Suckers by Pat Conrad MD
Far be it from me to pile on, but…what the hell. Doug recently posted a piece documenting how the supporters of the ACA are (again) surprised that the bad idea which is Medicaid just got a whole lot bigger, and worse.
The leftist oracle New York Times moans: “Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.”
The ACA gave temporary Medicaid rate increases, which are fixin’ to expire, while the Obama administration is briefing the Supreme Court that doctors have no legal standing “to challenge the adequacy of payments they received from Medicaid.”
At this point, let me throw a respectful shout out to Denise and other like-minded: how would YOU react to a 43% drop in your income, courtesy of the federal government? According to the Urban Institute – not my favorite source by any means – a haircut of that magnitude is in the offing for physicians who take Medicaid.
- Rates are expected to revert to 2012 levels, already deemed to be inadequate.
- “Under federal law, Medicaid rates must be “sufficient to enlist enough providers” so that beneficiaries have at least as much access to care as the general population in their geographic area.” However The Dear Leader has informed the Supreme Court that physicians have no legal right to enforce the “equal access” requirement in court, per Donald B. Verrilli Jr., the solicitor general of the United States.
- “Matt D. Salo, the executive director of the National Association of Medicaid Directors, which represents state officials, said his group had not lobbied for an extension of the Medicaid fee increase. “It has rewarded providers who were already doing the right thing, but did not bring in a flood of new providers.” At this point, my forehead started throbbing – who is this puny little bureaucrat to say what is and is not “the right thing”? Has this weasel ever given a Medicaid patient a bag full of free meds, only to follow up with them a month later to learn that they never took them? Has this government-funded altruist ever treated a damned obese, chronic pain, welfare patient who, repeatedly counseled not to smoke, fired up in the parking lot after the visit for chronic pain meds? Has this poisonous soul ever treated an STD-ridden crack mom on kid number six, all at government expense? I sure have, and to say it pisses me off is a mild understatement.
- “Joseph A. Reblando, a spokesman for Medicaid Health Plans of America, said, “The fee increase was a good idea in concept, but it was built on an antiquated system in which doctors were paid a separate fee for each service.” Doctors being paid for the work they did…”antiquated”.
Medicaid was/is a terrible idea, promoted by government, accepted by feckless establishment medicine, greedy doctors, do-gooder groups, and lazy welfare grabbers. And it’s being expanded by the ACA, which is about actual care the way I’m about alcohol-free-beer, fat-free-cheese, and the notion that Arianna Grande is an actual artist. Just a flimsy con-job for the dull-witted.
Pat: Medicaid a bad idea from the beginning ? in the 1960’s ?? no it wasn’t. But everything has changed since then. lifespan, technology,morality, doctor training and education costs, corporate profits for insurers. But, tell me, what is your solution to the problem of the std ridden crack addled mother with 6 kids ?? send her back to hospital EDs for her care, let her die on the street (I truly have no problem with this) and let the government take custody of the 6 kids into foster care. you don’t want any of the relatives taking them since the nut does not fall far from the tree ! voila ! problem solved. your untreatable, non-compliant patient is no longer your concern, you are not losing $$ treating her.
BUT, what about the 6 kids ??!! in foster care. do they get medical treatment ? you and I know that they are likely to have health problems. how about mental health treatment since they surely have been to the fourth level of hell and seen what no kid should ? and who pays for it ? maybe religious c harities will take it on. If not an evil govn’t bureaucracy seems like the only option
BTW, even at a nominal rate of $20/day for foster care, that = $600 per month PER CHILD or $3600 per month for 6 or $43k per year. Open to your ideas on how to deal with these issueS which surely transcend medicaid rates for PC docs.
Tad, yes, a terrible idea, as was Medicare. In fact, Medicaid was an afterthought grafted on to Medicare by then- Ways & Means Chairman Wilbur Mills in collaboration (the famous “three-layer cake” approach) with LBJ to implement the Great Society, political avarice sped along by a toothless GOP opposition and AMA incompetency. Medicaid costs grew from less than $1 billion in 1966, to over $200 billion in 2000. While administered at state level, it has been controlled at the federal level, greatly restricting state initiatives and flexibility (eg. Oregon 1993-94, which attempted to control costs by restricting the scope of their Medicaid services and was blocked by the Clinton Administration). It is common knowledge that their respective Medicaid expenditures have seriously impacted the economic health of states as diverse and widespread as Tennessee, California, and Massachusetts.
– Morality, doctor training? These have been grotesquely shaped by the collectivization of medicine. Any doctor who treats government patients ‘Care or ‘Caid, works for the government first and the patient second. It is mere denial for colleagues to try and argue otherwise, wrapping themselves in a self-righteous veneer of morality to avoid acknowledging the reality. (Ditto big insurers, but they can’t yet send armed agents to conduct an audit, unlike Uncle Sugar).
– Longevity? Yes, as with Medicare there was only emotion, and no cogent thought, applied to the certainty of program growth. The economics responded to unrestrained demand, driving up prices, expenditures, and enrollee numbers. So as with so many other bureaucratic “successes”, Medicaid created its own expanded need.
These problems are the result of the federal government doing something for which it was not designed, specifically, wealth transfer dressed up as institutionalized compassion. This has reduced flexibility, and increased costs, and built a legislative structure behind it so large that now everyone shrugs with Soviet stoicism and and says we have to live with it.
My solutions?
