Medicaid and the Plight of the Poor

8 Problems with Our Health Care System #7

At no point in the history of our health care system have the poor received adequate care. The common misconception is that health care is available for everyone. It's simply not true. When you consider that the poor are less likely to have a nutritious diet and more likely to face conditions hazardous to their health in the work place or at home, you see that this the fact that this is true is to our great shame.

The poor, of course, missed out on the post World War II boom in private health insurance as provided by employers. What little health care they could receive, typically only for an emergency, was available at the large public hospitals and some charitable hospitals. Today, charity hospitals are run little different from their for-profit brethren, so they are an increasingly minor option for the poor.

In the 60s, health care for the poor was improved through the creation of Medicaid by the federal government. Medicaid, an entitlement program run by the states and largely funded by the federal government, would extend health care to more people than ever before. Unfortunately, this would lead to runaway costs.

Medical spending exploded under Medicaid. Congress would take it upon themselves to limit eligibility in order to control costs. Suddenly, large groups of people were once again without health insurance. Worse yet, many of the working poor who had insurance would see their companies drop their insurance plans or reduce coverage to a level that would do little to alleviate the financial burden of sickness. In 1982, President Reagan would cut Medicaid spending forcing many more out of the system. Many states would unleash managed care on their Medicaid programs and the poor would suffer from the same problems caused by HMOs as everyone else.

Medicaid was an ambitious plan that fell far short of its goal. At this point, is a particularly unpopular government program thanks to demonization by conservatives not for its inefficiencies, but for the very idea. How can a country this vast and this rich not take care of the least among us?

Source - Sick: The Untold Story of America's Health Care Crisis --- and the People Who Pay the Price by Jonathan Cohn