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Medicaid In A Squeeze

New reports peg Medicaid’s future as dismal and unsustainable, as states struggle for ways to pay for the rising costs of caring for their poorest residents. The Deloitte Center for Health Solutions study, “Medicaid Long-Term Care: The Ticking Time Bomb,” estimates Medicaid costs will nearly double as a percentage of state budgets by 2030, or perhaps nearly triple.

Meanwhile, the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured estimates Medicaid expansion will cost $464.7 billion by 2019. The federal government will cover $443.5 billion (95.4 percent) and the states will cover the remaining $21.2 billion. Minnesota won’t expand its Medicaid program until 2014 because of budget fears. Connecticut will. (The Fiscal Times, MedPage Today, Reuters, U.S. House Rep. John B. Larson)

U.S. Senators, meanwhile, are looking to phase out federal subsidies Medicaid as a way of pushing through stalled legislation – the same package that had included the “doc fix.” Speaking of that, Sen. Majority Leader Harry Reid said the Senate may soon turn its attention away from that toward other issues. (Wall Street Journal, The Hill, ABC News)

*This blog post was originally published at ACP Internist*

Why The Healthcare Reform Bill Is Racist

We learn from the healthcare reform bill that the federal government will help subsidize Medicaid funding for all the new patients who qualify, but they will only do it for two years. After that, the states are on their own. Medicaid unfunded liabilities will crush state governments everywhere.

Why is Medicaid so expensive and going bankrupt? I’ll give you one example why. This is played out day after day, night after night in communities all across our country. And the only ones paying for it are you and me. The ones spending all the money have no incentive to stop.

I’m in the ER the other day when I see a chief complaint fly by on the radar. What is that chief complaint, you ask? Let me tell you a story.

Refused By Detox

The patient was so drunk even the community detox center refused him. So how did this play out? The patient was taken by ambulance from his home to a small-town community ER for altered mental status. There he was checked into the ER and seen by a small-town community ER physician, family practice resident, or PA or NP.

Diagnosis: Acute alcohol intoxication. Plan: Discharge to community detox center. Read more »

*This blog post was originally published at The Happy Hospitalist*

How To Improve Access For The Poor: Allow Physicians To Deduct Uncompensated Care From Their Income Taxes?

As we wrestle with political factions and mull over assorted ideas for reforming health-care in America, one simple solution bears discussion.  Of course, we notoriously hate simple solutions.  The modern American solution to simple solutions is to develop layers of complexity and inefficiency.  I can only assume that in government, as in hospital administrations, this has to do with creating jobs.  To the extent that it keeps nefarious, clever individuals off the street and occupies them in what passes for gainful employment, I applaud the effort.  But it seldom solves problems, and typically creates them.

Nevertheless, I digress.   My painfully simple solution is this.  Allow every health-care provider to deduct, from their federal income tax, the care they provide for free to uninsured patients.  It can be the Medicare value of the care; possibly even the Medicaid value.  But in the end, a financially savvy doctor, dentist, therapist or any other health professional will end up paying no income tax. Read more »

*This blog post was originally published at*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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