So, here is a new number to consider that may help simplify not the bottom line but what is at stake specifically for residents of Floyd County.
It is 17,347.
That’s the figure in a new Census Bureau report based on the 2010 nosecount of those men, women and children in this county who are without health-care insurance of any kind. It includes only those under age 65, the point at which Medicare kicks in. The number tallied is also limited to those with income less than or equal to 138 percent of the poverty level. One supposes that means if a Greater Roman is earning $50,000 a year and simply opts not to have insurance they are not counted.
The number of those with some sort of health insurance in Floyd County — employer program, individual policy, Medicaid/PeachCare, military retiree benefits and so forth — is given as 62,039.
The “uninsured” percentage here is 21.9 percent, which happens to exactly match Georgia’s overall rate that translates into 1,848,505 uninsured citizens. That’s the fifth worst/highest percentage among the 50 states. Georgia is also 47th in state health spending per capita and 49th in the amount spent per Medicaid patient. For a state whose leaders brag so much it is alarming how often Georgia shows up on “worst” lists.
BUT THAT’S enough mathematical confusion, which unfortunately completely clouds this entire situation/debate. It just would get even worse from this point on. For example, the planned national Medicaid expansion — which Georgia says it won’t do — would only dent the problem with perhaps 650,000 of those 1,848,505 eligible. Of course, many of those others, particularly with incomes, could be in line for federal “subsidies” to help them buy insurance of their own … but nobody actually at or below 100 percent of poverty. Seriously, somebody goofed in writing this encyclopedic law. But that’s an entirely different aspect of this scheme that once would have been described as a “Rube Goldberg” machine after the late cartoonist who won fame in the early half of the past century by creating visual contraptions that accomplished simple things by complex means.
That’s the whole problem with this particular contraption made up of federal/state/private-sector parts and now upheld by the U.S. Supreme Court. It seeks the rather simple end, already accomplished in most economically advanced nations, of providing basic health care for everybody. It uses an extremely intricate Rube Goldberg machine built by incompetent engineers, known as politicians, to try to achieve that result.
Yet, trying to keep things simple, the only number that counts in Floyd County is that 17,347. In Georgia it is that 1,848,505.
THOSE NUMBERS represent human beings first and foremost. There are both legal and moral mandates that insist they cannot be left untreated if sick or injured. Their bills are not “unpaid” but rather covered through a variety of relatively inadequate tax-supported programs, or outright charity on the part of medical providers, but mostly by adding to the premiums/charges of those patients who are insured.
When Gov. Nathan Deal recently announced rejection of the Medicaid expansion, saying “I think that is something our state cannot afford,” he was right … and wrong. Our state already cannot afford a lot of things it does anyway. Given the envisioned budget impact of 1.9 percent — starting no sooner than 2017 — that might require a choice regarding priorities. More Medicaid or fewer expressway lanes in Atlanta, for example. Such choices are no novelty in that, for some years now, the state has been cutting its budget an average of 3 percent a year. Additionally, that estimate of 1.9 percent is provided by the state while some private-sector groups have figured the probably impact on the budget to be 0.17 percent.
Additionally, for the first three years (2014-15-16) of an expansion Washington has said it will pick up the entire tab and 90 percent thereafter — a total of $14.5 billion in federal health-care funds in the first six years just for Georgia. Turning down the money doesn’t mean state taxpayers will pay less in federal income taxes, etc. It only means their taxes going to Washington will make the life and health of residents of other states snapping this up that much happier.
DEAL ARGUES the federal government itself can’t afford this and he may well be right. At the same time, he says he’ll accept all those billions if he can decide how to spend them without federal direction. Given the state’s known track record in all things health care (remember the “worst” lists and additionally consider the mental-health overhaul, lack of nursing-home supervision, underfunding of public-health services and so forth) that will never, ever happen.
He also forgets to mention that accepting the Medicaid expansion is not necessarily an eternal commitment. Those states accepting the expansion (and its federal dollars) can opt out at a later date if it is not working out in a way they like ... or can afford themselves. So, basically, it looks like Deal simply wants control of all those billions using the argument that Georgia can handle money better than Washington. It would be nice if the state could actually prove that first.
The strong adverse reaction to this Deal decision by local health-care providers is entirely warranted. Both they — and the continued employment of their huge number of employees — are being put at considerable risk by this. This whole Rube Goldberg/house-of-cards creation was based on hospitals, doctors, etc. agreeing to certain cost/support cuts in exchange for getting at least something in compensation for treating the currently uninsured instead of practically nothing. Now, for Georgia health-care providers the cuts are coming anyway being a different part of contraption while the added income flow is being denied. No Rube Goldberg creation would do what was intended with even one part removed.
Given that health care is both the main “industry” of Greater Rome as well as the engine driving most of its recent growth, this likely will have particularly nasty consequences for this region.
THAT’S NOT to say Floyd Medical Center, Redmond Regional Medical Center, Harbin Clinic and all the other local entities will go away. It does mean their problems in doing what they are called to do — healing — will increase and their ability to do so be decreased. Moreover, FMC in particular is not only in a county with many uninsured but is the main treatment center for bordering counties with even higher rates of those uninsured. Few seem to realize that FMC serves the second highest volume of such patients in the state already (only Grady in Atlanta handles larger numbers). It also does so with no direct local tax support (while Grady gets gobs of add-on local property-tax revenues).
Frankly, this is already a mess, which is why Washington came up with its Rube Goldberg device. It is now certain to become even worse unless a different and more temperate choice is made regarding the path the state should follow.
But, as noted as the outset, this should not be about $$$ and cannot be. It is about those 17,347 neighbors and 1,800,000-plus other Georgians, their well-being and even longevity.
To simplify it even a bit further, let’s assume a family only has enough money to buy food for the baby or beer for daddy. No doubt there are some few who would buy the beer, but that would be considered totally aberrant, disgusting and even inhuman behavior.
NOW THEN, reduced to the basic black-and-white core of the problem and subtracting all the political gimmicks and posturing involved, what would you do? Keep the baby alive or keep drinking beer so you can watch the pink political elephants dance?
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