Roy For McArdle: "Health INSURANCE Is Not The Same As Health CARE"
Avik S. A. Roy, blogging at TheAtlantic.com's space that was Megan McArdle's, writes:
Chapin White of the Center for Studying Health System Change has published an important new paper in Health Services Research, a journal of health economics, which suggests that a critical part of the Affordable Care Act--its expansion of Medicaid coverage to 16 million more Americans--may actually reduce those individuals' access to health care.White's report comes on the heels of numerous studies that show that patients on Medicaid, our national government-run health-care program for the poor, do far worse on health outcomes than do those on private insurance, and in some cases, worse than those with no insurance at all. (For an extremely deep dive into these studies, see my three-part series on the topic.)
1) Medicaid underpays doctors for their expenses
Why does this occur? The main reason is that Medicaid underpays doctors and hospitals to care for Medicaid beneficiaries. Medicaid's reimbursement rates are around half of those paid by private insurers. In many cases, Medicaid pays doctors less than it costs to care for Medicaid patients, meaning that doctors face the choice of caring for the poor, and going broke, or shutting their doors to Medicaid patients. One survey found that internists were 8.5 times as likely to accept no Medicaid patients at all, relative to those with private insurance. Another found that two-thirds of kids on Medicaid were denied a doctor's appointment for a serious condition, relatively to only 11 percent for the privately-insured.
Believe it or not, physicians even do better caring for the uninsured than they do caring for Medicaid patients. Two MIT economists, Jonathan Gruber and David Rodriguez, have found that three-quarters of physicians receive lower fees for serving Medicaid patients than they do for the uninsured, because many people without health insurance are still able to pay out-of-pocket for routine health expenses. (Gruber was the intellectual father of Obamacare, and remains an outspoken advocate of the law.)
And #2 and #3:
2) Overall, Medicaid expansions do not lead to more doctor visits3) Obamacare's Medicaid expansion could worsen physician access
Most of the medical care providers that accept medicaid -- I don't want to go too. It feels like I'm waiting in the stockyard pen of a slaughter house.
Jim P. at March 11, 2012 11:06 AM
Health insurance is regulated, manipulated, and distorted in every state. Lobbyists at the state level arrange for their particular offerings to be covered by insurance, such as accupuncture, chiropracty, and health clubs.
Insurance plans differ in total financial coverage, but don't offer ways for the consumer to benefit from choosing older, cheaper drugs. So, everyone has the incentive to choose newer, more expensive drugs, and the state-standardized insurance plans evolve to universally cover those and to cost more. Or, everyone is restricted to the older, cheaper drug to save money, and you find yourself uninsured for the newer drugs which you would have preferred.
That may seem as if I am arguing both sides at the same time. The point is, the individual has lost the ability to choose the detail of what his insurance will or will not cover, because it is a product sold to companies and is standardized by the state.
A woman might prefer more mammography rather than a discounted health club membership. She does not get to choose. She gets what lobbyists and health bureaucrats have chosen for her.
The government is breaking the free market in healthcare. Our policy makers have already designed a system of price controls that doesn't work. Their solution is to cover up this failure by blaming "the market". The "market" is short for the freedom of people to produce and cooperate among themselves, always delivering value and achieving efficiencies that government cannot match.
That freedom is what the government has taken and is taking away, in favor of higher hidden taxes and rationing. Our leaders have been buying votes with lavish promises of what the government will deliver. Their plan is to put us all in one small boat, then make us pay for their promises to prevent the boat from sinking.
Obamacare Bails Out Medicare.
Andrew_M_Garland at March 11, 2012 2:21 PM
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