Wednesday, December 02, 2009

Thoughtful comment on Medicaid and its improvement

Dr. James Baker is the CEO of Metrocare Services here in Dallas, Texas.

Metrocare Services, formerly known as the Dallas County Mental Health Mental Retardation (MHMR) Center, has served Dallas County for over 40 years by providing first rate clinical and social services to persons with mental illness, developmental disability, or severe emotional problems.

Jim is an expert on mental health care delivery among the poor and, thus, an expert on Medicaid.

Click here to refresh your memory on my previous post that addressed what I considered an outrageous comment about Medicaid made by Senator Lamar Alexander (TN-R).   Be sure and read the comments on that post. 

Here's what Dr. Baker left in the comment box on that earlier post: 

I want to go back to the original question by c hand: Why do "so few physicians...accept patients covered by the ... very good plan?" and why do patients with these plans have to wait for care?

Medicaid IS a very good plans from the perspective of its benefits, that is, what it will pay for. It is very generous in that respect.

The reason docs dont "accept patients" (actually it is the insurance that many dont accept...) is that Medicaid's reimbursement does not even cover most docs' costs for the services.

And if Congress doesnt repeal a Medicare reimbursement cut of 21% that is set for Jan 1st, the same access problems will worsen for the elderly that already happen for the poor.

The fix is counter-intuitive: increase both the number of people covered and the doc rates for both programs, so that access is easier and happens sooner in the course of a disease, so that the cost of each episode goes way down -- and therefore so does the total cost to taxpayers...

Unfortunately since it is counter-intuitive, many policymakers have a hard time grasping this reality...

Wednesday, November 25, 2009 3:30:00 PM CST

Jim, thanks for the clear and rational explanation. 

Ever consider a run for Congress?


Anonymous said...

If you take these comments, add to that portability, open insurance availability across state lines, and lawsuit reform, you have a remedy for health care problems. All in less than a couple of pages. Common sense tells us that 2000 pages will not correct the basic problem but rather confuse everyone.

Anonymous said...

"All in less than a couple of pages." With all due respect, you haven't spent much time reading federal law, have you?

Anonymous said...

Where are the doc rates increasing?

Chris said...

I don't see how you can increase the number of people covered and the reimbursement rate for the docs increase and have the total cost to the taxpayer go down. Even if the total cost for each episode goes down, it would be offset by the increase in patients and reimbursement rate,, IMHO.

Larry James said...

chris, Dr. Baker's point is well-established among medical pros. More and routine treatment is much less costly than what we have to pay for when the routine is not available. Paying docs more brings up service options for the poor who will remain healthier and avoid larger problems that cost exponentially more.