The Problem with Medicaid by Pat Conrad MD

The position of, 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.

Your thoughts?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “The Problem with Medicaid by Pat Conrad MD

  1. T Newberry
    March 19, 2018 at 5:26 pm

    I see a lot of assumptions and not a lot of facts here. What percentage of Medicaid spending is going to the slothful, entitled bums? Is it 10%? That would be a lot. Fuck the other 90%, right? We cannot possibly help them if we have freeloaders. I have heard lots of anecdotes, but no actual statistics to support this point of view. Also, I cannot imagine $13 making that much difference to me. The fact that I cannot imagine it must mean it is not true. Nobody could possibly be that hard up for money. Of course I only think that because I have never been poor so I lack empathy for them. <=true story

    Let me be clear. I have no real opinion about Medicaid. I do not know how it works and it does not affect me directly at all. But I know biased opinions when I see them. This is not at all persuasive. What else you got?

    • Pat
      March 19, 2018 at 7:46 pm

      Oh not much. Just over two decades of watching entitled, obese, cig-smoking, multi-kid having, “disabled” waddle into the ER, sneering at those obligated to serve them, bitching about any service deemed to be slow or inadequate though its free, all the while knowing a miss could end up at least as a complaint to administration, or worse, a lawsuit, while bleeding hearts chide me over a perceived lack of empathy.

      • T Newberry
        March 21, 2018 at 10:38 am

        Yes, but what percentage of them? Enough that we should stop helping all the others? I never said anyone but me lacked empathy. What I think is lacking here is perspective.

        • Pat
          March 21, 2018 at 6:05 pm

          Good goobers – read what I wrote. Where is your empathy for doctors, nurses, and taxpayers? I did NOT say abolish the safety net. I said that for it to work properly there needs to be patient accountability, and $13 freaking dollars a month is not going to break anyone. I cannot put it more plainly than that.

  2. Paul Douglass
    March 14, 2018 at 9:58 am

    Medicaid is a fraud. Those receiving it think they have insurance until they need to use it and find a doctor willing to accept the payment and hassles. Then, the average citizen thinks docs are being compensated to the level of their own insurance when the reimbursements do not cover expenses, especially considering all of the “red tape”. It would be far better to make time-limited payments into HSA’s with a superimposed commercial catastrophic policy.

  3. Judy Adler
    March 14, 2018 at 9:24 am

    I couldn’t have said it better! I totally agree.

Comments are closed.