This situation shows why we need health care reform, yes even the individual mandate but even better a public option or single payer. It shows that we already have and have had for a long time a public option but one that is run horribly inefficiently because rather than being a something that was intended is a consequence of the requirement to provide emergency medical care and the failure of providing insurance to all. This is a bit of a long read so have highlighted a few key paragraphs. http://rockcenter.msnbc.msn.com/_ne...pitals-overwhelmed-by-permanent-patients?lite Health care laws leave hospitals overwhelmed by 'permanent patients' By Kate Snow, Janet Klein and Dustin Stephens Rock Center For Barbara Latasiewicz, home was a hospital room. The Poland native, who had cleaned homes in the Chicago area for 20 years, suffered a stroke while on the job in September 2009. An ambulance took her to Adventist La Grange Memorial Hospital in Illinois. "I was thinking that after a few days, that I'm just gonna get better," Latasiewicz told NBC’s Kate Snow through a translator in an interview airing April 25 at 9pm/8 c on Rock Center with Brian Williams. Latasiewicz suffered paralysis on one side of her body, but eventually became well enough to leave the hospital. However, more than two years later, the 62-year-old was still in the hospital. “She hasn’t needed to be in this acute facility for a long time,” said Richard Carroll, the hospital’s chief medical officer. When asked about Latasiewicz’s more than two year stay at the hospital he oversees, Carroll said, “That’s really a function of how our health care system is working right now, which is it’s not working very well at all, particularly in cases like this.” Carroll said that Latasiewicz belonged in a skilled nursing facility where she would receive a more appropriate rehabilitation, but she had no way to pay. Latasiewicz had no insurance and was an undocumented resident with no access to government safety-net programs like Medicaid. Without payment, no facility would take her. The end result? Latasiewicz stayed at La Grange. Her care cost the hospital $1.4 million. A skilled nursing facility would have been a fraction of the cost. An NBC News investigation discovered that cases like Latasiewicz’s are not unusual, but the result of current health care policies and guidelines. They are known as “permanent patients” and are hidden in plain sight in hospital rooms across the country. That’s because under federal law, hospitals must treat any patient who needs emergency medical attention even if they have no way to pay. Nursing and rehab facilities are not required by law to do so. At the same time, hospitals cannot discharge a patient without a plan in place for his or her ongoing care. The result is patients stuck in the hospital in need of long-term care but with nowhere to go, large medical bills, and no way to pay – a cost that is usually covered at the hospital’s expense. “It would be cheaper to take these patients and send them to the Ritz Carlton,” said Harvard University School of Public Health Professor Ashish Jha. “They could get room service all day, and that would be cheaper.” Jha estimates there are tens of thousands of these patients stuck in the hospital with no clear place to go. Some stay an extra week, some months, and some like Latasiewicz even years. NBC News spoke with officials at dozens of hospitals across the country who confirmed housing patients who didn’t need to be there for extended periods. Many patients are stuck because they have no money or insurance to pay for long-term care. Other patients may have insurance, but their medical needs are too complex for most skilled nursing facilities to accept. Then there are those in limbo at the hospital waiting sometimes for months to qualify for Medicaid. Once they’re approved, Medicaid will cover the nursing or rehab facility they need. A spokesperson for the American Health Care Association which represents skilled nursing facilities says that the industry works with hospitals to find facilities for such hard-to-place patients. According to data from the National Inpatient Sample database at the Agency for Healthcare Research and Quality, the problem of permanent patients appears to be on the rise. From 2005 to 2009, the last years for which data was available, uninsured hospital patients with no access to Medicare or Medicaid in need of long term care increased 20 percent. “Most of them are Americans,” Jha said. “And if they get hit by a bus, they get sick, they’re in this situation.” Garrick Amato, 59, arrived at Banner Heart Hospital in Mesa, Ariz., after suffering a heart attack. A few days later, he was ready to leave the hospital for a rehab facility. However, Amato, who said he worked part-time at a local discount store, had no health insurance and no way to pay for his rehab. “I guess no nursing home will take me cause I don’t have insurance,” Amato said. Furthermore, as a single adult without dependent children, he did not qualify for Medicaid in Arizona. Amato spent most of March and much of April at the hospital. Banner Hospital eventually found charity care for him that placed him in a skilled nursing facility where he belonged. Other patients linger in hospitals despite their best efforts to find charity care. Fatima Khydarova, a professor from Uzbekistan, has been at Maimonides Medical Center in Brooklyn, N.Y., for more than two years. Khydarova arrived there after suffering an incapacitating stroke while visiting her grandchildren in New York. While Khydarova will never walk or talk again, doctors say she does not