Caring for the Poor Without Medicaid Bureaucracy

Published May 31, 2016

It is time for politicians to admit that the government cannot provide health care. All government can do is set up an administrative scheme that pays many people to decide who qualifies for which government program, handing out entitlements even as they underpay for actual care.  Bureaucrats get paid. Physicians do not. And taxpayers get fleeced.

Consider the results of this approach, especially when it comes to caring for the poor. Once, the administrative costs in a doctor’s office were negligible. For the average patient, the doctor charged a reasonable fee, and if the patient had insurance, it was his job to get reimbursed.

Today we have government-run systems such as Medicaid, where physicians must fill out complex forms to receive just a fraction of a reasonable fee. Most refuse to take Medicaid patients at all. So, poor Medicaid recipients clog up emergency rooms with twice the frequency of the uninsured, and the system becomes expensive for taxpayers, demeaning to patients, and generally unworkable.

There is a better way.


Three Layers

An ideal and innovative solution to the nation’s health care crisis would involve several layers of care.

The first layer could involve the average person paying his or her doctor directly for services rendered.  Paperwork would be minimal, patient-physician confidentiality would be maintained, and prices would be kept down by simple competition.

A second layer would be personally obtained, non-cancelable health insurance for unforeseen major medical maladies and accidents, fitting a family’s needs and budget. The states should merely oversee that the policy contract terms are met, but not mandate what is to be covered.

Third, safety-net nongovernmental charity clinics could be scattered throughout every county in every state—with each clinic, not a bureaucracy, deciding ways to determine the eligibility of those seeking free care.


Care for the Poor

The Zarephath Health Center, established in central New Jersey in 2003, uses volunteer physicians and nurses to provide care to the poor free of charge. Patients include the homeless, the mentally ill, the jobless, undocumented immigrants, and even patients with Medicaid cards.  Physicians diagnose and care for patients with acute and chronic illnesses. Thanks to those who are willing to donate their time, currently 300-400 patients get free care each month.

The cost to provide services at the ZHC is $15 per patient visit, compared with $150 per patient visit at the federally qualified clinic in the neighboring town. The latter clinic has huge bureaucratic administrative overhead and collects funds from the federal and state governments and the patients.

The difference: The Federal Tort Claims Act of 1996 provides free medical malpractice coverage for professionals who volunteer at any free clinic. Freed from the specter of frivolous lawsuits, physicians can offer commonsense care, leaving compliance up to the patients.


Trading Protection for Care

Why not devise a similar plan with state, rather than federal, government involvement?

Imagine a system where physicians donate four hours per week in free care. A surgeon might agree to take on one charity case per week. Then, to compensate the professionals who donate their time and expertise, the state could agree to provide full medical malpractice coverage for the physician’s entire practice.

Such coverage is already provided for physicians who work or teach in medical school university hospitals. The state would not be laying out money for medical malpractice insurance, just agreeing to pay the costs of litigation and payouts.


Lower Costs, Improved Care

Under such a system, poor patients would get care and physicians would be rewarded with lower office overhead, not having to pay expensive medical malpractice premiums. Taxpayers would not have to fund the enormous Medicaid bureaucracy or payments for a significant portion of care to the poor. Unnecessary defensive medical tests would be diminished, causing health insurance premiums to drop for everyone. And the number of lawsuits would diminish.

It is time to think “outside the box,” come up with workable solutions, and lower the cost of healthcare for all.  President Obama said he is willing to entertain any reasonable proposals.  Charity care and tort reform are a good place to start the discussion.

Dr. Alieta Eck, MD, ([email protected]) writes from New Jersey.