"I see no reason why a government-run healthcare insurance plan would put private plans out of business. Public libraries didn't kill the bookstore business. State colleges didn't put an end to private ones. Free public elementary and high schools didn't run expensive private schools out of business. People like choices, and as long as people want choices, there will be choices. That's the nature of capitalism, to identify a need and provide the service or product that fills it."
From Yahoo!News (now "expired"):
"AUSTIN, Texas – Just nine people accounted for nearly 2,700 of the emergency room visits in the Austin area during the past six years at a cost of $3 million to taxpayers and others, according to a report. The patients went to hospital emergency rooms 2,678 times from 2003 through 2008, said the report from the nonprofit Integrated Care Collaboration, a group of health care providers who care for low-income and uninsured patients.
"What we're really trying to do is find out who's using our emergency rooms ... and find solutions," said Ann Kitchen, executive director of the group, which presented the report last week to the Travis County Healthcare District board.
The average emergency room visit costs $1,000. Hospitals and taxpayers paid the bill through government programs such as Medicare and Medicaid, Kitchen said.
Eight of the nine patients have drug abuse problems, seven were diagnosed with mental health issues and three were homeless. Five are women whose average age is 40, and four are men whose average age is 50, the report said, the Austin American-Statesman reported Wednesday.
"It's a pretty significant issue," said Dr. Christopher Ziebell, chief of the emergency department at University Medical Center at Brackenridge, which has the busiest ERs in the area.
Solutions include referring some frequent users to mental health programs or primary care doctors for future care, Ziebell said. "They have a variety of complaints," he said. With mental illness, "a lot of anxiety manifests as chest pain."
Another news article:
Million-Dollar Headache: Victor Valley Hospitals Spend Millions on Uninsured Patients
Posted on: Tuesday, 6 June 2006, 12:01 CDT
By Tracie Troha, Daily Press, Victorville, Calif.
Jun. 6--Hospitals in the Victor Valley spend on average $4 to $6 million a year treating uninsured patients, including illegal immigrants, with the burden of this cost eventually falling to taxpayers.
How much of this expense can be attributed to illegal immigrants is unknown, primarily because hospitals do not track legal status, according to hospital administrators. The bills are often absorbed by the hospitals, taxpayers and private insuranceholders through higher premiums.
"The number of uninsured we treat, we anticipate that and plan for that on the financial side," said Randy Bevilacqua, spokesman for St. Mary Medical Center. "It's a burden we all share."
Desert Valley Hospital currently treats the highest number of uninsured patients. Of the 30,457 patients treated in the emergency room in 2005, 23 percent were uninsured, according to the latest figures from the Office of Statewide Health and Planning Development.
In this same year, Desert Valley Hospital spent more than $4 million, or nearly 6 percent of its operating expenses, on uninsured patients, said hospital Chairman Dr. Prem Reddy.
"I don't know why we see the most uninsured patients," said Leuis Leon, hospital administrator. "It probably just has to do with our location. Our location is key to the (ambulance) system. We see the most number of ambulances a month, so by default we have the most number uninsured."
Leon said the Desert Valley Hospital emergency room keeps its doors open for ambulances longer than the other local hospitals.
The nonprofit Victor Valley Community Hospital treated the second highest number of uninsured patients last year, according to OSHPD. Of the 28,858 patients treated in the Victor Valley emergency room, 18 percent were uninsured.
"This 18 percent has remained steady for the past three years," said Ray Marien, hospital spokesman.
Victor Valley Community Hospital has spent around $3 million a year, or about 7 percent of its operating expenses, on uninsured patients, according to OSHPD.
The total cost for treating the uninsured at the nonprofit St. Mary Medical Center is about $6 million a year, said Bevilacqua. Of the 50,535 patients treated in the St. Mary emergency room in 2005, 15 percent were uninsured, according to OSHPD.
"Taking care of those who don't have insurance is part of our obligation," Bevilacqua said. "All of us end up paying for those who can't. The impact of the uninsured on health care is enormous, and it falls on all of us."
Both St. Mary Medical Center and Victor Valley Community Hospital try to recoup the money through the hospitals' foundations, which host fundraisers and charity events throughout the year. They also have financial aid programs in place to help patients make their payments.
The program at St. Mary assists around 100 patients a month who cannot afford treatment, according to Bevilacqua.
