Sunday, January 29, 2023

Bill Crawford: Argument Against Medicaid Expansion Intellectually Dishonest

Among the flawed arguments made by opponents of Medicaid expansion in Mississippi is this one: Because Medicaid generally does not compensate hospitals enough for what it takes to provide the care, they could actually end up doing worse financially if the state expands the program to cover the working poor.”

That led off a remarkable editorial by the Greenwood Commonwealth which called an example of the above argument by Douglas Carswell, president and CEO of the Mississippi Center for Public Policy, “intellectually dishonest.”

“Every time a rural hospital treats someone on Medicaid, the hospital normally loses money,” Carswell wrote in an article he distributed. “How would expanding such a loss-making system improve the financial position of rural hospitals? It wouldn’t.”

The Commonwealth editorial pointed out that, yes, hospitals often do not recoup costs from Medicaid, but they lose far more by not collecting much of anything from those whom Medicaid expansion would cover. 

The Emergency Medical Treatment and Labor Act (EMTALA) adopted by Congress in 1986 requires hospital emergency rooms to accept and triage patients “regardless of ability to pay.” Federal funds were provided to help hospitals offset those losses until the Affordable Care Act which passed in 2010. ACA replaced those subsidies with Medicaid expansion. Mississippi did not expand Medicaid, so uncompensated care losses skyrocketed in Mississippi hospitals.

Evidence is clear that Medicaid expansion would greatly reduce those losses to levels most hospitals could manage. The Commonwealth editorial cited a case study regarding Ascension Health Hospitals provided by Russ Latino, now CEO of the Magnolia Tribune.

No doubt the Greenwood newspaper reacted so strongly to Carswell’s cavalier and deceptive argument because of the plight of its own hospital. Greenwood Leflore Hospital is on its last legs financially. Other Mississippi hospitals are not far from that status.

So who is this Carswell guy? In announcing his arrival as head of the Mississippi Center for Public Policy in January 2021 he cited as his background “twelve years as a Member of the British Parliament, and co-founder of Vote Leave, the official campaign that won the Brexit referendum.” 

Since taking over the policy center, Carswell has become a loud voice for the libertarian “economic freedom” ideology promoted the infamous Koch brothers. Perhaps that is why a number of policy nerds deemed the center as “the center for public propaganda.”

Intellectual dishonesty pervades the world of propaganda. Carswell’s piece on Medicaid expansion suggests the policy nerds may be on target.

“And you shall know the truth” – John 8:32.

Crawford is a syndicated columnist from Jackson


Anonymous said...

In other words, a man is better off having two fingers partially amputated than one. He still can't roll a cigarette, but two nurses are employed in the surgical unit instead of one.

Anonymous said...

Crawford is often oblivious to what the hell is even talking about... but this is time he's on the money.

Carswell is no Libertarian, and the Koch brothers spout Libertarian values, but are Communists in practice...they fully support amnesty for the 40 million illegals we're rapidly approaching because they want that cheap labor.

Anonymous said...

Only a Low-IQ socialist believes that more government money will save failing hospitals.

BTW, the European style socialist healthcare system is collapsing under the weight of tens of millions of economic migrants.

Anonymous said...

Bill Will Crawfish and like bolsheviks won't be happy til the workless own the hospitals by their predatory persistent demands of pity parties and free service.

A lifetime of work and earned advancement could enable many of these self impoverished to access group plan insurance which pays a negotiated fee for service.

Anonymous said...

@11:56 - source for your claim of collapsing European healthcare?

Anonymous said...

Our healthcare is collapsing. We need to figure out whether we will continue treating everyone or just the wealthy.

Anonymous said...

It’s sure keeping the hospitals open in Louisiana and other states that expanded.

Anonymous said...

1: It's not the purpose of Medicaid or any other health insurance plan to improve the fiscal position of hospitals.

2: If Mr. Crawfish wants some additional someones covered by insurance, perhaps he should buy them a policy. With his money, not mine.

Anonymous said...

