Gov. Chris Gregoire's proposed health care budget for 2011-13 has been described as a pile of shifts. The governor's proposed cuts will disproportionately affect the poor, the disabled, the mentally ill and those people suffering from chronic diseases.
What taxpayers need to understand is that those people — the poor, the infirm, the chronically ill — won’t go away once they lose health care coverage. They won’t stop showing up in community health clinics or hospital emergency rooms. They will still get sick or suffer injuries and seek medical care.
And the costs to treat them won’t go away. What will happen is that the cost of treating them will shift. It will shift to middle-class taxpayers who are lucky enough to have health insurance in this horrible economic climate.
Those with insurance will pay higher premium costs. They will pay higher deductibles and their co-pays will increase, too. The budget cuts at the state level simply shifts the costs from the state general fund to the pocketbooks of individual taxpayers.
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Anyone who has visited a hospital emergency room and had a look at the hospital/doctor bill, knows about cost shifting.
How can that short stay in the emergency room — with X-rays and a few lab tests — or an overnight stay in a hospital bed, possibly cost $6,000 or $7,000, $8,000 or even more? How is that possible?
It’s possible because the hospital has to keep the heat and lights on. It has to keep the doctors, nurses and support staff in place and that costs money — money they are not receiving from the charity patients who flood the emergency room. To pay the utility bill and staff salaries, the hospital has to charge those with insurance more to cover their total costs.
That $8,000 bill that your insurance carrier may or may not pay in full, is paying for your care, but also for the care of the charity patients in the adjacent beds.
That’s what cost shifting is all about in the incredibly complex system of health care financing.
There’s more at stake than just cost shifting.
When state budget cuts hit and thousands of Washington residents lose their health care coverage, and health clinics are unable to provide low cost primary health care to the poor and infirm, the hospital emergency rooms that already have four- and five-hour waits, could see wait times double. A trip to a hospital emergency room to set a dislocated shoulder or for three stitches to a cut above a child’s eyebrow, could take a full day — a full day of waiting while more seriously sick or injured patients move to the front of the line.
Then there’s the human toll.
There are stories of an epilepsy patient, for example, who lost health care coverage and could no longer afford maintenance medication. The patient had a seizure, ended up in the hospital in a coma and before the family decided to pull life-support systems, the hospital bill topped $1 million.
Let’s see — $20 or $30 for medicine or $1 million for hospital treatment. Penny wise and pound foolish? Absolutely.
The reality is that the health care industry has taken more than $1 billion in budget cuts over the last couple of years, according to Len McComb, former state budget director and a public affairs lobbyist for the Washington State Hospital Association. McComb said the effects of the governor’s budget proposal would be another $1.2 billion in cuts over the next two years.
McComb said legislators are asking him how they are going to balance the budget, whether people will die if certain programs are cut, whether people with disabilities will suffer and whether people lose their job?
Yes, it’s come to that. It’s come down to deciding whether to cut people off kidney dialysis or force others to end cancer treatments.
There is no magic solution. Advocates for K-12 and higher education, promoters of social services and other state-funded programs are singing the same “Don’t Cut Us” blues.
The fact is Washington state faces a $4.6 billion budget shortfall on top of billions of program cuts already taken. And short of a referendum to increase taxes to pay for some of these crucial programs, this state is headed into more difficult days ahead.
That’s the sad reality.
What Washington residents must understand is that whether it’s higher fees, higher health insurance premiums or more out-of-pocket expenses, a big portion of the cuts lawmakers will ultimately approve will merely shift from the responsibility of government to the pocketbook of individuals. No where is that more evident than in the health care arena.