Many clinics appointment desks set limits on how many Medicaid patients they see during a month. This is done to keep the cost of care reasonable for paying patients with and without insurance.

At around 1/3 reimbursement of regular fees, one could get a much more beneficial level of coverage for those in need by allowing the unreimbursed cost of charity care to be tax deductible at full rates (or tax credits at Medicaid rates) by providers of such care. Providers who currently provide little to no care for Medicaid would be falling all over themselves to provide enough care to make it so they paid no taxes. Unlike government programs, such as system would be naturally self limiting since eventually providers would max out how much charity care they could provide and get tax benefits for, while still being reasonably profitable. Such as system would also allow for the social marketplace to experiment with various options to promote wellness, preventive care, and other health care initiatives, many of whom are begrudgingly offered because they currently come with lots of managed care red tape and political strings.

Of course, don’t expect anything like this to ever happen because the political capital and credit for charity care would go to providers, not politicians…

It’s not access to care, it’s a lack of responsible effectuation. It is available…

I have repeatedly asked Greg (my co-author) about this issue of the overall cost of care for children, vs those expense that really drive health care spending. He says that the actuaries have that information. It’s sort a “who’s fooling whom” thing. SCHIP makes for good headlines, but accomplishes nothing, save perhaps making a mother nervous when a Medicaid-paid doctor discovers some minor abnormality in little Johnny that triggers a regimen of unnecessary tests and prescriptions.

I’ve begun using a balloon in my presentations, squeezing it this way and that until breaks.