Dr. Doug Cox, a Republican state legislator here in Oklahoma, has written this piece, in which he bemoans Governor Mary Fallin’s rejection of Obamacare’s Medicaid expansion.  Among his complaints?  Hospitals, facing a loss of their DSH (disproportionate share hospital) payments (this cut is in Obamacare, but is by no means final..the hospitals will in all likelihood retain these payments in some form) will have to cost shift much more aggressively, now that they can’t count on all of the uninsured folks being “covered” by Medicaid.  You can refresh your memory on DSH payments, the uncompensated care scam and more here.  

Let’s get started by revealing that Dr. Cox is an employee of Integris Health, the largest hospital system in Oklahoma.  Yep.  You read that right.  OK.  Try to concentrate on the other remarks in this blog like anything else that I jot down matters compared to that little gem.

Cox relays two sob stories, one of which is about a woman that needs her gallbladder removed, the price for which at our surgery center is $5865 and posted online.  Our price includes the surgeon, anesthesia and facility charges.  And yes, we are making a profit at this price.  Having established that, it goes without saying that the actual cost for this procedure, an amount representing no profit (not for profit?) would be less than $5865.  Dr. Cox maintains that the big hospitals will have to jack up their prices (what are their prices, anyway?) to cover losses like this.  Keep in mind that “not for profit” means that these institutions don’t pay tax.  What’s that perk worth?  Try to fathom how much these hospitals spend on print and television ads.  Try to imagine how much they spend sponsoring sports franchises.  You already have some idea what their administrative overhead is if you have seen “Oklahoma Doctors vs Obamacare,” the Reason documentary about our facility’s free market approach to health care.  (Try to also keep in mind that Jim Epstein of Reason Magazine discovered during his research on this documentary that our online pricing is less than what Medicaid pays the hospitals for the same procedures.  Yes, you read that right.)  

The hospital expenditures above pale in comparison to what is spent building new and unnecessary facilities, hostile takeovers of physician practices and buying out their competitors, particularly the rural hospitals.  Seriously.  Where are they going to find any money to cover a gall bladder removal for a poor uninsured woman?  You would think these hospitals were operating pretty close to their margin reading Cox’s piece, since the only way they can survive, offering an occasional gall bladder surgery at a discount or free of charge, is to charge all of the rest of us much more.  

His economics is no better.  ”The federal reimbursement for the expansion of Medicaid would have been 100% of the cost through 2016….”  Where does Cox think this “federal” money comes from?  And who should know better than a legislator the folly of trusting future government payments?!

Finally, and perhaps the most troubling part for me is this:  ”The fact is, it (Obamacare) is now the law, whether we like it or not.”  Translation?  ”Give up.” “Surrender.”  ”Lie back and enjoy it.” “It’s time to join up!” I find this Vichy attitude disgusting.  I am glad that rather than surrender to and collaborate with the regime the governor and the attorney general and several legislators in this state still have some fight in them.  Obviously, Cox isn’t in this camp.

As one friend wrote to me regarding Cox’s piece:  ”Obamacare cost my family thousands in debt and made us go without health insurance.” “I’m glad I don’t live in Doug Cox’s Oklahoma.”  Another wrote to me: “I love that he can be compassionate by taking money from my children and grandchildren.” 

We can only hope that more people see the promotion of Obamacare’s Medicaid expansion by individuals as conflicted as Doug Cox, as completely and utterly lacking in credibility.

G. Keith Smith, M.D.