This commentary was originally published in The Monitor on November 28, 2016.
Voters in Hidalgo County now have twice rejected adding another administrative special taxing district. Both rejections were in health care. In 2014, voters rejected a proposal to create a Hidalgo County Hospital District by a 2,508-vote margin. And on Nov. 8, Proposition 1 to create a Hidalgo County Healthcare District was voted down by a wide margin of 72 percent to 28 percent.
Hidalgo County voters were wise to do so. Adding new districts simply adds more layers of bureaucracy and increases costs, while redistributing more money from taxpayers and away from needed services, instead of focusing on the intended beneficiaries — patients, in this case.
Apparently, the citizens of Hidalgo County have their own version of the Obamacare mantra to “repeal and replace,” their South Texas mantra apparently is “reject and redirect.”
The first half has been accomplished. However, the second half is missing. Hidalgo still faces the problem of providing timely, as well as quality, medical care for the uncompensated care group.
So what should Hidalgo County voters do to improve access to needed medical care services for the poor yet not break the bank?
Fifteen years ago, a colleague testified before the New Mexico Legislature that: “Healthcare doesn’t need more money. It just needs to be distributed properly.” That sentiment is equally true today. Hidalgo County officials need to be more dollar-efficient with money used in the current budget, instead of simply raising taxes and spending more money.
Dollar efficiency in health care is surprisingly easy to define. Dollars that help people get care are “dollar efficient.” Dollars that do not provide care in any form are “dollar inefficient” — these are dollars that go to bureaucracy, administration, rules, regulation and compliance (BARRC).
Hidalgo County Commissioners budgeted $5.5 million for indigent care for the past two fiscal years. This money gets sent to the state, which returns $13 million to fund indigent health care.
But how many of your tax dollars goes to hospitals, providers of care and nursing homes? How much of the $13 million is consumed by BARRC? We don’t know the answer. Apparently neither does anyone else.
Don’t you want to know what you’re getting for all of the money you’re giving the government? We do, too.
A certain amount of BARRC is necessary to coordinate and facilitate healthcare activities. How much healthcare spending should go to BARRC and thus become unavailable to pay for care? Should it be 5 percent or 10 percent or event 25 percent?
If Hidalgo County is anything like the rest of the nation, more than 40 percent of spending on so-called health care goes to
BARRC and is unavailable to pay your doctor, nurse practitioner or hospital. The reason payment schedules to doctors are being reduced is the money that BARRC is directing to itself. If so, that would be $5.2 million of the $13 million in available funds.
Ask your physician or local hospital administrator if it would help if the county redirected $5.2 million to care services, thus nearly doubling the money available to pay doctors and hospitals. After they emphatically scream “Yes!” then demand that the county precisely account for how much healthcare spending goes to care and how much goes elsewhere. Then demand that the dollars that go elsewhere be redirected to care.
Of course, the best longterm solution to the cost of indigent care is more jobs — thus reducing the number of indigents. Officials throughout the county should focus on limiting the footprint of government to assure a strong foundation for job opportunities to get people out of poverty so they can afford their own health care.
When the amount of money wasted on unnecessary BARRC is known, that amount can be redirected to the people who care for the poor while at the same time leaving more money in taxpayers’ pockets. That is the moral as well as dollar efficient way to achieve reject and redirect.
Dr. Deane Waldman is director of the Center for Health Care Policy at the Texas Public Policy Foundation, a nonprofit research institute based in Austin. He also is author of “The Cancer in the American Healthcare System.”
Dr. Vance Ginn is an economist in the Center for Fiscal Policy at the Texas Public Policy Foundation.
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Vance Ginn, Ph.D.