Friday, June 06, 2008

If You Don't Pay They Will Close

The old Gray Lady stumbles upon another story of why the Cenurbs are toast and procedes to mangle conclusion. So, what's new? Hospital emergency rooms have been closing all over the Southland for more than a decade. For years they have been a secret subsidy of the urban milieu but that became an unaffordable luxury as it drove health care costs for paying customers out of reach.

Here's the NYTimes:
“You call an ambulance and you think you’re going to St. Francis and they say it’s full,” said Denise Provost, whose largely untreated asthma routinely sends her to the emergency room. “So they take you to Kaiser. If that’s full, then it’s Long Beach. You go way out of your way.”

The vast majority of residents in central Los Angeles are uninsured or are on the state’s Medicaid program — known as Medical — which offers the lowest reimbursement rates in the nation, and a growing population of illegal immigrants who are not eligible for government insurance have flooded the ranks of the uninsured.

Gov. Arnold Schwarzenegger, a Republican, has proposed another 10 percent cut in the state’s Medicaid program to balance the state’s budget while Congress contemplates a host of reductions to the program that, if approved, would mean $240 million less for Los Angeles.

Los Angeles County’s health department, the provider of last resort, is sagging under its own budget woes, and it adopted complex patient-transfer policies that have shifted an increasing number of its indigent patients to private hospitals, which are in barely better financial shape.

Roughly 14 percent of the nation’s uninsured live in California, and one in three visits to a Los Angeles emergency room are made by someone without insurance. Many of those patients have conditions that have gone untreated for months and need to be admitted, further straining hospital resources.

From 2000 to 2006, the number of Medicaid-covered patients using the South Los Angeles hospitals on Medicaid increased 18 percent and the uninsured ranks rose more than 20 percent, while patients with commercial coverage fell 20 percent, according to the hospital association’s figures.

As a result, many hospitals in the South Los Angeles area are unable to stay afloat, and centers that once served 100,000 patients here have closed.

I have two phrases for the policy makers to consider as the struggle with the problem of their own construction: "attractive nuisance" and "economic disincentive." There's no mystery here except why anyone is confused over the situation.


Jean ValJean said...

FIRST to say... umm.. not really sure what the first phrase means.


Oil Bubble?

Max said...

Oh, Dawg, don't be so naive! Why would the country agree to nationalize medicine if coverage was effective for the majority. Sometimes you have to break a few eggs, you know.

Rob Dawg said...

An attractive nuisance is something that induces people to behave badly because the opportunity is too compelling to resist. The classic legal example is an unprotected pool in plain sight where children might drown. Were it not for the availability of free local health care many poor and indigent and possibly illegal people would not behave or reside as they do.

And oh yes, most certainly there is an oil bubble. I was saying previously that all those $135 futures contracts for Aug were in for a surprise when no one actually wanted them for delivery. End users are just not going to pay that much. Look at the inventory build up and declining VMT for but two indicators.

Peripheral Visionary said...

It's long past time to close the mandatory ER care loophole.

The question, of course, is who will provide emergency care for the desperately poor if the hospitals aren't required to? The answer is: the hospitals will, voluntarily, through their charitable service arms, with the money they save from not having to provide a full range of free services to every uninsured person who walks through the door. Is it so completely inconceivable that organizations, most of them nonprofit, could voluntarily provide charitable services?

The problem is that there is now a perception that the government will take care of the poor, so there is no need for the charitable sector to do so. There are a few private homeless shelters and soup kitchens holding out, but the vast array of privately funded charitable services from the pre-New Deal era have all but dried up, replaced by faceless, impersonal government agencies and for-profit institutions. Hospitals once provided free healthcare to the poor (why do you think so many of them were founded by religious institutions?), but now that the government is in that particular business, they have gotten out of it--or rather, have tried, but failed, to get out of it.

Peripheral Visionary said...

P.S. The healthcare system, particularly in places with large numbers of the uninsured, is headed for serious problems. Keep an eye on Las Vegas and Phoenix, the healthcare systems in both cities are near the point of collapse.

soem dood said...

Seems like similar thinking right here:

Malone's room for the past three months, along with three meals daily, have all been paid for by taxpayers.

"Do you work?" asked NBC 15's Andrea Ramey.

"No. I'm not working right now," said Malone.

Malone says she can't drive and it's too hot outside to find work within walking distance. "Since the storm, I haven't had any energy or pep to go get a job, but when push comes to shove, I will," said Malone.

Casey Serin said...

Oil rises almost $10 in one day because a lone Morgan Stanley speculator said it might reach $150/bbl in a month. Unbelievable...

... another light, sweet, crude deal. :-p

Property Flopper said...

"all those $135 futures contracts for Aug were in for a surprise"

Well, just went over $140. There is a bit of a bubble forming from speculation, but oil isn't going out of style. I seriously expect > $200 / barrel and $8 / gallon within three years.

Centipede said...

Illegal immigrants are flooding the hospitals in my area as well. To mitigate the situation the local government has created a lower cost preventative health care facility in the area that was raided by Op Return to Sender. As long as Californians keep their heads in the sand over illegals, I think preventative care is a more economically viable solution. For example, it is utterly ridiculous how many emergency hospital visits involve nothing more than some woman having a baby. A relatively inexpensive contraceptive patch would be a far less costly alternative. However, Arnold’s H&HS budget cuts directly affect these facilities. At some point, Californians need to get real and understand that one can’t have it both ways. "Cheap" illegal labor isn’t so cheap when it comes to the medical and prison systems.

Lou Minatti said...

We'll have nationalized medicine within 2 years.

Zintradi said...

a lot of this is the false perception that health care is just too expensive, or that you can not go to the doctor if you do not have insurance...

take the lady with asthma for instance... I'm sure in a city as big as L.A. there is a network of free or low cost clinics with doctors that volunteer that could prescribe her generic medication that wall mart sells for cheap...
is it the latest breaking BEST medicine? NO, but will it keep it under control and her out of the ER? YES...
Up here in seattle, I have several friends that bemoan how expensive it is to see a doctor, but don't even think to be a little resourceful in HOW they get care. Free clinics, negotiating a self pay, payment plans, or "gasp" saving money in a health savings account if you don't have insurance... even if you could scrape together $50 a month to go into one of those accounts, it would help.
there's ways around other than completely throwing in the towel and going with a government run solution where nobody except the truly elite can get exceptional care.