Mazel tov! Talking Medicaid expansion in different terms

Ethan: OK, the battle to expand health care in Maine has been mightily forged between the two sides, yet you and I have not really taken the time to cut through the mishigas to inform the readers of what is really going on.

Phil: Mishigas?

Ethan: You WASPs are so goy.

Phil: Goy?

Ethan: Oy, gevalt. Have you never been out of Yarmouth?

Phil: Went to North Yarmouth once, but they spoke English.

Ethan: “Mishigas” is similar to “craziness.” “Goy” is a non-Jew, or “gentile.” “Oy, gevalt” means, “Oh, my goodness. Did you see the tuchis on him!”

Phil: Tuchis?

Ethan: Don’t ask.

Phil: So, you were saying about the health care expansion? You want us to try and peel away the “mishigas” and get to the core. You start.

Ethan: Democrats want people to provide health care, and Republicans don’t.

Phil: Oy, gevalt.

Ethan: Now you’re getting it.

Phil: How about, Democrats want to spend money no one has and promise benefits we can’t afford? That seems more in line with the truth.

Ethan: Money no one has? The federal government is going to pay for 100 percent of the cost for three years and 90 percent thereafter. If someone said they would pay 90 percent of your health care bill, I assume you would kvell.

Phil: Kvell?

Ethan: Express great joy.

Phil: Unfortunately, no joy. Because the “someone” you refer to is all of us. Or more clearly, the Chinese, from whom we’ll need to borrow the money.

Ethan: Expanding coverage reduces expense and means we will borrow less, and your taxes will be able to meet other needs.

Phil: How do you say, “If you believe that, I have the Brooklyn Bridge to sell you” in Yiddish?

Ethan: “You’re a schmuck.”

Phil: What’d you call me?

Ethan: No, no. That was my translating your statement into Yiddish. When you think a guy is a sucker, you’d call him a “schmuck.”

Phil: Then you’re a “schmuck” if you believe what you just wrote. Whenever the government creates a program, we hear your side claim that it will reduce expenses. But we only ever see expenses rise.

Ethan: Don’t take my word for it. The Kaiser Foundation estimates the state will save $690 million over the next 10 years if we expand health care and accept federal money. It will also save and/or create more than 4,000 jobs.

Phil: If that’s true, why didn’t we realize these results 10 years ago when MaineCare was expanded? Instead today we are experiencing out-of-control costs, and our employment numbers are still below 2007!

Ethan: Actually, MaineCare growth has been flat. According to the nonpartisan Office of Fiscal and Program Review, MaineCare has grown at little more than the rate of inflation over the past decade and has grown at a tenth of a percent in this fiscal year. In terms of the unemployment rate, all the more reason to accept this money. More than 4,000 jobs will knock a point off that puppy!

Phil: And the millions you take out of the economy to pay for it will take that point away. Look, if your focus is simply a more perfect union, why don’t we see better outcomes from the folks already on welfare? They get health care for free, yet we see higher incidents of tobacco use, drug problems and obesity. Today 40 percent of Maine infants are born to parents on welfare. These precursors certainly don’t support your utopian outcomes.

Ethan: I don’t think the data supports your thesis. Across the board, people who have access to health care and a primary care doctor have much lower rates of all of the above. In terms of births, I didn’t realize a goal of providing health care was population control. But, honestly, my idea of utopia is not smaller families.

Phil: Nor is it mine, but I also don’t want so many impoverished kids. The point is that these strategies just aren’t pulling people up.

Ethan: Well, we can debate for decades whether these policies are making it better, but what’s your strategy for providing health care to the tens of thousands who would otherwise be covered if we expanded?

Phil: First, it’s what they want, not what you want. If they truly want health insurance, then they need to pay for some of it, make good choices and be rewarded for them. Enable anyone who buys health insurance to deduct the cost from their taxes. Act like consumers so they/we know where the good prices and outcomes are in the market. I could go on, but you would likely accuse me of suffering from mishigas.

Ethan: Not quite the right use, but I would call you a meshuggener (crazy person) for believing that the difference between those who have insurance and those who don’t is simply “want” and the lack of a tax deduction. We are talking about people who make less than $16,000 a year. There isn’t an available tax deduction large enough to help someone at that level pay for health insurance. Plus, you’ll blow a huge hole in the budget.

Phil: As you know so well, tax policy influences behavior. If we incent people to buy health insurance, and elected officials make the necessary cuts elsewhere, we’ll see Maine truly on the move.

Ethan: Honestly, this idea really isn’t worth bupkis. But mazel tov on having the chutzpah to propose it.

Phil: Feh. You’re such a nudnik.

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