Gordon Morse: Health care and all its choices | Guest Columnist

U.S. HEALTH CARE reform tanked again this past week, and has this been going on forever or what?

Don’t tell me about President Donald Trump. He has his issues, his administration its flaws, heaven knows.

But this is vastly more about “us” writ large than any passing occupants of the White House.

As a people, we like each other well enough not to wish harm to befall our countrymen. We would not have them suffer pain or be left helpless in the streets, victims of some accident, disease or unforeseen malady.

But are we ready and prepared to foot the bill for that deeply heartfelt sympathy?

No way.

None of this is new. I recall writing turgid, detailed editorials more than 30 years ago on the subject of DRG’s — “Diagnostically-Related Groups” — as part of an early effort to rein in the costs of Medicare by systematically organizing the things that can go wrong with your person.

Once we had this all tidied up, you see, we could then align our resources against the more demanding, expensive issues and get a grip on things.

Or so the theory went.

As a practical matter — this is the highly simplified, truncated version — the health-care industry learned how to game the system, thereby steering patients toward categories that had the equivalent effect of hitting three “7’s” on a Vegas slot machine.

Money. You may be busted on your back, flattened by a steamroller, but someone at that moment is calculating how to either profit off you or keep their health care facility from taking a loss.

The center of attention for Virginia government remains Medicaid, which adheres to federal standards but gets substantially funded through the state budget.

Medicaid keeps growing. About 11 years ago, Medicaid absorbed less than 14 percent of the commonwealth’s general funds. Now it takes up more than one-fifth. Only K-12 education funding demands more.

Leading Republican lawmakers in Virginia have confronted proposals to expand health-care coverage, via the Affordable Care Act and Medicaid, with a straight-forward position: No.

The long-term uncertainties, thanks to the uncertainties of Congress, argue against it, GOP legislators say.

Democratic Gov. Terry McAuliffe has an equally unadorned position, perhaps best expressed by Zero Mostel in “The Producers:” I want that money! He sees the poverty-driven need, in rural areas especially, and that seals the argument.

These two positions glare at each other over an ideological, partisan divide. Yet both also enjoy a valid point of view. That’s why this stuff is so hard to resolve.

Should Virginia be concerned about Medicaid’s demand on the state budget? While Washington covered about half of Virginia’s Medicaid program in fiscal year 2016, the state still spent more than $4 billion in general funds.

Answer: Yes.

Good grief, at some point you have to acknowledge that Medicaid is squeezing out funding for other vital priorities, including higher education, K-12, public safety and corrections.

On the other hand, might Virginia lawmakers have been a tad more clever and creative in the crafting of a “Virginia alternative?”

You do not want to minimize the challenge of doing that, but other states attempted that approach, and Virginia might have profited by their example.

It still could.

Here’s another problem. It’s always hazardous to risk predictions, but it seems highly likely that as we struggle to resolve health care and its costs, America will finally realize that personal responsibility seldom factors into the debate.

This is the part closer to home, the part that involves living life in ways less likely to elevate the risks of disease and disability. You know, when you stop hanging everyone else with the costs of your lousy choices.

Burrow down into the details of Virginia’s Medicaid program and you find that 36 percent of the cost gets taken up by 10 percent of the recipients.

The common denominator? Heart disease, with diabetes following.

There are ways to avoid both of those disasters, and we all know what they are.

Is it possible that the threshold for medical care could be narrowed on the basis of personal lifestyles?

It’s already happening. All you have to do is read the news about the opioid crisis. The same people are being resuscitated over and over again, and the costs of that care keep getting higher and higher.

Ergo, restrictions are being debated and considered

The prediction? Such a manner of thinking will gradually, but steadily, move toward other personal choices and the relative risks involved.

Gordon C. Morse wrote editorials for this newspaper in the 1980s and was former Gov. Gerald L. Baliles’ speechwriter.


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