November 22 2013
Expanding Medicaid Isn’t a Government Health Care Success
Carrie L. Lukas
Ezra Klein--who has been a leader on the Left in acknowledging the extent of the ObamaCare rollout disaster—now seeks to defend the crumbling perception that government really is suited to run the nation’s health care system. He likes the idea of a single-payer system, naturally, which would remove the pretense of choice and competition entirely. So for now, he points to the ongoing Medicaid expansion as an example of a government health care achievement.
Obamacare’s Medicaid expansion, for instance, is going perfectly well in states that chose to accept it. Take Oregon, which has emerged as perhaps the worst disaster zone in Obamacare’s implementation: Oregon’s state-run exchange is simply broken. More than six weeks after it was supposed to open, not a single person has successfully enrolled for insurance through it. Yet at the same time, the state has signed up more than 70,000 people for Medicaid -- reducing Oregon’s uninsured population by more than 12 percent.
Nothing about the law’s difficult debut in Oregon or elsewhere has undermined its huge expansion of Medicaid or Medicare; indeed, the argument for a broader single-payer health-care system is very much intact. Instead, the elements of Obamacare that are failing are precisely those market-based initiatives that Republicans most want to work.
Medicaid’s expansion is going “perfectly”? Perhaps in comparison to the government’s incompetent health exchange website, from an administrative stand point, state governments are succeeding in adding names to their Medicaid rolls. And yes, giving someone a card that says they have Medicaid means they are technically no longer “uninsured.” But that doesn’t mean that they are any closer to accessing quality health care.
As Hadley Heath explained in this policy paper:
Nationally, for every dollar of primary care received by someone with employer-sponsored insurance in 2008, Medicaid only paid 52 cents. That means that doctors received just about half of the payment for treating a Medicaid patient that they did from someone with private insurance.
Not surprisingly, because of this broken payment structure, Health Affairs reports that only 70 percent of physicians accept Medicaid patients. This makes it difficult for Medicaid patients to get appointments with private physicians.
The health outcomes for Medicaid patients confirm they are not receiving a high quality of care: A university of Virginia Study shows that surgical patients on Medicaid are 13 percent more likely to die than patients with no insurance at all. They are 97 percent more likely to die than those with private insurance. The poor standard of care for Medicaid patients has resulted in severe harm and in some cases, even death.
So Klein can applaud the statistical drop in the number of uninsured, but given that Medicaid already offers poor health outcomes and long waiting times for accessing care, the "insurance" is little comfort to those who actually have to take part in the broken system. And isn't getting care, not insurance, the real point?
Klein's other idea that the health insurance exchanges are the culmination of the Right’s free market dreams and therefore the disastrous roll out is really evidence of a free market failure is simply laughable. Yes, Republicans have at times called for government managed websites that function as exchanges. That in itself isn’t an absurd idea, and recall that the Obama Administration made the website exchanges much more complicated by trying to shield people from the actual premiums they would incur before qualifying for government subsidies.
Yet the website failure--telling as it is about big government's incompetence--isn’t the reason why millions of people are losing insurance today. The lost insurance is because of government regulations outlaw any plan that doesn’t mean the HHS definition of covering “essential benefits.” The biggest problem with ObamaCare is the idea that government ought to dictate what every single insurance package must contain for every American and to prevent the insurance industry from functioning as a provider of “insurance” by taking one’s expected health care costs into account.
The Left is desperate to pin the ongoing ObamaCare disaster on something other than the fundamental idea that government knows best and ought to be in charge of running American life. But Americans are rightfully becoming skeptical of the Administration and its allies blamegame on why the health care law is such a mess, so they are unlikely to buy this latest fraudulent line.