The state of California has decided to slash Medicaid payments to physicians by more than $50 million. AMNews reports that Dr. Richard Frankenstein, President of the California Medical Association (CMA), thinks the state has created a monster:
Cutting funding for health services, particularly when it costs California valuable federal matching funds, is neither humane nor financially sound.
He’s right, of course. The cuts are indeed inhumane because they will reduce primary care access for California’s poorest patients:
AÂ 2001 California HealthCare Foundation survey found that 55% of primary care doctors and 50% of specialists accept Medicaid patients. The new Medicaid cuts mean these numbers will decline further.
And they are fiscally irresponsible because these patients will have to avail themselves of the more expensive ER alternative:
More program enrollees will wind up in the emergency department because they could not get primary care … They’re going to end up going to the hospital at the last minute and getting very expensive care.
The CMA plans to fight the cuts. It’s probably an exercise in futility, but Dr. Frankenstein hopes to stitch together a compromise:
We absolutely do not think this is set in stone, and we are exploring our options about what we can do to turn it around.
This is what always happens when government controls the health care purse strings. Arbitrary funding cuts are a way of life.
Government-run health care is an unholy monster, cobbled together from the corpses of failed Lefty ideas. It needs to be destroyed once and for all.
[HT Kevin,MD]
Comments 13
I fully support you in condemning cuts in government spending and am pleased you have come round to my way of thinking.
Posted 04 Mar 2008 at 8:20 am ¶Marc Brown - You miss the point … as usual.
Since free health care at public expense is a bottomless fiscal hole, the government will always be forced to make arbitrary funding cuts. - And once government is in control of our entire system, we will all be like those hapless Medicaid recipients.
Posted 04 Mar 2008 at 9:11 am ¶‘And once government is in control of our entire system, we will all be like those hapless Medicaid recipients.’
Stuart, your irony detection attenna is again faulty. But what you say is nonsense, isn’t it. This can never happen - even if you live in the UK there is nothing stopping you buying private health insurance.
The serious point though is that you are indeed either asking for improved state Medicaid/care funding or none at all - and if the latter, Mr Catron has a word for you, which begins with whack and ends in job.
Posted 04 Mar 2008 at 10:37 am ¶Stuart, you miss the point, the only reason there is medicaide is because the market wouldn’t absorb these people in the first place. Funny how you and your colleagues denounce this as “govt run health care” in one breath but given the choice you would offer no other way to cover them. keep going though if nothing else it is good for a few laughs.
Posted 04 Mar 2008 at 10:46 am ¶You (except Stuart) are missing the point of the post, which is, that once thegovernment is in “control,” they will do what is necessary to control costs, including reducing benefits if need be.
Marc suggests that there will always be a choice - really? how do you know? Do Medicare recipients have a choice? Do medicaid recipients have a choice? With what will they purchase private health insurance?
Posted 04 Mar 2008 at 12:12 pm ¶‘Do Medicare recipients have a choice? Do medicaid recipients have a choice? With what will they purchase private health insurance?’
Well exactly. So what exactly is your beef here, if you agree that Medicare/aid is necessary? You and Stuart (and Catron) are making no sense at all. I would have thought you free market buckeroos would be cheering every cut in government funding to the rafters.
Posted 04 Mar 2008 at 2:31 pm ¶Wow - is this circular.
It’s easy to argue half a point, isn’t it?
Yes, I think the free market could devise better solutions (through free market evolution, not central planning) than medicare, medicaid. However, if practictioners are forbidden by law from engaging in free market activities (a la Medicare and Medicaid) then cutting the programs does NOT demonstrate a free market failure, it demonstartes a failure of government control and central planning.
Remove the regulations that hamstring providers and patients, and then remove the programs, and let the market do it’s thing. The reductions in funding did nothing to relieve providers of the restrictions that would allow them to negotiate directly with patients for their services. We are still bound by those restrictions, which are that we must take the gov’t money or none at all. There is now just less gov’t money.
Government funding is not the problem, government regultions and controls are.
Proponents of universal insurance, mandates etc, should take note that in spite of these cuts, the same number of people are “covered.” Where and how they will find access to care, however, is another question.
Posted 04 Mar 2008 at 3:45 pm ¶‘then cutting the programs does NOT demonstrate a free market failure, ‘
No one is talking about a market failure in this story.
