Getting health care in emergency rooms stinks. But it’s better than Medicaid when Uncle Sam goes into default.
by James A. Bacon
As Richmond lawmakers ponder whether or not to expand Virginia’s Medicaid program, the center-left Commonwealth Institute has made another pitch for the program. Their paper, “Medicaid is Far from Broken,” creates plausible talking points to bolster anyone inclined to accept the federal government’s offer to cover the vast majority of the costs associated with the expansion.
Some 400,000 uninsured, low-income Virginians would receive medical coverage, argue Massey Whorley and Michael J. Cassidy. The Medicaid program is efficient; it has lower administrative costs than private insurance. Medicaid costs less than private insurance. Contrary to claims that doctors are deserting the Medicaid program, almost as many physicians are accepting new Medicaid patients as are accepting new patients with Medicare or private insurance. And contrary to reports that the health outcomes of Medicaid patients differ little from those of the uninsured, Medicaid recipients are more likely to report good health than the uninsured.
“Medicaid isn’t broken,” write Whorley and Cassidy. “Far from it. Lawmakers should expand Medicaid to get hard-working Virginians the help they need.”
Medicaid may not be broken (the point is arguable, but I’ll grant it for the purposes in order to make a larger point) but the federal government very nearly is. The Medicaid push in Virginia comes just as the federal government is hobbled by a partial shutdown and facing default on the national debt. Even more strikingly, the much-anticipated roll-out of the Obamacare health-care exchanges, a companion initiative to the Medicaid expansion, has been stymied by a disastrously flawed IT system.
Is this really a good time to make 400,000 more Virginians dependent upon the fiscal solvency of the federal government?
Die-hard liberals will say yes. The political problems of the federal government are all the fault of evil Republicans, and if they just behaved themselves, there wouldn’t be a problem. Yeah, and if pigs had wings, they could fly. The Republicans aren’t going away. They might buckle under public pressure but they aren’t going away. They’ll come back and re-fight the same battle every time the debt ceiling need to be raised.
Even if the Republicans did go away — it is possible that the Dems will trounce the GOP in the 2014 election — the budget issues won’t. The nation still is saddled by a $17 trillion debt. Deficits still are running at more than $500 billion a year and, even according to the Obama administration’s forecasts, red ink will resume its rise as aging Boomer retire and cash in on Medicare, Social Security and Medicaid. The Social Security disability trust fund is almost empty — no one is even talking about a fix. President Obama has ignored the recommendations of his own Bowles-Simpson budget-balancing commission, and he has shown zero interest in reforming entitlements — except to expand them.
If federal finances are unsustainable over the long run and Uncle Sam faces eventual financial collapse — liberals won’t accept that premise, but most other Americans do — is it really a good idea to expand the population’s dependence upon the Medicaid program? Shouldn’t we be distancing ourselves from the federal government and reducing peoples’ dependence upon federal transfer payments? Here in Virginia, shouldn’t we be looking instead for ways to drive costs out of the health care system and to make private insurance affordable to more people?
If we expand Medicaid and dismantle the system for indigent and uncompensated care, as inadequate as it is, what safety net will exist for the poor and near-poor should the federal government go into default? Where will those people go for care? Who will pay for them? What plan will the Commonwealth Institute recommend for picking up the pieces on short notice?
With a dysfunctional government in Washington, D.C., expanding Medicaid in Virginia is madness.
