Stanley Feld M.D., FACP, MACE Menu


Don’t Confuse Me With Facts


The Obama administration refuses to believe that
physicians are not interested in seeing Medicaid patients. The Obama
administration must think that by increasing Medicaid enrollment the number of
physicians willing to see these patients will increase. I believe the Obama
administration is wrong.

survey called the Health Tracking Study Physician Survey,
sponsored by the Center for Studying Health System Change, polled more than
4,700 physicians around the country in 2008.

The survey covered many private practice
issues. One question surveyed was about new patients these physicians would
likely accept.

The survey showed that Internists are 8.5 times
more likely to reject all Medicaid patients as opposed to patients with private

There is an additional cohort of doctors who
only accept “some” (i.e. reject most) new Medicaid patients.

These numbers might surprise some but they
reflect reality.

 The physicians who accept “all” or “most”
Medicaid patients are a concentrated minority.

This means that if you have Medicaid
insurance coverage it will be very hard to find a physician who will see you.

Medicaid and MD


The administration refuses to believe
that the 32 million new Medicaid patients will have a difficult time finding a

Most other observers accept the fact that
Medicaid beneficiaries have a tough time finding physicians. The main reason is
due to the fact that Medicaid deeply underpays physicians and hospitals for
their services.

There is also resistance by progressive
thinkers to believe that Medicaid coverage has poor performance outcomes.

In reality Medicaid coverage is bad
insurance coverage.

Scott Gottlieb M.D.’s article in the WSJ in 2011

Medicaid Is Worse Than No Coverage at All!

research shows that patients on this government plan fare poorly. The question is
why does the President Obama want to shove one in four Americans into it?"

Dr. Gottlieb’s question is a very good

The Oregon Experiment just published in
the New England Journal of Medicine reached the same conclusion.

We found no significant effect of Medicaid coverage on the prevalence
r diagnosis of hypertension or high cholesterol levels or on the use of
medication for these conditions. Medicaid coverage significantly increased the
probability of a diagnosis of diabetes and the use of diabetes medication, but
we observed no significant effect on average glycated hemoglobin levels or on
the percentage of participants with levels of 6.5% or higher.”

The was no difference
in “clinical outcomes.”  However, as I
explained on many occasions, in the past there are large defects in measuring
clinical outcomes.

In additional, the
findings in clinical outcome studies are often misinterpreted.

Medicaid coverage decreased the probability of a positive
screening for depression (−9.15 percentage points; 95% confidence interval,
−16.70 to −1.60; P=0.02)
, increased the use of many preventive services, and
nearly eliminated catastrophic out-of-pocket medical expenditures.”

The results of
screening for depression in the Oregon Experiment are not statistically
significant. In order to be statistically significant a p value has to be less
that .05.

Ezra Klein of the Washington Post found the
words to publish the results as very positive for Medicaid
coverage using the
Oregon Experiment as proof. The article was entitled Here’s what the Oregon Medicaid
study really said”

Since the media
is the message Ezra Klein used the media to get his biased message out even if
the message is wrong.

He might be
right that Medicaid coverage is important but the Oregon Experiment did not
prove it.

The real
problem with the Oregon Experiment is that the design of the study is
defective. If a study’s design is wrong the conclusions are wrong on both sides
of the argument.

There are
real structural problems with Medicaid coverage in its present form. Its
reimbursement method is also wrong. The only way to provide quality affordable
care to lower income families is to fix Medicaid’s structural defects.

To force 32
million people into a defective system is going to lead to disastrous fiscal
and medical care consequences.

I have to think
the Obama administration does not care about the results or the administration is
blinded by its own ideology.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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