No one disputes that everyone needs access to health care. In fact we currently have a safety net but it does not work very well. Medicaid covers the poor who need medical care. But anyone with a job or savings or a home cannot receive any benefits until they spend every thing that they have. This is called a “Spend down” and it is a huge problem for the uninsured.

We believe the spend down should be eliminated or at least modified so that a patient does not have to be dragged into poverty before they can receive benefits. Make the spend down a 10% spend down or anything else rather than the 100% spend down into poverty that is currently required. This would make medicaid just unattractive enough that it would encourage patients with means to think about helping themselves rather than rely on government. This would prevent a lot of bankruptcies as well as save lives.

Another thing that Medicaid could do is to kick in with cost control before the spend down. This is how it would work: A patient with a serious condition would immediately get a medicaid card based on the diagnosis and no insurance. The patient would see a physician who takes Medicaid and present his card. The patient would see the physician and pay the doctor out of pocket but only at the rate that medicaid approves. This would prevent price gouging which is a big problem for the uninsured. For example, a patient goes to the emergency room with a painful lump in his groin. The ER doctor diagnosis a hernia, gives the patient pain medication and then sends the patient home with instructions to see a surgeon and get his hernia fixed. At this point the patient is looking a cost of surgery of about $16,000 which is the average charge for this surgery around the country. Give the patient a medicaid card. Now he will be able to find a physician who accepts Medicaid and will be able to get his hernia fixed for about $5,000. If he cannot afford that price even with financed monthly payments he probably already qualifies for Medicaid with no further spend down and will get his surgery without any cost to him.

The point of this is that we can cover the uninsured without overhauling and giving government complete control of our health care. We have heard one news commentator say that it would cost about $35 billion a year to cover everyone that is currently uninsured. This is much less than a trillion dollars and does not ruin what is good about what we now have and is the envy of the world.