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Health care needs a backbone

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I watched Brad Little and Paulette Jordan debate on a Boise TV channel. You could catch it online. It was clear to me Brad knows healthcare issues, but I’m detecting some bad symptoms in his approach. It’s a big issue, Idaho healthcare, and Brad will need some backbone, heck we all will, if we are going to get to work on it.

Here’s the first symptom: Brad can’t even say whether he thinks Prop 2, expanding Medicaid insurance is good or bad, just that he will “respect the will of the people”. That’s a sign of a politician wanting cover for doing something that might make some of his constituents unhappy. Expanding Medicaid coverage as Prop 2 will do is just one small step of many steps that will need to be taken. I have diagnosed a weak backbone. And I’m not a chiropractor.

But Brad does understand that the individual market on the Idaho Exchange is not functioning. He points to solutions to reduce premiums for young healthy small business people. His solutions carve up the marketplace, so people not expecting to get sick can pay less. Well, when they get really sick, they won’t have coverage. Brad’s OK turning the marketplace back into a roulette game by abandoning the requirement for “essential benefits”. If we (Idaho voters) aren’t all in this together, his plan will have us playing Russian roulette, not just the spinning casino wheel game.

Little has also embraced the plan to move really sick people with expensive diseases (advanced cancer, organ failure, systemic disease) out of the individual market and onto Medicaid. 90% of health care costs come from only 5% of the population. This sort of cost segregation in the health care pool has long been known to be an effective method to reduce costs. For private insurance companies, after they couldn’t exclude pre-existing conditions, the problems came in the numbers and the geography. If the model is to pool these high-cost folks from different insurance companies onto a government plan, managing more with more leverage, maybe there could be some savings.

Do you trust that the government will fund this program, good times or bad? Diseases don’t fluctuate with tax revenues. That sort of public commitment will take a very healthy backbone. Can Brad’s get stronger?

This last proposal clearly leads one to think of a single payer plan, so I’m surprised Brad Little and Department of Insurance Director Dean Cameron are suggesting it. Maybe they think we won’t see the logical progression. If their goal is just to segregate the very sick, and they expect this model to hold fiscal water without a clear public commitment, they are being either short sighted or cruel. Knowing both these men well, I’m diagnosing nearsighted.

Brad Little’s nearsightedness and weak-spine on Idaho healthcare are correctable. What about his opponent, Paulette Jordan? She displays no understanding of the complex issues and is just trying to ride the populist wave of Prop 2. I’d much rather deal with a patient who wants to understand and work on their problems, than one that is oblivious of them.
 

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