Medicaid: An Ongoing Public Health Disaster

The NEJM reviews the limitations of Medicaid, which is about to get worse whether or not there is agreement on debt extension:

Since Medicaid was enacted in 1965, its coverage guarantee for millions of the poorest Americans has faced a substantial vacuum in actual access to health care. Multiple factors contribute to this problem: severe shortages of physicians and hospitals in many low-income inner-city and rural communities; low rates of participation in Medicaid among available providers, owing to low payment rates; state administrative practices that drive providers away; and the economic, clinical, educational, and cultural characteristics of Medicaid beneficiaries. Where they are operating, federal programs such as community health centers, federally funded family planning agencies, the National Health Service Corps, local public health agencies, and public and children’s hospitals help to mitigate the situation. But thousands of U.S. communities lack such programs, and even where they do exist, they don’t address the specialized long-term care needs of beneficiaries with severe disabilities.

Medicynical note: This in the “best” and most expensive non-system of healthcare in the world.

5 responses to “Medicaid: An Ongoing Public Health Disaster

  1. Medicaid is a classic single-payer health care system. What could possible be wrong with single-payer health care?

    • What’s the alternative? Insurers want no part of the sick and infirm and this population is likely the least healthy in our society. If these people are to receive healthcare care a government program and/or subsidy would appear essential. The “free” use of ER’s as has been suggested by some on the right. But obviously such care isn’t free and is the least efficient most expensive care available.

  2. The obvious point, judging from your criticism of Medicaid is that “single-payer” isn’t some panacea that somehow produces wonderful health care at a reasonable cost. A honest statement might be that health care for the underclass will always be a debacle. See “In Iraq, life expectancy is 67. Minutes from Glasgow city centre, it’s 54” ( That’s with a single-payer and single-provider system…

    As for the U.S., I favor the Singapore approach. See “Singapore’s Health Care System: A Free Lunch You Can Sink Your Teeth Into” (

    In the short-term, I favor abolishing Medicaid in favor of a “charity hospital” system. This would eliminate the fee-for-service incentives that have turned Medicaid into a quagmire of unsustainable costs and poor quality medicine. To make it work, I would give the hospitals legal immunity for all non-economic damages from alleged malpractice.

    • For what it’s worth I didn’t particularly criticize Medicaid. My concern is that it is underfunded and facing further cuts.

      It’s obvious something terrible has gone wrong here. The Singapore approach of co-pays does result in people valuing services more and I have no problem with such payments. There is a significant population in our country, however, who simply can’t afford such payments and the challenge is to assure access for them.

      I live in a small town 80 miles from Seattle. Charity hospitals are unlikely in such an environment. Asking sick indigent patients to travel to such locales is unrealistic (Singapore has no such distance problems) More support to community clinics which currently are overwhelmed would help. Their staff is on salary and the clinic on a budget which assures more cost effective treatment decisions. The old PHS and the military provided support for medical school costs in return for work in their facilities. Such an arrangement would be quite tempting to erstwhile medical students and provide quality staff for such clinics.

      We have a terrible pricing and utilization problem. Comparison studies are essential to help sort out the mediocre very costly approaches.

      The question is whether we can sort through the bull and find a way to economically deliver quality health care.

  3. First of all Medicaid is not free to Disabled Adults. In most States Disabled Adults have to pay Co-payments to Doctors and Pharmacies these payments can range from a dollar or thousands of dollars. You see in most States Medicaid Program offers their Disabled Adults what is called Slots. At the beginning of each Month the Adult Medicaid Patient has three Slots for medications. If the adult patient exceed these Three Slots they pay full price for any additional medications,unless someone informs the patient they can get up to six Slots on their prescriptions if their Doctor will put in a request for the maxium of six Slots along with a co-payment ranging from a dollar or up to six dollars or more per prescription depending on the cost of their medication. Medicaid only allows five-hundred dollars a year for Doctor’s Visits,Lab Test,and Radioloy Test or life saving Scans and EKG’s. When these Tests exceeds five-hundred dollars,the Adult Medicaid Patients are billed for these additional cost. We all know the Uninsured is billed at a higher rate than their insured counterparts, well guest what Adult Medicaid Patients are billed the same as the Uninsured when their medical cost have exceeded the annual five-hundred dollars which can add up into thousands of dollars.Most Adult Medicaid Patients are very sick SSI recipients they receive less than nine thousand dollars a year and are not eligible for Medicare or any other form of Health Insurence. Adult Medicaid Patients can have medical bills that exceed hundreds and even thousand of dollars as well as anyone else but they cannot afford the cost of Filing for Bankruptsy so they are being denied access to Housing and many other things most Americans take for granted because of bad credit due to unpaid MEDICAL BILLS. So if you think Medicaid is stil a free ride for the poor, then you need to think again. Not meaning any disrespect to anyone but I hope you could just sit down and think about the poor and how they have to struggle to survive even when they are sick and Disabled.

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