‘Remove the regulations that hamstring providers and patients, and then remove the programs, and let the market do it’s thing.’
But you said yourself how would Medicaid patients pay their bills. You seem very confused by this.
‘There is now just less gov’t money.’
That’s right! I see Bush is trying to force huge healthcare cuts in Medicare and Medicaid. So - do you support or oppose these cuts? This is a simple question.
‘Proponents of universal insurance, mandates etc, should take note that in spite of these cuts, the same number of people are “covered.â€? Where and how they will find access to care, however, is another question.’
Under universal healthcare systems we also get resource planning to build facilities and recruit staff where they are needed. Hence we get access to care.
Posted 04 Mar 2008 at 5:00 pm ¶“But you said yourself how would Medicaid patients pay their bills. You seem very confused by this.”
I am not confused at all.
Remove the regulations that increase the cost of providing care to all patients, so I can negotiate with ALL of my patients, one on one. Then I can afford to provide a certain amount of charity care, reduced fee care, ability to pay care, or care in exchange for an apple pie, whatever.
‘There is now just less gov’t money.’
“That’s right! I see Bush is trying to force huge healthcare cuts in Medicare and Medicaid. So - do you support or oppose these cuts? This is a simple question. ”
I oppose them. I see that it is you who are confused. You seem to think that reducing funding to government programs that limit personal liberty is a step toward the free market, something a free market type such as myself would favor. This just demonstrates your lack of understanding. The funding cuts are in fact a consequence of government meddling that will result, much as it has already, in a shortage of providers. The reason I oppose the cuts is that I still have to live under the rules imposed by the system that is so financed.
Do I support abolishing these programs completely and all of the regulations that hinder my ability to negotiate with my patients for services? Yes. But as long as my liberty, my ability to negotiate with individuals to provide a service for mutually acceptable compensation is shackled in the dungeon of well-meaning entitlement programs gone awry, reductions in funding do no good. They do me no good as a physician, nor as a taxpayer, nor as a patient.
I have a query for you, out of curiosity: In the UK, is there any patient for which a physician is legally forbidden from accepting remuneration directly from the patient for services, at a rate negotiated strictly between the parties, and outside of governmetn regulation?
Posted 04 Mar 2008 at 7:58 pm ¶‘Remove the regulations that increase the cost of providing care to all patients, so I can negotiate with ALL of my patients, one on one.’
What’s stopping you only taking purely private patients?
‘You seem to think that reducing funding to government programs that limit personal liberty is a step toward the free market’
No - I just see the cuts as just that - cuts in sorely needed government programmes.
‘The funding cuts are in fact a consequence of government meddling’
This nonsensical. We are talking about government programmes. They are theirs, or rather yours, to meddle with. It’s simply the case that your present president chooses to slash the funding.
‘But as long as my liberty, my ability to negotiate with individuals to provide a service for mutually acceptable compensation is shackled in the dungeon of well-meaning entitlement programs gone awry’
Just don’t do it then. You’re sounding rather pitiful. How much do your earn, anyway?
‘In the UK, is there any patient for which a physician is legally forbidden from accepting remuneration directly from the patient for services, at a rate negotiated strictly between the parties, and outside of governmetn regulation?’
Any private practitioner can do what they want. But most acute sector doctors are salaried employees who work in the NHS, and patients do not pay anything directly, bar a small charge for drugs if they do not qualify for free drugs (eg pregnant women, kids, low income). Many primary care doctors are self-employed and run their own practices, but solely under NHS contract. Some consultants work in both the NHS and have a private practice, subject to fulfilling their NHS contract.
Posted 05 Mar 2008 at 4:53 am ¶“What’s stopping you only taking purely private patients?”
Very frankly, the law.
The medicare program has created a set of laws and perverse incentives to minimize or eliminate “purely private patients.”
Posted 05 Mar 2008 at 8:27 am ¶‘Very frankly, the law.’
You are legally bound to see Medicare patients? If you a private physician and don’t work in a group or hospital I don’t think that’s true.
Posted 05 Mar 2008 at 9:06 am ¶No, one is not legally bound to see them.
But what kind of internal medical practice does not see any patients over 64 years of age?
Posted 05 Mar 2008 at 10:54 am ¶Post a Comment