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What if Mayo CEO Dr. John Noseworthy is right about Medicare and Medicaid?

News reports about Noseworthy’s comments on how the clinic needs to deal with the government’s inadequate reimbursement for Medicare and Medicaid patients have ignited a firestorm. Mayo has a big job ahead to explain.

Here’s what he said : “We’re asking ... if the patient has commercial insurance, or they’re Medicaid or Medicare patients and they’re equal, that we prioritize the commercial insured patients enough so ... we can be financially strong at the end of the year to continue to advance, advance our mission.”

There are enough qualifiers in there to drive several trucks through: “asking,” “if,” “enough so,” “we can” ... The Star Tribune story about Noseworthy’s comments had few details and zero context. But the impression that’s left is that Mayo will now heartlessly pick and choose the patients that it treats on the basis of how much money it can make. That’s grossly inaccurate and unfair.

The clinic put out a damage-control statement to say it remains committed to publicly insured patients, who comprise half of its total patients — but “we need to balance requests from these patients with their specific needs — if it’s necessary for them to come to Mayo — as well as the needs of commercial paying patients.”

That fits with other strategies Mayo is pursuing to maximize its regional clinics for certain types of care and its main campuses in Rochester, Phoenix and Jacksonville, Fla., for specialized care. That’s part of managing finite resources.

At bottom, though, Mayo and every other major health care system is dealing with the potentially catastrophic gap in what it costs to treat Medicare and Medicaid patients and what the federal government provides for reimbursement. The number of government-insured patients has grown dramatically under the Affordable Care Act, but reimbursement ranges from 50 percent to 85 percent of actual costs.

This is not a minor issue, in other words. This issue also has erupted at a time when the very existence of ACA — Obamacare — is up for grabs and profound and unpredictable change is coming to the health care world.

It’s easy to demagogue and misrepresent what Noseworthy said. A more fair reaction is to say there are historic, existential issues threatening American health care — even institutions with relatively deep pockets and a long tradition of charitable care, such as Mayo.

The way the issue came out last week may be awkward for Mayo, but it’s a key part of the debate in Washington over the future of health care.