California’s Separate and Unequal Healthcare System and How Sacramento May Only Be Making It Worse.


Article by Paul Y. Song, MD


Over the past two years, there have been countless tragic stories about the separate and unequal nature of Medi-Cal (California’s Medicaid system). These reports have highlighted numerous disadvantages, overall difficulties, financial hardships, and outrageous delays that far too many Californians and especially those from communites of color face.


From excessively high amounts of amputations at MLK Hospital due to uncontrolled diabetes, to unreasonably long wait times to see specialists with some patients dying, to layers of private insurance company profit through skimping on services, the stories have demonstrated how Medi-Cal is an apartheid system.


California’s Medi-Cal reimbursement ranks 48th out of 50 states as per the Medicaid Fee Index and pays California physicians and hospitals half of what Medicare pays. Because payments are so low, very few doctors and hospitals serve the nearly 13 million enrolled Californians. In fact, some disadvantaged communities have ten times fewer doctors than more affluent cities. And a 2015 survey found a ratio of only 39 full-time primary care doctors per 100,000 Medi-Cal patients.


As a former oncologist, I have witnessed and participated on both sides of this unequal system. When I practiced at Cedars Sinai in Beverly Hills, I treated few, if any Medi-Cal patients. But, when I practiced at Dignity California Hospital in downtown Los Angeles, I treated mostly uninsured and Medi-Cal patients. In fact, a 2021 Lown Institute report found MLK Hospital received 75% of its total patient revenue from Medi-Cal versus 10% for Cedars Sinai. And 94% of patients treated at MLK were of color, but only 36% at Cedars Sinai.



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