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How Medicaid Fails the Poor [Paperback]

Avik Roy

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Book Description

21 Nov 2013
Medicaid, America's government-run health insurance program for the poor, should be a lifeline that provides needed health care to Americans with no other options. Surprisingly, however, it doesn't. The medical literature reveals a $450 billion-a-year scandal: that people on Medicaid have far worse health outcomes than those with private insurance, and no better outcomes than those with no insurance at all. Why is this so? In "How Medicaid Fails the Poor," Avik Roy explains how Medicaid's clumsy design and perverse incentives make it hard for people on Medicaid to get the medical care they need. Medicaid doesn't reimburse doctors or hospitals for the cost of caring for Medicaid enrollees, forcing many doctors to opt out of the program. The Affordable Care Act, otherwise known as Obamacare, doubles down on this broken system. Roy shows us that there are better ways, using private insurance, to provide needed care to our poorest citizens.

Product details

  • Paperback: 48 pages
  • Publisher: Encounter Books,USA; 1 edition (21 Nov 2013)
  • Language: English
  • ISBN-10: 1594037523
  • ISBN-13: 978-1594037528
  • Product Dimensions: 19.6 x 11.9 x 0.3 cm
  • Amazon Bestsellers Rank: 3,281,869 in Books (See Top 100 in Books)

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Product Description

About the Author

Avik Roy is a senior fellow at the Manhattan Institute. In 2012, Roy served as a health care policy adviser to Mitt Romney. He is editor and principal author of "The Apothecary," the influential Forbes blog on health care policy and entitlement reform. MSNBC's Chris Hayes calls "The Apothecary" "one of the best takes from conservatives on that set of issues." Ezra Klein of the Washington Post calls "The Apothecary" one of the few "blogs I disagree with [that] I check daily." In addition, Roy writes a column for National Review Online on politics and policy. He is a frequent guest on television news programs, including appearances on Fox News, Fox Business, MSNBC, CNBC, Bloomberg, PBS, and HBO. His work has also appeared in "The Atlantic, USA Today, National Affairs, " and "The American Spectator," among other publications. He was born and raised near Detroit, Michigan, and graduated from high school in San Antonio, Texas. Today, Roy lives in lower Manhattan.

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Most Helpful Customer Reviews on (beta) 4.3 out of 5 stars  14 reviews
39 of 42 people found the following review helpful
5.0 out of 5 stars A lot of good information 13 Nov 2013
By Michael T Kennedy - Published on
Format:Kindle Edition|Verified Purchase
I'm reading Avik Roy's book (pamphlet) on Medicaid. I have some strong opinions on this topic. In 1965, when Medicare and Medicaid became law, I was a medical student at the Los Angeles County Hospital. My experience has been that the big city hospitals that once served as the safety net for the urban poor, were devastated by the new law. Medicaid (MediCal in California) would not pay for care in the County hospital where resident physicians were often the providers. I knew men who quit their residencies to start MediCal mills.

Years later, after I had done a graduate program at Dartmouth, I asked permission of the new MediCal administrator to study the results of an HMO model versus a fee for service model. I had the funding and the academic support. Permission was refused.

The author does an excellent job of describing the evolution of Medicaid and the effects on the poor. I have never changed my mind about the benefits of the previous model, using big community teaching hospitals to treat the poor. Medicaid promised them "mainstream private care" which they have never had and will not have under Obamacare. Many primary care docs I knew when I was in practice would treat Medicaid patients and never bill the system because the payment was so poor and it took two years to get paid. They were in practice in a prosperous community. Many inner city docs had no choice but were unable to provide good quality care. Medicaid was never a real choice for the poor.

Good account and well worth reading. His last section advocates a free market system for the Medicaid population. I tend to doubt its efficacy and think the basic safety net would be stronger in a system that included teaching hospitals and clinics. There is a reason most poor people are poor. For years after Medicaid began we would get patients coming to the County Hospital clinics for a second opinion, then going back to the private second rate hospital because of the amenities. They trusted us but liked the semi-private room.
2 of 2 people found the following review helpful
2.0 out of 5 stars way too short 1 Feb 2014
By JustinHoca - Published on
Format:Kindle Edition|Verified Purchase
This is an essay, not really even a Kindle single. The information and content are fine, but could be more in-depth.
2 of 2 people found the following review helpful
4.0 out of 5 stars Good on the problem but skimpy on the solution 6 Jan 2014
By David P. Graf - Published on
Format:Kindle Edition|Verified Purchase
After reading Roy's long column (it's really too skimpy to call it a book), I can agree with him that Medicaid isn't doing the job and should be replaced. However, the book gave just a few pages to how to replace it. I was left really wanting more.
1 of 1 people found the following review helpful
5.0 out of 5 stars Blindingly Simple 16 Feb 2014
By David Jones - Published on
Format:Kindle Edition|Verified Purchase
Why do we have 2800 pages of bureaucratic crap that is being bungled instead of the concept clearly expressed in this book that can actually help the needy data far more affordable cost.
2 of 3 people found the following review helpful
3.0 out of 5 stars Informative Pamphlet But No Bang for the Buck 8 Jan 2014
By Michael Porter - Published on
Format:Kindle Edition|Verified Purchase
Overall, this is a very informative pamphlet. If you buy it, you need to understand that the authors purpose isn't to look at the topic in depth but to present a lot of information quickly. It's a quick read but full of information. The author does a great job explaining why a service that actually pays for medical care fails in its stated cause........ to improve health care outcomes. Overall, I'm glad I bought the pamphlet even though it's short.

Why only three stars you ask? Well, I reserve five starts for fantastic books. Four for really good and three for solid.
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