LITTLE ROCK — Medicaid will break the bank of state government if we don’t do something. And it has been interesting to watch the two political parties in Arkansas as they react to that largely undisputed assertion.
They provide a classic study in the contrast between staunch conservative thought and centrist thought, which is the full range in Arkansas.
It’s positively uplifting. It’s philosophical and ideological and important. It’s not petty like the partisanship that imposed itself in the recent fiscal session. Everyone worried more about the effect of a policy vote on the next election than about the merit of the policy itself.
An honest difference of opinion about how we see the world, or at least the world of poor people’s medical care-how refreshingly retro, so 1960s.
The stakes are real, even profound. The direction we go in Medicaid largely depends on the direction you go in your local vote for a state legislator in November.
A continued Democratic majority takes us to one kind of reform and a Republican takeover leads to quite another.
Gov. Mike Beebe, a centrist Democrat who believes in making government services work, wants to continue providing existing services to the same eligible people. He wants to try to be more efficient about it. He want to try to do that in part by reducing, at least in some cases, the types and sizes of Medicaid reimbursements to hospitals and clinics and mental health facilities and doctors.
Republican state legislators cry that government should not punish accomplished people who provide a vital service and try to make a meritorious buck.
Instead they talk about such counter proposals as means-testing Medicaid recipients to make some people share costs, or setting up a system of vouchers to steer the poor into private insurance plans, or taking a look at the expansive eligibility of children for the ARKids First program, which is available to youngsters in households of up to 200 percent of poverty.
Republicans have been heard to remark disapprovingly that a family with a household income of more than $50,000 could put its four or five children on ARKids First.
That’s a bad thing, you see.
Or maybe you don’t.
I don’t. A kid in a $50,000 household with four siblings needs health care as much as an only child in a $25,000 household.
What the Beebe administration wants to do is embark on a limited pilot project in a few carefully chosen areas of care, among them neonatal and pregnancy, attention-deficit disorder, cardiovascular disease, upper respiratory infections and hip and knee replacements.
For these, Arkansas Medicaid would stop the current system of direct reimbursements for fees charged for services for every doctor’s visit or procedure or test. Instead, these conditions would be defined as “episodes” and the payments for care and treatment would be “bundled” for divvying up among the various providers.
Doctors and hospitals cry foul. They say they lose money on Medicaid already. They say such a system hasn’t worked anywhere else and would amount to an administrative nightmare.
On Sunday this newspaper ran a lengthy takeout on the issue. As a result of the article, I found myself engaged in a debate on Twitter with state Rep. David Sanders of Little Rock, and, peripherally, a couple of other Republican state legislators.
Sanders told me that, as it happened, two obstetrician-gynecologists were coming to see him the next day to explain the horror of bundling for episodic care for neonatal and pregnancy services.
Asking a health-care provider about health-care reform ideas-what a ridiculous notion, chimed in, sarcastically, state Sen. Missy Irvin of Mountain View, a Republican who has a doctor in the family.
So before emotions fester too severely, let us try to agree on what we’re arguing about.
The problem is that Medicaid costs seem certain to rise out of the state budget’s control in two or three or four years. The solutions are three, jointly or separately, wholly or partially.
We could raise taxes, which no one in political office favors.
We could reduce services to recipients, as well as restrict eligibility and institute cost-sharing by recipients based on means, which Republicans tend to want to consider in some form.
Or we could try to keep doing what we’re doing, but do it more cheaply, which inevitably would mean providing the same services for less money to the providers of those services, meaning hospitals and mental health clinics and doctors.
Generally speaking, Beebe wants the same government services for the same people for less money, while Republicans want reduced government services maybe for fewer people, thus less money.
It’s fairly true to form. But to the extent that it’s an honest difference, it’s welcomed as a lesson in the consequences of elections.
John Brummett is a regular columnist for the Arkansas Democrat-Gazette. Email him at firstname.lastname@example.org. Read his blog at brummett.arkansasonline.com.