Wednesday, February 3, 2010

Health Reform and Medicaid: Clinics vs. Private Practice (2)

I left a point out of yesterday's post on the consequences of granting $10 billion (that's ten thousand million dollars!!?) to the Community Health Centers, while leaving private practices that treat Medicaid patients severely underfunded and headed out of the business of treating the poor.

Some might argue that granting this money to the CHC's will improve care for the poor. But in the end, that is an unlikely event. By pushing private practice out of the Medicaid picture, Health Reform will in effect be creating a very separate system for the poor, and we know enough now to understand that separate is inherently unequal, with the advantage to the overclass, not the underclass.

It is clarifying to look at the looming situation from the viewpoint of graduating primary care residents. They will have to choose - will I serve middle class patients, or will I serve the poor? There will be no middle ground, no practices like Bayside (our practice), that serve both. Medical schools and training programs do a surprisingly good job of indoctrinating their charges with the mantra of equal care for all, and the precepts of the Hippocratic Oath. Graduating residents tell me in job interviews that they really very much like that they will get to serve everyone. After Health Reform? Not so much.

Obama is right in saying that getting health care for all is a moral issue. It is. This under-appreciated part of the the Health Reform legislation, however, cuts exactly the opposite way. Alas.

Budd Shenkin

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