Paul Krugman wrote recently about how Medicaid is the salvation of the American health care and entitlement system, because it controls costs so efficiently and none of the problems you hear about really matter.
Ah, but you say, Medicaid patients have trouble finding doctors who’ll take them. Yes, sometimes, although it’s a greatly exaggerated issue. Also, middle-class patients would surely be unhappy if transferred from the open-handedness of Medicare to the penny-pinching of Medicaid. But the problems of access, such as they are, would largely go away if most of the health insurance system were run like Medicaid, since doctors wouldn’t have so many patients able and willing to pay more.
Krugman thinks the problems of Medicaid when it comes to access and quality are greatly exaggerated, and that it provides a worthwhile example of how to control health care costs. On the latter, he’s of course completely correct: denying access to care to patients and denying market-value payment to physicians will absolutely control costs.
But what about the rest of it, that access and quality bit? We already see Obamacare-supporting groups complaining about potential access problems in thinly-sliced coverage networks. And that’s within the health exchange marketplace, not the stand in line Medicaid system.