Let’s take a deep breath, calm ourselves, and then look at violence in American schools. The facts are likely to surprise most readers. The in-school homicide rate is not rising and our schools are relatively safe places. Continue reading PREVENTING SCHOOL VIOLENCE
Category Archives: health
THE HIGH SCHOOL SURVIVORS ARE RIGHT
The high school students who survived our most recent mass killing are right that it’s time for action. Now. We should begin with what we know will work and continue improving gradually. But we’re unprepared to unite behind any course of action because we remain woefully uninformed about gun violence. Let’s focus on it and begin fixing the problem. Continue reading THE HIGH SCHOOL SURVIVORS ARE RIGHT
CITIZENS MUST LEAD THE HEALTH CARE DEBATE
Politicians seem weary of hurling half-truths and insults at each other in their years-long shouting match over health care. Nobody won. All of us lost. It’s easy to blame them, but conversations with a physician friend helped me realize that lawmakers can’t work well together until voters agree on our values and goals. My hope is that this column will shed some light on key questions and help readers think through them with family, friends and neighbors. Let’s open our minds, listen, and look for ideas on which we can agree.
Three important questions are: 1) Which kinds of health care (if any) should be basic rights guaranteed to all Americans? 2) Who will pay for it? and 3) What can we do to make health care more affordable?
Hospitals and doctors practicing there are required by law to provide certain emergency services without regard to a patient’s ability (or willingness) to pay. The cost is built into the prices paid by benefit plans and by individuals who do pay. That is very clearly an undocumented tax on everyone who pays for health care. Any health care that is promised by government as a right for all Americans will be taxpayer-funded, one way or another.
Our decisions regarding which kinds of health care will be a basic right need not be an “all or nothing” choice. We could conclude that government (taxpayers) will fund some kinds of health care but not others. A government-guaranteed plan must have a way to update which services are covered based on our values, goals, scientific advances, and budgets.
By providing wellness services such as vaccinations and screening with no out-of-pocket cost, we might improve our health and reduce our long-term costs. Colonoscopy is an example of a screening that might prevent enough colon cancers to reduce lifetime costs, but it doesn’t make financial sense for short-term, employment based insurance because the savings come later in life when someone else (likely Medicare) is paying the bills.
There are high cost services that are of questionable value. Suppose that a cancer treatment has a 20 percent chance of extending a patient’s life for not more than three months at a cost of $500,000. Maybe that treatment wouldn’t be included as a government guaranteed service. That wouldn’t mean that you can’t have it. It simply means that you have to pay for it yourself through a supplemental insurance plan or out of your own pocket. Insurance companies and Medicare are already making those coverage decisions today.
The Obamacare individual mandate to purchase insurance is an attempt to answer the “Who pays?” question and (according to the US Supreme Court) it is a tax. But why do we want to levy special taxes to fund whatever health care we guarantee as a right for all? Generating government revenue is a budget issue, not a health care issue. Compare this to the way we pay for public safety. We’re all guaranteed a good, basic level of protection by law enforcement agencies and we don’t pay a special tax for that or tie eligibility to employment. If you are wealthy and want more protection you can pay for a gated community or private security. Why should paying for health care be different from paying for public safety?
The third question, regarding making health care more affordable, deserves serious attention. American health care spending is roughly double that of other high wealth nations. All of them guarantee a broad range of health services to all of their citizens. The astonishing truth is that per person American government (taxpayer) spending exceeds all health spending (including government, individuals and employers) in Australia, Canada, France, Japan, and the U K.
The reasons why our health costs are so much higher than other nations is a subject for another day. For now, I’ll just point out that citizens of other nations are getting more care for far less money. We would be wise to carefully study how they are doing that before we make up our minds about the future of American health care.
Please engage your friends and family in the discussion. What health care do they want for you if you fall ill and have limited financial resources?
CLICK HERE for the OECD website where you can explore the cost of health care, who pays and health outcomes in most of the world’s developed nations.
Below are three comparisons that I created as research for this column. You can see international comparisons and track how US spending has changed since 2010, when Obamacare was just being created. Click the chart to expand it.
