For Kids, Being Uninsured is Healthier than Being on Medicaid
From a recent GAO study, with a big hat tip to Avik Roy, on Forbes.com, we learn that uninsured children get better care than children on Medicaid.
Why?
From Roy's piece in Forbes.com:
It turns out that Medicaid’s problems aren’t just that the program underpays doctors. It’s also that the program is a huge hassle to work with, in terms of paperwork and billing requirements. It’s also that Medicaid reimbursement checks come late, and it takes a lot of effort on the part of busy doctors to track bureaucrats down for timely payment. An uninsured patient who pays cash is infinitely easier to deal with, even if the uninsured patient only pays $20 up-front for an office visit.
The GAO survey studied this problem too, asking physicians why they don’t want to deal with Medicaid patients. Among physicians who have opted entirely out of participating in Medicaid/CHIP, 94 percent said “low reimbursements” greatly or somewhat limit their willingness to take Medicaid patients. The other top problems were “billing requirements and/or billing paperwork burdens” (87 percent said this greatly or somewhat limits their participation); “delayed reimbursements” (85%); “burdensome provider enrollment or participation requirements” (85%); and “difficulty referring patients to other providers” (78%).
A glimpse into the future of Obamacare. And what's amazing, of course, is that we already knew this -- big government programs cost more, deliver less, and, once enacted, can never be changed.
Well, that's not strictly true. Roy points to a very interesting counter-example:
What does this tell us? It tells us that Medicaid harbors all of the hallmarks of extreme government mismanagement: burdensome requirements, excessive paperwork, and unresponsive bureaucrats. In other words, simply throwing more money at the program, as the Left advocates, won’t work. Even if we did have the money.
This is why the best solution is to do what the House of Representatives has done, and what Tom Coburn and others in the Senate are trying to do: convert the Medicaid program into block grants for the states, and let the states experiment with ways to deliver Medicaid more efficiently. Examples as diverse as Rhode Island and Indiana show that states can do a far better job than Washington can.
Ezra Klein and others contend that block grants have “nothing to do with making the system work better.” The exact opposite is true: block grants have everything to do with making the system work better. The 1996 welfare reform law was such a tremendous success because it used precisely this approach.
And in a previous post, he tells the harrowing story of how socialized medicine kills children:
Deamonte Driver, a seventh-grader from Prince George’s County, Maryland, died in 2007 at the age of 12. In certain ways, Deamonte’s story fits the stereotype of poor black boys who die young. He, along with his brother DaShawn, were raised by one parent: his mother, Alyce. Deamonte was on welfare. He spent much of his time in and out of homeless shelters. But he wasn’t the victim of gang violence or drugs: instead, he died of a toothache.
Deamonte, as you might guess, was on Medicaid. Deamonte and his brother had never received routine dental attention. When the toothaches started, it took months and several dozen phone calls to get an appointment with a dentist. It took another several months to get an appointment with an oral surgeon who was willing to extract his six abscessed teeth.
Five days before that appointment was to have taken place, Deamonte began to complain of a headache. Soon after, he underwent emergency brain surgery. Several weeks later, he died. Deamonte did not die because he was uninsured. He died because he was insured: or, more precisely, because he was insured, in bad faith, by the government.
If the government had given his mother the equivalent subsidy in cash or a health-savings account, she would have had no problem finding a dentist to see her kids. Indeed, in the Pediatrics study, 100% of Medicaid-enrolled dentists who denied Medicaid appointments, but were asked if they would take cash, said they would, requiring an average of $124. Over at ReformMedicaid.org, Ben Domenech found a study showing that offering a doctor $20 in cash, and offering to pay the balance later, allowed for physician access that was comparable to that of Medicaid.
Medicaid is a $450-billion-a-year lie.
Medicaid is a lie. Obamacare is Medicaid+. It's got to be repealed, and the remaining rotten system needs to be scrapped and replaced with block grants, or something, anything, else. And when the left responds with their lower lip all trembling, "What about the kids?" we should point them to the GAO study and remind them: It should be scrapped because of the kids.
Oh, and clearly Avik Roy should be writing for Ricochet! (We're working on that....)
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May '11
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
A fine example of the liberal approach to problems, which I analogize to a primitive society that tries to bring rain by sacrificing a virgin to the rain gods. If it doesn't work, it just means that they should have sacrificed two virgins. It never, ever occurs to them that sacrificing virgins is stupid and doesn't work. Liberal programs always fail, and the liberal explanation is always the same -- we didn't do enough of it.
Here we are, 45 years into the war on poverty with trillions of dollars spent, and no results. Let's sacrifice another virgin!
May '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
"Here we are, 45 years into the war on poverty with trillions of dollars spent, and no results. Let's sacrifice another virgin!" (Hey, where did the formatting buttons go?) I'm as disgusted by this as anyone, but the above statement is not fair. The poor are less poor than they used to be, so to say "...and no results" is not fair. The poor may have been poorer without those trillions of dollars. Just saying...
