He Went That-a-Way


Today’s news gave me the opportunity to view two competing views of reality.  The headline at the top of Page B1 of today’s Plain Dealer was “Hospitals keep leaning on lawmakers over balking at Medicaid expansion”.  It took two reporters and over 30 paragraphs to clearly explain why hospitals around the state were pushing to have the Republicans in the Ohio House reconsider their decision to kill Ohio’s participation in the program to deliver health care to the poor.  Dr. David Bronson of the Cleveland Clinic’s executive board and Robin Bachman, assistant vice president for government affairs and public policy at Sisters of Charity the nonprofit Catholic system that operates St. Vincent Charity Medical Center, seemed to completely understand how the Medicaid expansion would work and benefit their hospitals.  The Speaker of the Ohio House, William G. Batchelder (R-Medina), wasn’t as clear. “I have never seen anything as confusing as this situation,” said Batchelder. 

It was easy to understand Batchelder’s confusion.  His governor, John Kasich, had crossed the big red line and agreed to expand Medicaid, a key part of the Patient Protection and Affordable Care Act (PPACA).  Republicans are supposed to block Obamacare, not implement it.  Worse, the Hospital Association and the Ohio Chamber of Commerce are also OK with the expansion. 

There was one guy, two pages away on Page A7, who was not confused, who is never hampered by either indecision or second thoughts, and who was totally prepared to stay the course.  Kevin O’Brien, the Plain Dealer’s representative from the Right and resident scold, KNOWS the answer.  Unconcerned about budgets or deficits during the first six years of the Bush presidency, Mr. O’Brien now appears to spend a great deal of his waking hours tinkering with his own, personal, federal debt register.  Accepting the expansion of Medicaid “would do nothing more than move some of Ohio’s hospitals a few places farther back in the line of institutions and practitioners destined to starve to death under the federal bureaucratic yoke if Obamacare remains the law of the land and produces the single-payer, government-run health care by utterly destroying the insurance market, as it is designed to do.”   

Even when we agree, we disagree. 

This blog has contended for three years that we are marching towards a single-payer type system.  I am not a fan.  Never have been.  But, that doesn’t mean that we will have bodies on the streets, abandoned hospitals, and shuttered clinics.  I’m not even positive that any BMW dealerships will be forced to close. 

We can’t have a conversation if we don’t lower the volume. 

The online Crain’s Cleveland Business released an article this afternoon about MetroHealth’s position in this fight.  We are paying for the care Metro delivers.  We pay in higher insurance rates and higher taxes.  In an effort to take a stand against the President, Speaker Batchelder may have, accidently, destroyed a program that was funded entirely by Cuyahoga County and the federal government.  The article explained why Metro is so concerned.  “Expanding Medicaid to cover more of the county’s poorest residents –who typically are the most expensive to treat because they often use the emergency room for routine care or have neglected medical needs – is expected to help buoy MetroHealth’s finances.” 

So will Medicaid be expanded in Ohio?  I think so.  It will be a bit of a slog and the horse-trading may be unpleasant, but I think it will get done.  And once again we are all reminded that the national health care debate is not about health care.  Never was.  

The issue is money.  Who is going to pay our medical providers?  And once that is settled, we might tackle How Much?

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