TOTAL SPENDING BY NATION
GOVERNMENT SPENDING BY NATION
PRIVATE SPENDING BY NATION
Congressional Legislative Malpractice
The 13 Senators who drafted a bill to replace Obamacare are all Republican, male, white, over age 40, and prosperous. California, Florida and New York, which together account for one-fourth of our population, were not in the room but there were two Senators from number fifty Wyoming.
Discussing diverse opinions is one way to identify and avoid unintended consequences of new legislation. Do Republicans think that women, middle class, minorities, young, poor, and other Americans left out of the process have no ideas worthy of consideration?
They did their work in secret meetings without input by experts in health policy or economics, out of the sight of the public and the press. The result is a political bill to satisfy Republican ideology with little regard for facts or alternatives.
Previously, Republicans in the House of Representatives passed a similar bill that was designed behind closed doors without serious public hearings, expert testimony or debate. They proceeded despite a Congressional Budget Office projection that it would cause 23 million Americans to become uninsured. The CBO’s estimate of spending reductions from the bill amount to $43 per month saved for each person who loses health benefits – not a good deal!
There’s no doubt that Obamacare has serious problems in the individual and small employer exchanges. Republicans try to mislead us into believing that those troubles mean that the law is failing. It isn’t. Because of Obamacare 20 million more Americans are now insured and the rate of growth in total health care spending is lower than it was before Obamacare. It is a successful law that needs improvements.
Bluntly, Republican lawmakers don’t believe that all Americans should receive basic health care regardless of their ability to pay and they’re willing to let other Americans die for that ideology. Republican leadership intends to pass their bill before Americans understand that it will cause more people to lose health benefits, more healthcare related family bankruptcies and more individuals suffering death or disability.
Rushing ill-considered bills through a legislature to satisfy an ideology is not limited to the congress. North Carolina Republicans imagined an “emergency” when Charlotte passed a civil rights ordinance allowing transgender citizens to use restroom facilities consistent with their gender identity (and, in most cases, consistent with their physical appearance). Rather than holding hearings and carefully considering what (if any) legislation was needed, they packed the infamous HB-2 with unrelated and controversial provisions then passed it as “emergency” legislation. If standard legislative processes had been followed, a more appropriate response (or no response) to Charlotte’s ordinance might have been made. HB-2 has been mostly repealed, but the damage to the state’s reputation remains and some economic losses will never be recovered.
Similarly, North Carolina Republicans gerrymandered the state’s congressional and legislative districts through secret processes. They hired attorneys who hired consultants to design legislative districts that would give massive election advantages to Republicans. Because the work was done through attorneys, they were able to claim attorney-client privilege as justification for refusing to let the public and the press see exactly how they instructed the consultants. The US Supreme Court ruled that the result of their work was racial discrimination. It again seems obvious that an open process with public hearings could have produced a better outcome.
If Republicans were practicing medicine rather than legislating, their negligence would be called malpractice. They circumvented the rules and procedures that assure thoughtful deliberation before laws are passed. That violates American values, undermines trust in government and exposes us all to the negative consequences of ill-considered laws.
Senate Republicans plan to debate, amend and pass a healthcare bill back to the House of Representatives in 10 days, with no public hearings and no expert testimony. As an example of the unanticipated consequences of doing that, unemployed Republican rural voters in the coal mining areas of the Kentucky mountains will probably lose their Medicaid benefits and see closure of clinics opened to serve them under Obamacare. Health care has added more jobs than mining lost in the Kentucky mountains. Similar outcomes are inevitable in other places. The damage to the credibility of our legislative processes is severe. Worst of all, Americans will die as a result of Republican legislative malpractice.
WE CAN CHOOSE HOPE OVER DESPAIR
“There are people whose lives are so hard they break.” Those are the words of Eileen Crimmins, a professor at the University of Southern California. She wasn’t talking about Syrian refugees or undocumented immigrants. She was talking about a large subgroup of white American citizens.
