We learn from the healthcare reform bill that the federal government will help subsidize Medicaid funding for all the new patients who qualify, but they will only do it for two years. After that, the states are on their own. Medicaid unfunded liabilities will crush state governments everywhere.
Why is Medicaid so expensive and going bankrupt? I’ll give you one example why. This is played out day after day, night after night in communities all across our country. And the only ones paying for it are you and me. The ones spending all the money have no incentive to stop.
I’m in the ER the other day when I see a chief complaint fly by on the radar. What is that chief complaint, you ask? Let me tell you a story.
Refused By Detox
The patient was so drunk even the community detox center refused him. So how did this play out? The patient was taken by ambulance from his home to a small-town community ER for altered mental status. There he was checked into the ER and seen by a small-town community ER physician, family practice resident, or PA or NP.
Diagnosis: Acute alcohol intoxication. Plan: Discharge to community detox center.
The patient was then transported to detox by a cop where he was promptly refused by detox for being too drunk. Too drunk for detox. How sad is that. At this point another ambulance was called and the small town hospital refused to accept him back because he was “too drunk” for them to handle if he became comatose and critically ill.
So the ambulance drove him 75 miles to my hospital which has to accept him, where he was promptly booked into the emergency department in front of the 28 year old with heartburn, the 19 year old looking to get a pregnancy test and the 14 year old who’s mother brought her in because she just had her first period.
What happened with our drunk? He was promptly placed in a room where stat lab confirmed what everyone else had suspected. He was drunk. The big-city ER doctor billing $500 an hour proudly made his diagnosis and disposition plans known to the world:
Diagnosis: Acute alcohol intoxication. Plan: Discharge to community detox.
By now, the patient’s alcohol level was down to 320 and he was awake, responsive, and asking for a “samich” as the cops show up to take him away. Let’s conservatively add it up:
- Two ambulance rides: $1,000
- Two ER visits: $3,000
- Two ER physician visits: $500
Almost $5,000 to take care of a drunk in which doing nothing would have given you the same result. And you wonder why Medicaid is going bankrupt? Here’s what’s going to happen: These people, the ones who have no personal responsibility for the actions they choose, they are going to find themselves without their community safety net.
As Medicaid expands (because the Democrats so wrongly believe that Medicaid is the answer for poor people), hospitals will collapse under the weight of this non-viable payment model. These hospitals will simply close for good or move to the suburbs where Medicaid is a rarity. I guarantee you there are hospital “expansion committees” out there right now trying to decide how to open up new satellite hospitals in the rich parts of town that are geographically buffered by at least one other full service hospital that can take the brunt of the Medicaid population.
You don’t think the healthcare reform bill is racist? Medicaid, by definition, is a racist insurance program. Give poorly-paying insurance to all the blacks and Hispanics and underfund their care by billions and billions of dollars a year. Then blame hospitals and doctors for not playing along. Medicaid is a scam. As it expands, it will crush hospitals that rely on limiting their Medicaid exposure. And who’s going to get crushed? The inner-city hospitals.
You’re going to see hospital after hospital in inner-city America shut down, and all the folks they employee will become economic wards of the state. This is Obama’s plan to prosperity. You’ll have no jobs for the local community and no doctors to care for the inner-city poor. All the poor Medicaid patients will find themselves without their community safety net. Hospitals taking care of predominantly poor people will disappear and those left standing will make life difficult for those patients to find them.
What will these poor patients who can’t walk to their ER anymore for their primary care do? They’ll call an ambulance to take them for a free ride to the nearest hospital for everything. They’ve got Medicaid. It’s FREE=MORE.
*This blog post was originally published at The Happy Hospitalist*