Journal Express, Knoxville, IA

February 7, 2013

In the House of Wood

The case against Medicaid

Steve Woodhouse

Knoxville —  

I support Gov. Terry Branstad's decision to not expand Medicaid in Iowa. 

First of all, the federal government is broke. Its debt, as I write this Tuesday afternoon, is $16.5 TRILLION. Meanwhile, instead of dealing with this like responsible stewards of taxpayer money, Congress chose to put off a debt “ceiling” (let's face it, there's no point in setting one, they will just keep increasing it) for a few months with a gimmick that their pay will stop if the fail to pass a budget.

As if either of those things – a pay stoppage for elected officials or the Senate passing a budget after waiting four years – will happen. 

Second of all, our unfunded liabilities (promises made that will never possibly be kept) are at $122 TRILLION. Of that, there is an $85 trillion Medicare liability. Our total national assets are at $93 trillion. Does it seem like a good idea to expand federal medical insurance liability? 

Third of all, doctors in Iowa are not reimbursed the proper rate from federal health care programs because they, and the hospitals in which they serve, are too efficient. The federal government, in its infinite wisdom, has a history of rewarding inefficiency. The more poorly a medical facility runs, the more money it receives. I believe Iowa's reimbursement rates were supposed to increase, thanks to Obamacare, but I'm not sure how much. I doubt if the extra money would make the extra work, which Medicaid will likely create, worthwhile. 

Fourth of all, which kind of touches on my previous point, if more people think their health care costs are “free” or won't hit THEM in the pocket, they're more likely to visit the doctor for things that a Tylenol or a bottle of cough medicine could solve. In rural Iowa, access to medical professionals is already at a premium. More appointments will stretch their resources even further, thus causing more of a decline in the quality of care. 

Fifth of all, the entire argument that this will magically keep people from being denied care, is flawed. No one in an emergency room is turned away because of an inability to pay. There are laws against that already. I might be a dreamer, but I don't believe there's a doctor, nurse or any medical professional who would tell someone, in urgent need of care, to buzz off even if that professional may not get paid. Exercising discretion in whom you treat, when you treat and how you treat those in non-emergency situations just makes sense. 

Doctors aren't stupid. They want to look out for themselves, to repay those MASSIVE debts they accumulated to get into the position they are in. If somebody can't pay, or if the doctor won't be properly reimbursed by a poorly run government, the doctor has the right to dedicate her or his time to people who will make payment. Why do you think so many offices already refuse Medicaid patients?

I realize, as my dear friend Charlotte points out, that some other state will just take the money we refuse. I guess principles no longer matter, we should just all keep our hands out and get our share, regardless of the true costs. 

I realize, too, that those of us who pay health insurance are already paying for the uninsured. We're also the ones who foot the bill for Medicaid patients. 

Until everyone kicks in something to the kitty, and not just the 50 percent of us who pay taxes, but  EVERYONE - even the 8.75 million people who have left the work force in the past four years - there should be no further discussion of any kind of federal spending expansion. 

The bottom line is that Branstad is absolutely right not to trust the federal government to live up to its promise. These are the same people who are wasting their time complaining about having too many illegal immigrants in the country, even though many of them are the ones who decide how to fund and enforce the immigration laws the immigrants broke. There are 11 million illegal immigrants in the country now? Why didn't you address the issue when there were maybe 2 or 3 million? 

You see, it's this kind of idiocy and corruption we're dealing with in the federal government. Giving the federal government more power, authority and control over any aspect of our lives is an invitation to further misery and poorer service at a higher cost. Stick to your guns, Terry. 

Take care of yourself and thank you for reading.