LITTLE ROCK — IT’S A no-brainer. Here the federal government is offering to pay the full cost for every additional patient Arkansas enrolls in its Medicaid program under the new Affordable Care Act, yet state government hesitates. Why wait? Take the money!
There’s a catch, of course. There always is with these deals out of Washington. There’s even a phrase for it in federalese: unfunded federal mandates. Yes, the feds will pay the full cost for some 200,000 to 250,000 new Medicaid clients in Arkansas for a few years, but after that, the state might have to pay 10 percent of the cost. But no need to go into all that. It’s free money! Or rather federal money, which is the same thing, right? Take the money!
Why all this hesitation and calculation and legislative deliberation and general hemming-and-hawing? Why delay? Leap before you look, he who hesitates is lost, strike while the offer is hot, or however the proverb goes. Just remember this: These people are from Washington and they’re here to help. Take the money!
Our governor says he’s inclined to accept this generous offer. Why not? By the time Arkansas’ share of the cost for all those hundreds of thousands of new Medicaid enrollees begins to creep up and Washington starts tightening the screws on state finances, Mike Beebe will be well out of the Governor’s Mansion and it’ll be some other governor’s problem. Don’t worry, be happy. Take the money!
Why all the talk about being dunned a few years from now? More of our people need into Medicaid now. Later can take care of itself. Take the money!
In the meantime, we can reduce the number of uninsured in the state’s health-care system. That’s the important thing, isn’t it? Indeed, that’s the only thing to consider in this debate. Take the money!
Who’ll pay for all this? Just charge it to the federal government. If it’s not worried about amassing still more debt, what’s it to us out here in Arkansas? We’re home free, at least for a few years. Take the money!
It’s not as if anybody in Arkansas is affected by the ever growing national debt, or has to pay federal taxes to finance it. (You over there, stop looking at your pay stub. Especially that part about how much is being withheld for taxes.) Why get technical? The important thing is that we get more of our people without health insurance into Medicaid. Take the money!
T HE MORE we spend, the more we save! All the experts say so. You know, the kind of experts who used to be physicians but now have become administrators who run state and federal programs—and get paid a hefty sum for it. It’s long been said that medicine would be a fine profession if not for the patients, and these doctors-turned-bureaucrats have found a way to avoid them. They no longer have to fool with actually treating people, just obtaining grants, manipulating numbers, and improving efficiency. Improving it on paper, anyway. And all those numbers and stats and projections show that the larger Medicaid grows, the better and cheaper medical care becomes. So go ahead, take the money!
Just don’t ask too many questions about the quality of care Medicaid provides. Or doesn’t provide. Or inquire too deeply into just how Medicaid works, or doesn’t work. Stick with the numbers of uninsured we can now cover through Medicaid, hundreds of thousands of them. And take the money!
No need to look into actual case histories like that of young Deamonte Driver of Prince George’s County, Maryland, one of the poorest in the country. He died of a toothache at age 12. Can you believe it? A neglected infection spread to his brain. By the time he got to a dentist or a doctor, then a hospital, it was too late. Not because he didn’t have insurance. He did. He was on Medicaid. But as it happens, only 16 percent of Maryland’s dentists accept Medicaid, the rate of reimbursement is so low. But don’t worry about how Medicaid works in practice; the theory is what counts. So just take the money!
The same problem with reimbursements applies to Medicaid in general. Which explains why more and more physicians decline to accept more and more Medicaid patients. Accepting them all would be a sure route to bankruptcy. But never mind all that. Just keep expanding Medicaid beyond its capacity to actually deliver health care. The only thing that counts is that more people are insured, not whether they’re treated or how well. Put ’em all on the Medicaid rolls and forget about ’em. And say we’ve done our duty by the poor. And get that warm feeling of self-satisfaction that comes with being on the right side of a political issue, or rather the left side. No need to delve into the messy details of what actually is happening to the Deamonte Drivers of the world. Just take the money!
WHAT’S happening to Medicaid provides a preview of what could happen to Medicare, the government’s insurance program for older Americans. According to Medicare’s chief actuary, Richard Foster, within eight years the Affordable Care Act, aka Obamacare, will make Medicare’s reimbursement rates even lower than Medicaid’s. With much the same consequences, no doubt: More health insurance, less health care. Which is what happens when government sets the price of a commodity unrealistically low: The supply tends to shrink even as demand grows. And indeed it will grow as all those baby boomers become eligible for Medicare. But why get caught up in technicalities like the law of supply and demand? Leave all that to the pointy-headed economists. Just take the money!
By now it’s not clear which word in the title of the Affordable Care Act, the official name for Obamacare, is more dubious—the affordable or the care. But why bother debating the point when the federal government is offering states like Arkansas a free ride? Or what seems a free ride. For now anyway. But who cares about all that except a few fiscal nitpickers and those mean-spirited Republicans in the Ledge? They’re just racists. Anyone who opposes any expansion of any federal program—and the waste and debt and bureaucracy that may come with it—will inevitably be accused of racism. Or bigotry or fundamentalism or cheating at craps, or whatever tops the list of politically incorrect offenses today. Name-calling is so much easier than debating the complexities of a complex issue, like whether and how to expand Medicaid in this state. Instead, just cram all the uninsured into a onesize-fits-all-states system. Why bother devising a way that best fits each state’s needs and the needs of its patients? Talk about a headache. Why go into all that, and have to take that much trouble and care and thought about a complicated issue and formidable challenge? Just take the money!
Editorial, Pages 76 on 07/29/2012