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BILL CRAWFORD: Consensus perspective needed on Medicaid


Perspectives, hmmm. 

“It is the obvious which is so difficult to see most of the time,” wrote Isaac Asimov. “People say ‘It’s as plain as the nose on your face.’ But how much of the nose on your face can you see, unless someone holds a mirror up to you?” 
A conservative Republican legislator, speaking about Medicaid cuts, shared this perspective with Mississippi Hospital Association members, “some don’t think government should be involved in health care at all.” 
Prominent social conservatives like Gary Bauer also reflect this notion. While “liberals have traditionally been seen as standing up for the weak and the vulnerable,” said Bauer, “conservatives can be just as empathetic. But they believe that, in most cases, it’s not government’s role to be the primary dispenser of empathy.”
Other conservative mirrors, however, reflect a different perspective. As C. S. Lewis wrote, “For what you see and hear depends a good deal on where you are standing: it also depends on what sort of person you are.” 
Even Mississippi’s old 1890 Constitution reflects a role for government in caring for the insane, indigent, and “those persons who, by reason of age, infirmity, or misfortune, may have claims upon the sympathy and aid of society.” (See Sections 86 and 262). 
Sen. Roger Wicker appears to support an active role rather than no role. Last week he told MSNBC, the Senate is working to give the 50 states greater say in how Medicaid works, “while also preserving the system that was meant to protect poor children and disabled people.”

Wicker’s perspective no doubt reflects that of most Mississippi conservatives. Turns out lots of them have elderly relatives in Medicaid funded long-term care facilities. This includes many not-so-poor conservatives who pragmatically move nursing home costs to Medicaid by transferring their elders’ assets to other family members.
“Our country is great because it is built on principles of self-reliance, opportunity, innovation, and compassion for others,” reflected Ronald Reagan. 
It was Reagan who, in 1986, created one of the most intrusive roles of government in health care. He signed the Emergency Medical Treatment and Active Labor Act (EMTALA) that requires all hospitals that accept Medicare and Medicaid payments to provide people emergency room care “regardless of ability to pay.”
Missing in action are social conservatives willing to undo the government’s intrusive EMTALA dictates, despite the abusive and costly use of emergency rooms by patients with no emergency medical conditions. 
Also missing in action are conservatives willing to have government pay for the free care EMTALA requires hospitals to provide, which puts many Mississippi hospitals in financial jeopardy. 
This was particularly evident last week when Gov. Phil Bryant’s Division of Medicaid ignored Mississippi hospitals’ proposal to provide managed care for Medicaid recipients, a proposal designed to keep money in Mississippi to help offset losses from uncompensated care. Instead, millions in fees for Mississippi Medicaid managed care will continue to flow to out-of-state vendors. 
While most may join with Reagan and Wicker in seeing an active role for government in health care, our state and nation are far from a consensus perspective, especially regarding Medicaid.
»Bill Crawford is a syndicated columnist from Meridian (crawfolk@gmail.com)


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