The sustainability crisis of Medicare and Medicaid programs

Sociology Discussion Responses

Response to Post #

Your post raises some very important issues that face the entire nation as well as the individual states such as New Mexico. The largest social services programs such as Medicare and Medicaid are unsustainable for the long-term, largely because of the dramatic demographic changes in American society since their development. Today, the average longevity is almost double what it was in the early 20th century when the average life span was only 47 years of age. Likewise, the fact that the post-Word War II Baby-Boom generation is now entering retirement age means that larger than ever numbers of program beneficiaries will have to be supported by fewer working program contributors. Meanwhile, the economy is undergoing a very difficult period and unemployment and underemployment rates, even for college graduates, are at all time lows. Some of the most sensible approaches to solutions might include raising the retirement age (or the eligibility age for program benefits) and devoting much more attention to identifying and eliminating the sources of financial waste such as duplication of services, unnecessary services, and fraud and abuse of social welfare programs.

Response to Post # 2

While I certainly agree with the sentiment of your post, I am confused by some of your statements. For example, you suggest that there are plenty of financial resources available but that they are not being appropriately directed where they might do the most good for children's services. Is that really the case in your state; because in my experience, social services across the nation are struggling financially.

You seem to acknowledge that various strategies have been attempted that have been unsuccessful at improving the effectiveness of child protective services in your state. Unfortunately, you describe a situation of continuing inability to protect children adequately and you provided several extremely troubling examples. I would be curious to know what specific strategies or alternative solutions you might suggest instead of those you have described as being ineffective. For example, if additional training and certifications are contraindicated in many cases because of the additional time pressure they represent what other types of improvements might help make a beneficial change that you would support?

Response to Post # 3

I understand the frustrations that you have expressed in your post. However, I would be curious to know what other types of approaches you might recommend to ensure that social services meet specific program criteria and goals and that practices satisfy the applicable regulatory criteria. Certainly, when viewing individual decisions in from an isolated perspective, it is conceivable that controls that are established to maintain the sufficiency and safety of extensive programs might produce less than optimal results.

However, I wonder whether those standards and policies also serve important functions in the aggregate. In my opinion, when evaluating the record-keeping functions you describe, it might also be important to consider the benefits they provide and what harms might occur with greater frequency and severity in similar situations where records and authorizations are less strictly mandated.

Response to Post # 5

As I expressed to my colleague's post above, I certainly do understand the potential negative consequences of privatizing various institutional functions traditionally handled by the state. I would also agree that the penal system is a prime example of the extent to which the cost-savings motive is behind the trend toward the privatization of prisons in the United States. On the other hand, I have to admit that there may also be a partisan motive for opposing privatization that sometimes comes across in discussions of these issues with people who are employed within the field.

For example, your post goes into quite a bit of detail about the consequences to prison guards employed within the traditional penal system framework but deals much less with the issue of whether or not replacing government employees with private-sector civilian employees is actually detrimental to the quality of services provided and the potential benefits to state budgets. That is not to say that I am insensitive to the obvious consequences anytime employees within any industry lose their primary means of occupation.

However, in my opinion, focusing on the fact that state employees need their jobs might be a partisan perspective that reflects a bias attributable to working in that field. In principle, I think we need to remember that state employees have their jobs because the state requires certain services. To the extent that the state either needs less of those services or that the state is able to secure comparable services from the private sector, I am not sure that considering the fact that displaced state employees suffer the consequences of losing their positions is the most appropriate focus. In my opinion, the much most important issue is whether or not the change affects the quality of services.

Response to Post # 6

I sympathize completely with the situation faced by teachers in your state as well as with the disastrous effects the changes you describe could conceivably have on the overall quality of education in Louisiana. It would seem to be a very short-sighted approach to reduce educational program expenses by substituting inexperienced teachers for those with invaluable experience. If there is one profession where the quality of services delivered varies substantially in relation to experience and time on the job, it would be the teaching profession. I share your concern that this immediate measure to reduce costs to the state could have highly damaging consequences in the longer term by virtue of the diminution in the overall quality of education students receive in your state.