So this is Medicaid reform?

Don Gaetz 
05/31/05

Politically, it couldn't have happened at a worse time in a worse way with worse people.

As some legislators pat themselves on the back for enacting Medicaid reform in the recently-concluded session, the State of Florida sheepishly acknowledges that taxpayers' money is being used to purchase Viagra for men on Medicaid.

Medicaid is the jointly funded federal and state program designed to provide reasonable and necessary health care services to the medically indigent.

Ordinarily, we could start the debate right there. What public policy rationale this side of Bill Clinton could justify making "longer, lasting" male sexual enhancement a legitimate Medicaid expense? What wacko definition of "reasonable and necessary" care for the indigent includes what has wryly been called the ultimate recreational drug?

The context for this debate is a time when Governor Bush says Florida Medicaid costs have metastasized far out of control and, along with the class size reduction amendment, threaten to swamp the state's budgetary boat by 2008.

So, to save money, the Legislature cut adult eye care as a Medicaid covered service. Because Medicaid now won't pay for an indigent adult to receive a vision examination and corrective lenses up front, that doesn't mean taxpayers are off the hook. The public is still stuck with the bill - but arguably a much larger bill - to cover the costs of eye problems that worsen and get more complicated and expensive because they aren't detected and treated initially.

Medicaid will pay much more for eye treatments once conditions deteriorate but won't any longer pay far less to prevent the deterioration. The Legislature's solution is to save the costs of an ounce of prevention but still hit the taxpayers with subsidizing pounds and pounds of cure. Having authored and passed federal and state health care legislation that actually saves money while improving care, I can attest that the incentives and counter-incentives in health care are complicated. How Medicaid should be "reformed" is worthy of serious discussion. People of good will can disagree.

But here's the kicker: it turns out those Medicaid recipients who've been buying Viagra with your tax dollars are - wait for it - convicted sexual predators. Hundreds of them. Right here in the Sunshine State. Maybe in your neighborhood.

Yes, the same state government responsible for the Medicaid program and its data base is the same state government responsible for the probation and parole system and its data base.

Yes, the same lawmakers who've been reforming Medicaid this year were also reforming how sexual predators are tracked and controlled.

Is stupidity the defense? State government just didn't connect its health care system to its criminal justice system through a brain.

Is carelessness the defense? The state and federal governments, who each fund a portion of Medicaid, were out of synch with each other in defining covered services and eligible beneficiaries.

The finger-pointing has already begun.

Meanwhile, this news from the U.S. Food and Drug Administration: Viagra may cause blindness.

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