> At one point my physician was ordering lab work and kept asking if I wanted any additional lab work of my choosing and this just seemed absurd because on private insurance I would never consider lab work to be discretionary.
From your perspective that's great, but it's still another sign of the system being broken. As soon as you involve cash flowing between multiple entities, it just becomes a massive cash grab. The physician seemingly knew they could take advantage of your cover in that instance. That in itself seems problematic.
Note: I'm not from the US, so there's probably an aspect of Medicaid that I don't understand. We have a more sane healthcare system :)