Make no mistake. Arizona faces a quandary when it comes to Medicaid expansion, but mostly in terms of perception, in our humble opinion. On the one hand we have a highly reticent Governor and Legislative leadership that has marked its position very publicly. On the other hand, the federal government is perceived to have proffered a hardball “take it (full expansion earns the highest possible federal support) or leave it (do nothing, because any lesser additional coverage will receive no federal support)” option to all states.

Outside of the fact that both sides appear deeply dug in, there is the option to rise above and play a higher level game of “Let’s Take a Deal” (with apologies to Monty Hall and company) with an eye on how Arizona will compete with other states for growth. Behind door number one lies an economically competitive and attractive state with a functioning health care system to backstop the workforce and our children. Behind door number two we can see an economically challenged and ideologically stalwart state whose leading rural and urban general hospitals will struggle mightily to stay open as support for uncompensated care evaporates and no other options for coverage are considered.

Things are obviously more complicated than either a political high noon or a game show analogy can suggest. The ultimate state action (or inaction) will also have much more impact on all Arizonans than most of us realize. While it’s been privately asserted that some application of collaboration, innovative thought and positive intent can yield other possibilities, at the moment everyone involved is just trying to assess what might be done.

So for now we’ve got ourselves a quandary. Yet even considering just three criteria – (1) doing what’s right for the health and well-being of all Arizonans, (2) lessening the financial impact of health care on state finances in the short- and long-term, and (3) keeping our health care system from imploding – you’ll still come out thinking that, absent a breakthrough that we haven’t heard about so far, we’re best off if we say “Let’s Take a Deal.”