Sunday, June 04, 2006

Even Without Illegals, Healthcare in Crisis

I had a bit of an argument with my mom over illegal immigrants in which she blamed them for the closing of California ERs. And I know that many blame illegal immigrants for the problem. Here's one blogger's take:

While the New York Times does not exactly specify illegal aliens as the cause, it is quite obvious by these numbers.

"This is definitely cause for alarm," Carol Meyer, director of the Los Angeles County Emergency Medical Services Agency, said on Friday in an interview.

Ms. Meyer said 30 percent of the nine million people in the county were underinsured or had no medical insurance at all. Statewide, seven million people are uninsured, according to the California Medical Association.

So, lets break these numbers down. 30% of 9 million is about 3.3 million people or nearly half of the 7 million in California that are uninsured, That's just in their county.

The US Bureau of Citizenship & Immigration Services, however, says that in 2000 there were only 2,209,000 illegal immigrants in all of California. Los Angeles Almanac used California's share of the national percentage to figure that the county percentage would be about 619,000 illegal immigrants in Los Angeles County. That's a whopping 93% of the population of LA County which is both legal and uninsured.

Gee, I wonder why the NY Times didn't specify illegal aliens as the problem.

But more interestingly, the California Medical Association's Annual ER Losses Report from 2004 also doesn't blame illegal aliens.

Nearly 7 million Californians—one in five—have no health insurance and use the ER as their family physician or go there for treatment when their untreated chronic conditions have turned critical. California is 4th in the nation in the percent of uninsured, with nearly 20% without health insurance.

Emergency care is an essential public service, yet remarkably it is rapidly becoming less available to everyone because of overuse by patients seeking care for conditions that are neither critical nor emergent. Why is this happening? For some Californians, particularly the uninsured, our emergency departments are their only source of medical care. But increasingly, emergency rooms are also being visited by HMO patients who would otherwise have to wait days or weeks for an appointment with a physician or specialist. Emergency room visits are soaring. They totaled 10 million in 2001 and are expected to hit 12 million by 2006.

Don't I recall something about how the American medical care system is the best in the world because, unlike those socialist countries with universal healthcare, we don't have to wait weeks or months for doctors?

Illegal immigrants contribute to the problem, certainly. But even if all illegals were rounded up and kicked out, ERs would still be losing money, still be overburdened, and still be closing.

Why? Because even those who are covered aren't getting covered.

The state’s Medi-Cal program severely underpays for the actual cost of emergency care. Many HMOs reduce reimbursement, delegate the responsibility for payment to medical groups, or refuse reimbursement completely because auditors have decided—after the fact—that the service provided was not an actual emergency.

Illegal immigrants aren't the problem. Assuming all illegal immigrants are uninsured, a quick look down the chart comparing uninsured and indigent visits to Medicare, Medi-Cal and Third Party Payors shows quite clearly that those who are insured play a large role in overburdening emergency rooms.

Our medical care system is failing on its own. As an August 27 2004 LA Times editorial quoted in the report, " ... emergency departments have become de facto providers of universal care."

Doesn't it make more sense to acknowledge that universal care already exists, but that it needs to be administered intelligently and uniformly for greatest efficiency, money management and effect?

[edited in two places for clarity and to reduce redundancy]

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