Breaking news: Soda not responsible for majority of Medicaid spending!

Let’s talk about taxing soda. Background here: http://www.nytimes.com/2016/04/23/upshot/a-new-policy-disagreement-between-clinton-and-sanders-soda-taxes.html

Reading online comments on this and other articles, Facebook, etc, I find it interesting that so many say things like, “I’m tired of my taxes going to fund Medicaid for people who gave themselves obesity and type 2 diabetes by drinking sugary drinks all day” (I’m paraphrasing multiple comments but it’s quite a literal paraphrase). Clearly, these proponents see taxing soda as a way to control behavior of people they perceive as a public burden. Even the ones that kind of recognize what they’re saying and sort of apologize for it still go ahead and say it. “We have to save those poor people from their bad choices. Not only are we helping them, but this way we won’t have to pay for their dialysis.”

I’ve also seen comments supporting a tax on unhealthy or “junk” foods in general, even on all packaged and processed foods. This all just reminds me too much of outraged comments about people using EBT/SNAP cards to buy chips or cookies. Confession: I buy frozen doughnuts at the grocery store. Sometimes I use SNAP. It’s my one indulgence, along with caffeine. Am I not allowed to have any indulgences because I’m lower income? Don’t get me started on the fact that my son will only eat processed foods due to his sensory issues. That’s a whole separate post.

I will leave it to other people to discuss how paternalistic and insulting this attitude is. I will leave it to others to discuss alternative ways of addressing unhealthy eating habits among low-income Americans (and Americans in general). What I want to discuss right now is the ludicrous image these people have of Medicaid.

There are four groups of people who receive Medicaid: children, non-disabled adults, disabled adults, and elderly adults. Average spending per person varies widely by group: In 2011 it was roughly $18,500 for adults who qualified due to disability, $17,500 for elderly, and $4,000 for non-disabled, non-elderly adults. Among children, those classified as medically complex (like my son, although he is definitely not the highest tier of medical complexity) account for 6% of enrollees but 40% of spending. In the Medicaid population as a whole, 5% of enrollees account for more than 50% of spending. This number has stayed pretty consistent in recent years.

But how can this be? you ask. It’s because elderly people requiring long-term care, and to an even greater extent people with multiple and profound disabilities, need much more services: diagnostic tests, home medical equipment, nursing care, etc. And there is a small subgroup – that 5% – whose needs are even more extensive (and expensive). These are the people with repeated heart surgeries, brain shunts, frequent inpatient stays, with trachs and ventilators and g-tubes, the ones who need 20 or more different medications, home health nursing, therapy, wheelchairs. These people’s needs are real and they are intense and they are not, I can absolutely assure you, the result of drinking too much soda. In fact, most of these individuals probably don’t ever drink soda due to problems with swallowing. It’s hard to thicken carbonated beverages with commercial thickeners, and there wouldn’t be much point in pouring them down a g-tube.

Folks, this is where your tax dollars are going. They’re going to people with developmental disabilities, to children with special health needs, to grandparents in nursing homes. A relatively small percentage of them is going to non-disabled low-income adults and children, and a relatively small percentage of that small percentage is being spent on problems that are the direct result of drinking soda.

However. If the reasoning behind the soda tax is that we are trying to offset Medicaid costs from people’s lifestyle choices, then logically, the revenue from the tax should go to Medicaid funding and not to preschool as in Philadelphia’s current proposal. I guess even the politicians behind the tax realize that would be just too transparent.

 

Sources:

http://www.gao.gov/products/GAO-15-460

http://kff.org/medicaid/issue-brief/medicaid-per-enrollee-spending-variation-across-states/

http://managedhealthcareexecutive.modernmedicine.com/node/406160?page=0,0

http://kff.org/health-reform/issue-brief/medicaid-moving-forward/

http://healthaffairs.org/blog/2014/12/08/evolving-medicaid-to-better-serve-children-with-medically-complex-conditions/

 

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