WHAT MEDICAID TELLS US ABOUT GOVERNMENT HEALTH CARE

January 9, 2009

Medicaid provides coverage to poor and disabled Americans, many of whom face the highest burden of chronic disease owing to cultural and socioeconomic challenges.  The program beats being uninsured, but it often relegates the poor to inferior care, says Dr. Scott Gottlieb, a resident fellow at the American Enterprise Institute and a former senior official at the Centers for Medicare and Medicaid Services.

Reimbursement rates are so low, and billing the program so complicated, that it is hard for internists to get beneficiaries access to specialized care or timely interventions. For many patients, many of whom are uneducated or don't speak English, Medicaid is replete with paperwork, regulations and rejections that make the program hard to navigate, says Gottlieb.

Accumulating medical data shows that Medicaid recipients' poor health outcomes aren't just a function of their underlying medical problems, but a more direct consequence of the program's shortcomings.  Take the treatment of serious heart conditions, which are among the most closely evaluated Medicaid services:

  • One study published in the Journal of the American College of Cardiology (2005) found that Medicaid patients were almost 50 percent more likely to die after coronary artery bypass surgery than patients with private coverage or Medicare.
  • The authors suggest this may be a result of poorer long-term, follow-up care.
  • Another study in the journal Ethnicity and Disease (2006) showed that elderly Medicaid patients with unstable angina had worse care, partly because they were less likely to get timely interventions or be treated at higher quality hospitals.
  • Three other recent studies showed that Medicaid patients presenting with heart attacks or unstable angina received cardiac catheterization less often than Medicare or private paying patients; this procedure to open blocked heart arteries has become standard care, with ample evidence showing it improves outcomes.

The same trends can be observed in other diseases.  For example, a study of adults with cancer published in the journal Cancer (2005) found that patients on Medicaid were two to three times more likely to die from the disease.

Turning Medicaid around should be the least we demand before turning over more of our private health-care market to similar government management, says Gottlieb.

Source: Scott Gottlieb, "What Medicaid Tells Us About Government Health Care," Wall Street Journal, January 8, 2009.

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