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Seniors depend more and more on Medicaid as they outlive their savings.  

Dr. Don McCanne of PNHP comments on this article which asks doctors to accept more Medicaid patients. 

http://www.nejm.org/doi/full/10.1056/NEJMp1310974 

Comment:  The expansion of Medicaid for low-income patients is one of the more troublesome features of the Affordable Care Act. Because of low payment rates, many physicians, especially high-income specialists, already refuse to accept Medicaid patients. Increasing the burden on those physicians who do accept Medicaid is apt to result in a pushback wherein access may be further impaired.

 

What can be done? Lawrence Cassalino has provided us with an excellent description of the dilemma, but I’m afraid that his 5% solution – physicians devoting 5% of their practices to Medicaid – will fail since it depends on physician professionalism, of putting patients first. After a career of trying to obtain specialized care for Medicaid patients, it was quite clear that that level of professionalism was not ubiquitous in my community, and I doubt that it is in most other communities. Relying on the pure goodness of physicians will not work because there are not enough so oriented to meet the need.

 

One important measure in ACA is the expansion of funding for federally qualified health centers. These centers improve access for vulnerable populations, though they still have difficulties obtaining adequate support of specialists. Today, the government announced a $150 million grant to assist these community health centers. $150 million? Unless the government becomes serious about community center funding, and unless something is done to attract specialists to support these centers, we cannot expect them to fill the void either.

 

There is a clear solution. We could establish a single payer national health program in which everyone has the same coverage and access to care. That may or may not renew the commitment of today’s physicians to professionalism, but at least it would create the appearance that patients would be placed first. For individuals considering a future career in medicine, professionalism would be a given.