Recent Posts

Saturday, August 25, 2012

How Obamacare Harms the Poor

Avik Roy
Where to begin?

The story of Deamonte Driver illustrates how our health-care system leaves millions of Americans behind. Deamonte lived on the wrong side of the tracks, in Prince George’s County, Md. He was raised by a single mother. He spent his childhood in and out of homeless shelters. He was an African-American kid on welfare. Deamonte died at age twelve — not, however, in a drive-by shooting, or in a drug deal gone bad. He died of a toothache.

In January 2007, Deamonte told his mother, Alyce, that he had a headache. She took him to the hospital, where he was diagnosed with a severe dental abscess and given some medication. But the next day, his condition worsened. It turned out that the infection from his tooth had spread to his brain. He was taken to the hospital again and underwent emergency surgery. After a second surgery, he got better for a while, but then began to have seizures. Several weeks later, Deamonte was dead.

According to Ezra Klein, Deamonte Driver’s story shows us why it would be immoral to repeal Obamacare. “To repeal the bill without another solution for the Deamonte Drivers of the world? And to do it while barely mentioning them? We’re a better country than that. Or so I like to think.”

But Deamonte Driver died not because he was uninsured. Indeed, Deamonte Driver died because he was insured — by the government. Deamonte, it turns out, was on Medicaid.

Although Deamonte was insured, he never received routine dental care. It turns out that only 16 percent of Maryland dentists accept Medicaid patients. Fewer than one-sixth of Maryland kids on Medicaid have ever had a cavity filled. Deamonte’s younger brother, DaShawn, had six rotted teeth, but it took dozens of calls before DaShawn could find one dentist who would see him. When the dentist concluded that DaShawn’s teeth were beyond repair, and required extraction, it took another several months to find an oral surgeon who would see him.

Obamacare does not offer better health care to the Deamonte and DaShawn Drivers of the world. Under Obamacare, if Deamonte were alive today, he would still be stuck with the dysfunctional Medicaid coverage that he was stuck with before. In fact, according to the Congressional Budget Office, Obamacare will shove 17 million more Americans into Medicaid, the developed world’s worst health-care system.

There are many problems with Obamacare. But the law’s cruelest feature is what it will do to low-income Americans who are already struggling. Study after study shows that patients on Medicaid have far worse health outcomes than those with private insurance. The largest study of this type, conducted by the University of Virginia on nearly 1 million patients, found that surgical patients on Medicaid were 97 percent more likely to die in the hospital than those with private insurance, and 13 percent more likely to die than those with no insurance at all.

These results are not surprising. Medicaid pays doctors and hospitals, on average, about half of what private insurers pay. Most often, Medicaid pays less than what the care actually costs. As a result, doctors face the choice of caring for Medicaid patients — and going bankrupt — or shutting their doors to the poor and focusing instead on those with private insurance.

One survey has found that internists are 8.5 times more likely to reject Medicaid patients altogether than to reject those with private insurance. Another study found that children on Medicaid with serious conditions, such as uncontrolled asthma and broken forearms, had a 66 percent chance of being denied a doctor’s appointment, as compared with 11 percent for kids with private insurance.

This is why it was so hard for Deamonte Driver to find doctors who would see him. Every American whom Obamacare puts on Medicaid will face the same challenge.

And it’s not a problem only with Medicaid. According to the Medicare program’s chief actuary, Richard Foster, within eight years Obamacare will bring Medicare’s reimbursement levels below those of Medicaid. Imagine a nation of 77 million retired baby boomers, all of them having as much difficulty as Deamonte Driver in convincing doctors to see them. That is our future.

No comments: