Why Aren’t These People At Work? by Pat Conrad MD

This week I shelled out $731 to Uncle Sam for the privilege of being able to legally prescribe controlled medications.  As a full-time ER doc, I have to have a current DEA number or I can’t work.  Last week the rat-licking scumbags at Blue Cross raised their premiums another 10% for no apparent reason, and dutifully vacuumed that money out of my bank account.  I have to shell it out for lack of a better option, in order to continue having health coverage.

So perhaps you’ll understand my complete and total lack of sympathy for those on whom the compassionate classes would further bestow victim status in this latest news on the Medicaid front.  The reliable old Kaiser Family Foundation is wringing its hands that between 1.4 and 4 million Medicaid recipients might lose their benefits if states begin instituting work requirements for those able-bodied that are on the program.  The states will have this flexibility as a result of the Trump Administration seeking trying to help states in dealing with crushing Medicaid budgets.  CMS reported in April that there were 67,305,506 Medicaid recipients (excluding the little CHIP’rs), so 4 million losing said coverage comes to less than 6% of the total.  That total, interestingly enough, grew over 16 million in the preceding 5 years.  So thanks, ObamaCare.

Kaiser estimates that about 23 million would be affected by the new rules, because they are not elderly or disabled, adding that most of these have jobs.  So about a third of all adult Medicaid recipients might be affected, and most of them work.  So what is the problem?  All one has to do to keep their “gold card” current is to work 20 hours per week or attend job training classes.  What’s the problem?

Kaiser:  “In all scenarios, most people losing coverage are disenrolled due to lack of reporting rather than not complying with the work requirement.”  You mean all they have to do is fill out the paperwork?

Kaiser:  “Adults who are already working likely will have to report and document their hours… There is a risk of eligible people losing coverage due to their inability to navigate these processes, miscommunication, or other breakdowns in the administrative process.”

You mean beneficiaries are too stu-, uh, mentally infirm to fill out the forms?  So by implication, Kaiser (soon to be joined by other ostentatiously compassionate hand wringers) is suggesting that a great many working poor could lose access to health care because they can’t be bothered to fill out the forms, which might be too hard anyway.

Which reminds me of a funny story.  Last week in our little rural ER, one of the frequent fliers came in – on the ambulance, of course – for a trivial complaint.  He was transported, triaged, examined, all free of charge, in accordance with federal EMTALA requirements.  While awaiting discharge, the very pleasant lady from the business office brought a packet of forms for him to complete for financial assistance.  She had brought this packet to him on previous occasions, as this was his 24th visit in recent months.  In fact, this time she had even filled out most of the forms and only needed a few items like his signature, driver’s license, and work place (he does work).  She pointed out that he could quickly get this information and she would handle the rest.  He demurred.  She pointed out that they had done this dance many times.  He yelled at her, demanding that she not treat him like he was stupid.  She responded, “Then stop acting like you’re stupid!”  He cursed her and stomped out AMA.

The patient is (too) well known to us, and is assuredly not illiterate.  He has his own car, and a job.  He is also entitled and able to play the system without fear of consequence.  For those of you who don’t spend any time in emergency departments, you had better believe this sort of scenario is playing out in every ER nationwide.

There are truly disabled people for whom the state – NOT the federal government – should provide some safety net.  I am happy to contribute my share for those, and glad to treat them.  There are also the working poor, for whom the state should offer assistance as needed, as well as accountability.  Those able-bodied, otherwise mentally competent who cannot be bothered to get off the couch should not get health coverage on the taxpayer dime.  If I have to fill out paperwork to care for them, and for myself, then I will have no sympathy when they cannot put forward even this minimal effort on their own behalf.  The implication of the Kaiser piece is that productive citizens who pay the damn freight should have no say in the matter.

At least be well with one of our t-shirts. 

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] 

  4 comments for “Why Aren’t These People At Work? by Pat Conrad MD

  1. John A. Goldman, MD
    July 21, 2018 at 4:35 pm

    The bottom line – they need skin in the game. Or they are out. Entitlement needs scrutiny, lots of scrutinies.

  2. Christopher Osan M.D.
    July 15, 2018 at 10:35 am

    Having insurance doesn’t guarantee healthcare. It won’t matter that you have that card in your pocket if no one accepts it.

  3. Hawgguy
    July 15, 2018 at 9:32 am

    The picture with your article shows about 9 people, 8 women 1 man. All will-groomed with no apparent disability chanting in unison. The signs they hold are nearly identical . The first lady has a small flyer with the headline “BANKS PAY” peeking out.

    This is not grassroots. This is astroturf. I’d really like to know who funded and organized this and why it is not made clear.

  4. William E Green III MD
    July 15, 2018 at 8:34 am

    Agree 100%!

Comments are closed.