Insurance for the Poor - Are state run programs really all you need?

With perhaps as many as 40 million Americans lacking even basic insurance-particularly for healthcare provision, it is perhaps one of the most fiercely debated and contentious political and social questions of modern times. Fortunately for those who are either unemployed or on low incomes, there are federally-funded state programmes available that will provide reasonable cover.

However, despite the affordable levels of cover offered by such programmes, are they really as good as they might seem at face value, or are there most systemic problems associated with these state solutions?

The first thing to remember is that the level of coverage offered by such programmes will be different depending on where you live. Also, a program that is known as medicaid in one state might go by an entirely different name in another. Also, for programmes with such wide-ranging and all-encompassing aims, it is impossible to cater for specific needs on a limited budget when you are dealing with as many as 40 million people. Certain provisions must, by nature, go by the wayside. This can be a real problem if your particular health requirement is not covered by such a plan.

The second-and perhaps most serious- criticism aimed t such programmes is that they actually served to restrict the poor's access to quality healthcare. The fact is that doctors participating in plans like Medicaid receive extremely low reimbursement rates and face increasing levels of bureaucracy by doing so. By not taking into account market values in this way, doctors are hardly incentivised to take part in such programmes, thereby squeezing provision to the most needy. It can often be hard for those on low-incomes to find a registered doctor even if they themselves are accepted onto such a program.

Also, with costs for such programmes spiralling out of control, certain provisions are seeing rationing, such as prescription drugs-which can hardly be viewed as non-compulsory for those in need of them. It also means that access to certain types of drugs(usually the most expensive, for obvious reasons), are severely restricted, making a difficult situation worse-especially for patients with multiple health problems that require a range of medications.

So, despite the laudable aims and robust coverage that is often offered, it appears that lack of access to treatment and the inadequate payments made to healthcare professionals participating in such systems, many problems remain. And it is poor patients that will face any further squeeze.

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