PNHP

Banned in Boston: Access to psychiatric care

Banned in Boston: Access to psychiatric care

By J. Wesley Boyd, MD, PhD and Rachel Nardin, MD
KevinMD.com blog, MedPage Today

Imagine you have severe depression and go to a Boston emergency room for treatment. You are told to follow up with a psychiatrist within two weeks. You have good health insurance, so this shouldn’t be a problem, right?

Wrong. In a new study just published in the Annals of Emergency Medicine, we found quite the opposite. Access to outpatient psychiatric care in the greater Boston area is severely limited, even for those with excellent private insurance.

We posed as patients insured by Blue Cross Blue Shield of Massachusetts PPO, the largest insurer in the state. We called every BCBS in-network mental health facility within a 10-mile radius of downtown Boston, reporting that we had been evaluated in an emergency department for depression and discharged with instruction to obtain a psychiatric appointment within two weeks.

Only eight (13 percent) of the 64 sites listed on the BCBS website offered appointments, four (6 percent) of which were within two weeks. Fifteen clinics (23 percent) never called us back, despite our leaving two messages requesting an appointment. Another 15 clinics told us that we could only be seen in their facility if we had a primary care physician in their system.

Our Boston findings are consistent with national data showing limited availability of mental health services. For example, two-thirds of primary care physicians report that they cannot obtain outpatient mental health services for patients who need them.

The limited availability of psychiatric services has serious consequences for patients and their families. Mental health disorders are common, affecting nearly one in four adults annually. Inadequate treatment can result in individual and family suffering, lost productivity, and even death. Suicide, the third leading cause of death among youth ages 10-24, is more common among those suffering from mental illness.

Inadequate mental health care also creates problems for our health care system and society at large. A third of the homeless and more than half of all prison and jail inmates have mental illness.

The nation’s emergency departments are de facto psychiatric wards, with 79 percent of emergency doctors reporting that their hospitals board psychiatric patients for whom appropriate treatment resources could not be found, sometimes for days.

Although there are many contributors to the inadequacy of our mental health system, managed care has hit psychiatric services hard. Private insurers aggressively constrain patients’ access to services through stringent provider networks. As our study shows, this is often covert: insurers provide lists of in-network providers, but most are unavailable.

Because insurance company reimbursements for psychiatric services are far lower than for other types of care, hospitals also frequently restrict access. By contrast, hospitals compete for insured patients who need highly profitable procedures such as MRI scans or elective surgeries like knee replacements.

Insurance industry practices have also discouraged many private psychiatrists from accepting patients with health insurance.

Until such time as we have a truly universal health system providing comprehensive care, we need to ensure that insurance companies reimburse psychiatric care adequately. Until they do so, psychiatric patients will remain vulnerable, second-class citizens.

J. Wesley Boyd is an assistant clinical professor of psychiatry at Harvard Medical School and Rachel Nardin is an assistant professor of neurology at Harvard Medical School.

http://www.kevinmd.com/blog/2011/08/banned-boston-access-psychiatric-care.html

We all deserve excellent coverage

By Ewell Scott, M.D.
Letters, The Lexington (Ky.) Herald, July 28, 2011

As regards to the discussion and analysis of Lexington-Fayette government employees’ health insurance, the casual observer might comment that the current coverage is quite good.

In fact, better than most working Americans have today.

The question is who in the world should expect or have such excellent coverage? Well, how about all of the citizens of France, Great Britain, Spain, Japan, Sweden, Norway, Denmark, Germany … you get the picture … the list goes on and on. The rest of the civilized world has universal, affordable, comprehensive health insurance regardless of place of employment, at half of the per capita cost. We could have it too by enacting Medicare for all. It is that simple.

Dr. Ewell Scott resides in Morehead, Ky.

http://www.kentucky.com/2011/07/28/1826618/letters-to-the-editor-july-28.html

St. Louis Post-Dispatch editorial on single payer

Editorial: If U.S. is serious about debt, there’s a single-payer solution.

By the Editorial Board
St. Louis Post-Dispatch, August 10, 2011

If America truly is serious about dealing with its deficit problems, there’s a fairly simple solution. But you’re probably not going to like it: Enact a single-payer health care plan.

See, we told you weren’t going to like it.

But the fact is that everyone who has studied the deficit problem has agreed that it’s actually a health care problem.

