July 13, 2019
Note: the opinions expressed in this, and other postings, about the issues being addressed by The Partnership for Prosperity are those of the author and should not be attributed to any other organization or person unless so noted. The facts cited in these postings are from personal observation and experience, and from websites, newspapers, or other publications that the author has determined are credible sources.
The battle to reduce poverty and make life better for 12,809 Forsyth County residents moved to Raleigh last week when John Railey, Executive Director of The Partnership for Priority took his advocacy for expansion of Medicaid to the state legislature.
When The Partnership for Prosperity (P4P) was created by Mayor Joines to prioritize the approaches to ameliorating poverty that had been suggested by the Poverty Task Force two years previously, it was acknowledged that there was one that could not wait: expansion of Medicaid. And this was the year to strike while the iron was hot. With the state legislature no longer veto-proof, some kind of compromise on Medicaid expansion became possible, but needing a strong push to overcome the dug-in opposition of the GOP. Forsyth County’s Rep. Donny Lambeth introduced a bill that would expand Medicaid, under certain conditions, on April 9, about the same time as P4P was created. P4P knew it had to become part of the push to make it happen. As things turned out last week, Medicaid expansion was stalled once again, but P4P’s Railey confirmed that the fight is ongoing and the commitment remains strong.
The Winston-Salem Journal carried an excellent run-down on the impact of expansion of Medicaid by Richard Craver (who, by the way, is one of the best business reporters I’ve ever read and we’re lucky to have him), is laid out. In addition to the 12,809 “new individuals covered,” expansion would create 2,058 new jobs in Forysth County, generate savings of $1.2 billion, and $7.8 million in new revenue.
Social-economic impact studies are frequently used by government to demonstrate the value of legislature or policy initiatives and are at best projections. No one can predict the future. But the experience of the 36 states that have expanded Medicaid protection seems to justify expansion. Actually, the word “seems” is just my hedge. The Kaiser Family Foundation, one of the most respected of all health care analysts, is pretty categorical on their website about the social, health, and economic benefits of expansion.
So, if it’s such a good deal, with the Federal Government paying 90% of the cost of expansion, and 36 states having endorsed it, why does the GOP in North Carolina oppose it? Well, you don’t have to go any further than Rep. Bill Berger to learn why. He has said that there is a risk the Federal Government could default on its commitment, leaving North Carolina holding the bag. The Federal Government has defaulted only once, on maturing T-Bills in 1979 for a bunch of reasons and for only a few days before making good. Other than that one time, the Federal government has never defaulted, although it has flirted with it a number of times, mostly because of the GOP’s entrenched idea that constantly raising the debt limit is a bad thing and they have actually or threatened to shut down the government if the debt limit is raised. Of course, most of them have overcome their reluctance to incur huge national debt now that Trump lives in the White House. (Parenthetically and off the point, I have always been amused by the hypocritical practice of introducing huge earmarks (also known as pork-barrel) while also advocating limits on national debt.)
But it was Berger’s quote in the Journal that got to me. “There is no such thing as free money: somebody has to pay. In this case, it’s the taxpayers in the private insurance market who at the end of the day will pay the price of this new tax to fund expansion.”
He’s partially right. Taxpayers will pay for any Federal expansion of a social program whether they have private insurance or not. But the real question should be: “What are you willing to pay taxes for?” As it is, the private insurance industry works to make billions in profits, that, when coupled with the higher costs of administration associated with private and public health care because of stimulations on providing care, the higher cost of physician for-fee income, and the cost of drugs, means that the U.S. spends more on health care than the next twelve nations, (France is the most efficient, cost-wise) and has the worst outcomes. So something’s wrong with the system.
But, to me, the thing that makes his opposition suspect is his claim that it is the taxpayers in the private insurance market who will pay the price. As taxpayers with a private insurance policy, they will. But more and more voters are saying that’s what’s wrong with the system, if the polls are right. Their overarching point is that no one should make a profit on sick people, especially if the government’s medical research programs and clinical trials have been used to build that profit. The question boils down, as it usually does, “What do you want to spend your money on?” Helping make insurance companies rich or helping sick people get well? I’d suggest that the half million to one million Americans who experienced bankruptcy or had some adverse action taken against them because of failure to pay health care bills might feel strongly about it. And they’re not the only ones. Our nation is going through as critical an examination of our way of life as it did before the Civil War, during the Great Depression, before the Great Society, or since Donald Trump was somehow elected President.
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