Caught In The Medicaid Safety Net
In America, one in four citizens—the poor, disabled, and elderly among us—receives government-run health care.
Universal health care is an admirable goal. But is it an achievable one? Only at a cost: government-run insurance, it turns out, is not quality insurance—and Americans know it.
At the most obvious level, government-run and –funded health insurance is comparable to the DMV: time consuming, wasteful (losing $750 billion per year), and staffed by people who would rather not be handling your call.
Wait, there’s more. In its current federal form—Medicare and Medicaid—universal health insurances currently eliminates choice and control for individuals.
Liberals don’t seem to realize this inevitable reality. The “Life of Julia” cartoon illustrating the advantages of a government-administered life from birth to death is a good place to start. The federal government gives Julia everything: her start to education at the age of 3, federal loans to go to college and start a business, and then a pension in her retirement. Naturally, the cartoon also promises free federal health care.
The cartoon leaves the impression that Julia has the best health care in America. But then, it’s always possible see future plans with rose-colored lenses.
Real life is a better gauge than cartoons.
I recently spoke with Jackie, a nurse at a D.C. hospital, about the problems she faces when dealing with DC Medicaid. Her daily job consists of tending to patients from every corner of the nation’s capital, from the most influential—who walk in with body guards—to those without two cents to their names. But in Jackie’s eyes, socio-economic standing is irrelevant: every patient should receive the best possible care.
When a real life, 57-year old Julia was checked-in, Jackie was assigned to her case. This Julia had no husband, no extended family, no friends, although she did have a job. Though she was admitted to the floor for pneumonia, she had a history of multiple co-morbidity, diabetes, and hypertension. Julia also walked with a cane.
The pneumonia was easy to solve: high doses of antibiotics for a week. Other problems, however, were less simple.
As Jackie monitored Julia’s heart, drew her labs, and assessed the amount of oxygen in her blood, she noticed that her weak left side was becoming weaker (as often happens in hospital settings due to inactivity). After a week, Julia’s walking deteriorated to the point where she could barely move at all. Jackie knew that Julia would not regain her mobility after she left the hospital if she did not receive some type of rehabilitation.
This is where Jackie, the doctors, physical therapists, and case managers met the real barrier—the barrier put in place by federal regulations. Unlike private insurance, Jackie could not order in-home therapy for Julia. Julia had a classic frustration: Medicaid regulations concluded she was not sick enough to recover fully at home.
Medicaid determined that Julia—who could no longer walk—was only qualified for outpatient therapy. No matter what any of her doctors recommended, Medicaid would not change its conclusion.
Like the cartoon Julia, this Julia was alone in the world. Julia had no car, and no family to drive her to an outside facility. As Julia was wheeled out of the hospital to a taxi she couldn’t afford, she looked at Jackie and quietly asked: “I’m not going to walk that well again, am I? I don’t have any way to get that therapy, and the only person who sees me is my social worker.”
Illness makes anyone feel powerless. Compounding illness with an inability to choose necessary care makes both the illness and recovery far worse. The Julia in this story had no voice against Medicaid, though she, her nurse, and her doctors knew what was best for her health. The Julias that Jackie sees every day face insurance regulations that her patients with private insurance never encounter.
An obvious objection can be raised: isn’t this imperfect health system better than no system at all? Yes, if a government-run health care is all that is possible for the poor, disabled and elderly, we should take it, even with diminished patient choice and control, out of control spending, and poor service. But surely there are other options.
Lack of choice and control is a perpetual problem in countries where national socialized health care exists. Just look at Britain. Everyone may have health care, but it is insurance without individual choice. The Minister’s hope is to reform NHS so that “Patients will be ‘put at the heart of the NHS’ and have more choice over how and where they are treated.” The Brits lack what government-run health care, by its nature, cannot provide: choice and control.
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