need to be in a hospital. “In a perfect world she should be either at home with her family caring for her or in a nursing home,” Maimonides CEO and President Pam Brier said. Khydarova’s grandchildren said that they cannot take care of their grandmother at their mother’s small apartment and at the same time make a living to support all of them. “I’m working, I’m working.” said granddaughter Nigina Abdullaeva who works at a doctor’s office. Dr. Jha of Harvard University says that the costs for treating permanent patients are passed on to other consumers through higher medical bills and insurance premiums. “The bottom line is we’re all paying for it,” Jha said. To mitigate the cost of these patients, some hospitals have paid out of their own funds to move them to skilled nursing facilities. Once there, the hospital could pay for their care for the rest of their lives. “Hospitals don't want to widely advertise that they will pay for your care elsewhere,” Jha said. “But in select situations, they look, and they realize, instead of spending tens of thousands of dollars to keep the patient in the hospital, it's probably cheaper for them to send them somewhere else.” Back in Illinois, case workers at La Grange Hospital also struggled for years to find charity care for Latasiewicz in America. They eventually found a facility in her native Poland that would accept her. Wiping tears away from her eyes, Latasiewicz told Kate Snow through a translator that she did not want to leave. Latasiewicz lived in the United States for 20 years and has a son and grandchildren living nearby. However, her son, Peter Latasiewicz, said he could not take his mother into the small apartment he shares with his children and another family. “I wouldn’t be able to provide as much help and support and care for her,” Peter Latasiewicz said, “she’s got a lot of medical conditions where she requires 24/7 care.” The hospital eventually went to court for permission to send Barbara to the rehab facility in Poland. The hospital won and on March 1, Latasiewicz boarded a flight back to her native Poland, where a government safety-net program will pay for her care. In Brooklyn, Khydarova, the professor from Uzbekistan, remains at Maimonides and the hospital is still working hard to find a solution for her family “She’s going to stay in the hospital unless we can find a spot for her,” CEO Brier said, “She could stay here potentially for the rest of her life.”
Deplorable. This is as a good a thread as any for this other nugget of American health care folly... How much does an appendectomy cost? Somewhere between $1,529 and $186,955 A team of researchers at the University of California San Francisco started with a simple question: How much does it cost to get your appendix removed in California? They did not find a simple answer. The price of appendectomy ranged from as little as $1,529 to as much as $182,955 depending on where it was performed, according to results published in the Archives of Internal Medicine. These results came after the researchers focused their data on 18- to 59-year-olds whose hospitalization lasted fewer than four days, to make sure they culled out any complications. The price of an appendectomy looked to vary more by individual institution rather than geographic region. “While Fresno County had the smallest range of charges, the lowest and highest charges still differed by a remarkable $46, 204,” the study found. The authors think this points to the fact that we’re not shopping for price when it comes to health care - and many obstacles stand in the way of doing so. A patient doubled-over in abdominal pain, they write, “is in a poor position to determine whether his or her physician is ordering the appropriate blood work, imaging, or surgical procedure.” “Price shopping is improbable, if not impossible, because the services are complex, urgently needed, and no definitive diagnosis has yet been made,” the authors conclude. “In our study, even if patients did have the luxury of time and clinical knowledge to ‘shop around,’ we found that California hospitals charge patients inconsistently for what should be similar services as defined by our relatively strict definition of uncomplicated appendicitis.”
Making sure everyone has insurance and insurance that will cover long term acute care. That sounds really familiar.. Almost like something that has been talked about a lot and which the USSC might strike down..
Problem not solved. It will help more people afford/access health care, but there would still be gaps. I think universal health care is the only way. The insurance system is not working.
It should not be costing 1.4 mil. Charging 4000 dollars a day is ridiculous. We need a single payer system and we need to greatly lower costs. Doctors don't need to make more than 200k. If they complain it is time to let people come to this country who will for that much.
True there will still be gaps but the HCA is a step in the right direction. Given how many people are crying "SOCIALISM" over something this modest, a single payer / universal system is not going to happen anytime soon in the US. To hold out of that IMO is making the great the enemy of the good.
Charging too much, yes. Making $200K max? You're crazy. Maybe for a general practitioner, but I think Neurosurgeons should make more money. We already live in a messed up world where we value advertising to the point where pro athlete salaries dwarf those of Physicians. I think we should be decreasing how often we need a doctor. Many problems could be dealt with by nurses. Cutting out insurance would provide for savings as well.
