Re "Know what cutting Medicaid would do," Sept. 9
Michael Hiltzik makes some good points, but there is a larger issue. The battle over our commitment to Medicaid is part of the war over our nation's healthcare system.
Today, our patchwork system of Medicaid, Medicare and private insurance (including PPOs, HMOs and indemnity plans) has imposed extraordinary administrative requirements on healthcare providers, with physicians being the most affected. Their time is increasingly devoted to administrative demands at the expense of patient care; escalating healthcare costs result.
As long as America refuses to engage in honest dialogue on a single-payer system, we'll continue fighting battles and losing the war.
Hiltzik's analysis is quite correct, and his discussion about the catastrophic effects of Medicaid on hospitals in low-income areas is especially astute.
The president's healthcare reform law does not provide a revenue stream for treating undocumented immigrants or low-income recent citizens. Without a continuation of the increased amounts paid to low-income-area hospitals by the federal government via its Disproportionate Share Hospital fund, here in L.A. County — even with Medicaid expansion — the results will be catastrophic.
As Hiltzik points out, White Memorial will take a $20-million hit with the deep cuts in the hospital fund. Where will that money come from? Unlike hospitals such as Children's Hospital, Cedars-Sinai or St. John's, White Memorial cannot shift costs onto its well-insured patients, nor does it have the ability to significantly raise money from private philanthropy.
Without serious leadership in Washington, L.A. County's safety net will implode.
Howard C. Mandel, MD
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