Charlie Mitchell: Throwing less money at Medicaid

May 29, 2013 10:46:58 AM



OXFORD -- Suppose you pick up your paper and a headline says the school superintendent is "declaring war" on dropping out of school. 


You would infer the superintendent will deploy assets and tactics to reduce the number of students who quit before receiving their diplomas. 


Suppose a year passes. You pick up your local paper and a headline reports that school dropouts increased. 


You would infer that the superintendent's plan did not achieve the desired result. 


Dr. David Dzielak, appointed by Gov. Phil Bryant to direct the Mississippi Divison of Medicaid, made a comment last week worth pondering. Specifically, he said there's no reason to believe increasing Medicaid spending will result in better health, overall, of Mississippians. 


That should -- but won't -- give politicians pause. 


Medicaid -- a federal-state program to pay medical expenses of the poor and disabled -- was created about the same time that President Lyndon Johnson "declared war" on poverty, generally. Definitionally, to declare war on something is to reduce it, to bring it under control. That hasn't happened with poverty, not in Mississippi or anywhere else, despite an alphabet soup of programs that provide subsistence aid, cradle-to-grave for legions of Mississippi families. Indeed, gaming the programs for maximum payouts has become an art form. 


Not blame the poor for being poor or seeking all possible aid, but the question remains: If a "war" is not having desired or expected results, doesn't that indicate a need to re-examine the strategy? 


Medicaid was not designed to eliminate illness, but it was supposed to make us a healthier population, generally. 


Dzeilak was interviewed by Mississippi Public Broadcasting. "I think it is very similar to the problem with education. Just throwing more money at it isn't going to solve the issue," the director said. "We really need to dig a little deeper into the root cause of these things. And that is where I think any real progress is going to come." 


In other words, if we're spending more and more on health and people are less healthy, does it make sense to keep forging blindly ahead? 


Statistics can create weird, even false conclusions. Take that superintendent. If school enrollment rose sharply and the number dropping out rose only slightly, then the actual dropout rate would have fallen even though the actual number of dropouts rose. 


That make your head hurt? Think of it this way: Suppose Medicaid expansion resulted in people going to see doctors who had not done so before. Suppose they started receiving treatment for hypertension, a silent malady not previously diagnosed. Statistically, it would appear the rate of hypertension was soaring, while in reality the rate was unchanged -- just more people taking medicine for it. 


There is plenty of fuzzy math buzzing around Jackson as fish or cut bait time comes on whether Mississippi will accept or reject broadening of Medicaid eligibility as envisioned by Obamacare. 


Dzielak himself has reduced the predicted cost in Mississippi tax dollars from $1 billion over the next six years and now projects the "mid range" at $450 million. No one knows for sure how many people would enroll under the new ceiling -- 133 percent of the federal poverty level -- or how many would seek services. 


Some states -- Arkansas in particular -- have been innovative in trying to figure out how to come to budgetary grips with what everyone should admit is another step toward single-payer, national health care. That state has endorsed a route using its health exchange and private providers to fund the expansion. 


In Mississippi, though, the contest remains purely a battle of ideological wills -- labeling expansion as "liberal" and the status quo as "conservative." The discussion stops at "we give enough to the poor" vs. "let's help working families." 


The public would be best served by what Dzielak observed: Increasing the allocation and pretending it is the total solution is, well, nuts. It's like giving a losing coach a raise and expecting, as a direct consequence, the team to win more games. 


Structurally and culturally, American lawmaking systems are not designed to engage in analysis and make data-driven decisions. Today, there's a Medicaid funding fire in Jackson and, one way or another, it has to be put out. 


Still, wouldn't it be nice to know that the federal and state billions already being pumped into health care were achieving the intended results. 


Are we a healthier state? If so, what is making the difference? If not, why not? Money? Access? Poor personal decisions? What can be fixed? How? All good questions. But they're not being asked.