The average life expectancy of white Americans age 25-54 declined between 1999 and 2014 because of a rapid rise in premature deaths from drug overdoses, suicides, and cirrhosis associated with alcohol consumption. The death rate from drug overdoses among 25 -34 year old whites was five times higher in 2014 than in 1999. It tripled among 35 – 44 year olds. By 2014, the overdose death rate among whites was double the rate for blacks or Hispanics. Although whites still live longer, the black-white gap closed considerably because of the premature white deaths.
The rising death rates are heavily concentrated among whites without college degrees. Rural areas and small towns of the Southeast, Southwest, and the Midwestern “rustbelt” have been especially hard hit.
Why are so many white Americans killing themselves with drugs, alcohol and guns? (Almost half of all American suicides are by gun.) The most common hypothesis among researchers is that these are “deaths of despair” among Americans who no longer have hope for a satisfactory future.
Economists, sociologists, psychologists and public health researchers are only beginning to study and understand this troubling trend. It’s clear that the problems of poverty, lack of jobs with good wages, and lack of education have existed at higher rates among black Americans than among whites for all of our history but it’s the white Americans who are killing themselves with drugs, alcohol and guns. Why?
One hypothesis is that this large group of white Americans have been taught to expect that, like their parents, they could support a family and live middle-class lives with a high school education. They counted on factory work, and semi-skilled labor to pay for necessities and a few luxuries. Those expectations have been shattered. They blame corporations, immigrants, government, and public policy (such as trade treaties) for their plight. They also point a finger at themselves and far too many turn to drugs, alcohol, and suicide as avenues of escape.
The white labor class may be suffering so much despair because they are just now experiencing what the black labor class, unprotected by labor unions and discriminated against by employers, have known from childhood. They can’t pay their way into the middle class. In many cases their marriages have failed and their families have shattered under the stress of economic pressures. Many lack the literacy skills, time and money to pursue better opportunities. They see little hope for themselves and their communities.
Our economy will use the least expensive combination of machines, computers, and people to produce goods and services. Then it will sell those goods and services in exchange for more money and repeat the process. In that environment, it is up to each individual to find a way to succeed. Otherwise, the economy will find you to be expendable.
Blame is irrelevant. The important question is, “What future will we choose to create?” The replacement of human work with automation and artificial intelligence has barely begun and no one knows how rapidly it will accelerate. A report by PWC, an international consulting firm, says that 38% of American jobs are at high risk of replacement by automation in the next 15 years.
We shouldn’t even try to stop the trend, but we do need to prepare for it. Public education must be redesigned to prepare every student for life-long learning at the college level. Parents and communities must encourage and support it because jobs with good wages will require continuous learning at that level. Even if manufacturing returns to the US, the old jobs will not accompany it. There will be far more automation and the new jobs will require skills that few of us have today. In addition, minimum wage, healthcare, and other public policies must be sufficient to support viable families.
As we envision our futures, it’s good to remember Jackson Browne’s line, “You can dream but you can never go back the way you came.” We can create a good future, but it won’t be the same as our past. We must not sacrifice another generation of Americans by preparing them for a future that won’t exist. Instead, we should prepare them for hope and success.
References for further reading:
Commonwealth fund brief on white mortality trends
DO YOU HAVE A RIGHT TO HEALTH CARE?
The legendary American philosopher Yogi Berra supposedly said, “If you don’t know where you want to go, you’ll end up someplace else.” That is the story of American health care. We have not decided whether health care is a “right” for all Americans or a “privilege” for those who can pay. It seems that health care is a right for some of the people all of the time and for all of the people some of the time but not for all of the people all of the time. If you find that confusing, then you’re on the right track. We haven’t chosen our destination and we have arrived at a place that confuses and frustrates us.
Health care with little or no out-of-pocket expense is a lifetime right for veterans and for prisoners serving life sentences. I can’t think of any other large groups who have that benefit. Medicare eligibility bestows a permanent right to most health care for those who pay their out-of-pocket share. The rest of us have temporary and partial rights that depend on our employment, wealth, personal choices and luck.
Our national debate should be about who has a right to health care, which elements of health care are included, who will pay for it, and how the cost will be paid. Arguments about whether or how to replace or repeal ObamaCare (the Affordable Care Act) are pointless and counterproductive until we make a firm national decision about whether health care is a right. Where do we want to go?