That being the case — and nobody argues that it isn’t — there are two broad ways for the government to address its spiraling health care costs. One, shift more of those costs to recipients, by trimming benefits and/or extending eligibility ages and indexing eligibility to personal income. This is politically unpalatable, particularly to most Democrats, President Barack Obama being a conspicuous exception.

The second way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.

The advocacy group Physicians for a National Health Program estimates that “private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

Once everyone is covered, the government would have the clout to bring discipline into the wild west of health care spending.

Eventually, the United States will have a single-payer plan. But we’ll waste a lot of money and time getting there.

http://www.stltoday.com/news/opinion/editorial/article_97afa329-42f8-5f12-adb0-97fa305c3e4b.html

The Editorial Board of the St. Louis Post-Dispatch is right. Eventually we will have a single payer program, but only after wasting much more money and time.

Get rid of the greedy insurance companies

By Lynn Chacko, M.D.
The Gainesville Sun, Aug. 7, 2011

As a family physician, I applaud June Girard’s guest column promoting national health care.

Although I graduated from the University of Florida College of Medicine just a few years ago, I have already seen countless numbers of patients suffer or die needlessly because they can’t afford to see a specialist, pay their medication copay or have a necessary test. And these are the patients with insurance!

Not only are one-third of Floridians uninsured, those that have insurance are sadly not much better off. The problem can be summed up in one word: “profit.”

Health care shouldn’t be about making money. It should be about caring for people. The only affordable answer is to get rid of the greedy insurance companies and pass universal, single-payer health insurance.

Lynn Chacko practices family medicine. She resides in Gainesville, Fla.

http://www.gainesville.com/article/20110807/OPINION02/110809657/-1/opinion?p=2&tc=pg

Obama asks Supreme Court to allow compromised care for Medicaid patients

Democrats Challenging Administration on Medicaid

By Robert Pear
The New York Times, August 8, 2011

In an unusual break with the White House, the Democratic leaders of Congress told the Supreme Court on Monday that President Obama was pursuing a misguided interpretation of federal Medicaid law that made it more difficult for low-income people to obtain health care.

Faced with severe budget problems, many states have reduced Medicaid payment rates for doctors, dentists, hospitals, pharmacies, nursing homes and other providers. In many parts of the country, payment rates are so low that Medicaid recipients have difficulty finding doctors to take them.

Federal law says Medicaid rates must be “sufficient to enlist enough providers” so that Medicaid beneficiaries have access to care to the same extent as the general population in an area.

The issue, of immense importance to poor people and states, comes to the Supreme Court in a set of cases consolidated under the name Douglas v. Independent Living Center of Southern California, No. 09-958. The court plans to hear oral arguments in October, with a decision expected by the spring. The original plaintiffs in the case, Medicaid beneficiaries and providers, say they were harmed by California’s decision to cut payment rates that were already among the lowest in the country.

The federal Medicaid law does not explicitly allow such suits. But the United States Court of Appeals for the Ninth Circuit, in San Francisco, said beneficiaries and providers could sue under the Constitution’s supremacy clause, which makes federal law “the supreme law of the land.”

The Justice Department, siding with California, told the court in May that no federal law allowed individuals to sue states to enforce this standard.

http://www.nytimes.com/2011/08/09/us/politics/09medicaid.html?_r=1&hp

Comment: 

By Don McCanne, MD

President Obama’s Affordable Care Act relies heavily on the expansion of Medicaid to cover low-income individuals who are uninsured. Yet at the same time, his administration is appealing to the Supreme Court, under the supremacy clause, the federal government’s right to critically underfund the Medicaid program to the extent that patients will have significant impairment of their access to health care.

As we have stated many times in these messages, a severely underfunded welfare program for low-income individuals that clearly impairs access violates our sense of equity and health care justice. Apparently President Obama does not share this view. Otherwise, as a constitutional lawyer, why would he allow the Justice Department to take to the Supreme Court a case that would permit his administration to violate the law that says that Medicaid rates must be sufficient to enlist enough providers so that Medicaid beneficiaries have access to care to the same extent as the general population?

Where does this lead? Yesterday, in the context of reducing the deficit, he said that the country needs “modest adjustments to health care programs like Medicare.” More cuts.

Try doing that in nations with universal social insurance programs. It will never happen. But in our fragmented system, there is an opening for battles based on demographic divides. The tax-cutting, government-shrinking young rebels are taking up the cause of putting greedy geezers in their place.

Having been raised in the 40s and 50s – a time when there was great hope of an egalitarian America – I have to ask myself that trite but timely question, what kind of a country have we become?

