Medicaid is not just a program for the poor; it's a poor program. Reimbursement rates for doctors, dentists and other professionals are so low under Medicaid that enrollees have difficulty finding care. Having health insurance does not equate with having medical care. As Avik Roy recounts in "How Medicaid Hurts the Poor," there is 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." In fact, people without health insurance get care in a variety of ways. The startling news is that Medicaid enrollees fare worse on health outcomes than those with no health coverage at all.
Expanding Medicaid was sold on the premise that uninsured people were driving up health care costs by waiting until they were very sick before seeking care and thus overburdening emergency rooms. If the near poor had Medicaid coverage, the argument went, they would see doctors before their conditions became critical and required expensive emergency room treatment.
But research on Oregon's program, published in the journal Science, found the reverse to be true. Tracking 25,000 enrollees for a period of 18 months, researchers found that Medicaid patients used emergency rooms 40 percent more than similarly situated adults who lacked health insurance. Having a Medicaid card did not divert people away from emergency rooms and into primary care. The number of ER visits for nonemergency matters increased. There was no change in the number of visits for nonpreventable emergencies.
An earlier analysis of Oregon's data found that having a Medicaid card did not improve health outcomes. Medicaid patients were no healthier than the uninsured, except on one measure of mental health (which might be the result of people initially feeling -- however incorrectly -- that they had access to good medical care).
Medicaid is a poor program because it promises benefits but squeezes provider reimbursement to keep costs down. The result is rationing. The poor are forced to wait in long lines for treatment and are sometimes denied care altogether. Klein may applaud these results, but the poor clearly don't. Medicaid is also the model for Obamacare -- top-down price-fixing and mandates from Washington.
There are alternatives -- like a combination of health savings accounts and catastrophic insurance -- that would provide better care to the poor and an improved outlook for the nation's fiscal health. Klein's happy talk notwithstanding, there are no "successes" in Obamacare. Left alone, it will remake the entire health care system in Medicaid's image.
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