Critics of ObamaCare point to extremely high insurance premiums in some of the exchanges where insurance is sold to individuals and small groups. Some areas of the country have only one insurance company participating in exchanges. Those problems are real but correctable. They occur in local segments of the healthcare marketplace and are worst in states that resisted ObamaCare by refusing the Medicaid expansion.
Here’s a snapshot of what ObamaCare has accomplished. The annual rate of increase in health care spending (both government and private) was 3.3 percent before ObamaCare. It dropped to 2.7 percent after ObamaCare was implemented. Simultaneously, the number of uninsured Americans decreased by 20 million. That is a picture of success.
President Trump’s promises sound amazingly like President Obama’s. For example, on January 15, 2017 Mr. Trump said, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” …People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.” In the same interview, he claimed that the people covered by Medicaid expansion would continue to have coverage.
A credible replacement for ObamaCare should improve on its performance. But according to the Congressional Budget Office (non-partisan and under Republican supervision) the bill that Republicans tried to rush through congress would have led to 52 million uninsured (4 million more than before ObamaCare). Less thorough analysis from the highly respected Commonwealth Fund agrees. The President and Congressional Republicans dispute the CBO estimates but they have produced no research to support their conclusions. It’s all based on their opinions.
Two principles of ObamaCare are that basic health care is a right for all Americans and that everyone should be required to participate in the cost. Those principles are implemented through the individual mandate to purchase approved coverage along with Medicaid expansion for the very poor. Approved coverage includes services for prevention and early diagnosis of health problems that often lead to premature death, disability and extreme expenses. The Republican plan lacked similar features and would produce more late stage diagnoses of illnesses that were preventable but not curable once they occur.
Because there was no individual mandate in the Republican bill, there would be two options for care of those who don’t pay. Either provide the care and build the cost into the bills of those who do pay or let those who can’t pay suffer or die without care. The individual mandate is better than either of those alternatives.
What should we do? I have asked for a meeting with my (Republican) Congressman. I want to show him the evidence that I’ve found and I want him to show me any evidence that the Republican replacement would produce better results. What will you do? Your answer will come to you after you decisively answer this question, “If the person that I love most in this world is sick and broke, does she /he have a right to health care?” ___________________________________________________________________________
Evaluate performance data from the US and other developed nations HERE using tools developed by the Organization for Economic Cooperation and Development.
This prior column contains links to references and more evidence.
Replacing Obamacare
President Trump and our Republican controlled congress have promised to quickly repeal and replace ObamaCare. President Trump says that coverage will be better, cost will be lower, and everyone will be covered.
We should consider where we were before ObamaCare and where we are today as a basis for judging proposed replacements. Using the years 2004 – 2009 as a baseline for how we were doing before ObamaCare and 2010 – 2015 as a measure of its effectiveness, here are some facts.
Each of the following statistics is for five years of change before and after ObamaCare. All spending is inflation adjusted to 2010 dollars.
- The five year increase in healthcare spending by government (federal, state and local) declined after passage of ObamaCare from 19.5 percent to 12.3 percent.
- The five-year increase in private expenditures grew from 6.5 percent before ObamaCare to 7.8 percent. Much of that growth represents insurance premiums for previously uninsured individuals.
- The five-year increase in total healthcare spending declined after passage of ObamaCare from 12.3 percent to 9.9 percent.
- Total health care spending grew 1.9 percent faster than our Gross Domestic Product in the period before ObamaCare. In the period following passage it grew one half of one percent faster than GDP.
- Prior to ObamaCare, the number of Americans who were uninsured was growing every year. It peaked at 48.6 million in 2010. After five years of ObamaCare, the number of uninsured was down to 28.6 million, the lowest number since we began keeping records.
Below is similar cost data from a different source and a link that will allow you to browse a wealth of relevant information.
Evaluate performance data from the US and other developed nations HERE using tools developed by the Organization for Economic Cooperation and Development.
Some other changes brought about by ObamaCare are:
- Before ObamaCare, important screenings like colonoscopies and mammograms were unaffordable for many people. Now they are covered without deductibles.