Obama asks Supreme Court to allow compromised care for Medicaid patients

Democrats Challenging Administration on Medicaid

By Robert Pear
The New York Times, August 8, 2011

In an unusual break with the White House, the Democratic leaders of Congress told the Supreme Court on Monday that President Obama was pursuing a misguided interpretation of federal Medicaid law that made it more difficult for low-income people to obtain health care.

Faced with severe budget problems, many states have reduced Medicaid payment rates for doctors, dentists, hospitals, pharmacies, nursing homes and other providers. In many parts of the country, payment rates are so low that Medicaid recipients have difficulty finding doctors to take them.

Federal law says Medicaid rates must be “sufficient to enlist enough providers” so that Medicaid beneficiaries have access to care to the same extent as the general population in an area.

The issue, of immense importance to poor people and states, comes to the Supreme Court in a set of cases consolidated under the name Douglas v. Independent Living Center of Southern California, No. 09-958. The court plans to hear oral arguments in October, with a decision expected by the spring. The original plaintiffs in the case, Medicaid beneficiaries and providers, say they were harmed by California’s decision to cut payment rates that were already among the lowest in the country.

The federal Medicaid law does not explicitly allow such suits. But the United States Court of Appeals for the Ninth Circuit, in San Francisco, said beneficiaries and providers could sue under the Constitution’s supremacy clause, which makes federal law “the supreme law of the land.”

The Justice Department, siding with California, told the court in May that no federal law allowed individuals to sue states to enforce this standard.

http://www.nytimes.com/2011/08/09/us/politics/09medicaid.html?_r=1&hp

President Obama’s Affordable Care Act relies heavily on the expansion of Medicaid to cover low-income individuals who are uninsured. Yet at the same time, his administration is appealing to the Supreme Court, under the supremacy clause, the federal government’s right to critically underfund the Medicaid program to the extent that patients will have significant impairment of their access to health care.

As we have stated many times in these messages, a severely underfunded welfare program for low-income individuals that clearly impairs access violates our sense of equity and health care justice. Apparently President Obama does not share this view. Otherwise, as a constitutional lawyer, why would he allow the Justice Department to take to the Supreme Court a case that would permit his administration to violate the law that says that Medicaid rates must be sufficient to enlist enough providers so that Medicaid beneficiaries have access to care to the same extent as the general population?

Where does this lead? Yesterday, in the context of reducing the deficit, he said that the country needs “modest adjustments to health care programs like Medicare.” More cuts.

Try doing that in nations with universal social insurance programs. It will never happen. But in our fragmented system, there is an opening for battles based on demographic divides. The tax-cutting, government-shrinking young rebels are taking up the cause of putting greedy geezers in their place.

Having been raised in the 40s and 50s – a time when there was great hope of an egalitarian America – I have to ask myself that trite but timely question, what kind of a country have we become?

Taxpayers ripped off by for-profit hospices

Medicare costs for hospice up 70%

By Kelly Kennedy
USA Today, August 7, 2011

Medicare costs for hospice care have increased more than in any other health care sector as for-profit companies continue to gain a larger share of the end-of-life medical market, government records show.

A recent report by the inspector general for Health and Human Services, which oversees Medicare, found for-profit hospices were paid 29% more per beneficiary than non-profit hospices.

At the same time, some of the nation’s largest for-profit hospice companies are paying multimillion-dollar settlements for fraud claims and facing multiple investigations from state and federal law enforcement agencies.

Critics say costs have also increased because for-profit organizations have cherry-picked patients who live the longest and require the least amount of care — such as those with dementia or Alzheimer’s, rather than those with cancer.

“Certain hospices seem to be seeking out beneficiaries with particular characteristics, and these beneficiaries are often found in nursing facilities,” said Jodi Nudelman, a regional inspector general for HHS in a webcast about the report.

In a growing number of cases, hospices are collecting the same daily rate for visiting patients in nursing facilities as other hospice programs that also provide patients’ room, board and medical care not related to their terminal illness.

http://yourlife.usatoday.com/health/medical/story/2011/08/Medicare-costs-for-hospice-up-70/49854600/1

Report of the Inspector General of HHS:
http://oig.hhs.gov/oei/reports/oei-02-10-00070.pdf

Comment: 

By Don McCanne, MD

PNHP has long advocated removing for-profit corporations, with their passive investors, from the health care equation. This report on hospices from the HHS Inspector General provides more compelling support for this view.

