Prop 2: There are actually 3 choices

The people of Idaho will soon be voting on whether to offer the medical care available under Medicaid to the 62,000 fellow citizens who are not eligible now for assistance, and who will never be able to purchase useful insurance on their own. I have heard many arguments for and against this based on several philosophical creeds, but as a physician who has struggled with these issues for decades, I think that in practical terms it boils down to just three options.

First, we could let these individuals and families fend for themselves, and get medical care only if they can afford it. We have to be clear, though, that this would mean worsening illness and even death for many of them. This is not an exaggeration. I have seen it. This “solution” does not seem acceptable to me or to most of us, even if not paying for insurance were a choice rather than an unavoidable necessity. Almost all of the 62,000 affected are already working one or more jobs or are unable to work, and would buy insurance if they could. Anyway, we have already decided as a society that we aren’t willing to let sick or injured people die if they can’t afford care.

We have always decided, and I think and hope always will, to help at least by the point when life is threatened. In that case, if patients aren’t among the minority who get help from private charity (which can’t or certainly won’t cover all those in need), their care is partially paid for by a patchwork of sources. Hospitals and providers give a great deal of deeply discounted or free services, which leads to higher charges and premiums for those of us who can pay since this is the only place to make up the losses. In Idaho, counties and the state have “catastrophic funds” to pay for some of the costs. These are funded by local taxes, and the expenditures are huge. This is the current system, option number two. The problems are that we are already paying for the care of these citizens, but in a way that is much more expensive than if they had comprehensive insurance, since we help only when the illnesses are severe, though most can be treated earlier for less cost. And, we are paying twice, since we’ve already contributed to the Medicaid fund with federal taxes which we are choosing not to get back for our people, in addition to the local taxes for the catastrophic fund.

The third choice is to accept the Medicaid monies which have been offered to us for many years and which we have already paid for and will continue to pay for in federal taxes, and which would allow us to stop paying most of the local taxes for the catastrophic funds which are often applied too late anyway. Our cost would drop dramatically and our citizens would receive earlier, better, more appropriate, and less costly care. This is what Proposition 2 offers us.

Reasonable people may object to this solution in the interest of encouraging self-sufficiency, but I have seen that modern medical care is just too expensive for many of our neighbors, even if they are working to their best effort. Practically and economically, let alone from a humanitarian standpoint, taking the third option by voting for Prop 2 is obviously the right thing.

•••

Robert M. McFarland, MD, is a Coeur d’Alene resident and past president of the Idaho Medical Association.