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Avik Roy

How Medicaid Fails the Poor (Encounter Broadsides) Paperback – November 12, 2013

by Avik Roy (Author)

35 ratings

Book 35 of 66: Encounter Broadsides

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Medicaid, America’s government-run health insurance program for the poor, should be a lifeline that provides needed health care to Americans with no other options. Surprisingly, however, it doesn’t. The medical literature reveals a $450 billion-a-year scandal: that people on Medicaid have far worse health outcomes than those with private insurance, and no better outcomes than those with no insurance at all.

Why is this so? In How Medicaid Fails the Poor, Avik Roy explains how Medicaid’s clumsy design and perverse incentives make it hard for people on Medicaid to get the medical care they need. Medicaid doesn’t reimburse doctors or hospitals for the cost of caring for Medicaid enrollees, forcing many doctors to opt out of the program.

The Affordable Care Act, otherwise known as Obamacare, doubles down on this broken system. Roy shows us that there are better ways, using private insurance, to provide needed care to our poorest citizens.

Print length

48 pages
Language

English
Publisher

Encounter Books
Publication date

November 12, 2013
Dimensions

4.75 x 0.25 x 7 inches
ISBN-10

1594037523
ISBN-13

978-1594037528
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About the Author

Avik Roy is a senior fellow at the Manhattan Institute. In 2012, Roy served as a health care policy adviser to Mitt Romney. He is editor and principal author of The Apothecary, the influential Forbes blog on health care policy and entitlement reform. MSNBC's Chris Hayes calls The Apothecary "one of the best takes from conservatives on that set of issues." Ezra Klein of the Washington Post calls The Apothecary one of the few "blogs I disagree with [that] I check daily."

In addition, Roy writes a column for National Review Online on politics and policy. He is a frequent guest on television news programs, including appearances on Fox News, Fox Business, MSNBC, CNBC, Bloomberg, PBS, and HBO. His work has also appeared in The Atlantic, USA Today, National Affairs, and The American Spectator, among other publications.

He was born and raised near Detroit, Michigan, and graduated from high school in San Antonio, Texas. Today, Roy lives in lower Manhattan.

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Product details

Publisher ‏ : ‎ Encounter Books; 1st edition (November 12, 2013)
Language ‏ : ‎ English
Paperback ‏ : ‎ 48 pages
ISBN-10 ‏ : ‎ 1594037523
ISBN-13 ‏ : ‎ 978-1594037528
Item Weight ‏ : ‎ 1.98 ounces
Dimensions ‏ : ‎ 4.75 x 0.25 x 7 inches

Best Sellers Rank: #1,632,879 in Books (See Top 100 in Books)
- #174 in Medicaid & Medicare (Books)
- #313 in Medical Law & Legislation (Books)
- #397 in Health Insurance (Books)

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35 ratings

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The author used the Deamonte Driver case to make a point, but he left out a critical point.

Reviewed in the United States on March 30, 2020

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I find this book to be irritating on so many levels. The title is incorrect; it should be something like I do not like Obamacare because it places some low earning people into Medicaid. I used the Bing search engine to look up additional information about the Deamonte Driver case. I found a Washington Post article entitled 5 years after boy dies from toothache, Maryland Medicaid dental care is on mend by Katherine Driessen dated February 15, 2012. The report states, “When Deamonte first became sick his mother, Alyce Driver, was searching in vain for a dentist for her other son, who was suffering from six rotted teeth. With her Medicaid lapsed, the family’s struggle to find a dentist was compounded by stretches of homelessness, a lack of transportation and trouble maintaining a consistent phone number or mailing address.” I wonder why the author of this booklet forgot the critical fact that the boy was not on Medicaid at the time his mother was looking for a dental surgeon. The author created a strawman to attack Medicaid in general and Obamacare specifically. I am quite sure that some states poorly run Medicaid, but I seriously question whether all states run it poorly.
I have had experience with Medicaid in two states as a young married adult. I have had private insurance from my various jobs in four different states over the years. I also have had experience with the military health care system. I found the Medicaid system beat all of the private insurances in terms of cost and aggravation.
Lastly, the author did not use footnotes or a bibliography to defend his statements. At least he could’ve given dates of the articles he referenced in the booklet. This e-book is more like a term paper that an undergraduate might write, but I expect more from someone who is writing a book for money. The only thing that will improve this book is a good bonfire. I am glad that I read this booklet on time so that I can get a refund. Generally, if I see an e-book at a reasonable price, I will buy it, and it may be years before I read the book.

