Medicaid

St. Louis Post-Dispatch

We Americans ... like to believe we all have the same opportunities. That is a fiction, of course, especially when it comes to health care.

For the working poor in Missouri, medical care is not free -- even if the patient herself gets it for free. One way or another, for every man who can't pay for his gall bladder surgery, for every uninsured asthmatic who makes a midnight trip to the emergency room, and for every working single mom who waits months and months to get a suspicious lump checked, the cost to the rest of us goes up.

When the state legislature cut 90,000 poor Missourians from the Medicaid rolls earlier this year, the cost of their care did not simply evaporate; it effectively was passed on to the rest of us in the form of increased insurance premiums and higher fees for services.

Medicaid is just one small part of a much larger problem in health care in the United States. ... Politicians in Missouri and elsewhere like to talk about Medicaid in isolation. ... Perhaps that's because it's easier and more politically acceptable to scapegoat the poor ... who are threatening to bankrupt state budgets.

... The overall cost of Medicaid has ballooned because fewer businesses offer health coverage to their workers. Most people who get Medicaid and the overwhelming majority of those without health insurance are from working families.

The problem isn't just Medicaid and its costs, it's the cost of health care, period, and the fundamental conflict that underlies every doctor-patient interaction. ...

In Missouri, GOP legislative leaders have argued that by slashing Medicaid, society will save money because state taxpayers won't be saddled with poor patients' bills. ...

Those who see health care as a privilege also often argue that it's immoral to appropriate the fruits of one person's labor to provide a benefit to another. ...

But we already ration health care in this country: Try getting a heart transplant without health insurance. And we use tax money to care for our elderly. ...

By cutting Medicaid, we just shift those costs onto hospitals and clinics. They recover their expenses mostly by charging more. Insurance companies pass extra costs along. That raises the cost of insurance, putting it farther out of reach for people who would otherwise buy it. The results are increasing numbers of uninsured. ...

We could recognize a right to health care and provide everyone ... with access to basic health care services. That would allow us to focus spending on prevention and other, more efficient, forms of care. ... There is no excuse -- moral or economic -- for doing otherwise.