For-profit hospices that provide care to Medicare patients have been ripping off taxpayers by cherry-picking less expensive patients, collecting much larger fees by providing services prematurely, and, worst of all, collecting full fees for merely providing what is not much more than house-call-type services in nursing homes rather than providing the full range of services expected in hospice care. Their multi-million dollar fraud settlements don’t seem to deter them.

It is imperative that we remove passive investors and their corporate executive goons from health care.

Taxpayers ripped off by for-profit hospices

Medicare costs for hospice up 70%

By Kelly Kennedy
USA Today, August 7, 2011

Medicare costs for hospice care have increased more than in any other health care sector as for-profit companies continue to gain a larger share of the end-of-life medical market, government records show.

A recent report by the inspector general for Health and Human Services, which oversees Medicare, found for-profit hospices were paid 29% more per beneficiary than non-profit hospices.

At the same time, some of the nation’s largest for-profit hospice companies are paying multimillion-dollar settlements for fraud claims and facing multiple investigations from state and federal law enforcement agencies.

Critics say costs have also increased because for-profit organizations have cherry-picked patients who live the longest and require the least amount of care — such as those with dementia or Alzheimer’s, rather than those with cancer.

“Certain hospices seem to be seeking out beneficiaries with particular characteristics, and these beneficiaries are often found in nursing facilities,” said Jodi Nudelman, a regional inspector general for HHS in a webcast about the report.

In a growing number of cases, hospices are collecting the same daily rate for visiting patients in nursing facilities as other hospice programs that also provide patients’ room, board and medical care not related to their terminal illness.

http://yourlife.usatoday.com/health/medical/story/2011/08/Medicare-costs-for-hospice-up-70/49854600/1

Report of the Inspector General of HHS:
http://oig.hhs.gov/oei/reports/oei-02-10-00070.pdf

PNHP has long advocated removing for-profit corporations, with their passive investors, from the health care equation. This report on hospices from the HHS Inspector General provides more compelling support for this view.

For-profit hospices that provide care to Medicare patients have been ripping off taxpayers by cherry-picking less expensive patients, collecting much larger fees by providing services prematurely, and, worst of all, collecting full fees for merely providing what is not much more than house-call-type services in nursing homes rather than providing the full range of services expected in hospice care. Their multi-million dollar fraud settlements don’t seem to deter them.

It is imperative that we remove passive investors and their corporate executive goons from health care.

Medicare for all would save billions on paperwork

By Melissa Stiles, M.D.
The Capital Times (Madison, Wis.), Aug. 4, 2011

Medicare’s path started 46 years ago on July 30, 1965. Medicare has been a lifesaver for millions of senior and disabled Americans. Medicare has improved the health of our seniors, reduced their risk of poverty, and improved the financial security of their families.

Unfortunately, there are discussions in Congress that would steer Medicare off path. Wisconsin Congressman Paul Ryan’s “Path to Prosperity” proposes to shift Medicare to a private voucher system. Other proposals would increase the age of eligibility from 65 to 67, and increase deductibles and co-pays.

These approaches would increase the number of uninsured Americans and shift costs to Medicare recipients. The Congressional Budget Office estimates Ryan’s plan would shift two-thirds of the cost of care to consumers by 2030, with out-of-pocket costs amounting to over $20,000 per year for each Medicare recipient.

The current economic crisis was not caused by Medicare and will not be solved by cutting benefits or shifting costs to beneficiaries.

We should look to build on and expand Medicare, not weaken or dismantle it. By replacing our patchwork of private and public insurance programs with a single publicly financed system that handles all bills, we would save about $400 billion annually that’s currently spent on unnecessary paperwork and overhead — enough to provide comprehensive coverage to all the uninsured and to improve coverage for the rest of us.

Now is the time to take the path forward to an improved Medicare-for-all health care program.

Melissa Stiles, M.D., is a member of the Wisconsin chapter of Physicians for a National Health Program. She resides in Madison, Wis.

http://host.madison.com/ct/news/opinion/mailbag/article_32000a21-2109-5d86-a655-b7d95fad1597.html

U.S. doctors' administrative costs 4 times higher than in Canada

By Mark Crane
Medscape Today, Aug. 4, 2011

American physicians spend almost four times as much in money and staff time on administrative costs as physicians under the single-payer system in Ontario, Canada, a study published online August 3 in Health Affairs has found.

Dealing with multiple health plans on claims, prior authorizations, and pharmaceutical formularies is estimated to cost at least $82,975 per physician annually in the United States, compared with $22,205 in Ontario, according to the study, partially supported by The Commonwealth Fund, which favors single-payer systems.

