The Michigan Paradigm

It is Friday, at the end of a joy filled week for my building as we wrap up nursing home week. However, it has been a week of apprehension and "what ifs" for those of us who are fiscally responsible to adjust our budgets as the June 1st deadline comes closer, bringing the 6 percent cut in our medicaid reimbursement as a potential reality.

So what does 6 percent really represent to our industry? To some buildings, and elders, it means closing a business and losing your home. For some communities it will mean a devastating decrease in economic growth and spending as the only profitable entities left standing become profit neutral, or worse; profit deficit. It will mean lay-offs, an increase in unemployment; and a lack of jobs in the one area Michigan was still hiring labor. It will represent another hit to the construction market as companies who were planning on remodels, or upgrades put project plans away for a better day. It will represent a decline in quality as we are faced to make choices about labor, service costs, and budget cuts with the smallest elder impact; yet they will have an impact.

Word out of Lansing today is that we are looking at a budget deficit of over 800,000 million dollars for 2007. (by the way, it is May, and the budget year ends in September). So what do we do?

Historically, we would raise taxes, or seek other types of revenue generating proposals that would place the cost burden on the residents of the entire state. Given the already stressed economic climate, the citizens, (those who still reside here and have not fled to healthier economic states); will not tolerate any type of tax increase that affects their already stretched dollar.

I can think of several critical questions that if answered, we could find solutions to the problem that exists in Michigan. Unfortunately, they are tough questions, some of which we may be resistive too; however, if we consider our sister states who are thriving we can find the answers; whether we agree with them or not; they are demonstrating fiscal growth and opportunity; and their citizens are experiencing financial well being, not strife.

The list of critical questions as I see them...

What services could we privatize, contract out, or eliminate without causing harm to the frailest and most dependent of our citizens?

Why are we still allowed to not be compliant with asset recovery for medicaid?

What about right to work laws, and the reality of their economic potential for our state?

What about barriers to free economics; especially those that are antiquated and out of sync with our current reality? (For example the certificate of need that is required to build new nursing homes).

Why would we spend millions to create another layer of bureaucracy that when fully implemented will not be cost neutral? (Single point of entry program).

Why do we provide medicaid and financial support to people who enter our country/state illegally, yet deny it for citizens without insurance who are faced with catastrophic events?

What about privatizing all travel venues that the state currently holds? (State historical museum, parks, and travel services).

Why isn't there an across the board decrease in payment to all state employees, including all state elected officials?

What about real cost sharing for state employee medical and benefit programs?

What about a cap on the years/amount of retiree benefits, to cut on legacy costs for the state?

Why do we have a state pension fund that includes health benefits, when the majority of the state's citizens are not afford this type of retirement plan any longer?

Where is the vision of our state? Are we so wrapped up in the rhetoric of tax increase, and cutting options, that we have lost sight of the large picture?

Perhaps it is the loss of vision that bothers me the most; and perhaps it is this lack of vision that is giving many Michiganders the vision of a new horizon, outside of the Michigan border.

But the biggest irony for me; is that we as providers can create new paradigms of care; change our culture and do it with very little change in our revenue. Look at what we have done in 10 years. While our government; who "speaks" of the need for change; cannot look beyond the same rhetoric, same "box" that Michigan has always operated in.