The U.S. Government Accountability Office (GAO) recently put out a remarkable report on how state governments fund their share of the Medicaid tab.
In 2012, the most recent year for which numbers were available, states were getting about 40 percent of "the states' share" of Medicaid costs by taxing physicians, hospitals and other health care providers.
In other words: Medicaid programs pay doctors and hospitals poorly to provide care for Medicaid plan enrollees, and then get much of the little money Medicaid providers get…from health care providers.
In other words: When the states get money to pay for Medicaid, they are a little like robbers who charge homeowners for the crowbars needed to break into the homeowners' homes.
And yet we're supposed to be celebrating because the Patient Protection and Affordable Care Act (PPACA) Medicaid expansion has sharply reduced the percentage of people who have no coverage whatsoever.
On the one hand: Personally, I want someone, somewhere, to pay for decent health care for everybody. I respect libertarians' argument that government involvement reduces the efficiency of the health care and health finance systems for almost everybody, even poor people and sick people.
But, on the other hand, before we enter state of free-market bliss, we have to do something for the people who are sick today.
On the third hand: Pretending that we're providing real health coverage that can pay for real health care, if we're not really doing that, is not good for anyone, other than for people who write happy reports about the uninsured rate falling.
