From a press release produced jointly by 18 Alabama Health Care professional societies requesting that additional revenues be sought for Alabama Medicaid

The Fiscal Year 2013 General Fund budget passed the Alabama House of Representatives on Tuesday with an unprecedented 38 percent cut to the Alabama Medicaid Agency, an agency that provides health care coverage for more than 900,000 Alabamians. These cuts are poised to threaten access and ultimately drive up healthcare costs for ALL of our citizens by:
– eliminating prescription drug coverage for more than 185,000 adults;
– closing community pharmacies, especially in rural areas;
– eliminating kidney dialysis coverage for adults;
– jeopardizing critical care transport for children;
– eliminating hospice and home care services, which will result in lengthier hospital stays;
– threatening access to primary and specialty care providers for both children and adults; and
– crowding already overburdened emergency rooms.

From Dr Ron Paul’s book, The Revolution, a Manifesto

In the days before Medicare and Medicaid, the poor and elderly were admitted to hospitals at the same rate they are now, and received good care. Before those programs came into existence, every physician understood that he or she had a responsibility towards the less fortunate and free medical care was the norm. Hardly anyone is aware of this today, since it doesn’t fit into the typical, by the script story of government rescuing us from a predatory private sector.

I learned a new phrase today, ipse dixit. It means, near as I can tell, that the person making the argument asserts that their own authority is the only proof needed. When discussing health care delivery, public and private sources of funding, reasons for inability to pay for needed health care, and the consequences of the inability to pay for needed health care, it seems that everyone has an ipse dixit reaction. This may be because everyone has accessed the system and this may entitle them to expert status. It may be, when it comes to programs funded by the federal government, that folks really want to believe in the existence of easier, better, cheaper solutions. Whatever the cause, the readers’ comments regarding any story about Alabama Medicaid (such as this one) will give you a taste of what an ipse dixit argument looks like. Dr Paul’s argument is an example as well, as it is based on the fact that he WAS a doctor before Medicare and Medicaid were introduced, thus making him an ipse dixit authority.

The average commenter on Medicaid stories (as well as Ron Paul and his supporters) argue that Medicaid recipients suffer from a “lack of personal responsibility” as well as seemingly an unwillingness to seek out  charity from willing physicians. Perhaps the elimination of Medicaid will offer physicians the opportunity to provide high quality care to deserving poor people for free or reduced cost. Unfortunately, Dr Paul’s memory regarding the time before Medicaid is faulty. Physicians were not so much noble as they were greedy.  From “The Unfilled Promise of Public Health: Deja Vu all over again.

One achievement of the Progressive Era reformers had been the Sheppard-Towner Act of 1921,which provided matching funds to the states for prenatal and child health centers. Staffed by female doctors and public health nurses, these centers offered advice to mothers, with the aim of lowering infant mortality rates. In 1922 the AMA condemned Sheppard-Towner as an “imported socialistic scheme” and by 1927 was able to persuade Congress to eliminate the program.

The services were not provided by physicians to all folks, subsequently. Despite Dr Paul’s assertion, many never received this care until the passage of Medicaid. Today 40% of Alabama’s children are on Medicaid.  It is not provided by their parents’ employer 61% of the time.  Access to care through Alabama Medicaid has lead to marked improvements in care delivery for Alabama’s children. Evidence is that neither these children nor their parents can exhibit more “responsibility.” Evidence is also that we will do Alabama irreparable harm by implementing these Medicaid reductions. Arguments, on the other hand, can apparently be made in either direction.