"We try to be as frugal and efficient as we possibly can. The profit in health care is very small," Bevilacqua said. "This is the same for all hospitals, not just us. We have to be careful."
Agreement to cover more uninsured; no cost to taxpayers
Don Wilkinson, Associate Editor
JOPLIN, Mo. — According to the 2008 "Cover Missouri" report by the Missouri Foundation for health, more than 720,000 Missourians are living without health insurance, placing a considerable burden on Missouri's hospitals and emergency rooms.
As the recession deepens and the number of unemployed and uninsured grows, the results could put more stress on the system.
However, a landmark agreement between the state and the Missouri Hospital Association could provide quality health care to nearly 35,000 additional parents
– at no cost to the taxpayers – thereby reducing the burden on the health delivery system.
"Ensuring that our workforce has access to quality, affordable health care is vital for turning our economy in the right direction," said Gov. Jay Nixon, who was in Joplin March 17 on a statewide tour of medical facilities promoting the agreement, and listening to the medical providers working in the trenches.
According to the agreement, the MHA will voluntarily contribute an additional $52.5 million per year to provide health care to parents in Missouri; these dollars will come from the funds Missouri hospitals receive currently for providing uncompensated care to uninsured patients."
From the same article:
"When asked what he thought about the level of service that was being provided not just in Joplin but across the state, Nixon said that health care in Missouri was not a political position, but a value.
"People here expect high quality health care and they are getting it. Secondarily, this is a time when we need to make some progress forward so that more people are covered under health insurance. Otherwise with the increased numbers of people without insurance, the increased challenges of unemployment, we are going to have excellent facilities such as this being overrun by people that have neither private insurance or coverage by Medicaid."
"Based on studies conducted before the 2005 health care cuts, Missouri families were paying between $110 and $291 more a year in premiums because of the cost of providing care for the uninsured. Estimates made before the 2005 cuts predicted that in 2010, Missourians would be paying an additional $225 to $609 per year to provide care for the uninsured."
Page 222 of _Money-Driven Medicine_ by Maggie Mahar describes what happened when Oregon made health care cuts:
Kitzhaber offers a casebook example of irrational rationing: "In February of 2003, in order to save money, the Oregon legislature discontinued prescription drug coverage for a certain category of patients on its Medicaid program.
As a consequence of this decision, Douglas Schmidt, a man in his mid-30s suffering from a seizure disorder, was no longer able to afford to purchase the medication which controlled his seizures. He subsequently went into a sustained grand mal seizure and ended up with severe brain damage and on a ventilator in a Portland hospital. He remained in the hospital for several months and then was transferred to a long-term care facility where he finally died in November 2003 when life-support was withdrawn. Now, the cost of his anti-seizure medication was $14 a day, Kitzhaber points out.The cost of his care in the intensive care unit was over $7,500 a day, and that cost was billed back to the state Medicaid program. So the legislature did not save any money by its decision."
And a different state, West Virginia:
"In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act, which has proven to be an inefficient form of universal health care. This landmark legislation mandated that emergency rooms throughout the nation that receive government support may not turn away a patient who seeks necessary medical treatment. As a result, we have millions of Americans who seek their "primary" medical care in ERs. The cost of treating these uninsured patients are written off by the hospitals as "uncompensated care."
However, as the truism goes, nothing in life is "free," and certainly no exception exists in the health care delivery system. All of the doctors, nurses, lab technicians, pharmacists and other health care providers who work in these facilities must, and will, be paid for the vital services they provide.
The cost of treating the uninsured is merely passed on or shifted from the "non-payers" to the "payers" in order to support the system. This current crude form of universal health care - which focuses on crisis and emergency treatment (at a significantly higher cost than services rendered for primary and preventive care) - ultimately shifts billions of dollars in "hidden costs" to the final cost of obtaining health care insurance for those Americans who are insured."
From Congressman Sullivan of Oklahoma:
"The price of treating the indigent at hospital emergency rooms is astounding compared to the cost of care found in a primary care setting. The Oklahoma Health Care Authority recently found that the cost of a claim for asthma treatment in the a primary care setting was $34.12 per claim, while the average cost for the same asthma treatment in the emergency room setting was $61.20 per claim."