What about all the money these hospitals have taken by charging insurance companies regular price for meds they can get at a reduced price? There's a government program for that.

Anonymous said...

Bill, regardless of the argument Carswell makes, your arguments (made relentlessly for the past four or more years) are disingenious. Medicaid is a "health" program, not a jobs program. Your argument about the economic impact of Medicaid expansion on small rural areas, the jobs that the (almost completely) government owned and operated rural hospitals that would be maintained; the necessity of having a "hospital" in these rural towns for other employers to locate or remain.

You ignore the purpose of Medicaid - which is a medical insurance program. Whether its your continuation of job development positions you have held over the past few decades, or your lobbying for the MS Hospital Association against your/their most unfavorite Governor, we don't know.

Mirrors are useful tools at times - you should try using one while you talk of other folks being disingenious.

Anonymous said...

I’m with Carswell on this-

Anonymous said...

Those of you opposed to Medicaid expansion: If you want to win someone over to your position, consider making a logical, well-supported argument. Cite facts, evidence, etc. Attacking Bill Crawford personally and spouting off about Marxist plots isn’t very persuasive. You do see this, right?

Anonymous said...

@11:59, are you really that stupid? Do you really think the working poor have access to group insurance? Medicaid expansion will help thousands of needy Mississippians.

Anonymous said...

Maybe I don't run in the right circles, but I don't hear the argument Crawford presents in this article too many times. The main argument I hear, and it's a good one, is where does the money come from when the Feds cut the funding.

When the federal dollars quit flowing, do we then tax the mostly poor people of the state more to cover the expansion of medical care?

Anonymous said...

Going back to colonial and pre Civil War days, Southern oligarchs have always made life hard for poor people. The oligarchs back then wished slavery could have been expanded to poor whites. (Read "The American Nations" by Colin Woodard) The tradition continues with modern Southern oligarchs like Tate Reeves and Philip Gunn refusing to enact Medicaid expansion.

Anonymous said...

Bill is spot on on this commentary. The mandate from the government that all who enter the ER are to be seen, with or without the ability to pay has put a huge financial burden on all of our hospitals. Any reimbursement they receive at least goes against their costs of care for these individuals. A portion of something beats nothing. This is a political football, being tossed around while our potential to take care of patients is quickly dwindling.

R. U. Shure said...

So, If the Koch Brothers are practicing Communists, where does that place Russ Latino, their former employee, who jumps from lily pad to lily pad on the pseudo-political commentary landscape?

Anonymous said...

Crawford doesn’t mention howMeducaid expansion will be paid for after your federal government quits paying for expansion

Anonymous said...

11:46, in addition to low IQ socialists, anyone proficient in math or accounting believes that more government money will save failing hospitals. The population Medicaid is intended for tends to use emergency rooms as their regular doctor and seldom have the ability to pay. The government reimbursed hospitals for treating those patients, and the system rocked along. Under Obamacare, that reimbursement took the form of Medicaid. If Mississippi expands Medicaid, it will simply put us back to where we were pre-Obamacare, when hospitals were able to survive while treating indigent patients. This is a real no-brainer, except for the fact Medicaid expansion seems to be a litmus test in Mississippi for how right wing you are. I’m right wing myself, but just not stupid enough to use that issue to measure my conservatism.

Anonymous said...

No Bill. It’s actually much simpler than that.

Two reasons why to reject it:

1) Once the federal government gives you something, they become your master. See highways funds.

2) When you give something away for free, it becomes worthless. The people that would benefit from this expansion don’t give a shit about their health or investing in it until they need professional help. Plus, healthcare is not a right, so if you want it, pay for it.

Anonymous said...

Why do all the doctors in Madison accept Medicare.

That means it does pay the bills.

Anonymous said...

10:43 - You jumped into the wrong boxcar. This is about Medicaid, not Medicare. There is a difference. Please tell me you know this.

But, to your point...Whether or not Medicare pays the bills for 'all doctors in Madison' is rather beside the point. The fact is people over 65 represent 80% of the patient population - Those who visit clinics and hospitals an average of twelve times a year. Do 'doctors in Madison' really want to reject that fact? Or that segment of their practice?

