It's Not Just The Insurers - Hospital Costs Are Rising Too Fast

The following is from an article by Assistant Professor Zack Cooper (Yale School of Public Health) in The New York Times: 

There is boiling rage at health insurers among the public — for instance, over the fact that premiums for a family health plan can exceed $27,000 a year, even as patients routinely get their care denied. Such is the rage that when an insurance executive was murdered in 2024, one poll found that 41 percent of American voters under 30 perversely thought the killing was acceptable.

Republicans and Democrats have been eager to haul insurance executives to hearings and grill them. President Trump tried to justify removing subsidies for Americans to buy health insurance — a policy that will lead to 4 million people losing coverage and thousands of deaths — by arguing it would mean less money going to insurers.

Responding to the wrongdoing of insurers is imperative, but it won’t do much to address the unsustainable cost of health care. We are directing our anger at the part of the system that is most visible and frustrating (insurers’ restrictions on care) while ignoring the part of the health system that is most responsible for high costs and economic pain: hospital prices. At a time when two-thirds of the public are worried about the price of health care — a greater share than are worried about affording groceries, gas or housing — we need to have an honest conversation about what is driving high premiums and how to lower them.

Americans receive a similar amount of care as people in other countries, but we pay much higher prices for the care we receive. Take hip replacements. Hospitals in the United States earn $29,000on average for a replacement covered by private insurance and $16,000 for one covered by Medicare. In Germany, the public system of nonprofit insurers, which covers 90 percent of the population, pays hospitals $9,400.

Hospital prices are the leading driver of the 320 percent increase in insurance premiums that Americans have experienced over the past 25 years. Since 2000, prices at hospitals have grown faster than prices in virtually any other sector of the economy. They have grown three times as fast as inflation and twice as fast as prescription drugs and doctor visits.

The reason hospital prices are so high: hospitals’ accumulation of market power, which brings them more bargaining heft when they negotiate prices with insurers. Since 2000, there have been more than 1,300 hospital mergers among the nation’s approximately 5,000 hospitals. When hospitals that were once competitors merge, prices go up, often by double-digit percentages, with no measurable improvement in patient outcomes. Even though we rely on competition to determine hospital prices, 21 percent of hospitals are effectively monopolies — they have no competitor within a 30-minute drive — and an additional 24 percent face only one competitor. . . .

Politicians from both parties have called for reining in insurance denials. They’re right to. Such denials, and the bureaucratic processes that accompany them, are stressful for patients, and, in the worst cases, lead to patients missing out on lifesaving care. Likewise, research shows the high out-of-pocket costs included in many insurance plans can drive up death rates. We need to lower out-of-pocket costs and make insurance less bureaucratic. However, unless we pair such reforms with a focus on addressing hospitals’ rising prices, rolling back insurer restrictions on care risks driving growth in health spending that, in turn, will slow economic growth and drive job losses among low-wage workers.

If hospital prices are such a key driver of rising costs, why aren’t elected officials doing more about them? Partly the answer is politics. Hospitals are the largest or second-largest employer in many counties in America, and a formidable lobbying force — spending more than $100 million annually in Washington, often more than health insurers spend, to protect their interests. Politicians who represent places with dominant hospital systems are not eager to pick a fight with these institutions. Moreover, when an insurer denies your claim, you know it immediately. When a hospital merges and its prices go up, the harms — slower overall economic growth and job losses outside the hospital sector — are real but diffuse.

Another reason so little has been done about hospital prices is the chronic underfunding of the Federal Trade Commission. Each year, there are approximately 20 potentially harmful hospital mergers, but the cost of pushing back on all of them would potentially exceed the agency’s entire budget for antitrust enforcement across all sectors of the economy.

Addressing this issue would require regulating the prices for at least some hospitals. Economists generally prefer to rely on competition to determine what companies get paid. But in hospital markets that are effective monopolies, regulation isn’t a departure from sound economics — it’s the only tool left. Congress should cap the prices monopoly hospitals can negotiate with private insurers, using Medicare rates or prices in other competitive markets as benchmarks.

Perhaps more than anything else, what makes hospital prices so hard to confront is that the relationship we have with our health care providers is very different from the transactional relationship we have with our insurers.

