Ezra Klein defends against Megan McArdle’s told-you-so on health care reform.

Yesterday, Megan McArdle linked to the study showing that Illinois children on Medicaid have trouble getting appointment with specialists and wrote “proponents of health care reform are gnashing their teeth, while opponents grimly say ‘I told you so.’” Really? Why?

The study gets at two problems: In an effort to control costs, Medicaid pays doctors too little, and too many uninsured people go without care. These are exactly the sort of problem health-care reform is designed to address. Most directly, the law dramatically expands coverage and increases Medicaid reimbursement rates, particularly for primary-care doctors. That doesn’t do much for the specialists, who were the subjects of this study, but it’s a start.

More importantly, the law is thick with efforts to control costs in the health-care system itself — and in Medicaid itself — which is the only approach that’s really sustainable over the long-term. They may or may not work, but people who believe they’re our best hope, at least for the moment, aren’t gnashing their teeth at this study. They’re saying, “See? This is what I’ve been trying to tell you about. This is why we had to pass that law.”

I remain skeptical that any of these essentially demand side policies are going to do the trick.

As Megan notes some hospitals are claiming that Medicaid reimbursements are running below their marginal costs. That is, they would do better to leave a bed empty than fill it with a Medicaid patient.

I find this maddening. Not for the usual moral implications sort of way. Just in the fact that I am faced with a business which cannot profitably perform this service at a reimbursement rates far, far, far above the median wage.

There is nothing that can be done? Really? Nothing?

I can’t put an out of work construction worker in that room with a thermometer and pay him 7.50 an hour to take that patient’s temperature. I cant hire a 16 year-old kid to haul around one of the blood pressure monitors, hook each patient up to it and then type the results into some old rusty laptop.

You have got to be kidding me. There is this much money on the table and there is just no profitable use you can put it to?

Are you running a business or a hole in the ground where profit goes to die?

I mean crap, can’t I at least hire someone with a iPhone to walk into each room and ask the patient a series a questions, record on the iPhone camera and the email the results to a triage nurse in India who can give me a heads up on what’s wrong with this patient.

We have lots of unemployed workers in America. We have lots of people who want some form of medical care. There is no way to get these two groups of people together. Just NO WAY?!

I hate to keep going with this but a fair number of my Medicaid patients might be old, illiterate or not have access to the internet. I can’t pay some kid to type in their symptoms into FirstConsult and at least find out something?

This is just a joke. I have workers. I have capital. I have customers. There should be some transactions going down here.

I don’t know how to see this as anything other than a serious supply side catastrophe.

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