Tuesday, August 12, 2014

Why We Should Hope Rick Scott Does NOT Expand Medicaid in Florida

The title of this post is meant to be ironic. You'll see why in a moment.

Many are hoping that should he get re-elected, Rick Scott will make good on his promise to expand Medicaid. I'd like to suggest that while some good may come of such an expansion under Scott, we would be no better off, as a whole, if he did expand it.  In fact, his behavior so far on this issue paints a frightening picture. 

Consider the following:

  • Some have wondered about the delay in Scott's fulfillment of his promise to expand Medicaid. Although he said he stood behind it, he has done nothing to push the Florida Legislature into passing it. And so, while the Florida Senate approved the expansion, the House did not.
  • Scott has said he would approve the Medicaid expansion only if he got something he wanted from the federal government - namely, the ability to privatize its application. And he got that.
  • Finally, we all know about Scott's past as someone who made millions of dollars thanks to fraud orchestrated on Medicare.
What does all this mean? Put it all together, and a very unpleasant conclusion is apparent: Scott has approved the Medicaid expansion, but delayed its implemenation, in order to allow enough time for his friends in the private sector to take the fullest advantage of the profits they can make from it. That might even include Scott himself, who is probably thinking that once he is  out of the governor's seat, he can turn a tidy profit. 

As bad as this may sound, it can be even worse. Right now it is estimated that between 3 and 6 Floridians a day are dying because Scott has not expanded Medicaid, and many more are suffering more than they should. The figures can be discussed back and forth, but even if Scott does approve the Medicaid expansion, don't look for that number to go down at all as the plan is administered. If you want to see what the administration of the Medicaid expansion will look like under Scott, you need to look somewhere else in the state, and in a place that you wouldn't have thought to look: The state's prisons.

Right now, prison medical services in Florida are being administered by two private companies -- donors to Scott's campaign. Their names don't matter, because all such companies operate the same way. These two companies, however, have a distinct record which is illustrated by one of many news stories about them. This one happens to come from Arizona, where each of those companies has had a turn at providing medical services. 

If you read the story, you'll notice these elements to the process of "treatment" afforded this inmate.

First, a clear effort to "underdiagnose" his condition, even as his condition gradually got worse.

Second, prescribing the minimum amount of care, in accordance with that underdiagnosis.

Finally, an effort to delay and put off care for as long as possible -- until death was imminent. The obvious purpose: Minimum expenditure, maximum profit.

That's the likely future of medical care for the poor, if Scott expands Medicaid in Florida. And now, suddenly, Rick Scott's lip-service support for the Medicaid expansion makes horrifying sense. It will all be part of Scott's grim game of reaping maximum profit from minimum effort, while everyday citizens become meat for his money-machine grinder.

It's tragic enough for me to think that we will be far better off if Medicaid is expanded by Florida's next governor instead.

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