By the time this week is over, dozens of bills will have been sent to Gov. Nathan Deal’s desk. He will sign most of them into law, adding and deleting hundreds of lines from the state code.
What all of them have in common is that none of them will help repair a health care market that is disintegrating faster than we’d like to believe.
Obamacare, as sweeping as it was, and even if it weren’t so wrong-headed, isn’t a big-picture answer. Obamacare doesn’t address a looming doctor shortage. Obamacare is silent on the question of states’ certificate-of-need laws.
While Georgia hasn’t expanded Medicaid as envisioned by Obamacare, that would not be much of a salve, either. An expanded Medicaid wouldn’t do anything about low reimbursement rates that keep many health providers from taking Medicaid patients in the first place.
As health officials acknowledge in private, Medicaid expansion most likely would leave even safety-net hospitals with high rates of uninsured patients worse off financially than they have been historically under so-called disproportionate-share payments — which Obamacare is set to slash. It would be a mere band-aid for rural hospitals that suffer from low rates of privately insured patients who pay full freight.
The problem with trying to fix health care is that it’s typically done by pulling one lever here and another there, in the hopes that a flat-lining system will be miraculously cured. Health care is too far removed from anything resembling a rational market for one or two fixes here and there to make a difference.
In the past few years, our state has employed commissions of appointed experts to take the long, broad view and recommend a series of reforms to criminal justice and, beginning this year, k-12 education. The criminal-justice group’s work has been widely acclaimed, and the education commission is by all accounts off to a promising start.
Georgia needs to take a similarly long, broad and sustained look at health care.
We need people who will look at insurance and access, yes, but at other aspects as well: Incentives for bright young minds to become doctors, and the educational capacity to enlist as many as we need; licensing and scope of practice for other health professionals; the creation of health care networks tying together rural areas with failing hospitals; the further expansion and strengthening of Georgia’s telemedicine and charity clinics to help fill in gaps; and encouraging the opening of more health facilities by loosening the state’s relatively strict certificate-of-need laws.
There’s more, but that’d be a pretty good start.
What these, and any other, issue areas have in common is that their successes would be mutually dependent. That’s why they can’t be done very well alone. They need to be considered collectively, and that’s more than we can expect from our annual 40-day sessions without an overarching effort to string them together.
And that effort probably needs the backing of a governor. The reforms from Deal’s criminal-justice commission have enjoyed more legislative success than similar endeavors by task forces created by the Legislature itself.
If it doesn’t fit into the rest of Deal’s tenure, it ought to be in the sights of anyone already looking ahead to 2018.
