Medicaid was never designed to be a public option, but it’s quietly become one. In this episode of The Doctor’s Lounge, we unpack how backroom policymaking, academic bias, and political cowardice converged to turn a safety-net program into a bloated, unsustainable entitlement.
We begin with the truth about work requirements: far from being cruel, they’re modest, fair, and rooted in precedent. Yet outrage ensues—not from data, but from ideology. We dissect a recent NBER paper that claims “Medicaid saves lives” and expose the academic sleight of hand behind it. Spoiler: correlation is not causation, and issuing someone a Medicaid card doesn’t magically improve their A1C.
We dive into the real-world impact—physicians in San Francisco are seeing five-year wait times for cataract surgery. Primary care access? Six months. Meanwhile, private care gets faster, better, and more expensive—all by design. This isn’t accidental. It’s policy.
Medicaid’s rapid expansion, especially in states like California, where eligibility reaches 400% of FPL, is creating a two-tiered system: one for subsidized votes and one for everyone else. And buried beneath it all is a crowding-out effect that punishes the truly vulnerable—pregnant women, children, the disabled—by rationing care in the name of equity.
“You treated the patient. They got the check.”
That’s how the game works now.
Watch the full episode and judge for yourself.
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