Wednesday, October 25, 2006

"All hail the mighty state"

The "front page" lede read:

For many patients with chronic diseases, it would be cheaper to provide free preventive care than to absorb the high cost of repeated emergencies.
So naturally I was intrigued. Was economics finally triumphing over plain greed? Were the champions of market forces right, and bottom-line thinking would finally start lifting the smallest, least sea-worthy boats, as a matter of efficiency?

So I read on:

Unable to afford health insurance, Dee Dee Dodd had for years been mixing occasional doctor visits with clumsy efforts to self-manage her insulin-dependent diabetes, getting sicker all the while.

In one 18-month period, Ms. Dodd, 38, was rushed almost monthly to the emergency room, spent weeks in the intensive care unit and accumulated more than $191,000 in unpaid bills.

That is when nurses at the Seton Family of Hospitals tagged her as a “frequent flier,” a repeat visitor whose ailments — and expenses — might be curbed with more regular care. The hospital began offering her free primary care through its charity program.

With the number of uninsured people in the United States reaching a record 46.6 million last year, up by 7 million from 2000, Seton is one of a small number of hospital systems around the country to have done the math and acted on it. Officials decided that for many patients with chronic diseases, it would be cheaper to provide free preventive care than to absorb the high cost of repeated emergencies.

With patients like Ms. Dodd, “they can have better care and we can reduce the costs for the hospital,” said Dr. Melissa Smith, medical director of three community health centers run by Seton, a Roman Catholic hospital network that uses its profits and donations to provide nearly free care to 5,000 of the working poor. Over the last 18 months, Ms. Dodd’s health has improved, and her medical bills have been cut nearly in half.
The large print giveth, the small print taketh away. I have to admit up front I have a soft spot for Seton Hospital: my daughter was born there. That's the extent of my contact with it, but I'm not surprised it has a charitable desire. The order founded by Elizabeth Seton is, after all, the "Sisters of Charity." But that's as far as this charity goes. It's offered by a handful of public hospitals and some private ones, like Seton. Thus do we care for the poor, the widow and the orphan, in this "Christian" nation.

And, of course, even Seton is a business (I think again of bluemeadow's reference to Walter Wink), and is doing this because it is good for their business, not solely because it is good for the people involved. Which, actually, is what Christianity is supposed to be about: not what's good for me, but what's good for you. Try as we might (and we don't try hard), we keep missing that target.

Still, I suppose, better than a poke in the eye with a sharp stick. Which is what we offer most poor, ill people in this country. And this is still Texas, after all:

[O]nly a fraction of the uninsured, in Central Texas and in most other states, are benefiting. “All these local efforts are commendable, but they are like sticking fingers in the dikes,” Ms. Davis of the Commonwealth Fund said, noting that the larger trend was hospitals’ seeking to avoid the uninsured.

Nowhere is the problem more acute than in Texas, where nearly a quarter of the population is uninsured, the nation’s highest rate. Small businesses here are unlikely to offer benefits, and the state government’s unusually stringent restrictions on Medicaid for adults leave many of the working poor at risk.

Even without counting the large immigrant population, Texas has the country’s highest share of uninsured, at 21 percent, according to the Center for Public Policy Priorities in Austin.

“All the hospitals here provide some uncompensated care, and they are eating it and passing the costs along to the payers,” said Patricia A. Young Brown, president of the Travis County Healthcare District, which was set up last year to oversee care of the indigent through public clinics, drawing on property taxes to pay.

“So insurance rates go up, and then more businesses drop insurance,” Ms. Young Brown continued, describing a trend unfolding nationwide. “It’s hard to see where it will end. We hear a cry for national and state leadership.”
Is this the place to point out that the cry of the widow, the orphan, the prostitute and the beggar, was the cry Jesus gave voice to? Is this the place to remind everyone how "Christian" Texas is, how many Baptists we have per square mile, about the "mega churches" we have, some with four and five campuses?

In March 2005, Ms. Martinez, a Seton patient, was found to have liver cancer. She was put on Medicaid, applied for federal disability and was put in line for a liver transplant, without which, doctors said, she had six months to two years to live. Through the summer of 2005, she made the hour-and-a-half drive from her home to San Antonio for preparatory tests.

That August, she was awarded disability payments of $561 a month. But because her income surpassed the $535 limit for Medicaid in her circumstances, she said, she was told by the state that her coverage had ended, and the hospital said it could not proceed with a transplant.

“I asked Social Security if they couldn’t just reduce my payments by $30 a month,” she said, “but they said it doesn’t work that way.”

In another twist, by federal rules, she will qualify for Medicare two years after the initial finding of disability. She awaits the start of Medicare coverage next March, when she can rejoin the transplant line.

In Texas, as throughout the country, the coverage of poor children through Medicaid and related programs expanded greatly over the last decade. But a majority of states do not provide Medicaid to parents making even poverty-line incomes, and Texas is one of the least generous: here, a working parent of two does not qualify for coverage if he or she makes more than $3,696 in a year, leaving people like Ms. Dodd to fend for themselves.
When I was a lawyer, I actually had to counsel a woman, a devout Christian, to divorce her husband so she could qualify for Medicare payments. She had to divest herself of enough property and income to get the payments to pay for her chronic condition. The divorce, of course, was on paper only, but she still felt like she was "living in sin." I would like to say this is all because of a political party, or an Administration in Washington.

But clearly, it isn't.

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