This earlier post decried the failure of the Obama Administrationís reform of the U.S. health care finance system to address one of the fundamental problems with the system ñ the over-reliance on third-party payor of health care expenses.

Take Medicaid, which is the foundation of Obamacareís insurance-for-all principle. As the Happy Hospitalist explains, Medicaid is a particularly shaky foundation:

Not accepting Medicaid used to be the in thing for primary care.  Only one internist out of thirty in Happy’s town accepts new Medicaid patients.  That’s nothing new.

However, this Medicaid contagion has now spread to subspecialty care. In a first of its kind for Happy’s community, I learned that some subspecialty surgeons are no longer accepting Medicaid for outpatient evaluations.    Cash is king.  If they are forced to care for a Medicaid patient during ER call, they don’t even bill Medicaid for the care.  The hassle factor outweighs the payment received.

Going to the ER does not guarantee you’ll get a hospital admission which would mandate the physician to see you.  If you aren’t sick enough to get admitted, you may get referred back to the subspecialist doctor  from the ER for an outpatient evaluation.  And the  front desk at the office will tell you  they don’t accept Medicaid and will ask for a cash payment up front for a clinic evaluation.  They may be required to see you.  They aren’t required to accept your insurance.

If a Medicaid patient shows up in the clinic as an outpatient referral from a primary care doctor’s office, the patient is told they do not accept Medicaid and cash is necessary for an evaluation.  There is no where for the patient to go, except to the University Hospital 60 miles away.  The surgical clinic doesn’t  offer cab vouchers like Happy’s hospital does.  This is the current reality of Medicaid.  This is ObamaCare’s cure to health care finance reform. 

Medicaid is not a solution. It’s pollution.  Medicaid is an insult to physicians everywhere. [.  .  .]

A nation of disgruntled patients with all the insurance in the world, and no where to go.  Take it up with your Congressman I would say.  They are the ones that destroyed it.

Yes, but everyone will still have health insurance.

For whatever thatís worth.