Despite research that points out the negatives, some continue to root for Medicaid expansion.

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As the Obamacare debacle rolls on -- looking even worse than it did a week ago, if that's possible -- there's a separate but related issue involving Medicaid expansion. And, as with Obamacare, people who oppose the expansion risk being called heartless murderers for "denying sick people care."

The thing is, though, there's a difference between care and coverage. Insurance programs, whether Obamacare or Medicaid, only provide coverage. It's doctors who provide care. But because government insurance programs -- even money-sucking ones like Medicaid, which costs $450 billion a year -- can't pay doctors enough and smother them with paperwork, doctors are hard to find. Without doctors, coverage doesn't mean much.

That's the point of How Medicaid Fails The Poor, a new book by Forbes columnist and Manhattan Institute fellow Avik Roy. Coverage isn't care, notes Roy -- and in the case of Medicaid, coverage may be worse than not being covered.

That's because extensive research indicates that Medicaid recipients actually do worse than people without any insurance at all. A University of Virginia study found that Medicaid patients hospitalized for major surgery were actually 13% more likely to die in the hospital than those without any health insurance. Likewise, the National Cancer Institute found that late-stage prostate cancer, late-stage breast cancer, and late-stage melanoma were actually much more common in Medicaid recipients than in the uninsured. And a Johns Hopkins study of patients receiving lung transplants found that Medicaid patients were 29% more likely to die within three years.

What's more, a University of Pennsylvania study (published in the journal Cancer) found that colon cancer patients with Medicaid had a higher mortality rate than uninsured patients, and a higher rate of surgical complications. And these findings hold up even when you correct for age and socioeconomic status.

Why Medicaid recipients do worse isn't entirely clear, but it's likely because the best doctors seldom accept Medicaid, leaving patients with subpar physicians. In addition, Roy opens with the story of Deamonte Driver, a seventh grader with a tooth abscess who wound up dying when it turned into a brain infection, after being shuffled from doctor to doctor for weeks. Uninsured patients probably go straight to the Emergency Room or to a free clinic, while Medicaid recipients may waste precious days, weeks, or months trying to navigate the bureaucracy.

As Roy notes, people who have complained about Medicaid problems and argued against its expansion, like Connecticut Sen. Joe Lieberman in 2009, are called the equivalent of mass murderers. But on numbers like this, it's the Medicaid-boosters who are guiltiest.

Roy observes:

While Medicaid costs too much, its principal problem is that it doesn't make Medicaid patients healthier. It's not wrong to spend a large sum of money on health care for the poor. It is wrong to waste large sums of money on health care for the poor. ... Many conservative opponents of the Affordable Care Act are concerned that the law costs too much, that it represents too much government intrusion into the lives of ordinary citizens. But the law's true weakness is that it endorses and expands the humanitarian scandal that is today's Medicaid program.

It's not surprising that a government that can't build a working health insurance website can't run a massive health insurance program so that its beneficiaries actually benefit. What's surprising is that there's been so little push back over the awful results that Medicaid has yielded. It's as if the government "health care" boosters don't really care about the well being of the poor.

It wouldn't be hard to do better, relying on free markets and individual choice to take the place of bureaucracy. As Roy writes: "Start by paying a primary-care physician $80 a month to see each patient, whether he is healthy or sick. That's what so-called concierge doctors charge, and it would give Medicaid patients what they really need: first-class primary-care physicians to manage their chronic cardiovascular and metabolic conditions." On top of that, he says, add a $2,500 a year catastrophic plan to guard against financial disaster. "The total annual cost of such a program would be $3,460 per person, 42% less than what Obamacare's Medicaid expansion costs." And hey, it might actually leave its recipients' health better off, instead of worse off.

Is this the best solution? I don't know, but it's better than doubling down on failure, which is what both Obamacare, and the accompanying Medicaid expansion, are all about. I fear, however, that an approach like Roy's won't offer sufficient opportunities for graft and patronage to appeal to politicians. Worse yet, putting people in charge of their own health care might lead to similar approaches elsewhere, something that's our political class' worst nightmare. So as appealing as Roy's prescription is, I suspect we'll continue with business as usual. Which is too bad for the country, and for poor people who get sick.

Glenn Harlan Reynolds is professor of law at the University of Tennessee and the author of The New School: How the Information Age Will Save American Education from Itself. He blogs at InstaPundit.com.

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