America is believed to be a place where healthcare is a paramount concern and provided to all, especially those in need. As delineated by guidelines, the needy are those who live near or under the poverty line, which varies by state. For them, there is Medicaid, but that may mean little opportunity for care. How can that be?

The fees that Medicaid pays are so far below the usual fees that healthcare professionals receive that there is a refusal to take these patients. Practitioners will say they have no openings or are not taking on new patients. I was witness to a glaring example one day as an ENT surgeon blurted out to his colleagues why he was leaving medical practice.

In his late 60s, the surgeon said, “I get $75 for an operation on a kid where I would usually get $3K, and I’m not going to do it anymore. I’m retiring.” He had the means by virtue of many years in practice and having married a wealthy woman, so no financial loss for him, and he could play golf every day.

Where would those children who need an ENT’s expertise receive needed healthcare? It might fall to the charity sections of local hospitals and health clinics. There was no concern for them as he packed up and drove off to his beachfront home, one of two he owned.

The wealthy need not worry about the absence of healthcare, especially if they have contracted to receive concierge medical care. Paying a monthly fee or up to $10K/year, no waiting for an appointment and care is a phone call away.

The situation for those who are struggling financially and who have medical disorders as well, however, is dire. Even those who serve the greater community find they’re unable to find the help they need. I recall receiving several emails from an EMT worker who was active on 9/11 after the attacks and, as a result, developed hypertension and had two strokes.

We discussed what he needed because he was being denied Social Security disability benefits that would also provide Medicare, and he couldn’t work. Fortunately, I had been a consultant for that service, had written a book on it, and noted what he needed to do. Weeks later, I got an email telling me he received benefits.

Today, I received yet another note from an EMT worker who is suffering from PTSD as a result of pandemic work, can’t work because of panic disorder, and no therapist will accept her Medicaid. I couldn’t recommend a therapist, but I know that every profession has an ethical responsibility to take some pro bono cases.

Gauging How We Value Life

All life is precious, and there is no difference between a poor mother and her children or a yuppie gamboling in the Hamptons for the summer. Do all the therapists still take August off and attend Cape Cod seminars? The NYT thinks that’s where all the wealthy go to escape the summer heat. But that mother and her kids have no choices like that, and she has to pray they don’t get sick and need medical or psychological care. Who’s taking their Medicaid?

Can medical professionals refuse Medicaid patients? They always do it, but what consequences are there for them? One physician wrote eloquently on this dismal situation:

An oft-cited study showed that 31 percent of physicians nationwide were not willing to accept new Medicaid patients. The rate was even higher for orthopedic surgeons and dermatologists, two of the highest-paying specialties in medicine. The Affordable Care Act led to some modest improvements, particularly in access to primary care, but the acceptance rate of patients covered by Medicaid remains dismally low.

Should a retiree with a serious medical condition who lives with his wife on a fixed, marginal income have to drive 50 miles to see a physician who takes Medicaid? The answer is obvious, but no one in his area will accept his insurance.

Charity care is something hospitals do provide, and some states require them to do so. But the care may be at a high cost to hospitals. The patient load can be unusually large, staff suffer burnout, and wait times are long. For these reasons, many people delay going for care or are on waiting lists for care. Being on one of these lists isn’t unusual in mental health. But there can be a price to be paid by potential patients as they wait.

We find that longer waiting time is significantly associated with a deterioration in patient outcomes 12 months after acceptance for treatment for patients…Mental health clinics will open “wait list” groups to provide relief for patients in need until they receive an appointment with a therapist. Does that handle the deterioration? I guess we need another study.

What is the solution? There is no easy solution except to work within a more giving philosophy for those in need and an expansion of services. Creative solutions are required when funds are scarce because lives are on the line, and there is no value you can place on a life.