Oh, You Wanted Health Care?

We don't write often about health care policy. Mostly, this is because so much ink already gets spilled about the politics of health care that we rarely feel the need to pile on. It's also because, as this smart guy once said, few people are capable of discussing the subject without losing at least 50 IQ points. But today, we saw this Ventura County Star report about the possible impact of the July 1 switch to New Medi-Cal. By the tone of this report, it'll be about as popular as New Coke.

In July, Medi-Cal will reorganize itself from a top-down system run out of Sacramento to something resembling circa-1993 managed care. Well, except that it won't include any money. Essentially, primary care physicians will be paid a captitated monthly fee for each Medi-Cal member they serve. The per-member amount? $8. Seriously. These payment rates, which are about a sixth of what a doctor would receive for a privately-insured or Medicare patient, are what you get when your third-party payer is California's chronically broke government.

It doesn't baffle us whenever our liberal friends don't see that the last thing you want is for your access to healthcare to be subject to the whims of politicians. But we're always surprised they have such a hard time understanding that having health insurance is not the same thing as getting health care when you need it. In the case of Medi-Cal, the low payment rates make it financially prohibitive for many doctors to accept these patients, and primary care docs who do so often cannot find specialists they can refer them to. In other words, having insurance doesn't mean much if no doctors will see you.