If American physician practices had administrative costs similar to those in Ontario, the total savings for US health spending would be about $27.6 billion per year, according to estimates by lead author Dante Morra, assistant professor in the Department of Medicine at the University of Toronto, and colleagues.

The authors surveyed 141 Canadian physicians, 45 Canadian practice administrators, 668 American physicians, and 194 US administrators.

US physician practices interact with multiple health plans with different insurance products, each of which may have its own formulary of approved drugs and its own rules for prior authorization, billing, submitting claims, and determining payment. Canadian physicians generally interact with a single payer with a single product.

“The U.S. spends nearly twice as much per person on health care as any other country, and high administrative costs due to our inefficient and fragmented insurance system are a contributing factor,” Commonwealth Fund President Karen Davis said in a statement. “Greater continuity of insurance coverage and insurance administrative simplification reforms in the Affordable Care Act can begin to streamline health care administration and reduce the time medical staff must spend on billing and authorization issues.”

The biggest single factor in the cost disparity is due to the single-payer system in Canada, the authors state, adding that “it would be incorrect to assume that all of the extra US costs represent waste.…Having multiple payers clearly generates more administrative costs than a single-payer system. These costs should be balanced against possible benefits generated by such a system — for example, benefits that may arise from competition, innovation, and choice among insurance products.

“Prior authorization requirements increase administrative costs for physicians and health plans but may reduce the amount of inappropriate care provided; savings and increased quality generated by reducing inappropriate care should be matched against the costs of prior authorization. To our knowledge, no reliable estimates of these savings exist,” the authors write.

There are many other differences between the Canadian and American healthcare systems. For example, Ontario introduced a capitation model for physician funding 10 years ago. Doctors are paid according to the number of patients on their roster, not how many times a patient is seen.

Waiting lists are common in Canada. The median waiting time between referral from a general practitioner to the receipt of elective treatment is 18.21 weeks in 2010, up from 16.1 weeks in 2009, notes a 2010 survey by the Fraser Institute, a Canadian think-tank that favors a free-market approach to healthcare issues. Canadians wait on average 4.2 weeks for computed tomography, 9.8 weeks for magnetic resonance imaging, and 4.5 weeks for ultrasonography, the survey found.

Other findings from the Health Affairs study include the following:

* Nurses and medical assistants spend 20.6 hours per physician per week on administrative tasks, nearly 10 times the time spent by Canadian practices. The main reason is obtaining prior authorization in the United States.

* US clerical staffs spend 53.1 hours per physician per week on administrative tasks related to insurance, compared with 15.9 hours in Ontario.

* Senior administrators of US physician practices spend 163.2 hours a year overseeing claims and billing, compared with 24.6 hours a year in Ontario.

* Very little time is spent submitting quality data to health plans in either the United States or Ontario.

How can administrative costs be reduced in the United States? The authors cite recommendations from the Institute of Medicine and others that include “creating common, possibly mandatory standards for billing, claims payment, prior authorization, etc.; making all standard interactions electronic; using a single credentialing process; using a single quality measurement process; and using automated verification at the point of care of patient eligibility for health insurance benefits.”

They also note that “Section 1104 of the Affordable Care Act of 2010 instructs the Secretary of Health and Human Services to take steps to simplify interactions between providers and health plans.”

In addition, the reform law’s emphasis on new payment methods, such as bundled payments and pay-for-performance, and new ways of organizing healthcare delivery, such as accountable care organizations, could move US health care away from fee-for-service payment, and “reduce the administrative costs involved in producing, reviewing, and processing claims for each service provided.”

[PNHP note: See Dr. Don McCanne’s “Quote of the Day” comment on the study described above. For a more extensive comparison of U.S. and Canadian administrative costs, see “Costs of Health Care Administration in the United States and Canada,” by Dr. Steffie Woolhandler, Terry Campbell and Dr. David Himmelstein in the New England Journal of Medicine.]

http://www.medscape.com/viewarticle/747566

In support of universal Medicare

By Bill Davidson, M.D.
Lebanon Daily News, July 25, 2011

In past letters I have advocated for the idea that America should acquire a universal, single-payer health care system — an improved, Medicare-for-all. As Medicare has been very much in the news in recent months it seems appropriate for me to explain why I would expand a program which some say is “broke,” contributing to our national debt, and non-sustainable.

