With the Affordable Health Care Act health insurance is being extended to the uncovered American public in two primary ways. And the cost is levied in two ways as well.
The first is through employers; employees are covered through group health plans provided by employers. They bear the expense, except that there are incentives that flow to them from the federal level. The way that the insurance is provided is not through a centralized system, such as in Great Britain or Sweden, but rather through health insurance exchanges. These are competitive private sector networks from which people select their plans. The insurance companies lobbied hard for this and succeeded. It is a private sector solution.
The second is through the extension of government subsidized insurance like Medicaid. This will cover the unemployed, poor and disabled. In Missouri the expansion of Medicaid would cover another 300,000 people and add some 20,000 jobs to staff it. It is paid for with taxes, federal taxes.
Though extending Medicaid through state structures is far more efficient and keeps management control with the states, our Missouri House just blocked the attempt to add that funding for the coming year. It would have amounted to 900,000 and would be paid for by the federal government to the state.
Opposition stated that the state should not position itself in such a way that in coming years, if federal money dries up, the state would be left holding the bag. In addition, running up the federal deficit is not good policy either. Those are interesting arguments. In fact, they are familiar arguments. I have just finished reading the recent biography of FDR by H.W. Brands entitled, Traitor to his Class (Doubleday, 2008). The arguments against the establishment of unemployment insurance and social security ran exactly the same way. By today, however, social security is seen as an important part of our security fabric, right along with Medicare. At the time and much like the Affordable Health Care Act today, it was hotly disputed and barely came into law.
The second reason the Missouri House did not vote to extend Medicaid benefits to uninsured Missourians was much more ideological. They may not have been able to block the Affordable Care Act but they can attempt to block it from happening on the state level. The thing is, this is coming to the state one way or another. Ideological resistance may play well politically (I’ll do everything in my power to block this socialized Obamacare…), but reality is that Missourians can choose to determine the form this takes on the state level or not. It is much more efficient and effective to utilize our existing structures and extend them with federal money and more Missouri jobs than to make room for a free-standing federal program to do the same thing.
As we have discovered, however, practicality and efficiency have much less to do with this than political ideology. We are losing a great opportunity, not only to do the best with the situation in which we find ourselves, but to make sure that the most people possible get the health care they need. Other strategies have not succeeded to date. If they had the solutions they propose would already be in place. Our strategy up unto the present has been to ignore the problem and let the poor keep showing up in emergency rooms – the most expensive and inefficient way to deliver care.
What the Missouri House has demonstrated for all the world to see is the vast capacity of human beings to do the wrong thing for supposedly the right reasons. It’s a travesty and embarrassment.