Sometimes I have to deliver messages to let folks know what’s going on.  Most of the time, the messages I have to send are because someone has told me to do X, and I do X, and then someone is mad because I did X, most of the time that person being the same person who told me to do X.  Amazing.

So, the messages I send are not always happy messages.  They can’t be made happier.  If you don’t have money to provide a service, and there is no other feasible alternative, then you are simply unable to provide that service. Take Medicaid, for instance.  I know that there are lots of folks out there who are very much in favor of expanding Medicaid, for many reasons.  I, personally, am not in favor of it, not because I don’t believe that people should have access to healthcare, but I don’t believe it should be expanded because I think it’s the wrong way to provide healthcare for the millions who have no insurance.  Medicaid wasn’t meant to be a life-long healthcare program for healthy, non-disabled folks.  For the kids who are born with debilitating life-long diseases, like cerebral palsy and such, Medicaid is their only way to survive.  Many, if not most, of the families with children with disabilities are regular folks who cannot afford the millions of dollars in healthcare that their children will need long-term, and those families eventually get old themselves or die, leaving those children with no way to care for themselves.  That’s what the program is about.  It’s not about providing healthcare insurance for the millions of people who, for whatever reason, have none.  That’s what a healthcare insurance exchange it about – and it will take some pains to get there.  This will eventually be at the cost of the large, family-centered care suites (let’s just say it, they are no longer mere rooms) that hospitals are asked to provide for an increasingly picky customer.  Waiting mere days for surgery?  Out the window, unless it’s truly life and death.  Hundreds of providers just lining up to provide these services because they went to medical school, incurring hundreds of thousands of dollars of debt, so that they could get out and provide services at 50 cents on the dollar, with no ability to ever pay back their student loans?  Not going to happen.  Healthcare providers are already denying Medicaid patients for this very reason.  I mean, put a doctor in the shoes of your favorite department store.   Do you truly believe that JC Penney would buy clothes at wholesale, only to turn around and sell them at 50% of what they paid?  It doesn’t make sense. 

Having a friend who has been a physician in Japan for many years, I do actually have some data to back up my claims.  Trust me, in your lifetime, one of two things will happen:  Medicaid and it’s progeny will either bankrupt thousands of hospitals and providers or will go bankrupt itself.  You may believe that hospitals and doctors can cut their costs and provide those services more cheaply.  You may be very right.  But, before that happens, regulatory agencies and patients (and their families) are going to have to cut back on the constraints on one hand and their expectations on the other.  You simply cannot do the math and come out any other way.

So, one of the messages I had to deliver a couple of weeks ago was apparently not received very well.  Why?  Because I told the truth.  I stated a fact, and even though I flowered it up as nicely as I possibly could, it was not received with the intent in which I had sent it.  Why?  Because people don’t like to be told no.  The folks I told it to didn’t like it any better than the patients are going to like it when they are told that the new healthcare way of life in America will mean that Grandma doesn’t get her hip replacement until 3 months from now, even though she’s in great pain.  They will be told no when they ask for a private room.  Cut healthcare costs, yes we can.  Do it where everyone gets the services they want, at a cost they want to pay, and with all the hotel-like amenities they desire?  Not going to be possible with the current system.

The shortsighted never see past their own noses.  Those who have the gift of farsightedness do.  The former should listen to the latter.