Medicaid: I’ll tell you what SC’s ‘core problem’ is

SC House Republicans yesterday killed the first attempt to expand Medicaid in keeping with Obamacare, promising that today they would unveil a Plan B that addresses South Carolina’s “core problem.”

Hey, I’ll tell you what South Carolina’s “core problem” is, at least with regard to this issue and ones like it: We keep trying to secede from the union again. Or, to spell it out more specifically, we keep pretending that decisions already made on the national level haven’t been made, and that we have rational options when we really don’t.

There is a plan in place, a national plan. It will proceed. It is a fact. And trying to come up with a separate SC approach is duplicative and wasteful at best, and smacks of nullification at worst.

Actually, that’s not the worst thing. Yeah, the fact that some prominent SC Republicans, in the 21st century, unabashedly embrace nullification, by that name — no euphemisms — is pretty appalling. But what’s worse is that lawmakers would throw down roadblocks to citizens in SC getting any benefit from Obamacare, which with all its warts is the only game going in healthcare reform.

The House GOP can come up with a Plan B that is brilliant, and has everything in it you would want a health care plan to have. I’d be shocked if they did that, but let’s suppose they do. It doesn’t change the fact that Obamacare is, and that it’s crazy not to take the federal money that would help us extend coverage to more South Carolinians who need it.

Cindi Scoppe, as usual, put it well in a recent column.She said Tony Keck, Nikki Haley’s director of Health and Human Services, had some good ideas for alternative ways to deal with Medicaid, ideas that make more sense than what the feds want to do. But in the end, she said, SC has to deal with reality:

if I could redesign our health-care system, I’d do it Mr. Keck’s way.

But here’s the thing: I don’t have that power. And neither does he. Or the governor. Or anyone else in South Carolina….

Anthony Keck Picture

Tony Keck

The problem is the way Medicaid in general, and the Medicaid expansion in particular, is funded. The federal government will pay $9 for every $1 South Carolina spends to expand Medicaid to cover more of the working poor; it will pick up 100 percent of the cost for the first three years.

What this means is that South Carolina and other states do not have the luxury of behaving logically, of considering merely where we get the best health per dollar spent….

We can argue all day about whether the rules under which states must operate Medicaid make sense (and I think many of them do not), or whether creating the Medicaid expansion program was something the federal government should have done.

But it won’t make a difference, because it’s done, and South Carolinians are going to help pay for the Medicaid expansion throughout the country. The only choice we have — the only choice — is whether or not we will allow the federal government to send any of our money back to us.

Railing against Obamacare, and pursuing alternatives that ignore reality, will get South Carolina nowhere. This is reminiscent of Mark Sanford’s stubborn refusal to accept stimulus money that was either going to come to South Carolina or go to some other state. Sanford had no say over whether the money would be spent. And SC has no alternatives that make sense in this case.

Hey, I can come up with a better plan than Obamacare, too. That doesn’t mean it’s going to happen. The decision, after generations of national hemming and hawing, has been made. It’s foolish to pretend otherwise.

143 thoughts on “Medicaid: I’ll tell you what SC’s ‘core problem’ is

  1. Brad Warthen Post author

    An interesting aside…

    Above, I referred to “Tony Keck, Nikki Haley’s director of Health and Human Services.”

    I went to the agency’s official site to make sure I had his title right, and was intrigued to find this on his bio page: “Anthony ‘Tony’ Keck is Director of Health and Human Services for Governor Nikki R. Haley.”

    It’s one thing for an opinion writer to casually refer someone as “Nikki Haley’s director.” It’s a way of making a point, a shorthand way of saying that we have to remember that his boss is a politician who hates Obamacare.

    It’s another when that’s the way he is described on the official state agency site. Not “Director of Health and Human Services for South Carolina,” which is the way you’d think he’d want to style himself, but “Director of Health and Human Services for Governor Nikki R. Haley.”

    It’s not a big deal, but the decision to word it that way is interesting — to a word guy, anyway. Did it not strike anyone at the agency as odd?

    Reply
    1. Silence

      If the SC Department of Health and Human Services is a cabinet agency, he serves at the pleasure of the Governor, so technically the description is correct. Contrast that to the Adjutant General, who heads a constitutional agency, and who is answerable directly to SC’s voters.

      I had this distinction explained to me one time when the constitutional agency that i worked for wasn’t implementing one of a former governor’s executive orders.

      Reply
    2. Tourism Bureau de Argentina

      Regarding the wording: It’s a little odd. I checked on a couple of the other Cabinet level appointees to compare. They didn’t have that exact wording, but most of them referenced Gov. Haley in the first line. One could argue that each of these cabinet level directors “serves at the pleasure of the Governor” to explain the wording. Or maybe it’s not significant at all.

      Personally, I do think it’s clumsy/sloppy wording. Too bad that’s not our biggest problem.

      On the central point, even I (as ACA opponent) kind of agree that you have to deal with what IS, and not simply rage against the dying of the light.

      Reply
    3. Kevin Dietrich

      Not to be melodramatic, but the phrase “Anthony ‘Tony’ Keck is Director of Health and Human Services for Governor Nikki R. Haley” somehow reminds me of Wehrmacht soldiers swearing loyalty to Adolf Hitler, rather than to the German state. Keck is director of Health and Human Services for all South Carolinians, not just Nikki Haley.

      Reply
  2. Kathryn Fenner

    Yes, silly me. I thought he served the people of South Carolina.

    Why, against so much evidence to the contrary, does South Carolina think it has a better idea so often?

    Reply
    1. Doug Ross

      Why, against so much evidence to the contrary, does the Federal government think it has a better idea so often?

      At least with states being in charge of their health care, you get get 50 shots at doing it right and finding the optimal configuration that matches a state’s needs.

      One size fits all is usually a bad fit for most people.

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      1. die deutsche Flußgabelung

        When is the last time the state legislature has passed a major healthcare reform package? Never. This is mostly due to our South Carolina politicians view their own constitutes. Conservatives love to think of economics as a morality play, where the “good” are rewarded and the “bad” are punished (i.e. the Right’s fetish with austerity during recessions), oblivious of the macroeconomic effects. But mostly why you don’t see a state passing major healthcare reform is because the healthcare market is national market. The federal government is the obvious polity that should try to reduce costs and increase access. There is only so much a single state can do.

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      2. Scout

        “Why, against so much evidence to the contrary, does the Federal government think it has a better idea so often? ”

        In SC’s case specifically, what evidence to the contrary are you referring to? In most cases I can think of, the federal plan is better because any plan is better than no plan. SC doesn’t have a history of addressing it’s problems. It has a history of doing nothing until the federal government says it has to.

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        1. Scout

          Having just read down the page, I would add SC’s history of doing nothing to address certain problems, I think, is related to the “those people” conundrum. SC specifically chooses to not address certain problems because it deems the people who would be helped by solving them as unworthy. That is my take anyway.

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  3. Brad Warthen Post author

    Here’s a simple way of explaining why NO plan SC can come up with on its own can possibly do as much good for South Carolinians as cooperating with the federal approach…

    There is no way that we can afford to cover as many people as adequately on one-tenth of the money. Excuse me, on LESS than one-tenth of the money, since the GOP members are complaining that the Obamacare approach costs SC too much.

    If we cooperate with Obamacare (I keep using the term in order to desensitize those who shudder at it), we get nine dollars from the feds for every dollar we spend. If we go our own way, we get zip, right?