The cycle: Nancy Pelosi once had trouble finding a babysitter. So her aspiration these days is "doing for child care what we did for health care reform"—pushing a comprehensive solution. In fact, it's not just an aspiration—it's at the top of her agenda. This sounds like an absolutely wonderful idea. But if "we" really are going to do for child care what we have done for health care, the U.S. will have to take some intermediate steps in order to replicate the experience faithfully. (1) First, the U.S. should create a labor shortage by launching a major war and drafting men and women to fight. (2) Then it should impose wage and price controls, as Washington did during WWII, to prevent employers from bidding up the price of labor. (That would further drive up the prices for war materiel, which would be costly and inconvenient to the government. The Emergency Price Control Act of 1942, for instance, stipulated that its aim was "to assure that defense appropriations are not dissipated by excessive prices.") (3) The president—Barack Obama, presumably—should then establish a War Manpower Commission with the power to forbid people to change jobs, as just such a commission did during WWII. This will prevent individuals from skirting around the wage controls by quitting one job to take another that pays more. (4) Practices such as these will encourage employers to compete for scarce labor by offering non-wage benefits. During WWII, employer-provided health coverage was one such benefit. It is reasonable to assume employer-provided child care would be another one today. (5) To facilitate the spread of employer-provided child care, Washington should grant it preferential tax status, as it does with health care. The IRS should back this up by declaring that child-care benefits do not count as wages. (6) To further ensconce the third-party-payer system, the National Labor Relations Board should declare, contra the IRS finding, that child-care benefits do count as wages for the purposes of collective bargaining (just as it did with health coverage). This, combined with the favored tax status, will encourage labor unions to push for extravagantly generous child-care policies for current workers and for pensioners. (7) Washington then should enact two major new entitlement programs akin to Medicaid and Medicare, guaranteeing government-funded babysitting for the poor and elderly. Washington should produce wildly low-balled estimates of the future costs of such programs. (8) While all this is going on, the states should impose complex bureaucratic oversight of the child-care system—especially a "Certificate of Need" program through which bureaucrats, rather than the free market, would decide whether new child-care facilities are needed and may be allowed to open. That way, existing child-care facilities will have government allies in their attempts to limit competition that might hold down costs. (9) Likewise, professional child care associations should lobby Congress for market-entry barriers requiring providers to obtain highly restricted licenses for performing even the most mundane procedures. (10) Meanwhile, politicians at both the state and federal level should propose a host of various mandates on employer-provided child care—requiring such programs to pay for trips to the zoo, cultural institutions and parks; to cover weekend child care for romantic parents' getaways; and to cover full-time au pair services for parents of children with special needs. This will help drive up the cost of insurance even faster. (11) As the share of GNP devoted to child care begins to spiral out of control and the government assumes control of 50 cents out of every child-care dollar, liberals and progressives should argue that this proves the current free market in child care doesn't work, so the government should stop sitting on the sidelines and step in to fix everything. (12) Ideally, the stepping in would consist of a complete government takeover of child care: a single-payer system in which the government does all the child care in the country, and nobody else is allowed to. (13) Short of that, Washington should pass legislation forbidding providers to turn anyone away, and requiring all Americans to buy child-care coverage—whether they have children or not. This should be part of a massive child-care overhaul that will drive costs up even further and prove equally untenable. Then the country can go back and try Step 12—and we will all live happily ever after. Right?
I agree. All these stop-gaps and half-measures are just aggravating the problem, and the problem is so big that we can't just ignore it or wait for the market to 'fix' it.
You know what's kind of sad? The stuff you actually believe is so disconnected from reality that, when you type something like this, I can't tell if you're joking.
Cost is roughly $1,500 annually, but climbs much higher as you are older. That isn't very affordable for those who work labor intensive jobs. I'm all for not helping the lazy people or people that blew through their opportunities, but we can't ignore those who weren't born as fortunate as most of us. The current system is the rich/middle class pay for their healthcare and they pay for the poor, including illegals.
And when you, or a loved one, has a condition that can only be treated by a board-certified surgeon who has gone through years of training (with massive accumulated debt) to be able to fix your condition... don't complain when you get an inexperienced hack who speaks little english.
38% of all doctors in this country are Indian. Most doctors in India can speak English. So I would have no problem giving everyone one of them visa, greencards, etc. to come here.
Here's the thing - I agree that we need a single payer system, but I think we can, and should, pay doctors well (also in response to Nick above). Without all the market-share, CEO, administrative bull**** occupying a primary position in the pricing department, we can easily pay for good care and continue paying for good doctors. A massive amount of the profit generated in hospitals goes to insurance companies, giant bonuses for CEOs, and other people and groups who have almost nothing to do with actually developing and administering medical care and technology. The people getting the biggest payouts are the people whose sole reason for existence is to find ways of increasing the profitability of the healthcare system. With a single-payer system, that's not as much of a concern. Accordingly, those massive-salaried people are no longer as necessary. So, we cut a huge percentage of the profits that go into the pockets of non-medical personnel, continue paying doctors well, and also pay for the system itself. We can have a single-payer system and still continue to compensate doctors well for their work and training. As an added bonus, we can learn from the mistakes that other countries have made and improve upon already-existing models. This is something that economists know about - the late-adopters of a system are often at a significant advantage because they already have tangible examples of the things that work and the things that don't. We're the United States. We can have both the best AND the most equitable healthcare system in the world.
Because it's too expensive or because it's not a priority? And I mean, why would you buy it if you 'can't afford' it when you can't be denied treatment? There is no incentive to buy the coverage if it is between eat out twice a month for a nice dinner or buy LTC. [obviously this does not refer to the poor, more of a middle class observation]
...and that's the key point here, I think. There are vastly more poor people, people poor enough that buying long-term care insurance is genuinely impossible, in this country than most people assume. It's unfair to hold those people accountable because a small percentage of middle-class people who can afford insurance choose not to pay for it.
