While most of Obamacare is a labyrinthine contrivance to avoid being socialized medicine (commonly known now by the odious euphemism “single payer”), the Medicaid component is pretty close to the real thing. In the case of Medicaid, the government pays for the medical care of some individuals.
But they don’t pay a market price. Even more, they add to their payment structure complicated bureaucratic rules that doctors must follow. In a sense they are haggling with the doctors. They threaten to deprive them of a number of patients who, though not paying much, are still paying something. Furthermore, doctors typically don’t like turning away patients on humanitarian grounds, so they are sometimes willing to operate at a loss and hope to make it up with their other patients who are better off or have better insurance plans with better reimbursement rates.
But as Medicaid’s reimbursements become lower more and more doctors are deciding that they can’t afford to accept Medicaid clients.
Dr. Ted Mazer is one of the few ear, nose and throat specialists in this region who treat low-income people on Medicaid, so many of his patients travel long distances to see him.
But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough.
“It’s a bad situation that is likely to be made worse,” he said.
His view is shared by many doctors around the country. Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.
Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.
Community clinics, which typically provide primary but not specialty care, have expanded and hired more medical staff members to meet the anticipated wave of new patients. And managed-care companies are recruiting doctors, nurse practitioners and other professionals into their networks, sometimes offering higher pay if they improve care while keeping costs down. But it is far from clear that the demand can be met, experts say.
In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and are unable to take on more low-income patients.
So nine million are going to be “covered,” next year. Covered for what? Normal doctor check ups? Getting the flu? The moment something exotic or dangerous shows up they are going to find that their coverage means they get to be put on a waiting list.
The lesson here is that you can’t control one part of the economy without taking control of the rest. First, we’re going to have to force doctors to accept Medicaid prices. Then we’re going to have to draft students to become doctors the way we used to draft soldiers. In other words, we need to create a state slavery system.
The other lesson is that the government claims to be able to solve our problems when, in reality, it is intentionally creating more problems which it will then force us to fix in emergency situations. The Medicaid expansion forces us down a path that goes much further than what has been promised.