I visited the eye doctor earlier this week and spoke to him briefly about Medicaid when my examination was completed. What I learned is compelling, and it is proof why Medicaid has been a failure.
1. When Medicaid was first adopted, the state paid $20 for an initial office visit to an ophthalmologist. Today, decades later, the state still pays $20 for that visit.
2. Follow up visits are paid by the state at the rate of $7.20 each.
Think about this. An office visit to an eye doctor usually takes at least 15 minutes, even if it is rushed. That means that the ophthalmologist is getting paid about $30 per hour to see Medicaid patients after their first visit. From that $30, the doctor has to cover the cost of maintaining his office, buying the equipment, paying the staff and buying insurance, supplies and other necessities. Simply put, there is no way that any eye doctor in the New York City area could do that. I doubt that it could be done anywhere in the USA.
So we have a program which cost billions of dollars each year, but which pays so little to doctors that they cannot make ends meet by seeing Medicaid patients. Much of the cost of the program goes for the bureaucracy that processes the claims. Another big chunk goes for payment for services that are not really needed for healthcare. Because of the amazingly low payment levels, however, there are fewer and fewer doctors who are willing even to see Medicaid patients; the number is now less than half of all doctors across the country who will accept Medicaid patients.
What good is it to tell the poor that they now have coverage in the form of Medicaid when most doctors and nearly all good doctors won't see them?
This is not an unimportant question given that Medicaid is the only mechanism under which Obamacare has actually increased the number of covered individuals (even if that number is outweighed by the losses among those with individual policies.) Can we really say that medical care is improved if all that we do is push more people into the situation where they supposedly have coverage but essentially no doctors will see them?
1. When Medicaid was first adopted, the state paid $20 for an initial office visit to an ophthalmologist. Today, decades later, the state still pays $20 for that visit.
2. Follow up visits are paid by the state at the rate of $7.20 each.
Think about this. An office visit to an eye doctor usually takes at least 15 minutes, even if it is rushed. That means that the ophthalmologist is getting paid about $30 per hour to see Medicaid patients after their first visit. From that $30, the doctor has to cover the cost of maintaining his office, buying the equipment, paying the staff and buying insurance, supplies and other necessities. Simply put, there is no way that any eye doctor in the New York City area could do that. I doubt that it could be done anywhere in the USA.
So we have a program which cost billions of dollars each year, but which pays so little to doctors that they cannot make ends meet by seeing Medicaid patients. Much of the cost of the program goes for the bureaucracy that processes the claims. Another big chunk goes for payment for services that are not really needed for healthcare. Because of the amazingly low payment levels, however, there are fewer and fewer doctors who are willing even to see Medicaid patients; the number is now less than half of all doctors across the country who will accept Medicaid patients.
What good is it to tell the poor that they now have coverage in the form of Medicaid when most doctors and nearly all good doctors won't see them?
This is not an unimportant question given that Medicaid is the only mechanism under which Obamacare has actually increased the number of covered individuals (even if that number is outweighed by the losses among those with individual policies.) Can we really say that medical care is improved if all that we do is push more people into the situation where they supposedly have coverage but essentially no doctors will see them?
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