Medicaid is far from perfect, but it helps millions of people get the health care they need, and for many poor people in this country, it's the only thing helping them get the medical care they need. It has lower co-pays and deductibles than almost any private insurance plan and covers most needed services. But underfunding is a major problem - the government has decided that it's ok to pay doctors less to take care of the poor than to take care of everyone else, and that means that, in many parts of the country, Medicaid reimburses doctors so little that they just won't accept Medicaid patients. Nevertheless, studies show that people who get on Medicaid are still far better able to get the care they need, and they're at much less risk of going bankrupt due to medical bills.
JB: Would you care to comment about Vermont's brand-new experiment with single-payer, Sam?
SD: I don't know much about it, though I believe there's some concern that implementation has been slow and the state has not yet applied for all the federal waivers required to move forward with the plan. The original proposal by William Hsiao and his team at Harvard was very exciting. Vermont's proposal rests on the overwhelming evidence from other industrialized countries that a single-payer plan in the US -- an improved Medicare program that covers all Americans -- would be far more equitable and cost-effective than our current fragmented system.
JB: Anything you'd like to add before we wrap this up? What else do we need to keep in mind during this time?
SD: It's crazy that in 2014 we have a system that lets hundreds of thousands of people go bankrupt just because they get sick. We'd get a lot more bang for our buck if we stopped subsidizing private insurance plans that make money by cherry-picking the healthiest people to get on their plans. A single-payer insurance program, which would cover all Americans, would be a far better solution for not just the poor, but for the middle class too. But until we get there, Medicaid expansion is critically important for millions of American families.
JB: Agreed. Thanks so much for talking with me, Sam. I understand that your research focuses on disparities in access to health care, prisoner health, substance abuse, and HIV/AIDS. You're into a lot of very timely topics. That's good. Please keep us in the loop.
Sam's research papers are available on Pubmed.org . Several articles about their Medicaid paper have been published in the lay press, for example:
St. Louis Post-Dispatch, Jan. 31, 2014 Number-crunchers estimate deaths that could result from not expanding Medicaid