- Insurance companies and employers can no longer deny coverage or charge more for pre-existing conditions. Previously, cancer survivors, diabetics and others likely to need expensive care were uninsurable on most family budgets.
- Lifetime limits on coverage were banned.
- Mental health services are covered on the same basis as other medical and surgical services
- Dependents can stay on parents’ coverage up to age 26.
ObamaCare is a success compared to what we had before it passed. But health care costs are still rising faster than our economy is growing and we still have over 28 million uninsured Americans so more improvement is needed.
The ObamaCare insurance exchanges where individuals and small employers should be able to purchase affordable coverage are not consistently working well . Millions of young, healthy Americans are not buying coverage as required by the law. That leaves a disproportionate number of unhealthy and older people in these insurance pools. In markets where that has happened, premiums have risen at double-digit rates and several insurance companies dropped out, leaving meager choices for consumers.
That problem leads directly to critical questions about replacing ObamaCare. Will congress decide that it’s acceptable for some Americans to have no health benefits? If everyone is going to have benefits, is there a less expensive alternative than Medicaid expansion? If so, will it be included in the Republican replacement for ObamaCare? If not, will it then be acceptable for doctors, hospitals and other health care providers to deny services to those who can’t pay? To be very clear to free market friends, “There ain’t no such thing as a free lunch.” If the ObamaCare replacement does not include a way to pay for care of the uninsured then either they will die without care or the cost will be built into your bills and insurance premiums.
There are proven ways to provide more care for less money while covering the entire population. Every other developed nation has adopted one of them and they are all more cost-effective than ObamaCare. They range from price controls to “medicare for all” or government operated health care similar to the British model. All of them require a larger role for government and that seems to be the antithesis of Republican thinking. President Trump said that no one should be required to buy health insurance. At present it appears that he intends to provide something (health care) for everyone without requiring anyone to pay for it – a miracle of biblical proportion.
We can hope that the post-election hostility will wane in favor of intelligent consideration of how to replace or improve ObamaCare. It can be done if legislators and the President are willing to forego political rhetoric for what is practical. If they are not, then both human and economic catastrophes are likely.
A CHRISTMAS NEWSLETTER
Instead of a Christmas column from me, I tried to imagine a message from someone far wiser.
Dear American Friends:
I’ve noticed that many of you send newsy letters about your families as part of your celebration of my birthday. This year I decided to try it myself by writing to all of you. Christians often call me Father, Son, or Holy Ghost – three different ways to see me. Today I’m writing as Son.
It’s been a disappointing year for Dad and me. H.G., my spirit partner, is sad because so few of you welcome her into your thinking and conversations. Many of you don’t seem to hear her.
Your wars in the Middle East have killed about four million people in the last 25 years. Most of them are Dad’s Muslim children. He loves them as much as he loves you and he wants you to quit killing each other.
You’ve been writing “In God we trust” on your buildings. Dad’s not impressed. If you trusted him, you’d be taking his advice about which things are most important. I explained that to you once when I said that all of Dad’s laws are based on just two things. Love him; and love your neighbor as yourself. Everything that his prophets said, the laws they gave, and all that I taught comes from those two instructions. Love God. Love your neighbor as yourself. I know that’s sometimes difficult for you to do but it isn’t complicated.
Did you notice that when I lived on your planet, I tried to be a respectful friend of people regardless of their station in life or whether they agreed with me? I enjoyed time with Roman soldiers that invaded my country, tax collectors, prostitutes, and lepers. I ignored nationality and welcomed whoever came to me. When I saw injustice, I spoke up about it. Think about that when you’re deciding whether to deport people who came into your nation hungry, needy, and looking for work. You must love and respect people of all races and cultures, whether straight or LGBTQ. There are no exceptions to “love your neighbor”.
Back at the beginning of time, Dad put you in charge. In one of the books that your ancestors wrote about him, they called it “having dominion” over the whole earth. You sometimes call it “free will”. Dad lets you make your own decisions and then he lets you live with the consequences – good ones and bad ones.
