Reading this morning in the New York Times a story about a doctor having to give away a patient suffering from cancer becuase the Medicaid payments to doctors had been cut in the state of Ohio, and other places too I expect.
It seems that the reduced payments simply do not cover the administration costs of the practice. From my American doctor source I gather that if you have a good balance of insurance covered patients you can afford to deal with a few medicaid patients. But this Ohio doctor cannot have enough full fee paying patients to make ends meet in the practice, so he cannot afford to spend time on medicaid patients.
There is a major cost for any american doctor and that is malpractice insurance which quoted in the article at around $43T is much more than many have to live on, quite a lot I'd guess in Ohio with cutbacks over the years of industry. My informant told me he was paying around what a superanuient gets to live on here in New Zealand.
So we are very lucky that a person by the name of Woodhouse came up with our Accident Compensation scheme, messed around by subsequent politicians but at least still basically a worth while arrangement. Abused by some as they found loopholes but I guess that is to be expected with any scheme. It is a human characteristic to look out for oneself in the short term, be they capitalist or socialist, it just reveals itself in differing opportunities. The boss tries to screw the worker and he returns the compliment.
So for all the problems we have here I think we are lucky to have the system of medical care and accident coverage that we have.