Saturday, April 2, 2011

The Medicaid card: a useless piece of plastic?

Quotation of the Day from "Today's Headlines," an e-newsletter from the New York Times:
"My Medicaid card is useless for me right now. It's a useless piece of plastic. I can't find an orthopedic surgeon or a pain management doctor who will accept Medicaid."
--NICOLE R. DARDEAU, a nurse in Opelousas, La.,
who needs surgery for herniated discs in her neck.
I found this especially interesting since just yesterday I learned that the highest-salaried doctors in the United States are orthopedic surgeons who specialize in the spine.

The problem is not limited to orthopods, of course. As the linked article by Robert Pear, "Cuts Leave Patients with Medicaid Cards, but No Specialists to See," points out, physicians across the board are turning away patients enrolled in the Medicaid program, which is supposed to assure health care to our poorest citizens.

To compound the problem, as states cut Medicaid payment rates for doctors - 20 states did so last year, 16 more states propose doing so in 2011 - people are swarming onto the Medicaid rolls. "Medicaid will soon be the nation’s largest insurer," Pear writes. "It accounts for almost half of the increase in coverage expected under Mr. Obama’s health law."

It's easy to throw blame around for our country's health-care problems: we've been doing it for years, to no appreciable effect. Democrats blame Republicans for doing nothing, and Republicans blame Democrats for doing the wrong thing. Consumers blame greedy doctors, hospitals, insurance companies, and pharmaceutical companies. Doctors blame greedy lawyers, the high cost of medical education, and inadequate reimbursement.

Hold your blame, folks, no matter how certain you are of your opinions. Blame could justifiably be attached to any or all of the above. The underlying problem, though, is neither greed nor bad law nor a broken system.

The underlying problem is that the United States, unlike all other developed nations, has no system at all. Nor do we have the non-system of a genuinely free market with open pricing, vigorous competition, and informed consumers. And until we get some sort of unified approach to health care, prices will continue to rise, accessibility will continue to fall, and Americans will continue to die younger than we need to.

At last count, people of 27 other nations live longer than we do. All 27 pay considerably less per capita for health care.


greg metzger said...

I comety agree with the systemic nature of the problem, and I won't blame a particular party, but I will blame an ideology--extreme libertarian--whcih makes even the identification of a systemic problem/solution an ideological sin. Until this ideology is confronted by us all, and paricularly by Christians, we will be incapable of acting.

Anonymous said...

I agree with you and Greg Metzger. It is a shame that the greatest Nation in the world cannot provide health care for all of our people, especially children. Who is to blame. The system I guess. I am 73, and rely on my Medicaid Card for my health needs, but I am healthy, have a great exercise program, and eat healthy. I try to live a healthy life, and rely on my God to sustain me. I hope to live and serve Him for at least 20 more years, but hope that my Medicaid Card will still be useful. I live close to the greatest medical centers in the Nation, UNC, and Duke. Richard Peterson

Jason said...

I think you make a good point, although I suspect we'd disagree over the right solution (as i'd be in favour of a much more genuinely free market approach).

It is worth nothing though, that as a proxy for the quality of health care the average life expectancy is a misleading statistic. Lots of things kill people that have nothing at all to do with the quality of health care and there are much better and more direct measures that can be used.

Try something like 5 year cancer survival rates or something if you want a direct measure of the effecivness of a healthcare system.


LaVonne Neff said...

Yes, Jason, life expectancy can be misleading, but our lagging life expectancy conforms to our lagging results in quite a few other areas. As for 5-year cancer survival, that can be even more misleading than life expectancy. Check out this article in the JAMA, for example ( It concludes, "changes in 5-year survival over time bear little relationship to changes in cancer mortality. Instead, they appear primarily related to changing patterns of diagnosis."