Monday, July 30, 2007

Government Experiments on Poor

In an effort to overcome double digit inflation and flowing red ink, the state of Georgia has decided to experiment with their poorest citizens. By forcing those on Medicaid to move to a more structured HMO the state achieved their goal.

But all is not well in the Peach State.

Consumer health advocate Linda Lowe said, "There are widespread reports of children with serious conditions being denied therapies while their medical providers jump through arbitrary authorization hoops."

Widespread reports . . . denied therapies.

Sounds like rationing of services.

The state believed the HMOs "could do a better job managing the care of our members" and save taxpayers money,

The plan worked. In the last fiscal year the state saved the taxpayers of Georgia $78,000,000.

Since the HMO startup, a number of doctors, aggravated by what they call slow and reduced pay from HMOs, have limited the number of patients they will accept from the government programs. Dr. Richard Wagner, a Sandy Springs pediatrician, is one who has cut his Medicaid/PeachCare patient load. The HMO experience, he said, "has been a mess.''

And based on lower fees and more administrative hassles, Dr. Mark Ritz, a Homerville dentist, says he and other dentists are re-evaluating their participation in the government programs.

It would appear that medical providers don't want any part of this program that covers approximately 900,000 Georgians.

What good does it do to have a taxpayer funded program for the poor if they are denied access to services?

A lingering problem involves gaps in the HMOs' doctor networks. Beth Sullivan, a family doctor in Commerce, said a 5-year-old patient had to be driven more than 100 miles to Augusta for an orthopedist willing to treat his broken wrist under his HMO.

That's a two hour drive.

Of course, had it been an emergency care could have been administered closer to home.

At least, that's the theory.

Adding to the chorus of criticism are complaints from many hospitals that say they're losing money on the government programs. "It has been an administrative nightmare," said Tish Towns, vice president of government relations for financially strapped Grady Health System, which operates Grady Memorial Hospital in Atlanta. "I think there's a tremendous amount of work to do to get this right.''

So doctors aren't the only ones threatening to pull out.

"Several rural hospitals have faced near-failure to make payroll, and most rural hospitals are in a cash-flow crisis" because of reimbursement problems

What does this tell us about the future of government managed health care?

Georgia has an estimated 4.6M citizens. About 900,000 of them are on Medicaid. If the state can't do a better job of managing care for 20% of their citizens, then how well would they do if they were to cover 100%?

Right now the state is experimenting on the poor. People who have few, if any choices. If this type program were instituted to cover 100% of our citizens, how many with the means to pay would simply cross state borders, seeking care from private practitioners willing to treat on a cash basis?
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