Burn Notice
Think of Miami and you think of the TV shows - fashionable people is stylish clothes making witty remarks while playing fast and loose with the rules. All of this takes place with salsa music playing in the background. The only way you can tell the good guys from the bad guys is that on TV the good guys always win. Unfortunately, this isn't TV, and it's harder to determine whether the gentleman in the crisp pastel jacket is trying to help you or kill you.
The attention we have given to the Haitian earthquake and the relief efforts centered in Miami have caused a bit of a stir. Reports have been coming in from many sources about overburdened schools, shelters and hospitals.For a period of several days the humanitarian airlifts out of the Port-au-Prince airport were suspended, as local entities went to the state government, and Governor Charlie Crist went to the federal government trying to get help in the form of cash to keep services running. It is not just the payrolls that must be met, but restocking of supplies, test and equipment costs, and things as simple as providing food and keeping the lights on. All of this costs money, and that is the one thing in short supply right now.
While the situation is widespread in Miami, it is always useful to look at a specific example to illustrate what is going on. Josephine, a reader from Miami, suggested looking at one of the primary providers of care for the Haitian quake victims - Jackson Health, which is now teetering on the verge of bankruptcy and closure.
Jackson Health is in many ways a victim of it's own success. During the good economic times Jackson expanded rapidly and paid generously. It can be argued that they expanded too rapidly and paid too generously, but that can be said of many institutions who thought that the gravy train would never end. Where Jackson sits now is in the middle of a restructure, cutting salaries and shedding employees. Serious consideration is being given to abandoning a new state-of-the-art $102 million Jackson South Health Center, which is 40% complete.Construction for this project was started after approval of a bond measure by voters in 2004. It is 2010, and Jackson is on life support. What factors beside "corporate greed" have contributed to the decline of what was once the gold-standard of healthcare for the Miami-Dade area?
The short answers are demographics and economics. Jackson Health has provided quality medical care to all strata of Miami residents.They work with the University of Miami, and are leaders in both research and as a teaching hospital. In addition, Jackson has always been the primary health services provider for the poor and indigent. This was factored into their business model, and is a source of pride that quality health care is provided to this community. With the economic meltdown of 2008, Jackson's business model was overwhelmed. High unemployment and loss of employer provided health insurance provided pressure on emergency room facilities. ER's became primary care centers for those who no longer had the financial resources to keep their normal doctors. What was once a manageable system for providing health resources to the poor community swelled to a situation where 45% of emergency room patients have no insurance. As was stated earlier, medical care costs money, and this patient base has no ability to pay
One would think that this would be a great basis for the argument that government provided health insurance would be a solution to this problem. That is until one examines current government programs to provide such insurance.
Medicare, Medicaid and similar programs pay what they want to pay. They create a set schedule of what they will pay, if anything, for any given medical service. Often the schedule of payment does not reflect the reality of the costs involved. Imagine going into your local Subway for a Five-Dollar Foot Long. Now imagine slamming $2.00 on the counter and walking out the door with the sandwich. That, in essence, is how the system works. Individual doctors have some latitude in dealing with this by offsetting this loss by limiting the number of Medicare or Medicaid patients. There is certainly some of this cost passed onto the rest of us, by tossing an extra dollar or two onto each office visit or service. No one denies a doctor's need to pay staff or his right to earn a living.
Hospitals, by law, have no such freedom. Any person showing up at the emergency room MUST be examined and treated, regardless of ability to pay. In the case of Jackson Health, that means that they will see nothing from 45% of their emergency room patients. At best, they will receive a Medicaid payment that will provide some fraction of the cost of the treatment. This is not merely people showing up with colds and getting an aspirin. This includes surgeries, heart attacks, cancer treatments, chronic conditions, and serious disease. Many times the treatments run into the thousands of dollars of which only a fraction comes back. This is what is unsustainable.
There is a myth circulating that healthcare is a right and should be free. Maybe it should be - that's a judgment call that TPP is not going to make One we can make is that healthcare is made up of people - doctors, nurses, clinicians, lab techs, and even the guy sweeping the floors and cleaning the restrooms. These people for the most part have dedicated themselves to providing that health service. They also need to make a living and support their families. The hospital buildings need to pay for the electricity and water they use. Equipment needs to be supplied - a x-ray machine with no film is pretty useless. It is hard to meet any of these obligations when the cost of giving medical care is more than the amount of reimbursement.
Getting back to Haiti for a moment - Jackson Health and the University of Miami immediately jumped in and set up a 240 bed field hospital in Port-au-Prince. Airlifts to Miami began as soon as the airport was able. These airlifts included patients with spinal injuries, critical care and those requiring more than could be provided at a field hospital. a few days in 434 people had been airlifted to several Miami hospital and the projection would be that there would be another fifty or so added every day, with no real end in sight..
