My view: Charity cannot replace Medicaid expansion

By Raymond Ward

For the Deseret News

Published: Tuesday, Dec. 24 2013 12:00 a.m. MST

Senator Allen Christensen ("Medicaid expansion forces charity," Dec. 17) said that Medicaid advocates believe “the government can fix everything by throwing money at it,” and “have forgotten that government money comes by taking it from someones pocket.” I understand that every tax dollar spent is a dollar taken out of my pocket, but it is clear that government can accomplish some important things by taxing their citizens and spending the money wisely. Those of us who support the Medicaid expansion believe that the government can also (and should) set up a program to arrange for basic health care for the poor. This is not a strange idea. Medicaid already provides basic medical services to poor children and pregnant women and the disabled, and while far from perfect, it provides better care to them than they would get if we left them without coverage.

My friend Sophia has brittle diabetes. She works full time in a small dental office, which does not offer insurance. She is a single mom with two children. She earns $18,500 per year, and spends $14,000 on health insurance premiums, co-pays and medication costs. She survives because her parents allow her to live in their small home rent free and help with other living expenses.

I have a patient Michael who has Crohn’s disease, but no insurance. His intestines have eroded through his abdominal wall, so he has 4 holes out his side which are very painful and ooze feces mixed with pus all day long. I can see him for free, and write him prescriptions for pain pills and antibiotics, but I cannot get him what he really needs, which is a gastroenterology specialist to get the IV treatment that would stop the disease, and a surgeon to repair the holes in his abdomen. I have tried unsuccessfully to get these services on a charity basis.

With these two real life examples in mind, let me ask the same question that Senator Christensen posed in his column: “Where is the line of personal responsibility?” Just what “personal responsibility” is he asking Sophia and Michael to show? Taking personal responsibility for your own health means making healthy lifestyle choices, getting preventive care to stay healthy and taking your treatments correctly if you have a chronic illness. If a person can’t get access to the medical care they need, how is it possible for them to “be responsible”?

He said if we expand Medicaid, "A huge portion of the money will go for administration.” That isn’t true. Our Utah legislators frequently remind everyone how efficient government in Utah is, and in this thing they are right. Administrative costs for Medicaid are about 7 percent of the total, compared to 15-20 percent in the private insurance market.

Every other industrialized nation provides basic health care to their poor and starting in two weeks our neighbors Colorado, New Mexico, Arizona and Nevada will also provide basic health care to their poor by expanding their Medicaid programs. It just isn't believable to say that all of them are “On a one way dead-end street.”

No one is saying “This is free money from the government.” We are saying 90 percent of the money to fund this program has and will continue to be taken from us in federal taxes that were raised starting last year. We can have that tax money leave our state and get nothing for it, or the Legislature can find a workable Utah solution to expand health care coverage to the poor and get that money back. It doesn’t even have to be Medicaid to provide the coverage. Other states like Arkansas and Iowa have found ways to go through private markets and unique state programs to get the federal funds back and provide the needed medical services, and Utah could do the same if the Legislature would choose to.

I hope they will.

Raymond Ward is a doctor at Cope Family Medicine in Bountiful.

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