Ampelio Garcia, 74, was barely able to walk when he got to White Memorial Medical Center in Boyle Heights, after the latest flare-up of a chronic lung condition that left him wheezing and gasping for air.
Emergency room physician Brian Johnston prescribed drugs and a breathing treatment to open Garcia's airways. Then he admitted him -- for the second time in less than a week.
"I can't send this guy home; there's no way," Johnston said. "And I don't think our treatment here is extreme or excessive. We're doing basic stuff."
Basic stuff adds up. And the tab is especially high for chronically ill patients seen at White Memorial. Medicare spends an average of $130,992 on patients seen there in their last two years of life, the biggest share of it on hospital care.
That's nearly three times the national average for similar patients, according to an influential study.
Why so much?
Some experts say high costs for patients at big-city hospitals such as White Memorial reflect a free-spending, out-of-control medical marketplace. Others say medical costs are higher in urban areas because the poor need more care and the rich demand it. Others say the profit motive is at play.
Still others say that when lives are at stake, cost should not be an issue.
Whatever the reason, the question itself has taken on added importance as the Obama administration pushes a massive expansion of medical care to the uninsured. In campaigning for a healthcare overhaul, President Obama has made repeated calls for changes that will help "Americans avoid the unnecessary hospital stays, treatments and tests that drive up costs."
Among the ideas before Congress are rewards for hospitals that reduce costly readmissions and for physicians who coordinate care to keep patients out of hospitals.
Studies show that the sickest 10% of patients consume two-thirds of the nation's healthcare outlay. So even small improvements could reap big savings.
In looking for answers, policymakers on different sides of the issue are turning to pathbreaking studies by the Dartmouth Atlas Project, a research institute at Dartmouth College. Some of the studies looked at what Medicare spends on chronically ill patients in their last two years of life, a time when medical costs are highest.
The national average for Medicare spending on such patients was $46,412, including outpatient care. But in Los Angeles County, the average cost was nearly double that, $84,179, according to a Los Angeles Times review of Dartmouth data.