The physician and scholar Jay Katz spent his career writing abouthow vulnerability, fear and gratitude make it difficult to hold doctors and hospitals to the kind of scrutiny that we apply to other powerful institutions. We lean on hospitals when our children are born, when our parents get sick and when we approach life’s end. That kind of reliance requires trust.

Hospitals / Clinics Are Continuing To Close In Rural Areas

The following is from Axios.com: 

A string of recent rural health clinic closures is threatening to further reduce access to care in outlying areas as health systems brace for cuts in the in the Republican budget law and grapple with inflation and workforce issues.

The big picture: Rural health cutbacks already are a fact of life. But some of the latest closures are in anticipation of the nearly $1 trillion reduction in federal Medicaid spending that will in large part hit starting in 2027.

State of play: Three health clinics in rural Virginia will be consolidated and patient care moved to other facilities, Augusta Medical Group announced last week.

 

• The change is "part of Augusta Health's ongoing response to the One Big Beautiful Bill Actand the resulting realities for healthcare delivery," the provider said. 
• Curtis Medical Center in Nebraska, the first health provider to cite Medicaid changes as a reason for closing, will shut its doors on Sept. 30, per the Washington Post.
• At least three rural health centers in Maine have announced plans to close this month, Portland's WMTW reported.
• Mayo Clinic last week said it's closing six clinics in southern Minnesota, including in rural towns, and reducing services at a hospital in the area, although a spokesperson told Axios the transition isn't tied to the new law.

Zoom out: Nearly 200 rural hospitals have closed or ended inpatient services over the past two decades, far outpacing expansions or facility openings.

• Almost half of rural hospitals operated at a loss in 2023, according to the American Hospital Association. 
• "Rural hospital financing has not worked well for a long time," said Carrie Cochran-McClain, chief policy officer for the National Rural Health Association.

The tax and spending package Congress passed in July is widely expected to add to the financial difficulties in rural areas, where patients are often poorer and older and where there are fewer private coverage options. 

• Federal Medicaid spending in rural areas could decrease by $137 billion over the next decade, KFF estimates.
• The law established a $50 billion rural health transformation fund to be doled out to states over five years, in part to assuage Republican lawmakers' concerns about how Medicaid cuts would hit providers. 
• The size of the fund has been panned as inadequate. That, and ambiguity over how funds would be distributed, is raising concerns about whether funds will reach the hospitals that need it most.

Hospital Beds Are Decreasing - And Republicans Want To Make It Worse

 

Researchers have determined that the availability of hospital beds is decreasing. Between 2009 and 2019, the hospital occupancy rate was 63.9%. By 2024, the rate had risen to 75.3%. It is estimated that by 2035 the occupancy rate will reach 85%.

An 85% rate is deemed to be a shortage, because medical officials say at that rate "basic hospital operations can become dysfunctional and even unsafe".

The reason for the decrease is two-fold - an increase in the number of senior Americans (who require more hospital care than you're people) and hospitals that are closing their doors and going out of business.

This is especially true in rural areas, where many hospitals are having trouble meeting their expenses - and many are closing each year.

Sadly, the Republican in Congress are planning to make things worse - not better. How? By making a huge cut in Medicaid funding. In the bill under consideration, they want to cut Medicaid by more than $800 million. 

This would be devastating for many hospitals, especially in rural areas. These hospitals rely on Medicaid to provide the money they need to keep operating. Without the Medicaid money, they will have to close.

And it won't be just rural hospitals that will be hurt. The rural people will have to then travel to urban areas to get hospital treatment. That will decrease the number of hospital beds available in urban areas.

It is critical for everyone's medical care that hospitals everywhere remain open. That means it is critical to maintain Medicaid funding at the present level (or increase it).

NOTE - Republicans are now considering a continuing resolution to keep the government open. While that would avoid the draconian cuts to Medicaid they want, it would include smaller cuts to it. And it would just delay the larger cuts until September. That's not a solution.

