Did Duggan and Morton estimate the long term economic impact of leaving these people untreated? Might it be more than a relatively modest cost shifting to those better able to absorb it.

I am a citizen not a unit of human capital, there is more at stake than accounting.

But if you really want to save money, get rid of the private insurance administrators.

If this is a reply to the immediate below comment I addressed to you in the middle of it, I never said nor inferred that just changing insurers would make care and progress better for Medicaid patients. A sizeable portion of people on Medicaid reveal the less than stellar efforts at insight and judgment to make themselves more difficult to provide care for with an impact. And, the insurer pays fairly woefully for the amount of time and energy by a provider. So, where is the real honest and dedicated intent by a provider to work with this reimbursement source?

The usual PPACA suspects will falsely pounce that I am derelict in duty by even suggesting this an issue. They then go on to deny it, but, all their words infer they want doctors to take a vow of poverty.

Those paying attention and are realistic, we are onto the false prophets of hope and change. So should those of you who are tired of being used and abused!

The commenter that I was responding to implied that Medicaid was a causative factor in their unhealthy behavior, and that removing their health insurance would make them healthier.

I make a living in part measuring continuity of care. No easy task, and I’m not certain it means all that much. I’m in the habit now of carrying my records on my android phones. I think that’s the future of continuity. Anyways, my only point is we don’t need constraints on care. We need a greater supply of care, and we need it delivered with some imagination, and imagination is clearly not what the Gov does well… at least any imagination which requires big investments which invariably become political rather than patient centered decisions. (speaking as a 35 yr civ servent spent mostly in health care w/ hcfa and some other agencies…..)

“Am I clear?”

Yes in that you think delivery of health care can be compared to the retail industry, but increasing providers has never reduced costs. What the Walmart types are doing is not providing doctors, but nurses, and hoping in the bargain someone will buy the nose spray or a pair of panty hose.

Continuity of care is probably one of the most important patient needs, fractionalizing delivery of care and taking the business away from, what seems to be, struggling PCPs, in not quality care, nor solving the problem.

Anyway, the cost crisis is not in primary care, it’s in hospitals, those monoliths to billing prowess and high costs.

It also seems you think forcing Medicaid clients to Minit Clinics is their (or our) answer, when it’s just second tier care.

Good night….

I didn’t lambast Medicaid. My fellow Chicagoan Quentin Young did. As my very progressive former MD boss would joke, Young was the ex-communist doc who would see Medicaid Patients in his practice.

My concern with the so called reform of ACA is it does nothing to increase the supply of care which is what would really drive down costs. Instead it imposes price controls, which will restrict supply, and continue to increase costs.

If our Public Policy were really concerned with decreasing costs, we’d look at people who knew how to do that: bit box retailers as an example. What form that kind of delivery would take I don’t konw. I just know they’re good at delivering goods and service cheaply and I bet have some lessons for us.

That’s not an easy leap for many in our industry to buy. I was roundly denounced once by an ED manager in Florida when I mentioned liqour stores routinely stock up before big football games, how come clinics can stock up before usually very predictable demand trends. She never got to looking at her trends because she was so bent out of shape over the comparison to a beer peddler. Well, sometimes those peddlers know a thing or two.

Am I clear?

I,m a little confused Bill, you seem to lambast Medicaid for not paying enough to attract providers yet look to Walmart and RPNs to fill the void. Is your intent that Minute Clinics will drive down provider costs? If so how will that attract providers?

Is there going to be a Minute Clinic for hospital care as well?

Would reduce the amount to be reimbursed. Better Access too… my daughter was on Medicaid and the clinic ran 9 to 5, five days a week. Walmart, Walgreens, the other big box retailers go almost 24/7 (she had a occassion to use the Nurse at Walgreens and pleased with service). A lot of healthcare could be turned over to them, and lessons learned from them, that would do patients a big favor. Retailers know how to drive down costs. If were serious about cost reductions and increased availability, the lessons to be learned are there. Not with the Government for sure…

So, is Walmart’s “driving down costs” reducing reimbursements?