It was widely reported that the medical airlifts were stopped for a few days. This was because the federal government was dropping patients with no ability to pay at the emergency room door. It seems that state officials of Florida had the temerity to ask the federal government "Hey, who's going to pay for all this?" The reply was mostly "Oops! Ah...umm... I forgot my checkbook - can we talk about this later?" To date, no firm commitment from the federal government to share even a part of the costs associated with this relief effort has been made. But treatment continues, supplies are used, and suppliers are not being paid. Staff is facing layoffs and worse yet, the community is facing loss of it's principal health provider to those most in need. The Haiti relief did not cause off of the problems, but it may be the tipping point for Jackson Health.
So what is the point? The point is that this is how the federal government handles the health of the people that it claims to assist. It enacts laws requiring treatment of patients, and then drops the patients off at the doctor's door. When payment needs to be made, Medicare / Medicaid makes a "take it or leave it payment". Or they leave it to the states to pick up the cost.
Common Sense Dictates
This truth is what is sensed by the American public - that whatever the reason that the federal government gives for wanting to reform the healthcare system, and however noble that goal sounds, the result will be what we see in Miami. TPP stands by it's view that reform is needed in some areas - costs, portability, pre-existing conditions and the uninsured. A wholesale makeover as envisioned by President Obama and the Democratic majority will only result in the crippling of an innovative and generous system of health services. In this case, past performance is an indicator of future results. Common sense is with the majority of Americans on the health care issue. Fix the actual problems, and keep your paws of my healthcare system.
RLB
Categories: Haiti earthquake, Healthcare, Partisan Politics
Tags: healthcare reform Haiti earthquake
This is EXACTLY what I'm talking about - the government can't run what it's already responsible for, and they want to take on the rest of the healthcare system? We'll all be going to Haiti for decent treatment.
Reply to this
What I can't get my head around is that this kind of thing is going on in every major city in the country. The complaint about Medicare or Medicaid not paying enough to cover costs is a common complaint coast to coast. Doing a major expansion into healthcare just seems like it will make the problem worse rather than better. How can anyone expect any different outcome than we are alresdy experiencing? It makes no sense.
Reply to this
The definition of insanity is doing the same thing over and over and expecting a different result. Seems the Dems are all crazy.
Reply to this
I'm getting the same thing in Los Angeles. It's pretty much the same in every hospital system. The ones that have access to the better neighborhoods are able to finance their work among the uninsured or those on Medicaid. The ones who's only patient base are the uninsured or Medicaid are drowning in debt. That's without any additional refugees - although we have a huge population of illegal immigrants or "guest workers" or whatever the PC name for them is now. The government doesn't pay enough to cover costs. I hate to admit it, but I don't expect any better from Obama. If it does go "universal" we'll all be in trouble.
Reply to this
Something still needs to be done for these people though. If nothing else it's in our own self-interest to figure out a way to do this intelligently. We are paying for those uninsured anyway in higher premiums and taxes. We might as well usr that money in a way that minimizes the problem.
Reply to this
This is the basis of what the Republicans have ben trying to do - fix the actual problems. There is no need to tear down a healthcare system that serves 300 million people well. There will always be mistakes and horror stories like the kind the Dems are trying to scare everyone with. Those horror stories are not the norm. Leave the 300 million alone and concentrate on what we need to do to insure the rest. If the government has to be involved, they should put in place a payment structure that allows providers who are primarily taking on these people the ability to meet expenses. As the system stands now, the government is driving the healthcare system towards bankrupttcy. It isn't fixing anything. You can write a law about anything. It tales a lot more work to fix the underlying problem.
Reply to this
That's all fine, but how do you fix this kind of problem. Insurance is just unaffordable to most of these people. It looks like government insurance, at least like it's done now is as big a problem as no insurance. I ad been leaning towards the Obama plan, but now I don't know. The problem seems huge.
Reply to this
The perception is that the problem is huge, but it really isn't in the context of the entire health care system. By all accounts there are 30 million people uninsured - some by circumstance, some by choice. 300 million are in the system and are pretty satisfied. I'll bet you are. Most people are except to gripe about the cost. 30 million is 10% of 300 million. We need to fix a problem that 90% of us are only affected by at the fringes. Destroying the system to save the system is crazy. Let's look at what will help these people and do it. As for the problems in the exicting system, fix the problems, don't scrap the system. There are simple ways to do it. See the Better Solutions post at gop.gov
Reply to this
I had no idea that the situation was this screwed up. I mean, I knew there was a problem, but I figured we could just expand Medicaid to take care of the uninsured. Seems like without an overhaul, that's only going to make things worse. From reading this I'm more convinced than ever that I don't want any sort of public option covering my family or me.
Reply to this
The role for government in this is an expansion of medicaid for those remaining uninsured. Before that happens, medicaid needs to be reworked so that it operates in reality. That will be a major challenge as the government is pretty much the schoolyard bully as far as payments are concerned. Once the rework is done, this is the natural place to put those with pre-existing conditions. It would fall under the same heading as flood insurance - taking care of those who the market won't. From there its some tort reform and insurance purchase over state lines. Voila! Problem fixed.
