Cutting Off Our Noses

CUTTING OFF OUR NOSES....The LA Times reports on the results of California's recent 10% cut in fees paid to doctors who participate in Medi-Cal (California's version of Medicaid):
After San Diego ear, nose and throat physician Ted Mazer recently billed the state's medical insurance program for the poor for a tonsillectomy, he got a check for $168, too little to cover surgical costs. The balance came out of his pocket.

Now legislators have cut the rates even further, leaving Mazer resolved to shut his doors to new Medi-Cal patients. Almost every other specialist in his field countywide has already done the same, he said.

....Reimbursement rates, doctors say, already are so low that a patient office visit nets only $24. Some clinics say the numbers simply don't work anymore. The result: Thousands of patients guaranteed healthcare under state law can't get in to a doctor's office, so they don't go or they sit for hours in an emergency room.

Experts warn that things may get much worse.

Chris Perrone, an analyst who tracks Medi-Cal issues for the California Healthcare Foundation, said Medi-Cal risks are becoming so unattractive to doctors that the program could soon "fall off the edge."

This, of course, is a classic case of "programs for the poor are poor programs." Also, perhaps, a classic confirmation of Ezra Klein's claim that state-funded healthcare programs (Medicaid is funded roughly 50-50 by the states and the feds) are fundamentally flawed. The former because, let's face it, the only reason this 10% cut passed is because the poor didn't have the political power to prevent it. And the latter because it's yet another case of a state being forced to cut back on healthcare at the very time when they need to be spending more. As the country (and California) slips into recession, this problem is only going to get more acute.

The punchline, if a story like this can be said to have a punchline, is this:

The Legislature's nonpartisan budget analyst, Elizabeth G. Hill, had advised against the cut because it could discourage so many doctors from taking Medi-Cal that patients would be forced into emergency rooms, where treatment is far more costly. The state will also lose hundreds of millions of dollars in matching federal funds.
No wonder Hill is finally quitting. What's the point of being the state's "widely respected budget analyst" — a phrase uttered so often in California that you'd almost think it was part of Hill's name — if, in fact, virtually no one ever actually listens to you?