Ounce of prevention?

August 20, 1991

Governor Schaefer's startling assertion over the weekend that he will move to require welfare recipients to undergo mandatory physical checkups before allowing them to qualify for Medicaid sounds like a ringing endorsement of preventive medicine -- which it is. But like a lot of things that look good at first glance, there's also a catch.

The rationale for the proposed policy change is straightforward enough: Since many long-term illnesses and their financial burden on taxpayers could be reduced if periodic physical examinations detected problems early, the state could save substantially by requiring welfare and Medicaid recipients to undergo annual checkups.

Schaefer said he wants to encourage poor women to get regular mammograms, Pap smears and prenatal care and to immunize their children. In addition, he would require welfare users with drug and alcohol problems to enter treatment programs before becoming eligible for Medicaid benefits.

That makes a lot of sense under the general principle that an ounce of prevention is worth a pound of cure. The new policy could significantly reduce state Medicaid payments over the long term. But now the catch: How do you, in effect, force people to get regular checkups?

For example, Schaefer says new applicants for Medicaid would have to show proof they had visited a doctor before being accepted into the program. That sounds fine, except what happens when someone who is too poor to afford a checkup by a private doctor applies for Medicaid and is told: "Of course the state will help you with your medical bills, but first you have to get a checkup from a private doctor!" That is the classic double-bind -- or "Catch-22."

The governor says these are all minor details to be worked out, and indeed we hope they can be. But if the new policy is as much cost-saving strategy designed to hold down soaring medical costs for the poor as public health innovation, then clearly there is a risk it could work exactly the opposite as intended and actually discourage poor people from applying for Medicaid. We fear there is potential for a good deal of confusion here unless state officials proceed with utmost caution.

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