Medi-Cal Cuts 03/24/2008
 

There was a disturbing article in today's LA Times about Medi-Cal, the program funded by State and Federal government to provide health care for disabled and poor California residents.

As part of his solution to the California Budget crisis, Arnold has proposed 10% across the board cuts to California programs, including Medi-cal.  It sounds like a reasonable choice on its face, but when you factor in the issues surrounding Medi-Cal...well, it just doesn't make sense.

There are very few doctors who accept new Medi-Cal patients these days.  The primary reason?  The program does not reimburse them adequately for the cost of services provided.  I'm not talking about greedy doctors here who want more...I'm talking about a program the pays substantially less than the doctor's out of pocket cost.

When you tell those doctors (some of whom care for our relatives with great compassion and professionalism) that these inadequate payments are going down--well, it's not surprising that many of them are not taking new patients.  A few are even withdrawing from Medi-Cal altogether.

Which leads me to the question I'm pondering these days.  Is there such a thing as a "right" to medical care?  If so, what does that right entail?

My stab at an answer is that emergency medical and surgical care is something we should provide for all residents.  Other basic care should also be provided--regular physicals, dental care, treatment of acute illness, eye care.

Do you agree?  Disagree?

 


Comments

Hal (your pal)

Tue, 25 Mar 2008 06:53:18

I think I read the same article. Medi-Cal reimbursed a physician $125.00 for a tonsillectomy (including operating room costs). The Dr. eats the rest and loses his shirt. Talk about a broken system, here it is. I could go on and on about this subject but here's my solution in a nut shell:

We need to have parallel medical systems in this country. One for those who have medical insurance and another for those that don't have or can't afford medical coverage. The system for those that don't have coverage will be paid entirely by the government. Of course we (as a civilized society) need to provide basic medical care for all. Notice I said "don't have or can't afford" because plenty of people that can have and can afford coverage still don't have it.

Secondly, for those of us that prefer to have coverage, we need to make a huge fundamental change. First, we need to decouple healthcare coverage and employment. Your medical coverage should have nothing to do with who or where you work. Too many people either choose jobs or a stuck in jobs they don't like only because of the benefits. There is no safety net for these people if they leave their jobs or get fired. COBRA is only an 18-month program. Here comes my final solution that I think makes perfect sense but I always catch grief every time I mention it:

Everyone that has or wants coverage is required to have a "healthy check" exam every 18-moths with their Dr. During the "healthy check" a persons "medical risk" will be measured. Things like height/weight ratio, cholesterol, level of fitness, etc. But only the things that a person can control will be allowed in their "risk" profile. Nothing genetic, no DNA screenings. If big boy Hal shows up weighing 250lbs with high blood pressure and type-2 diabetes and is out of breath walking across the room, I guess he gets a very poor risk rating and will pay a very high premium. However, big boy Hal can do another "healthy check" exam in 18-months after losing 75lbs and working out every day and probably qualify for the best rates and terms.

Very simple, as with most insurance, your premium will be entirely tied to your personal "controllable" risk. I'm sure with this system many more people would take much better care of themselves. And I know that with this type of system I would pay far less for my coverage.

 

Laura

Tue, 25 Mar 2008 14:47:04

Hal,

I think that's a brilliant way to assign at least a portion of premiums.

There would have to be the caveat about controllable risks truly being controllable. I have a friend who's thin, eats well and has high cholesterol due to genetics, for example. She shouldn't be dinged for that.

OTOH, those folks who have good test results despite poor health habits would be encouraged by their increased premiums to invest in themselves BEFORE they do damage.

Great idea, Hal!

 



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