Wednesday, March 20, 2013

Medicaid "Skin In The Game"

Not long ago I was reading an article from the New York Times.  They were reporting on the percentage of doctors who still accept Medicaid patients.  According to the Times, in 2008 73 percent of doctors accepted Medicaid.  In 2012 the number of doctors treating Medicaid patients had shrunk to 63 percent and the rate is still declining.

When surveyed doctors attributed the abandonment of Medicaid patients to a number of factors.  One was the extremely low Medicaid reimbursement rates, as low as $25 dollars for a doctor visit.  The docs say they can't pay their overhead, buy and maintain equipment, pay $200,000 a year in liability insurance and purchase supplies with rates that low.  Many doctors cited the poor Medicaid patient-doctor relationships; patients who routinely abuse drugs, patients who are so obese they develop Type II Diabetes and heart problems and show no willingness to fore go the fast food or make attempts to eat a more healthy diet.  Another survey conducted by the Texas Medical Association in July, 2012 cited the troubling trend of Medicaid patients who fail to keep their appointments.  Unlike Medicare patients who suffer penalties for missed appointments, the federal government forbids doctors from charging Medicaid patients either a co-pay or fines for missed appointments.

Ask any doctor who takes Medicaid and they will tell you that the Medicaid system is abused and "overused".  While the typical family who pay premiums for their medical care, along with co-pays, exercise judgement on when a family member needs a doctor's care, the Medicaid patient consults a doctor for a headache or when little Johnny develops a sneeze, thus putting a great strain on the system.

Note:  While Medicaid beneficiaries are given free dental care as well (unlike Medicare patients), the percentage of dentists who accept Medicaid is even lower; only 40 percent of dentists today are willing to accept Medicaid reimbursement.

Critics of Obamacare cite Medicaid as the prime example of why Obamacare will decimate America's medical system.  Bringing some 30 million more "free ride" Medicaid patients into the system will crowd out adequate care for those who pay the freight with medical premiums and eventually lead to a federal government "single payer" system where Uncle Sam dictates what a doctor and/or hospital will receive in compensation and lead the best doctors and the best hospitals to leave the system and construct a separate "free enterprise, cash only" system which will only be available to the very wealthy.

When one looks at the problem it becomes increasingly clear that if the federal government would just institute some "skin in the game" rules for those on the free medical care gravy train they could stop much of the waste, fraud and abuse in the system.

If seniors, who paid into Medicare for their entire working life,  continue to pay monthly premiums as high as ten percent of their retirement income, and continues to pay for doctor and hospital co-pays, what's wrong with mandating that Medicaid patients at least pay for missed appointments and a $12 dollar co-pay for doctor visits?  It would force those on Medicaid to think twice before burdening a doctor when a couple of aspirin might alleviate the sniffles and headaches.  And it would save the taxpayer a hell of a lot of money!

And if those welfare queens with eight or ten kids were forced to pay ten percent of that $6,000 to $12,000 dollar maternity bill how many would she then deem she can afford to breed?  (Prenatal and birth costs (a nine-month pregnancy typically involves at least a dozen obstetrical checkups) are better discussed as ranges. Because normal pregnancies can result in delivery by cesarean section, a more expensive procedure that accounts for about one-third of all U.S. births, the typical pregnancy costs between $6,000 and $12,000.)

We are now spending $16,500 hundred per year for every Medicaid family...and their "cost share" is zero!  What's wrong with insisting that Medicaid patients put some skin in the game, no matter how small!

We don't need Obamacare.  We just need the federal government, and those on the medical "gravy train" to exercise a little common sense...and spend a few cents as well!

1 comment:

Ken said...

Damn good idea here! Too bad it will never see the light of day, though. We can't further encumber a person already suffering, you understand, self esteem issues and such. I will pass this along, though I know it won't get any attention just like all good ideas. Thank you for your time.