BY: B. Keith Plunkett @Keithplunkett
Let’s say you’ve been working just a few miles from home for the past several years. Your employer has allowed you to use a company truck to get you back and forth. So, you’ve budgeted your life accordingly. You’ve given your spouse the family vehicle to drive. You want her to have a dependable ride.
Due to the down economy and a bigger tax burden, your current employer decides to cut back the use of the company vehicle to “official use only”, then they cut your hours.
You’ve decided it’s time to move on. You got lucky, and found someone who offered you a job, but it’s a 30-minute drive from home, and no company vehicle.
There is a public transit system available to get you close enough to walk to your potential new job, but it leaves 15-minutes later than you need in order to get there on time. If you’re asked to work later than the normal working hours you may miss the afternoon transit entirely. Further adding to the dilemma is that the public transit is many times off schedule, and often routes and times change, meaning you will have to try and keep up with those changes daily in order to work out a way to get to and from work.
- Do you opt for the “bird in the hand” and stay at the current job with less pay, and walk to work, maybe catch a ride?
- Do you take the new job and try to go out and find the best deal you can on a used car with the hope that it will be dependable enough to get you to work, while hoping it won’t cost you money you need in order to put food on the table?
- Do you take the new job and opt for public transit with the knowledge that the bus may not be there when you need it, and your frequent tardiness could eventually get you in ‘hot water’ with the new boss?
What do you do?
In many ways, this is the conundrum uninsured workers now face.
The form of transportation represents health insurance: employer provided, private insurance, and Medicaid Expansion. After all, transportation is basically insurance for being able to get where we need to be when we need to be there.
In our analogy, the problem with the company truck the employer is providing is that it only gets you so far, and as more regulations and taxes tighten the bottom line it becomes necessary for companies to cut it altogether, hoping you’ll find another ride. The problem with the privately purchased “vehicle” is that it may cost you too much for you to live at the level you are currently accustomed.
The final version of transportation in our story–public transit–is not dependable and many times causes a worse outcome than if you had just stuck it out with the first job.
Now imagine you’ve opted to go with public transit in our little analogy and you board the bus and find that it is already fully occupied with people. Where do you sit? What if tomorrow it is they who are late getting to the bus stop and it’s already full with you and an ‘expanded’ number of new riders?
Simple right? Add more buses. But, where do we get the money for that? Well, we increase taxes on more companies. Unfortunately, the added costs in taxes to these companies causes more cuts that add more riders to the bus.
What about drivers (doctors)? We have to pay the bus drivers. But, we have to keep costs down so we can’t pay them too much. Not paying market value in turn means we have a lesser pool of potential bus drivers willing to take the job. Should they accept the job of driving the bus, they are now being asked to drive longer hours and make more stops to cover the growing number of riders. AND, they are doing it for less pay.
See where we’re headed?
The wheels on the bus go round and round, but we’re stuck in an expanding and simultaneously deteriorating problem.
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The old saying in government is that if you want more of something then subsidize it, if you want less of something then tax it. That is what we’re seeing with Medicaid expansion. The subsidy carrot is being dangled in front of states through Medicaid expansion to incentivize the herding of more people into a system that already fails to deliver healthy outcomes to those it currently serves. As that system founders under the weight of expansion, then more taxes will be necessary to fund the increasing size of the system, meaning less jobs, therefore more people in the system, and less coverage resulting in less healthy outcomes . . . . repeat, ad nauseum.
We are subsidizing sickness by government mandate.
Medicaid already underserves the people it is supposed to benefit, and that is before any expansion. Pushing more people into a system that, in many cases, provides worse health outcomes than for those that have no insurance at all is akin to poisoning through small doses.
To use another analogy, Mississippi Democrats are proposing pouring a bushel of fresh apples on top of a bushel of spoiled ones. We know what happens to the good apples in that scenario.
Think that’s too harsh? Consider the results of a study published in the Annals of Surgery in 2010.
The study examined outcomes for 893,658 individuals undergoing major surgical operations from 2003 to 2007. Patients were divided by the type of insurance they held—private, Medicare, Medicaid, and uninsured—and adjusted the database in order to control for age, gender, income, geographic region, operation, and health conditions to allow for correction in differences. Three measurements of surgical outcome quality were examined: the rate of in-hospital mortality; average length of stay in the hospital (longer stays in the hospital are a marker of poorer outcomes); and total costs.
The results are depressing.
- Medicaid patients were almost twice as likely to die as those with private insurance; their hospital stays were 42 percent longer and cost 26 percent more.
- Compared with those WITHOUT health insurance, Medicaid patients were 13 percent more likely to die, stayed in the hospital for 50 percent longer, and cost 20 percent more.
- The average length of stay in the hospital was 7.38 days for those with private insurance. Those with Medicare stayed 19 percent longer. Those with Medicaid stayed 42 percent longer.
- The uninsured stayed 5 percent SHORTER.
Keep in mind, this is but one study. There are many, many more that show the same basic outcome; Medicaid is a death trap.
Anyone that says the uninsured deserve to be on Medicaid, deserves to have their head examined. If they do, they better hope they’re not on Medicaid when they have the examination performed. Studies show it might not end very well for them.
So what do we do?
The way to fix this problem is by first admitting that having 300,000 uninsured working poor in Mississippi is something that should be addressed. Unfortunately, we are hamstrung by a federal government that won’t take steps to innovate. There is little Mississippi can do to change that. It’s not like we have the money to fund new approaches to health care delivery. As it is we’re spending close to 40 times more in Mississippi on Medicaid than is spent on job creation.
If the federal government were willing to turn the Medicaid program into a block grant program to all 50 states, much like was done with Aid to Families with Dependent Children (AFDC) in 1996, then that opens the possibility of some serious innovation. It worked with AFDC.
Until that–or something like that–occurs, we are stuck with a top-down, one-size-fits-all approach that is literally killing off the indigent in our state and across the country. In the meantime, rejecting expansion of a system that kills in the name of health is the moral thing to do. Reauthorizing Medicaid at it’s current level is the only current option, but even that needs serious work.
About Keith: Keith Plunkett has worked on communications issues with a range of public officials from aldermen to Congressmen, and a variety of businesses, governmental agencies and non-profits. He serves or has served as a board member of several non-profit, civic and political organizations. Contact him by going to HorizonMediaMarketing.com or follow him on Twitter @Keithplunkett
