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| By Jim Epstein, ReasonTV |
"Most
physicians can't afford to accept Medicaid" patients, says Dr. Alieta Eck,
a primary-care physician based in Piscataway, New Jersey. "If you're
getting paid about $17 per visit, it won't be long before you can't pay your
staff or pay your rent."
Medicaid is the
nation's health care system for the poor. It's funded jointly by the federal
government and the states. Medicaid is either the first- or second-largest
budget item in all 50 states and the program is slated for a massive expansion
under President Obama's health-care reform law. Despite the program's huge and
growing overall cost, reimbursements to medical providers are so low that many
practices refuse to accept Medicaid patients, causing long waiting periods for
treatment.
Eck and her
husband, Dr. John Eck, are the founders of Zarephath Health Center, a free
health care clinic in Somerset, New Jersey, where they each volunteers six
hours per week taking care of poor patients. While the Ecks don't accept
Medicaid in their private practice, some of the patients that show up at their
free clinic are Medicaid recipients who can't find a regular doctor.
"The hardest
thing for a Medicaid patient to do is get a doctor's appointment," says
Avik Roy, who writes a health care blog at Forbes.com and is a senior fellow at
the Manhattan Institute. One consequence is that Medicaid recipients show up at
emergency rooms at nearly double the rate of the privately insured, often with
accute problems that could have been addressed earlier in a doctor's office.
They're also more likely than both the privately insured and the uninsured to
have late-stage cancer at first diagnosis.
After they've
been diagnosed, it's also difficult for Medicaid patients to find qualified
surgeons who will treat them. A University of Virginia study found that
Medicaid patients were about twice as likely as the privately insured to die in
the hospital after surgery. Even the uninsured were more likely to make it out
of the hospital alive than Medicaid patients.
Despite the
program's failings, in 2014 Obamacare will add millions of new patients to the
program's rolls. "All too often, people who claim to care for the poor
say, 'I'm going to give you a card that says you have health insurance and my
work is done,'" says Roy. "But the hard part is making sure that
person gets treated."
Obamacare was
designed to expand Medicaid by about 17 million enrollees by 2021, but it
likely won't meet that goal because the Supreme Court ruled that states don't
have to participate in this component of the law in order to keep current
levels of funding. So far, the governors of 19 states have come out against
expanding Medicaid in their states.
So what's the
best way to provide quality health care to the poor without spending more money
that we don't have? Roy says the federal government should take the same money
it spends on Medicaid and block grant it to the states so they can experiment
with health care plans in which the patient is in control.
"Let them
spend it on the doctor of their choice," says Roy. "Let people take
the money and get the bureaucrats out of the way, and you'll find there's
suddenly a lot more efficiency in the way people actually get health
care."
Eck believes
charity care could be a big part of the solution, if only the government made
it easier for doctors to volunteer their time. She has worked with state Sen.
Robert Singer (R-N.J.), who has co-sponsored a bill in New Jersey that would
allow the state to cover physicians for malpractice in their private practices
as a way of compensating them for volunteering. The bill is currently awaiting
consideration by the state senate's health care committee.
"Every
doctor I talk to says, 'I would do that in a heartbeat,'" says Eck.
In the meantime,
when Obamacare takes full effect next year, charitable clinics like Eck's will
be more essential than ever to pick up the slack for a social safety net that's
already not working.
"I've been doing this for nine years," says Eck,
"and I can honestly say that I come away feeling good that I was able to
make a difference."
