AMA leader on Medicaid panel stresses need to focus on physicians and patients

AMA Immediate Past President Dr. Nelson talks about why Medicaid is in disrepair and what he intends to do about it as a new federal adviser.

By David Glendinning, AMNews staff. Sept. 12, 2005.

Washington -- A federal commission tasked with reforming Medicaid has agreed on a set of recommendations aimed at cutting billions of dollars from the program over the coming five years. The next step for the 28-member group is to suggest a large-scale overhaul of the entire system. AMNews spoke with AMA Immediate Past President John C. Nelson, MD, MPH, one of 15 nonvoting members on the panel, in advance of the commission's September report.

Question: There are three other physicians on this panel. Carol Berkowitz, MD, is the president of the American Academy of Pediatrics, Howard Weitz, MD, is a cardiologist in Philadelphia and John Rugge, MD, runs a network of community health centers in New York State. Why is it important to have physicians on the commission?

Answer: It's important for physicians to be on this commission because physicians are in fact the ones who take care of Medicaid patients. Also, Medicaid constituents are not organized, so there isn't a constituency per se. Poor people often don't vote, they're not banded together, so someone needs to speak on behalf of the recipients as well as the physicians who care for them.

Q: Why does Medicaid need fixing?

A: There were some really good ideas when Medicaid began about how to cover those who are poor, but it's disintegrated because of differences between the states. What we have now is a hodgepodge where eligibility in one state is different from another, the benefits package in one state is different from another, and you just don't know what you're going to get. What has also happened is that Medicaid for the first time this year in aggregate has surpassed the amount of money being spent on education by the governors. It's the single biggest ticket item they're paying for. If you look at the bang for the buck, we can save so much money by getting people into care earlier, by using clinical preventive services, and maybe even be able to prevent the very kind of diseases we're putting them in the nursing homes for if we're wise in the ways we use the system. I'm looking for a very, very in-depth discussion and a total overhaul of the system.