Pretty Picture, Ugly Truths

Commentary by Ron Miller

Commentary by Ron MillerIt was the perfect politician photo-op. The earnest candidate, resplendent in a brightly colored dress, is flanked by the head of a progressive non-profit with a noble-sounding name, two doctors and an Episcopal priest. Their faces were etched with concern for the poor who aren't able to afford or acquire health insurance. It was a political consultant's earned media dream setup - and it's all wrong.

Let me say up front how much I adore Sue Kullen, my current delegate from District 27B in Calvert County. She is a big-hearted woman who is passionate about her beliefs but never belligerent, as sincere as the day is long, and one of the hardest workers I know. I like to think she does her homework on the issues, which is why her recent press conference celebrating the addition of 4,000 people to the state's Medicaid rolls bothered me so much.

As I've said here many times, I was campaigning for health care reform as a Republican in 2006 before it was cool. I said then, and I continue to say now, that if we don't address the costs of health care first, expanded coverage doesn't matter and, in fact, will further break the system. Before anyone accuses me of hating poor people, kittens and puppies, let's establish three incontrovertible facts:

1) Medicaid is broken

2) Doctors aren't accepting new Medicaid patients

3) Hospitals will go under because of Medicaid

One of my arguments against Obamacare is that government health care programs have NEVER met or come in below their estimated cost projections - EVER. In 1987, the House Ways and Means Committee estimated that Medicaid payments to hospitals that serve a large number of Medicaid patients would cost less than $1 billion by 1992. The actual cost? $17 billion.

Mandatory federal spending on Medicaid in fiscal year 2011 is $264.5 billion, and that doesn't include over $25 billion in additional funds requested to help the states with their Medicaid funding shortfalls. Medicaid is expected to reach $458 billion in annual costs by 2020, and the Congressional Budget Office calls Medicaid and Medicare spending "the single greatest threat" to the nation's budgetary stability. The current trajectory of federal health care spending is unsustainable, and the Congressional Budget Office said last week the new health care legislation does NOTHING to change the perilous direction in which we're headed. Where was all this candor when we needed it - before the bill was passed?

In 2005, about half of the nation's doctors were no longer accepting new Medicaid patients, and that number continues to grow. Doctors simply cannot afford to accept Medicare or Medicaid when their average reimbursement rates are 60% of what private insurers pay them.

The critical shortage of primary care physicians in Maryland and across the country will only get worse which the addition of scores of new Medicaid and Medicare patients. Columnist Barry Rascovar paints a grim picture for Maryland patients:
Sharp reimbursement reductions might persuade more practicing physicians to retire early, switch careers or refuse to take Medicare and Medicaid patients - just what we don't need with a tidal wave of newly insured patients about to flood waiting rooms.
Medicaid's cost sharing with the states is going to put incredible pressures on the Maryland state budget, already facing multi-billion dollar annual deficits for the next several years. Medicaid costs already account for more than 15% of the general fund, and thousands of new patients are being added. The state will be forced to reduce Medicaid payments to hospitals, some of which are already on the verge of shutting down.

The rapid expansion of Medicare and Medicaid costs, and the state's struggles to contain them, have already resulted in the state asking hospitals and insurers to absorb some of the costs of Medicare and Medicaid budget reductions. When combined with other pressures brought on Maryland's rate-setting program to stay below the national average on Medicare payments to hospitals, the net effect is more expensive hospital treatment or a reduction in services, particularly to the poor.

Barry Rascovar said Maryland hospitals could be forced "to end community health programs, cancel equipment purchases, lay off workers and shutter all but essential services."

I understand the desire to cover as many people with health insurance as possible, and I think those that advocate expanding health insurance to all have their hearts in the right place. I would also like to believe, however, that they are as aware of the challenges I've described as I am. Therefore, the questions that come to my mind are:

-- Why are they still pressing ahead to add more people to the rolls when the system can't handle the ones already signed up?

-- How are they going to address doctor shortages, or doctors refusing to take Medicaid patients or simply closing up shop because they can't afford to run a practice?

-- How are they going to close the massive budget deficits brought about by health care? Will they accept greatly reduced service, or diminutions in the quality of service, just to achieve broader coverage?

To me, the press conference was the perfect photo-op with the wrong message. We desperately need serious efforts to directly address health care costs - and private insurance is only a single-digit sliver of overall health care costs, so that's not the answer.

If we ignore health care costs, and refuse to change the paradigm on consumer use of health care, Maryland's Medicaid expansion will be insurance in name only, because it won't insure quality care, if it insures care at all.

Ron Miller, of Huntingtown, is a military veteran, conservative writer and activist, communications director for the Calvert County Republican Party, and executive director of Regular Folks United, Inc., a 501(c)3 nonprofit organization.  Ron is a regular contributor to, American Thinker, and You can also follow Ron on his website, as well as Twitter and Facebook.

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