Re: Senator Tom Coburn’s Healthcare Reform Plan

The inclusion of this item in Senator Tom Coburn’s national healthcare proposal

Keeping Medicaid on mission: The bill liberates the poor from substandard government care and offers states the option to provide their Medicaid beneficiaries the kind of health care coverage that wealthier Americans enjoy. The bill creates incentives for states to achieve private universal coverage for their population. The bill offers states the freedom to design the programs that serve their beneficiaries with the best care instead of the current, one-size-fits-all straitjacket.
…led commenter “mrh” to ask what “liberat[ing] the poor from substandard government care” meant.
John O’Shea of the Heritage Foundation provides the beginning of an answer…
In spite of Medicaid’s hefty price tag, Medicaid patients find it difficult to access the health care system. Medicaid payment rates are considerably lower than physician payment rates under private insurance or even Medicare, in which physician payment is a recurrent problem. This has deterred physician participation in Medicaid. According to a 2003 Medicare Payment Advisory Commission (MEDPAC) study, only 69.5 percent of physicians surveyed were willing to accept new Medicaid patients, substantially fewer than the number willing to accept new privately insured patients (99.3 percent), Medicare patients (95.9 percent), and even the uninsured (92.8 percent)….
Once Medicaid beneficiaries gain access to the health care system, they receive inferior quality of care compared to patients with private insurance.
For example, patients with non-ST segment elevation acute coronary syndromes (NSTSE ACS), a form of heart attack, benefit significantly from innovative therapeutic approaches, including early invasive management strategies. These measures have now been incorporated into the guidelines of the American College of Cardiology and the American Heart Association. According to a study in the Annals of Internal Medicine, however, Medicaid patients with NSTSE ACS were less likely to receive evidence-based therapies and had worse outcomes (including increased mortality rates) than patients who had private insurance as the primary payer. This study found that these differences in care and outcomes persisted after adjusting for clinical characteristics (associated illness), socioeconomic factors (education and income), and the type of center where patients received treatment. In other words, the most important predictor of treatment and outcome in the study was whether the patient had Medicaid or private insurance.
Plenty of references available in the original memo.

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17 years ago

Thanks for the clarification.
It seems to me that the poor need liberation not from “substandard government care” (since the government isn’t providing care) but rather from underfunding. As I read the example you’ve quoted, the Medicaid recipients would get better care if Medicaid paid for better care.

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