Docs that work in State hospitals are forced to take medicaid, straight Medicaid is not taken by the majority of private doctors because it doesn’t pay much. Managed care Medicaid will pay nothing to doctors and few doctors or private hospitals will be willing to accept it. However, many hospitals and Doctors take part of Medicaid Disproportionate Share Hospital reimbursement programs to make up for the low payments of Medicaid. Yes, a life threatening ER service they must see, but beyond that you'll get little care and sent out. Specialist care, forget it. In many areas people must drive hours to get specialist care or to another state.

So when someone who works full time as a construction worker (as 8 of 10 uninsured Americans are part of families where at least one person works full time) ignores the warning signs of early diabetes because he doesn’t have insurance, doesn’t manage his chronic disease because he can’t afford the doctor’s visit to prescribe insulin, can’t afford the blood monitors or insulin either, and therefore fights through the increasing pain and discomfort until he has to go to the Emergency Room for care because he can’t take it anymore, only to discover he has advanced stage diabetes and will require a four-week course of antibiotics and a foot amputation, effectively ending his construction work career as well as his ability to pay – yes, his care is paid for by the rest of us. And obviously, since primary care is cheaper and could prevent these expensive complications, we’re not getting a great deal. Our premiums are higher because we don't cover the uninsured.

But it’s not just about government creating a safety net for us all or picking your pocket (depending on your political point of view) your premiums are much higher because we don’t cover the uninsured. Providers must find some way to recoup the emergency medical care they provide that will never be compensated because the patient has no ability to pay. That way is to charge insurers more for their services. If you have insurance and go to the hospital, your paying for yourself and someone uninsured and rest assured they're heaping tons of profit on it. They say in 10 years insurance premiums could equal 40% of your salary if you're one of the lucky few to even have it. In NC about 40% of small businesses now don't provide insurance or make the employee pay 80% or more of the total cost.

Anyone with common sense would know that correct Universal Healthcare would solve many of these issues. The only other option is to accept about 49 million under/unisured americans should be cast from the system left to suffer and die when illness comes and why that might seem viable, it probably would suck if it were your wife or children. The government should at least provide assisted suicide to the many who kill themselves each year due to no medical care.

These problems were created when insurance and medical care became controlled by corporations for mass profit.... .

Kudos to your wife for still taking medicaid, ect...most private Doctors around here don't, nor do private hospitals. You call an ambulance here, if you don't have insurance your arse is getting hauled an hour away to a state hospital life threatening or not. Strange, the state hospitals around here like Baptist Wake Forest are growing leaps and making great profit.

In NM, medicaid is partially privatized. HMOs have their own versions of NM Medicaid (called "Salud"). So Pres Health Plan signs up people for Pres Salud, and the State pays Pres up front their entire annual medicaid payout—then Pres is on the hook for all medicaid approved care. My wife only takes a certain number of Salud patients from each plan (contractually arranged) since each costs money to see. See too many, and you'll have to pawn the car to continue with the privilege of treating them ;)

Regardless, anyone who shows at the hospital must be treated. If you live someplace where no one takes it, and you go to the ER, the ER doc will call the specialty on call, and they will HAVE to see you. Once they see you, they "own you" and must continue care, even if they "don't take medicaid."

Since my wife is on call every 6 days or so, she gets new medicaid over and above what she takes on those days.

Right now, they are also not taking any new mediCARE patients, either. And the way things are going they won't. A 23% hit is huge on care that already reimburses at break even levels or less.

Specialists also have equipment overhead, etc. Specialists in another state all have robotic surgery, so we need to spend a couple million bucks to buy one, etc. Everyone wants the latest stuff, but out here in the flyover states who's gonna buy it? (some of the new technology can be more flash than substance, too. Laparoscopy, for example, is over-hyped for many procedures. My wife knew people doing research, and after talking to them she realized that they'd cherry pick patients so they'd have the best outcomes instead of what they should do, do every single case that way for some period, warts and all). All that stuff costs money, though, and they need to have it (else all the cancer patients get on SW and fly to MD Anderson, instead, then want cheap, follow up care locally).

We had a guy who was known to be an illegal, and was seeking medical care with medicaid. Illegally. I looked into ways to report medicaid fraud. I could report a DOC on a website, instantly. A patient who was an illegal alien? Nope, it's not possible in NM to report patients fraudulently using the system, only docs.

Yeesh.

I always thought that docs should be allowed to write off the difference between medicaid and medicare and some nominal real insurance reimbursement as an in-kind charitable contribution. This would encourage providers to see that patient population, and would cost the government nothing.

Universal care is not the answer. It's not. As I said above, the hardest "insurance" to deal with is... the government. Didn't dot some i on the form, claim denied! (they won't tell you what was wrong, just denied). The 2 gov programs only work because they force docs to pay out of pocket to treat them. Expanding this makes medicine impossible. If you want costs reduced (presumably the point of universal care) there is ONE WAY to reduce cost.

One way.

People made fun of Palin and "death panels," but guess what, rationing care for life-threatening disease is the only meaningful way to reduce cost. Period. Over 90% of lifetime health expense is in the last months of life. By definition, that care is actuarially unsuccessful, since it's the last months—the patient DIES.

90%.

Cut all "preventive" costs to zero and you've dropped the outlay by 10%. If it was simply delivered at cost, you'd drop the total expense by maybe 2%.

The trouble is that the crazy money we spend on end of life in the US actually saves some people. People aren't cars, so sometimes a treatment might only work on a tiny %, but the only way to know is to try. If 1% live from some $100,000 cancer treatment, it wastes tons of money, but for the 1 guy that lives, the million dollar cost for his life seems well worth it, doesn't it? (99 failed 100k treatments, 1 successful. total cost 1M$ for 1 life) It's important to remember that warts and all (insured, uninsured, medicaid, etc, all combined), the US is the best place on earth to have cancer. That tells you about real quality of care, since bad care or no care means death. Better mortality per case is entirely a measure of quality of care. That includes the uninsured, too, so it's even better for everyone else.