Every day, people go to Washington, D.C. to rent or buy legislators. (I like the idea that legislators, like NASCAR drivers, should proudly exhibit their sponsors on their suits.) This is nothing new, and only the most naive would believe that the vast majority of legislation now oozing out of D.C. represents anything other than a purchased corporate favor.  Even vote-buying welfare programs invariably line the pockets of those who administer these programs.  

Obamacare is no exception, all of the big corporate players having had a hand in crafting this “law.”  In order for the Obamacare conspiracy to succeed, extending Medicaid “benefits” to folks with higher incomes was necessary, as this would socialize medicine for well over half the people in the country, if you count Medicare as a socialized medicine program (duh).  It is reasonable to think that finishing the job of socializing the industry for the rest of us would not be such a daunting task if over half the population were already “covered” by the government.  

Enter one of the greatest political miscalculations of all time.  The same bribes accepted in D.C. were refused by well over half the states, refusing to expand Medicaid (welfare).  These governors and state legislators have, unlike their federal counterparts, refused to throw the residents of their states under the Obamacare bus.  The governors that have expanded Medicaid have done so on the backs of those who can least afford it, those who are now  saddled with:

1) The purchase (not really a purchase since they have no alternative) of an expensive health policy they neither want or likely need

2)Subsidizing the healthcare and retirement of Medicare and social security beneficiaries with incredibly high (and rising) FICA taxes

3)Increased taxation at the state level (if not current, certainly imminent) to pay for the expansion of Medicaid.

Who are the true beneficiaries of Medicaid (welfare) expansion?  It is certainly not the folks with the new Medicaid (welfare) card in their wallet who will struggle to find a doctor who will see them.  Like Canadians they will have “coverage” but little or no access to care.  Like Canadians it will be illegal for a doctor to charge them directly in a mutually beneficial arrangement.  Like Canadians, they will receive only the care the bureaucrats deem appropriate and only after waiting in interminable lines.  They will have no choice and poor service.  They will long for the days when they were uninsured, although the bayonet of the IRS will preclude this choice for many.

Who wants Medicaid expansion most desperately?  The big corporate players who will plug in to the taxpayer trough more directly than ever want this and will be the primary beneficiaries.  I have always thought it interesting that the same big hospitals that claim that they are going broke on Medicaid loot, are leading the charge for the expansion of this program.  It is also important to keep in mind that the prices on our website are less than what Medicaid pays the big hospitals across town from our facility.  What we need is more competition, not more “coverage,” as true market competition always lowers prices and improves quality (cell phones, computers, automobiles…..), benefitting most those individuals on the economic margin.

Medical cronyism has hit a brick wall for once with the various states’ decision to shun the federal bribes accompanying Medicaid expansion.  Further resolve will be required to resist future “offers,” no doubt.  

G. Keith Smith, M.D.