A rational, Christian response to a mugging is to aid the victim while ensuring the perpetrator never repeats the crime. South Dakotans know this, which, along with Constitutional Carry, is why crime hasn’t spiked here as in so many other places across the nation. A small majority of South Dakotans, however, have voted to change the state constitution to join California and New York and allow medical mugging to continue.
I gather that supporters of Constitutional Amendment D (CAD) voted to help poor people with big medical bills, and use other Americans’ money to do it. What a deal! But Medicaid expansion really does not help the poor any more than reimbursing a mugging victim does, especially when the mugger goes unpunished, poised to strike again. It’s virtue signaling at best and at worst a capitulation to Big Sick Care.
Medicaid expansion under CAD will aid healthcare providers (HCPs), i.e., the perpetrators of the problem, the very institutions that pushed hard for expansion. Yes, HCPs should earn enough to induce them to provide healthcare services, which everyone needs to some extent or another. But do not forget that HCPs already get what a competitive market would pay them and a whole lot more besides. For a full explanation and proof, see Sean Masaki Flynn’s 2019 book, The Cure That Works.
Flynn points out that US healthcare, and unfortunately South Dakota’s too (after showing some promise before implementation of Obamacare), is much too expensive. There are no real prices, just negotiated settlements with insurers or governments. And the fee-for-service model creates a panoply of perverse incentives, including a predilection to treat symptoms but not to cure the underlying causes of illness. It’s more sick care than healthcare.
Early in 2022, my adult son was hospitalized in Sioux Falls for several days. The HCPs thankfully did not kill him, but they did not fix him either. He is still getting bills for services that may or may not have been rendered. (He is no doctor and barely remembers his emergency stay.) He was then earning a little too much to receive Medicaid yet his total cost was in the thousands. Under CAD, Medicaid would have chipped in for him but somebody else earning just over 138 percent of the federal poverty line would be in the same situation as my son, facing huge bills for “services” that may only serve the HCPs.
If South Dakotans really want to help the poor, and everyone else, with their medical bills they should compel HCPs to compete on the quality-adjusted price of their services. Then people can shop around for the best deal instead of committing themselves to pay big, convoluted, unknown bills, often for little or nothing in return.
Yes, such a radically commonsensical policy would run afoul of current federal regulations but some cities and states routinely declare themselves “sanctuaries” where federal laws do not apply. South Dakota has a long history of bucking widespread strictures on divorce, interest rate caps, residency rules, trust funds, and the like. Why not burnish that reputation for policy innovation by offering the country an example of a competitive healthcare system that, as Flynn shows, will be much cheaper and better than the one currently mandated from Washington, DC?
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