POOR RECORDS SHOW FLAWS IN HEALTH CARE

With great fanfare, the Missouri General Assembly this year passed, and Gov. Mel Carnahan signed into law, a measure expanding Medicaid coverage into the middle class. Supposedly designed to extend coverage to uninsured children up to age 18, the law is supposed to cover an alleged 90,000 uninsured youngsters. Coverage will be extended to middle-class families with incomes of nearly $50,000.

Leave aside for the moment, the arguments over the merits, or lack thereof, of such a policy move. How will it actually work in practice?

The answer, to date, is not so well. It seems that state health officials don't have anything resembling decent records about which medical providers take Medicaid as a form of reimbursement. Self-reporting as one who takes Medicaid reimbursement is voluntary for physicians and other providers. The state's records are a mess, the Southeast Missourian learned, as it attempted to discover how many providers in this are take Medicaid patients.

For example, there is only one medical doctor in Bollinger County, according to state records. However, state records also indicate there are five general practitioners who accept Medicaid reimbursement in that county. No one was able to explain the discrepancy.

Apart from the failure to keep anything resembling accurate records, the state's Medicaid program suffers from other deficiencies. "If you just opened the doors, you'd be so overwhelmed that you could never pay your employees," said Dr. David Johnson, a Cape Girardeau dentist, about taking Medicaid patients. He says doctors are so disgruntled with the old system that they don't want to be a part and would rather give away their services than deal with the complexities of the program. "With Medicaid," Dr. Johnson continued, "the provider is not allowed by law to bill any of the remainder of the unpaid portion, and when they add a large group of people, they are asking medical professionals to subsidize the state without meeting even our most minimal expenses."

Says Dr. Mark Milde, another local dentist, "It seems to be a political issue to expand the program and it sounds great, but there isn't any structure in place to handle it at this point. It's a dilemma when you feel like you have to do something, but it's difficult because the fees they pay don't even cover my overhead."

Welcome to government health care: A system with pathetic records that doesn't reimburse anything close to the costs of those heroic health care providers courageous enough to take Medicaid patients. By all means, let's expand it.