The Medicaid Files

How my opinion has evolved over a 2 year period

In 2023 my small business landed a contract assisting Medicaid recipients in an undisclosed state. I was a bit hesitant to take on this project because I completely disagree with the entire (and disgusting) “health care” system, but I decided it would be a good move because of the opportunity I would have to learn about Medicaid and, of course, to possibly help some people. The experience has been eye opening, to say the least.

The first thing I learned was just how broken this entire system is. The number of rules, regulations, and laws surrounding Medicaid are insane, oppressive, and strangling. I learned that not only are doctors required to “do what they are told,” but they are also reimbursed for their services based on a “fee schedule.” This fee schedule reimburses doctors, hospitals, clinics, etc. at a contracted rate which is often only pennies compared to what the same practice would receive from commercial insurance or a self-pay patient.

I am not going to say too much about the doctors in this post because I really want to focus on what I have learned about the people who receive Medicaid, though I am going to mention something about the ridiculous laws these doctors are mandated to follow. The most ludicrous one I have come across over the last two years is this: In this undisclosed state, if a man in a dress comes into the practice demanding a PAP test (often called a PAP smear), the doctor is bound by law under threat of fines and imprisonment, to give that man a PAP test even though the man does not have a vagina, cervix, etc. To make things fair, if a woman who thinks they are a man comes in and demands a prostate exam, the physician must perform the prostate exam even though the woman does not have a prostate. This will be paid for 100% as “preventative care.” How many of you knew this? This gives you an idea of what your tax dollars are paying for. When we hear that “Medicaid cannot get cut” I get very irritated. Are they telling me that this kind of insanity cannot be cut without cutting essential services?

I want to be careful here because I have learned so much about the people who receive Medical Assistance. I do not want to demean them or talk bad about them because the thousands and thousands of individuals I have assisted have been nothing like the people I had been led to believe receive Medicaid. First, they are not all black or brown people. As a matter of fact, I have found there to be just as many white people on Medicaid. Second, they are not all lazy sitting at home watching TV. On the contrary, most of the Medicaid recipients I have assisted often work 2 or 3 jobs trying to make ends meet, or they work a full-time job that just barely covers their rent and utilities. These people are often on other types of assistance (Food Stamps, etc.) while working. The cost of housing, food, and utilities are so high they cannot afford to go to the doctor (and again, this post is not about going to the doctor… which, of course, I believe we are doing way too much of in our society). I do need to mention I have been surprised at the number of aliens (legal and illegal) who receive Medicaid. A significant percentage of the calls I get require a translator and the languages vary from Spanish, to Russian, to Haitian Creole (and many others).

I have found in most cases that the person who is getting Medicaid is grateful for the “health” coverage they receive. In the undisclosed state I have been serving, the recipient has benefits that make commercial insurance plans pale in comparison. The recipients get everything, and I mean everything: Physical health, Dental, Vision, and Mental Health services are all covered 100% (keep in mind the coverage itself is also paid for 100% with no premium) with no (or very small) co-pays and no deductibles. Granted, surgeries and any major dental work do require a Prior Authorization, but in most cases all procedures are approved and, if not, there are 3 levels of appeals a recipient can go through if they really want something covered.

It is very rare I speak with someone who is demanding and ungrateful for what they are getting for free. Even though I am sure most of these recipients do not realize that the money used to pay for their “health insurance” is stolen from people’s paychecks, most of them seem to understand they are fortunate to have such amazing coverage even though many of the medical practitioners they are allowed to see are not “award winning.”

Something that can be very disturbing are the types of calls I receive. A *huge* percentage (I would estimate 70%) are parents with 1 or more autistic children needing incontinence supplies and other services. A couple of the worst calls I have received were an older lady in her 60’s looking to get diapers and an adult sized stroller for her adult autistic son, another was a mother of 3 young children, all diagnosed with autism.

The second most “popular” call I get are from recipients looking for Mental Health services.

The 3^rd most common call are people wanting to know the status of all the prescription drug authorizations their doctor submitted for them (It is my opinion that many of these pharmaceuticals are unnecessary. Again, cuts need to be made, this is another area in which I truly believe some major cuts could happen without affecting quality of care).

Here are a few examples of some of the calls I receive:

I spoke with an older Caucasian lady who was incredibly kind. She was one of the nicest people I have ever spoken to in my life. She was calling to see if an authorization for imaging (an MRI) services were approved. While checking the status for her, she mentioned that ever since she did “the right thing” and got her “covid” mRNA gene therapy injection, and the subsequent boosters, she has had numerous health issues. She mentioned that before the injections she was in perfect health. This trusting soul broke my heart at the end of the call when she said, “do I need another covid ‘vaccine’?” I could only say, “please speak with your doctor about that.”

