HOSPITALS: Hospitals on the verge of a nervous breakdown

Sorry, so the title is another bad attempt to be imitate an old Spanish movie but the problem is real enough. If the formula is, increase the number of jobs available without insurance, add more people moving into a county without regular  access to physicians, reduce the number of community clinics, and limit the amount of services at county hospitals, then the result will be more and more people showing up in the ER at other local hospitals. And of course if this is in LA County, all those problems are going to be magnified. The study claims that at "40 private hospitals reporting jumps in
emergency room visits by the uninsured, the cost of caring for them
rose from $63 million in 2000 to $77.5 million in 2004."
So amazingly enough, the health care system for the people at the bottom appears to be connected to the one for the rest of us? Who’d have thought it, in this day and age when there are no social problems, no issues with inequality, and we’re all happy in Arnie’s golden state?

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  1. I know this is a healthcare related, I would like to see it stay that way, but I just have to address Paul Martin’s political comment. Campaign contributions are a form of speech, no different than buying a billboard, print space in a publication, or TV spot supporting/denouncing a position. You spend money to get your message out.
    Thanks to the internet, this last election cycle proved that so-called “Corporations” aren’t the only ones throwing their money around. It is kind of naive to believe that “corporations” are the evil empire that causes all of this country’s ills. May I remind you that other large contributors include Unions and lawyers. In a democracy, everyone is a special interest group. Being self-righteous about your cause is noble, but don’t be holier-than thou and think that only one group has a monopoly on truth.

  2. Hi Matt –
    Don’t know whether you’ve visited this topic here in the past, but I’d like to call attention to something as close to the root cause of America’s healthcare problems as I’ve been able to find: the 1976 Buckley v. Valeo Supreme Court decision, which equates unlimited spending on behalf of political candidates with “free speech”.
    Money has been talking with a megaphone ever since. Corporate money buys the politicians we get to choose from. It purchases the sort of legislation that allows boilerplate health insurance policy language to explicitly state that your health insurance’s medical director can overrule the treatment decisions of your doctor.
    In case people haven’t noticed, this isn’t much of a democracy anymore. Washington chiefly represents corporate interests, not “we the people.” Frankly, I don’t know that anything can be done to turn the ship of state around. It’s massive.
    The National Voting Rights Institute in Boston, MA http://www.nvri.org is at the forefront of trying to remedy Buckley v. Valeo, as well as other issues social and political injustice.

  3. There are also hospital staff without medical insurance in California.
    I had to go to a retina specialist for an eye problem last year, and the assistant who did the angiogram told me that her job didn’t have any health insurance. The office of the retina specialist was part of Summit medical center, and I’m sure she wasn’t the only assistant in the building with those terms of employment.
    I also applied for work in a doctor’s office about 10 years ago. It paid $7/hr. in Manhattan. Nurses were extremely low paid until recently: I have an aunt who is a nurse, and she racked up a lot of education debt and then cried when she got her first paycheck. I always thought that people couldn’t earn a living wage in health care. At Kaiser, however, managers in “business” or “IT” areas make more than the doctors do. It’s depressing to think how the profits get distributed in corporate health care.
    Perhaps education debt is something to think about, too. I know that when Berkeley justifies fee increases for the professional schools (law, business, etc.), administrators assert that professional graduates will be able to support the debt because their professional degrees will enable them to command huge salaries. Professional schools and government agencies have had to set up debt forgiveness programs just to enable some of their graduates to work in the public sector. With an enormous burden of debt, students are driven to seek out high paying jobs at a time when their skills are entry level. If their entry level pay is high, their raises as a percentage of their initial pay will be higher.
    On the other hand, if professional education did not foster huge debts, then more students would apply for medical school, and society would end up with better doctors through competition based on merit. The financial rewards would still be higher than non-professional work even if salaries dropped to respond to the decreased debt pressure on job applicants. At the same time job applicants would be able to take other issues into consideration besides salary. As people take lower paying job, the “market salary” set by HR departments would drop across the board.
    When I worked for Kaiser, one of the saddest things was hearing doctors frequently voice the regret that they went into medicine. Many doctors felt like their work was highly routinized, with short overbooked appointments – they spent more time documenting than doctoring, and their skills were being undercut by automated diagnostic tools. Many doctors wanted to get into IT where they could get the cushy management jobs and engage in get-rich-quick schemes. Most thought they should have gone to school for computer science. This was sad in light of the fact many of the consultants, who were being paid $150/hr. and up, had not gone to school in computer science. They were just people who taught themselves some programming and socialized their way into good jobs at consulting firms. So the doctors were more trapped by the investment they had made into their medical degrees than their actual technical skill level. This is the saddest thing about society in general I think: when people see parasites, they want to join the parasites because that’s where the money is to be made.

  4. It’s amazing how hospital assume this veil of poverty, yet continue to make health profits. In S. Fla one major hospital system (Baptist Health Systems, having a monopoly on half the county) pleads poor in reference the number of charity care, and bad debt write off ($91m in 2004). A few weeks earlier, in the South Florida Business Journal an article discusses the profits hospitals make. Baptist Hospital is at the top of the list. As HMO’s profit margins sunk in the early 00’s, hospital profits continued to increase. In fact, Hospitals in South Florida make more money than all the HMO’s combined in the State. In 2003, Florida HMOs posted net income of $478.9 million, or 3.5% of premium revenues. South Florida hospitals reported $514.9 million in net income, an average of 6.9% of revenues. http://www.allanbaumgarten.com/index.cfm?fuseaction=dsp_report&state=fl
    Consider the mark-up hospitals provide for declaring gross charges for the uninsured (http://www.revolutionmag.com/newrev15/top100.html) and you quickly realize what a scam hospitals run. Add to this the fact that most hospitals in Florida do not provide health insurance to their employees because of the hiring of per diem nurses and the hyprocrisy is enough to make you gag.
    I have no sympathy for hospitals. In my opinion they much more of the public scorn than HMOs do. They wrap themselves up in this divine benevolent mission when in fact they are as merciless as Scrooge.

  5. In the case of Alta Bates (Summit) in Berkeley, the hospital tries to escape the billing issue all together by shifting responsibility to outside providers through contract arrangements. And then both the hospital and the outside providers obfuscate the billing process so responsibility processing can be shifted to a disreputable collections agency that has no authority for negotiation and can use unlimited means of harassment and punitive measures (such as interest and fees) to get the money. Or, more likely, they won’t get the money, and a person who is already on the bottom of the social heap will suffer harassment and will end up in a deeper financial hole than when they were already in – lessening the chances that they will be able to pay the next time they have a medical emergency.

  6. this is such a growing and disturbing problem. What can hospitals do to address this? sigh…
    on a side note, I thought the “$63MM to $77.5MM from 2000 to 2004” comment from the hospital association spokesman didn’t help his case. That’s only a 5.3% increase per year?!