“Expert” Wrong On One Point In Health Reform

Ezra Klein has a piece up where he asks “the expert” his view on the Republican-sponsored Patient Choice Act. This is written by Henry Aaron of the Brookings Institution. I agree with many of his points but strongly disagree with one of his criticisms of the bill, and back the Republicans on this:

The idea of turning Medicaid patients over to the private market is wacky. Medicaid managed care can be a good idea. Medicaid recipients include lots of people who are poorly educated, mentally handicapped, and have other problems. That is not where one wants the private market to control.

As I noted in my initial comments on the proposal, a proposal which “gives lower-income Americans a way out of the Medicaid ghetto so they can have the dignity of private insurance” is a plus over many Democratic plans. Medicaid differs tremendously from Medicare in being seriously underfunded, provided second-rate health care to the poor. With limited reimbursement, it is necessary for doctors to severely restrict seeing Medicaid patients. Quite often Medicaid patients have limited choices, often winding up in Medicaid mills which provide limited care in order to still make money off the limited payments received.

The fact that many are poorly educated or mentally handicapped does not make Medicaid managed care plans a good idea. Even the poorly educated and mentally handicapped have a better chance of receiving quality care if they are in the same types of plans as the general population as opposed to Medicaid. A goal of  health care reform which aspires to universal care should be to make care beyond the “Medicaid ghetto” accessible.

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