy Institute of Georgetown University, said: “Florida’s proposal is one of the most far-reaching and radical proposals we’ve seen to restructure Medicaid. The federal government and the states now decide which benefits people get. Under the Florida plan, many of those decisions will be made by private health plans, out of public view.”

Vernon K. Smith, a former Medicaid director in Michigan who is now a consultant to many states, said: “Florida’s program is groundbreaking. Every other state will be watching Florida’s experience. South Carolina has developed a similar proposal. Georgia and Kentucky are waiting in the wings.” . . .

President Bush has proposed similar changes at the federal level for several years, but Congress has not accepted those ideas. In Congress, Democrats and some moderate Republicans resisted the president’s proposals on the ground that they would have allowed states to reduce coverage for very poor and very sick people. On Wednesday, Mr. Leavitt waived many provisions of federal law, letting Florida make the changes in a demonstration project.

Under the waiver, Florida will establish “a maximum per year benefit limit” for each recipient and fundamentally change its role. The state will largely be a buyer rather than a manager of health care.

In an interview, Alan M. Levine, secretary of the Florida Agency for Health Care Administration, estimated that no more than 5 percent of Medicaid recipients would hit their annual limits. At that point, Mr. Levine said, “the health plan will still be responsible for providing services to the consumer, but the state’s reimbursement would be limited to that amount.”

Asked whether the beneficiary would be responsible for paying costs beyond the limit, he said: “That can happen today. There are arbitrary limits and caps embedded in the state Medicaid program, limits on home health services, doctors’ visits, prescription drugs.”

For each beneficiary, Florida will pay a monthly premium to a private plan. Insurance plans will be allowed to limit “the amount, duration and scope” of services in ways that current law does not permit.

But of course that’s going to have no effect on quality of care . . .