Gorman on Attendant Services Under Medicaid

We recently had Medicare provided hospice for my dying father , and it was absolutely horrible...absolutely horrible.

"in health care you can achieve at most two of the following three goals: high quality, universal access, and cost containment."

I pick high quality + universal access. Actually, things are not quite that binary. You can get a little of all. So I would take universal access 100%, high quality 70%, cost containment 30%.

My reasoning is as follows: I am quite loss adverse. So, having the assurance that if all else fails, I will still have access to medical care (and basic food and housing too) is worth a lot to me. To me, it is worth paying more taxes. Also, it is worth the corruption of my otherwise pristine libertarian ethic when I use the government's hand to reach in your pockets to pay for my safety.

Attendant services are a slightly atypical example of health care, as wages for that group are fairly low, much like orderlies (or health care aides, or nurses aides, various names) and cleaning staff. However in most other respects they are typical of health care services: complex regulation, byzantine administrative processes, and little involvement from the patient.

The big failure in home health care services is that they are always being plugged as upstream cost savers that defer costly nursing home admissions. The evidence there is dismal, but perhaps this is because patients do not see themselves as benefiting financially from that deferral.

This article sounds like consumer directed care is wonderful. But the fraud problems are huge. What's to stop a person from claiming disability and then paying their friends to 'care' for them. It's incredibly hard to measure how disabled somebody is.

@Rachel: Yes. If I get to decide what another person is paying, fraud is to be expected. That's why consumer directed usually involves removing third-party payments.