    I fully believe that someone in SC could, conceivably, come up with a better way to spend the ten dollars. But if we don’t do it the feds’ way, we have less than ONE dollar to work with.

    If there’s something wrong with my arithmetic, I’m sure y’all will point it out. I sort of expect Doug to say that the SC approach would be more efficacious because there’d be at least 90 percent waste in the federal way. But I’m sorry; I don’t find a number like that to be credible.

    Reply
    1. Silence

      Essentially, the Medicaid expansion offered under Obamacare is a bribe. Come along peacably and we’ll pay for EVERYTHING for three years. After that we’ll pay for 90% for a while. Until the feds decide to reduce the amount that they are paying. By expanding medicaid they draw us down the single payer primrose path towards health care rationing, European style socialism, higher taxes, increased federal power and an eventual nationalization of the entire economy (to avert the spending-driven bankruptcy).
      Carrots and sticks.

      Reply
  4. bud

    Given the fact that we, as a compassionate people, have long ago accepted the concept of making sure anyone with a medical need WILL, by law, be treated then it comes down to a matter of how best to pay for situation where a patient cannot pay. Medicaid is what we have decided to do. If, because of Obamacare, Medicaid is expanded to include more people the state automatically is the recipient of additional income. That’s because the poor will be treated ANYWAY. And since someone has to pay it is best to pay for it with money we are already sending to the Federal Government. Sure it’s a clumsy way to do things but for crying out loud it is money we have spent already. Why spend money twice to treat folks of modest means? It makes no sense on any level to refuse this money. Jan Brewer, hardly a radical liberal, understands this. Why on earth is this even under discussion? It is just mind boggling.

    Reply
    1. Kathryn Fenner

      It isn’t everyone with a medical need who gets treated. Only emergencies. Preventive care and chronic illnesses have to rely on free medical clinics, which are overburdened.

      Reply
  5. Doug Ross

    Where do the nine dollars come from? Thin air? The magic government printing press?
    How about you give me $100 and I will give it back to you later (minus appropriate handling fees)?

    I guess we should take as much federal money as we can get. May as well continue being on
    the dole as a state since we apparently are unable to survive without the help of those Yankees up North.

    Reply
    1. Silence

      Doug’s correct, Brad. It’s basically OUR own money just being given back to us through Medicaid block grants or whatever. If you want to get technical about it, it’s our grandchildren’s money since our elected rulers have already spent all of our money and a lot extra too.

      Reply
    2. Steve Gordy

      That’s about the size of it, Doug. Just to cite one unrelated example: How long has the business community in Myrtle Beach been whining about their inability to get funding for I-73? They know there’s little chance of getting it from the state. Even so, the last time I was there (four months ago), lack of highway access didn’t appear to be putting much of a crimp in their business.

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  6. Steven Davis II

    No, the problem is that this was only scheduled to be a 1-year trial run and if it didn’t work they’d have to move to Plan B or end the program completely… an almost impossibility. So the smart thing to do is step back and look at Plan B more closely before stepping into something that could end up horribly wrong.

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  7. Karen McLeod

    Unfortunately our state congressmen, and many of their constituents are convinced that the people who need medicaid are 1)lazy, 2)black, and therefore 3) worthless. I don’t like it, but that’s the conclusion I have come to. They aren’t interested in getting what SC can out of this program; they’re interested in making sure these human beings don’t get this care, because “they” don’t deserve it. I am sure that there are those in this state who meet those criteria, but there are many who don’t, and it’s a pity that these congressmen are willing to cost SC money and, ultimately, lives in order to block them from getting medical care. The rub is, we are already paying via elevated insurance premiums for these folks to get very expensive care, many times for conditions that would not cost nearly as much if it had been monitored by a doctor before it got to its final stage.

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  8. bud

    Doug, what would you do with the 40 or so million uninsured when they come to the ER with life threatening injuries? The choices are pretty straightforward:

    A. Let them die
    B. Have the hospital absorb the cost, thus passing the cost along to insured patients.
    C. Have the government provide some sort of insurance. (The current system is Medicaid through Obamacare)

    That’s it. Pick one. There is no “D”. Perhaps we can improve on Obamacare but right now these are the options.

    Reply
    1. Steven Davis II

      Why is it that poor people don’t have any trouble paying for cigarettes and booze yet they don’t have money for food or medical care?

      Reply
      1. Scout

        Possibly at least in part because…………living in poverty is stressful and when real medical care is not an option one tends to self-medicate with what is available.

        Reply
        1. Steven Davis II

          Really??? The best you can come up with is “self-medication with cigarettes”? Does poverty also make you ignorant because any doctor will tell you that cigarettes and alcohol are the root of many health problems. When has a doctor ever prescribed, “Take two cigarettes and call me in the morning”?

          A little math lesson, a pack of cigarettes costs around $5.00/pack. I’d estimate that the average “poverty line” person smokes two packs of cigarettes per day. So that’s $10/day or $300 per month. Double that for a married couple. That’s $600 per month wasted income. And I’m supposed to feel sorry for these people? I say if you are on government subsidies of any kind and are tested for nicotine or alcohol you automatically get dropped from all programs. You are free to choose what is more important to you and your family, cigarettes or food.

          Reply
          1. Scout

            ” Does poverty also make you ignorant because any doctor will tell you that cigarettes and alcohol are the root of many health problems. ”

            Well, actually, if poverty in our country makes it less likely that you have access to a doctor, then yes, in fact, poverty may cause you to be ignorant of what “any doctor will tell you.”

            And yet plenty of middle class and wealthy people also drink and smoke despite having access to doctors to do this telling. What is their excuse?

            Clearly the issue is not that people don’t necessarily know it’s bad for them. Human behavior is a bit more complex than that.

            Are you ignorant of the fact that many middle class and wealthy people are taking something like xanax, prozac, paxil, lexapro, wellbutrin, ritalin, adderal, cymbalta, etc. that they got through the doctor they have access to to manage dealing with underlying innate health issues and/or the stresses of modern life. This phenomenon is not exactly rare these days. Do you think these needs just don’t occur in the poor who live in the same world and probably have even more stresses to deal with.

            Are you ignorant of the fact that alcohol and nicotine are both drugs?

            Are you ignorant of the fact that self medication is something that actually happens?

            Nobody ever suggested self medication is a good idea – typically people who self medicate are doing the best they can to manage a problem with the limited information or resources they have available in their situation. Self medication usually solves some problems in the short run but creates bigger problems and unintended consequences in the long run.

            But the point is it’s just people trying to deal with a problem the best they can with what they’ve got available to them.

            You seem to have a deficit in being able to visualize/understand a situation from someone else’s perspective. You might want to try and develop that skill.

            Reply
      2. Steve Gordy

        Why is it that Mitt Romney can’t spend all the money he still gets from Bain Capital yet whines that taxes are too high? Cigarettes and booze will cost you in the long run. Lack of medical care may cost you a lot more in the short run. We’re all blind in one way or another about money.

        Reply
  9. Brad Warthen Post author

    Karen, there’s no question in my mind that this is a “those people” problem. You know, those shiftless, good-for-nothing people who are not like us good, hard-working people who have health insurance.

    And I’m pretty sure that most people who follow this line of thinking have a picture in their mind of what those people look like.

