Medicaid Is Not The Route To A Single-Payer Plan

Corrente is a far left blog which I generally have little interest in, but there are bound to be times when our interests overlap. Today I must say they are right while Paul Krugman and several other liberal writers/bloggers, who I would generally side with over Corrente, are wrong. Paul Krugman and some other liberal writers have been praising Medicaid expansion as if it is a path towards a single-payer plan. A writer at Corrente counters with a post saying that Paul Krugman is wrong about Medicaid.

The writer describe some of their negative experiences in a Medicaid program and concluded:

This is not the system Krugman imagines. He’s not alone; most Democrats and many people who describe themselves as progressive are celebrating the Medicaid expansion under Obamacare as an extraordinary advance. In terms of coverage, they’re right. In terms of steering the country toward health care equity, they’re wrong. Medicaid patients are too often treated as second-class citizens, and the problem is likely to worsen without the kind of drastic reform I mentioned earlier.

There are at present about 150 million Americans being served by at least a half-dozen single-payer systems. We need to take the most popular of those systems and expand it to provide cradle-to-grave coverage for everyone in the country, and improve it to achieve the health care equity that Americans deserve and that President Obama has described as a basic human right. We need Medicare for all.

Medicaid, as the author acknowledged, varies from state to state and even within different parts of states. Some people will have better or worse experience, but the fact remains that in general Medicaid patients are second-class citizens in the health care system. Access to care does vary, but is far different from the health care experiences of most Americans who have insurance or are covered by Medicare. My office receives quite a few calls each week from both people on Medicaid who do not have physicians and from those who desire to get away from the second-class care they often receive in the clinics which will see them. While better than no coverage, to those who have better coverage Medicaid would represent all the horrors of government run health care which the right has been crying about.

I bet that Krugman, and those who echo his views, would change their minds very quickly if they had to give up their private physicians and obtain all their care through Medicaid clinics.

The blogger at Corrente is also correct that, while Medicare is not perfect, Medicare for all would be a much better model for a single-payer plan. It is far better than Medicaid, while still keeping costs down.

I must conclude by also pointing out that Medicaid expansion is not without benefits. Having Medicaid is still far better than having no coverage, despite misinterpretations being spread by conservatives regarding studies of Medicaid expansion in Oregon. I previously discussed this topic here. When the Affordable Care Act was being considered in Congress while the Democrats technically had sixty votes, there weren’t sixty votes for either a pubic option or even a Medicare buy-in, due to opposition by Joe Lieberman and Ben Nelson. With limited money to expand health care coverage, and the impossibility of a single-payer system based on Medicare getting through Congress, Medicaid expansion was an understandable compromise to provide some coverage to the working poor. That does not make it a desirable model for moving to a single-payer plan.

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2 Comments

  1. 1
    Larraine says:

    What on earth are Medicaid clinics? We have a family member who is on Medicaid. She sees a regular doctor at Jefferson U Hospital in Philadelphia. She doesn’t have to go to a special clinic.

  2. 2
    Ron Chusid says:

    It varies. A tremendous number of people on Medicaid are more limited in their choices. It sounds like your family member is one of the more fortunate ones.

    Being by a University probably helps as they are less affected by the normal economics of health care which keeps private practices from being able to afford to treat Medicaid patients.

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