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Paul Howard and Douglas Holtz-Eakin
A Medicaid Rebellion? « Back to Story

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Joseph McNelis,M.D. February 12, 2011 at 2:10 PM
It's a little confusing,but my impression was that the states with stricter eligibility criteria,like Texas,would get more support than states with more lenient standards,like Massachusetts.
The article is correct in noting the key role of Medicaid in PPACA.The significant outright fraud and bureaucratic fraud must be addressed.A single NYT reporter uncovered more fraud on his laptop than the office of AG Cuomo.At this point,Medicaid care is pro bono work for an MD as the reimbursement is essentially nothing.The lack of any tort reform makes it difficult for even the most altruistic physician.An increase in payment to acceptable levels is essential,but many physicians will still be wary given this program's abysmal track record with the private practitioner.
Beyond the above issues,though,Medicaid has been the primary provider for the nursing home industry.To be honest,Medicaid is just as much a middle class entitlement as one for those below the poverty line.Increasing home care services for the elderly does not lighten the bill either.This is the big portion of the program that really can't be reduced,especially with the Baby Boomers entering the 'elderly' category.
Certainly this was an important,albeit brief,article on a topic much avoided.Hopefully,the authors will have their views more widely disseminated.
It will be funny when the Repblicans explain that "Obamacare" is the backbone of their own health care reform proposal intended to counter "Hillarycare." The "Mandate" pure republican. You can't make this stuff up.

http://www.kaiserhealthnews.org/Stories/2010/February/23/GOP-1993-health-reform-bill.aspx
While I am sure there are many good points to the points the authors make in this article, I can't help but notice that the authors criticize Medicaid for the poor quality of care that its users sometimes receive, and note the case of a boy who died because a dentist was unavailable through Medicaid. Yet, without Medicaid, that boy and millions of others like him would have no care at all.
Is it any surprise that OBAMACARE is a disaster in the making? There were few hearings on the bill, almost the entire program was put together by the Democrat Congress, with little or no input from Republicans, and not all that much from the Obama Administration other than making sure the program conformed to certain broad policy considerations, much of which had to do with paying off political debts. And the public, of course, has never been told how it all works.

Naturally, the traditional media didn't bother to closely examine the program since such an examination would have hurt Democrats, with whom the traditional media has a symbiotic, if not seamless relationship. So no media oversight - which of course would not have been the case if this tables were turned and Republicans were the driving force behind the plan, and Democrats opposed it.

Under the best of circumstances it would have been difficult to craft a plan that would have worked. The rush to approval - so that SOMETHING would get through, ensures a disaster. And in this political climate, the chances of tweaking are negligible - Republicans will seek to have the whole thing scrapped, and Democrats will resist major changes.

Oddly enough, if the Supreme Court throws out the statute it could end up helping Democrats. We will never truly find out how bad the statute is, and Democrats can claim that they tried but due to obfuscation by Republican appointed judges the result is no health care reform. And the media, of course, will support the Democrat party line, without scrutinizing the flaws of the statute. (Like $12 billion in administrative costs!).


Never mentioned is the government's order a number of years ago to Medical colleges to reduce entrollments, with compensation for lost revenue. Was this to make room for immigant doctors who would be needed for the immigrant invasion seen in recent years. Now, native-born Americans are forced to go to doctors with whom they cannot satifactoily communicate, and who were educated in sub-standard foreign med schools. The coming shortage of doctors, with the expansion built into Obamacare, will require ever more foreign doctors. Saying the whole thing stinks is a polite description. And there is the standing promise of traditional, native-born American doctors to take immediate retirement when O-CARE kicks in. It is not just a worst-case senario, it is an unimaginable-case senario.