Medicaid: Out of Control

By Senator Brent Hill

When a small number of cells in an otherwise healthy body multiply without control, healthy tissue is destroyed and survival of the whole body is endangered. The condition is called cancer.

When a small number of programs in an otherwise healthy government multiply without control, the condition is called Medicaid.
Over the past fifteen years, expenditures from Idaho’s General Fund for Medicaid have increased 935%. A program that made up 5% of the state General Fund in 1990, now consumes 14%.

Medicaid was established in 1965 to fund medical and health-related services for people with limited income. (Not to be confused with Medicare, the national health insurance program for the elderly.) Since that time, many low-income Americans have come to expect a level of health care denied by even the most robust health insurance plans. With no deductibles or co-pays, Medicaid recipients have their medical services paid for by others.

Like a cancer, Medicaid continues to eat away at the state’s budget, leaving fewer funds for public education, economic development and public safety. This year, Medicaid expenses in Idaho will exceed $1 billion. The trade-off is unavoidable: other important government services will suffer as the cancer grows. So far, the Idaho Legislature has refused to face the harsh inevitability of setting the following limits and priorities:

1. Establish Co-Pays. People will always over-consume free goods. Co-pays utilize the market system to discourage marginal care. Yes, it may discourage some isolated cases of needed care, but the trivial use of our over-crowded emergency rooms by those seeking free care must be curtailed to improve access to those who truly need medical attention.
2. Set Limits. Costs can be contained by limiting the number of visits or the amount paid annually for certain services. A professional clinical review to determine the necessity of certain services could avoid unnecessary and expensive medical procedures.
3. Review Services. Although many Medicaid services are mandated by the Federal Government, over half of our Medicaid costs are the result of optional services added by the Idaho Legislature during more “prosperous” years in the past. Since taxpayer monies fund these add-on services, each program must prove its worth among all competing social needs. Good intentions must be grounded in economic reality.
4. Define Public Policy. There is more to health than health care. Research indicates the primary determinants of health are factors such as education, income, nutrition, sanitation and working conditions—not medical care. Public policy can save more lives more economically than many of the costly technologies with which we fill our hospitals. A drunk-driving bill is health care. Idaho’s Clean Indoor Air Act that prohibits smoking in public places is health care. Campaigns against smoking and obesity can save more lives than tripling our expenditures for Medicaid.
5. Demand Self-Responsibility. We are our own best doctors and cannot expect society to cure the consequences of all our self-imposed illnesses. Government cannot be expected to always come to the rescue of those who have abused their bodies with drugs, alcohol, tobacco, irresponsible sexual activities and other unhealthy indulgences. All modern health care must be founded first on self-responsibility.

These reforms represent only first steps in our therapy against the malignant growth of Medicaid. But treatment must begin if we are ever to be cured.

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