Monday, February 22, 2010

What does emergency care really cost?

We all have seen the reports of how much it cost to have uninsured people using emergency rooms for general medical problems. But what are these costs really in the sense of the hospital actually losing money?

First off, we’re all aware of the inflated charges assessed individuals using medical facilities. These charges can be as much as ten times what health insurance companies are charged for the same medical procedures. At the very least, for costing statistics, uninsured patients shouldn’t have more than the insurance company rates charged against them as losses to the hospital.

Secondly, for tax purposes, do hospitals use these inflated individual charges for the purpose of tax deductions? Couldn’t in fact the deductions for loss be equal or greater than what the insurance companies would have reimbursed the hospital?

For example – an uncollectable $1000 charge billed against an uninsured patient that would have been billed against an insurance company at $400 could generate a tax deduction for the hospital (a loss to the federal government) of almost that whole $400 at the highest corporate tax rate?

Thirdly, unless the volume of uninsured patients using emergency room services caused more hospital employees to be placed on duty, there are no extra costs for the payroll of regular staff. That money would have been paid to staff even if there were no patients to see.

Are we being misled about the scope of this problem or is it just we don’t care?

Thursday, February 11, 2010

The people with the answers

Following the health insurance debates, it has occurred to me that everyone had been missing the mechanism that could provide a satisfactory resolution of this problem.

Those who criticize the health insurance proposal being offered have the answer in their own criticism and yet no one appears to have considered listening to them.

Many of the criticisms are merely there to present stumbling blocks to implementation of any alternative, others (probably most) are general broad brush statements focusing on policy level objections without any detailed specific suggestions for implementation. BUT, a significant number might pass muster in combining an objective criticism with an alternative worked out in a level of detail that could be a valid stepping stone to an objective solution.

It was the same in 1993 with the Clinton proposal. Everyone spent their time defending against the criticisms instead of objectively examining the criticism as an opportunity for improving the project.

I’ve found it amazing how many feel comfortable in criticzing without offering a solution. I’m even more amazed in how passive proponents of health insurance reform have been in not demanding problem solution details from the critics.

The Democrats seem to have either no spine to push back or so little confidence in their proposals they are unwilling to even consider critics’ objections and proposed solutions.

Let’s be willing to compromise and highlight who isn’t.