Anonymous said...

10:43- We are talking about Medicaid here. Pay attention.

Anonymous said...

They should add a special tax just for being a landlord, doctor, or lawyer. Then use that tax to pay for free healthcare.

Anonymous said...

Medicaid expansion has stabilized rural hospitals and is a huge success in Arkansas and Kentucky and Louisiana. With the federal matching rate, MS would get a 900% return on investment for the money invested. This money goes directly to hospitals and providers. Keep rural hospitals open. Keep our citizens healthier.

Anonymous said...

It's only a matter of time before Mississippi accepts federal money to allow those with incomes of 133% of the federal poverty level to access certain governmental healthcare programs - and avoid drastic medical debt when seeking medical care. A vast majority of other states have expanded Medicaid - why do we think we should buck that trend?

Anonymous said...

I'm surprised the naysayers haven't bothered with how it has worked for States that expanded and how things are going in the ones that didn't.

God forbid we do anything that actually works! We can't be pragmatic and practical!

And,Lord knows these same naysayers think that government money used to help communities solve real problems they lack the resources to fix what is broken is " communist". Nope, communism is when you force labor to fix it without adequate compensation and they aren't chosen based on merit skill. Communism is a form of thoughtless "group think" with slogans and buzz words so you can recognize your "group". Fascism works the same way. They both result in repression and eventually, a corrupt autocracy...everytime.

Without government money, Mississippi would have been 3rd world by now. Your Mississippi assets would have less value.

Mississippians on SSI and Medicare/Medicaid, think they are getting their " social security money back". Nope. Few of you never paid enough taxes to cover you monthly check and certainly not actual medical insurance costs as you age.

Good Lord, we are already rivaling 3rd world countries in health care and education and we are reducing our expected life span. But, naysayers don't wonder "why"? And, worse, you hate welfare " moms" but are bound and determined to create more of them with your policies.

I'm appalled listening to all the Naysayers whose family members would be living with them and not independently or in a nursing home if not for " welfare". They deny that their family members " social security" wasn't earned.

It's MATH!

It's also the policy that Nixon gave you to "reduce" welfare by paying it out of Social Security funds. But you naively believed he "cut welfare" costs.

That's what blind loyalty and deliberate ignorance gets you.

And, the fact more Mississippians than you imagine didn't get enough hours to be entitled to full Social Security benefits.

And, yeah, your boy Trump well knows that most of his followers are on "government assistance". That's why he keeps saying " Don't touch it!"

And I wish I had a dime for every Mississippian who doesn't think they are on "welfare" when they get their SSI or SS check or show their Medicare or Medicaid card. But they can rationalize and justify they "deserve" the money.

I guess such people don't know that no community can build it's own bridges or highways or even raise a barn anymore . I guess they would have been happy for all banks to fail in 2008 and for car costs to be even worse because we have no automobile industry if they weren't rescued.

But what you are ALL missing is your party loyalty will not immune you ,nor will your wealth. A philosophy allegiance with not make you immune. The crazies of both parties are the " have nots"...some are "have not be liked or admired" and have resentments. It's the unsuccessful, resentful, egotistical with nothing to show for it, delusional , criminals of every society who will be "the hordes" at your steps stealing your stuff and burning down what you built.

And, some of you think you can play " nice" with them and be immune. You think they'll be your "enforcers" and " protectors".

Your only protection is holding your elected officials to plans and results and knowing enough about how things work not to be bamboozled.

History proves that over and over as Lincoln pointed out " A house divided cannot stand". So yeah...he'd read centuries of human history. You might should try it. It used to be called " Enlightenment".

Anonymous said...

Here is the common sense layout. These people are going to end up going to the Emergency Room anyway because they don't have insurance and therefore do not go to primary care physicians. When they go to the ER the Hospital gets nothing reimbursed because these folks have nothing to pay. If you were running a business and were forced to provide a service and your options were not getting any money or getting 50% of your cost which would you choose. People saying this lets the Federal government run our state have their heads in the sand. This state is already one of the largest recipients of federal funds per capita in the nation, so we are already sucking at the Federal teet might as well get some more money to help our struggling hospitals.

