Medicaid and Rational Rationing
Medicaid is supposedly for poor people, those who are destitute. It seems a nice enough idea, that even those with no money can still have access to basic medical care. Unfortunately, that is not what is actually going on. Because of the ways the ideal has been distorted by those who know how to game the system, Medicaid is also for the well off, even the rich.
A recent story on NPR, also available on Kaiser Health News, tells us that the CEO of a children’s hospital has her child’s health care paid for by Medicaid – the taxpayers.
Medicaid has certain monetary qualifications, basically you have to be broke to qualify. So how does the child of the CEO of a hospital qualify, well, the child has no assets, even those she is the child of those who are well off. By that definition, 99.9% of the children in the United States qualify for Medicaid. Is this what was intended by Congress and the people in trying to help the destitute? One can hardly think so. Even worse is how the system has been abused by this particular family.
Katie Doderer was born with a very unusual condition – she couldn’t breathe. In her first year of life her medical expenses topped $1,000,000. If she was the child of a couple with their own insurance, they would have had to make some hard decisions. Katie probably would have been allowed to die. Since her mother knew how to game the system, the taxpayers paid for Katie, because her mother and father didn’t want to risk her own lifestyle just to keep a child alive. What a deal!
Let me be perfectly clear here – everyone dies. So anything done to “save” a life is actually only done to extend it. Katie Doderer’s life is worth millions to her parents, so long as they can get someone else, the taxpayers, to pay for it. But there is a problem here. There are only so many Medicaid tax dollars to go around. If Medicaid spends $1,000,000 on Katie, that is $1,000,000 that is not available to 1,000 others whose health could be vastly improved by the expenditure of $1,000 per year. These are the choices we are already making, whether you, the taxpayer, know it or not. People talk about “death panels” but insurance companies already make those type decisions and the government will and does already. There is only so much money to be spent, and if a large portion is spent on one person, then it is not going to be available for others. These are the type decisions which
will have to be made.
Currently, as the Doderer’s have shown us all, those who are well connected, politically or otherwise, will get better care for themselves and their families than is available to the average person. This is what happens when government becomes involved. Who you know and what you know will get your life extended while others die.
Let me not just pick on the Doderer’s. There are others, many others. There are lawyers who make too much money by suing the government to get more health care for their clients. Judges, those paragons of (in)justice decide in favor of the plaintiffs using this logic “I can’t in good conscience say no to spending the money, even though my decision is at odds with the law as written”. There are people on Medicaid who have better medical care than those who work and purchase private insurance.
So the question lingers: how do we decide who gets the benefits of the
taxpayers largess? If it is for the “general welfare” then why is it
that only some of the people benefit while the many pay?
There is not enough money to pay for all the health care everyone
wants or needs. There are limits. The question is how to determine
those limits. So let us start here.
Everyone dies. Life is not about health care, but about living and the
survival of the species. Some would have us believe that everything
possible to medicine be done for each and every person. Others are
more practical; there are limits to how much we should spend. Should
the general population suffer so that a few might have their lives
extended a few years? Should those who are well off be subsidized by
those who are not? Should a child be defined as destitute when their
parents make $250,000 a year or more?
Unfortunately our history distorts our thinking. One hundred years ago
and more, doing everything possible for someone meant keeping them
comfortable or amputating a limb with the benefit of a strip of
rawhide between their teeth. It was not expensive, just time
consuming. Today, we can spend millions to keep someone 80 years old
alive another few weeks. We have heart transplants and plastic
surgery. Medicine can be expensive. But should our entire economy be
focused on that? More importantly: why should those who are well
connected get better care and financial considerations than those who
are not?
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