A couple of weeks ago I visited my internist for the annual physical to which she subjects me in order to confirm that my various organs are still operating according to specifications. As she poked and prodded, I asked how her practice was going. This question elicited a resigned sigh and a brief but poignant discourse on the necessity of “firing” her Medicaid patients. Medicaid, the government program that ostensibly provides health coverage for the poor, imposes so much red tape and pays so parsimoniously that she simply cannot afford to treat these patients if she wishes to avoid bankruptcy.
This is a conscientious doctor, and she is clearly troubled that Medicaid forces her to choose between solvency and treating patients who truly need care. Nor is she alone. This choice is being forced on physicians across the nation. And the ironically titled Affordable Care Act is about to make the problem far worse. As Avik Roy writes in his new book, How Medicaid Fails the Poor, “Obamacare will shove 17 million more Americans into Medicaid, the developed world’s worst health care system.” Thus, over half of the uninsured ACA will allegedly cover will receive nothing but a useless card.
This is the cruelest deception of the “reform” law. As Roy phrases it: “There’s a massive fallacy at the heart of Medicaid and therefore at the heart of Obamacare. It’s the idea that health insurance equals health care.” And, as is usually the case with the deliberately deceptive fallacies promoted by the Democrats, the target victims are poor Americans. Just as Obamacare’s Medicare Advantage cuts will be felt primarily by low-income seniors, its Medicaid fraud will hurt the country’s most vulnerable patients. It will restrict their access to doctors and reduce the quality of what little care they receive.
This is not speculation. Even if the patients covered by Medicaid had a reasonable chance at access to primary care, there are mountains of data demonstrating that they would receive lousy care. Countless studies, including the “Oregon Experiment” whose results were published in the New England Journal of Medicine last May, have shown that health outcomes for Medicaid patients are no better than those enjoyed by the uninsured. In fact, as Scott Gottlieb has pointed out in the Wall Street Journal, being covered by Medicaid is demonstrably worse for your health than having no coverage at all.
Roy reinforces this point by citing a chilling study from the University of Virginia: “Patients on Medicare were 45% more likely to die before leaving the hospital than those with private insurance; the uninsured were 74% more likely; and Medicaid patients were 93% more likely.” Medicaid coverage is clearly bad for one’s health. And yet Obamacare’s more cynical pimps are now touting Medicaid’s metastasis as an under-reported success story. The reliably dishonest Ezra Klein, ignoring all of the data discussed above, describes its expansion as a “huge win” and laments that this is “rarely mentioned.”
Meanwhile, back on Earth, the economists who published the outcomes data for the Oregon Experiment have dropped another bombshell in the Journal of Science. This one demolishes a core justification for imposing Obamacare on an unwilling electorate. The New York Times gingerly describes it thus: “Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits because people would go to primary care doctors instead. But a rigorous new experiment in Oregon has raised questions about that assumption.”
The new study does more than “raise questions.” We were repeatedly told by Obamacare’s cheerleaders, including a variety of columnists employed by the Times itself, that Medicaid expansion would help eliminate the “free rider problem.” According to this theory, millions of uninsured patients were getting free primary care in America’s ERs and allowing the rest of us pick up the tab via higher insurance premiums. Medicaid, we were told, would provide these patients with coverage, whereupon they would seek primary care through their local GPs. Overall health costs would then drop.
The new study exposes the “free rider” theory as nonsense. The Times explains how the experiment was conducted: “The study… compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured.” Did the Medicaid patients reduce their ER use? Nope. They made “40 percent more visits to the emergency room than their uninsured counterparts.” Why did all these people with Medicaid coverage show up at the ER? Because GPs can’t afford to treat them.
Just how poorly does Medicaid pay? Roy spells it out: “It has gotten so bad that, in the average state, for every dollar that a private insurer pays a primary care physician to care for a patient, Medicaid pays 52 cents.” Many states pay even less. New York, for example, pays 29 cents. And don’t make the mistake of blaming this problem on “greedy doctors.” Medicaid doesn’t merely pay less than private insurance. It pays less than the cost of treating a patient. A primary care medical practice is essentially a small business. How many small businesses can afford to sell their wares for less than they cost?
This is why those millions of poor patients who will be herded onto Medicaid by Obamacare will be unable to access care. Conscientious physicians, like my own doctor, want to treat these folks. But they have families to support just like everyone else. Thus, 17 million people President Obama has promised health coverage through Medicaid are about to discover that they have been betrayed just like all the people who were told they would be able keep their insurance if they liked it. The only difference is that the victims of Obamacare’s Medicaid fraud are the most vulnerable people in our society.
This, come to think of it, is to be expected. The Democrat record regarding the underprivileged isn’t pretty. They defended slavery, enforced racial segregation, opposed women’s suffrage, and still chain low-income students to public schools that teach them virtually nothing. It shouldn’t be surprising, then, that the Democrats have created a health “reform” program that denies poor people access to decent medical care.