By James T. Binder, M.D.
Saturday Gazette-Mail (Charleston, W.Va.), July 30, 2011
In the fall of 1982, when I working as a pediatrician in upstate New York, a mother made an appointment to have her child seen on an urgent basis. The child did not really need to be seen quickly, but the mother didn’t know better. She was just worried about her child. She arrived and checked into the clinic. The receptionist greeted her with, “I should have known — Medicaid.”
The humiliation that mother experienced was the price she paid to obtain health care for her child. She was poor.
It is almost 30 years later, and this condescension for those using Medicaid insurance persists. And, in many instances, the actual medical care provided is inferior. A number of health-care experts consider Medicaid close to having no medical insurance at all. The system is chronically and grossly underfunded.
The U.S. Government Accountability Office recently reported that less than half of physicians are willing to accept children with Medicaid and CHIP as new patients, and over four-fifths experienced difficulty referring Medicaid and CHIP children to specialty care. I can say, from my experience at Marshall University Department of Pediatrics over the last 11 years, that obtaining competent mental-health treatment in the Huntington area for children with Medicaid is sometimes close to impossible.
Many mental-health care clinicians, as well as other specialists, in Huntington and across the country, don’t accept Medicaid because payments are low and unreliable. It is understandable. However, it is likely this contributes to the overuse of psychotropic medications in children, since it makes it harder for them and their families to be referred for psychotherapy.
In addition to the inability to access specialty care, parents of the children with Medicaid insurance typically do not have medical coverage. Clinicians cannot possibly provide good health care for children without treating the family. A new mother with untreated depression can affect her child’s school performance years later; a father with an untreated chronic lung condition cannot play actively with his children.
I think one of the reasons the system remains in place, despite all its deficiencies, is covert prejudice against the poor. The poor have no political clout. Poverty is a very complex, multiproblem condition. It seems to me that promoting healthy bodies and healthy minds for all children living in poverty is essential to any efforts to help them overcome poverty. Universal, caring and comprehensive health care is needed.
There is a way to accomplish it. But we cannot listen to conservatives (e.g. Rep. Paul Ryan) who would eliminate government health insurance for the poor, and we cannot heed the liberals who want to place more and more people into a broken and inadequate system. Sixteen million more people will be added to Medicaid as a result of the health-care reform passed by congress and President Obama last year. And, sadly, private insurance will reap even more profit than they do now, once the new law takes effect.
We must advocate for a nontiered system and creation of a comprehensive national health insurance program. A universal plan would be equitably funded, based on the current tax structure. We already put enough money into health care to cover every American for all necessary medical care. Huge savings would result from eliminating the bureaucratic costs of private insurance (20 to 30 percent of health-care spending goes for unnecessary bureaucracy, advertising and private profits).
It would be an expanded and improved version of Medicare. Almost every other industrialized country provides some version of this for their citizens, and at a much lower cost. Everyone in; no one out!
Dr. Binder is associate professor of pediatrics at Marshall University School of Medicine in Huntington, W.Va., and a member of Physicians for a National Health Program.