Gaza Hospitals Will Become Morgues For Lack Of Fuel

The following op-ed was written by Dr. Hussam Abu Safyia (a pediatrician in Gaza) for The New York Times: 

At Kamal Adwan Hospital in northern Gaza, we are no strangers to treating victims of airstrikes over the years. The team all too often must rush into the emergency room, all hands on deck, ready to treat shrapnel wounds, burns and blood loss. In the early days of the current Israel-Hamas conflict, our hospital of only 80 beds was quickly overrun. On Oct. 17, following the explosion at Al-Ahli Arab Hospital in Gaza City, we were flooded with dozens of wounded and dying victims. By the next day, our patient roster had grown by nearly 120. We knew it would be another sleepless night, another in a string of far too many since the violence started 10 days earlier.

As many as three to four children had to share single beds, and many more were forced to settle for the floors. Some patients from the hospital explosion came in screaming in pain, but others were silent, in shock or beyond saving. With anesthesia, iodine, alcohol, blood and even gauze running low or entirely gone, we had a dwindling supply of tools to help ease the human suffering. The people who flocked to Kamal Adwan to sleep in our hallways or even the parking lot, believing it safer than their homes, were no doubt as frightened as we were.

As I write this, the hospital is on the precipice of true disaster. We are down to the last gallons of fuel necessary to run the electric generators, despite our most stringent efforts to ration it since the start of hostilities. Lights are off most of the time, elevators are out and patients are carried between floors. When the fuel runs out, we will no longer be able to function at night after the sun goes down. Most of the tools and equipment needed to run a modern hospital like ventilators, defibrillators and our neonatal units will become useless. When the generators fall silent, we will be relegated to practicing medieval-level medicine. Without an urgent resupply of fuel, the lights will go out permanently, and our hospital could turn into a morgue.

Kamal Adwan is far from the only hospital reaching its breaking point, as doctors like myself desperately cry out for more aid to Gaza. I’m a pediatrician at Kamal Adwan, part of a team of nine MedGlobal doctors and humanitarian aid workers that have been on the ground in Gaza since 2018. In that time we’ve seen our share of tragedy, suffering and shortage, but nothing could have prepared us for the horrors of the past few weeks. My team and I have divided our time between caring for patients and locally sourcing and distributing medical supplies, food and fuel to 11 different hospitals — $1.3 million worth of resources since the violence began. And it is still not nearly enough. . . .

Doctors are no strangers to tragedy or death and are trained to steel themselves against it, but the pressure we’ve been under these past few weeks is beyond any training. One of my colleagues lost his father and brother to an airstrike in the first week of the fighting; another saw his dead son wheeled in by an emergency crew. At a professional level, a personal level and most fundamentally a human level, the people of Gaza and the medics who care for them are at a breaking point. Like our patients, especially the children, this conflict will leave every one of us traumatized.

Even so, we are treating our patients to the best of our ability with the bare minimum of electricity, medicine and supplies. We sterilize wounds with vinegar, previously unthinkable in our modern intensive care unit. Drinking water ran out days ago, and the water we do have isn’t potable, contributing to a rising tide of intestinal infections and diseases not seen in Gaza in years. Our morgue filled to capacity within the first week and we’ve had to store many dead children in a nearby tent, praying that the decomposing bodies don’t contaminate the water wells or spread further disease. We fear an outbreak of cholera and typhoid. We fear for the long-term mental health impacts on the children in our care. Their little bodies are quick to injure and quick to heal, but their minds and spirits will need a lifetime of care to overcome what they have seen and experienced. . . .

As Kamal Adwan Hospital and Gaza itself run out of everything — food, water, fuel, medicine — the one thing we have not yet run out of is hope. I see it in my fellow doctors and the MedGlobal team risking their life every day to drive the streets of Gaza delivering supplies. I see it in the eyes of our patients — not all, but many. There’s a resilience and tenacity at the heart of the human experience that’s stronger than any horrors men can inflict on one another.

Through that hope, we make an urgent plea to the rest of the world to send more aid into Gaza. In order for hospitals like Kamal Adwan to continue functioning, we desperately need more resources — especially fuel for our generators. If we cannot turn the lights back on and keep lifesaving equipment running, too many of our patients will end up needlessly dying.

