22 June, 2005


These folks are trying to save TennCare.

I'm not so sure they should. There's been a lot of talk about people dying without TennCare, but I have yet to see who or have explained to me why in anything other than hyperbolic terms. "Estimates" and "...will surely die..." are different from empirical evidence of Person A being deprived of goods and services, the absence of which directly leads to the death of Person A.

I am fortunate enough to not need TennCare right now, but I do have a chronic health problem so I realize that I'm living in somewhat of a glass house.

I have three anecdotal experiences with TennCare, through people I know. These anecdotes have formed a large basis of my opinion about the program.

1. Single Mom

I worked with a single mother who had a sickly child and couldn't afford the insurance our company offered. The mother worked 40-plus hours a week for a low wage, and our family deductable would have taken more than half her take-home pay. She couldn't afford groceries and insurance for her child.

2. Yuppie In Training

I worked with a woman who got on TennCare when she was a freelancer. As I can attest, freelancers' incomes vary with season and those who don't have ethics do a lot of work under the table. This particular woman was clearing $50K a year in unreported income before coming to work on the books for us. She stayed on TennCare because buying insurance was "just too expensive, and {she'd} already made the cut."

3. Overweight Beautician

This woman cut my hair for years, and owned her own franchise of a nationwide hair salon. Any woman who has had her hair cut and styled knows that beauty operators can talk your ear off. According to her, she purchased the business in part with funds she saved by not declaring her tips and not paying for health insurance. When she had to have her uterus (!) removed, her doctor phonied up some extra paper work so that TennCare would pay for a tummy tuck.

I'm sure that these real people, that I have known and eaten with and shared car rides with are exceptions to the rule, and two out of three people on TennCare aren't cheats. I'd like to think that Single Mom is the best example of who should qualify for social programs--someone working hard and trying to raise a family but just needing help making ends meet. However, the more I hear, the more it seems as though there are many people who are in love with the idea of "beating the system".

Reading through the Myths & Realities page seems to be a schizophrenic experience. On the one hand, proponents of the program are claiming that TennCare is meant to be

the safety net that fills the gaps in the commercial insurance system.

They then go on to say that

The relatively small number of people (around 150,000 of the program’s total enrollment of 1.3 million) on whom the majority of TennCare money is spent have 5 or more simultaneous chronic illnesses. Their care costs a lot, but it is not optional or discretionary, and they are too sick and poor to pay for it themselves.

Okay. I understand. But then why are we chafing at eliminating 300,000 enrollees, on whom we have seen that the majority of monies are not spent?

The mythbusters then claim that

The real money in TennCare is being spent to treat the sickest people. Real savings can only be achieved by reducing the cost of their care. There are clinically sound ways to reduce those costs. But arbitrary limits are not among them, and they certainly are not painless.

It sounds like the 300,000 people who will have to opt into their employers' plans or stop getting free tummy tucks are a drop in the bucket, and once again political operatives are using an entitlement program to jockey for elective office positions.


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