The Public Sector
Much has been made of public healthcare through the years of debate regarding healthcare reform in the United States. Public healthcare systems like those implemented in Canada and Great Britain have been at the forefront of positive and negative publicity surrounding large scale public healthcare programs. The United Kingdom provides almost free healthcare to its citizens through the National Health Service in which the national government owns the healthcare facilities and employs the healthcare workers, although there is small but growing number of British citizens that are privately insured. Canada provides a national insurance program to all of its citizens. The Canadian system is a single-payer system in which the government provides payments to hospitals and physicians that are negotiated annually between the federal and provincial governments. In the United States, the private insurance model is predominant, with a publically funded health insurance program for retired workers (Medicare) and a publically funded program for low income residents (Medicaid).
Medicaid was signed into law as part of Title XIX of the Social Security Act of 1965 by President Lyndon B. Johnson. It was introduced as a way to cover low-income families who were not covered by employer-sponsored insurance. The misconception that Medicaid covers everyone who is poor is not true and shows a gap in the coverage provided by the government. Low-income, non-disabled adults, whether they have children or not, are very rarely covered by Medicaid and those people form a significant percentage of the uninsured population. In many states it falls to counties, cities, and communities to fill the gaps left after those with private insurance and Medicaid. Medicaid is jointly funded by the federal and state governments to take care of citizens. The administration is handled at the state level and because of this, many states handle Medicaid funds very differently. Every state must answer to the Center for Medicare and Medicaid Services (CMS). Within the broad regulations laid out by the CMS, states can use the funds to care for children’s healthcare in the way that best suits the uninsured population of their state.
Medicaid works by paying for services in the private or public sector for beneficiaries of the program. A Medicaid participant is able to see any doctor willing to take Medicaid patients, and the doctor then bills the state Medicaid administration. There is a troubling tendency for many doctors to opt not to see patients who use Medicaid as health insurance because the pay is not as good as private insurers and in some cases, barely covers the cost to the doctor for performing the service. In a 2007 Wall Street Journal Article, Vanessa Fuhrmans explains some of the glaring problems with Medicaid in the state of Michigan.
For every chest X-ray Dr. Mukkamala performs, for instance, Medicaid pays him $20. Commercial insurers such as Blue Cross pay about $33 and Medicare pays $30. But with technicians, film and other equipment, his costs are about $29 per X-ray, he estimates. (Fuhrmans, 2007, p. A1)
This is a snapshot of the growing problems with Medicaid due to lack of funding, and this is seen in every state to one degree or another. Many attempts have been made to expand coverage to more uninsured children.