by Dr. Alieta Eck, MD
Medicaid hurts the poor, the physicians and the taxpayers
In 1821, Josiah Quincy, a legislator in Massachusetts noted that the poor
are of two classes. 1) Those who are wholly incapable of work — through
old age, infancy and sickness and 2) the able poor — those who are capable
of work. At first he believed that the government was a perfectly reasonable
deliverer of help to the first category but soon learned that there was no
good formula to determine who belonged in which group.
A great case can be made for the government to get out of the business of charity. While it seems like a compassionate answer to poverty, there are many reasons why it does harm on every level. While this has been debated since the establishment of the United States, the downside of the Medicaid system could never be clearer than now.
Medicaid hurts the poor. It causes them to become despondent and idle, promising them free care only if they remain that way. When people no longer need to rely on their own foresight and industry, their poverty is worsened and becomes permanent.
For example, last week I met a 47 year old woman who has managed to secure public support due to her disability. She drinks a six-pack of beer and smokes two packs of cigarettes per day. As long as an impersonal check is in the mail, she seems to have no incentive to improve her lot — and depression and an unmotivated boyfriend keep her miserable.
Medicaid hurts the physicians. As budgets are tightened, they are the first to receive lowered payments, and most have found that they can no longer continue to meet their own obligations when participating in the program. It is not that physicians are hard-hearted toward the poor. They just realize that they will be of no use to anyone if they cannot sustain their practices and must close their doors. So they wind up avoiding the program and treating the poor for free.
Medicaid hurts the taxpayers. The ever-increasing burden has reached the tipping point. It is bankrupting the states that then look to a bankrupt federal government for more help. The federal government is now running an unsustainable $1.65 trillion/year deficit, some likening it to a train heading for a cliff. The Medicaid system consumes up to 25 percent of every state budget and becomes a black hole for taxpayer dollars — dollars that disappear into a huge unaccountable bureaucracy.
Medicaid attracts scoundrels. “Federally qualified clinics” (FQC) can apply for $650,000 in federal start-up money, get “enhanced Medicaid payments,” and are awarded free medical malpractice coverage from the federal government, competing with local physicians who ironically must pay the taxes to fund them. Furthermore it appears that, since money flows from many sources, accountability and oversight are lax. One FQC has government income totaling $14 million and sees 25,000 patients per year. The administrators are very handsomely compensated. A nearby non-government clinic, utilizing all volunteers and private donations, sees 3,600 patients for a total budget of $58,000, 300 times less expensive.
The question of whether government ought to fund charity is not a new one. In 1853, Rev. William Ruffner noted that “charity is a work requiring great tenderness and sympathy, and agents who do their work for a price rather than love, should not be trusted to execute the wishes of donors.”
Why should the taxpayers be funding a system that demoralizes and hurts the poor? When will we question the wisdom of government charity? The poor will be better served when the Medicaid system is ended and the community rises up to lift them out of their conditions. Real charity is individualized, assertive, challenging and gradual.
The N.J. Volunteer Physician Protection Act is being considered whereby physicians will be compensated only by state medical malpractice protection for their entire practices when they donate four hours a week to care for the poor in non-government free clinics. These clinics will cost the taxpayer nothing, but will be funded by the decreased tax burden and the generosity of caring people who are close to the problem. America will be America once again. CV
Dr. Alieta Eck, MD is in private practice with her husband, Dr. John Eck, MD in Piscataway, N.J., since 1988. She has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care.