mentioned below, I think there's also a reimbursement rate issue.

I have a good friend who is part of a concierge practice. The vast majority of his patients have medicare as their primary insurer. He says that the medicare reimbursement covers their overhead. It's the annual fee that pays him and his partners their salary. Now admittedly, he runs a "concierge" practice, so they maintain a much smaller patient pool which would not be viable on medicare reimbursement alone. He'd have to increase his patient load by 2-3x (basically churn patients in and out each day) to earn a decent living on just on medicare reimbursement. I can see people not being drawn to that.

Now I realize the discussion is around medicaid, not medicare, but I assume they operate with similar reimbursement schedules.