Friday, November 07, 2008

Another possible upside...

...to a Democratic Congressional majority and an Obama presidency might be that the US will finally join the rest of the industrialized nations in recognizing that health care is a basic human right instead of a privilege of the wealthy, and getting rid of for-profit health insurance and instituting single-payer health care to cover all US citizens.

The New York Times
Hospitals See Drop in Paying Patients
By REED ABELSON
Published: November 6, 2008

In another sign of the economy’s toll on the nation’s health care system, some hospitals say they are seeing fewer paying patients — even as greater numbers of people are showing up at emergency rooms unable to pay their bills.

While the full effects of the downturn are likely to become more evident in coming months as more people lose their jobs and their insurance coverage, some hospitals say they are already experiencing a fall-off in patient admissions.

Some patients with insurance seem to be deferring treatments like knee replacements, hernia repairs and weight-loss surgeries — the kind of procedures that are among the most lucrative to hospitals. Just as consumers are hesitant to make any sort of big financial decision right now, some patients may feel too financially insecure to take time off work or spend what could be thousands of dollars in out-of-pocket expenses for elective treatments...

... The loss of money-making procedures comes at a difficult time for hospitals because these treatments tend to subsidize the charity care and unpaid medical bills that are increasing as a result of the slow economy.

“The numbers are down in the past month, there’s no question about it,” said Dr. Richard Friedman, a surgeon at Beth Israel Medical Center in New York, although he said it said it was too early to call the decline a trend...

...Many people are probably going to the hospital only when they absolutely need to. “The only way they are going to tap the health care system is through the emergency room,” Mr. Taylor said.

...While the drop-off in patient admissions may still seem relatively slight, hospital executives and consultants say it is already having a profound impact on many hospitals’ profitability. As fewer paying customers show up, there has been a steady increase in the demand for services by patients without insurance or other financial wherewithal, many of whom show up at hospital emergency rooms — which are legally obliged to treat them.

“It’s disproportionately affecting the bottom line,” Mr. Latimer said.

...Another source of financial anxiety, hospitals say, is the continued difficulty in raising money through the credit markets. The majority of the nation’s hospitals are nonprofit, and they often raise capital through the municipal bond market to erect new buildings or make other significant capital investments. Because many hospitals say they are still unable to borrow easily, they have reacted by scaling back projects or holding off on major purchases...

...Mr. Rock predicts that many hospitals will soon start to reconsider the services they provide, with an eye toward scaling back or eliminating some altogether.


The vast majority of people can no longer afford cosmetic or elective medical care, or care that the HMOs and other for-profit insurance companies consider "medically unnecessary," not meaning that you don't need it, but meaning that they won't pay for it. (What care you actually need for quality of life is not in any way relavant to for-profit care - if it won't kill you immediately, it's not "necessary.").

Hospitals will not be able to survive when the only customers they have are people with inadequate or no health insurance who only come into the emergency room. If Obama doesn't simply nationalize health care and put the doctors and nurses on a flat salary instead of the private insurance companies preferred "fee-for-service" scam, hospitals will start dropping like flies here soon, leaving wide swaths of America with no access at all to hospital care. If he continues to allow for-profit insurance to skim people's premiums to pay million-dollar executive payment and benefit packages, health care will continue to become more and more unaffordable. Like basic utilities, health care should never have been allowed to be for-profit in the first place. Unlike the rest of the world, the US has been slow to recognize this.

Hopefully, under Obama, this will change. That's one change that will be for the better.

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