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The Need for Medicaid Reform

By Dr. Linda Burke-Galloway
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As a physician who has devoted 20 years of her professional career working with the indigent, I think I am well-versed to make a comment or two regarding Medicaid.

Of late, the topics of Medicaid and Medicare have been in the media based on threats of its extinction.  Whenever there is a lopsided budget with gaps wide enough to form a two-lane highway, the most vulnerable populations are the first to suffer. Eliminating services from a population that is presumed not to vote is unconscionable but often commonplace. If Congress wants to reduce the costs of healthcare, it needs to review its payment disparities. It always amazed me how a county public health department could receive approximately $161.00 as fee-for-service for a patient visit while physicians or health care providers receive approximately $27.00 for the same service. Do you know what this type of disparity promotes? Fraud and lack of patient quality care. It becomes a numbers game with the onus resting squarely on the shoulders of the healthcare provider to see as many patients as possible in the name of so-called “productivity.”

Medicaid is the lifeline to the indigent. In some cases, having it literally saved someone’s life. Yet, a fair number of physicians in private practice refused to see Medicaid patients because of the poor reimbursement. Does that really surprise anyone? In an ideal world, Medicaid would not be necessary because we would have a universal health plan that was paid for by a tax system that was fair and equitable. People would pay taxes according to their incomes and corporations would not be exempt. Congress would realize that Medicaid fraud not only involves individual providers, but government entities as well. My friend, Edna* (name changed), a former state employee would still have her job of thirteen years. She would never have been terminated because she refused to “upcode” and overbill as instructed by her immediate supervisor. Complaints of Medicaid fraud committed by people in positions of undeserving power would be taken seriously, as opposed to falling through a black hole never to be heard from again. You have no idea how frustrating it is to have documentation of wrongdoing, and the complaints fall on deaf ears. I suppose it’s easier to remove or reduce funding than it is to hold people accountable in a meaningful way. The adage, “everyone benefits from the poor being poor – except the poor” holds true.

As we continue to fight for the continuation of Medicaid and Medicare benefits on behalf of our patients, let’s also hold those who abuse the administration of these benefits accountable to the fullest extent of the law. The devil is in the details. I hope someone is watching.

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