Not Enough For Everyone

The more government has inserted itself into health care, the more health care has become a spoils system.  This should be a statement of the bleeding obvious, but what grates is that so many simply accept the assumption that this should be the system because, well, this is the system.

Reps for Medicaid providers are upset because Medicare is gobbling up more of the emergency Covid-19 funding granted by HHS. 

“The problem largely lies in the complicated structure of the safety net program. It is easier for HHS to quickly send out funding to Medicare providers because it is a federally funded program. Medicaid programs are managed by states and providers are paid directly by state governments.”  It stands to reason that an extra layer of bureaucracy is going to gum up the works a little bit more.

And it also makes sad sense that when 40 million are suddenly thrown out of work, the poor will suffer, and the addiction and other mental health problems will enlarge.  There clearly needs to be a safety net for the poor and disabled, but the past half-century suggests that involving the federal government has not delivered good results.  Though Medicaid is typically a state’s largest expenditure, payments to physicians, clinics, and hospitals do not, shall we say, encourage.  And while no one should expect to pay the mortgage treating the poor, you gotta keep the lights on. 

We could look at this latest upheaval as the opportunity for radical reform to fix a broken system.  We could implement plans to devolve all Medicaid activity to the state level, getting the feds completely out and save at least of the chunk blown on D.C. middlemen.  This could and should encourage states, local communities, and beneficiaries to be more accountable to each other, and deal more honestly with long-term budget priorities.  Perhaps individual states could give income or property tax breaks to facilities and providers based on their degree of Medicaid participation.  Perhaps states could use this opportunity to institute more narrowly covered services restrictions, based on their own local citizens’ needs and available resources (the state of Oregon attempted this in the early 1990’s, but was immediately overridden by the Clinton administration). 

What is clear is that this safety net continues to become less available and reliable for all concerned, less safe the more the “net” has been widened.  And the longer we drag this out, the more proponents of a single-payer system gain fodder for their cause.  Proponents like Sen. Ron Wyden (D-Ore., oh the irony) who said “HHS’s continued neglect for the needs of Medicaid-dependent providers struggling to deal with the COVID-19 crisis is unacceptable.” Sure he does, but just try transferring some of the funding from Medicare and see what he says.

No, the grab-scramble between those representing seniors and the poor/disabled will continue, blowing more money, while providing less, while everyone continues to wonder how we save a system because, well, it’s the system, and these problems will continue to worsen until we face long-term solutions honestly.

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  1 comment for “Not Enough For Everyone

  1. Diane Bergmann
    June 20, 2020 at 12:39 pm

    I have watched this deterioration for 43 years as a nurse. It has been painful to watch. The system is so broken that it cannot be “fixed”. It must completely collapse and be rebuilt, hopefully by those with vision and common sense.

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