May '11
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
I don't know if there are any hospitals that refuse medicaid. I haven't heard of one. Soon all doctors will be hospital employees, so if there is any benefit to this shift in employment pattern, this might be one. However, I can say anecdotally that expanding hospital systems into community wide behemoths has not yet affected the overutilization of emergency rooms for non-emergent care.
Dec '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
An American goes to a Mideast bazaar and sees a very fine pair of boots on display. He asks the shoemaker, "How much are they?"
"$250 American, I make you ones just like custom fit to your foot."
"Too much. I'll give you $75."
The shoemaker shakes his head. "I cannot for $75."
After a few more offers by the American, the shoemaker agrees to make him a pair of boots for $125.
The American returns a week later to get his boots. The shoemaker hands him a pair of basic, utilitarian boots - well-fitted but without the beautiful details of the display boots. The American is livid. "You said you'd make me a pair of boots just like those on your table!"
The shoemaker says, "Yes, for $250 I make you those ones. For $125, you get these ones."
If you try to impose price caps on service providers, you get less service to go with your lower reimbursement rates.
Edited on Jul 6, 2011 at 8:01amJul '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
Medicaid not only has the disadvantages covered above, but it forbids by law "your" doctor discussing options with you or ordering procedures for you that are not called for under their protocols. It is illegal for any doctor to provide treatment to a Medicaid patient, even on a cash basis, outside of the Medicaid system. A child under Medicaid with no clear diagnosis is better served in Mexico than the US. Thanks for the story, Rob!
Jun '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
I saw inside the mouths of low-income kids at a Catholic school where I substituted occasionally as the school nurse. I honestly sometimes couldn't tell which teeth were baby teeth, which were permanent, and what was bad hygiene vs. decay. Just a mess!
These were kids whose parents cared enough to bus them out of a bad neighborhood to an out-of-town school. But how did they miss teaching their kids how to properly brush? Very sad. And as just a sub, I was in no position to get a dental hygiene program up and running.
And that poor Deamonte boy would never have had six absessed teeth if he had at least brushed daily. The kind of dental nightmare he was living would not have been fixed with dentist visits if he then went home and didn't brush for six months. It's lifestyle changes that are needed more than anything.
Nov '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
There's a sentence hiding in this article that I think makes another important point:
"Deamonte, as you might guess, was on Medicaid. Deamonte and his brother had never received routine dental attention."
This is a common problem among people who are raised to be wards of the state. They abdicate responsibility for their own well-being. This woman could have taken her kids to the dentist regularly, but nobody was making her do it, and there wasn't a government program that picked up her kids and took them to the dentist for her.
I worked in a hospital lab for a couple of years, and can tell you that this kind of behavior drives medical professionals crazy. You just can't get medicaid people to be proactive about their health. If it doesn't get done for them, it doesn't get done at all.
I think this is the worst aspect of big government social welfare programs. Over time, it turns independent people into permanent children who don't know how to take care of themselves.
Dec '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
Rob,
Why do they call you a RINO? You are on fire today.
Aug '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
Rob,
You're confusing Medicare and Medicaid. Medicaid is indeed associated with bad outcomes and there are a fair number of studies showing it's worse than no insurance at all.
Medicare on the other hand is actually associated with good health outcomes. For instance, there's an appreciable favorable regression discontinuity for odds of surviving a heart attack at age 64. The problem with Medicare is not that it hurts patients but that it's fiscally unsustainable in a country with a rapidly aging population, a static retirement age, and pre-approved hover-rounds to get you your mobility back.
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
Stephen: Rob,
Why do they call you a RINO? You are on fire today. · Jul 6 at 9:06am
Thanks, but I still have lots of RINO tendencies.
Jul '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
Here's a typical scenario in dentistry:
An endodontist might charge a cash patient $1,200 for a root canal. The patient shows up on time, the thing is done and the cash is in hand.
A Medicaid patient - or a patient on one of many state dental plans - very often does not show up for the appointment, so the endodontist forgoes revenue for that time. When the patient does show up, his case, because of prolonged neglect, is often very complex - so complex that a cash patient might pay $2,000.
But a public plan will pay the endodontist only $300.
And then the games begin. The paperwork is onerous. It's often lost in the black hole of bureacracy for months and the practice is tortured by constant demands for revision of the original claim. Often this goes on so long that the claim is ultimately denied for lack of timeliness. That isn't a bug, it's a feature.
To sum up, does the dentist want to deal with patients who don't show up, with plans that pay only 25% of market and then often do not pay at all?
Edited on Jul 6, 2011 at 10:03amRe: For Kids, Being Uninsured is Healthier than Being on Medicaid
anon_academic: Rob,
You're confusing Medicare and Medicaid. Medicaid is indeed associated with bad outcomes and there are a fair number of studies showing it's worse than no insurance at all.
