A thanks to the U. of U. social work students whose op-ed in the March 31 Tribune asked the above question.

For a primary care doctor caring for poor people, this is not some abstract, political question. In the last six years the Utah Legislature has turned down somewhere between 2 billion and 4 billion (that’s billion with a "B") Utah taxpayer dollars coming back to Utah to pay for health care for the poor. (The exact amount is illusive.) More recently, they have chosen to ignore their constituents’ mandate for a full Medicaid expansion.

Why? Let me give you the legislators stated answers and then what I think are the real reasons.

Legislators say:

1. “We can not afford to pay for our portion of the cost.”

Throw that one out right away. The state’s share of the expansion would have been zero for the first three years and 10 percent after that. The influx of those billions of dollars would have generated enough economic activity to generate tax revenue to cover much of this cost. Savings on the the state’s on-going Medicaid and charity care costs would have covered most of the rest.

2. “Medicaid is a program fraught with waste and abuse.”

Any large, complex program will have some waste or abuse. As a Medicaid provider I never saw waste or abuse. More important, audits of Medicaid have not shown substantial waste or abuse. This argument is simply cover for those who feel any “entitlement” program is bad - no matter who it helps.

3. “People already have access. Its called the emergency room.”

I will get the best care in the world if I have a massive stroke and go to the ER. However, that ER would not have given me a $4 a month prescription for the blood pressure med that could have prevented that stroke. Guess the acute/long term/disability costs for that stroke. It’s that simple.

4. “The federal government is not dependable. If we expanded our Medicaid program, the feds will back out and we’ll be left holding the bag.”

Come on, now. At the bequest of Utah and other conservative states, the Supreme Court ruled that states didn’t have to expand Medicaid. If the feds had reneged, the Legislature could have shut it down. In the interim a lot of people could have received needed health care.

5. " Medicaid costs will be skyrocketing."

Medicaid is a state administered program. Our Legislature takes pride in its innovative and intelligent administration of state monies. Imagine the opportunity we had 6 years ago to expand our Medicaid program and demonstrate to the country the ability of Utah to provide cost-effective universal health care coverage. It can be done. In fact every other developed country in the world has done just that. Instead our legislature has been busy thinking of reasons it can’t be done.

Real Reasons

1. Politics. Blocking, destroying and discrediting anything the Obama administration did became the highest priority for many conservative politicians. Even more important than helping the poor.

2. Lack of empathy. This is something you can not fault our legislators for. You can neither learn nor teach empathy. It is acquired through personal experience. I am sure that many of our legislators have empathy for the poor. I simply worry that too many don’t. More people with empathy need to step up and get elected.

3. I got mine. The exact health insurance we buy for our legislators is “none of our business.” As best I can determine, for a relatively small premium and two months of work, they and their families get premium health insurance for the year. If this is incorrect, I apologize. But maybe such information should be public.

There is one argument against expansion that merits a discussion. Full expansion will cover some able-bodied, non-working adults. Over my 45-year career, I have done thousands of disability evaluations. Making a determination of “able-bodied” is at best difficult and sometimes impossible. My experience was that few people were trying to game the system. Also, people vary from month to month on their disability. Moving people on and off that list would be difficult. Have you ever known someone who has stayed in a job they hated to keep their health insurance? Not having a work requirement allows these people some mobility. We just gave our wealthiest citizens a $1.5 trillion dollar windfall. Maybe we can afford to give our poorest citizens some health care security.


Doug Douville, M.D., is a family physician currently working at a charity clinic. He was an Air Force physician for twenty years and was in private practice in West Valley City for 15 years.