Well, the state of Utah managed to outdo itself this week in stupidity. Unlike many states who have ballot referendums, Utah allows the legislature to “adjust” the ballot initiative as needed once it’s approved by the voters. In a sense, does it mean that they rewrote the referendum for their own special interests? That happened once again with the Medicaid expansion that was voted on by 53% of the voters.

All politics aside, there are two things totally wrong with the situation. The first is that the legislature chose to not let the referendum stand “as is.” We essentially scrapped a very lean and reasonable Medicaid expansion for one that costs almost 3 times as much with far more overhead than the original bill. Utah, as many of you know, is a very red state with a lot of “fiscally conservative” legislators (They pretend to be at least, but spend millions redesigning a logo…). So, why are we throwing away the taxpayer’s money on a bill that provides far less care and a hell of a lot more corporate welfare. That brings me to the second thing that’s wrong with this bill. It is not providing care to the people who need it the most.

So, let me school you a little bit about Medicaid. Most people view Medicaid like people view welfare in that they call it a “hand out for the lazy.” Want to know who really ends up on Medicaid? It comes down to about three different groups of people; one being the frail elderly who have a limited income and need more care than Medicare can provide. The second is pregnant women and newborn infants of folks with a limited income. Before you start complaining about that, think about all the campaigns against abortion and birth control. The last group is the disabled, usually, before they are eligible for Medicare and because of their limited income, even when they do have Medicare.

Medicaid is not a Cadillac health plan. It is bare-bones, and anything beyond a doctor’s visit has to be prior authorized, at least in Utah. Most states fluctuate the program based on the monies available, so if there’s more money, you get more services, and if there is less money, you guessed it, fewer services.

There is a lot of opposition to a universal healthcare option in this country; there shouldn’t be. Potential tax increase aside, there really shouldn’t be any debate. Insurance companies are the worst to deal with as both a provider and a patient. As a provider, when we develop a plan of care, a lot of times in order for insurance to pay we have to obtain a prior authorization. This prior authorization requires submitting documents to your insurance company, along with notes, that demonstrate that you meet the criteria to receive this procedure. If your insurance company doesn’t like the information I submitted, they are very likely to deny the procedure.

Full disclosure, Nursie poo worked the evil that is an insurance company. I worked as a utilization manager. The utilization manager looks at prior authorizations and claims submitted to determine eligibility for the service. I will say upfront that there is an effort to deny approximately 20% of all claims to insurance. In fact, all insurance companies track utilization manager’s denial rates. Quite frankly we were evaluated on this in our performance evaluations. Insurance only works for the insurance company. If they don’t have to pay money, they’re happy. I’m sure everyone realizes this, but I have literally watched in a staffing meeting where the medical director told a utilization manager to call a facility and strong arm them to move the patient to a different level of care due to the cost to the insurance company. So, all the fear that was generated in the 2008 election about death panels is already going on in corporate boardrooms, and you just don’t even realize it (and I bet Sarah didn’t want you to either).

A universal single-payer plan would, in truth, be fraught with the same authorization process, except it would be one standard and without a corporate bottom line making decisions about your health care. Thus, from the provider side, the process would be streamlined and well known. The best model of this is Medicare and a hospital system like the VA. The VA is better than the nay-sayers say (that sounded weird).

Oh, I know, blah, blah, everyone doesn’t need healthcare, it’s not essential. Grow up, seriously, grow up. You think you don’t need it until you are met with a catastrophic bill for an illness or injury that you are forced to pay because of lack of insurance. Now, because you are so personal responsibility, you are going to pay that like a good boy and not try to wiggle out on it through bankruptcy, assistance programs, or force your friends to pay for it through a go-fund me. Grow the hell up and stop acting like you are personally writing everyone’s health care. Do you realize that you already pay for Medicare? Medicare is self-supporting when it is not stolen from. If you are on Medicare, you have no horse in this race so stay out of it, you have your health care as you deserve.

In order to work, we all need to be paid, and we all need to be healthy. Stop letting people screw with your health and realize that all the bitching about Obamacare was stirred up by folks who don’t have to worry where their paycheck comes from.

The bats…the bats. We can’t stop here…it’s their country…