You’ve learned a lot from your science. You can produce food, shelter, clothing and other things that you need. You know how to cure some of the illnesses that killed your ancestors. Those are great things and you should be proud of what you’ve achieved. You should apply my “love your neighbor” teaching to those things too. You have brothers and sisters who are starving. Here in your wealthy nation you often reserve your nearly miraculous health care for those who have money or insurance.
You’ve written your laws so that individuals and businesses get to own knowledge. Anyone who wants to use the knowledge to save a life has to pay whoever owns the knowledge. Such greed makes some of you angry at others. You need to do something about that.
You’re making a mess of the planet that Dad gave you. It’s getting warmer and you’re about to flood a lot of it. You already know that from your science but you’re not doing much about it. Is that because it would cost money? But won’t it cost more when the floods come? And wouldn’t the work to clean up the planet create jobs for people who don’t have a way to support themselves today?
Even though Dad and I are sad and disappointed we still want to help. When I tried really hard about 2000 years ago, people like you crucified me for my trouble. We’re not going to do that again, but Dad did send H.G. to help you find your way. Listen to her. Look inside yourself. She’s there and if you pay close attention to her you’ll discover how to love your neighbor; and then you will know what to do.
Thanks for reading this. Dad, H.G. and I will be thinking of you and wishing you a Happy 2017.
Your friend,
Jesus
What to do on the morning after?
The day after the election will be the first day of the rest of our lives. What should we expect of our elected officials? Will we help or undermine each other and elected leaders? If individuals, families and communities listen to each other’s ideas and agree on how to move forward together, we can invigorate the idea of “commonwealth”, a society that is organized to benefit all. Everybody wins. If, on the other hand, winners kick losers while they’re down in order to maintain dominance and if losers do all they can to stop winners from implementing their ideas then the republic will decline. Everybody loses.
It’s happened in great societies throughout history and it’s especially clear in the Bible’s Old Testament. When those in power dominate and abuse the powerless, everybody loses and the society fails. When the principle of commonwealth guides decisions, the society blossoms.
Poverty, income inequality and homelessness are at crisis levels in many places. Rural America has depended on agriculture and manufacturing to provide family incomes and property tax revenue for local governments. Both of those economic sectors now produce more goods with fewer people than ever before. At the same time that rural employment opportunities paying middle class wages have become scarce, the tax revenues of rural communities have stagnated. Budgets for public education, safety, and human services are under severe stress at a time when they are critical to redevelopment of communities. The plight of rural America has much in common with high poverty neighborhoods of urban America. Low incomes and insufficient resources have similar effects in both places.
Will legislatures reconsider how public services are funded and which tax revenues are available at local, state and federal levels? Will high poverty areas have funding for education, high-speed internet, water, sewer, quality of life, health and other priorities at a level that is proportionate to wealthy areas? If not, will their future be inter-generational poverty and emigration of successful residents to more desirable areas? Will legislators work at solving the underlying problems or will they pit urban vs rural and white vs black vs Hispanic for partisan gain?
What about the sanctity of human life? Will we expect our congress, legislatures and executives to behave as if “all lives matter”? Does someone who wants a gun have the right to own an assault rifle designed for mass killing? Does a woman have the right to remove a fetus from her body? In which decisions should government have a role?
Conflicts between personal and constitutional values will not be fully resolved but can we make progress for the common good? Could we agree to reduce the demand for abortion by providing free birth control, better access to pre-natal care, simple and inexpensive adoption procedures, and by solving our income inequality problems? Will we expect legislators to find ways to preserve gun ownership for self-defense and recreation while getting weapons designed for mass killing out of circulation and screening gun purchasers to rule out suspected terrorists and known criminals? Or will we reward leaders for continuing to insult each other?
The Republican controlled Senate has refused to consider President Obama’s nominee to the Supreme Court. They hope to win the Presidential election and get a conservative-leaning nominee. Senators Richard Burr and Ted Cruz have made the radical statement that if Hillary Clinton is elected, they will refuse to confirm nominees and let the court shrink. That abrogation of a senator’s constitutional responsibility would invite similar behavior from Democrats toward a Republican president. Will we insist that senators fulfill their constitutional duties?
