Friday, May 29, 2009

Groucho Marx was not so wrong

Groucho Marx's saying goes something like this: "A hospital bed is like a parked taxi with the meter left running". As discussions of health care reform swirl around us, a quick look at the history of hospitals in our country as well as a focus on Louisiana's unique system, before and after Katrina, provide a great deal of information as to how that happened.

As the first hospitals were built, often by religious groups, work was often done by volunteers and members of religious orders. They were traditionally non-profit and sponsored by a religious denomination and called almshouses, providing "only a minimum of charitable medical care". Later, large public hospitals were built in cities with research hospitals. Now many hospitals are funded by the government or compete as for-profit entities in the private sector. As much as the for-profit system has produced "some of the best hospitals in the world, a proportion of the populace may have little or no access to healthcare services of adequate quality".

Lousiana ,which built up a state-run charity-based model of care during the Depression years, stayed with it as the rest of the country changed. A microcosm of clashes between the old and the new way was highlighted in Louisiana after Katrina "blew the medically uninsured into the arms of the states' private hospitals, clinics and doctors" when two indigent-care hospitals were destroyed.

In a 2006 article, USA Today noted that :

In Louisiana, virtually all state-administered aid for the uninsured and indigent is channeled through 10 charity hospitals run by the Louisiana State University medical system. Most private hospitals are ineligible for this assistance, which came to about $1.1 billion in 2004.

This resulted in astronomical losses for the remaining private hospitals, who took on the toll of uninsured patients while those who closed temporarily fared better.

A comprehensive report by Pricewaterhouse was done to address healthcare delivery and the financing system in Louisiana hospitals. (link is to pdf file).

It found that Louisiana's two system hospital approach, one for the insured and the other for the uninsured or underinsured , was unworkable and didn't provide the best quality care for either sector, the private hospitals caring for the insured or the public hospitals caring for those who are uninsured or underinsured. The report found a shortage of general practitioners, nurses and physician's assistants, coupled with an abundance of specialists and medical students. The report also found that information technology was lacking.

Those who support continuing the Louisiana system decry these results and note the breakdown of the post-World War II system in hospital care on a national basis, stating that "LSU has never received the funding that it said it needed and has never been able to overcome the drag of the aging physical plant on its ability to attract a more economically diverse patient base," adding that

The fact remains that healthcare is in crisis across the country. As even industry comes to terms with the fact that this country will have to move to some form of a single-payer healthcare plan, that means that it will be the private, for-profit providers who will disappear. We are the only major industrialized country without a single-payer plan and the economic costs we bear because of that are not sustainable from a competitive standpoint.

Who can afford hospital beds that work like parked taxis with the meter left running?

No comments: