The NY Times bemoans the entirely predictable health care situation in south Los Angeles: A City Where Hospitals Are as Ill as the Patients
For thousands of residents of South Los Angeles who had depended on the large county-run King-Harbor hospital, the past 10 months have been a grueling exercise in cobbling together medical care. When King-Harbor was shut by federal officials, it became the 15th general acute care hospital to close in Los Angeles County since 2000, about half of which served residents in South Los Angeles.
… South Los Angeles is one of the most difficult places in the nation to both receive and give medical care. Family doctors are few and far between, and the area is one of the hardest to draw new doctors to, physician recruiters say.
Why might it be hard to draw new doctors to the area? Perhaps because doctors, like everyone else, would like to be paid for their services. Would you move to an area and provide services for which you’ll be paid less than market rate, if you get paid at all? I wouldn’t. In fact, I’d be looking for another career or another city.
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.
It’s not just a matter of a lack of “government insurance” because the government insurance is part of the problem, not the solution. It’s breaking the state financially, and they are consequently cutting it.
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.
“We have an all-out crisis here,” said Carol Meyer, the director of governmental relations for the Los Angeles County Health Services Department. “In terms of lack of access to care, emergency room overcrowding and total underfunding of the health care system.”
… Also, Medicaid reductions in recent years have helped contribute to the rising tide of the uninsured — roughly 2.2 million more in 2006 than in the previous year — largely because of a decrease in employer-sponsored insurance and Medicaid reductions.
“Over the course of the last 10 to 15 years, there are entire populations that have been wiped off Medicaid,” said Larry S. Gage, president of the National Association of Public Hospitals.
But even against that backdrop, the situation in South Los Angeles is particularly grave. Most strikingly, the state Medicaid program offers the lowest reimbursement rate per capita in the nation, nearly 12 percent less than the second lowest-paying state, Arizona, according to 2005 figures.
So to sum up, you have a city with a huge population of uninsured illegal immigrants who cost the government about $20k more per year than they pay in taxes, and large number of people on Medicaid, which the state is cutting back because it can’t afford it, in spite of the fact that the state income tax rate is among the highest of the nation (9.3% for those making $44,815 and up). They can’t keep enough doctors on staff because neither individual patients nor the state can pay them, and hospital care has also suffered because of the same serious lack of funding. The few hospitals/clinics that remain open are seriously overburdened, leading to long waits and worse care, which will inevitably lead to more closures and worse care until the whole thing collapses. Which probably won’t take too much longer.
And none of these geniuses could see this coming.
UPDATE: Kevin, MD notes the same article, and writes, “Pete Stark, consider your bluff called.” Stark had previously declared his indifference to Medicare cuts in physician pay, stating,
“My colleagues, my staff say, ‘Oh, dear, the doctors would all drop Medicare.’ I don’t believe it. I don’t believe that doctors are willing to give up half their income.”
Believe it, baby. Nobody, but nobody, wants to work harder for less money. Why should medical professionals? I swear, Atlas Shrugged ought to be required reading, and passing grade on a test on the book should be mandatory before you can be sworn into any Congressional office.
