Closing Range

Inspecting the Elephant, Part One

Doing the “popular” thing by knee-jerk Medicaid expansion, or Obamacare, is helping the monster grow

With Medicaid expansion front and center in the Montana Legislature, I’ve found my topic for at least one column, perhaps more.

State Sen. Mark Blasdel, R-Kalispell, calls Medicaid the “elephant in the room.” Yep. Here in Flathead County, health care is now our largest, um, “industry,” employing 6,300 people on a $313 million payroll, a $49,683 average.

But the sick fact is, health care isn’t just Montana’s elephant. Overall, health care burns up almost one-fifth of America’s Gross Domestic Product, which is running at $19.39 trillion. According to statista.com, the latest estimate is 18.2 percent of GDP, or $3.52 trillion.

Let’s put that in today’s context by looking at a couple numbers. First and foremost, at current rates, the “health sector” is close to outgrowing the entire federal government, which will spend “only” $4.4 trillion in 2019.

Second, divided among 325.7 million Americans (including non-citizens, I guess), that’s $10,807 per year per person. I had a hard time with that, too many zeroes for my scientific calculator, for Gosh sake. But yep, ten grand a year, eight hundred dollars a month per person!

Kids, are you socking away $800 per month for every member of your family? Well, guess what? You probably should be socking away even more, because third:

In 1980, health care’s share of U.S. GDP was 8.9 percent. Care to guess what it was in 1960? According to CNBC, $146, which adjusted for inflation is $1,248 – compared to ten big ones now? Can you imagine the numbers in 2039 if current trends continue?

Some might argue that health care is way “better” than it was 60 years ago. I certainly wouldn’t want to be cut on using 1960’s techniques, tools, or knowledge. But is care really better?

When we think of “better,” we can point to thousands of consumer products that are orders of magnitude better, and cheaper, than they were in 1960. Telephones. Computers. Automobiles. Food. Clothing! Appliances! Houses! Guns and ammo! So, what about routine surgery? Nope!

Healthsystemtracker.org has a breakdown of “common” costs. A laparoscopic appendectomy, a 30-to-60 minute, nip-clip-zip procedure, cost $8,500 in 2003. In 2016, it was $20,192, an increase of 136 percent over 28 percent “real” inflation. A new knee? 20 grand in 2003, 34 grand in 2016.

How about just an “office visit” where you’re told to take two aspirin? Sixty bucks in 2003, a hunnat dollah today, doubling inflation. What hasn’t changed? The waiting, and the ratty, outdated magazines you’re expected to read.

Yeah, I know you’re wondering – a nose job (which involves about as much hacking and blood as an appendectomy, and is about as routine) will cost you a paltry $10,000 – I’ll discuss why that is in another column – but here’s a hint: “Insurance.”

What are we seeing here? Utter dysfunction, with the biggest problem being a systemic failure to not only offer quality, but control the costs of doing so. Kinda like government, ya know.

Worse, there seems no desire by the “industry” to slow its bloat. Hospitals brag to patients they are “nonprofit,” right? Well, just last week news hit that Bozeman Deaconess Hospital paid $10 million to settle a lawsuit (filed in 2013) alleging the hospital made millions in fraudulent claims to government health care programs as part of an illegal kickback scheme to keep a monopoly on radiology services in Gallatin County. $2.5 million went to the lawyers, with the plaintiffs getting an “undisclosed portion of settlement funds” according to a 2018 story by the Bozeman Daily Chronicle, well worth reading.

Then there was the $24 million settlement paid to settle Kalispell Regional’s whistleblower lawsuit. Allegedly, in order to get top doctors, arrangements were made in which some physicians were “steeply overpaid.” Who and what, and why? Forget it, the CEO responsible has passed away, and same as Bozeman, the settlements carry no findings that “confirmed any allegations” of wrongdoing.

So, while I understand that most citizens are justly terrorized of being eaten by the monster that health care has become, it’s more important to understand that doing the “popular” thing by knee-jerk Medicaid expansion, or Obamacare, is helping the monster grow.