Read this LA Times article by Jason Felch about emergency room closures and you may notice a couple of words conspicuously absent.
Los Angeles County, which has lost six emergency rooms in a little over a year, is on the brink of a far more serious problem, facing more closures that could jeopardize emergency care for tens of thousands of residents, according to public officials and independent analysts. ...And who are these people? Hmmmm... could it be that illegal immigrants are overburdening our health care system? The Times gives us no clue, and mentions very few dollar amounts -- Good Samaritan Hospital's emergency room losing $10 million per year, Downey Regional Medical Center losing $2 million. According to a Mercury News article by Dan Stein from last year, though, illegal immigration costs Los Angeles County $350 million in health care costs alone. As Mr. Stein points out, "The inescapable conclusion is that California is being bankrupted by cheap immigrant labor."Public officials and some healthcare economists warn that further closures of large emergency rooms could set off a chain reaction. As uninsured patients move from closed emergency rooms to others that are already under financial strain, those facilities too could close. ...
Several factors have contributed to the problem, but the overwhelming one, according to hospital officials and healthcare economists, is the weight of the county's huge population of people without health insurance, who account for 1 in 3 emergency room visits.
Instead of addressing this significant cause of ballooning health care costs, Mr. Felch reports that a group of doctors is proposing a tax increase.
Hospital officials have been warning of a crisis for the last 15 years, and have used the issue to gain support from the state and federal governments. An initiative on the November ballot supported by doctor groups would impose a 3% surcharge on telephone bills to pay for additional emergency services and other health costs.Well, that would be better than an income tax, I suppose, but still. Meanwhile, the California legislature wants hospitals to pass the costs on to their paying customers.
The state Assembly on Monday passed a bill that will limit the amount hospitals can charge the uninsured.This despite the fact that uninsured patients will often simply disappear or declare bankruptcy to avoid paying the bills. Hospitals can't demand payment up front before providing care, so they're essentially forced to finance the costs of the uninsured. This means hospitals are assuming the risk that they won't ever get paid, and they have to factor that risk into the prices they charge. If the governor signs this bill, these costs will get passed on to all health care consumers through higher insurance premiums -- basically, the insured will pay more so that their insurance covers the risk of the uninsured. It's basic economics.Hospitals have been under fire because they often charge uninsured patients much more than patients who receive similar care but have health insurance. The practice has been standard among hospitals across the country, leaving many uninsured patients stuck with large bills they cannot pay.
If signed by Gov. Arnold Schwarzenegger once it arrives on his desk later this week, the measure, SB379, will be the first of its kind in the nation. It will force hospitals to bill the uninsured at rates that are comparable with those paid by the government for Medicare, Medi-Cal or workers' compensation.
(HT: Rough & Tumble.)
My best friend is a doctor and I asked him why uninsured people get charged more. He said what happens is insurance companies work out deals with hospitals that say they will pay 80% of the normal cost of the procedure. So the hospital raised the cost by 20% to insure they get what they want.
The reason uninsured people don't get the 80% rate is because the insurance companies check to make sure they are really paying 80%. So the hospitals have to charge more to the uninsured.
Its yet another weirdness in the medical business.
It seems like it would be a good thing to simply not take insurance, not subsidize emergency rooms, and for hospitals to, instead of closing them, simply rent out the space to somebody else who would run them.
Cross-subsidization and third party pay is a horrible burden on our healthcare system. If refusal to pay means you're treated like somebody refusing to pay at a restaurant or other establishment (ie, you either have to work it off or get arrested) people who made adequate advance preparations wouldn't have to suffer the closure of emergency rooms, closures which endanger their health.
A large problem is that emergency room treatment is both expensive and mandatory. If the people who drop by the emergency room at 2AM to get stomachache medicine could be told to go 2 blocks to a pharmacy for antacids and a private practice appointment the next day for $70 instead of using up $400 in the emergency room, you'd save a great deal of money.
The other half of the equation is also not being addressed. If the ER did indeed send someone "to go 2 blocks to a pharmacy for antacids and a private practice appointment the next day", then there is a possibility that they will be sued heavily when something really does go wrong. ERs have to be able to show that they made a legitimate effort to determine the problem. The pateint thought it was an emergency. Because of the nature ot the tort system, this usually entails more service then would be recieved from a routine doctors visit.