The U.S. Census Bureau places the number of uninsured people in the U.S. at 45.7 million in 2007, down slightly from 2006 but still unacceptably high.1 Who are they? Eight in 10 uninsured live in families with at least one worker; most uninsured workers are self-employed or work for small firms that don’t offer benefits; 66 percent of the uninsured come from low-income families (below 200 percent of the federal poverty level), but a surprising 9.1 million earn $75,000 or more.
The uninsured span the age spectrum, but young adults have the highest uninsured rate (28 percent of 18-24 year olds and 25.7 percent of 25-34 year olds); 78 percent of the uninsured are U.S. citizens; non-citizens have high uninsured rates due to employment in low-wage jobs.
Minorities have been hit hard by the problem – 7.4 million blacks or 19.5 percent, and 14.8 million Hispanics or 32.1 percent are uninsured.
(1) U.S. Census Bureau, Income, “Poverty and Health insurance Coverage in the United States: 2007,” August 2008.
Aetna goes on to say:
Q: Don’t the uninsured already receive free or discounted health care?
A: No, uninsured patients typically do not receive services at discounted rates. In fact, most are likely to go without care at all or be treated in high-cost emergency room settings. According to the Kaiser Commission on Medicaid and the Uninsured (August 2008), one-quarter of uninsured adults “go without needed care due to cost each year.” Because they do not receive early treatment and regular preventive care, the uninsured are more likely to be hospitalized and die from preventable causes. When those without coverage do receive treatment, expenses are significantly higher than those of their insured counterparts due to group discounts negotiated by employer-sponsored insurance plans. According to Health Affairs, bills that cannot be paid – the uninsured will receive about $56 billion in uncompensated care in 2008 – are passed on to taxpayers through government programs that will finance 75 percent of the cost, or to the privately insured through higher rates. In short, America covers the uninsured in the least effective, most expensive manner possible.
Q: Doesn’t an individual coverage requirement place a financial burden on the poor?
A: A properly designed individual coverage requirement would encourage personal responsibility by recognizing that those who can afford health coverage should purchase it, and by acknowledging that government should help pay for those who truly cannot afford it. To be workable, subsidies from low-income individuals should be paid for through a broad-based funding mechanism. If this happens, the poor would benefit by enjoying the same access as everyone else to health care innovations available through a competitive, private marketplace that is not encumbered with regulation.
From South Carolina (an SCPHCA document
It is important to note that while FQHCs receive federal funds to help subsidize the cost of providing health care services to uninsured and underinsured patients, the current level of federal funding has not kept pace with the increasing uninsured population served by state health centers (see Exhibit 1). Furthermore, the state legislature has not yet committed to providing a source of recurring funds to alleviate this financial burden. After Alabama and Kentucky, which received no state level funding for FQHCs in 2008, South Carolina ranks last among the Southeastern states receiving state appropriations for health centers.
Between 2000 and 2003, a study of a health center in SC determined that Medicaid patients with diabetes treated by the FQHC cost the state $400 less per patient when compared to those treated by private family physicians. Cost savings were driven by fewer Emergency Room (ER) visits and hospitalizations, as well as lower costs for specialists, lab, and other services .
Compounding the ability of people living in our state to effectively manage their health are various barriers to accessing health care services. The majority of the state of South Carolina is rural and 40% of the population is considered to be “low-income”, meaning they earn annual incomes that are less than 200% of the Federal Poverty Level (FPL)—less than $34,340 for a family of three in 2007 . An insufficient public transportation infrastructure results in an inability to access health care providers and many people simply can’t afford to go to the doctor. Language barriers also prevent individuals from accessing health care services in their communities. A lack of health insurance, as well as inadequate health insurance coverage further inhibits people from accessing health care. In addition, a statewide shortage of health care professionals, as well as strict federal policies regarding Medicaid eligibility have resulted in barriers to accessing health care services in South Carolina and an overall increase in the state’s uninsured population, respectively.
South Carolina spent more than $265 million on avoidable ER visits in 2006; visits for Ambulatory Sensitive Care (i.e., non-emergency) that could have been better provided at an FQHC . Enhanced access to primary care services through health centers will not only decrease inappropriate use of ER services for non-emergent care and make limited ER resources available for truly urgent situations, but it has also been proven to be cost-effective—the cost of treating one FQHC patient for one year costs less than just one ER visit . The SCPHCA and its member health centers believe in providing the appropriate care at the appropriate time in the appropriate setting.