No foolin’ As the world turns, Oklahoma’s high stakes Managed Care fight sparks tension

Pat McGuigan
Oklahoma City, April 1, 2021 – In the public square, each major policy confrontation has unique aspects.
Events and personalities within any one legislative fight (or election) can never be perfectly equated with those in another.
Nonetheless, in the study of policy and politics, as in history, there are lessons.
Journalists and historians – like sages and philosophers – often make points by telling stories. This essay shares a few stories meant to provide context for an important health policy debate at the Capitol in Oklahoma City.

Wilson: Not a great president, but he said this … 

As a wee lad, I thought Woodrow Wilson (1856-1924) was a great U.S. president.
My assessment of him grew strongly negative as I studied history in more depth. Nonetheless, there is an American political adage, sometimes attributed to Wilson, distilled here in my own words, which seems apt.
After eight years as president of Princeton University, Wilson served a mere two years as governor of New Jersey. As he transitioned from academia to the arena of state governance – so the story goes – a wise old Democratic Solon warned him how harsh and mean-spirited things could be at the capitol building in Trenton.
Wilson, it is said, told the gray-head to save his breath, saying, “The reason academic politics is so vicious is that the stakes are so incredibly low.”
Once upon a time, the “low stakes” sketch might have been accurate. These days, more and more nonconforming conservatives and Libertarians face “cancel culture” pressures for their reasoned deviations from the dominant left-of-center synergy in higher education. It seems improper to describe consequences for contemporary scholarly free thinkers as “low stakes.”
Nonetheless, the Wilson story is shared because, assuming there is truth in the observation that low stakes fights can be brutal, it is not hard to agree that high stakes battles are often more so.
Another story follows. 

‘We already have socialized medicine’ 

I worked at The Oklahoman for Edward L. Gaylord (1919- 2003) for 12 years (1990- 2002), first as an editorial writer then as the newspaper’s opinion editor.
His guidance to editors was most often nuanced and broad, and gently offered.

For some time during the Clinton Administration (1993-2001), I crafted frequent and passionate editorials about the economic sins of proposed changes to American health care quickly dubbed “HillaryCare” (named for then-First Lady Hilary Clinton).
I reasoned her push would lead the country to socialized medicine, which I opposed.

One morning, sitting at morning coffee with Mr. Gaylord and political cartoonist Jim Lange, the boss was in a thoughtful mood.
Responding to one of my printed “HillaryCare” blasts, Gaylord said words to this effect to me, “Pat, we already have socialized medicine. It started long before Medicare. What we need to do is encourage ways to make the socialized medicine we have better for people, and slow down the ways it speeds up the growth of government.”
His comments transformed the way I have dealt with health care issues ever since.

A Big … Deal 

Which brings me back to the proposed Managed Care approach for voter-mandated Medicaid Expansion in Oklahoma.
Unveiled to the public in late January, the effort from Gov. Kevin Stitt and the leadership of the Oklahoma Health Care Authority is attentive to health outcomes and also aims to direct cost factors in a positive direction.
This is a good thing, because along with education and corrections, all things relating to government involvement in health policy amount to, as the current president of the United States said in a prior phase of his career, “a big f—ing deal.”

Indeed, as a journalist I respect (Ray Carter) wrote recently: “From 1999 to 2019, total expenditures on Medicaid in Oklahoma — adjusted for inflation and including both state-and-federal dollars — surged from $2.33 billion to $5.6 billion.”
(Memorably, the Late U.S. Senator Everett Dirksen of Illinois (1896-1969), both a politician and a sage, once reflected ruefully, after years in the nation’s capital, “A billion here, and a billion there, and pretty soon you’re talking real money.” (These days he would likely amend the sum to “trillions.”)

So: the stakes are high, not low – both in fiscal terms (the broad desire to address the spiraling costs of tax-financed health care programs for Oklahoma government) and in programmatic terms (the effect of health care evolution on the lives of real human beings – patients, pharmacists, nurses, doctors, and other medical personnel.

Worth understanding is the impact battles like this have on the political class – Republicans and Democrats, conservatives of all stripes, liberals of all nuances and those increasingly uncomfortable with traditional designations.
Any one of the sketched categories of those governing us deserve at least some understanding, appreciation and even tolerance as they walk through the Medicaid Expansion fight at the state Capitol, within the legal system and throughout Oklahoma’s large (and ever-growing) taxpayer-financed government.