Anonymous said...

I'm surprised the cheerleaders haven't bothered with how it has worked for States that didn't expand and how things are going in the ones that did.

Anonymous said...

So if Medicaid IS expanded in Mississippi? Can those whose private insurance has skyrocketed because we are paying for these lazy leeches, get our rates reduced and rebates?

Seems only fair…

Anonymous said...

January 30, 2023 at 8:34 AM, is this your first novella, and where will you set up for a signing tour?

Anonymous said...

I just want to make sure that someone pays for my insulin and my dialysis!
I will vote for anyone who promises to make that happen!

Anonymous said...

I will only support Medicaid expansion if it is modified to have quarterly BMI requirements and narcotics blood testing.
Basically, it’s dependent upon the recipient being forced to maintain basic person responsibility for their health.

Anonymous said...

I grew up poor by every spoiled American metric of today.

We had no health insurance at all and to this day, based on my Dad's reaction back then...I am certain that if I go to the Emergency Room for anything I will bankrupt the next 7 generations of my family.

I am still astonished at people who casually go to the hospital for a sniffle, get charged $800 for a Benadryl and just never pay.

I don't know what the answer is, but I think it is far more complicated than Medicare can address.

Anonymous said...

@354 the answer for those who show up for unnecessary ER visits is telehealth. how many visits could be avoided by a phone call with a dr? it is the most cost effective treatment and could free up er's for those in need of true emergency medical care and save our private insurors as well as medicaid, medicare and aca plans billions of dollars

Anonymous said...

Let's see...That's six posts, by the same poster, recommending Mississippi take a look at the states where expansion has 'saved rural hospitals' (as if that's a worth goal). Healthcare should not be about saving the jobs of hospital employees. That's not a function of government.

But, thanks to the Hospital Association for weighing in multiple times.

(Vote as often as you can. Help my daughter win the prize!)

Anonymous said...

5:58 you make a valid point and I am all for telehealth.

But I don't think telehealth would deter even 20% of the people who currently show up at the ER for a cold. They are not looking for alternatives. They are happy with being treated in the Hospital and they don't care about the cost.

Anonymous said...

@558 all insurance policies could be written in a way that incentivizes the insured to utilize telehealth vs an unnecessary er visit.
almost all of the comments only address the symptoms of the problem!
the problem is the system is broken and most are debating transferring the problem to the feds?!
Please, let's take the lead on this and address the problem!
You can visualize a telehealth kiosk in the hospital er's with a blood pressure cuff, oxygen readers. Quick connection with a phone or face to face call with a Doc!
The solution is right in front of us! We have the technology now!
If I am a Hospital Administrator there is no way I am putting up with the unnecessary er visits when I could qualify those visits via telehealth.
Furthermore, you could add a blood draw for a quick analysis to give the Doc's great information without wasting there time!
The heck with looking what other states are doing! Let's do this now and lead the way for the Country beacuse we can't afford the medicaid / medicare mess we've created!

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Trollfest '07 was such a success that Jackson Jambalaya will once again host Trollfest '09. Catch this great event which will leave NE Jackson & Fondren in flames. Othor Cain and his band, The Black Power Structure headline the night while Sonjay Poontang returns for an encore performance. Former Frank Melton bodyguard Marcus Wright makes his premier appearance at Trollfest singing "I'm a Sweet Transvestite" from "The Rocky Horror Picture Show." Kamikaze will sing his new hit, “How I sold out to da Man.” Robbie Bell again performs: “Mamas, don't let your babies grow up to be Bells” and “Any friend of Ed Peters is a friend of mine”. After the show, Ms. Bell will autograph copies of her mug shot photos. In a salute to “Dancing with the Stars”, Ms. Bell and Hinds County District Attorney Robert Smith will dance the Wango Tango.

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