6 Degrees of Health Care Is No Idle Game

One of the great advantages of the universe as well as one of its biggest problems is that everything is connected to something. From the forces that act on the tiniest subatomic particle to the most massive of planets, nothing works apart from everything. Nothing exists entirely within a vacuum, completely unaffected by anything around it.

For years, people have been playing games like "six degrees of Kevin Bacon" to prove the fact that anything is eventually connected to everything.

The budget process in Tallahassee is like a game, too. In fact, it is like several games rolled into one. It is one part poker, one part fencing, one part chess and one part big sliding puzzle.

The ultimate goal for everyone in the process is to start with a picture of what they want, and, they hope, to end up with what they need. To win, you have to persuade the other side to make compromises they didn't even consider until the handwriting appeared on the wall. Just like chess, you have to think several moves ahead. Just like in poker, you have to study your opponent's nuances to figure out what their last move meant, and what their next move will be. Just like in fencing, it is all in the timing of thrust and parry.

The similarity to a big sliding puzzle is obvious. Pieces and offers slide across an ever-moving landscape until everything settles into their final place and the final vote is taken on the balanced budget. Move one piece at the last minute, and you see again that, even though the categories may have looked separate, altering any piece's size, shape or color can change everything.

In the House, with its "finite total" approach, the only way to get an increase for the category you think needs it is to take away funding from someone one else who wants it. Players have to consider whether an increase in a pot of money to help get kids necessary technology for education or vocational training could be done by taking it away from an agency like Big Brothers and Sisters or Laura's Kids. They can be very stressful decisions, and this sliding puzzle sometimes comes with grave consequences to getting the job done.

To ignore any piece of the game as unrelated, and you ultimately lose.

One solid example involves the pieces associated with health care. The big argument at the end of the Session was whether Medicaid expansion and the Low Income Pool(LIP) funding were truly separate. The governor went so far as to sue the federal government for assuming one isn't possible without the other.

In part he is right. You can have full LIP funding but not Medicaid expansion. However, it's like having a car with a half tank of gas and a cross-state trip to make. You can take the trip, but you may not make it to your destination, at least not without getting some gas from someone else, say, a school bus. Just realize that you may get where you have to go, but the kids might not get to school.
Senate Appropriations Chairman Sen. Tom Lee ponders one of Gov. Rick Scott's many budgetary explanations

Now the Legislature is working with a truncated LIP budget, but with none of the money that could have come from the federal government in that seemingly "disconnected" matter of Medicaid expansion. Thus the health care needs go unmet for more than 800,000 Floridians, many of them working poor.

They are destined to end up in emergency rooms where costs are high and the money from LIP, for the most part, won't be there. It would have helped the hospital pay for the care needed for those able-bodies, hardworking people because they have no way to pay for their healthcare. Or else they go to work sick or miss their desperately needed hourly pay that pays bills and buys the things, a cycle that keeps our economy sound.

Now that the Medicaid expansion piece has been archived for another session, our lawmakers are working on a budget with missing pieces. The budget can still be made, and they have worked long and hard at the various conference meetings, in the open and behind closed doors. There has been great wailing and gnashing of teeth. Committee meetings, conference meetings and even the Regular Session have been shut down when things went badly.

Many projects and funding needs have hit the budget room floor with no chance of getting picked up again this year. Even the money that conservatives, including the governor, wanted for economic development has been lost. So missing out on the pieces and connections that healthcare provides has even reduced the state's ability to bring in new jobs and industries that would put more money into the economy and, eventually, the state budget.

It has been said that you shouldn't sweat the small stuff, even though, eventually, it's all small stuff. Here's a corollary: If you don't sweat the health stuff, you will soon find out that, eventually, it's all health stuff.

Ignoring the connectivity of the situation has its consequences.

Gary Stein MPH, a native Detroiter, worked for the Centers for Disease Control, landed in the Tampa Bay area to work for the State Tobacco program and is now a health advocate and activist and blogger for Huffington Post. Column courtesy of Context Florida.