For an up-close view of the brokenness in our political and health-care systems, and especially of the way they make one another worse rather than better, you could hardly do better than watch the debate over Georgia’s hospital bed tax. It has it all.
First, there’s Medicaid. It’s the program states can’t live with — no matter how much money they pour into it one year, the cost only rises the next, in part because states have limited control over it — and can’t live without — the federal dollars involved are too numerous to pass up.
Medicaid funding is an inherent contradiction in fiscal responsibility: In order to balance their budgets, states look for ever more ways to get ever more money from a federal government that is ever more in debt. Meanwhile, even as Medicaid funding rises, Medicaid patients have ever more trouble finding doctors who will accept them because of the program’s low reimbursement rates.
So, Medicaid is so broken as to somehow render politicians incapable of anything but pouring more money into it. Which, I suppose, means it meets the threshold for being a true government program.
There’s the tax itself. Politicians like to call it a “hospital provider fee,” even though a “fee” is something the state charges for a service it provides. The only service provided here is the state’s role in asking the feds to dole out another half-billion dollars a year in matching funds, roughly $2 for every $1 raised by the tax, er, “fee.”
Those matching funds flow back to the very same hospitals that pay the tax. That makes it more akin to an extremely high-return investment, the kind of consistently high return one normally associates with an investment scam. (Given how unsustainable this entire arrangement is, that sounds about right.) It’s as if the hospitals are charging U.S. taxpayers a usurious interest rate for the pleasure of holding their money awhile. And yet, despite all this, the hospitals still end up losing money on many Medicaid patients.
Then there’s the way in which Georgia legislators have approached the tax this year compared to its initial approval in 2010. Three years ago, the tax was the source of much drama toward the end of the session. And while I’m hard-pressed to name a legislator who lost re-election after voting for the tax in 2010, the impact on the Senate wound up being truly historic.
Passing the tax involved a great deal of arm-twisting, including the loss of committee chairmanships for some senators who opposed the tax. The bullying was one of the reasons GOP senators cited the most after the 2010 elections when they staged a coup against their fellow Republican, Lt. Gov. Casey Cagle, and opted for governance by consensus within their caucus. That schism shaped the past two sessions, with fallout that continues today: Disaffection with leadership of the Senate by the Senate led to wholesale changes for this year’s session.
Having learned their lesson, GOP leaders don’t want to force legislators to walk that plank again. So they’re asking them to let someone else walk the plank.
This year’s bed-tax bill would delegate authority for levying the bed tax to the nine-member board of the Department of Community Health. It would be four years — that’s two legislative cycles and one gubernatorial race from now — before lawmakers had to act on the tax again.
Finally, there’s the near-certainty that, after jumping through hoops to renew this tax without being seen renewing it, Georgia Republicans will campaign during the next electoral cycle on the notions of cutting spending and refusing to raise taxes. They’ll probably add a few barbs about federal spending for good measure.
And, if history is our guide, almost all of them will be re-elected two Novembers from now — right about the same time Georgians of various loyalties will begin demanding their favorite football teams replace this coach or that one because he’s made a mess of his team and can’t seem to fix it.
– By Kyle Wingfield