31 December 2005

Emergency Economics

Half of Emergency Care goes uncompensated

This is no surprise. My experience is that our ED group collects about 35 cents on the dollar. What the study does not mention is that the government, via Medicare and Medicaid, reimburses around 30 and 25 cents on the dollar. It also alludes to the fact that we are the only industry in the United States which is obligated by federal law to provide services to any one who requests them, regardless of their ability or willingness to pay. It's a huge unfunded mandate. I have no problem with that policy on a moral basis, but it is a huge liability on the backs of hospitals and physicians.

Of course, it wouldn't be an issue if there was universal health insurance, since everybody who came to the ER would have health coverage. But we don't, so 20% of all our patients are sicker and wind up with huge bills which they can't pay and we write off as "bad debt." And then after we apply the proverbial million-dollar band-aid, they can't get follow-up care. In 1990, there were 6000 ERs and 90 million ER visits. In 2001, there were 110 million ER visits, but only 4000 ERs.

Our health care system is so f*cked. It's an outrage that the richest country in the world can't provide even basic health care to 20% of its population. There's a simple solution, that Bush would never support and too many democrats lack the imagination or courage to propose: Medicare for all. It would have to be supported by premiums and means-tested. A program that big couldn't be viewed as an entitlement or supported solely out of the general fund.

Medicare for all. Three simple words. Who wouldn't jump at it, if it were offered? And it would be so much more efficient than the current system -- the overhead savings alone would go a long way towards paying for the program. And a huge, bloated, inefficient beauracracy (the health insurance industry) would simply cease to exist. Well, that's not entirely true -- some form or supplemental insurance would probably persist -- Medigap and the like. And that's not a bad thing either; I think there is some advantage of some stratification in the health care system. But the administrative cost reduction would be massive, and the tangible benefits inarguable.

I don't know that it is possible in the forseeable future. The medicare drug bill is such a mess, and fixing that and fixing the budget deficit will take years and years. It's hard to imagine Congress taking on such a sweeping health care initiative in the current environment. But something has got to be done, because what we have now is a train wreck. And it's going to get worse.

1 comment:

  1. I had more to say about this topic (although not all that well-formed) than I could fit in a comment so I blogged about it here.


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