Those interested in the failings of the U.S. health care system would do well to read Richard Pérez-Peña's long piece on Medicaid in the New York Times today. It touches on a theme mentioned often around here; that the system is so complex that many eligible families don't even know that they're eligible, or can't sign up easily. Obviously, states experiencing budget crunches have every incentive to throw up hurdles to prevent people from enrolling, and the burden falls disproportionately on the poor. The proposed cuts to Medicaid by Republicans in Congress will make a bad situation even worse. Ultimately, this is a problem that can only be fully corrected by a truly universal health care system that doesn't try to exclude those just over the income threshold. (That would also remedy another problem mentioned: doctors often shy away from Medicaid patients, because they don't get paid as much for treating them.)
Pérez-Peña also notes that many poor Americans, even those insured by Medicaid, don't necessarily have good access to care, either because low-income communities are underserved or they lack information, suggesting that improvements along these lines could go a long ways. This point often gets overlooked. Good health involves more than just having insurance, especially in poorer areas, and health-care policy can and should focus on the broader aspects here: prenatal and postnatal care in low-income communities, neighborhood public health clinics, better child health screening in schools, health care education and mentoring. Providing insurance to those who need it is really just the start.