Smart observers of health care policy have always known that access to a government program is not the same as access to medical treatment. Today's Wall Street Journal tells a story from a decrepit Michigan town that illustrates that point.

Benton Harbor has been in sad straits for as long as I have known anything about Michigan. According to the U.S. Census Bureau, the city's population has decreased 17 percent since 1990. In 1999, its median family income was $19,250, far below the state figure of $53,457. (I suspect that both numbers have gone down since then).

In other words, it's the kind of city that Medicaid's acute care program was made for.

But according to the Journal, residents are having a hard time finding medical care. Why? The reimbursement rates are so low that many doctors find it not worth their trouble to take on new Medicaid patients.

As a result, one teenager profiled in the story had to wait three months to find a specialist in her ailment. The Journal notes that "on paper, Medicaid coverage is real insurance," but the girl's mother has a different opinion: "When we had real insurance, we could call and come in at the drop of a hat."

A report from the Center for Studying Health System Change, cited by the Journal, found that "about one-fifth of physicians (21 percent) reported accepting no new Medicaid patients in 2004-05-a rate six times higher than for Medicare patients and five times higher than for privately insured patients."

The number of doctors in the state who accept new Medicaid patients dropped from 88 percent in 1999 to 64 percent in 2005

What then, does the state's governor propose doing? Expand the rolls by 500,000, which should ... spread the meager payments even thinner, and make it harder for current Medicaid beneficiaries to find treatment. The implosion of the auto industry - - something driven in part by bad choices in health care coverage - - only makes things worse, to the point where one in five Michiganders are either without insurance or are on Medicaid.

So shouldn't the state simply pay more money to doctors? That isn't a great long-term strategy if the system remains as it is. Many other items compete for state budget money, and health care cost inflation is self-perpetuating the more disconnected the patient is from the money spent on treatment.

Two years ago, this blog's Michael Bond suggested another way (PDF).