Healthcare in America: Guns or Butter?

By Benson Weintraub, Esq.
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FORT LAUDERDALE, FL (October 25, 2008) My interest in health care fraud originated as a white collar criminal defense lawyer in the federal courts with an abiding commitment to academic excellence, particularly in the criminal justice environment.
But when the proportion of health care fraud cases in which I participated increased so significantly, this did not occur in a vacuum. So, too, was the proliferation of this type of fraud increasing in prosecution at an incalculable rate.
As a scholar in sentencing law and policy, individual and corporate, I intuitively search for explanatory reasons for trends in criminality and reactive public policy on a federal, state, and local level.
An holistic approach to fluctuating crime rates, detection and prosecution, sentencing, imprisonment, all require the analyst to address the interplay of predominating political, economic, and social priorities established by governments at every level. Sometimes, this permits a remedial integration of resources to conserve capital outlay and expenditures. In other cases, however, the aggregation of social, economic, and legal policies which governments face must be driven by a maximization and continuity of provider-type services.
The perfect example lies in the competing governmental interests between delivering reasonable health care services to all residents and the maintenance of sentencing policies and expanding prison populations. Departments of Correction(s) consume not only major percentages of governmental budgets but in the main, the lengthy prison sentences mandated by state and federal laws, and aging prison population, make it increasingly difficult to accommodate both social needs: health care and social protection.
This dichotomy is underscored by the social engineering of seeking to meet both health care needs and correctional concerns. “According to a new federally backed study conducted at the University of California, Irvine, the state’s corrections costs have grown by about 50 percent in a decade and now account for about 10 percent of state spending—nearly the same amount as higher education.” Editorial Board, The California Prison Disaster, NEW YORK TIMES (Oct. 25, 2008) at A18.
Ironically, for Medicaid in California, this comes at a time when “the state ran out of money for Medi-Cal payments to clinics, hospitals, medical equipment suppliers, adult day health care centers and others.” Ken Carlson, California Budget Impasse Hurts Health Clinics, THE MODESTO BEE (July 25, 2008) http://www.modbee.com/1618/story/371108.html (last visited Oct. 23, 2008).
Tragically, the article further noted that “State leaders, in an effort to erase a $15.2 billion deficit, have considered changes that would make fewer people eligible for Medi-Cal, the state health program for the poor, and reduce funding for dental care, vision services and services for children with genetic diseases.”
These distressing trends emerge as international markets are adrift in fluidity. Well, we have had a Drug Czar, a de facto Economic Czar (Greenspan), a post-9/11 Homeland Security Czar (Tom Ridgefield). Notwithstanding marginal success achieved by prior royalists, where is Joe Califano when you need him (You’ll recall that under JFK, he rebuilt HHS’ predecessor, HEW)?
Whether it’s California or the nation, that ancient quandary over guns or butter is again supper talk over more and more spaghetti.