Sal Nuzzo: Don't double down on bad Medicaid policy

When I was 11 years old, I begged my parents for a dog. I’ll feed it, clean up after it, walk it; you’ll never have to do anything – FOR-E-VER. I promised, and at 11 years old, I sincerely meant it. Fast-forward three months, my dad was walking the dog, my mom was feeding it, and I had moved on to the next must-have (I think it was a skateboard).

Every time I hear someone discuss Medicaid expansion in Florida, I harken back to that promise I made and how disingenuous it ended up being. No matter how much I meant it at the time, reality proved otherwise. And with Medicaid expansion, no matter how much the federal government intends to make good on its promise to “pick up the tab,” the reality of the immense burden of $18 trillion of debt and countless trillions in unfunded liabilities will smack good intentions in the face.

An oft-quoted senator once famously said, “You are entitled to your own opinion, but you are not entitled to your own facts.” This can be integrated into the debate on whether or not to expand Medicaid in Florida. Facts:

• Florida’s Medicaid reimbursement rates are a small fraction of the actual cost of providing health care services
• The result of these price controls is a shortage in the number of physicians accepting Medicaid patients
• The resulting shortage of Medicaid physicians means longer waits, diminished access and reduced health care for the poor
• Medicaid accounts for approximately 30 percent of the state’s budget (and growing)

Florida also faces a unique challenge in health care access – a significant and growing shortage of physicians. Facts:

• Florida has less than 85 physicians for every 100,000 residents, substantially below the national average – ranking the state 30th in primary care physicians per capita
• Approximately 30 percent of Florida’s doctors are older than 60 (5th highest percentage in the U.S.)
• Florida stands to lose roughly one-third of our doctors to retirement by 2030
• Florida ranks 36th in medical school students per capita, even after doubling medical school enrollment from 2000 to 2010

Now, we can shift from facts to opinion. The proponents of Medicaid expansion argue this is “free money.” This opinion is grounded in a misrepresentation of where Medicaid money comes from – taxpayers. Proponents of Medicaid expansion say the poor need a safety net and denying them access to Medicaid is akin to letting them suffer. This opinion distorts the history of terrible access to care and even poorer outcomes among Medicaid patients, and conveniently ignores the existing safety net available. Proponents of Medicaid expansion will argue that there is no alternative. This is simply not true.

Florida can, and should, work to address the fundamental challenges inherent in improving access to quality health care, as opposed to increasing the number of people with access to inadequate insurance through Medicaid.

The James Madison Institute recommended practical reforms in a 2014 Policy Brief and the concepts behind our recommendations are still valid. Florida has made some strides, but there is more to do. We need to address why we have such a shortage of physicians in this state, and why so many leave Florida after graduating from medical school. Medical malpractice reform is a good first step. Florida’s legal climate is consistently ranked as one of the worst in the U.S., and medical malpractice rates are astronomical because of frivolous lawsuits.

Further, while we embrace groundbreaking technologies in the operating room, we need to be more open to addressing the same advancements in areas such as telemedicine, which can revolutionize care to underserved communities. We also must address the obscene complexities in the cost structure of care delivery and bring forth more transparency to the industry.

Inevitably, discussion of real reforms will run up against powerful entrenched interests whose financial ties are vested in the status quo – but make no mistake, real reform is what’s needed.

In Florida, we are faced with a choice – thoughtfully examine the challenge and address the fundamental causes, or take a short-term path toward future calamity. Do we have a serious discussion about the root causes of our health care challenges, or do we give in to the enticement of “free money.”

The definition of insanity is doing the same thing over and over, yet expecting a different result. We have the opportunity to show the rest of the nation that positive reforms are possible, and that doubling down on bad policy is simply that – more bad policy.

Sal Nuzzo is vice president of policy for The James Madison Institute.