THE HOSPITAL CRISIS AND UNDERPRIVILEDGE HEALTH CARE

In my previous article regarding health care for the underprivileged I alluded to the impact from the Social Security Act of 1965 and especially Title XIX which established Medicaid.
To digress a little we should remember 1965 was an earthshaking year that had tremendous impact on Lyndon B Johnson’s administration. Less we forget t his was the year in which Johnson escalated the military adventure begun by Kennedy in support of South Viet Nam into a major conflict
Not only did that war rapidly become a morass devouring physically and mentally America’s youth. Unfortunately, for various reasons most were members of minority ethnic groups. But the fall out a great and lasting impact not only on the quality of life in this country but also on the United States relationship with the world in general.
1965 was the year of the college campus flag burnings and riots. Nationwide civil unrest exploded in the Selma and Montgomery riots. Malcolm X was assassinated. M martin Luther King led the March on Montgomery Alabama.
Remarkably, Johnson a true son of the bigoted Texas border society had become, for better or worse, one of the leading civic and social reformers in our history. His visionary “The Great Society” was to remake this country and cure its ills’
One action, the Voting Act of 1965 prohibited the use of literacy as a voting qualification. This enfranchised a large portion of the population who had received little education.
For the purpose of this discussion on the deterioration of health care delivery, we must turn to the other great reformation of that year. Which forever changed and in m y opinion for the worse this nation’s health care.
It came about as two amendments to the Social Security Act. Title XVIII became known as Medicare and Title XIX became known as Medicaid. Title XVIII includes Part A, which provides hospital insurance to the aged, and Part B which provides supplemental medical insurance. Title XIX proclaims that at the states discretion, it can finance the health care for individuals who were at or close to the public assistance level.
The Democrat’s solution resulted in Medicaid which was created on July 30, 1965 through Title XIX of the Social Security Act. Although there was provision for federal funding for political reasons the program was not federally administered. Each state was allowed to voluntarily opt into and administer its own Medicaid program. While the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards. The fact is that there is no national standard.
State participation in Medicaid is voluntary; however, all states have participated since 1982.
Certainly this well meaning flawed legislation was a major factor leading to today’s health care financial crisis that has (1) reduced the quality of care, and (2) led to the demise of many hospitals.
Early on enterprising and often unscrupulous entrepreneurs including unfortunately unprincipled physicians established “ health clinics in designated inner city locations, Because the Medicaid reimbursement was free flowing even if inadequate, the clinics prospered for a long period of time. Due to lack of oversight fraud was rampant resulting in a large drain on available funds.
The Hospitals discovered that they could now be paid for both in-patient and out-patient care. Not only could they bill for the institution’s services but also for the professional portion of care. The latter portion was not distributed to the physicians rendering the services but retained in the hospital coffers. Unfortunately many hospitals were also not above questionable billing practices.
Naturally those doctors treating patients in the outpatient setting resented someone else collecting and keeping the proceeds for their work. The doctors actively sought to be able to bill for their services.
The hospitals thinking they had the golden goose began to employ under contract physicians or residents to staff the clinics. And soon began to employ hospital based physicians.
The previous uncompensated services were now a cost item. Obviously the operational costs rapidly increased. The non –profit hospitals had met all deficits through charitable gifts. All produced a yearly budget which often was more illusionary than factual. Few hospitals were able to identify actual costs and often the final budget was just numbers.
Additional operational cost resulted from the paper work needed to meet mandated reports from various governmental agencies. This increased with the advent of the managed health care plans. Moreover, unions found a fertile field among all groups employed in hospitals. All has resulted in a massive increase in hospital operating expenses.
At the same time the federal government supported HMOs appeared on the scene. The big insurance companies as well as fly by night entrepreneurs found the captive patient panels to be cash cows. Traditional commercial health insurance held no clout and was discouraged; by selective bargaining against competitive hospitals the carriers were able to pay sub-minimal amounts for hospital services. In some cases as with Blue Cross and Muhlenberg the carrier would not sign a care contract with a hospital.
Hospitals that provide a disproportion of uncompensated care cannot survive under present conditions. To close them only means that the burden and its negative results will either be shifted to other institutions or those needing health care will not be able to receive it.
There are other factors, involved in the financial crisis that has impacted upon the hospitals; however I will not go into them in detail at this time. I will suggest that the Baby Boomers generation is more materialistic than their parents and charity per se has a low priority. A major source of meeting deficits is lost.
Additionally I am convinced that in this ‘Soprano State” so much tax funds were siphoned off for other agendas that little was left to meet required hospital obligations. Medicaid reimbursement was cut to a level that met only a fraction of the true costs.
Government has created this Frankenstein and it should be up to the state to cure not destroy the victims of its malfeasance.