Tuesday, July 18, 2017

The Enemy of My Enemy: Medicaid

As a physician, I treat Medicaid patients in New York City. Perhaps to your surprise, I can say with assurance that my patients receive good care. Those looking for a bottom-line may read no further. For those interested in the details, I will add that their good care is not without extraordinary efforts on both their and my parts, and there is no relief in sight.
Medicaid has become one of the most hotly debated issues in health reform. Almost all agree that reform is badly needed. In Congress, it has become a numbers game about millions of people and billions of dollars. One side decries the poor health outcomes that will derive from people losing coverage; the other argues that Medicaid desperately needs reform, not only to serve today’s recipients but also to effect solvency for future generations. Many are being told that empowering the federal government further is the way forward; conversely states, both red and blue, feel they can better serve their citizens if they were given more flexibility in managing Medicaid. How Medicaid is reformed is critical to the future of health care reform because it will form the template for the design of Medicare and private insurance going forward.
Indeed, Medicaid today represents one of the weakest forms of health insurance in the United States. The problems of managed care are in full force for Medicaid on a daily basis: Academic journals and lay publications have documented Medicaid waste, its loopholes and gaming, its fragmentation and inherent inefficiencies. Often patients are rebuffed and unable to see their usual provider because he or she has suddenly gone “out of network.”


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