In a column before the June 30 vote, former Gov. Frank Keating raised three good points in opposition to SQ 802:

1. Oklahoma’s potential costs for one year of Medicaid expansion could be as high as $374 million, and we can’t afford that.

2. Medicaid expansion won’t improve health outcomes.

3. Medicaid expansion won’t reduce consumer costs.

Keating’s first point is based on the assumption that a very high potential number of people — driven by the COVID-19 shutdown — will be eligible for expanded Medicaid on July 1, 2021, and that the state would have no resources to deal with the situation. I hope the first assumption isn’t right; the second is certainly wrong.

If the state’s cost for newly eligible patients is $374 million, the federal government’s share would be $3.366 billion. That’s a total of roughly $4 billion going into the state’s economy. The sales and income tax growth on such an infusion would largely pay the state’s portion of the costs, not to mention the estimated $200 million in state costs savings associated with expansion. So much for the $374 million boogyman.

Keating’s second point is debatable.

There has been some good research to show some health outcomes — diabetes rates, heart attacks and strokes — haven’t improved in expansion states yet. If you think about it a bit, you’ll realize why. Some health indicators improve over generations, not years. But there is also evidence that health indicators that respond quickly to people having an improved relationship with primary care physicians are getting better. The commonly cited example is early diagnoses of cancer. Before the election, Oklahoma Policy Insititue analyst Paul Shinn wrote a very interesting piece that brought together some other research showing Medicaid expansion improves and extends lives, especially in the South, especially in rural areas.

I have no doubt that, over time, Medicaid expansion will improve health outcomes in Oklahoma. We will live longer and the quality and productivity of our lives will be better.

Keating’s argument about medical inflation is probably right, but you can’t blame Medicaid expansion. One of the causes of rising costs of health care for insured patients is cost-shifting of unreimbursed costs by hospitals and other providers. Uninsured patients get treated in emergency rooms, can’t pay their bills and the costs are shifted to insured patients, who see it in higher charges and insurance premiums.

Medicaid expansion obviously addresses that issue. The hospitals get reimbursed and, with some management, the patients can be diverted from emergency rooms to less expensive (and easier to access) treatment opportunities.

But unreimbursed costs are hardly the only factor in medical inflation.

The other day we all saw that a pharmaceutical company has a new patented drug — remdesivir — that helps people with COVID-19. It can shorten their hospital stays by about five days, studies show.

The drug was reportedly developed with about $99 million in federal research funding.

The pharmaceutical company that owns the patent says a course of treatment for one patient will likely cost $3,100, and, of course, every COVID-19 patient will want it. The culprit in that bit of medical inflation is not Medicaid expansion.

More notoriously, there are the case of skyrocketing insulin prices and pharma-bro Martin Shkreli who hiked the price of a drug used by AIDS and transplant patients from $13.50 per pill to $750 in 2015 just because he could. Shkreli ended up in prison for other reasons, but the cost of the drug remains extraordinarily high.

The contrast in all of these cases is to Jonas Salk, the hero-physician responsible for the first polio vaccine, which has saved and improved the lives of millions around the world.

When Edward R. Murrow asked Salk who owned the patent to his vaccine, he said, “the people.

“Could you patent the sun,” he asked.

There’s research out there showing that, in fact, the National Foundation for Infantile Paralysis had looked into patenting the vaccine and found that patent law at the time wouldn’t allow it.

Whether Salk’s motives were pure or practical, the vaccine was never patented. Polio is practically eradicated and the current price of the vaccine is about $1 per dose.

Polio vaccine: $1.

Remdesivir: $3,100.

There’s your medical inflation.

Medicaid expansion in one state won’t control that. It’s a problem for Congress, which, in the thrall of Big Pharma, isn’t likely to act effectively.

But it is reasonable to say that Medicaid expansion will help control consumer medical costs to insured patients. Without it, those costs would surely rise faster.

Keating is a friend, a brave man and a very smart one, but he’s was wrong on SQ 802. I’m glad that 50.48% of the voters agreed with me on that point June 30. A year from now, we’ll start learning exactly what it will mean for the state.

Featured video