Medicaid’s problems and health-care reform

at 09:55 AM ET, 06/17/2011

Yesterday, Megan McArdle linked to the study showing that Illinois children on Medicaid have trouble getting appointment with specialists and wrote “proponents of health care reform are gnashing their teeth, while opponents grimly say ‘I told you so.’” Really? Why?

The study gets at two problems: In an effort to control costs, Medicaid pays doctors too little, and too many uninsured people go without care. These are exactly the sort of problem health-care reform is designed to address. Most directly, the law dramatically expands coverage and increases Medicaid reimbursement rates, particularly for primary-care doctors. That doesn’t do much for the specialists, who were the subjects of this study, but it’s a start.

More importantly, the law is thick with efforts to control costs in the health-care system itself — and in Medicaid itself — which is the only approach that’s really sustainable over the long-term. They may or may not work, but people who believe they’re our best hope, at least for the moment, aren’t gnashing their teeth at this study. They’re saying, “See? This is what I’ve been trying to tell you about. This is why we had to pass that law.”

At the end of the day, it doesn’t matter if you’re worried about costs or access. The only answer — barring incredibly radical restructuring of our entire health-care system — is figuring out how to make it cheaper to treat sick people. The Affordable Care Act has a lot of ideas on that, and though I think they’re pretty good ideas, it’s certainly true that they could fail. But then we need to try something else. The status quo isn’t sustainable, and simply throwing people off Medicare, Medicaid and employer-based insurance plans isn’t plausible.

Indeed, it’s rather peculiar to look at a study where the harm is that people can’t get health care and use that as an argument against a law that, whatever else it does, clearly gives people more access to health care. Ultimately, this study seems much more troubling for critics of the law, who are still searching for a plausible solution to these problems, than for proponents of it. The right response to this isn’t, as McArdle would have it, “I told you so.” It’s “what else can we do about the dual-eligibles?”

 
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