Perhaps the most important Obamacare lie among many will turn out to be the one that says that the Obamacare Medicaid expansion will lead to quality health care for the people newly covered by it.

Anyone who was even remotely familiar with the way Medicaid already worked was quite aware of this at the time Obamacare was passed.  Medicaid recipients were already having great difficulty getting a doctor to see them due to the low reimbursement rates.

The Obamacare Medicaid expansion provides people with the trappings of care but is unlikely to be able to deliver all that much of it—unless, of course, more doctors come under the thumb of government and are forced to accept Medicaid levels of reimbursement.

Oh well, doctors. They earn too much money anyway, don’t they?

Not in the Soviet Union they didn’t. Not even in post-Soviet Russia.  Here’s why [emphasis mine]:

Soviet doctors never had anything like the status and money of Western doctors. The medicine they practice was considered to be below the levels of the West, the system always suffered from shortages, and the social status of a provincial general practitioner was akin to a schoolteacher’s, respectable, but modest…

But under Communism, doctors at least lived no worse than anybody else — and maybe a bit better.

That has changed. Caught between an impoverished government that cannot afford universal medical care and a deep-rooted Soviet scorn for medicine-for-profit, many of Russia’s doctors, especially here in the provinces, seem worn thin, out of canteen water but still marching ahead.

When everything else took the capitalist road of development, and medicine was left on the socialist road, we got an imbalance that is killing medicine,” said Dr. Aleksei Golland, one of a handful of private doctors in Kostroma.

”It’s an economic death,” he said. ”If it continues like this, I see the murder of medicine in that the masses of quality doctors don’t have ground to stand on. A surgeon has to plant potatoes to feed his family.”

Ask what keeps the government-paid doctors going and the same words keep coming up: Vocation. Duty. Mercy. Naked enthusiasm…

A few doctors are doing pretty well. There are a handful of legally private doctors. And there are the doctors who practice a sort of black-market medicine in which they operate in state facilities, but charge their own little tolls.

Has the situation changed much in Russia since the above quotes from 2000? It certainly doesn’t seem that way. Perhaps that’s even part of the reason life expectancy there is so lousy.

Expect a war on doctors who don’t take Medicaid patients.  We already know what the result will be.

[Neo-neocon is a writer with degrees in law and family therapy, who blogs at neo-neocon.]


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