    It’s a phenomenon with fairly ugly roots in our history. And fairly ugly sprouting branches, as well…

    Reply
    1. Brad Warthen Post author

      Note that I say, “there’s no question in my mind,” and “I’m pretty sure.” I can’t prove a thing, unless those holding such attitudes spell them out overtly.

      It’s just that the inference is so very strong.

      Some might argue that it’s a coincidence that lawmakers from safe Repubican districts — which means districts that have too few black voters to even take note of them — tend to be in the camp opposed to expanding Medicaid. But I think that strains credulity. These lawmakers are reflecting their constituencies. And among white voters in SC, the “those people” narrative is a potent one.

      Reply
    2. Steven Davis II

      And more and more of society are tired of seeing people take and give nothing back. I think you’re living in a bubble if you think otherwise. People are learning that they don’t have to provide for themselves, if they do nothing the government will be there to provide for them. Well sister, those days are about to come to an end and not a day too soon. Two generations ago, people had the work ethic of “work or go hungry”… today it’s “don’t work and the government will feed you”.

      Reply
    1. Doug Ross

      D – Ask charities like the United Way to fund healthcare services. It is charity, right? People are getting something for nothing. Tax deductible contributions from those who want to pay for other people’s health care seems like the best system.

      I spent last weekend in a state park in Blackville, SC. It’s obviously a poor town. But you know what is at the center of town? A liquor store with two convenience stores next to it. You know what appears to be the highest grossing items in the convenience stores? Lottery tickets, beer, and cigarettes. Please convince me why my tax dollars should pay for the healthcare of anyone who spends his or her money on any of those three items.

      Reply
    2. Doug Ross

      @Karen

      Then take care of them. Convince others to give their money to take care of them. Collect money at the church to pay for healthcare for those who come seeking help.

      But don’t try to suggest that taxes = compassion. Never has, never will.

      Reply
      1. Brad Warthen Post author

        And by all means, give to charity. But don’t pretend that private entities — churches or other NGOs — are adequate to meet the scale of the problem.

        Never have been, never will be.

        Reply
      2. Brad Warthen Post author

        And of course, if you’ll recall, I have all along maintained that the problem is about more than the poor who have no insurance.

        I think this hodgepodge of private insurance and public programs and free emergency care is a lousy system for all of us. It’s just a mess, and the proof is in our high per-capita cost, and lousy per-capita outcomes.

        It doesn’t make sense. Having employer-provided insurance is a drag on our economy. Not only does it drive up the cost of employing someone, but it causes people to cling to dead-end jobs for the coverage. It’s a huge deterrent to people quitting safe jobs in which they are stagnating and taking a chance on starting new businesses.

        It’s just crazy for the health of your family to be dependent on keeping a particular job, or jumping immediately to another job like it. It means people jump from one large, established employer to another. Starting a business or taking a chance on a nontraditional job that could give you an exciting future are risky enough without gambling with your family’s lives and health.

        Health coverage needs to be divorced from that dynamic. You need to know that you’re covered no matter what, so that you can focus on other considerations as you decide what to do for a living, and how to make a contribution to society.

        Reply
        1. Mark Stewart

          It is just that simple. The future depends on educating our citizens and unshackling their productivity. Splitting healthcare from employment is a major part of that. We pay either way; why not pay sensibly?

          What we really need to break is this hidebound adherence to an imaginary past. SC needs to spend far more of its collective time looking forward.

          Reply
        2. Steven Davis II

          Oh I’m sure your job at The State kept you from doing something else just because of health insurance. I’ve never met a motivated person who wanted out of a job forced to stay because of health insurance. That’s just an excuse.

          From what I reading, people are also kept from working part-time or doing something on the side to create a start-up business. People must end one job in order to start another. Is that what you’re implying?

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          1. Mark Stewart

            You are not serious, are you? You have never met a person with a sick child or spouse? That’s some sheltered oblivion you have found.

            Reply
        3. susanincola

          If it wasn’t for government-sponsored health insurance, my husband would have no way to get insurance other than to go get a 30-hour-a-week job — so he’d have to give up at least 30 hours per week that he now spends doing other useful, charitable things just for the healthcare. We would much rather just pay for private individual insurance — but it doesn’t exist outside of government-sponsored options (in this case, the SC Reinsurance facility, which we do).

          Can’t wait for a pool that isn’t a “rejects” pool (and thus very expensive) that’s not tied to a company!

          Reply
  10. Michael Rodgers

    The federal money will go to our hospitals, doctors, and nurses. Rejecting the federal money means encouraging our hospitals to shut down and motivating our doctors and nurses to move to Georgia or North Carolina.

    Reply
  11. Kathryn Fenner

    Doug,
    Charity is not synonymous with “people are getting something for nothing.” It is based on the “charis” — the grace and goodwill we ought have for our fellow man.

    As Brad said, clearly we do not collectively have sufficient charity to meet the needs of our fellow man, woman or, especially, child. Much as most people need to have property taxes escrowed, and far too many let Uncle Sam be the refund check windfall, rather than adjusting their withholding and saving sensibly all year long, we must be forced to do what we ought to do out of common decency!

    Reply
  12. Juan Caruso

    “But it won’t make a difference, because it’s done, and South Carolinians are going to help pay for the Medicaid expansion throughout the country.” -Famous last words, Brad!

    You think?

    Reply
  13. Brad Warthen Post author

    Yeah, I think.

    While South Carolina fights its rear-guard action, we have this out of Florida tonight:

    Florida Gov. Rick Scott announced he will accept federal funds to expand Medicaid for three years on Wednesday, after which the law would have to be reauthorized. “I cannot in good conscience deny Floridians to healthcare,” he told reporters. The decision adds him to the list of conservative Republican governors who accepted the expansion even though the Supreme Court ruled that states could refuse to go along with the measure to provide health care to the poor without losing existing federal funding. Scott accepted the expansion in exchange for a federal waiver to allow the state to privatize Medicaid, and the decision will expand coverage to about 1 million more Floridians. Pledging to defy Obamacare in all its forms has been a popular stance for Republican governors, including Wisconsin’s Scott Walker, Oklahoma’s Mary Fallin, North Carolina’s Pat McCrory, and Texas’s Rick Perry.

    Reply
  14. Pat

    Just a few thoughts…
    Keck seems more than qualified to make his argument against, but he’ might not be really vested in SC. I think I read his family has never moved here.
    The Arizona Republican governor is in favor of the Medicaid expansion. On her webpage, her advisors explain that the expansion is revenue/expense neutral. They seem to believe expansion of jobs and spin off jobs will offset any negatives making it a win-win for Arizona. Some news links below
    1. South Carolina’s Health and Human Services Director on why his state might sit out the Medicaid expansion (Keck’s thinking from last summer) http://www.washingtonpost.com/blogs/wonkblog/wp/2012/07/13/south-carolinas-health-and-human-services-director-on-why-his-state-might-sit-out-the-medicaid-expansion/
    2. Florida Gov. Rick Scott is the latest Republican to come out in favor of his state expanding Medicaid through a now-optional provision of the Affordable Care Act…
    …Across the country, Republican governors in Ohio, Michigan, Arizona, North Dakota, New Mexico and Nevada are putting politics aside to seize this opportunity to create jobs and stand up for taxpayers in their states,”
    (St. Louis, MO)
    http://www.stltoday.com/news/local/govt-and-politics/elizabeth-crisp/another-republican-governor-announces-support-for-medicaid-expansion/article_30ab1c20-7520-5af9-ab19-965bfe55f6b5.html
    3. The Daily Briefing
    Where each state stands on ACA’s Medicaid expansion
    http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap

    Reply
  15. Juan Caruso

    Brad, how about this news:

    “Instead of joining the majority of Americans who want this bill repealed, unions are seeking to use their political leverage to shield themselves from the harm Obamacare will impose on hundreds of millions of their fellow Americans.”

    http://www.washingtontimes.com/news/2013/feb/17/clancy-labor-unions-pushed-obamacare-through-want-/

    The undeniable and ULTIMATE truth: http://aquilinefocus.blogspot.com/2011/11/uh-oh.html

    Communitarianism is nothing more than the the old, “Third Way” Fascism!