Republicans Disagreeing Among Themselves

The balance of this commentary is mostly focused on two conservative Republicans.
They share many views about public policy, but are clashing memorably over Managed Care.

State Senator Kim David of Porter has characterized the governor’s vision as a timely decision about “coordinated care.”
State Senator Rob Standridge of Norman, in contrast, agrees with the state medical establishment’s recent attacks on the Stitt proposal. Standridge’s allies have described Stitt’s plans for SoonerSelect as a “Health Care Holdup.”

Senator David was described in a ‘Read Frontier’ story (January 29) as “a longtime proponent of managed care.” And: “[David] said she had no concerns that the Legislature and critics within it could block the program. She said the state question that placed Medicaid expansion in the constitution guaranteed it.”
According to that story about a press conference in which Sen. David participated, “She said that critics in the Legislature simply don’t understand the policy, or that they’re looking out for special interests that benefit under the status quo.”
The report directly quoted Sen. David as saying, “I think a lot of a lot of members — some of those who have been outspoken about it — don’t understand exactly what the concept is.”
And: “They know what they’ve been told, and they know they should be afraid. And then I have several who stand to gain by keeping the system the way it is.”

From time to time, especially in public life, stating the obvious is an act of courage.
Put mildly, this brand of bravery can get a person in trouble.
The reaction within the Senate Republican caucus was reportedly intense.

Sen. David accepted from the President Pro Tempore of the Senate a one-week censure.
She later said in a letter to colleagues, “I respect his decision and will learn from this moment. My comments were in no way intended to put Sen. Treat or my colleagues in a negative light.”
She reasserted passionate advocacy for wisdom in Medicaid administration, going forward: “Only a handful of states do not have third-party managed Medicaid. In fact, 40 states do, with proven results.” 

As this disagreement heated up, ‘The Norman Transcript’ reported — concerning two pharmacies that Senator Standridge owns: “Blanchard Drug & Gift and LegendCare Pharmacy — that were reimbursed more than $3.4 million from 2017 to 2020 by the state Medicaid system, according to Oklahoma Health Care Authority data that was obtained through an Open Records Request.”
Further details: “The sum of the annual average pharmacy reimbursements over those four years was over $2.1 million. Blanchard Drug & Gift, located in Blanchard, was reimbursed $1.02 million during that time period, while LegendCare pharmacy, located in Norman, was reimbursed more than $2.38 million.”

Standridge told his hometown newspaper, “Certainly some may disagree with me on managed care, but based on what I have studied and observed in surrounding states that have implemented managed care in this way it is neither better for the state nor for our most vulnerable citizens it is intended to help. However, if it eventually becomes the system in which we deliver Medicaid, I will continue to work to make sure the delivery of care is the best that it can be.”

Politics and men named Paul 

Sketching this disagreement (I share Sen. David’s policy preference) brings me back to things I learned while working for the late Paul M. Weyrich (1942-2008) during my sojourn in Washington, D.C.
Weyrich was, like many persons in public life, much more than the sum of his news clippings (which were prodigious). Among other things, his first real job was in radio journalism.

And, I heard him say more than once that politics is not to be confused with theology:
In bringing someone to faith, you seek a person’s conversion – 100 percent. In politics, anyone interested in gratifying results should understand that the elected official who agrees with you more than half of the time on the big stuff is your ally, not your enemy.”
Of course, Paul believed that some issues are more significant than others. The things he fought for still count.

But as time goes by, his adage about politics, and his behavior toward at least many of his policy adversaries, comes to mind.
He bequeathed to me friendships with, among others, the Rev. Jesse Jackson, and the late U.S. Senators Paul Tsongas of Massachusetts and Paul Simon of Illinois.
Further, there’s this bit of wisdom. which Weyrich believed:
“[N]ow these three remain: faith, hope and love. But the greatest of these is love.” (1 Corinthians 13: 13).

Perhaps there is something about the name, “Paul.”
Another Paul co-wrote a popular tune back in the day, with this memorable repetitive chorus:
“We can work it out.”
Perhaps, at least in Oklahoma, we can manage that.

Note: McGuigan’s analysis first appeared in the Southwest Ledger, April 1, 2021 print edition and online: . Southwest Ledger, 7602 US Highway 277, Elgin, OK 73538, (580) 350-1111. It is reposted here with permission.