Reply to this
Wow! what a crock. Think you have healthcare fixed that easy? Do you have any idea what it will take to reform Medicaid so that it works in the real world? You have 435 congressmen and 100 senators all looking for a Ben Nelson deal for their constituents. I wouldn't look to anything that makes congress the go-to place. It will just turn into a bigger mess.
Reply to this
It took us a long time to get into this mess, it will take a major effort to get us out. It does seem like the first step in fixing things is to either fix the payout or the expectations of Medicaid and probably Medicare. I'm not sure if increasing payouts is feasable, and I'm sure cutting benefits will be unpopular. The problem is that without this as the starting point, we will just be tossing gasoline on the fire. In the meantime, rather than some big overhaul, doing some common sense things that address the real problems seems like a good idea. I wouldn't want to give up my coverage, and certainly not for some public program. The Republican plan isn't perfect by any means, but it makes more sense than what President Obama has proposed.
Reply to this
The whole "fix medicaid" idea seems to be entirely lost in the debate on health care. Examining that brings a lot of issues out to the front. Things like can the government run a health care program effectively, and even more important SHOULD the government do such a thing. Hospitals have been complaining about Medicare and Medicaid payments for as long as I can remember. If they've always been complaining then it's always been a problem. If it's always been a problem, then it's never worked right. If it's never worked right, it should either be fixed or stopped. Otherwise it's just contributing to health costs going up.
Reply to this
Now that's smacking the nail square on the head. If what is currently
"government run" health care is just making things worse, why would we want to expand it?
Reply to this
That does speak to the heart of the problem. Governments always contract to the lowest bidder. Do I really want my health in the hands of the lowest bidder. My premiums might be a little higher than I would like, but I'd rather pay a bit more and get quality care. I don't want my medical treatemnt to turn into a trip to the DMV.
Reply to this
Miami looks like its getting screwed from all directions. More often than not, this is what happens when the big, lumbering fed gets involved beyond passing out dollars. They trip over themselves and do more harm than good.
Reply to this
Looking at it, I'm not sure that Pelosi even has the votes to pass this healthcare plan. If she did, Obama's signature would be on it already. I think that come the vote, it might go down in flames. That's the "hope" I'm working with.
Reply to this
Ragman, I sure "hope" you are right. Wish I could be more optimistic, but fear they are gonna take us down w/this monstrosity, putting student loans into it & who knows what else! As Piglosi said: when they pass it we the people will get to see what's in it! They only know spend, spend, spend, w/o caring about what they are doing. "The welfare of humanity is always the alibi of tyrants." - Albert Camus
Reply to this
I gotta have faith that enough preople will do the right thing and support the Constitution. That and the self-preservation of several congressmen who want to keep their seat. If nobility won't do the right thing, expediency will take over. My count is Pelosi only has about 200 votes locked - that's 16 short and I don't think she can buy that many. And if they do the Slaughter strategy, when it goes back to the Senate, it will be rejected there. This is down to playing hot potato and unloading blame until time runs out on this power grab.
Reply to this
Looks like the spaceman Kucinich is on board - and he's one of the single-payer guys who think this doesn't go far enough. I hear there are two California congressmen who are trading a vote for getting the water turned on in their farm belt. Maybe Pelosi can buy enough votes.
Reply to this
I read all of this and you would think that Obama and every other Democrat is some sort of evil person - a whole party of Cheneys trying to impose their will on the American public. All they are trying to do is fix an expensive and unfair medical system that the poor do not have access to. How is it wrong to do that?
Reply to this
So Obama isn't evil - Cheney is. I'm going to assume you thought that through before you wrote it. That would explain why the Democrats are so upset that 70% of the country doesn't want this health disaster being piled on us. It would also explain how the Democrats can't pass this legislation even though THEY ARE THE MAJORITY PARTY. The reason that it's not passing is that most congressmen are not prone to political suicide - which voting for this clearly is.
Reply to this
Ragman might be right. Obama has just caneled his postponed trip to Indonesia and Australia. He wants to be here to push this through. That means Pelosi still hasn't got enough votes for passage. His track record of intervening to get something, be it a campaign endorsement or the Olympic for Chicago, is pretty poor. This healthcare plan may be in final approach as it crashes and burns.
Reply to this
Hey, don't forget about how he was going to save the Climate Change conference. That worked out well for him too. So what are the odds that if this does get defeated that Obama takes no for an answer and tries something that the American people support?
Reply to this
I can't see that happening. He's as stubborn as Carter, and not nearly as smart as Clinton. My guess is that he goes at it again, right after the election. If it were up to him he'd probably try sooner, but he'd lose his party. You're only a leader if people follow you.
Reply to this