Expand Health Care, Not Healthcare Bureaucracy

In a recent op-ed piece, former New Mexico Lt. Governor (under Bill Richardson) Diane Denish advocated the politically correct, but medically and fiscally ludicrous party line about Medicaid expansion.  Her magical thinking and ill-founded policy recommendation cannot go unanswered.

It is true that "having 25% of our population uninsured is a huge cost."  But before we ask where all that money is going, note that at least one quarter of all the uninsured are so by choice.  The 2010 Report on Uninsured Americans from the GAO shows that 12-15 million qualify for government assistance but refuse to sign up.  Will expanding Medicaid eligibility suddenly make them change their minds?

Next, there is the ever-popular "jobs" card -- the claim that expanding Medicaid will bring billions of free federal dollars into any other state listening to Washington's siren call.  Those dollars could then be used, according to Denish, to "sustain our doctors and other health-care providers" and to create thousands of new jobs.

First, those free federal dollars are anything but free.  They get added to the deficit, an ever-expanding bill we are passing on for our children to pay.  Will the big government advocates ever accept that putting shackles on the future to pay for the present is a bad idea?  For proof, they need only turn their gaze to the cradle of Western civilization: Greece.

Second, those dollars do not go to doctors and nurses for patient care.  Indeed, provider reimbursements are reduced (again).  All those billions of freshly minted dollar bills go to pay for new bureaucrats, regulators, overseers, managers, compliance officers, and directors.  Money will indeed be spent on new jobs in healthcare, just not for the practice of medicine or nursing.  There won't even be dollars to "sustain" the doctors and nurses we now have.

More and more doctors are refusing to see Medicare patients.  With what the government pays providers, they simply cannot afford to do so.  The same thing is happening in Medicaid, as dollars are taken from delivery of care and given to 'deliver' more and more...red tape.

(In the 19th century, documents drawn up by lawyers were tied together with red tape in order to show everyone that the documents were official.)

Health insurance premiums, which were already unaffordable for most people, are rising still higher.  Denish (correctly) wrote, "As premiums go up, more businesses trim back on offering health insurance" to their employees.  Before one can fix a problem, one must know the root cause.

Both Denish and the U.S. Congress avoid asking two key questions: 1) Why have health insurance premiums risen 20%-30% since the ACA was passed, and 2) Where is all that money going?  (It sure as hell is not going to care providers!)

Consider the testimony before Congress and the warnings of large businesses such as Caterpillar, Deere, AT&T, Whole Foods, Medtronik, etc.  When their CEOs did their fiscal due diligence, which Congress did not, they found that ACA expansion of the regulatory bureaucracy increases business costs by up to 25% per year.  These bureaucratic (nonproductive) costs must be paid somehow.  So insurance premiums rise to cover this cost-of-expanded-government, not the cost-of-patient-care.

We need to stop stealing dollars from patients to give them to healthcare bureaucrats.

Denish and sanctimonious Washington are the ones "playing politics with the health needs" of We The Patients.  Our healthcare so-called "system" is indeed a critically ill patient.  The ACA and expansion of Medicaid will hasten the patient's demise.

Postscript.

Denish also wrote about caring for the "poorest among us."  She carefully avoided pointing out that ACA-mandated expansion of Medicaid would include people up to 400% above the poverty line.  That translates to a family of four making over $88,000 per year.

One look at a U.S. income distribution chart tells us that such Medicaid expansion would include 79% of the entire nation.  Do you really want to extend a nanny-state government dependency to over three quarters of the U.S.? I don't.

Deane Waldman, M.D., MBA is the author of Uproot US Healthcare and Not Right! (December 2012).  He is a tenured professor of pediatrics, pathology and decision science and an adjunct scholar for the Rio Grande Foundation in New Mexico.

In a recent op-ed piece, former New Mexico Lt. Governor (under Bill Richardson) Diane Denish advocated the politically correct, but medically and fiscally ludicrous party line about Medicaid expansion.  Her magical thinking and ill-founded policy recommendation cannot go unanswered.

It is true that "having 25% of our population uninsured is a huge cost."  But before we ask where all that money is going, note that at least one quarter of all the uninsured are so by choice.  The 2010 Report on Uninsured Americans from the GAO shows that 12-15 million qualify for government assistance but refuse to sign up.  Will expanding Medicaid eligibility suddenly make them change their minds?

Next, there is the ever-popular "jobs" card -- the claim that expanding Medicaid will bring billions of free federal dollars into any other state listening to Washington's siren call.  Those dollars could then be used, according to Denish, to "sustain our doctors and other health-care providers" and to create thousands of new jobs.

First, those free federal dollars are anything but free.  They get added to the deficit, an ever-expanding bill we are passing on for our children to pay.  Will the big government advocates ever accept that putting shackles on the future to pay for the present is a bad idea?  For proof, they need only turn their gaze to the cradle of Western civilization: Greece.

Second, those dollars do not go to doctors and nurses for patient care.  Indeed, provider reimbursements are reduced (again).  All those billions of freshly minted dollar bills go to pay for new bureaucrats, regulators, overseers, managers, compliance officers, and directors.  Money will indeed be spent on new jobs in healthcare, just not for the practice of medicine or nursing.  There won't even be dollars to "sustain" the doctors and nurses we now have.

More and more doctors are refusing to see Medicare patients.  With what the government pays providers, they simply cannot afford to do so.  The same thing is happening in Medicaid, as dollars are taken from delivery of care and given to 'deliver' more and more...red tape.

(In the 19th century, documents drawn up by lawyers were tied together with red tape in order to show everyone that the documents were official.)

Health insurance premiums, which were already unaffordable for most people, are rising still higher.  Denish (correctly) wrote, "As premiums go up, more businesses trim back on offering health insurance" to their employees.  Before one can fix a problem, one must know the root cause.

Both Denish and the U.S. Congress avoid asking two key questions: 1) Why have health insurance premiums risen 20%-30% since the ACA was passed, and 2) Where is all that money going?  (It sure as hell is not going to care providers!)

Consider the testimony before Congress and the warnings of large businesses such as Caterpillar, Deere, AT&T, Whole Foods, Medtronik, etc.  When their CEOs did their fiscal due diligence, which Congress did not, they found that ACA expansion of the regulatory bureaucracy increases business costs by up to 25% per year.  These bureaucratic (nonproductive) costs must be paid somehow.  So insurance premiums rise to cover this cost-of-expanded-government, not the cost-of-patient-care.

We need to stop stealing dollars from patients to give them to healthcare bureaucrats.

Denish and sanctimonious Washington are the ones "playing politics with the health needs" of We The Patients.  Our healthcare so-called "system" is indeed a critically ill patient.  The ACA and expansion of Medicaid will hasten the patient's demise.

Postscript.

Denish also wrote about caring for the "poorest among us."  She carefully avoided pointing out that ACA-mandated expansion of Medicaid would include people up to 400% above the poverty line.  That translates to a family of four making over $88,000 per year.

One look at a U.S. income distribution chart tells us that such Medicaid expansion would include 79% of the entire nation.  Do you really want to extend a nanny-state government dependency to over three quarters of the U.S.? I don't.

Deane Waldman, M.D., MBA is the author of Uproot US Healthcare and Not Right! (December 2012).  He is a tenured professor of pediatrics, pathology and decision science and an adjunct scholar for the Rio Grande Foundation in New Mexico.