Now the Sunshine State can get on with finding a real solution to helping its locked-out citizens in need of health care. It can become a national model in melding innovation and compassion without -- please, God -- firing an order to Washington to print more money.
Let's look a little more closely at the nation's fiscal predicament.
First, the idea that the government gives "free money" is a myth. Medicaid expansion adds an estimated $638 billion in new government spending from 2013–2023. That's just Medicaid expansion, not Obamacare as a whole, which is still a running, open tab with no end in sight.
What I'm saying here is, the red states' defiance is all we've got to slow down this locomotive on its way to an otherwise cataclysmic fiscal train wreck.
New spending at the federal or state level is reckless in light of the country’s trillion-dollar budget deficits and over $18 trillion in national debt. It was Texas Gov. Rick Perry who said, “[T]here is no such thing as ‘free’ money. We know there’s only money that’s collected from taxpayers, and money borrowed from other countries like China against the good credit of our children and grandchildren.”
The federal debt really is a bloated beast. That's no exaggeration. In 2004, the federal debt was $7.3 trillion. This rose to $10 trillion when the housing bubble burst four years later. Today it exceeds $18 trillion and is projected to approach $21 trillion by 2019.
When you break this down to an amount per taxpayer, the numbers are substantial. The chart on this page includes this data, which shows how it has more than doubled over the past 11 years, rising from $72,051 per taxpayer in 2004 to $154,161 today. Let me repeat: That's $154,161 per taxpayer.
We look at Greece and shake our heads, but economists tell us -- in spite of our wealth, our resources, our status -- we're on that Pantheon path.
Certainly the Affordable Care Act is not the only thing responsible for our withering debt, but it's the biggest-ticket item -- up there with defense spending -- and it's an issue we still can address.
The 21 red states -- Florida included -- have a tough job ahead. By giving up Medicaid expansion, they forfeit more than $8 billion in federal cash, the Rand Corp. estimates. Nevertheless, the 21 reds say it would cost them even more in the long run; they would have to fork out 10 percent of coverage costs from 2020 onward.
Widespread rejection of key Obamacare provisions reflects a growing unwillingness among these states to accept one-size-fits-all mandates.
“They rightly see this as sucker money,” said Randy Barnett, a constitutional law professor at Georgetown University Law School. “There’s no absolute that the federal money … will continue, given the huge fiscal problems we have at the national level. States would almost be idiots to take this federal money.”
So, where does Florida go from here?
Bob McClure, president and CEO of Tallahassee-based James Madison Institute, says the spending and debt problems are brought on by the federal government and the regulatory bureacracy it creates; the solutions are in the private sector. "We didn't get in this overnight and we're not going to get out of it overnight," he said.
"The Senate wants to give everybody care and bring home Florida dollars, and as well-meaning as the sentiment is, that plan was going to reduce access, provide a marginal quality of care and blow a hole in the state budget. Even (former Senate President) Don Gaetz is arguing on behalf of expansion. We've agreed with him on so many issues and although we agree on the need to help the truly sick people without access to health care, this is just one area where he and JMI don't agree -- on the means to get there.
"Necessity is the mother of invention," McClure reminded me. "Let's figure something out that will actually help those who genuinely need it."
I agree with Bob McClure, who sees Florida in a unique position to move ahead creatively, thoughtfully -- find innovative solutions, attack crony capitalism and special interests, perhaps create a network of telemedicine, expanding the ability of physicians' assistants to treat more patient symptoms. Those things will help bring down costs and help get sick people the medical attention they need.
I wonder how many little-publicized gems of ideas are planted in counties around Florida. I hope to interest the governor in visiting the one I know about in Martin County. It's called Volunteers in Medicine and it's beyond marvelous -- an entirely free clinic for anyone who falls through the cracks, staffed by retired doctors and nurses, with the cooperation of Martin Memorial Medical Center, which conducts all needed tests. Every patient has his or her own personal doctor. Even the drugs dispensed are free -- vendors' samples donated by medical practices in the county. It has saved the county and the not-for-profit hospital literally millions of dollars over the last 20 years.
In larger South Florida counties, where retired physicians run over each other on the golf course -- given the right incentives -- consider how many copycat Volunteers in Medicine operations might be established.
We have a governor who can make ideas happen. If not this, then something else. He knows how to do it, knows not only where problems lie but where possibilities are buried.
Gov. Rick Scott told his Economic Summit last week that the nation would do well to follow Florida. Now I think he might want to take that statement a step further. Don't you think he might want to look at a legacy that specializes in health-care solutions and create a Florida showpiece there, too.
Reach Nancy Smith at smith@sunshinestatenews.com or at 228-282-2423. Twitter: @NancyLBSmith