We hope that people will read our story and share in our desires: for a cease-fire, for a full opening of border crossings so that the wounded and sick may leave and lifesaving supplies can reach the tired, hungry and the displaced. For a normal life of peace where hospitals in the region see Israeli and Palestinian patients side by side, unburdened by grief, separation and war. We need the world’s help to sustain these hopes and bring this senseless violence to an end.

COVID Hospitalizations For Children Is At A Record Level

While ignoring the COVID pandemic, Donald Trump told Americans that young people, especially children, didn't get the disease. That was a lie, but it seems to be a lie that is still being put forward by right-wing Republican politicians.

As school is starting across the country, many schools want to mandate that their students (and teachers) wear a mask. That is a reasonable action. Consider the chart above. It shows that not only can children get sick with COVID, but many require hospitalization -- and those child hospitalizations have reached a record level nationwide.

But in spite of the virus raging across the country, many red-state governors are banning mask requirements in schools (or anywhere else). This is especially true of Gov. Abbott in Texas and Gov. DeSatis in Florida. Both have issued edicts that say schools cannot have a mask mandate.

They did this in spite of the fact that their own states are experiencing record child hospitalizations due to the Coronavirus (especially the Delta variant). They do this to please their extremist base. Evidently, playing politics is more important to them that saving the lives of children in their states.

Congress Still Needs To Fix Our Broken Health Care System

The facts in the images above are from a new study of hospitals by Johns Hopkins University. It paints a portrait of a medical care system that is badly broken. 

We already knew that millions of Americans have no health insurance, and that prevents them from getting needed preventative care -- killing about 17,000 each year.

Now we learn that 64% have avoided or delayed getting medical care out of fear of the cost. And that fear is well-founded. Some hospitals charge patients 10 times the cost of their care, and 57 of the 100 biggest hospitals charge at least 5 times the cost.

We also learn that 58% of all debt collections in this country are because of medical debt, and thousands must declare bankruptcy each year because of it. And sadly, many of these are people who thought they had good insurance, but because of high deductibles and other uncovered expenses find themselves with huge hospital bills.

This doesn't happen in any other developed nation. It only happens in the United States, where politicians love to claim we have the best medical care in the world. The quality of care may well be excellent, but that is of no importance to the people who cannot afford care (or even health insurance).

The truth is that our heal care system is the shame of the developed world. It is broken, and needs to be fixed.

The obvious answer would be a Medicare for All system that covers all citizens and controls costs. A partial, but significant, solution would be a public option for health insurance. Sadly, neither is likely to happen as long as Senate Republicans have the filibuster. They still consider health care to be a product to be sold to those consumers who can afford it -- not a right of every citizen.

Hospitals Are At A Breaking Point & It's Going To Get Worse

The image above is from Taegan Goddard's Political Wire, and it should scare the hell out of Americans. Hospitals across the nation are in trouble. They are overwhelmed in trying to deal with this pandemic. And it's not going to get any better soon.

The nation is currently in the worst phase of the pandemic since it started, and some health officials are predicting we will have 350,000 deaths by the end of this year. We haven't started to feel the effects of the spreading caused by the travel and gatherings of the Thanksgiving holiday (which is expected to cause a huge spike in cases and deaths). And by the time the nation's starts to feel that holiday effect, people will begin to travel again for the Christmas and New Year's holidays.

You may be thinking that this is not important because of the news about vaccines being close to approved. That's a false hope in the short term. Only heal care workers will get the vaccine this year, if it's approved. And unless you live in a nursing home, you will probably not be able to get the vaccine until nearly Spring. 

It's going to be a long and deadly winter, and it's likely that the nation will be flirting with 500,000 deaths by the time the vaccine is widely available.

And while this crisis is happening, Donald Trump is doing NOTHING. He's too busy whining and lying about losing the election and playing golf. His lack of action shows he has surrendered in the war against COVID-19. He no longer cares.

AMA And AHA Both Oppose The GOP's Health "Plan"

It's not just Democrats that oppose the horrendous "repeal and replace" plan the congressional Republican leadership has proposed. Medical professionals have also come out against the plan. Below are letters sent to Congress by the American Medical Association (AMA) and the American Hospital Association (AHA).

