Healthcare From the Trenches

I recently talked with a physician from south New Jersey.  He thoughtfully enlightened me on a couple of healthcare talking points.

The 30 million uninsured
A while back, says my friend, a woman physician in south Jersey got a grant to start a clinic that would exclusively serve the uninsured.  He helped her getting started with office space in his own clinic.  The clinic for the uninsured closed after a couple of years due to lack of business.  The truth is that when an uninsured person gets sick they can probably sign up for Medicaid on the spot.  So why bother getting insured?  An elderly acquaintance from Peru, wife of a retired Lima physician, reports that when she gets health care in the US she never has to pay.  Now why would that be?

Those Medicaid reimbursement rates
How, I have wondered, given that Medicaid reimbursement rates are notoriously low and Medicaid patients have trouble getting physicians to see them, do Medicaid patients get their health care?  My friend told me.  In south Jersey they have recently set up a federal funded chain of clinics to serve the Medicaid folks.  How do the clinics get paid, I wondered?  They get paid through the usual reimbursement schedules, just like the private docs.  But, of course, they also get federal funding.  Nice gig if you can get it.

Entitlement mentality
The wife of a friend of mine here in Seattle works in University Hospital and complains that Medicaid patients tend to move in, and often only get discharged after a couple of weeks when the Medicaid coordinator puts an end to their shenanigans.  Regular patients with private insurance are whisked in and out in a couple of days.  My south Jersey friend has similar experiences.  He gets Medicaid recipients that come in and say: Give me the works, doc: MRIs, CAT scans, the whole enchilada!  Whatever happened to the grateful poor?

Maybe we should all be outraged by this corruption of the entitlement state.  But I am not.  It is perfectly obvious to me that any entitlement program or indeed any government program of any kind is bound to be riddled with waste, fraud, and abuse.  Government programs are not responding to human need; we have a market economy for that.  Government programs are projections of political power:  We are doing this because we have the power to do it.  In the end all government programs regress into a simple scramble for loot.  But at least when Boss Tweed looted the City of New York the city gotuilt a magnificent marble City Hall for their trouble.  The monument to our corrupt liberal welfare state will just be the broken lives and gigantic debt it left behind.