An African American mother of two called to dispute some bills she had received for services (by law, Medicaid providers in this undisclosed state are *not* allowed to bill a recipient for services). This woman was incredibly sharp, kind, and professional. She was not shy about telling me she has her own business and does not bring in enough revenue to pay for commercial health insurance. She candidly told me, “And even if I could afford health insurance, Medicaid is a much better deal.” During the call I was able to chat a bit with her and, much to my surprise, we agreed about numerous issues facing society.

An elderly Caucasian woman living on tiny Social Security checks had to have surgery on her hip. She spoke to me in regards to an authorization that was required for her to be released from the hospital. She practically begged me to find something out for her because she felt like a prisoner of the hospital. This call ended on a positive note because I was able to inform her that the authorization was approved and she would be released within the next couple of days.

An African American woman with 1 child called regarding receiving benefits for her child who was recently diagnosed with autism. I mention this call because this person was so full of hope as she discussed different options for her child. My heart was in my gut as I listened to all the programs, she was going to enroll the child in, in hopes that their autism would be reversed. It was very difficult for me not to reference the older lady I mentioned above that was getting diapers and a stroller for her adult autistic child. As I glanced at the child’s account, one thing stood out: “Up to date with all ‘vaccines’.” (*dozens*)

A first-generation Indian couple (from India) contacted me on a 3-way call and started discussing their options for fertility services because they were trying to have a baby. Unfortunately, I had to tell the couple that fertility services are not a covered benefit, but if they wanted to get sterilized, have an IUD (Inter-uterine device) inserted, or get an abortion that would be covered 100%.

The stories go on and on. Over the last two years, I have heard an incredible number of stories about heartache, loss, and illness. What do all these people have in common? They are all barely getting by financially. When I take a call, I never pre-judge the caller. I have learned to put my personal feelings aside. I have no idea what has happened to these people or what has put them in the position they find themselves in. If I was to ask each caller if they planned on the life they ended up with, I believe 90 percent or greater would say unequivocally, “no.” I have spoken with people in the inner-city, a few living on farms, and many living in less populated areas and, except for just a handful over the last couple of years, I did not get the sense that any of these folks were “gaming the system.”

I have deduced that many of these people are lonely. I get the feeling that many of them have become addicted to the medical industrial complex. I believe, for a large segment of those on the Medicaid recipient rolls, they just want to feel like they have a life. Like they matter. In some instances, I believe they just want to have someone to talk to (thus the numerous “doctor” appointments) and have someone touch them in a non-threatening way.

It has been an eye-opening experience for me to go from mining coal to helping people. I have learned more than I can speak about in this short post. I went into this project with preconceptions about those who receive “benefits” from our tax dollars. For most of my life I believed that people on “the dole” were lazy (and I assure you there are some of those I have spoken with as well), selfish, and unaware of where their handouts come from, but after this two-year stint I have changed my mind. I still do not believe that government programs are the way forward for anyone. I still believe that good charities, churches, and private organizations (and there is still *thousands* of those out there as well, you just must look for them www.findhelp.org) are better able to effectively treat and help the infirmed and the poor in our society. The difference now, is I do not look down my nose at those who are taking advantage of a system that has been put into place. I do not believe in it though, not at all. I still think that hard working people are being robbed to give others (in many cases) better perks and benefits than they receive themselves. Someone who works hard and pays their own way should be able to benefit from their labor and should not be subsidizing someone else’s lifestyle. As I mentioned though, many (if not most) of those I speak with regarding their Medicaid benefits *do* work hard.

So, what is the answer? How do we change this system? I have no idea. We live in an insane world and the government has become incredibly big, evil, and complex. The government has a hold over almost every aspect of our lives. I have concluded that the only way out of this is the complete collapse of this evil system. Sure, we would all suffer, but you know what? Our ancestors did pretty darn good without getting everything they have from “the government.” It may be time to revive that “can-do” spirit of our ancestors. In fact, I would say if we do not, we will eventually lose everything from our freedom to our health.

The next time you speak to someone who receives Medicaid services from the state, do not be afraid to ask them a few questions. You may find out what happened in their lives that put them on the path they are on, and maybe you will even muster a bit of compassion for them. You may be surprised at what you find out, and it could very well change your entire attitude about that person. I asked above, “What is the answer?” Coming together and learning to understand each other may not be “the” answer, but it would go a long way toward helping us climb out of the miserable hole we are in as a society.