From the AMERICAN MEDICAL ASSOCIATION:

Dear Chairman Brady, Chairman Walden, Ranking Member Neal and Ranking Member Pallone:

On behalf of the American Medical Association, I am writing to share our views on the “American Health Care Act” (AHCA) as detailed in committee prints released by the Committee on Ways and Means and the Committee on Energy and Commerce.

More than 20 million Americans currently have health care coverage due to the Affordable Care Act (ACA) and among the AMA’s highest priorities for on-going health system reform efforts is to ensure that these individuals maintain that coverage. While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.

The AMA has long supported advanceable, refundable tax credits as a preferred method for assisting individuals in obtaining private health care coverage. It is important, however, that the amount of credits available to individuals be sufficient to enable one to afford quality coverage. We believe that credits should be inversely related to an individual’s income. This structure provides the greatest chance that those of the least means are able to purchase coverage. We believe credits inversely related to income, rather than age as proposed in the committee’s legislation, not only result in greater numbers of people insured but are a more efficient use of tax-payer resources. 

AMA policy also supports increased flexibility in the Medicaid program so that states may pursue innovations that improve coverage for patients with low incomes. We are concerned, however, with the proposed rollback of the Medicaid expansion under the ACA. Medicaid expansion has proven highly successful in providing coverage for lower income individuals. Beyond the expansion, the underlying structure of Medicaid financing ensures that states are able to react to economically driven changes in enrollment and increased health care needs driven by external factors. The Medicaid program, for example, has been critical in helping many states cope with the increased demand for mental health and substance abuse treatment as a result of the ongoing crisis of opioid abuse and addiction. Changes to the  program, therefore, that limit the ability of states to respond to changes in demand for services threaten to force states to limit coverage and increase the number of uninsured.

In addition to the concerns listed above, the AMA cannot support provisions that repeal the Prevention and Public Health Fund or that eliminate the ability of patients to receive their care from qualified providers of their choice. The Public Health and Prevention Fund has supported many critical projects, including investments in immunization, childhood lead poisoning, and health-care associated infections. Currently the fund comprises approximately 12 percent of the budget of the Centers for Disease Control and Prevention and should be preserved. In addition, choice of health care provider is an important element of a reformed health care system. The AMA cannot support provisions that prevent Americans from choosing to receive care from physicians and other qualified providers, in this specific case, those associated with Planned Parenthood affiliates, for otherwise covered services.

As you consider this legislation over the coming days and weeks, we hope that you will keep upmost in your mind the potentially life altering impact your decisions will have on millions of Americans who may see their public, individual or even employer-provided health care coverage changed or eliminated. We encourage you to ensure that low and moderate income Americans will be able to secure affordable and adequate coverage and that Medicaid, CHIP, and other safety net programs are maintained and adequately funded. And critically, we urge you to do all that is possible to ensure that those who are currently covered do not become uninsured.

Sincerely,
James L. Madara, MD 

You can read the letter from the AMERICAN HOSPITAL ASSOCIATION here.

The Horrors Of War Continue

(This photo of the Medecins Sans Frontieres (Doctors Without Borders) Hospital is from ibtimes.co.uk.)

The following message is from the group called United for Peace & Justice. I agree with it.

The horror continues in Afghanistan with the deadly bombing of the Doctors Without Bordershospital in Kunduz killing 22 people - 12 staff members and 10 patients, some of them children, with dozens more wounded.

Bombing a hospital is a violation of International Humanitarian Law and a War Crime.

Afghanistan is our country’s longest war – entering its 15th year today, October 7th. President Obama can’t claim he ended combat operations in 2014 when we continue to bomb the country. Bombing is war!

The President and military leaders have repeatedly told us there is no military solution in Afghanistan. Why are the same failed policies that began under the George W. Bush administration still in effect?

Since the 2009 “surge”, things in Afghanistan have only gotten worse. The Taliban have launched more attacks every year. Rather than being diminished they have grown in size and capacity. For the 5th consecutive year Afghan civilian casualties have hit record highs. Some Afghan people, fueled by anger at foreign occupation and a corrupt government, have turned to the Taliban.

The government of Afghanistan is one of the most corrupt in the world – hundreds of millions of our dollars go into the hands of crooked officials, warlords, drug lords and the Taliban. 

