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Those who can’t pay for care costing millions for those who can
Sept 21, 2009;
Triangle Business Journal |  No question that the hospitals are gearing up for the next phase of the health care reform debate, describing the millions in their expenditures for health care covering indigent patients. The North Carolina trade association for the hospital sector says that hospitals’ charity care spending in the state doubled between 2005 and 2008 from $338 million to $624 million. One “expert” says that between $900 and $1,000 of a family’s average annual health insurance premiums subsidizes nonpaying patients-whose health care is therefore “free”.  But how free? First, there’s the problem that not all indigent get care at these generous nonprofit hospitals, or if they get care, some then get chased by bill collectors who garnish meager incomes and assets when they can to compensate the hospitals. Second, the number of uninsured is growing. According to a research institute in the state, the number of uninsured in North Carolina has increased 25% between 2001 and 2007. Third, according to the Health Access Coalition of the North Carolina Justice Center, indigent patients “receive the equivalent of about 40 percent of the care that an insured individual receives”, that is, if they receive care at all at the nonprofit hospitals. Since health care reform, as the legislation slogging through Congress suggests, will leave millions of people without insurance coverage, the problem isn’t just health care insurance. It is also a question of the availability of and access to health care services.  The nonprofit hospitals are going to have to do their part beyond boasting about how much they deliver in community benefit outreach services and acceptance of Medicaid reimbursement shortfalls.—Rick Cohen

A Small Number of Non-Profit Clinics in US Deliver Health Care to Working Poor
Sept 21, 2009; Voice of America News | The debates over health care reform get confusing and confusing-er. The Baucus plan that would allow nonprofit hospitals to escape from charity care requirements has hospitals loudly applauding, citing what they think is the extensive health care they as nonprofit hospitals provide to the uninsured. Of course, by the numbers, the nonprofit hospitals have proven to be relatively chintzy with their charity care delivery. As this brief piece from the VOA notes, there is a free health clinic sector, quite distinct and different from the mammoth hospitals, that offers low or no cost health care to many poor people in various parts of the nation. But these health clinics only treat at most 10 percent of the 45 million uninsured people in the U.S., and that’s hardly comparable to fully insured treatment.  But the big hospitals shouldn’t implicitly claim credit for the free clinics’ services.—Rick Cohen

After ‘Inappropriate’ NEA Conference Call, White House Pushes New Guidelines
Sept 22, 2009; ABC News | Although we found nothing particularly wrong with the National Endowment for the Arts conference call that encouraged artists to participate in the national day of service on September 11th and suggested that they produce art addressing current topical issues such as health care, some right wing bloggers did. They suggested that this was the NEA promoting President Obama’s health care plan. That wasn’t true, but the charge has stuck. Ethics advocate Melanie Sloan found the NEA “disturbing” even though that the NEA didn’t suggest or promote any sort of expressly political or electoral agenda. Sloan didn’t say that the call was illegal, just sort of troubling. We don’t quite get it. The White House bumbled its response to the initial criticism, but encouraging artists to do community service and draw about current societal themes seems to us to be entirely appropriate.—Rick Cohen


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