    Reply
  16. Peggy

    failing to implement ACA’s Medicaid Expansion will not only hurt our state’s low income earners but our employment numbers:

    ” Expanding Medicaid would lead to 44,000 new S.C. jobs, the S.C. Hospital Association said Friday, firing the first major return volley in the battle over whether South Carolina should expand the federal-state program that pays for health care for the poor. In addition to more jobs, the study says expanding Medicaid would create $3.3 billion in economic activity in the state and $1.5 billion in additional income from labor through 2020.
    http://www.thestate.com/2012/12/08/2548702/sc-hospital-group-touts-economic.html

    ” expanding Medicaid would create $3.3 billion in economic activity in the state and $1.5 billion in additional income from labor through 2020.”
    sounds good to me!
    (i just wish we all could choose a public option to compete w/ the health insurance companies — eg: public option would compete for prices while health ins companies would compete for waiting time)

    Reply
  17. Doug Ross

    @Kathryn

    “Forced charity” is an oxymoron. Taxes are not charity.

    Anyway, there is PLENTY of money in the government coffers to offer world class health care to all citizens. Unfortunately, we have too many people who think bike paths, Confderate subs, ballet companies, Publix supermarkets, empty buildings in the Vista, and hundreds of other “charities” are more worthwhile than health care. What are you willing to give up (besides my money) to make sure the poor have their basic needs met?

    We need a mindset of “this or that” instead of “more”. Guns OR butter not guns AND butter.

    We also need people to be responsible and there’s no way you can do that if you give people something for nothing. If you can’t afford health care and someone else is paying for it, there should be a set of requirements that break the cycle. At a minimum, no health benefit should be given to smokers. That’s a fair trade for free health care, isn’t it?

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  18. bud

    Please convince me why my tax dollars should pay for the healthcare of anyone who spends his or her money on any of those three items.
    -Doug

    I’ll put you down for A – let them die. If that’s the way you feel just say so. But as I said, D is NOT an option.

    Reply
  19. bud

    I saw something in the State this morning that I didn’t get a chance to read fully. Apparently someone in the GOP is offering a proposal to replace the Medicaid expansion option with a plan to pay hospitals to provide other options for the poor besides the ER. Does anyone know how this would work? Seems like a pie in the sky proposal but until I learn more I’ll withhold judgement.

    Reply
  20. Silence

    To threadjack a little here: Did anyone else notice that “Moneyball” and “The Bad News Bears” are essentially the same movie?

    Reply
  21. Dave Crockett

    Perhaps putting us back on thread:
    http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/

    Reply
  22. Kathryn Fenner

    Taxes are not charity. They are the price we pay for a civilized society. A civilized society takes care of its sick.

    Reply
  23. Doug Ross

    And we do that. Just not to the level you like. A civilized society would put heath care ahead of bike paths and ballet.

    Reply
    1. Doug Ross

      Really? A civilized society would put bike paths and ballet on equal level as basic healthcare? How about we start with all the tax revenues we have and prioritize spending so that all the health care you want is paid for first before we moving on to the nice-to-have, special interest group projects?

      The bottom line is you and Kathryn define society as government and taxes and I do not. You believe the answer to society’s ills are increased taxes, more government programs, more rules and regulations. We’ve got several decades worth of evidence that it doesn’t work.

      Reply
      1. Brad Warthen Post author

        I said nothing to indicate I’d put those amenities on the same level as health care. I did say that a civilized society would make provisions for those things as well.

        A couple of other points. You say, “The bottom line is you and Kathryn define society as government and taxes and I do not.” No. I do consider them to be an essential PART of a civilization, and don’t begrudge them. I prefer not to live in anarchy.

        Then you say, “We’ve got several decades worth of evidence that it doesn’t work.” No, actually, we don’t. Nothing of the kind.

        We certainly have never tried in South Carolina having the sort of public amenities that England has. Or even Pennsylvania, to name another place with which I have recent familiarity. Since we haven’t tried it, it’s impossible to have any evidence that it doesn’t work.

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        1. Steven Davis II

          “I did say that a civilized society would make provisions for those things as well.”

          So spending $1 million dollars on ballet vs. spending that same $1 million on healthcare is a good trade off in your mind. What you’re talking about is fine and dandy if the country had a surplus of money to spend… but when you’re broke, you don’t spend money on luxuries. It’s like a bankrupt millionaire buying a Porsche instead of a Ferrari and bragging that he saved $100,000.

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        2. Steven Davis II

          “We certainly have never tried in South Carolina having the sort of public amenities that England has.”

          I think you’d be much happier if you moved to England.

          Reply
      2. Brad Warthen Post author

        But to get back to our original point…

        Our topic doesn’t have anything to do with levying new taxes on you or anyone else. It’s about getting back some of the tax money that we’re paying anyway, getting a better health system, and some economic stimulus in the bargain.

        Which is why governors who oppose Obamacare, such as the one in Florida and the one in Arizona, have opted to expand Medicaid. They know there’s no rational excuse not to.

        Reply
    2. Steven Davis II

      Why do you bother living in this Hell hole called America? You obviously aren’t happy here.

      Bike paths and ballet aren’t necessities in running a government.

      Reply
  24. Kathryn Fenner

    Agreed, Brad. But Doug, we do not care for our sick adequately. We only care for them expensively in acute emergencies. Poor people with cancer, HIV, diabetes, etc., do not get adequate care by a long shot! And preventive care, such as diagnosing and treating hypertension and diabetes is sorely lacking and would save us all money!

    Reply
    1. Steven Davis II

      Do these people not qualify for Medicaid? I don’t know of any cancer patient who has been denied treatment because of their income. Hypertension and Type II diabetes are largely caused by diet and obesity. Why eat an apple when you can eat a Twinkie?

      Reply
  25. Doug Ross

    So where is the money going to come from to give all the poor all the medical care you want them to have? How much money do you think that will take? Which taxes do you propose raising to meet those needs? What’s next after you’ve raised the taxes to cover healthcare? Then we move onto education, right? How much more do you need to give every poor person a better education? Once we’ve paid for all that, what’s next? Environment. How much more do we need to take care of that?

    I just need a number because I’ve been doing my taxes lately and I see that my tax bill exceeds my wife’s income. I need to let her know she will have to find a second job to pay for the additional taxes you want to cover all the non-workers. I’m sure she’ll understand that it’s for a charitable cause.

    Reply
    1. Brad Warthen Post author

      Yeah, back when I worked at the newspaper, I’m pretty sure my taxes always exceeded my wife’s income, although it never occurred to me to think about that.

