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 V.17 No.18 | May 1 - 7, 2008 

Ortiz y Pino

What are We Paying For?

In recent weeks I have been reminded over and over that what is usually billed as our “health care crisis” has a lot in common with our “education crisis” or our “mortgage crisis”that is, it is yet another situation resolvable by the simple expedient of throwing bushel baskets of money at it. In this light, the essence of such social dilemmas is purely financial. We have an answerall we lack is the wherewithal to pay for that answer or the guts to write the checks (or to hock our kids’ future).

Thus, the president, ostensibly a “fiscal conservative,” chooses to respond to the abuses of the subprime mortgage fiasco by shoveling a mountain of cash onto the fire, bailing out (with the next generation’s inheritance, not ours) the very perpetrators of the mess.

And in New Mexico, confronted by appallingly low graduation rates, we are supposed to suspend disbelief and accept the assurances that all will be made well by digging deeper into our pockets to pay teachers more … the same teachers who are working in the schools that generate those dismal results.

The reason the Occupation of Iraq will ultimately cost U.S. taxpayers in excess of $3 trillion is that we are waging it according to that same marketplace dictum, the one we use for every conceivable situation: Just throw a couple billion more dollars at it every week until it improves.

I wonder if the “crisis in health care” might be yet another in the long series of manufactured opportunities for America’s corporate geniuses to siphon off a few billion of the public’s money. Two recent experiences have aroused my cynicism about the reality of this “crisis.”

During the six years since Bill Richardson became governor, the amount of state dollars going into the Medicaid program has soaredhas, in fact, more than doubled. It is now just under $800 million and was at $365 million annually when Gary Johnson left office. This year, the Legislature tacked on another $91 million to last year’s level. When you add in the generous federal matching funds (at our three-to-one ratio, the best deal in government financing imaginable), the full Medicaid budget, state and federal, for next year will come to $3.3 billion. The last Johnson Medicaid budget was less than half of that.

Unfortunately, the number of people covered by that enormous increase in spending has not exactly grown commensurately. Would you believe their numbers have grown by less than 2 percent a year? Let me recap for you: We are now spending $1.7 billion more than we were just six years agoand we are serving (at most … the census fluctuates each month) 20,000 more people than we did in 2002.

That’s a great example of two things: how we attempt to solve problems by writing bigger checks for the same things we’ve been doing all along, and how extremely lucrative the Medicaid business is for corporate medicine. Not doctorscorporations; the companies that contract with the state to run the Medicaid program ... into the ground.

Here’s another example. This one has nothing to do with public expenditures but shares the underlying principle. Assisted living facilities are booming. They are business opportunities with a capital O. Only private money is involvedfrom elderly people with at least $50,000 a year to throw at their problem (most are women; a lot of men are gone by the time assisted living becomes an attractive option).

The typical assisted living customers are having a hard time keeping up their homes; they're tired of rattling around in lonesome houses much too large; they aren’t able to cook or shop for themselves easily but are otherwise pretty independent. They don’t need a nursing home (with its state inspections and regulation); they just need a form of congregate living in which they have their own apartments but share a common dining area where meals are prepared for them.

For this they usually pay “rent and board” of $3,600 to $4,000 per month, right around $50,000 a year with a few extras thrown in. But these are for-profit operations with shareholders to take care of. The residents are simply the raw material to be churned into gold. Too much “care” provided cuts into the bottom line, so not much is given. And the rent increases with pendulum regularity, jumps far higher than the cost of living adjustment blips. The residents usually pay the added toll … where else can they go? They may have sold their house to afford the facility in the first place. They lose their deposit if they move. And there is no appeal. Take it or leave it.

Both the Medicaid cost explosion and the plight of the assisted living clientele squeezed to generate dividends for stock owners are symptoms of what truly ails this society: We have made a business of literally everything, cradle to grave.

There ought to be room for caring, for real help, real care even when there is no profit to be made. That’s not revolutionary; that’s the way it used to be done in societies that placed greater value on how we treat one another than on how much we are paid.

Our health care financing “crisis” would actually be best dealt with, in my opinion, by figuring out how to provide more caring, not by providing more and more financing for the same wretched level of care.

The opinions expressed are solely those of the author. E-mail jerry@alibi.com.

 

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