PERSPECTIVE FROM THE 19^TH HOLE: This is the title I chose for my personal blog, which is meant to give me an outlet for one of my favorite crafts – writing – plus to use an image from my favorite sport, golf. Out of college, my first job was as a reporter for the Daily Astorian in Astoria, Oregon, and I went on from there to practice writing in all of my professional positions, including as press secretary in Washington, D.C. for a Democrat Congressman from Oregon, as an Oregon state government manager in Salem and Portland, as press secretary for Oregon’s last Republican governor (Vic Atiyeh), and as a private sector lobbyist. This blog also allows me to link another favorite pastime – politics and the art of developing public policy – to what I write.

I have written about health care issues in the past, owing mostly to my 25 years as a lobbyist representing hospital and health insurers.

Two new developments caught my interest late this week and both illustrate the need for a centrist, bi-partisan approach to craft smart health care policy.

Development #1: Incredibly, Senator Bernie Sanders, in his campaign to convince Democrats to nominate him to take on President Donald Trump in 2020, came up with another crazy idea.

Under a Wall Street Journal (WSJ) headline that read, “Bernie’s Medicare for All Bailout,” editors said Sanders “wanted taxpayers to save hospitals after he bankrupts them.”

Here’s more from the WSJ:

“Usually politicians pass a bailout to clean up a mess they’ve created in the past, but Bernie Sanders is now promising cash up front. Witness the democrat socialist’s opening offer to the hospitals he’d bankrupt with his Medicare-for-All bill.

“Sanders last month suggested a $20 billion federal bailout fund for struggling hospitals. He announced this plan in Philadelphia, where the city’s Hahnemann Hospital is in bankruptcy proceedings. He spins the failure of the hospital as a tale of corporate greed perpetrated by a private-equity firm.

“Yet, one under-appreciated reality is that nearly two-thirds of Hahnemann’s patients are on government insurance, either Medicare or Medicaid, a fact noted in passing in a letter to Health and Human Services from members of the Pennsylvania delegation in Congress. This detail is significant because Medicare and Medicaid are notorious for paying hospitals less than what it costs to provide services.

“The best estimates are that Medicare and Medicaid pay hospitals on average about 87 to 90 per cent of the actual cost of care, often lower in high-cost areas like New York City. Hospitals then shift costs onto private insurers, which tend to pay more than 140 per cent of costs, according to data from the American Hospital Association.”

Sanders, thus, is topping his own “government health care for all plan” with another proposal for government funding to bailout hospitals his first proposal would threaten to bankrupt.

Save us from Bernie I say.

Development #2: The WSJ also reported late this week that “states cover millions of people who exceed income thresholds, some quite well-heeled.”

In a piece by two health care economics professors, it was reported that a National Economic Research Council found that, in several Medicaid-expansion states, many people who gained coverage under Medicaid did so regardless of their income.

In practice, the authors said, “ObamaCare has turned Medicaid into an entitlement program for the middle class.”

Here’s more from the WSJ:

“Using data from U.S. Census Bureau’s American Community Survey, the authors assessed coverage changes from 2012-17 in nine states that expanded Medicaid vs. 12 states that didn’t. They uncovered a huge problem. In 2017 alone, in those nine states, “around 800,000 individuals . . . appeared to gain Medicaid coverage for which they were seemingly income-ineligible.”

“ObamaCare is supposed to make Medicaid available to households with incomes below 138% of the poverty line, or nearly $36,000 for a family of four. In the nine states—Arkansas, Kentucky, Michigan, Nevada, New Hampshire, New Mexico, North Dakota, Ohio and West Virginia—the authors found that among households with incomes 138% to 250% of the poverty line (about $65,000 for a family of four), some 78% that gained coverage had improperly enrolled in Medicaid. That was also true of 65% of the population above 250% of poverty that gained coverage.”

For me, these two developments underscore the need for smart people on both sides of the political aisle – yes, there are some left – to get around a round table in a room and pound out a centrist, middle-of-the-road approach to health care policy.

Instead, we have, (a) Republicans on the right slamming every proposal as “more government;” (b) Democrats on the right, like Sanders advocating for a government-only solution that none of us can afford; and (c) both sides appealing to this or that political trend identified by a new poll and avoiding the hard decisions of finding middle ground.

In the past in Oregon, various of us were able to do the heavy-lifting of smart health care policy. That, however, is not in the past and it is time for new solutions today that will provide health care access for citizens while avoiding budget expenditures that would make federal deficits even deeper.