The Problem with Medicaid

Arizona’s plan to severely restrict Medicaid eligibility reflects the real problem with American medical care: its cost.

Arizona’s plan to severely restrict Medicaid eligibility reflects the real problem with American medical care and that is its cost.

I am a nephrologist and Medicaid actually pays nothing to nephrologists for the outpatient care of patients receiving dialysis treatments. We care for these patients as a professional responsibility but it is not reasonable to expect this as an activity that all physicians can perform gratis. Hospitals lose money on Medicaid patients, on the average about 76 cents of payment for every dollar of services provided. Hospitals that have large Medicaid populations must receive substantial state aid or they cannot survive. This has happened in Philadelphia with about 20 hospitals having closed their doors over the past decade.

Something must be done for states that have this burden. One approach could be to only cover catastrophic illnesses while allowing hospitals to refer non-urgent care to community health centers. Nursing home care is a major component of Medicaid costs around the nation.  Making certain that families care for their elderly family members rather than utilize nursing homes should be required if at all a possibility for a family. Elective procedures might be outside the purview of Medicaid as well. Managed care should be an absolute requirement of Medicaid care.

Having said all this, states will still be under severe economic stress to pay for Medicaid care. Only a reform of health care delivery itself will provide any hope for sustaining health care for the poor.

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