ERJedi’s Solution to the Medicaid Problem

My solution to the medicaid debacle is this; incentivize people to be healthy, and they will need less health care. Less heath care equals less burden on the medicaid system, equals more money for paying physicians and providers, equals better coverage for those that need it. Now, I say all this having done absolutely no research. I admit this up front. But I’m an intern, and don’t have the time or energy to do that at the moment. But my plan is based on the presumption that a super expensive procedure, or stay in the ICU, cost more than a few thousand dollars (which it certainly dose)

Gist of the plan

  • Pay people for being healthy – Its often stated that those in low socioeconomic classes have the hardest time leading a healthy lifestyle, for all the various reasons that are better discussed elsewhere. It has also been shown that minimal financial compensation is enough to significantly motivate people to change their behavior.  What if you paid someone $10 to go for a checkup? Paid them $5 for every month they took their medication as prescribed? $25 for a colonoscopy. Lose 10 pounds? Here’s $10. Make healthy lifestyle changes and no longer need to take insulin? Here’s $50 my healthy friend.  By medicaid paying money upfront to the consumer, to promote healthy living, they avoid paying buckets more money downstream when this same person, who was bound for a triple bypass in 20 years, eventually shows up at the doors of the ER having not seen a doctor for 15 years and is now having crushing chest pain. Now, with a simple bit of financial motivation, people who could most use a few hundred bucks in their pocket are getting both a little extra walkin’ money and the benefit of increased health. Some smart guy with a calculator would have to do all the math, but I’d be willing to bet you could pay someone $500 a year in incentives and it would still be cost beneficial compared to what medicaid is shelling out now. And $500 might be enough to get someone to walk to work. To take their pills. To eat healthier food (and pay for it at the same time).
  • Those that “buy in” get access to the best health care – Despite the above plan, we still need to cut back on medical spending. But we need to do it smartly and justly. If you smoke for 40 years, I don’t think its fair or right to expect the taxpayers to pick up the tab for your radiation therapy. That sort of bullshit has to stop. Your cholesterol is 4 billion and you had an MI? And we have to pay for it? F-that!  Rather than this, where anyone can get “top level care” regardless of their past interest in their personal health, I’d propose that only those earning X dollars in incentives qualify for “top level care”. Sure, you could not earn a penny, and still get top level care, but it would be more like other countries. It would be rationed. You’d be put on a list, and have to wait until it was your turn to receive it. If 2,000 (just making this number up) cardiac bypasses are performed annually in this country the way it stands now, 400 bypass “slots” would be set aside for those that didn’t get on board with the program. The remaining 1600, or how ever many were needed, would be given to those who “earned” it in incentives. But guess what, since these people are now healthier, that number is only 1000 bypasses all of a sudden. So we just cut 600 bypasses that medicaid has to pay for. So now there is extra money to fairly compensate medical providers, money to pay those that are “earning” it and probably some left over.
  • So now you are fairly compensating providers? Guess what, more providers start accepting medicaid, which increases access to health care, which increases opportunities for John Doe to earn incentives, which increases the likelihood that he gets healthy, which decreases the chance that he needs expensive medical care, which increases the savings to medicaid, which increases their ability to compensate providers…. see where this is going? Its win win.

About ER Jedi

I’m a resident doctor in Emergency Medicine and I’ve learned during the past few years that 1) I’ve had some pretty amazing experiences 2) I have a very bad short-term memory. So this blog is just a place for me to write about some of these experiences, from the ER, medical school, the wards and life in general. At least that way I’ll have some idea as to where I’ve been all this time. A scrap-book of sorts, a place to vent, organize some clinical tools and post a few good songs I’ve heard along the way.

Posted on February 3, 2012, in Uncategorized. Bookmark the permalink. 2 Comments.

  1. Now I understand why you are ER Jedi and not Obiwan, just kidding! I work in an indigent clinic and we provide incentives/support for meds etc. Guess what people spend the money on cigarettes, alcohol, weed? Their lives are in such chaos they go for the instant thing to help them cope. What we do that is effective, thanks to our great social work staff. If a patient is send to a pharmacy they get a gift card marked pharmacy only or we call ahead and pre-pay the item. Your ideas are good but it would take alot of oversight to make sure people actually did what was expected to get the incentive. Look up the new info on Accountable Care Organizations, some insurances are providing payment to primary care offices to communicate with patients outside of the office visit. I am currently in one of these roles and the outcomes are amazing. Pt.’s who would no show at specialist appts. are now showing up with support for follow through. Guess what the primary care docs are happy campers, speeds up that office visit and quality indicators are better. Job security for this 30 year experienced nurse who can navigate health care systems barriers.

  2. “Here’s $50 my healthy friend,” haha. This sounds like a great plan to me.

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