In 2015 I published a book called The ObamaCare Reality. In addition to exposing the flaws in ObamaCare, I also discussed the flaws in Medicaid.

It has always been postulated that the uninsured are more likely to use Emergency Rooms for routine healthcare than those with insurance. But research has proven this assumption to be false.

In 2008, the State of Oregon was faced with a dilemma. They wanted to expand Medicaid eligibility to more residents, but they didn’t have enough money to pay for everyone. So, they held a lottery for low-income uninsured adults. Winners in the lottery would get Medicaid and the losers would go uninsured. This created an ideal situation for studying the impact of Medicaid in a randomized, prospective manner.

This study, now known as The Oregon Health Insurance Experiment, has revealed many surprising conclusions about the impact of healthcare insurance. Thus far, the researchers have learned that having Medicaid does not improve health, at least in standard measurements of blood pressure, blood sugar, and cholesterol. Medicaid reduced observed rates of depression by 30% but increased the probability of being diagnosed with depression. Medicaid significantly increased the probability of being diagnosed with diabetes and the use of diabetes medication, but did not have the expected impact of lowering blood sugar. In other words, Medicaid had no impact on actual healthcare outcomes.

But the real surprise was the impact on Emergency Room usage. The Oregon study showed those with newly enrolled Medicaid were 40 percent more likely to use the E.R. than the uninsured! Medicaid expansion actually increased Emergency Room visits. A report from the Colorado Hospital Association published in 2014 confirmed the same findings. They reported that in states that expanded Medicaid, E.R. visits increased 5.6%, while in states without Medicaid expansion E.R. visits increased only 1.8%.

Why does expanding Medicaid increase E.R. visits?

John C. Goodman, in his book Priceless, said having Medicaid may actually be worse than having no insurance at all. That’s because most doctors do not accept Medicaid patients, and the ones who do often ration their appointments making waiting times very long. Many doctors are listed in directories as accepting Medicaid patients, but in actual practice they don’t. Medicaid patients are forced to respond by going to the Emergency Rooms where they are sure to be seen the same day.

This reality of poor access to healthcare by Medicaid patients was dramatized in a recent Wall Street Journal article by Christopher Weaver, Anna Wilde Mathews, and Tom McGinty. They say, “Private Medicaid insurers dominate the government healthcare program that covers more than 70 million low-income and disabled Americans. But when Medicaid-plan enrollees need care, they often can’t get appointments with the doctors listed in those insurers’ networks.”

A Wall Street Journal analysis of state and federal data showed that the networks of doctors that insurers listed for their Medicaid members are less robust than they appear. Some doctors are erroneously shown in states or cities where they don’t actually work. Others won’t book appointments for Medicaid patients, who typically are far less lucrative than those with employer coverage. Some medical practices limit slots allotted for Medicaid visits, or simply won’t take new Medicaid patients.

To assess private insurers’ Medicaid networks, the Journal compared the insurers’ lists of providers with records of Medicaid care provided across 22 states in 2023. The analysis found that more than a third of the doctors listed in the networks didn’t treat the insurers’ Medicaid patients that year.

This confirms what I said in my book ten years ago. The uninsured actually have greater access to health care. The reason is the uninsured can choose any doctor they wish and usually pay cash at a discounted rate wherever they go. Medicaid patients do not have the same option since taking cash from a Medicaid patient is a violation of the law that threatens a doctor’s license. The Medicaid patient then resorts to the E. R. for healthcare they can’t wait any longer to receive.

Here is a graphic published in the WSJ that shows specialists listed in Medicaid networks and the likelihood of them actually treating a Medicaid patient:

The government shutdown appears to be ending, but why did it happen in the first place? On October 13, I published a post entitled Schumer’s Government Shutdown. In that post, I stated four reasons for the shutdown:

• Protecting healthcare for illegal immigrants
• Protecting expanding Medicaid eligibility
• Promoting socialized medicine
• Protecting Chuck Schumer’s political future

At this point, it appears all of these objectives will fail. The Democrats were unable to get concessions on any of the above goals and Chuck Schumer’s political future looks grim. But the main talking point that seems to be on the lips of Democrats is their failure to make permanent the ObamaCare subsidies that are slated to expire on December 31.

These subsidies were only supposed to be temporary, enacted to help struggling families cope with the Covid pandemic which is long since over. Although Democrats knew they were temporary, they now insist they be made permanent. This issue will continue to be debated long after the government reopens.

What are the flaws of ObamaCare that continue to require government assistance?

ObamaCare was passed by Congress in 2010 without a single Republican vote. Numerous promises were made by President Obama about how it would lower healthcare insurance costs and preserve choice of physicians. All these promises have been broken. The costs of ObamaCare continue to rise, which is why Democrats want the government to pick up the tab rather than the people. But throwing good money after bad is never a good idea. What is needed is healthcare reform, not more government subsidies.

The first thing wrong with ObamaCare is the requirement that all plans must provide “essential minimum benefits.” In a one-size-fits-all debacle, all ObamaCare premiums must provide things like free mammograms and free prostate exams to everyone. In other words, men are paying for women to have mammograms and women are paying for men to have prostate exams. This unnecessarily raises the cost of everyone’s premiums.

