Editor’s Note: On the right, please watch our exclusive interview with Indiana Governor Mitch Daniels, and then below, please read an original guest blog to The Foundry from the Governor himself.
We’ve been through a global recession. Now we’re fighting through a stalled recovery. Revenues are the lowest they’ve been in half a century. Their finances a wreck, many states have effectively sunk into bankruptcy.
Indiana is still afloat. In fact, we’ve fared better than most. We continue to meet our obligations without raising taxes, and the reserves we carefully built and protected will get us through the downturn.
But as if we did not already have enough on our plates, the passage and implementation of Obamacare presents us with a whole new set of challenges and a costly to-do list.
Obamacare’s expansion of Medicaid, soon to cover one in every four citizens, will not only scoop up most of HIP’s participants, but will also cost the state between $3.1 and $3.9 billion over the next decade. It is hard to see how my successors as governor will be able to avoid a steep state tax increase to pay for it. Meanwhile, our medical device companies and small businesses will shed jobs as they wrestle with the taxes and penalties levied to help finance Washington’s “reforms.”
Of course, it’s a misnomer to even refer to this as “reform.” It doesn’t reform anything. Instead, it perpetuates and magnifies all the worst aspects of our current system: fee for service reimbursement, “free” to the purchaser consumption, and an irrationally expensive medical liability tort system. It’s a sure recipe for yet more overconsumption and overspending.
There were better options.
Since my election, my state coworkers have had the choice of Health Savings Accounts in lieu of traditional health care plans. The first year this option was made available, some 4 percent of us signed up for it. Six years later, more than 70 percent of our 30,000 state workers have opted for the personal account.
This trend has had a startlingly positive effect on costs for both employees and the state. State employees enrolled in the consumer-driven plan saved more than $8 million in 2010 compared to their coworkers in the old-fashioned preferred provider organization (PPO) alternative. Indiana will save at least $20 million in 2010 because of our high HSA enrollment.
It has also been the source of significant changes in behavior, as state workers with the HSA visit emergency rooms less frequently and are more likely to use generic drugs than co-workers with traditional health care. Hoosiers enrolled in HIP have experienced similar changes in behavior with generic drugs now accounting for 84 percent of all prescriptions used by enrollees.
This is a sharp contrast to the prevalent model of health plans in this country that encourage individuals to buy health care on someone else’s credit card. What seems free will always be overconsumed, compared to the choices a normal consumer would make. Hence our plan’s immense savings.
The condescension of the “reformers” is misplaced. It turns out that typical Americans are neither too dense nor too intimidated to make sound decisions about their own health. This is, of course, a fact that national policy makers sadly ignored during their overhaul of our health are system. Now the rest of us are left to pick up the pieces.
YANML, YANMA, etc. Apologies for length. I searched the archives but found nothing similar – please direct me if I missed something pertinent. It is surely possible that I don’t know the right terms to use to get good results.
Our 90-something grandfather is well-set financially. He owns a home in the state in which my brother and I live, and a second home in Idaho. Up until this year, he spent the summers in ID and returned to our state in the fall.
Gramps is getting slower and having some trouble caring for himself, but he is still mentally spry. He has no living children. Both of his deceased children’s spouses are living (our Uncle and Mother), and he is relatively close to both. He is very close to my brother, who is on Gramps’ bank accounts and cares for the home in our state when Gramps is away. Neither of us live in the house, or even anywhere near it, but it is important to Brother that Gramps’ home is well maintained in Gramps’ absence.
Earlier this year, Uncle (Gramps’ son in law) brought up, with Brother, placing Gramps in assisted living. Moving in this direction seemed prudent, and Brother discussed it with Gramps, who was amenable to having meals delivered and considered looking into in-home help. Gramps was somewhat resistant to committing to the assisted living facility, however. As far as we know, Uncle never discussed this with Gramps at all.
