A Canadian physician responds to Gov. Pence’s Medicaid program

Yesterday's Quote of the Day ("Government supports rotten teeth for
patients in poverty") discussed the Medicaid waivers obtained by Indiana
Governor Mike Pence. Today's post continues on that topic.


The New York Times
January 28, 2015
The Goal Was Simplicity; Instead, There's a Many-Headed Medicaid
By Margot Sanger-Katz

Indiana has become the latest Republican-led state to expand its
Medicaid program as part of the Affordable Care Act. As has become the
pattern, it was done with a series of waivers from particular federal
requirements.

When the state's governor, Mike Pence, announced the news on Tuesday,
the focus of his speech was less about his state's decision to embrace
this part of Obamacare than about the special concessions he'd been able
to extract from the Obama administration.

Newly eligible Medicaid recipients will have to pay monthly premiums or
be locked out of certain services, he announced, and higher-earning
beneficiaries who fail to pay will be shut out of the program for six
months. People who use the emergency room frequently will need to pay
higher co-payments than the federal government has ever allowed.

The provisions, designed to encourage residents to take more
responsibility for the costs of their health care, break new ground in
what the Obama administration will allow in exchange for expansion.


NYT Readers' Comments:

Dr. Bob Solomon
Edmonton, Canada

You live in "Cloud-Cuckoo Land" in the fantasy you have the best medical
care system on earth. Baloney. Check it out.

Canada is right next door. Come see how a sane federal health plan
works, covering all and ensuring that (1) we live longer, (2) we have
fewer chronic ills, (3) we have lower cost drugs, (4) we have lower cost
hospitals, (5) we have lower cost operations, (6) we have lower
accounting costs for all parties, and (7) we have no medical
bankruptcies and impoverishment anywhere, for any income, for the
unemployed, for the elderly. Long waits for ER? I waited 4 minutes for
an asthma attack to be dealt with, 2.4 hours for a minor ear problem --
wax. In Philly, I waited 2.4 for a back injury. Twice. So no difference.

We get free (tax-paid) care in Alberta. No out of pocket, no minimum, no
exclusions, no co-pays, no nothin'.

Premiums exist in certain provinces: $35 a month per person or about
that, and some people purchase extended coverage. I also pay approx.
$1200 a year for added features: free or nearly free drugs, and a large
subsidy for glasses, hearing aids, private rooms, canes, and things like
that.

Americans live in a "exceptional" med world -- a medical services
madhouse. It was not created by ACA, of course. And because of the med
and drug and hospital corporations, I mean "people", and the
know-little-or-nothing GOP, it was ensured to endure after ACA. Medical
madness is still a disease you need to cure.

And…

Don McCanne
San Juan Capistrano, CA

Denying poor people dental care simply because they cannot pay the
premium, as Pence's program does, defies logic. Does sentencing poor
people to rotten teeth truly motivate them to find money that they don't
have in order to provide them with the "dignity to pay for their own
health insurance"?

Does Pence propose that we change the rhetoric from "skin in the game"
to "rotten teeth in the mouth"?

http://www.nytimes.com/2015/01/29/upshot/the-goal-was-simplicity-instead-theres-a-many-headed-medicaid.html