It is true that the rising costs of health care are a major contributor to our economic malaise and do threaten our long term economic stability. This is just as true, however, for privately financed healthcare (Blue Cross, Aetna etc.) as it is for publicly financed programs such as Medicare.

To suggest that our economic problems are a result of publicly financed healthcare programs alone is simply a lie. Indeed, it is the publicly financed programs that run most efficiently and are the reason that countries such as Canada, Germany, Taiwan and France pay half as much for healthcare as we do.

Why do they save money? First, they eliminate the exploitive private insurance industry which in this country drains off $400 billion a year that could be spent on health care but instead goes for advertising, stockholder dividends and CEO salaries. Secondly, they group-negotiate with the pharmaceutical industry (like our VA) and get much lower prices on drugs. Third, by having one financing system in place, administrative costs of 15 percent are achievable.

Our present, dysfunctional, bureaucratic system based on private insurance has an administrative cost of 31 percent. It should be noted that two-thirds of all Canadian physicians are in private practice. That efficient and cost-effective model for delivering personalized healthcare is encouraged and stands in stark contrast to the present trend in the U.S., which finds doctors herded into large, less-efficient group practices controlled by hospitals and insurance companies. Unlike traditional Medicare, these practices limit the patient’s choice of providers and often leave decision-making to non-medical management.

Some would say that Americans are unwilling to adopt the strategies of other countries. I don’t believe that’s true. We had no trouble acquiring CAT scanners developed in England or laparoscopic surgical techniques developed in Europe. Despite the resistance of the oil and automotive industries, many Americans bought fuel-efficient, reliable Volkswagens and Hondas.

No. It isn’t the average American who is hesitant to adopt a system that guarantees quality healthcare to everyone at an affordable price. It is the exploiters of our healthcare system who stand to lose billions of dollars in profits who systematically influence the legislative process and keep us bemired in a wasteful system that serves their needs more than those of most Americans.

Expanding Medicare to include everyone has the potential to rein in the cost of health care — something the private insurance industry has failed to do over the past 30 years. Those who would malign and destroy Medicare are simply ignoring the facts and have political agendas that are not in the best interests of most Americans.

Dr. Bill Davidson is a cardiologist and resides in East Hanover, Pa.

http://www.ldnews.com/ci_18544947?IADID=Search-www.ldnews.com-www.ldnews.com

Medi-Cal's lesson for reform

Doctors say Medi-Cal reimbursement is too low

By Dustin Corcoran
San Francisco Chronicle, August 4, 2010

Medi-Cal covers essential health care services for the poorest and most vulnerable Californians, including seniors, pregnant women, children and people with disabilities. Despite the lifesaving care and preventive treatment that so many Medi-Cal patients have received, the state is planning drastic cutbacks to Medi-Cal that will irreparably harm patients and cost taxpayers more in expensive hospitalizations and emergency care.

The Legislature passed, and Gov. Jerry Brown signed, AB97, which includes a 10 percent reduction in Medi-Cal payment rates to physicians, hospitals, nursing homes and other providers, patient co-payments ($50 per emergency room visit, $5 per physician visit, $100 per day in the hospital), and a limit of seven physician office visits per year. If these cuts are allowed to take place, Medi-Cal would pay doctors just $11 per patient visit, just a fraction of what it would cost to take your dog to the veterinarian.

Cuts in reimbursement rates force physicians to reduce the number of Medi-Cal patients they can see, and now more than half of all Medi-Cal patients say they can’t find a doctor.

Currently, Medi-Cal is the source of health care for 1 in 5 Californians (about 7 million). With the implementation of health care reform right around the corner, 3 million more uninsured will soon be added to the state’s Medi-Cal program. But how can we adequately provide more care to more people with fewer resources? California already ranks last in Medicaid payment rates per enrollee.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2011/08/04/ED4T1KIL9C.DTL

Comment: 

By Don McCanne, MD

California has a Democratic governor and a Democratic legislature, yet look at what they just did. Although California already ranks last in Medicaid payment rates, they are reducing payments another 10 percent. Much worse, they are imposing unaffordable co-payments on these low-income patients, and are not allowing them more than an arbitrary seven office visits a year. Punishment of patients and their health care professionals is not the reform that we needed.

Whether or not California is successful in obtaining federal approval to impose these cuts, this action confirms that we cannot allow our government to condemn low-income patients to a bottom-tier welfare program, yet this is precisely what the Affordable Care Act calls for.

Let’s fix Medicare and expand it so that we can bring in everyone under an umbrella that isn’t riddled with leaks.