“Somewhere out there is the world’s worst doctor. The scariest part is that someone has an appointment with him tomorrow.”
— George Carlin
If you are seeing a skilled and experienced doctor who is all but certain what is wrong with you and what ought to be done about it, but he doesn’t tell you what you have and what treatment you need, then he’s not really a very good doctor.
Several members of the Utah Medical Care Advisory Committee, speaking out as individuals because the body as a whole refused to take any action, have made a diagnosis and offered some specific prescriptions. Or, perhaps more in keeping with good medical advice, offered advice on what not to do.
But the federally mandated advisory panel couldn’t manage an official pronouncement, according to its chair, Dr. William Cosgrove, because the health care provider groups some of those members represent thought it improper.
This institutional cowardice is one of the big reasons why Utah has, for several years now, employed every trick in the book to avoid offering the kind of First World, virtually universal access to health care offered in 2010 by the federal Affordable Care Act and demanded by the voters of Utah with their 2018 passage of Proposition 3.
The hospitals, doctors, care homes and other medical providers of Utah should have been working hard, in public and behind the scenes, to get Utah politicians to either accept the full expansion of Medicaid as envisioned by the ACA, adopt the workable Healthy Utah alternative offered by Gov. Gary Herbert or, finally, bow to the will of the people and allow Prop 3 to take effect.
But the Republican-dominated Legislature was having none of any of that.
Most recently, lawmakers coolly eviscerated Prop 3 and replaced it with a deliberately cruel alternative that would spend millions more state tax dollars to serve thousands fewer state residents. Their plan is awaiting approval from the federal Department of Health and Human Services because it is such a significant departure from the parts of the ACA that still stand that it requires a waiver.
If there is any justice, HHS will deny that waiver and, by the same act of the Legislature that outlined the changes, the state Medicaid program will default to that outlined in Prop 3.
The plan put forward by the Utah Department of Health, in furtherance of the Legislature’s SB96, really has less to do with health care than with political dogma, with the idea that people who can’t afford health care don’t deserve to have it.
Cosgrove and his allies on the panel have done what they can to fight back, trying to drag Utah kicking and screaming into the 21st century.
They point out that the idea of a work requirement to qualify for Medicaid is a empirically foolish idea that will have an effect totally opposite of the one Utah politicians say they want, to help people become self-sufficient. All the research done on the topic, along with common sense, holds that if you want people to be self-sufficient, you provide health care first, not last.
Of course, all the arguments on both sides of this debate will dissolve unto dust if Utah Attorney General Sean Reyes, one of 20 Republican state attorneys general who just the other day tried to convince a federal court that the whole ACA is unconstitutional, wins his case.
Why Reyes feels that it is so wrong for the states and the federal government to continue to assist people in acquiring access to a service taken for granted throughout the civilized world is not clear.
Oh, he’s tried to explain it. But it’s still not clear, because there is no legal, medical or remotely humane explanation to be offered.
The best thing that can happen to Utah -- its politicians, its health care providers and every one of us who might someday be sick or injured -- is for the Legislature’s requested waivers and the attorney general’s lawsuit to be rejected and for the will of the people -- Prop 3 -- to carry the day.
It just shouldn’t have been so hard.