Second, ObamaCare has a feature called “medical-loss ratio” that obliges insurers to spend 80% of premiums on claims, which in practice is a profit cap that has driven industry consolidation. Fewer insurers means less competition which means higher premiums. The rich insurance companies get richer and the poorer ones go out of business.

Third, ObamaCare will not allow you to tailor your insurance plan to your specific needs. If you only want minimal coverage because you’re healthy, you still have to pay for a plan that covers everything. If you only want coverage for a limited time, because you may be covered by another plan, you still have to pay for a full year.

Fourth, ObamaCare encourages Americans to stop working. In a recent social-media post from Democratic Sen. Amy Klobuchar of Minnesota, she complained if Republicans don’t extend the turbocharged subsidies, she warned, “early retirees like Bill & Shelly will see their health insurance premiums increase nearly 300%—from $442 to $1,700.” This is a tacit admission that ObamaCare encourages Americans to stop working. The Biden subsidies turbocharged that incentive by making subsidies larger and available even to those with income above 400% of the poverty line. Do taxpayers – many of whom pay for their own coverage at work – want to underwrite baby boomer early retirement?

The Wall Street Journal editorial board says, “ObamaCare passed 15 years ago, and it’s still a product few deem worth buying unless they’re protected from the cost. The political and media ground have changed in the past 10 years, and an underappreciated question of the shutdown is whether the GOP will re-enter the debate on healthcare—and go on offense on ObamaCare’s failures.”

The Democrats will fight this because they fight everything President Trump does, but also because this is their legacy legislation intended to push the country toward total government control of healthcare – socialized medicine. But just as socialized government leads to loss of freedom, so does socialized medicine. In every country where it has been tried it has led to limited access to healthcare, rationing of healthcare, and complete denial of healthcare to the infirm, elderly, and disabled. That’s not what Americans want or deserve.

British Prime Minister Winston Churchill famously said in 1941 at the beginning of World War II, “Never give in, never give in, never, never, never, never-in-nothing, great or small, large or petty – never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.”

This lesson from the dark days of WWII apply well to every endeavor in life. Whether facing an enemy invasion, the treatment of life-threatening disease, or just the challenges of every day living, Churchill’s words are a good reminder when you find yourself losing hope.

The Los Angeles Dodgers might have lost hope in the last days of the recently completed World Series, but they didn’t. It’s doubtful that the words of Churchill were on their minds, but his lesson was embodied by their persistence in the face of mounting odds as they faced the last two games of the series, down three games to two to the Toronto Blue Jays and needing to win two games on the road.

After winning an exhausting, record breaking 18 inning Game Three, the Dodgers lost Games Four and Five and found themselves facing elimination as they returned to Toronto for Game Six. The odds of winning those last two games away were high, but not as high as the hurdle they faced in the bottom of the Ninth inning of Game Six. The Dodgers were winning 3-1, but the Blue Jays put runners on second and third with no outs. A single would tie the game and a home run would win the game and the series for Toronto.

The Dodgers brought in reliever Tyler Glasnow who ended the inning and the game in just three pitches. The first pitch produced a pop-up to the first baseman. Two pitches later a broken-bat blooper to left field looked to be a hit that would tie the game, but left-fielder Kike Hernandez got a good jump on the ball, made the catch and then threw out the runner on second who had expected the ball would fall in for a hit. Game over; Dodgers win and the series goes to Game Seven.

Game Seven produced an even more dramatic ninth inning. With the Blue Jays leading 4-3, and needing only two more outs to win the series, Miguel Rojas of the Dodgers hit a line drive homer to left field to tie the score, his only home run of the series.

But in the bottom of the ninth, the Blue Jays filled the bases with one out, needing only one run to win the game and the series. The situation looked hopeless for Dodgers fans. Dodgers’ manager Dave Roberts then made two strategic moves. He brought in ace-pitcher Yoshinobu Yamamoto, even though he had pitched Game Six! He also substituted Andy Pages into center field for defensive purposes.

Yamamoto got Daulton Varsho to hit a sharp grounder to second base and Rojas made the play, throwing off-balance to home plate to just nip the runner who would have brought in the winning run. The next batter, Ernie Clement, had just set a single-postseason record with his 30^th hit earlier in the game. Clement sent a long fly ball to left center that was over the head of left fielder Hernandez, but center fielder Pages leaped high and caught the ball just before it hit the wall, ending the inning. It is likely regular center fielder Tommy Edman would have been too short to reach that fly ball. The Dodgers were still alive.

The game would go on to the 11^th inning when the Dodgers Will Smith hit a home run to take the lead. But Blue Jays star Vladimir Guerrero, Jr. led off the bottom of the 11^th with a double and was sacrificed to third. After a walk to Addison Barger, Alejandro Kirk came to the plate with two on and only one out. The Blue Jays would tie the game with a hit and win with a home run. Kirk had been a thorn in the side of the Dodgers the whole series.

But Kirk hit a broken-bat grounder to shortstop Mookie Betts who started a double-play that ended the game and the series, giving the defending champion Dodgers their second World Series championship in a row. Despite a seemingly hopeless situation, the Dodgers had prevailed once again. They Never Give Up!

Author’s Note: For more on this historic Game 7, read Tyler Kepner’s New York Times article Why the Dodgers and Blue Jays just played the greatest Game 7 in World Series history.