Shortly after Gramps (and Uncle, who is also divides his time between states) returned to ID this year, a problem was discovered in the ID home that rendered it unlivable during repair. This remodel/repair was taken, by Uncle, as an opportunity to move Gramps into an Assisted Living facility without consulting any other family members, or (it appears) Gramps himself. The story becomes unclear at this point – Brother and I aren’t sure if the assisted living facility was misrepresented to Gramps or if he was in denial about it. Either way, he moved in – but called the facility a “hotel” for many weeks and expected to move home after the remodel was finished. He did, however, eventually sign a lease and consented to stay permanently. He seems happy there, his spirits have greatly improved, and no one thinks he should move back to his home.
The problem, then, lies with Uncle. Uncle has commenced treating Gramps poorly (speaking to him like a child and not consulting Gramps about important topics, among other things- none blatantly abusive, that we know of), and has repeatedly referred to Gramps as “incompetent.” It is my understanding that Gramps has not officially been declared incompetent by a court or a physician. We know of the mistreatment because we witnessed it first hand during a visit to see Gramps after his move to assisted living.
Uncle has now taken over Gramps’ finances, has power of attorney, and has been added on to at least one of Gramps’ bank accounts. Presumably, Uncle is paying Gramps’ bills (mortgages, etc) with Gramps’ money, but we are not sure. Since this time, Gramps has deferred every single decision (financial and otherwise) to Uncle, and when Brother suggested that a neutral third party handle Gramps’ personal finances instead of Uncle, Gramps stated “I can’t do that, it would hurt Uncle’s feelings.” Gramps has mentioned to Brother (several times) that he is interested in selling some of his assets (the real estate, a car, etc), but Uncle has told him that he can not because they are named in Gramps’ will, which Gramps is not willing to change.
Recently, Uncle told Brother that he was no longer free to make decisions in regards to Gramps’ home, the one that Gramps has entrusted to Brother’s care for many years. This occurred just a few weeks after Gramps asked Brother to look into readying the house for renters (since it can not be sold, according to Uncle). Uncle has also made it very clear that he is unwilling to discuss anything at all, financial or otherwise, with Brother or I in regards to Gramps.
We have a strong suspicion that Uncle is using his position of power to manipulate the situation and possibly get/steal/coerce more money out of Gramps (or, potentially, his estate, when he does pass away). No other family members live in ID, and it is suspicious that the move to assisted living occurred directly after moving back to ID for the summer. Additionally, Gramps told brother that Uncle recently convinced him to add Uncles’ children (Gramps’ step-grandchildren) to his will – a fact that does not inspire confidence that there are pure motives here.
It is of no concern to us what Gramps does with his money, both now and after his death (so long as he continues to live in the manner in which he worked hard to attain, which should not be a problem unless the money is mismanaged). We feel strongly that he is competent and able to make his own decisions. Our concern is that he is being taken advantage of (and treated like a mushroom, as Brother puts it). Uncle has mentioned several times that Gramps is “running out of money,” or “doesn’t have enough money” which seems very strange, given Brother’s (albeit limited) knowledge of the financial situation (from prior to Uncle taking over – Brother does not know how to check the accounts aside from going into the bank, which he has not yet done). Uncle is very careful to ensure that there are no checks and balances going on – he refuses to discuss the situation with anyone, particularly Brother. Brother feels strongly that if he were to check on the bank accounts and call this to Uncle’s attention, Brother would find himself removed from the accounts immediately (if this has not already happened).
We stand to gain nothing from this situation – aside from the new addition of Gramps’ step-grandchildren, we know nothing of the contents of the will, nor do we have any interest in knowing. Brother and I would simply feel more comfortable if Gramps’ finances were handled by a closely monitored independent third party, but we do not know how to make this happen (or even if it is possible).
What power does Uncle have at this point? What can we do, from our state, to help prevent mis-management of funds and potential abuse of power? Is it possible that Brother could be removed from bank accounts without his knowledge? Can large transfers of money or account closures occur without his knowledge? Brother is inclined to wash his hands of the situation and let Uncle do whatever he wants, but there is a lingering concern that Gramps will be bled dry and left unable to maintain his current lifestyle.
As a side note, it is currently believed that Uncle is also well-set financially, but one can never be certain.
Throwaway email: grampaisntamushroom@hotmail.com
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