In the current debate over the House and Senate versions of health care legislation legitimate and appropriate questions have been raised and not answered about the negative effects of the proposed legislation on virtually every aspect of the affordability, access, and quality of health care in the U.S. in the near as well as the distant, but foreseeable, future.
Medicaid is just one of many targets, but one that, if the proposed legislation were to become law, would strip millions of people of financial support for their health care needs. That is bad enough, but there is another point that seems to have escaped nearly any attention: the economic multiplier effects of Medicaid expenditures on local and state economies.
Medicaid payments do not go to the patient; they go to physicians, hospitals, other care centers, nursing homes, pharmacies, and other sources of health care as payment for services that have been provided to patients. And the money does not stop there. It enters the local economy as wages; payments for supplies, facilities, and services provided by others; and taxes in the well-known economic multiplier effects of all expenditures and investments. In addition, the “working poor” and the care-giving mother or child of aged parents can return to their job, no matter how low paying or menial it may be.
How is it that the Republican Presidential, Senate, and House of Representatives candidates who so strongly touted their interest in and ability to improve local, state, and national economies, especially in rural areas, can so blatantly ignore the fact that eliminating billions of dollars in Medicaid expenditures will serve only to further decimate those economies? Is it possible that they intentionally lied to the voters as is easily demonstrated in any collection of sound bites from the 2016 election campaigns? Or do they just not understand the simple economics of the multiplier effects of major expenditures? In either case, their political futures should end with the 2018 elections if not sooner.
Dr. Lewis has more than 40 years of executive experience with medical practices in medical schools, teaching hospitals, and community settings throughout the country. His experience includes operations, e.g., scheduling and appointments, revenue cycle management (billing and collections), staffing, and budgeting; governance and administration; departmental, institutional, and national policy analysis and policymaking; physician recruitment and retention; productivity, performance incentives, and compensation; facility siting, planning, and development; market analysis and marketing; and investment of surplus revenues.
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