Friday, May 02, 2008 - In an attempt to improve the state's bottom line, Gov. Jon S. Corzine has proposed that Medicaid recipients pay $2 for each prescription and $6 for each "unnecessary" ER visit. It is amazing how such a small bit of cash per person could save so much — $7 million on the prescriptions and $550,000 on the ER visits. This is especially remarkable since Medicaid pays so little for the services it generously promises those who are poor. Trouble is the state does not pay enough and the physicians, hospitals and pharmacies are struggling to stay afloat.
Medicaid pays 10-30 percent of the cost to provide care, six months after the fact. So every time a Medicaid patient is seen, those who care for that patient lose money. When Medicaid patients are seen in a physician's office, the doctor gets minimal reimbursement, yet still has to pay all the overhead and risk being sued as well. Hospitals have a different problem — they are mandated to see anyone who walks in the door regardless of ability to pay.
The problem with a $6 ER visit, as proposed by our governor, is that patients would tend to think that $6 is what their visit is worth. They actually could equate the cost of a doctor's visit with a Happy Meal. No offense, McDonald's, but medical care is a far more valuable service than a hamburger and fries, and patients need to understand that. And what if the person does not have the $6 on hand? Will there be bills and letters sent out? Who will pay the 41-cent — soon to be 42-cent — postage, and who will pay those secretaries?
The government cannot and does not provide health care for the poor; doctors, nurses, pharmacists and hospitals do. And it is about time the state admits it. So I propose that the federal and state governments step aside and let the physicians and the communities work together to solve the problem.
The way to care for the poor is through true charity — not government "charity" devised by politicians whose sole criterion for getting elected is their ability to spout generalities that appeal to those who feel vulnerable. Just like at the turn of the 20th century, when hospitals like Muhlenberg Regional Medical Center were forming, we need to get back to basics.
Every town could have a free clinic, staffed by volunteers, where the poor can get care. Given the opportunity and framing the challenge in the right way, most physicians and nurses would step up to the plate and donate four hours per month to their local community clinic. The funds for the utilities and supplies could come from tax-deductible donations, so no taxpayer funds need to be appropriated. Perhaps the town could provide a free location. To sweeten the scenario, the federal government offers free medical malpractice insurance to those professionals who care for patients in a free clinic.
The Zarephath Health Center, which started in 2003, is open only 10 hours per week and yet currently provides free care for 200 patients per month — completely through the kindness of volunteer doctors and nurses. Expenses last year totaled $44,000, so calculations tell us that the physicians provided care, including free medicines, for an average of $22 per patient visit. Compare that with the average hospital ER visit of well over $1,000.
Patients at the Zarephath Health Center were grateful as they understood the sacrifice of the unpaid staff. Many transitioned to private physician offices once their financial situations improved. These patients might still not have New Jersey's overpriced health insurance, but they can pay something toward the real cost of their care, knowing that a backup of the free clinic still exists should they fall into hard times again.
So, Mr. Corzine, keep the measly six bucks, and the rest of your "charity care" as well. Truthfully, it is not yours to give. Let those who provide the care receive the compensation of a grateful thank-you from someone who will one day return the favor to someone else as the whole tenor of our society is elevated. We don't need to fleece our fellow taxpayers to give you the satisfaction that you provided any care at all, Mr. Governor. We'll do it; just get off our backs. Alieta Eck, MD