The U.S. has spent $65 billion to build the Afghan Army and Police Forces. Despite the infusion of $110 billion in foreign assistance since 2001, Afghanistan’s only real economy is the poppy drug trade which has rapidly increased in recent years under U.S. occupation. America has supported a corrupt Afghanistan government at the expense of Afghan people American service members.

Now, President Obama has ordered a slowdown in U.S. troop withdrawal and we fear he may extend troop deployments beyond 2016.

U.S. military intervention is a proven failure. We invested in drones, bombs, soldiers, and night raids but did not invest in solutions. These failed military tactics have led to more enemies, more extremists and futile, endless war, while increasing suffering for the people of Afghanistan (2.5 million refugees and 700,000 displaced per UNHCR). 

How do we respond to those who say if the U.S. leaves there will be a bloodbath? Unfortunately a bloodbath has been underway for 14 years and the U.S. must take responsibility for its part in it. U.S. military involvement in Afghanistan and the Middle East is seen as a crusade against Islam and used by Al-Qaeda, ISIS and other extremist groups to attract recruits. There are no easy answers or fast solutions. But if we change course, take diplomatic methods seriously, backed by intelligence, money and our full, determined effort, we can achieve a political solution leading to stability instead of endless war.

The Afghanistan war is an abysmal failure. We must ask President Obama, our Congressional representatives, and the military two basic questions:

• Why should U.S. forces stay one more day in Afghanistan? 
• What is preventing a full, focused effort on diplomacy – in Afghanistan as well as in the Middle East?

Send a message to your Congressional Representatives calling on them to end military operations, bring our troops home, and demand focused diplomatic efforts to reach a political solution to the crisis in Afghanistan.

We need to end military intervention and support a diplomatic process leading to a political solution. As long as there are U.S. forces in Afghanistan there will be no peace. As President Obama himself has said, a lasting solution will depend on Afghans and their neighbors reaching a political settlement.

Please share this message with others who want to end the war.

Texas Refuses Medicaid Expansion - & Hospitals May Close

(This image is from the website theexpertinstitute.com.)

Texas leads the nation in both the number and percentage of uninsured citizens (with more than a quarter of the state's population being uninsured) -- and about 2 million of those people are poor people, who cannot afford to buy insurance. This has always caused a problem for hospitals, since these people clog up emergency rooms when they get sick. They have to do that since they cannot afford preventative care at a doctor's office.

But the problem goes further than overcrowded emergency rooms. While hospitals have to treat these people, they do not get paid for that treatment. To cover the costs, public hospitals need more city and county tax money -- and all hospitals must raise their prices for other patients (which just increases the number of people who cannot afford care). It was a real problem that had many hospitals in financial trouble.

Right after the passage of the Affordable Care Act, the federal government came to the rescue. They agreed to give Texas about $4 billion dollars a year for five years to help defray the cost of free care being given by hospitals through their emergency rooms. The thought at the time was that Texas would expand Medicaid in that five-year period -- giving poor people insurance so they could pay for both preventative care and hospital care (and removing the need for hospitals to provide free emergency room care).

But then the Supreme Court decided that states did not have to expand Medicaid -- and Texas Republicans decided not to do it. It was a political decision, ignoring the needs of the poor in Texas, designed to please the teabagger base of the Texas GOP. But that move was not only heartless, it was also short-sighted -- since the federal money is about to end.

The federal money (about $4 billion a year) to help subsidize free emergency room care will end at the end of next year. And the federal government has notified the state of Texas that there will not be a renewal of that agreement. Washington sees no reason to keep giving Texas this free money since the state refuses to expand Medicaid -- which would give those patients both preventative and hospital care, and remove the need for hospitals to cover the cost of that care.

The federal government is right. They should stop giving the money. There is no legitimate reason for the state to refuse to expand Medicaid (since the federal government would pay all of the costs of that expansion at first, and 90% after that). Continuing the free money would just allow the state to continue playing political games with the Affordable Care Act, while denying badly needed preventative care to the poor (resulting in unnecessary deaths, since by the time these people are sick enough to go to the emergency room, it is too late to treat some of their diseases).

