The Shakespearean qualities of the Medicaid expansion debate

The Affordable Care Act is a mere seven months away from being deployed in its full form--and it has been one of the great dramas in recent U.S. history. The wrangling to get it passed through Congress and the Shakespearean levels of bloviating and self-deception since then have been, for the most part, quite entertaining.

Still, some portions of the ACA production have been flops--the Health Insurance Exchange Show is moving forward uneventfully in all 50 states, as homogenous and uninspired as a community theater production of "Starlight Express." 

But Medicaid Expansion Theater has been a smashing success. It's toured more than half of the states so far, recruiting a memorable ensemble and following enough plotlines to fill virtually all of flyover country. 

For those of you who have yet to receive the Medicaid Expansion Theater playbill, it pivots on a number of rotating conceits constantly placing the title character in peril. Much like Desdemona, Medicaid expansion is mostly portrayed through the eyes of others. It has been labeled wasteful and useless, and there are a bunch of actors raring to throttle it.

Medicaid expansion itself has a number of champions such as state hospital associations who don't want their members to lose out on billions of dollars of revenue. Much like Cordelia, their intentions are mostly misinterpreted or ignored.

Indeed, the latest plot twist seems to conflate the Cordelia and Desdemona story arcs: Medicaid expansion will simply be betrayed by its father, the government, even though it's sincerely promised to fund much of her life in perpetuity.

And this version of King Lear just tells Cordelia straight out he plans to destroy her. And he won't have any raving regrets afterward.

The problem is, most of the Iago-like rumor-spreaders and Lear-like punishers are government officials themselves. They're Red state governors and lawmakers who actually hold the purse strings. They don't have to strangle Desdemona or disinherit Cordelia, but they're going to anyway.

The problem is, they're forced to convince the audience that it's actually not in their hands at all, because who could sympathize with someone like that? Nevertheless, they've been yammering on during the first several acts of Medicaid Expansion Theater that this irresponsible government character is a spender of the highest order. By act five, they're equally certain it is mean-spirited and penurious.

It's poor character development if you ask me, and sort of the otherworldly plot twist more characteristic of Tom Stoppard than Shakespeare. But who listens to the critics anyway?

Otherwise, you might miss this recent exquisite soliloquy by Arizona lawmaker Warren Petersen. To wit: Those who support Medicaid expansion already believe it will fail, people with minimum wage jobs have enough income to buy insurance on their own, and a lot of the money will be used to pay for abortions. 

It reminds me of the advice Polonius dispenses to Hamlet: Don't waste your money on frivolous entertainment, dress richly but conservatively, and don't borrow or lend money.

If only the cast of Medicaid Expansion Theater hadn't forgotten his final bit of advice: "This above all: to thine ownself be true."

But following that maxim means ignoring another: The show must go on. And at the moment, there's no timetable for Medicaid Expansion Theater to go dark. - Ron (@FierceHealth)

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