      If I had thought about it, I would have considered myself blessed. As I would consider myself to be if and when I’m in that situation again.

      Reply
      1. Doug Ross

        I guess if I can give my entire income to the government, I will reach nirvana.

        Everyone is blessed with what they have. You want to try and mess with the blessings to balance it out how you think it should be. If it makes you feel more blessed to pay more, add in a kicker to your tax bill in April.

        Reply
        1. Steven Davis II

          “I guess if I can give my entire income to the government, I will reach nirvana.”

          That’s what the liberals here are trying to convince those of who who actually go out and work for a living to do.

          Reply
  26. bud

    Besides Doug, what the working poor spend on cigarettes, lottery tickets and booze is tiny compared to what a long stay in the hospital would cost. Besides what about children? What about those who do not spend frivolously but are just of low income? Seems like you’re getting caught up in all this 47% nonsense that Romney tried to peddle. A civilized society should not be so judgemental about folks that may not have the skills and access to the resources that most of us on Brad’s blog have. But if you still want to let the folks die then that’s between you and your conscience. As for me I say take the Medicaid money.

    Reply
    1. Doug Ross

      @Bud

      What ABOUT the children? If you are poor, is it a good idea to have children? If you are poor and unmarried, is it a good idea to have children? If you are poor, unmarried, and a high school dropout, is it a good idea to have children?

      How much more money would be available to assist the poor if there was some personal responsibility on their part to avoid having children until they could afford them? or to avoid using drugs, alcohol, and cigarettes?

      The Lord helps those who help themselves. The government helps those who can’t be bothered to take control of their situation.

      Reply
    2. Steven Davis II

      bud, why are you comparing it to what the government spends on them? What they’re spending should be a percentage of what they’re income is individually. If you make $10,000/yr. and spend $50/week on cigarettes you’re spending a quarter of your gross income on something that could be spent on food or other necessities. Why should taxpayers be subsidizing your cigarette habit by giving you an extra $50/week to buy food? Why is this so hard for some people to understand?

      If you receive government subsidies, be it food stamps, free medical care, free heating assistance and are found to be using alcohol, cigarettes, or drugs… your free ride should be stopped immediately until you either get a job or prove that you’re responsible enough for your own welfare to be put back on a taxpayer funded program.

      Reply
  27. Doug Ross

    @Bud

    And at $4 a pack of cigarettes, even if you only smoke a pack a week and drink a $7 six pack of beer each week, and buy a $5 lottery ticket each week, you’ve just spent $800 on nothing.

    A pack a day smoker is spending $1500 a year. A six pack a day drinker is spending $2500. That’s enough for a high deductible insurance policy to cover major illnesses.

    I say we raise the sin taxes on cigarettes and liquor to the highest levels in the country and put that money back into healthcare for the poor. $20 a pack for cigarettes. 100% tax on liquor. And then let’s stop calling it the Education lottery and call it the Health lottery instead and funnel all the revenue into health care instead of giving subsidies to colleges.
    You know what would happen? Most of that money would never be used to deal with the problem. Politicians would invent new ways to waste it or funnel it to lobbyists.

    There’s an actual solution that would have the least impact on citizens. It would generate 100′s of millions of dollars each year. And it wouldn’t work.

    Reply
  28. bud

    I need to let her know she will have to find a second job to pay for the additional taxes you want to cover all the non-workers.
    -Doug

    You’re having a big disconnect problem here Doug. We ALREADY pay to cover the non-workers AND low income workers. (Why you insist on denigrating low-income folks by calling them “non-workers” is really very offputting by the way). That’s the option B I spoke of earlier. The only thing taking the Medicaid money will do is pay for those folks another way, mostly with federal money. Assuming the free-market system works reasonably well the lower costs the hospitals no longer have to absorb will be returned via lower hospital bills and ultimately lower insurance premiums and deductibles. Of course the free market can sometimes be a finicky thing but in this case the 10% cost we will assume after 3 years should more than be made up by lower costs to someone. And even if that goes 100% to the hospital it would still stay in state rather than get shipped in total to other parts of the country.

    Reply
  29. Lynn

    Your conversation dances around the issue of whether as a citizen of the United States, do you have a right to health and health care or is it just another private good/service that goes to those who can afford it or are lucky? Other economically advanced countries based on their social/cultural motivations find that health and health care a basic for humanity and through taxes and/or public insurance schemes provide for all their citizens (residents) to access to a basic level of health care services. Some nations do it through public health facilities, some so it through a balance of public and private health facilities but they do. They don’t understand why in the US health care is so difficult to get or navigate. They spend less per capita and having better health outcomes/higher health status (live longer, have lower rates of preventable early deaths, lower infant mortality etc.) Think about how you might live, if health care was just part of the wallpaper of your life and you didn’t live in terror of one serious (not even catastrophic) illness in your family could cause you to lose your house, your savings, or your job. You just knew if you get sick you’d get care. There’s a lot of energy wasted living in terror of not having health insurance and having someone you love get sick.

    Please stop blaming patients because they get sick or injured. Life style does affect health but so does income, education, and who your parents are. Even people who never drink, smoke, or drive without wearing their seat belts can be injured or ill. Sometimes bad things just happen. Judging patients as deserving or undeserving of care consumes way too much energy and costs way to much money.

    Reply
    1. Steven Davis II

      “They spend less per capita and having better health outcomes/higher health status (live longer, have lower rates of preventable early deaths, lower infant mortality etc.) ”

      They also don’t have the obesity rate or laziness rate rampant within this country. Which in many cases go hand in hand in this country. Why take care of yourself, when the government will provide for you if you don’t? People have been poor the entire history of this country, it’s just that they used to be skinny and poor, now they’re morbidly obese and poor because they don’t have to go work to try and make ends meet, they only have to walk to the mailbox… actually they probably use a scooter.

      Reply
      1. Lynn

        They are approaching our rates of obesity and they smoke more than we do. But on average we have equivalent rates of chronic and acute illness.

        Reply
        1. Silence

          Not at all. I’m 100% for capitalism. I’m against redistribution, and against theft. Call it what you want, but forcing any man to work for the any benefit other than his own is immoral. If he chooses to give by choice, so be it, but do not force him by coercion.
          You have no more right to healthcare than you do to a Disney cartoon or a Beatles song. You can have as much as you can afford.

          Reply
        2. Brad Warthen Post author

          Well then why did you say that you’re opposed to anyone enjoying the fruits of another man’s labor? We all do that.

          When you say, “Nobody has the right to the fruits of another man’s labor,” you naturally bring two things to mind. First, slavery. But we put that behind us in 1865; it’s a pretty settled issue.

          The other is capitalism. But I don’t say that in a judgmental way. On the contrary. In a modern economy, with a bewilderingly complex web of division of labor, everyone profits from the labors of millions of others. Some are doctors or lawyers. Some are teachers. Some operate shops. Some people build roads, and most people drive on them — to work, to school, to play, to grandmother’s house.

          And some people offer the strength of their backs, while others contribute capital.

          To talk of redistribution and theft is to misunderstand the interdependence of modern society.

