PLUNKETT: Does Anyone Remember The Goal Of Healthcare Reform?

By Keith Plunkett | July 18th, 2017 at 6:13 pm

BY: Keith Plunkett / Managing Editor

Keith Plunkett is the Policy and Communications Director for the United Conservatives Fund, and the Founder and Publisher of MississippiPEP.com.

Filed Under: Business, Contributor, Ethics, Feature Stories, Federal Government, health, Insurance, Keith Plunkett, Liberty, Medicaid, Medical Care, Mississippi PEP, National, Obamacare, Opinion, Politics, Republican, US Congress

Media resorts to their favorite play-call: insinuating that the advocates of unrestricted free-market solutions are racists who hate women and the poor.


Okay. Who is the smart aleck who referred to Medicaid recipients as “deadbeats” and ticked off the folks at the Clarion Ledger?

Fess up!

Somebody must have said something, although I can find nothing referenced in any of the C-L articles nor anything referenced in Google to show that such a charge has been leveled recently.

Rep. Karl Oliver is still laying low, isn’t he?

Leading up to Independence Day and the congressional recess the Clarion Ledger published several articles on the ongoing federal push for Medicaid reform and the U.S. Senate’s latest attempts at reworking the healthcare law. Each one of the articles took great pains to rebuild and reconquer straw men Mississippians have come to expect from much of the media. The obsession with race, poverty, and gender is enough to drive a concerned citizen maddeningly out of his gourd.

Why can’t we have a serious discussion in this state without the media immediately couching responses against expansive government in terms of class division or racial animosity?

First, the articles provide examples of how Medicaid is needed by disabled children. But these aren’t just any children. Heck, no! We are reminded that these children are middle-class white children, with white parents, who live in the white suburbs. 55-percent of those covered by Medicaid in Mississippi are kids. One mother tells the Clarion Ledger reporter she feels there is a misconception about who is on Medicaid in Mississippi.

“We’re a middle class, white family of five that lives in the suburbs of Jackson,” she said. “The price of insurance has just gone through the roof and the middle class, average, working families can’t afford it.”

Well, then. Do you have any examples of this “misconception,” ma’am, or is it just a “feeling”? The Clarion Ledger doesn’t offer any examples that this is indeed a public misconception. Unfortunately, they don’t stop there in pushing the idea that Mississippians have these built in prejudices.

We’re also treated to stories of how “cuts” to Medicaid would negatively effect the disabled, black Mississippians and women, too.

You’d think these days the media could at least be a little more creative with the stereotypes so as to keep more people interested in the conversation longer. It’s not as if there aren’t dozens of moving parts to try to keep up with in terms of how already severely restricted markets might react to tweaking government healthcare policy. Does the media really have to turn it into another episode of ‘Freedom Summer’?

While we’re talking about ground rules and starting points of the discussion, let’s also just go ahead and get this out of the way: Neither the House nor the Senate healthcare legislation introduced over the past two weeks does what Republican politicians have been promising they would repeatedly do for nearly a decade. Neither of these packages repeals ObamaCare. They each focus instead on remastering, reproducing and renaming it. As far as I’m concerned both bills in their current form represent a broken campaign promise. There’s still time to correct that, but not likely the votes or the willpower.

That said, the better play would have been to first completely erase ObamaCare from U.S. law, root and branch. That could have been done all at once but would have created even more chaos in the market. The smarter move would be to decrease the mandates and regulations over the course of the next three years. This would allow the recovery of private healthcare markets to responsibly fill the void. The markets reactions would inform lawmakers now so eager to replace the law with something just as bad as to the wisdom of specific actions to be taken; not just in how the law would best be replaced, but as to whether there should be any replacement at all.

I’m of the opinion espoused by my friend Bryan Fischer when he writes that lawmakers shouldn’t ‘repeal and replace’ ObamaCare. They should just repeal it.

There is absolutely nothing the federal or state government can do to help health care in this country except stand down. But, as Senator Chris McDaniel writes, these politicians simply won’t let go of their power.

