Medicaid

Georges Clemenceau said that war is too serious a matter to entrust to military men. There are, however, examples of military men who warned against war that politicians rushed to embrace. The same principle should be applied to health insurance, and Medicaid is a prime example. It could be a program to improve the health of the most vulnerable and sickest portion of our society or just another gold rush in a poorly conceived health system. A study from the University of Michigan reveals that the poorer health of surgery patients covered by Medicaid results in more complications, longer hospitalization and higher cost than patients with private insurance. I doubt that comes as a surprise to medical people, even surgeons. But, how urgent is the surgery? A wise surgeon once told me surgical skill is easier than knowing when to operate. Sad to say the hospitals will take the first step into the breech in order to brake their financial loses. Meanwhile, the medical community will continue to complain that medical decisions are taken out of their hands by administrators, bureaucrats and politicians.     

Granted the Medicaid population has more health problems and more serious health problems than the general population and certainly more than the population with private health insurance. During the early stages of expansion of Medicaid there will be financial strain. But what better population could there be to link health care with medical care to improve health status. Somewhere there needs to be a demonstration that the health care/medical care community can manage this problem. It is a more comprehensive approach than emergency rooms and surgical suites. I remember when during the early development of Family Medicine as a medical specialty they emphasized behavioral science. Maybe schools of public health should be a more active component in the struggle. Perhaps the University of Michigan will rise to the challenge now that they have highlighted the problem.