          Now, immediately, you or SDII or Doug will shoot back — but what about those worthless creatures who DON’T contribute? Yes, there are messed-up, dysfunctional people in society. But a healthy, functioning modern economy doesn’t have to send them out on ice floes to die. In varying degrees, lots of people won’t contribute everything they can. And you know what? Those people will have miserable lives. But your resentment of them shouldn’t prevent us from having a rational system that keeps the whole population healthy — that benefits us all by freeing us from employer-provided insurance, and even provides the innocent children of those shiftless people you so despise a chance to grow up healthy and be better contributors than their parents.

          It’s not about what THIS individual GETS and what THAT individual has to pay. It’s about a system made to benefit the entire polis, the whole economy. This adamant refusal to allow the possibility that some undeserving person might get some benefit from a dollar that you paid in keeps us trapped in a lousy system that costs too much and leads to lousy results. It just doesn’t make good sense.

          Reply
          1. Steven Davis II

            “Now, immediately, you or SDII or Doug will shoot back — but what about those worthless creatures who DON’T contribute? Yes, there are messed-up, dysfunctional people in society.”

            Let me finish that for you… who contribute nothing and expect to be handed something for nothing because that is how the system now works and others are joining the ranks on a daily basis.

            “But a healthy, functioning modern economy doesn’t have to send them out on ice floes to die.But a healthy, functioning modern economy doesn’t have to send them out on ice floes to die.”

            Sounds like a good idea to me. Doesn’t the Roman Catholic Church excommunicate members who don’t follow their rules? Are you admitting a fault with the way your church conducts itself?

            “Those people will have miserable lives.”

            Yeah, they complain that the government’s not giving them more.

            Mother Nature has a way of dealing with things like this, she casts aside the weak and the sick as to make the rest of the species healthier and stronger. It’s a fact of nature, but human beings try to counteract that and it ends up hurting the species more than it helps.

            Maybe if a 100 people a day give the panhandler on Main Street a dollar, he’ll go away… but he doesn’t, he comes back with 4 of his friends.

            Reply
          2. Doug Ross

            You understate the number of people who are undeserving. We are not talking about the elderly or the infirmed. We are talking about people who are provided with assistance from cradle to grave and have an expectation that someone else will take care of them. The system reinforces the behavior. It offers no penalty for poor choices.

            Would you suggest that there isn’t a real issue in South Carolina with people who drop out of high school (at least 35%), have multiple children out of wedlock without any means to take care of them, spend their money on cigarettes, alcohol, and lottery tickets despite living in poverty? This is not some tiny group of miscreants…. it’s a fairly significant percentage of the population of the state. And we OWE them what for their poor choices? I say nothing. We should help those who are willing to make an effort to improve themselves. The rest? You get what you deserve.

            Reply
          3. Silence

            @Brad – I never said I was against “enjoying” the fruits of another man’s labor. I do that all the time. If I want to watch a Spielberg film, I can pay whatever price he charges to see it, or I can’t (legally) see it. He chooses to make his intellectual property, the fruits of his labors available to the public for a price. It’s a fair exchange. That being said, I have no RIGHT to see his films. If he wants to, he could make a movie, and put it on a shelf somewhere. He could choose to only show it to a select group of his friends. He could throw it away. He could charge a price that I simply would or could not pay. It’s his choice.
            The same goes for authors. I have no right to read their book or article, unless they choose to make it available to me. The same goes for creators of more physical products – I have no right to a Ford automobile, but they are certainly happy to sell me one on their terms.
            I realize that the arguement could be made that medicine is a necessity for life, and in many cases that holds true. Even so, I have no RIGHT to the fruits of the doctors’ labor, unless they choose to sell their knowledge and work to me at a price we agree on.

            Reply
          4. Brad Warthen Post author

            Silence, as I’ve said before, I don’t think of this issue in terms of “rights.” I just look at society as a whole and think about what would be a rational healthcare system to have, one that would provide the best outcomes most economically. And the one we have ain’t it.

            Reply
          5. Silence

            Well, a little more free market and a little less government interference from the git-go would have helped set up a better system. The entire reason that health care is tied to insurance that derives from our workplace is FDR wage and price controls. Now more price controls are supposed to fix things. Fat chance.

            Reply
        1. Doug Ross

          No, he wasn’t kidding. He was talking about individuals demonstrating mercy, not about collecting taxes to redistribute.

          Reply
  30. bud

    Here’s the bottom line, we can argue all day long about what is fair and equitable. (Frankly the super rich live off the labors of others far more than some $20k uninsured worker who is treated for an injury in the ER. But that’s for another day) But the fact remains that we have decided long ago to treat EVERYONE, no matter their ability to pay or self-destructive lifestyles they may have. Doug and Silence may not like that. They can whine and moan about it all day long but that’s just the way it is and has been for decades. That part of the equation is a settled issue just the same as the repeal of slavery, the end of prohibition and legalization of inter-racial marriage.

    The debate now should be about the best way to do that. ALL other developed countries do this in a much, much, much, much more efficient way than we do in the USA. That’s just a fact given the enormous amount we spend compared to the outcomes that we get. And there isn’t any ongoing fight about the poor sick stealing from those who are better off. They just accept that everyone will be treated. With that acceptance everyone is better off.

    Reply
    1. Doug Ross

      @Bud

      No other country spends as much on the military as we do. When those other countries start doing that, let’s see how much they have left for health care.

      We can’t do both… and it’s a weak argument to say that the U.S. should do the same. There are far too many variables involved.

      Reply
  31. bud

    No other country spends as much on the military as we do.
    -Doug

    Nor on healthcare. That one-two punch holds back the rest of the economy.

    Reply
  32. Mark Stewart

    Doug, we CAN do both. And we must continue doing so. It’s what we do. We progress. And we protect ourselves. But we still find a way to move forward as a nation.

    What we can’t do is blame individuals for systemic failure; because that really is failure on all levels. Success is defined as creating pathways that lead to a long term, sustainable future that is better than the present. That’s what matters. The future – for people, families and society (which of course includes government).

    Reply
    1. Silence

      @ Mark Stewart – I guess the real questions at the heart of the healthcare debate, as I see them, are:
      How big is too big, and how much is too much? What is the appropriate role of the government in terms of actions, and what is the optimum size to accomplish the agreed upon functions? What are fair minimum and maximum total tax & regulatory burdens to place upon any citizen?

      I guess my follow up to your statement would be: You say that we progress, as a society. Is it really progress to create a class of dependents? To create a culture of dependancy that spans generations, and runs from cradle to grave? A class that seems to have little chance to escape dependency and poverty? I would argue that it is not progress to do what our federal system has done over the last 80 years. Progress would be to lift people up, to give them the tools and skills to help themselves, to make their way in the world. Instead we have created modern day serfs – tied to the manor by entitlement programs.

      Ultimately, unless we can sustain productivity increases and minimize the size of the dependent underclass, we are doomed to a dark, Malthusian future. There simply won’t be enough workers to feed, clothe, house and care for the dependents.

      Reply
    2. Doug Ross

      @Mark

      The only way to do both is to raise taxes, isn’t it? Those who want a different health care system never talk about how to pay for it. It’s just “I want.. I want.. I want” never “In order get what I want, we will pay for it by…. ”

      And I hope Brad won’t respond with his usual “with taxes”. If you want to change the health care system, tell us what it will be and specifically how it will be paid for. If you are championing moving away from private insurance, explain what impact that will have on the millions of people who work in that industry.

      Just once I’d like to see someone think things thru completely, covering costs, risks, possible consequences. It’s always the easy route – “We should have X”.

      Reply
  33. Michael Rodgers

    Hey, liberals or progressives or whatever, knock it off with all this morality talk; it’s insulting as well as irrelevant. Hey, conservatives or libertarians or whatever, do you want the federal government to help our local hospitals with the tremendous cost burden put on them by the people you call moochers and takers or would you rather have our local hospitals eliminate local jobs, reduce local services, and depress our local economy? The South Carolina Hospital Association wants SC to expand medicaid (video).

    Reply
    1. Silence

      That’s like saying that the South Carolina gas retailers want us to buy more fuel. It’s more money in their pockets.

      Reply
        1. Michael Rodgers

          Silence, We agree that the hospitals think that they, not the poor, will get the Medicaid money.
          Steven Davis II, You are exactly wrong, because what Silence said is exactly what I do want people to know.

          Reply
  34. bud

    I find it intersting how Silence, and to a lessor extent Doug, keep harping on this dependency culture we allegedly have in this country. Sure there are those who depend on the government to provide them and their childern a certain level of sustanance. Sure there are folks who will pass that culture of dependency down from generation to generation. It’s a very difficult cycle to beat and it’s worth a serious national discussion. HOWEVER. That is a completely separate issue from this Medicaid expansion issue. In effect we’re talking past each other because we’re talking about TWO entirely different issues. For starters most folks who would benefit from the Medicaid expansion issues WORK. Some WORK very hard. I was watching the guys who pick up my garbage the other day and I’d challenge Silence or Doug to do what those guys do everytime. They would probably quit after the first day whining about the poor job conditions. But what they do is important. They’re not depending on government to provide them food and shelter.

    But many of these folks do not work at a job that provides healthcare and cannot POSSIBLY afford to pay premiums for even a high deductable plan. It is simply not an option for many folks. So let’s move past this whole dependency thing and focus on the question at hand, Medicaid expansion. Once we see how beneficial that program will be at a cost that will ultimately be paid for by improving the overall efficiency of the system it is crystal clear that it is a tremendously beneficial approach compared to the status quo.

    So why don’t we compromise. If you have a full time job then you qualify for the Medicaid expansion program. If you don’t have a job we’ll let you die. Would that satisfy your objections Silence?

    Reply
    1. Steven Davis II

      @bud – You do realize that in some places where garbage is unionized that some garbage men can make a six-figure salary.

      Working a low salary job isn’t a life-sentence, most people have had a low paying job at one time or another, they worked harder and went on to higher paying jobs. Just because you’re a ditch digger or garbage man at 18 doesn’t mean you’re required to retire at 65 as a ditch digger or garbage man.

      BTW – How long would bud last at a job as a garbage man? If he’s sitting there watching them work, he must need something productive to do.

      Reply
      1. Scout

        Steven, you realize that place is not SC where we don’t have unions, right? Sorry if it doesn’t fit your imagined world view but working a low salary job can actually be a life sentence, in fact, for many working class people in the world we live in today. That is just how it is.

        Reply
        1. Steven Davis II

          @Scout – Interesting, I’ve held three different jobs since moving to South Carolina. One was a glorified ditch digger, salaried but worked 60 hours per week and my starting pay was likely below minimum wage if you factored in overtime over 40 hours. I’m far from that place I was 20 years ago. Your excuse doesn’t hold water, if you want to make something of yourself in South Carolina I have first-hand knowledge of it being possible.

          Reply
    2. Doug Ross

      @bud

      I’d like to see you do what I do.

      We all have talents and skills that the market assigns a value. Twenty years ago, I don’t doubt I could have lifted garbage cans all day. And if that was all I could do, I would do it to the best of my ability. But I didn’t have to because a) I got a high school diploma and b) I got a degree and c) I worked hard to improve my skills.

      Find me one of your example garbage men. Show me their paycheck, Then show me what they spend their money on. Do they put healthcare ahead of cable TV? Do they put healthcare ahead of an internet connection and cellphone? What would they be willing to give up for someone else to provide for their healthcare?

      Reply
  35. Doug Ross

    Seems like people who would know, those who run hospitals and medical university, aren’t as upset about the SC plan to deal with Medicaid expansion. Imagine that… they must all be greedy Libertarians. Should we consider their opinions more than those of editorial writers who don’t have a clue about the economics of running hospitals and dealing with the government?

    “But Howell Clyburn, vice president of community and governmental affairs for the Greenville Hospital System, said the proposal put forward by House Republicans is a good alternative.

    “We support Medicaid expansion, but this is another way,” Clyburn said. “It puts revenue into the hospitals and it clearly shows a willingness for all of us to work together.”

    The House Republican plan also would spend more than $30 million in rural areas of the state: $20 million to cover the cost of unreimbursed medical care given low-income patients at rural hospitals, $3 million to encourage doctors to work in underserved areas; and $8 million to expand the MUSC program in which doctors treat patients via video.

    “In a time of limited resources, the committee is targeting its appropriations judiciously to areas of great need and this bodes well for improving the health status of our state,” MUSC president Ray Greenberg said.”

    Read more here: http://www.thestate.com/2013/02/21/2643233/sc-hospitals-divided-over-gops.html#storylink=cpy

    Reply
      1. Steven Davis II

        As if Democrats haven’t used one-time money or cuts for recurring expenses. I’ve come to know this as the South Carolina way.

        Reply
  36. Doug Ross

    And here is a clearly stated argument listing 12 reasons why states should not accept the Medicaid expansion.

    It’s not for people who don’t want to deal with facts.

    http://www.nationalreview.com/articles/341306/twelve-reasons-say-no-avik-roy?pg=1

    This one may cause bud’s mind to explode.

    ” Mountains of clinical literature show that, on average, patients on Medicaid have poorer health outcomes than those with no insurance at all. The largest such study by far, conducted by surgeons at the University of Virginia, examined outcomes for 893,658 individuals undergoing major surgical operations from 2003 to 2007. It found that patients on Medicaid were 13 percent more likely to die in the hospital after surgery than those with no insurance, even when adjusting for age, gender, income, region, and health status. Medicaid patients were 97 percent more likely to die than those with private insurance. This is because the Medicaid program pays doctors and hospitals far less than private insurers do. In 2008, the Virginia Medicaid program paid doctors 29 percent less than private insurers did. In California and New York, states with expansive Medicaid programs, Medicaid pays doctors 62 and 71 percent less, respectively. As a result, many doctors refuse to take Medicaid — and when Medicaid patients can’t get predictable access to care, their cancers go undiagnosed and their heart conditions go unmanaged. Access to specialists is particularly challenging. When Medicaid patients finally do get care, their diseases are often more advanced and more difficult to treat. This is worse than having no insurance at all, because uninsured people pay out-of-pocket, which doctors accept, compared with Medicaid, which underpays doctors and requires lots of form-filling and arguing.”

    Reply
    1. Scout

      I suspect that a good many of the uninsured also fit the description of when they “finally do get care, their diseases are often more advanced and more difficult to treat” because few can afford to pay out of pocket and many just avoid doctors until they just absolutely can’t. How many of the uninsured just drop dead without ever getting any care or going to a hospital at all – do they get counted in these statistics? I doubt it. Were they better off? Was their life expectancy shorter than it would have been even on substandard medicaid care or private insurance? (probably) There are a lot of potential and convenient holes in this information.

      You’ve provided a fabulous testimonial for how the current Medicaid system has problems for among other reasons it has not been adequately funded.

