I want to applaud Director Cameron and former Director Armstrong for their creative and courageous work to bring down health care costs for all Idahoans and bring more of our neighbors out from under the threat of medical bankruptcy. If more of us would pay attention to this critical problem that all of us face maybe we could get past the slogans and sound bites and do some work for the common good. It shouldn’t be about Democrats or Republicans, because we are all in this mess together.
The Medicaid expansion I fought for under the Affordable Care Act was not a final solution. No, it would have been a simple first step: get all Idahoans covered by some health insurance plan. No more Catastrophic Fund tax burdens, no more liens filed on weak assets and medical bankruptcy ensured. Unburden our low wage workers from this threat. But that didn’t happen. Maybe the voters will consider the initiative and it could move forward. But their path is steep.
If Idaho would have (or chooses to) expand Medicaid coverage, the next step for all insurers (Medicaid is an insurance) would have been exactly what Armstrong and Cameron have proposed. Managing the most expensive patients is the holy grail for lowering health care costs. Fifty percent of all health care costs can be attributed to 10 percent of the population. Can private insurance companies do this better, or a government program, such as the Directors have proposed? I believe the market could have answered this. Whether Medicaid or private insurers had better success, the voters could have decided where these patients are best served, on the exchange, or on Medicaid. I would hope in such a consideration the voting public would consider the justice of such a program, not just what it would mean to their own pocketbook.
Medicaid already cares for many disabled and expensive care patients. Private insurers see these folks as outliers in their actuarial calculations. Before the ACA, these patients would have been denied coverage. No, a couple dozen expensive medical conditions in a small insurance pool will drive up costs for all. I can imagine the insurance industry would gladly welcome the Armstrong/ Cameron proposal. Will Idaho taxpayers commit to support folks with these expensive conditions when the next economic downturn hits and revenues drop? Will budget writers cut schools, or expensive cancer patients?
Their proposal means we will sort sick people for insurance by their diagnosis and prognosis. Does this remind you of the slogan of a former Vice-Presidential candidate? I am trying to avoid slogans. I ask the careful reader to consider what it means to sort people in such a way. Does such a law, such a program fit your sense of justice? It doesn’t fit mine.
The inscription carved in marble above the US Supreme Court pillars reads: “Equal Justice Under Law”. I can think of no higher ideal.
All people deserve access to appropriate health care. We can afford it. We already spend twice as much per capita on health care as other developed counties. We just have to think more of the common good.
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