EDITORIALS

Yes, trust — but verify

Don’t sign on the dotted line yet

THE SELF-celebration was hard to miss as the Ledge began its crowded week Monday. For example, here was Davy Carter (R-Enthusiasm), speaker of the House and bipartisan cheerleader in general, throwing verbal confetti:

“Members have taken what arguably was a terrible hand of cards that has been dealt to us by the federal government and . . . turned it into what I think is something good for Arkansas . . . the best-case scenario that I can envision . . .” and so happily on.

Mr. Carter’s counterpart over in the state Senate is the Hon. Michael Lamoureux, president pro-tem and now pro-Medicaid expansion. He was playing Tweedledee to Davy Carter’s cheery Tweedledum. And a good time was had by both.

It seems the “private option” for Medicaid has swept away all their previous reservations, like some kind of universal solvent for even the toughest problems. Call it political penicillin. And its discovery has got both Republican leaders jumping for joy. (The gentlemen might want to curb their enthusiasm a wee bit, or they won’t have any words left for the Second Coming.)

What’s in a name? Lots when the name is Private Option, which promises to give folks on Medicaid the same level of care as the paying customers with private insurance.

For years now—it seems like aeons—Medicaid’s clients have been short-changed, as every objective study of their treatment confirms. They have longer waits and poorer outcomes. Many doctors have decided they can’t afford to accept Medicaid patients at all—with fatal results now and then. Having mined the medical data, some researchers have trouble finding any significant difference between Medicaid’s “beneficiaries” and people who have no health insurance at all.

But, boy, just say the magic words Private Option and—hesto presto!—the gap between private and public patients will disappear. Or as Messrs. Carter and Lamoureux now have assured us, the Private Option will be good for Arkansas’ hospitals, insurers, taxpayers, and maybe even for patients.

AH, YES, the patients, who are now known as “consumers” of medical care, and whose welfare tends to be the last and least of considerations in all these great plans. Except, of course, for the physicians and nurses, the real healers, who will still have government bureaucrats, or rather government forms, telling them how to treat how many patients/units per hour.

But the state’s Medicaid lobby, with politicians now attached, will be happy, and isn’t that the important thing? With the coming of the Private Option (even if it turns out to be a front for one more public program), the Millennium will have arrived. Happy times are here again! Why, even the stout Republican firm of Carter & Lamoureux is hopping aboard the bandwagon called Medicaid Expansion.

All of which makes us wonder if either of these esteemed gentlemen have read the little ol’ memorandum out of Washington issued just in time for Good Friday under the broad aegis of the secretary and grinch-in-chief of Health and Human Services herself, the Hon. Kathleen Sibelius, who has this habit of raining on every parade in her immediate vicinity—and some as far away as Arkansas.

A perusal of the memo’s small print reveals that the state’s neat plan to just transfer Medicaid patients into those miracle-working insurance exchanges to be set up under Obamacare may have a few cracks in it. Indeed, our much vaunted Private Option here in Arkansas, like so much of Obamacare in general, may have more cracks in it than options. Do you think anybody in the Ledge has seen, let alone studied, this latest memo out of Washington? The business nerds at Forbes.com have, and here is their spoilsport conclusion:

The HHS Good Friday memo maintains this insistence on preserving Medicaid’s wasteful design. “States must have mechanisms in place to ‘wrap-around’ private coverage,” HHS writes, “to the extent that . . . cost sharing requirements are greater than those in Medicaid.” What this means in practice is that the kinds of plans that insurers will offer on the Obamacare exchanges—which will be able to use tiered co-pays and other instruments of modern health insurance in order to drive cost-efficient care—will not be available under the faux-exchange plans that Obamacare assigns to the Medicaid expansion population.”

OOPS. That whoosh you hear is the air going out of any hope that the Private Option could be truly private. A real private option for states wrestling with how to administer Obamacare is still an admirable goal even if it’s not yet the cure-all advertised by its original promoters. And by these latest high-ranking converts to the plan in our newly Republican legislature. Alas, when our governor said the Private Option made the debate over expanding Medicaid “a whole new ballgame,” he seems to have overlooked the possibility that it could turn out to be just one more sucker’s pitch.

But don’t give up hope. Every time those Republican skeptics in the Ledge have bargained for a better deal out of Washington, whad’ya know, they’ve been offered one. Two cheers for the Ledge! For progress has been made. But why stop now? Or as an old negotiator of some note named Reagan once said, in Russian yet, Trust But Verify.

There’s no reason to grab this latest offer, complete with strings attached, without asking some pertinent questions. No matter what the high-pressure salesmen say. And, yes, we’re talking about you, Mike Beebe, and you, Joyce Elliott, state senator and Democratic apparatchik. Congratulations on your roping Messrs. Carter and Lamoureux in on this newest deal, but they don‘t have to stay roped. If the people of Arkansas are going to buy this pig in a poke now labeled Private Option, let’s not buy the poke, too. Instead, let’s take another good, hard look at this “bargain.”

Besides, the administration keeps pushing the deadline back for states to set up these exchanges and making its requirements for them less and less onerous. As if it were conducting a fire sale. And why should that surprise? The feds are pushing a product lots of Americans don’t much want to buy, namely Obamacare.

Nor should it surprise when Washington proposes a two-tier (or more) system of benefits for patients, discriminating between those who can afford private medical care and the hoi polloi who can’t. It’s happened in country after country that has experimented with government-issue medicine.

One source says Washington will put off the deadline for establishing these exchanges till 2015, beginning with 33 states and then going on to the rest. So why is the Legislature rushing to set up these exchanges by the start of 2014? The longer we wait, the better the deal gets.

Anyone who’s thought about this whole complicated deal will surely recognize the best and safest course at this point:

Think some more.

Which is never a bad plan.

Editorial, Pages 14 on 04/04/2013

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