      We all agree that the current system is flawed. That is not in dispute.

      This discussion is about reforming the system. The reforms are probably not perfect either, but they are a step in the right direction.

      I’ve never understood why some people’s response to a flawed solution to an acknowledged problem is to reject the plan in any form and abandon any attempt to solve the problem at all, rather than to tweak the solution and keep working on the problem.

      Reply
      1. Brad Warthen Post author

        Actually, Scout, I don’t think you’re quite right when you say, “We all agree that the current system is flawed. That is not in dispute.”

        Doug regularly talks about how deeply satisfied he is with his insurance, and suggests that if others are not, it’s their fault; they should be able to go out and get a deal as awesome as his, if they’d just get off their duffs.

        Reply
        1. Doug Ross

          Yes, Brad, it’s just me who is happy with my insurance. Me and the majority of Americans according to the polls. And your only solution is to tax me more so you can have better insurance. Why not start with your own employer?

          I have said numerous times that I think all citizens should be able to purchase the same insurance their representatives have. That would be an easy fix for many people.

          Reply
          1. Brad Warthen Post author

            And on that, Doug, you and I agree entirely. It would be awesome for all of us to have the insurance that members of Congress have.

            Or the system that federal employees have. Which would kinda be like single-payer.

            Reply
      2. Doug Ross

        Scout – it was a five year study of 900, 000 patients. Do you think it becomes invalid because you don’t know exactly how it was conducted? I would tend to think that there was significant thought and research put into the study. The key point is that the significantly below market reimbursement rates results in fewer Providers willing to offer services. That is what you get when the government sets prices. It will be worse if we go yo single payer as many doctors will not participate.

        Reply
  37. Doug Ross

    3. Medicaid’s access problems will get worse as more doctors drop out.

    According to the Urban Institute, there is considerable concern about whether there will be enough doctors to see the influx of new Medicaid patients. While Obamacare provides for a two years of increased federal Medicaid payments for primary-care physicians, it seems unlikely there will be a permanent increase in participation among privately practicing physicians since the increase in federal payments for primary-care physicians will last only two years. The biggest problem in Virginia will be in developing sufficient capacity in the southern and southwestern parts of the state, where enrollment increases will be the largest and provider shortages the greatest.

    Reply
    1. Steven Davis II

      Small businesses are already aware of the fact that if you can hire a person for no more than than 28 hours per week that you are exempt from providing Obamacare to that employee. So instead of hiring 4 40-hour full-time employees, you hire 5 28-hour part-time employees.

      Reply
  38. Doug Ross

    There are just too many factual examples to ignore…

    “Official federal estimates show that at least 10 percent of Medicaid payments are fraudulent. Many prosecutors believe that the figure is closer to 30 percent. Unfortunately, health-care providers often aggressively resist efforts to police fraud and waste because excess Medicaid spending frequently accrues to their benefit.

    In neighboring North Carolina, state auditor Beth Wood, a Democrat, recently found that the state’s Medicaid program endured $1.4 billion in cost overruns each year, including $375 million in state dollars. As a result, North Carolina has decided not to expand its Medicaid program. Before considering a Medicaid expansion, Virginia should conduct a similar audit of the program and demand flexibility for reform.”

    Reply
    1. Doug Ross

      Yes, Steve. I’m sorry I brought a lot of factual information into the discussion. I know if liberals have to read more than a paragraph that doesn’t include “it’s for the children” they get bored.

      Reply
      1. Steve Gordy

        Doug, you rush to judgment assuming I’m a liberal. I consider myself a libertarian, albeit one who isn’t just focused on keeping the government out of my wallet, but also out of my bedroom and my correspondence. May I suggest starting your own blog on which you can control the terms of debate.

        Reply
        1. Steven Davis II

          @Steve – If you don’t like how Brad handles this blog, there’s nothing stating that you have to stay here. If you disagree with Doug, and Brad posts his comments… your beef should be with Brad, not Doug.

          Reply
      2. Scout

        Doug, that comment wasn’t much like you.

        You know, I’m fairly liberal (though not quite so much as Bud, I don’t think), and I slog through many of your factual links. It’s true, I do sometimes get bored, but so. I don’t stop. I read them and I offer rebuttal. In a civil manner. most of the time.

        Reply
  39. Mark Stewart

    Silence,

    What’s this talk of a dependent underclass? You are stating your own problem there – and perpetuating theirs.

    Doug,

    Any SC plan that rewards hospitals for pushing services out into the rural communities is not only bound to fail but is counter-productive. We need to get people off the land and into sustainable population clusters. Medical care, education and employment are never going to be found out in the sticks. Silence’s chronic underclass is more the result of rural stagnation than of the federal government’s policies since the Brown v. Board of Ed. ruling.

    Reply
  40. Michael Rodgers

    Hey liberals, progressives, whatever, Doug is arguing that accepting the federal money will harm the moochers and takers. He’s wrong, but again it shows you that the morality argument is not relevant if you’re debating with a reasonable person, such as Doug, who has a fact-based argument.

    Reply
  41. Mark Stewart

    If anyone is serious about reducing the systemic cost of healthcare in this country without reducing quality, there are two main cost-containment options:

    1) provide a mechanism to transition the indigent and the uninsured from Emergency Department care to primary care providers (with referrals to specialist care) and,
    2) institute across the board caps on non-palliative end of life care for everyone. Then, let those who will pay secure separate insurance plans or pay cash beyond pre-set determinations.

    That’s the way to address our system which is broken at both ends. That’ s the hard choice that has to be made. Or we can just keep paying and paying as we do now; through increased taxes, increased insurance and diminishing social and economic vitality.

    Reply
    1. Kathryn Fenner

      There is already a shortage of primary care providers, FWIW. We also need to shift doctors from specialties into primary care and expand the use of physician assistants and nurse practitioners.

      Reply
      1. Pat

        Some time ago, I asked my primary doctor what he thought of the Affordable Care Act. He said he would be paid more. Not so for specialists. This was the way he answered my question. I think the result will be more doctors going into the primary field and making some of the specialist careers less attractive. I’ve used the CVS Minute Clinic for minor illness – they were convenient, after work hours so no lost work time – and they sent a report to my primary care physician. Our healthcare system will be smarter and more efficient if we just won’t be so resistent to change.

        Reply
  42. bud

    Scout – it was a five year study of 900, 000 patients. Do you think it becomes invalid because you don’t know exactly how it was conducted? I would tend to think that there was significant thought and research put into the study.
    -Doug

    Not necessarily. It was featured in the National Review and hence we should be very skeptical of the results. We don’t know how adjustments were made for income or region. Without knowing we’re left to take them for their word. Any good research person would refuse to do that. Size alone does not for a good study make.

    A far better study was done in Oregon where they had an opportunity to expand Medicaid to include more people. The problem was that funding was only available for about 10,000 people. This gave them a great opportunity to match the results for the 10,000 people who won the Medicaid lotttery with 10,000 who did not. The folks on Medicaid had much better health outcomes compared to those without.

    http://www.nber.org/papers/w17190

    Reply
    1. Doug Ross

      “Not necessarily. It was featured in the National Review and hence we should be very skeptical of the results.”

      So reporting the results of a study performed by the University of Virginia surgeons on National Review’s website invalidates the study. Okay.

      The truth only exists on DailyKos and MSNBC.

      Reply

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