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Mostly Common Knowledge - With An Intriguing Proposal for Revision

Reviewed in the United States on January 10, 2017

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Roy begins with the 2006 story of 7th-grader Deamonte Driver, who died of a toothache in one of the wealthiest counties in America. Several months after Deamonte complained of pain, his mother was able to find a dentist that would see him. After being told he needed to see an oral surgeon, several more months passed by before he could be seen Meanwhile, the infection from one of his abscessed teeth spread to his brain. Despite emergency brain surgery, Deamonte died - despite being on Medicaid.

Medicaid cost over $450 billion in 2013. Study after study shows that patients on Medicaid do no better, and often do worse, than those with no insurance at all. Medicaid was burdened by the stigma of public assistance and allowing states to decide how extensive their programs would be.

The percentage of Medicaid spending that the federal government will sponsor varies depending on the relative wealth of a given state. Washington provides 73% of Medicaid funds in Mississippi, 50% in the wealthiest states such as New York and Massachusetts. The median state is funded at 60%. To keep Medicaid costs in check, some states pay hospitals and doctors less. A total of 39 states restricted provider rates in fiscal year 2011, and 46 states reported plans to do so in fiscal year 2012. The average state pays a primary-care physician 52 cents for every dollar that a private insurer pays. New York and Rhode Island pay 29%, New Jersey 32%, D.C. 38%, Minnesota 46%, and Michigan 47%. Thus, primary-care doctors are 73% more likely to reject Medicaid patients relative to those who are privately insured, and specialists were 63% more likely. In New Jersey, 60% of physicians were unwilling to accept new Medicaid patients, California 43%, and New York 38%.

A 2011 study found that doctors asked for appointments for a child with acute asthma attacks or a broken forearm would deny an appointment 66% of the time, vs. only 11% if told the patient had private insurance. Average wait time for an appointment was 22 days longer.

In the early 2000s, Oregon had randomly offered Medicaid coverage to 30,000 residents, leaving tens of thousands still uninsured. By tracking these new patients over time, it was possible to assess whether or not Medicaid was making its enrollees healthier. In 2011, economists who were studying this released their initial findings. While too early to measure effects on objective health measures, patients told the researchers they felt better. However, the study did not detect any change in mortality. However, the researchers also noted that two-thirds of the improvement in patients' self-reported health took place 'about one month after coverage was approved' but before the patients had seen a single doctor or consumed any health care services. When the following July came around and it was time to publish the two-year results, the researchers were silent. Finally, on 5/1/2013, the NEJM published the findings. It had generated no significant improvement in measured physical health outcomes. Further, out of the 35,169 individuals who 'won' the lottery tot enroll in Medicaid, only 60% actually bothered to fill out the application and only half those who applied end up enrolling.

Turns out that the real benefit is that health insurance protects policy-holders from catastrophic financial loss - like fire and auto insurance.

Concierge doctors in the Epiphany Health Plan charge $80/month, whether you see them or not, with spouses another $69/month and $49/month for each child. That would eliminate the need to search for a provider when someone of little means needs care. The dirty secret of Medicaid is that they clog emergency rooms because they can't persuade regular doctors to see them. The author proposes giving every Medicaid patient the Epiphany plan, plus a $2,500/year catastrophic plan to protect against financial ruin. The total annual cost would be $3,460/person, 42% less than what Obamacare's Medicaid expansion costs.

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