By Jeff Gorke
SUWANEE, Ga. | This is written in response to Jack Bernard’s Sept. 27, 2024 perspective, “Full Medicaid Expansion.” I appreciate Jack addressing a confounding issue that has plagued the United States since employer-sponsored healthcare began. He makes some good points. But as someone who’s worked in healthcare for more than 30 years, the remedies suggested don’t cure what ails us.
Gorke
I’ve not read the Medscape article so can’t speak to it with clarity. However, the criteria Jack alluded to are peculiar metrics, at best. Let’s parse out Jack’s thesis a bit.
- We do have a high cost of living in Georgia. But that’s mainly around the greater Atlanta area. Most physicians in Georgia are paid fairly well (general statement).
- Malpractice: some specialties have higher rates than others. This is often a demographic and specialty issue. It’s that simple.
- The health of states’ residents is problematic but across the country there’s a need for more patient involvement in their own care. People need to help themselves a bit. You can’t drink a fifth of whiskey a day, smoke a carton of cigarettes, and consume fast food, and still be healthy. Now you can make a reasonable argument about “food deserts” and access to quality food for people in certain areas. But people oftentimes fail to address their own chronic conditions, whether they are on Medicaid, Medicare, or are uninsured.
- Physician burnout across the country is a real thing. And we’re losing clinicians hand over fist (which will be a big problem in primary care access in the near future).
To put it bluntly, expansion of Medicaid may not be bad in terms of patient coverage but that will NOT mitigate physician burnout. In fact, it might exacerbate burnout. Medicaid is a notoriously poor “payer.” As you can see below, I chose two types of patient visit types, both “office visits.” In Georgia, Medicare pays 45 percent of a visit, and 124 percent more than Medicaid for the same service. And a commercial plan (e.g. BCBS) may pay 83 percent and 180 percent more than Medicaid (and that’s conservative).
I don’t know any physicians who’d welcome more Medicaid patients (from a financial perspective) because the payments wouldn’t cover costs (unless you were at an Emory or Grady Plan, where clinicians don’t need to pay to keep the lights on). How does Medicaid expansion buttress the tide of burnout? (I hope Medscape did not posit this as a remedy – completely nonsensical).
Now there are ways to better finance care and address the uninsured, such as in Singapore. And I would contemplate Medicaid expansion provided it offered clinicians a reasonable payment for their services.
Healthcare funding is complex, made more so by commercial insurance companies and the rigors of paperwork and non-clinical duties foisted on clinicians. But to suggest that doctors are leaving Georgia because people don’t have Medicaid is factually inaccurate.
To help doctors, we need to make it easier for them to see patients.
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