Help less fortunate, expand Medicaid

By Jack Bernard and Neil Shulman
The Atlanta Journal-Constitution, May 30, 2013

In a fruitless effort, the radical Republicans in the U.S. House of Representatives have once again pushed through a repeal of “socialist” Obamacare — for the 37th time. This is partisan politics at its finest, since Obamacare is simply an update of Romneycare, a thoroughly Republican concept based on private insurance first introduced by former Republican presidential candidate Bob Dole in more reasonable times.

As health care professionals with many decades of experience, we do not believe that Obamacare (the Affordable Care Act or ACA) is the best solution for our ills. Although it will not provide insurance for all Americans, it is at least a move in the right direction regarding access — especially if Republican governors like ours stop playing politics and accept the federal money to expand Medicaid.

We cannot just let our fellow citizens suffer, expecting the free market to miraculously change and take care of the problem of the uninsured, as has been proposed by Reps. Paul Ryan, Paul Broun and others. The percentage of uninsured has risen drastically in the U.S. and even faster in Georgia, where 22 percent of the population is uninsured.

Here are two examples of how the current system simultaneously mistreats patients while wasting money — problems that can be alleviated by immediate Medicaid expansion:

• A woman graduates with huge college debt, getting a job as a waitress with no health insurance. A pimple on her skin turns dark. She goes to an ER, where the doctor tells her to see a dermatologist. Because she’s broke, she applies to Medicaid, which sends her a letter stating that she is ineligible; she has to be even poorer or disabled from her disease. The cancer spreads and, six months later, she is admitted to a hospital on Medicaid. After $100,000 of health care, she is sent to hospice to die. She is 29 years old.

• A 47-year-old security guard is admitted to a hospital with severe shortness of breath and elevated high blood pressure. Within three days, he is discharged, with $68,000 in medical bills. His doctors know that his blood pressure will zoom back up without the needed blood pressure meds. However, he has no money, and the hospital is not required to give him meds, so he doesn’t get any. He is sick, exhausted and alone. His blood pressure zooms back up, and he bleeds in his eyes, becoming blind. Now, he is disabled and eligible for Medicaid.

In the words of the civil rights leader Philip Randolph: “A community is democratic only when the humblest and weakest person can enjoy the highest civil, economic and social rights that the biggest and most powerful possess.”

We must choose what sort of a nation we will be: a country of compassion, or a Darwinian society in which the strong ruthlessly trample the weak. If we Americans view ourselves as the moral beacon of the world, then we must take care of the less fortunate here at home. In the short term, we must fully implement Obamacare, including expanding Medicaid. Longer term, the most effective solution is Medicare for all, not just those over 65.

Jack Bernard, a Republican from Jasper County, is a retired senior health care executive and was Georgia’s first director of health planning. Neil Shulman is associate professor of medicine at Emory University Medical School.

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