Growing Number of Doctors Refuse to Serve Medicare and Medicaid Patients

Medical Progress Today is a newsletter published by the politically conservative Manhattan Institute. In their July 20 issue, Paul Howard wrote about the increasingly absurd pretense that programs funded jointly by states and the federal government such as Medicaid and Medicare are "expanding" to provide coverage to more uninsured or under insured Americans.

In fact, while these programs were originally intended to provide health insurance for those who are eligible, they have morphed in recent years to become political programs to manipulate the public into thinking that government funded health care coverage is expanding. In fact both of these programs are shrinking. Absent a major political shift, those who qualify for these "health insurance" programs(you're eligible for Medicare at 65 regardless of your income or assets. You're eligible for Medicaid if you meet certain poverty definitions-these vary from state to state-no matter how old you are)-will in fact only be eligible for "waiting lists" (i.e no care at all).

Howard quotes from a Wall Street Journal article that ran last week on the front page on "a phenomenon that has been long noted in the policy community: many doctors refuse to accept Medicaid patients because of the abysmally low reimbursement rates they receive from the program."


"On paper... Medicaid coverage is real insurance. the safety-net program is intended to provide comprehensive health-care coverage for more than 50 million Americans too poor or disabled to afford it elsewhere... But when Medicaid patients seek care, they often find themselves locked out of the medical system. In a 2006 report from the Center for Studying Health System Change, a nonprofit research group based in Washington, nearly half of all doctors polled said they had stopped accepting or limited the number of new Medicaid patients."(italics mine reo)

"That's because many Medicaid programs, straining under surging costs, are balancing their budgets by freezing or reducing payments to doctors. That in turn is driving many doctors, particularly specialists, out of the program."

Howard's commentary in Medical Progress today states "This problem is endemic to government funded health care problems. As the government expands services that appear to be free to the end-user, there is overuse of the system and rising costs. To contain those costs, government squeezes reimbursement to providers and rations access to more expensive, hi-tech care."

"Medicaid reimbursements are lower than Medicare reimbursements, which are in turn lower than what private insurers pay for their own patients. (Check out the helpful panel on fee disparities in the WSJ article.) Indeed, physicians refusing to accept new Medicare patients is a problem all its own."

"States that are rushing to expand eligibility for their own Medicaid programs (that claim to cover everything) to higher and higher income levels are basically trading expanded insurance coverage on paper with paper thin access to health care."

Howard, and the policy experts at the Manhattan Institute believe that the answer to this problem should be a free market one. Get rid of Medicare and Medicaid and use the funds to purchase private health insurance.

"Is there a better solution?" asks Howard. "For starters, give poor Medicaid participants vouchers to purchase their own health insurance on the open market, complete with a health saving account to roll-over any savings after premium payments. Florida and other states are currently experimenting with programs like these.

"Universal "free" health care may sound attractive in the abstract, but the rationing and restrictions that come with expanded government programs are often not what their advocates hoped for, particularly for the poorest and most vulnerable patients."

He's right on target when he says that government funded health care is not what their advocates hoped for,however, other policy analysts and health care providers say that the solution is a truly universal, government funded health insurance plan like most other developed countries already have. (See my previous post on Michael Moore's movie "Sicko" which is currently playing at a theater near you and breaking box office records for a documentary film.)

Bob O'Toole, Editor of this blog can be reached at bob@elderlifeplanning.com

Sources for this post:
http://www.manhattan-institute.org/html/about_mi.htm

http://www.medicalprogresstoday.com/blog/archives/2007/07/medicaid_covera.html

http://online.wsj.com/article/SB118480165648770935.html