– Admit, and reverse the mistake of the federal government providing daily care to any but veterans ( a separate topic). Get the feds totally out of Medicaid, leaving it to every state to decide. But GASP, SHRIEK, some poor states will have a tougher time! Yes they will, and let them be responsible for, and responsive to their own populations. Why should Wyoming be at all responsible for the obesity and diabetes costs of Mississippi? Why should the Rust Belt be further impacted by California showering illegals with freebies?
– End EMTALA and all federal restrictions on individual hospitals. Allow individual states the flexibility to allow their hospitals to treat – or not – who they will. Short of that, all Medicaid and Medicare patients should be regarded as under sovereign immunity, whereby those who treat them cannot be sued. That would be an enormous cost saving.
– Any physician or private facility treating charity cases i.e. not reimbursed ,should be able to write off such care for tax purposes.
As for our test case crack mom, my first instinct would not be to enlarge the effects of her misbehavior. I would NOT use either her or her offspring as a vehicle with which to further constrain those who committed no foul. I would at a minimum send her progeny to an orphanage and give her no further medical care without first sterilizing her. And I would encourage her to share her story with the media, her family, and neighbors in order to at least begin to attach some consequences to her behavior. Yes the cost of raising and caring for those sad kids is still a question, to be answered at as local a level as possible, but I damn sure would not use their existence as an excuse to perpetuate those conditions which created them. We should, and could at least stop the bleeding. Why should the cost of saving someone who will not help herself be the diminished economic future and freedom of thought and action of everyone else in the community? Call me a heartless bastard, but those are the real legacy costs of Medicaid.
Medicaid stinks for the person on it, too. Their income is scrutinized and Medicaid decides how much of it they can spare to pay for having Medicaid cover their co-pays. They decide that some of what you spend your money on is “frivolous”, such as having a pet, and all money that you have been paying out toward that expense is now taken away in their monthly “spendown”. You get to live on whatever is left. My disabled friend spent years working a good job and had a decent SSD check and small pension monthly, then had disastrous medical bills, and Medicaid came on board and decided she can live on $768 /month and the rest of her income goes to them. Rent, utilities, and everything food stamps don’t cover (she didn’t need food stamps until getting Medicaid) plus gas and car upkeep is hard to do on that budget! To top it all off, OF COURSE many doctors don’t take Medicaid patients because of the low reimbursement, so add on having trouble getting medical care. Not everyone on Medicaid is a loser and non-compliant patient.
Those are great points, Melinda. My generalizing, borne of experience, is to counter the moralizing veneer applied to Medicaid as “doing the right thing.”
Governments do not like to look like they are cruel, to make it obvious that they are the perpetrators of awful mistreatment of their citizens. They create cruel and inhuman bureaucracies out of genuine desires by the citizenry to provide help to the truly needy. Thus, every Congressperson has an office which will “help the unfortunate” who is caught up in the claws of a bureaucracy – a bureaucracy that this very Congressperson has had a hand in building and maintaining. They are the ones who scold us – that things would not be this way if we citizens were just better, kinder, more decent people!
I have watched a family friend grow up from birth. She is 22, and she cannot read a newspaper or make change for a dollar. She was thrown off Medicare for a while because her grandfather gave her a small bond that matured in 20 years, when she was born. Their family is working poor – not even making it at paycheck to paycheck. We help them when we can – they are stubborn, and will not take much assistance from friends, because they are Americans, a proud people. But they are going under – right here in America.
The invisible, by the millions and millions, are being slowly dragged under, in every state and city. They do not make the headlines or the evening news. Doctors and nurses, we see it every day – investors and lobbyists, they don’t. So they talk about the worthless and greedy, dependent and poor.
Why?
Melinda: your friend with the big medical bills did have an alternative to Medicaid – BANKRUPTCY. Or maybe she should have bought insurance on the private market just in case she got really sick. Couldn’t aftrford it on her income ?? oh well. too bad. Not any good options. AND remember that the bureaucracy is also there to make sure that the taxpayers are not subsidizing the welfare rats and cheats everyone complains about (see other comments here). It seems to me that Medicaid did not make her life any worse than a chapter 13 bankruptcy. check out what life is like under a chapter 13 payment plan (since straight chapter 7 is no longer an option thanks to our republican friends since 2005).
Sorry to get so thinky on my last few replies. The same media that brought us Democracy In Iraq after several trillion dollars and a few thousand deaths, is tucking doctors in the same pocket as bad-guy Saddam and his evil boys.
If doctors are bad and lying, well then – everything they say is bad and lying, too. If they are screaming that there’s a train heading down the tracks, straight for our li’l ol’ wagon – what are they trying to say? Ignore them.
In America, we neatly cleave our idiocy into Left and Right – that way, we can avoid the suffering of figuring things out on our own. That way, we don’t have to explain to the next generation how we made a shambles out of our future – trust me, it was the OTHER guys who did that!
If indeed this whole thing is a pitifully badly-planned mess in the manner of DHS and Iraq, who will suffer? Who do you think – the Wall Street millionaires who are making millions on the booming market? Their doctors are in the Hamptons, and take cash. Guess again.
It will be interesting to see whether the smart states (like Virginia) who did not take the ACA Medicaid expansion money will be appropriately recognized for their foresight in keeping their budgets under control. Here in the People’s Republic of Maryland, our Dear Leader, Governor Martin O’Malley took the money eagerly and just finished his term with a $750 million deficit and a 13% cut in the previously increased Medicaid rates.
Somehow, it seems like the profligate states, like the STD ridden crack mom above, will somehow come out on top, probably with freshly printed federal money.
Medicaid rates are being cut 28% in Ole Virginny.