I’ve been researching and writing about much of the policy surrounding ObamaCare since it’s inception, especially as it relates to Medicaid. I can’t imagine how someone new to this glut of policy information would react to all of this today. Government healthcare policy analysts might as well be attempting to compose the ending to Mozart’s Requiem as to try explaining to the general public all the complications that decades of regulatory changes and legal maneuvering have done to healthcare. This didn’t start with ObamaCare. It started in 1964 with Medicaid and Medicare, and with government attempts since then to “fix” the problems that government created.

The result is today we have a rickety old structure built on a rickety foundation and reliant on the one simple and incorrect premise that apparently no politician, government official or bureaucrat is capable of understanding. Complex challenges require diverse, decentralized solutions. The heavily government regulated system we have today, has systemitized some decentralization into Medicaid and Medicare out of sheer necessity. This is telling as it indicates at least some recognition that the benefits of decentralization have been learned through experience.

Unfortunately, bureaucrats can’t seem to let go of the driving ideology that leads to maintaining centralized power. As a result, periodically throughout history there have been political pushes by and for the administrative state to swallow up more and more control.

In their book Resilience Thinking, Brian Walker and David Salt define resilience as “the capacity of a system to absorb disturbance and still retain its basic function and structure.” They go on to write that, “The more you optimize the elements of a complex system, the more you diminish its resilience. The drive for an efficient optimal state outcome has the effect of making the system more prone to disturbances.”

There can’t be a system that accounts for all the individual circumstances associated with the purchasing of health insurance or in how healthcare is provided in the U.S. The federal governments involvement must eventually push health care consumers into restrictive categories that simply don’t fit in the complex real world we live.

In other words, there can’t be a man-made system designed to provide top down management of complexities of so many human interactions, nor can there be a system to predict the results of so many potential decisions. It is simply outside of the realm of human possibility. The brain can’t even conceive of such complexity, much less design an efficient system to manage it all.

As Thomas Sowell wrote in his classic book ‘A Conflict of Visions’, “There are no solutions; there are only tradeoffs. Whatever you do to deal with one of man’s flaws, it creates another problem. But you try to get the best tradeoff you can get. And that’s all you can hope for.”

Government shouldn’t be in the business of trading one individuals options in favor of another’s.

Elected officials and employees of government agencies motivations are no more honorable than any other person. They put their pants on one leg at a time just like all of us do and they, like us, agree to tradeoffs as a means to get things done.

Each of us are prone to take shortcuts. Each of us will sometimes make decisions under pressure that clouds our judgment. A system of government that isn’t engineered to absorb imperfections will only amplify them as it creates terrible outcomes.

Properly functioning markets are upset by these imperfectly politicized government priorities in many different ways. Likewise, the factors that work in conjunction to stabilize a particular market can also be upset by an unexpected shift in government regulatory policy. By way of a chain-reaction, a market upset by government action reverberates the impact down the chain of suppliers. Depending upon the size, number of resources and resource providers, the upsetting influence can be felt by service providers, laborers, and potentially hundreds, if not thousands, of other interconnected entities that might have as small a role as providing a single resource used in the production or the provision of services.

This is a level of human and social complexity of which government simply cannot negotiate.

Democrats have been all over both the House version, the American Health Care Act (AHCA), and the Senate version, the Better Care Reconciliation Act (BCRA), telling the public that Republican “cuts” would destroy the countries healthcare system. This is, of course, completely false. The government began the destruction of healthcare a long time ago.

In fact, despite the best attempts of media to convince the public otherwise, there are no proposals under consideration that make “cuts” to Medicaid. None.

Let me repeat. There are NO SPENDING CUTS to Medicaid being proposed.

The Senate bill makes two main changes to Medicaid.

  1. BCRA lowers the federal matching rate for the Affordable Care Act’s expansion population from the enhanced level of 90 percent to the regular, state-specific rates that apply to most Medicaid spending (the regular rates range from 50 percent for high-income states to about 75 percent for low-income states. Mississippi gets a higher percentage than any other state). States would be allowed to continue full Medicaid coverage of the expansion population, with very significant federal support.
  2. The bill would impose new, per-person limits on the growth of Medicaid spending for five different program eligibility groups. This proposal has been around for more than two decades, and was endorsed by the Clinton administration in the 1990s.

There’s nothing in the Senate bill that would force states to drop coverage of low-income elderly and disabled persons, or poor women and children, as so many of the misleading attacks on the plan have implied.

