Opinions

Medicaid not Alaska's only health care problem; we need an omnibus fix

I have watched closely the discussion and debate regarding Medicaid expansion and reform in Alaska. It has been quite the show; although I remain uncertain whether I am watching comedy or tragedy, and I pray that I am not watching farce.

What intrigues me most is that while Berta Gardner and Wes Keller, among others, duke it out with competing commentaries in Alaska Dispatch News, they are both right on this topic. And they are both wrong.

Keller is correct that the current Alaska Medicaid program is unsustainable. I will go Wes one step further, agreeing with Lance Pruitt's recent description of Alaska Medicaid at a Northeast Community Council meeting as "the most failed Medicaid program in the nation." Because it is. Bar none. Even Mississippi, a state that, in health care and public health circles, is the punch line to most any joke related to failed health outcomes, still has a better Medicaid system than Alaska does. An embarrassing disgrace for the Great Land.

But Keller is peeking through a keyhole; his exact wording is always, "Medicaid in its current, non-expansion form." The Alaska Medicaid program is arcane and obsolete by national best-practice standards, as only we and Wyoming still have no elements of managed care, and our system is governed by stagnant health statute that has seen no momentous change or revisiting since effectively the late 1970s.

Keller does not seem to understand that "reform, then explore expansion" is an overly simplistic way of managing a health system. Much like a spider's web, a complex health system is complex because it's made of numerous fibers extending in multiple directions. Keller's straight-line logic will not work in health care. He is applying one-dimensional thinking to a 3-dimensional problem. Health care in Alaska is not a line, where one only has the option of moving in one direction or the other; it's a sphere. Health care isn't as simple as third-grade geometry; health care is complex calculus.

Keller is also very correct that expansion, and/or any "budget offsets," will not address the state's already-existing Medicaid liabilities, which are significant. Keller is generally correct that his opponents have focused almost solely on the federal match under expansion, and Keller is very correct when he states that expansion would not solve the "sustainability problem of the overall Medicaid program." What Keller seems to forget is that he is a lawmaker, someone who can seem to make law; as such, the Commissioner of DHSS need not offer Keller and other lawmakers reformative ideas if they already have those ideas from the Medicaid Task Force and the Medicaid Reform Advisory Group. Lawmakers need simply now put those ideas forward as proposed legislation -- in, dare I coin the term, an Omnibus Health Bill.

And in the opposite corner of the ring, Gardner's team holds the moral high ground of this battle but, like a Mr. Magoo cartoon, they are myopic of the risks and liabilities that they are stepping into. Gardner's analogy of a paper boat is cute, but it skims over all of those facts that her side of the argument tends to ignore. Keller is correct that there is significant risk and liability associated with the existing Medicaid program, and that expansion in and of itself will not reduce or reset that liability. The DHSS Commissioner should be quizzed on this, thoroughly. Legislators' job is to understand just what they supposedly craft law and approve budgets for. Gardner may feel as if the questioning by lawmakers was an "inquisition" because the right questions were never asked, and fully truthful answers were never given by DHSS. But this is because the two parties were having practically two different conversations, just as Gardner and Keller are now.

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The claim Gardner makes that the system is "operating at 90 percent efficiency" is clear evidence that she is in the wrong conversation. The failings of DHSS, and the Alaska Medicaid program, go systemically and structurally much deeper than just the recent payment system issues, which DHSS now claims are 90 percent addressed.

Imagine for a moment that Alaska Medicaid were a house and that Keller and Gardner are arguing with each other through the bedroom keyhole. Keller talks about how the kitchen and electrical need redoing first, while Gardner talks about how the bathroom has already been remodeled and the living room and dining room now need additions, meanwhile the whole house has mold in the walls, a leaky roof and sits on a cracked foundation.

As such, both Berta and Wes are right about the current state of Alaska Medicaid. And they are both wrong. At this point, the argument is stalled, and it seems Gov. Bill Walker has no other choices but to call a special legislative session on Medicaid expansion unless he wants his key campaign promise to burn to the ground.

That special session should not focus solely on Medicaid expansion and reform, or Medicaid expansion or reform. It is best for this state that the next special session be called on a greater and better topic: Discussing the very future of Alaska's health care.

Alaska sits in a unique situation. We have the great disgrace, and thus the great fortune, of having been left in the dust by 49 other states on having a functional and competent health department framework. That gives us ample opportunity to now steal all of their good ideas, and avoid all of their mistakes, and to quickly and decisively move ourselves forward to become this country's first 22nd century health model.

We could lead by example again, being the change that we hope to see in others, instead of wasting any more of our state's valuable time with temporary fixes to the failed state that is this state's way of running a health department.

We need only set aside the temporary duct-tape-and-baling-wire repairs that have been this state's way of addressing health care, and instead bring all parties to the table for an open, honest and transparent discussion on how to extensively renovate our house divided.

The next special session should be spent on digging down to the very bedrock of our state's health system, and repairing the foundation of something that is literally life and death for communities statewide, including my hometown of Anchorage and the governor's hometown of Valdez. The next special session should be focused specifically on Omnibus Health.

John C. Laux is a health care consultant in Anchorage. He holds positions on the Anchorage Health and Human Services Commission, the Alaska Public Health Association, the American Public Health Association, and the editorial board of Frontiers of Health Services Management. He holds degrees in public health, psychology, and is nearing completion of an MBA at Alaska Pacific University.

The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)alaskadispatch.com.

John Laux

John C. Laux is a healthcare consultant in Anchorage. He holds positions on the Anchorage Health and Human Services Commission, the Alaska Public Health Association, the American Public Health Association, and the editorial board of Frontiers of Health Services Management. He holds degrees in public health, psychology, and is nearing completion of an MBA at Alaska Pacific University.

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