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To the Editor.—
The recent American Academy of Pediatrics policy statement on Medicaid contains many practical ideas for reforming our current system. It was disappointing, however, that they didn't take the opportunity to address the responsibilities of pediatricians in creating equitable health care for all children.
It is not necessary to wait for a national health insurance to arrive or for Medicaid reimbursement to improve before we pediatricians can make a real difference. Those changes, although important, would likely still result in a 2-tier system unless we also make fundamental changes in our own approach. We seem to be saying that the only way to persuade more pediatricians to accept Medicaid patients is to fix Medicaid when we ought to be taking a harder look at what it means to be pediatricians.
It is past time for us as a group to acknowledge our own role in disparate health care and recognize that we ourselves are a resource for change. If all pediatricians in this country opened their office doors equally to all comers, without regard for ability to pay, imagine what we could do! Yes, the paperwork and red tape are beyond annoying, and yes, some who are not currently treating low-income families might see a significant drop in practice revenues (although it seems very unlikely that they would wind up with their own children on Medicaid and food stamps). However, no matter how much our incomes drop and how many administrative headaches we get, the cost cannot possibly be as great as the moral cost of failing to care for those in need.
In some communities, there is a perception that some private pediatricians have no duty to take Medicaid patients because there are clinics specifically set up to do just that. This is a grave error and will only serve to reinforce inequity and class lines. If we are ever to create a true "medical home" for every child, we all must be personally willing to welcome Medicaid patients on an equal footing with those who have private insurance.
Equitable health care within our national borders is just the bare beginning of what we have the potential to do; it is becoming more and more clear that our call to heal poverty and its illnesses must extend to the global community. In the face of such need, we don't have the luxury of time to wait for the slow machinery of politics to solve our problems of access here at home.
We need the American Academy of Pediatrics to take a strong leadership role and clearly state the responsibilities of its members. When the poor are voiceless, invisible, and powerless, we who have influence and visibility are obligated to speak for justice. When we fail to do so, we compound their suffering.
REFERENCE
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