Health care policy analyst James Capretta writes that the Medicaid provisions of the bill are not perfect, but they at least aim the federal governments efforts in the right direction.

“Even with the changes to Medicaid contained in the Senate bill, which would be phased in very slowly, the program would remain a large and growing part of the federal budget. The Congressional Budget Office (CBO) projects that, under current law, the federal government will spend nearly $5.2 trillion over the next ten years on Medicaid. If the emerging GOP plan cuts federal funding by $0.9 trillion over a decade, which is possible, that will still mean the federal government will spend $4.3 trillion on the program over ten years. CBO estimates enrollment in Medicaid in 2026 would be about 71 million people under the House-passed Medicaid provisions (which are similar to those in the Senate bill), or 4 million more than were enrolled in the program in 2011.

Moreover, the Senate bill provides a new, refundable tax credit to anyone who has a low income or is poor and is not eligible for Medicaid. Under this provision, households with incomes below the federal poverty line (FPL) are guaranteed that they can enroll in an insurance plan with a premium that does not exceed 2 percent of their annual income. For a person with an income at the poverty level, this means his maximum premium for health coverage would be about $20 per month.”

I don’t know about you, but if a person with an income at the poverty level can’t afford coverage of $20 per month then I have to conclude that the coverage isn’t a priority for them. And if it’s not a priority for them then who the heck would be more qualified and say they know better?

The federal bureaucracy and number crunchers, that’s who.

The government already makes it difficult enough for those attempting to work their way out of the trap of welfare and poverty programs. It makes no sense for poverty level income earners to be forced to personally budget for health-care according to government dictates on top of everything else they have to negotiate.

At some point, no matter what strata of the progressive tax structure a person might occupy, there comes a time when individual income growth meets the governments disincentive to produce so as to not be bumped up into a higher tax bracket. That is all the more difficult when the loss of earnings to taxes threatens a larger percentage of a persons income like it does for those in or near the poverty level.

Anyone who dresses-up government mandates as necessary in order to care for people less fortunate is full of crap.

When it comes right down to it, the Feds have to have as many in the system as possible to be able to maintain the farce. It’s building another layer into what is little more than an unsustainable pyramid-scheme. The system, like that of all other government programs that hand out money or benefits, is constructed upon the premise that bureaucrats can tweak policy to restrict or deny benefits behind the scenes through administrative rule changes. Meanwhile, politicians have become salesmen for unelected government bureaucrats rather than representatives of the voters who put them in office. These lawmakers are trained via government orientation to do what they must to make sure the number of individuals added to the system is growing at a faster rate than the payout for services.

This is how any third-party payer system works, whether it be public or private insurance. In the case of government insurance programs like Medicaid the program is built on forcing taxpayers to invest and disallowing other options to enter the market on the one end, then doing everything possible to require health care services to participate on the user end. This is effectually a single-payer health care plan we have already. It’s just been built over time via ever-tighter restriction and regulation as opposed to announced all at once in an omnibus legislative package.

ObamaCare introduced the subsidies along with tighter restrictions on private insurers to get rid of the competition and create a government-run health care monopoly. It was designed to put the private insurer out of business or so deeply regulate insurance companies participation that they in essence end up becoming a functioning part of the government. The next step is to put the private health-care provider out of business or in-service to the government. They’ll all be working directly for the government at that point, and no person will have a choice of provider or services.

The only real option to correcting this mess is getting government out of it. That’s obviously not going to happen with the current crop of geniuses scurrying around under the Capitol Dome in DC. Removing government from the equation isn’t really a high priority for lawmakers in Mississippi either, no matter what they tell you. This includes the spineless Republicans who are more adept at spouting talking points on the campaign trail than they are finding ways to put those points into action that accomplishes the goal.

The goal. Remember the goal?

It’s difficult to recall. The goal is always changing when politicians in service to government bureaucrats are involved. Better not to get too specific or else a whole lot of time invested in creating false narratives and sympathetic storylines might be for naught.

But if that doesn’t work, the media can always resort to their favorite play-call: insinuating that the advocates of unrestricted free-market solutions are racists who hate women and the poor.

  • Gerard Gibert

    Spot on. Good stuff. And Medicaid is the elephant in the room that is toxic to political discourse.