The Oklahoma Health Care Authority (OHCA) which administers Medicaid in the state of Oklahoma and facing anticipated budget shortfalls, has proposed an increase in the copays Medicaid beneficiaries should pay for medicines and doctor visits.  Before you give too much credit to OHCA for this politically incorrect move, understand that no one has screamed louder for the Obamacare expansion of Medicaid than this government agency, an expansion rejected so far here in Oklahoma.  Copays for medicines could increase from 65 cents to $4.  For office visits?  From $3 to $4.  Statists are screaming, hanging the usual crepe.

A devastating editorial in The Oklahoman about the statist’s reaction caught my attention and here are my random thoughts.  Referring to the copay burden individuals with private insurance endure, the editorial had this to say:

“Keep in mind, those citizens (with private insurance) are forking over their hard-earned money for a copayment and at least a share of their premium  That latter expense is one Medicaid patients don’t face.” 

While this editorial is hard hitting, the writer has left something out, hasn’t he?  Namely that the citizens with private insurance are also paying the premiums for the Medicaid beneficiaries.  Come to think of it, these same citizens are paying the largest share of the premiums for Medicare beneficiaries.  Take a look at the FICA taxes deducted from any paycheck and see this for what it really is, the health insurance premium for someone you don’t know and many times, someone who can better afford it than you.

Governments work very hard to hide costs making the connection of the dots more difficult for the average citizen.  Devaluing the currency is a way for the state to spend the money in your wallet without actually physically taking it from you.  The true cost to the beneficiary of Medicare or Medicaid is blurred by the various tax subsidies stolen from others.  Corporate welfare subsidies at all levels of government are mainstream and commonplace these days, hiding the true cost of doing business, always to the advantage of those plugged in to this trough.  

In my opinion, the hidden costs of health care can only be addressed with transparent pricing.  Value cannot otherwise be ascertained as no comparison between choices is possible without transparent pricing.  Crony players in the health care industry, just like the apparatchiks of the state, have made out like bandits by leveraging their knowledge of the pricing games and manipulating the system to their advantage.  Corporate health care has taken the lead of their pals in government, concocting countless numbers of hidden schemes to rob the sick.

(My favorite recent discovery is when an insurance carrier deducts one amount from a self-funded employer’s health account and remits a different (smaller) amount to the folks providing the care, keeping the spread (basically repricing).  Employers suspecting this is the case and demanding to see their “claims data” are told this is proprietary per the terms of the contract.  Hidden from the employer is a source of massive profits for the carriers doing this.) 

Imagine the reaction if a taxpayer was honestly informed in this way:

“Here is what you pay for your health insurance coverage for yourself and here is what you pay for the coverage for other people you don’t even know.”  The real reason these numbers are hidden is fear.  If people can ever quantify the extent to which their government (at all levels) and their cronies have fleeced them to line the pockets of others, the fear of those in control will truly be something to behold.

G. Keith Smith, M.D. 

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