The other day, I was chatting with a longtime Payson resident who’d just built on a spare bedroom for me and then saved my beloved porch from collapse. He has worked hard all his life — and can do things with good sense and a hydraulic jack you’d normally have to hire four guys to pull off. He’s scrupulously honest and a perfectionist with hammers and screws. Somehow, we got to talking about his wife’s health care problems.
He’d been going to the local church clinic and paying out of pocket for his health care, since he’s self-employed and can’t find a health plan that would actually cover any of the health problems he and his wife have had. But a persistent sore on his wife’s finger cascaded into a life-threatening condition, with bills that ballooned so rapidly that he was almost immediately medically bankrupt.
Fortunately, Arizona hasn’t yet completely dismantled its mostly-federally funded Medicaid program — which we call AHCCCS. He qualified for coverage and a team of doctors in a Valley hospital saved her life, without bankrupting the business he’d spent his whole lifetime building.
I couldn’t help but think of my friend and that long, quiet conversation as I read Sen. Jon Kyl’s peculiar assault on Medicaid in this space on Friday. Medicaid currently covers about 30 percent of Gila County residents and about 60 million Americans. About a third of the money pays the bills of impoverished nursing home residents and most of the rest goes to poor children. For the most part, the working poor don’t qualify.
Sen. Kyl made the quite accurate point that the federal health care reforms will significantly expand the pool of working people who can qualify for coverage through Medicaid by raising the income thresholds. Estimates vary, but perhaps 46 million Americans went without health insurance in the past year. The federal health care reforms would ultimately enable perhaps 25 million of them to qualify for Medicaid.
That’s awful, concluded Kyl, since Medicaid is a “fundamentally broken program.”
As evidence, he cites several studies by Dr. Scott Gottlieb, who does research for the American Enterprise Institute, which Wikipedia describes as a “conservative think tank that promotes the advancement of free enterprise capitalism ... It is a center best for many neo-conservatives.
Gottlieb’s studies concluded that Medicaid patients were more likely to die when treated for neck cancer, more likely to have heart attacks or strokes when treated for heart disease and less likely to survive after lung transplants.
Interesting. Perhaps even true.
Other studies by researchers not necessarily committed to extolling the virtues of free enterprise health care have come to different conclusions. A quick survey of the research found some interesting studies showing that Medicaid patients had similar outcomes, despite per-patient costs substantially lower than private insurance plans. Other studies have found worse outcomes for Medicaid patients, although the differences often evaporated when the researchers corrected for things like smoking and drinking and delays in treatment and education — all of which have been shown to have a big impact on health outcomes. One study by the Urban Institute found that Medicaid programs cost 10 percent less for children and 30 percent less for adults. A study of AHCCCS by the Kaiser Foundation found that Arizona’s health-management plan approach costs 10 to 15 percent less than private plans, but produced comparable results and had higher patient satisfaction scores.
But set that aside for the moment.
Suppose Kyl’s right. Medicaid doesn’t provide good enough care.
So if a quarter of the people he represents rely on Medicaid to keep them alive — shouldn’t he be manning the ramparts of reform? Shouldn’t he be insisting on improvements in the system?
And if he doesn’t want those 25 million Americans without insurance now to qualify for Medicaid — shouldn’t he propose some other way to keep them alive? Mind you, one study by the Harvard School of Medicine suggests that 45,000 Americans die each year for lack of medical insurance. That’s the toll of 15 9/11s, year in and year out.
So what’s Kyl’s proposed solution?
He says maybe we ought to ”run Medicaid like a health program” by “abandoning the myth of comprehensive coverage.”
Huh? Did I get that right? He thinks Medicaid provides inadequate care, so we should strip away the covered benefits? Does that mean he thinks those 25 million people who could finally get coverage are better off just gutting it out on their own?
Does he think that my friend who has worked all his life and played by the rules should have just brewed tea and made his wife comfortable while she died?
I don’t get it. That doesn’t seem even faintly logical — especially for someone elected to look out for the interests of even the 30 percent of Gila County residents who rely on AHCCCS and the estimated 20 percent with no insurance at all.
Now, I don’t want to be cynical: But it almost seems like Sen. Kyl is more interested in scoring points against “Obamacare” than in keeping his constituents alive.
Surely, that can’t be true. I must be missing something.