For instance why is that someone on say Kaiser for example tends to get appointments faster and at (usually) way nicer facilities in nicer parts of town than say somebody on Medi Cal
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I work in healthcare so here’s a good behind the scenes for at least my state.
We set the minimum rates to pay for something. Let’s call it $1000 a day for that service. The managed care organizations (insurance companies) decide they want to have a leg up getting appointments for their insurees, so they pay $1150 a day. By law, we’re not allowed to ask them what they pay for the service. We just give them a whole bunch of money to manage Medicaid, and they go do it.
Now, in a lot of urban places there are multiple insurance companies competing for these slots. The free market idea here is that competition breeds healthy reimbursement for providers. What happens though, is Medicaid sets the bare minimum rate for something to be acceptable. Now private insurance companies (who often have Medicaid divisions) offer to pay $1750 for that same service. They pass the cost onto the companies or individuals who buy the insurance, so there’s no negative change to their earnings for that service to be more “expensive.”
This is where private insurance ends up being a lot more expensive for individuals in the long run, compared to a public health option. I don’t have the number in front of me because I’m not a robot, but it’s something like 1.2-1.3 times more expensive for a consumer to have private insurance in general, and that’s excluding things like major surgeries or births. Because for Medicaid, we guarantee no co pay and no cost sharing. So for me to get a surgery, it’s $11k on my admittedly good state employee health plan. For my cousin who works at Costco it’s $30k. If I had a foster kid, it would be free to me because all fosters are on Medicaid.
Tldr: some doctors won’t take Medicaid unless they get an incentive to do so, meaning they have a more exclusive clientele.
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