The Republican governor and legislature has the legal right to refuse to expand Medicaid. The Supreme Court gave them that right. But they do not have the right to keep getting federal money by refusing that expansion. It is time for the Texas Republican-dominated legislature to stop playing political games on the backs of the state's poor people, and expand Medicaid. If they don't, the hospitals will be back in the same financial trouble they were in several years ago -- and many of them will have to close their doors (hurting not only the poor, but everyone in those communities).

I think the lives of Texas citizens, and their access to a quality community hospital, is far too important to continue refusing Medicaid expansion. Unfortunately, Texas Republican legislators think getting teabagger votes is more important -- and that is shameful.

More Bad News For The GOP Regarding Obamacare

After their failure to keep the Affordable Care Act (Obamacare) from becoming law, the congressional  Republicans told a whole stack of lies about it. Among that stack of lies was the claim that Obamacare would drive up health care costs -- both for health care insurance premiums, and for actual health care itself. We already know that insurance premiums are not rising as the GOP predicted. They are going down in some states, and rising slower than in the past in other states -- thanks to Obamacare.

Now we have evidence that shows Obamacare may well be working as hoped to keep medical care costs down, instead of driving up costs as the GOP claimed would happen. The chart above was made with information from the Department of Health and Human Services (Office of the Assistant Secretary for Planning and Evaluation). Their recent report shows that the uncompensated care costs (UCC) incurred by hospitals is slated to drop by about $5.7 billion this year in all states, and the reason for the drop in UCC is due to more people having health insurance due to Obamacare.

The biggest reason for this drop in uncompensated costs is due to more people being covered by Medicaid. Hospitals used to have to eat the cost of treating these people in their emergency rooms (and sometimes in their care units). These costs would normally be passed on to other patients in the form of higher overall hospital charges -- which would drive up the co-pay of patients and the costs paid by insurance companies (which would drive up the premium price to customers).

That's what would happen in private hospitals. In public hospitals, the prices would also rise to help pay for the hospital's UCC, but part of the UCC would also be paid for through higher city, county, or regional taxes. That means Obamacare is not only helping to keep hospital costs down, but also helping to keep the tax burden from rising.

We know that most of the reduction in hospital UCC is due to expansion of Medicaid, because 74% of the reduction in UCC has happened in states that have expanded Medicaid. But costs in states that did not expand Medicaid also went down (about 26% of the reduction in hospital UCC happened in these states) -- and that was also due to Obamacare.

It comes form people who could not afford insurance before Obamacare. Since they didn't have insurance, a large medical bill would bankrupt these people and cause the hospital to have to eat the cost of their care. These people made too much to qualify for Medicaid under Obamacare, but the new law gave them a subsidy to help them buy insurance -- and since they now have health insurance, the hospitals are getting paid for the medical care they provide to these people.

Once again, the Republicans are exposed as being liars about Obamacare. Obamacare has helped hospitals to keep their costs for patients down by making sure they get paid for a higher percentage of those patients. And while the hospitals located in states that have expanded Medicaid are seeing the biggest drop in uncompensated care costs, Obamacare has also reduced those costs in other states.

I still believe we should institute a government-run single-payer health insurance system. It would be more effective in both covering everyone and keeping medical costs down. But it is now an undisputed fact that Obamacare has been a huge improvement over what we had before it was passed.

Hospitals Oppose GOP Medicaid Plans

The Supreme Court, while upholding most aspects of Obamacare, did invalidate one aspect of the health care reform act. They ruled that the federal government could not withhold all Medicaid money if a state refused to institute Obamacares Medicaid reforms (which dictates that many millions of poorer Americans could join the Medicaid program). Instead, the state could just continue the current vastly inadequate Medicaid program in place (which denies coverage to millions of poorer people).

Sadly, 10 states led by Republicans have already said they would not institute Medicaid reform, and it is likely that another 19 Republican-led states will follow suit. That means over half of the states will deny medical insurance coverage to millions of poor and working class people (about 17 million people). This should not surprise anyone, since the Republican Party has made it clear they do not believe health care is a right of all -- just a privilege for those who can afford it. The Republicans think of health care as a commodity, which a person can either purchase or not.

