מדוע יש לנו תוכנית Medicaid?

December 3, 2013  --  A Star Ledger headline reads: “ObamaCare fuels applicant boom for NJ Medicaid—Advocate hails 35% increase in October.” Almost 22,000 new applications were filed in October, up from 16,000 in September. Is this a triumph? Was a 990-page law needed to accomplish this? The taxpayers will have to fork over $5,000 per applicant to a Medicaid HMO—that’s $110 million—and what will the patients get?

I am a physician who volunteers at the Zarephath Health Center, a non-government charity clinic in central New Jersey, where volunteers care for the poor and uninsured. We see Medicaid patients who cannot find a Medicaid doctor. The other day I saw a 35-year-old mother with severe asthma. She is on Medicaid and had gone to the emergency room a few days earlier. She was instructed to find a physician for follow-up treatment. Unable to find a doctor who takes Medicaid, she was welcomed at our clinic. I saw her, spent time hearing her story, and was happy to give her prescriptions to keep her asthma in check.

A dishwasher repairman is paid more than a doctor who takes Medicaid. Yet the doctor could be held liable for hundreds of thousands of dollars if there is a bad outcome.

The next day she returned with the odd complaint that no pharmacy would fill her prescriptions. Since I had not enrolled as a “non-billing Medicaid provider,” the pharmacies were told they would not be paid if they filled my prescriptions. I have a license, am board certified in internal medicine, and pay each year to keep my controlled-substances licenses updated, so why would they not honor my prescriptions?

When the patient called the Medicaid office, they instructed her to go back to the emergency room to get her prescriptions rewritten there—presumably copied by a physician enrolled in the program. Why would the Medicaid program deny her the medicines she needed? One would think they would appreciate the fact that a doctor was willing to see and care for her without costing the system anything. But apparently this is not how a bloated bureaucracy works.

Another Medicaid patient, a single mother of two, came complaining of abdominal pain. This has been going on for three months, and she has been to the emergency room several times. On the first visit they did an abdominal ultrasound and saw gallstones. But because her liver enzymes were not elevated and this was not considered an emergency, she was sent home and instructed to find a surgeon to take her gallbladder out. After making many phone calls, she never made it past the receptionist, as no surgeon takes Medicaid. Here is why. A dishwasher repairman is paid more than a doctor who takes Medicaid. Yet the doctor could be held liable for hundreds of thousands of dollars if there is a bad outcome.

Happily, someone told this patient about our clinic. We contacted a surgeon who said he would be pleased to help. The clinic will be able to pay him a fair fee without the exhaustive paperwork and claim forms. The patient will be treated like a VIP.

So why do we have Medicaid? Is it about providing care, or about setting up a large bureaucracy to make it appear that the poor are getting care?

We do not need Medicaid. We do not need ObamaCare. In a sensible world, there would be three layers to provide optimal care at reasonable cost: 1) direct payment for routine care; 2) low-priced, high-deductible health insurance for major medical events; and 3) real non-government charity for those who cannot afford either.

Come let us reason together and throw off the government bureaucracy. Politicians ought not take credit for what doctors, nurses, hospitals, and communities do. In actuality, President Obama must take ownership of his failure and take the blame for fleecing the taxpayers to erect barriers to care.

The sooner we repeal ObamaCare, the better.


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