Photo by Sam Hodgson
Scripps Mercy Hospital in Chula Vista.
Every year I get the email. It’s a notice of how much our employees’ health care premiums are going to rise. This year, our chief financial officer came with a suggestion that we switch. Our health care costs were going up 15 percent if we didn’t find another option.
We did. Thankfully.
Not long after the switch, I had lunch with Chris Van Gorder, the CEO of Scripps Health, which runs hospitals across the county.
He told me a story that blew my mind.
In 2006, a man walked into the emergency department at Scripps Mercy Hospital in Chula Vista.
He had gangrene. His blood sugar was out of control. He had diabetes and peripheral vascular disease. Previous doctors had already amputated a leg.
One more thing: He did not have insurance or any way to pay Scripps.
It’s now 2012 and, $1.8 million later, Scripps is still taking care of him. They never could find a way to cut him loose to a safe environment.
We got his permission to talk about his case but with the stipulation that I not disclose his name.
That story troubled me. So I called the CEO of Sharp HealthCare, Mike Murphy, to see if he had anything similar.
He offered a different but stunning observation.
Murphy said that, last year, 4,745 people walked into emergency departments at Sharp HealthCare facilities in San Diego. They all had no way of paying. No insurance at all. No government support.
They all had one more thing in common: They had a medical issue that required Sharp to admit them for further treatment as inpatients. In other words, the emergency department wasn’t enough.
And just like Scripps’ notorious patient, Sharp could not release these people without taking care of them.
For those of you worried about the prospect of this country guaranteeing health care to everyone, and how much that would cost, I hate to break it to you, but we already do guarantee it.
It’s called EMTALA, short for the Emergency Medical Treatment and Active Labor Act. President Ronald Reagan signed it into law in 1986. It’s regularly cited as one of the greatest unfunded mandates our government ever passed.
EMTALA mandates not only that hospitals take care of anyone who enters their emergency departments — anyone — but that they not discharge those patients unless they’re safe and stable.
“It is the ultimate safety net,” said Dr. Jim Dunford, who is the city of San Diego’s medical director and a leader of UC San Diego’s emergency medicine efforts.
It is a safety net, and it’s an expensive one.
Supreme Court Chief Justice John Roberts cited it in the opinion that recently upheld crucial aspects of the Affordable Care Act, President Barack Obama’s signature health care reform effort.
He noted that federal and state laws require hospitals to provide care to people without regard to their ability to pay. Hospitals, he wrote, end up only collecting money for a portion of the services they provide.
Yet they still provide those services.
“To recoup their losses,” Roberts wrote, “hospitals pass on the cost to insurers through higher rates, and insurers in turn pass on the cost to policy holders in the form of higher premiums.”
And hence to me, as I gulp at our employees’ health care bill.
The numbers really are brutal. In 2011, Sharp Healthcare had to give $287 million in so-called “uncompensated care.” For Scripps, the number was $268 million. For UCSD? $80 million.
Uncompensated care is a bit of a misnomer. The hospitals don’t just absorb that loss and pout. Not all of it.
They have people to pay. Doctors aren’t cheap and their supply is controlled.
No, they pass those costs onto people with insurance. It’s an unfair burden for employers committed to providing health care to their employees. It certainly doesn’t make it easier to hire people.
I know, the world of health care costs is complicated, and full of lunacy. Some people much more intelligent than I have explored it. In fact, one of the best pieces of journalism I’ve ever read came from an exploration into this issue.
But let’s be clear about something: The uninsured are getting health care. It’s through emergency departments at local hospitals.
It’s a terrible way to manage their care. It often catches problems too late, making the care more expensive. It is just not the way to keep people healthy.
“If we don’t reform it and we continue to have the hospitals absorb this and have people come to the ER as their primary care place, we can’t take care of them cost effectively, and it will eventually compromise hospitals’ ability to maintain services for people who do pay,” Murphy, from Sharp, told me.
The answer that Obama came to, and the one former Massachusetts Gov. Mitt Romney came to before him, was to require everyone to get health insurance.
Under Obama’s reform, the federal government will stop paying hospitals as much as it does now for the Medicare and Medicaid patients hospitals treat. Hospitals are OK with that because they’re banking on the fact that, if more people are insured, they’ll make up the difference.
At the same time, as more individuals buy insurance outside of their employers, they’ll be able to shop easier than even a small organization like mine can.
Perhaps this will put a downward pressure on prices.
That’s the theory, anyway. I’ll know, in coming years, when I receive those emails about our premium prices, whether it worked.
Correction: In the original version of this story, we incorrectly referred to Sharp CEO Mike Murphy as working with Scripps in the third reference. We regret the error.
I’m Scott Lewis, the CEO of Voice of San Diego. Please contact me if you’d like at firstname.lastname@example.org or 619.325.0527 and follow me on Twitter (it’s a blast!):
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