Over the past few weeks, there has been talk both of funding infrastructure projects and defunding Medicaid, at least in part. I recently saw a patient who reminded me that Medicaid itself provides an essential kind of infrastructure.
His black beard pointed stiffly down his chest. At the middle of his sternum, it flowered out into plastic beads, strung on the dozens of rosaries he wore about his neck. Red, yellow and green beads flashed as he yelled, "Go, go, go on, and get me out of here."
A few years ago, before the expansion of Medicaid, we would have. We knew that if this patient stayed in the hospital, we could extinguish his mania and treat his acute injuries. We also knew that extended hospitalization was futile without access to ongoing care as an outpatient, so we often gave patients like him the green light for discharge.
He was homeless, mentally ill and uninsured. Back then, the last of those problems often seemed the most insurmountable.