Differences of race, wealth, religion and philosophy divide us on a long list of issues: immigration, transpacific partnership, climate change, war, taxes, LBGTQ rights, health care, and more.
We’re not all going to miraculously agree after the election. Continued success for our republic will require two things of us. First, we must look honestly at facts. Second, we must engage each other in ongoing conversation (listening more than arguing) about the principle of commonwealth – making decisions and laws that create opportunity and peace for all of us.
Our legislators are capable of that, but they will do it only if they know that we voters expect it, demand it, and that we’re doing it ourselves.
We can start on November 9.
We can do well while doing good
The ongoing debate about the economic impact of HB2, North Carolina’s “bathroom law” seems both sad and laughable because its effect is so small when compared to another foolish decision made by the state’s Republican legislature. The economic and human damage done by the decision to reject expansion of the Medicaid program is greater by far.
Republican friends, before you disagree, do your homework and discover the facts for yourselves. Bring truth to the debate and then see how your legislature’s decisions look under that bright light. Before considering human impact, let’s examine some raw financial facts.
The Robert Wood Johnson Foundation and the Urban Institute have collaborated on research to understand the economic impact on states that rejected Medicaid Expansion. They found that health care funding in North Carolina would be increased by $41 billion in the decade from 2017-2026 if the state accepts Medicaid expansion. That would require $4.9 billion of state funding and would bring $36.1 billion in federal funding. Do the math. $36.1 minus $4.9 equals $31.2 in net gain. Another way to look at it, suppose someone offered you $36.10 in exchange for $4.90. Would you accept it? That is one billionth of the deal that Republicans rejected. The legislature knew this information when it rejected the Medicaid expansion.
Some will argue that our state budget is too large and we shouldn’t increase it further by expanding Medicaid. That is a reasonable concern, so let’s look at Medicaid expansion in the context of other government spending.
Most federal highway grants require a 20 percent state match. State funding of $4.9 billion would produce a federal highway match of $19.6 billion. That is $16.5 billion less than we would get if we spent the money on Medicaid expansion. Therefore, if one accepts purely financial justification for not expanding Medicaid, the state would be better off by $16.5 billion to reject the highway match and use the money to fund Medicaid.
In addition to providing health care to uninsured North Carolinians, the Medicaid expansion would create thousands of new jobs in health care to replace those lost in other industries.
The argument that “we can’t afford it” doesn’t hold water when made by legislators who spend money on items that yield a far smaller return on investment. It’s a matter of priorities, and this legislature obviously sees other spending as more important than keeping poor people alive and creating jobs.
What about the human effect of the decision? The Medicaid expansion was designed to provide coverage for the working poor, many of whom have jobs (sometimes more than one job) but who are paid so little that they can’t afford insurance even with the help of the Affordable Care Act. Whatever became of that right wing mantra “take a bath and get a job”? As cynical as it sounds, the Medicaid expansion is designed to support exactly that behavior. It provides health care for people at the bottom of the economic ladder so that they can stay healthy enough to work and support themselves.
Instead of supporting a program that fits with their own traditional philosophies, Republicans rejected the expansion. That leaves us with a law that requires hospitals participating in Medicare and doctors with privileges to practice there to provide emergency and obstetrical care without regard to a patient’s ability or willingness to pay. The cost of that is invisibly built into the prices paid by everyone else. As a result, North Carolinians will pay for surgery to add a few months of life for an emergency patient diagnosed with advanced colon cancer. But we won’t expand Medicaid to pay for the colonoscopy that could have prevented the cancer from forming in the first place. The result of Republican policy is higher cost and a dead patient.
Yes, HB2 is a foolish law that should be repealed. Yes, the cancellation of concerts and sports events has an economic impact on hotels, restaurants and tourism. Yes, the law unfairly discriminates against a largely defenseless class of citizens. Yes, it should be repealed. But so far no one has died as a result of HB2 and the economic impact is microscopic compared to the rejection of Medicaid expansion.
It’s a fabulous opportunity when the right thing to do is also the profitable thing to do. We have two such opportunities at the moment. Accept the Medicaid expansion. Repeal HB2. Everybody will win.
Republican friends, the facts don’t support your policies. It’s time to change your minds.