Medicare on the other hand is actually associated with good health outcomes. For instance, there's an appreciable favorable regression discontinuity for odds of surviving a heart attack at age 64. The problem with Medicare is not that it hurts patients but that it's fiscally unsustainable in a country with a rapidly aging population, a static retirement age, and pre-approved hover-rounds to get you your mobility back. · Jul 6 at 9:19am
Thanks, Anon. I clarified it in the edit. I meant to be writing Medicaid, and racing to post before the wi-fi left me, I got sloppy.
And I agree that the key to Medicare problems is that it's financially ruinous. But the problem with Medicaid is its reams of regulations and bureaucratic nonsense, and that it clearly makes care almost impossible for the very people it's trying to help.
Obamacare seems to combine the worst aspects of both of them.
Dec '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
This points to one conceptual flaw in the debate. We don't have a health care delivery problem, we have a health care payment problem. The public debate is framed around the numbers of insured vs uninsured, rather than the kind of care that the various insurances provide. We have plenty of health care resources, most of which are inefficiently utilized because the market is warped by the large government intrusions via the payment & regulatory mechanisms.
Edited on Jul 6, 2011 at 10:43amNov '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
If you guage poverty by "..stuff in our houses" (ala Sharpton), then you are right. The poor have plenty of food, TV, air-conditioning (often), etc. But their poverty of opportunity is far worse in terms of unstructured lives, sloth, bitterness, and everything that attends dependency.
Edited on Jul 6, 2011 at 11:00amMay '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
Medicaids reimbursement schedules are also a nightmare.
In Wisconsin we noted that if we saw a patient in the ER and treated them for a real medical emergency like a heart attack the payment was something like $95. didn't matter what we did, flat rate. If however we put 1 or 2 stiches in a laceration the reimbursement went up to about $125. Just maddening.
Apr '11
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
Rob,
I agree with your points but have to say that pointing to any facts or anecdotal evidence to a liberal usually gets you nowhere. In my experience, liberals are more worried about the means than the ends. In the case of medical insurance, they are wedded to the idea that the gov't should provide for the good of all. Pointing out the failures or fiscal insolvency of these systems simply doesn't register and is akin to sacrilege to many on the left who would rather rationalize why kids are dying under their system than actually admit that they are wrong.
May '11
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
ctruppi: Rob,
I agree with your points but have to say that pointing to any facts or anecdotal evidence to a liberal usually gets you nowhere.
Usually? In my experience, if you try pointing out facts to a lefty, the lefty will:
1. Call you names. (“You’re an ignorant, racist, teabagger.”)
2. Attack your facts – not based on their accuracy, but based on their presumed source. (“You must have gotten that from Faux News.”)
3. Change the subject. (“You’re against raising the debt limit? We wouldn’t even have a debt if not for Bush’s illegal wars.”)
4. Attack someone else, who has absolutely nothing to do with the subject. (“The Koch brothers put out this mindless garbage, and you just repeat it.”)
5. Attack anyone who has made any money. (“The greedy corporate oligarchy runs everything.”)
May '11
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
ctruppi: Rob,
I agree with your points but have to say that pointing to any facts or anecdotal evidence to a liberal usually gets you nowhere.
Usually? In my experience, if you try pointing out facts to a lefty, the lefty will:
1. Call you names. (“You’re an ignorant, racist, teabagger.”)
2. Attack your facts – not based on their accuracy, but based on their presumed source. (“You must have gotten that from Faux News.”)
3. Change the subject. (“You’re against raising the debt limit? We wouldn’t even have a debt if not for Bush’s illegal wars.”)
4. Attack someone else, who has absolutely nothing to do with the subject. (“The Koch brothers put out this mindless garbage, and you just repeat it.”)
5. Attack anyone who has made any money. (“The greedy corporate oligarchy runs everything.”)
May '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
"Block grant it to the states." Sounds so right. It just rolls off the tongues of conservative pundits.
How it works in reality is that the state governor gets a big pot of money to do what he or she wants.
Rob, please note this very carefully: IT DOES NOT MATTER WHAT KIND OF REGULATIONS COME WITH THE MONEY, THE STATE WILL FIGURE OUT HOW TO TURN IT INTO PAYOUTS TO THE WELL-CONNECTED, AND SINECURES FOR A HANDFULL OF BUREAUCRATS.
I know this from personal experience here in Illinois. But then California being the apex of clean government maybe your experience has been different.
Voucherizing Medicaid would be better. Eliminate the state middlepeople.
Dec '10
Re: For Kids, Being Uninsured is Healthier than Being on Medicaid
California and Illinois are both poor choices to hold out as indicative of the whole union.
I have no doubt that they both squandered the block grants as you said, but that doesn't mean that every other state in the union will too. New Jersey and New York probably will, and maybe Oregon and Washington, but the rest of us will probably be OK.
That said, I'd still very much rather the entire edifice went away.
Let people keep that money instead of giving it to DC (to then give back to the states), and you'll see private solutions to these problems pop up all over the place.