The position of Authenticmedicine.com, as far as I remember, has been in favor of a safety net to care for those in dire circumstances. Even a laissez-faire libertarian/objectivist like myself supports that, though never, ever, at all, at the federal level. Social programs and entitlements at the federal level guarantee a lack of individual recipient accountability, as Medicare has so aptly proven. Safety nets need to be at the most local level possible to promote individual accountability, which in turn is necessary for a patient to respond to treatment and improve. That’s just common sense.
And yes, I know there are plenty of decent, working people having a tough time, or down on their luck, or those truly disabled, who are on Medicaid. And I also know that there are a bunch of slothful, entitled bums of all ages and lack of infirmity that are also on the program. Medicaid is choking state budgets, and the states always have their hands out for federal dollars to ease the assaults on property and income tax payers. So it’s a good thing when individual states try to get a handle on the problem.
As Medicaid was expanded in many states as part of the ACA, some of them tied that expansion to an attempt at accountability, including monthly premiums, health improvement encouragements, threats to suspend coverage, and heaven help us, gift cards. In Arkansas, only 20% of Medicaid recipients are paying the $13 dollar/month co-pays. “‘Families have to make tough choices every day about whether they buy food, pay the electric bill, their rent, or pay premiums,’ said Rich Huddleston, executive director of Arkansas Advocates for Children and Families. He notes that even the state’s $13 monthly premium is burdensome.” That’s THIRTEEN FREAKING DOLLARS over a month, for a population with ample rates of obesity, excessive fertility, alcohol, and tobacco use.
Able-bodied recipients don’t have to give a damn, because they know they can just pop into their local ER anytime they please, for any reason, thanks to EMTALA. Thanks a lot, federal government.
While all of us recognize the need for a true safety net, we are being exploited by a sclerotic federal bureaucracy, paid or elected do-gooders, media hand-wringers, a lot of bleeding heart voters, and a lot of lazy, apathetic recipients.
Doctors want patients to get/be well, and no one wants to turn their back on someone truly sick or injured. But without patients having skin in the game, there is no shot at making any of this better.