Unfortunately, that is some seriously flawed thinking. While many "commodities" are indeed the choice of the consumer, health care is different. Health care is not a choice, but is something that will be needed by everyone at some point in their life. Hospitals know this, because they are the ones that have to deliver those health care services. And that is why they are upset with the Republican plan to keep millions of Americans from getting insurance coverage from Medicaid. The hospitals know they will have to treat these people by law (probably through emergency rooms), and they still won't be paid for those services.

In 2010, hospitals were left with $39.3 billion dollars in unpaid medical bills, mostly from being required to treat people who do not have insurance and cannot afford the expensive medical costs. The hospitals were hoping to recover much of that in the future, since an additional 17 million people who make less that 133% of the poverty level would have been covered by Medicaid.

The Republicans would like for people to think they are saving money by not instituting the Medicaid reforms. But that is just another Republican lie. The hospitals don't just write off that $39.3 billion in unpaid bills. They couldn't stay in business if they did. They just pass those costs on to the rest of us, through higher medical bills (meaning higher insurance premiums and co-pays) and, in the case of public hospitals, higher local taxes. The Republicans aren't saving anyone any money -- they are just shifting the costs to local taxpayers and other medical consumers (who must bear the burden of the higher medical costs). This is why the hospitals must oppose the Republican plans to deny Medicaid reform, because it is a plan that is guaranteed to make the hospitals continue to raise their prices to stay in business.

Don't believe the Republican lies about how they can't afford Medicaid reform. The federal government will pay all of the costs for three years, and then will pay 90% after that. And don't believe their lies about how they are saving money for the American people. They are just shifting the costs, not saving money.

The only saving grace in the mean-spirited Republican plan to deny Medicaid reform is that it is probably pushing this country much faster toward finally adopting a single-payer medicam insurance program -- and that is a good thing.

Obama Takes Step Toward Equal Rights

For many years now, gays, lesbians, bisexuals and transgendered individuals have been unable to enjoy the same rights as other Americans. This is especially true when it comes to the rights of a sick or dying person in a hospital. Too many times, these individuals have been denied the right to visit or console a life partner in their time of need.

This is because many hospitals give visitation and decision-making authority only to legally-recognized family members. Since few states recognize the right of homosexuals to marry, that means their partners are not recognized as a family member -- even though they may have lived in a committed relationship for many years.

This unfair behavior even extends to a living will created beforehand by the sick person. Even though the person may have designated their life partner to be the decision-maker in a time of emergency, many hospitals have refused to honor that since the people were not legally married or related by blood. There is no way that this hospital behavior is right, but it has been happening in violation of the sick or dying person's wishes.

President Obama has decided that this terrible injustice must stop. Yesterday, he instructed the HHS secretary to draft new rules for hospitals receiving Medicare or Medicaid funds. They must now abide by the wishes of the sick person. If he/she wants an unmarried life partner (or just a friend) to visit, console or even make medical decisions, then that is the way it will be. Any hospital that doesn't abide by this new rule could have their government funds cut off.

When giving the order, President Obama said, "Every day, all across America, patients are denied the kindnesses and caring of a loved one at their side -- whether in a sudden medical emergency or a prolonged hospital stay. Often, a widow or widower with no children is denied the support and comfort of a close friend. Also uniquely affected are gay and lesbian Americans who are often barred from the bedsides of the partners with whom they may have spent decades of their lives -- unable to be there for the person they love, and unable to act as a legal surrogate if their partner is incapacitated."

He went on to say this should "guarantee that all patients' advance directives, such as durable powers of attorney and health care proxies, are respected", and that patient designees should be able to "make informed decisions regarding patients' care."

While this gives gays and lesbians rights they have long been denied, it also extends the rights of heterosexuals. If a person has no family, or is estranged from his/her family, they can designate a close friend or unmarried partner to visit and, if necessary, make medical decisions. In other words, these new rules will be beneficial to persons of all sexual orientations.

I don't know why this couldn't have been done a year ago. Maybe the president thought it could interfere with his proposed health care reforms. No matter. At least it has now been done. Finally the sick and dying have the right to make their own decisions -- regardless of hospital policy or rules.

With this decision, the president has taken a step toward insuring equal rights for all Americans. It is only a small step, and much more needs to be done -- but at least it is a step in the right direction.