CONTRARY TO the short-hand version in some national reports and even in-state conversations, South Carolina has not refused to expand medical care for the working poor now that the U.S. Supreme Court has said the Congress cant force states to do that as part of the presidents health-care law. Gov. Nikki Haley has said she opposes expanding the federal-state Medicaid program.
But while her veto pen gives her a bigger vote than anybody else, the governor doesnt get to decide that. Two-thirds of the Legislature can reject her rejection. And while there are a lot of numbers to be crunched and debates to be had and alternative approaches to be pursued, all indications are that if it came down to such a simple choice, it would be a mistake for the Legislature to follow the governors lead.
The governor says Medicaids rules are inflexible and sometimes wasteful, and we agree, and hope she and other officials will continue to press Washington for more flexibility, as they have done in recent years, to some success. She says the states should not have to pick up part of the bill for a congressional program and we agree with that as well, although not because we think a federal health law is a bad idea but because it has never made sense for the states to have to help pay for medical care for poor, sick, young people while the federal government picks up the entire cost for wealthy, healthy, old people.
The governor makes it sound as though our choice is between providing over-priced, substandard care through Medicaid or opting out of the Medicaid expansion and providing better and more efficient care under our own rules. And we might be able to do that if we could spend as much money doing it our way as we could doing it Washingtons way. Its theoretically possible that we could pull that off if we could spend, say, half as much i.e., that our way would be twice as efficient as Washingtons way.
But those arent our options. At the moment, our choice is to expand Medicaid or else do it our way with 10 percent of the money wed have if we expanded Medicaid and accepted Washingtons 9-to-1 match; less than 10 percent, actually, since one of Gov. Haleys objections is that we cant afford even 10 percent. And even if we were willing to adopt every conceivable nanny-state idea for driving down medical costs ideas that the governor would never condone and that would go too far even for our taste its simply not conceivable that our program would be nine times more efficient than Medicaid.
No matter how discounted something is, its always a bad buy if you dont need it. And if you do need it but cant afford it, then you cant have it. But if its something you need and its discounted by 90 percent, then even if the original price was ridiculously high, its foolhardy not to buy it. Particularly when, as a federal taxpayer, youre going to be picking up part of that 90 percent whether you accept it or not.