Medicaid for profit: the new normal in Michigan

By Michael Berger, RN

DETROIT, MI—The ability to provide care for the poor has met the reality of the market place. The Medicaid HMO plans are the sole providers for care in Michigan. The guidelines for patients to qualify for Federal Medicaid fee for service payments are arbitrary and extremely difficult to figure out.
Some of the Medicaid plans are designed to create such barriers that patients simply never see their primary care physician, and they do not allow people to use the Emergency Room for any care.
Barriers created by the criminal providers are:
1. Disenrollment. If you are diagnosed with bone cancer, it’s the beginning of the month, and you go to your clinic appointment. The hospital informs you: no coverage. Calling the company, they instruct the patient: call your social service worker. The response of the patient is “What have I done wrong that they want me to suffer and die?”
2. The compensation provided to the primary care physician (PCP) is so low that the quality of care is poor or non-existent. Here is a typical exchange: the patient is sent home from the hospital on a type of insulin. The plan needs a prior authorization from the PCP.  Multiple calls to the PCP are not returned. The patient’s blood sugar goes to 550. The Emergency Room directly admits them to a general medical care floor in the hospital.
3. Calling the insurance company is a waste of time. For example, family members call Total Health Care, a Medicaid HMO, requesting a prior authorization form that will allow for a type of care. “We sent authorization to the PCP last week” or “ I will take care of that today”.
Nothing is done to remediate the problem.
By delaying and denying care, the insurance industry profit margin is elevated. The poor are suffering and dying.
The obvious solution is “Medicare for All” which could guarantee a single, high-quality standard of care for all inhabitants of the USA.  The Affordable Care Act (ACA) has paralyzed the debate around comprehensive health care as the allies of the Democratic Party have circled the wagons to protect a nationalization of our health care industry favoring insurance companies to the detriment of the population.
The Democratic Party and its supporters are actively preventing the debate around a real solution—nationalization of health care in the interests of the people.  Just as the bank bailout was designed to support the bond market, the ACA health care nationalization favors the insurance industry.
It is time to put the resources of our nation at the service of our people instead of helping the 1% pile up more useless wealth while we suffer.
Michael Berger is a Healthcare professional from Metro Detroit.