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A teaching hospital, however, will never close its ER.
Libs don't seem to understand that hospitals, like any business, needs to make a profit or it has to close.
All the liberal freebies and give aways sound great, but bankrupting more and more hospitals only worsens access to healthcare. Interestingly, the hospitals most vunerable are those that serve poor areas, such that those underserved areas get worse over time.
Maybe, but then again maybe not.
Mount Sinai Beth Israel hospital here in NYC is undergoing a massive downsizing rebuild that includes closing their ER and opening a stand alone urgent care facility *not* attached to new (and smaller) main hospital.
Because the urgent care/ER is divorced from main hospital patients do not automatically end up admitted, indeed current laws/regulations do not require. However the reverse is true currently, if you get to a hospital's ER and require admission unless there are certain extunating circumstances you must be admitted.
Being admitted via ER is how people get into "wealthy" hospitals even if they are indigent, have no insurance or whatever. Since the other main way (being a patient of a physician with admitting rights) often is closed to them, this is how they roll.
Back to Beth Israel (which is a teaching hospital and has an affiliated nursing school as well), look well upon that model, because that is where healthcare is going in this country.
When Saint Vincent's closed North Shore LIJ (another teaching hospital) opened up an urgent care facility on part of the campus. Patients who require admission to a hospital either will be transferred uptown to Lenox Hill hospital, or sent across town to NYU, Beth Israel, or Bellevue hospitals.
I don't know how you could possibly make a connection between the Hahneman situation and Obamacare. Hahnemann was going town hill back in the 1990s as a result of the AHERF collapse. Maybe you should only comment on things you know something about.
Why would Medicaid not provide any reimbursement? Medicaid is almost always the lowest payer, but there will be some reimbursement. It seems like you should know that if you're a physician.
Of course they do. But without Medicaid or expansion, hospitals have to care for many more no payers.
Hahnemann University Hospital, a 496 bed major teaching hospital in Philadelphia, is closing its doors. It treats inner city residents both US citizens and aliens (legal and otherwise) who cannot pay for their treatment. Its other big mission is training residents and fellows who will then fan out to other parts of the USA. It has over 500 resident doctors who must scramble to find new teaching hospitals. It also has more than 2,5000 other employees who will loose their jobs.
This is a tragedy and a reminder of why "Obamacare" is a grossly inadequate solution to the US healthcare crisis.
Medicaid is better than nothing, but no hospital can survive with a high majority of patients on that scheme alone. Places need a healthy mix of self insured and or those with good health plans to pick up the slack.
Medicare is slightly better than Medicaid, but still again you simply can no longer run a hospital with a majority of inpatient beds filled with those on one or both schemes.
It must also be remembered a hospital is a hospital; all have same costs in a given geographic area regardless. Wages/employee compensation, utilities, etc... don't vary between a hospital of last resort and TOL world class institution.
What is killing many indigent hospitals is they no longer have a cheap workforce in form of nurses and other staff in holy orders, and or otherwise willing to work cheaply out of some idea of a mission.
Professional nurses expect the same pay in any given area regardless of hospital. Days of running a hospital staffed by well meaning sisters/brothers and with help from bake sales by local schools is over.
All hospitals must meet the same standards of care and so forth. This often when they cannot afford to compete with world class institutions with large endowments and wealthy donors. So they borrow/go into debt and otherwise hope to make things work. Meanwhile the need for their services grows placing more stress on system. In the end something has to give.
As someone who works at Hahnemann Hospital, I concur with StillWaterTownie - 36 percent of that hospital's revenue last year came from Medicare and 29 percent from Medicaid, and Medicaid reimbursement is quite poor. In fact, Joel Freedman, the current owner of Hahnemann, also owns St. Christopher's Hospital for Children in Philadelphia which despite treating a similar low income patient population made a profit last year and most years. The key difference is that reimbursement for patient care through Pennsylvania's Children's Health Insurance Program (CHIP) provides adequate payment and allows St. Christopher's to make some money, whereas it is very challenging for hospitals to staff afloat with Medicaid and Medicare reimbursement rates.
There are other reasons as well as to why Hahnemann has been losing money (including a half-hearted effort by Mr. Freedman and his revolving door of managers to support the hospital since taking over last year). However, before Mr. Freedman purchased Hahnemann (and St. Christopher's) from Tenet, a large hospital corporation, the hospital had lost money for 14 consecutive years. The Affordable Care Act, of course, was not in existence when Hahnemann began losing money in 2003. To attribute the hospital's financial challenges to "Obamacare" shows a clear lack of understanding of the situation.
Their average income earners pay an effective 45% (on average) national tax rate.
Do you think American households earning the average ($59,000/year) would agree to pay 45% of their annual income to the Fed Gov to get socialized medicine? I don't.
No, I don't think so. Those of us that have to buy ACA approved policies are already annoyed enough at high deductibles.
The information YOU referred to included State taxes. I was bringing an apple to apple comparison, and local taxes are NOT State taxes.
That's the point, which you are NOT getting. National health care, Medicare for all, whatever you want to call it... is provided by the FEDERAL government just like national health care in the EU-28 is provided by their NATIONAL governments. Comparing the effective national/federal tax rate an average income household has to pay to fund that is directly relevant.
That's the point, which you are NOT getting. National health care, Medicare for all, whatever you want to call it... is provided by the FEDERAL government just like national health care in the EU-28 is provided by their NATIONAL governments. Comparing the effective national/federal tax rate an average income household has to pay to fund that is directly relevant.
You really don't understand how various nations fund their universal healthcare plans. In Canada, the federal government provides a small portion of provincial healthcare costs, but only if the provinces meet the following criteria, which all do:
With respect to the criteria, the insurance program of each province must be:
publicly administered on a non‑profit basis;
comprehensive with respect to the list of insured health services provided by hospitals, medical practitioners or dentists;
universal in terms of covering all residents of the province;
portable between provinces and not impose residency waiting periods of longer than three months; and
reasonably accessible to insured persons.
The federal government pays about 20% of all healthcare cost, with the provinces paying 80%.
So, your comparison to just look at federal income tax rate is not valid, as once again, we are not comparing apples to apples. The only fair way to compare is to include ALL costs, and ALL tax sources. I can't research all the other countries who provide universal healthcare as to how they fund it, but looking at all costs and all sources of public monies paid is the only way to match that.
We forget that in the USA, there is a huge payment into healthcare insurance payments that is not considered tax payments, yet really need to be taken into consideration, as they are part of the total cost to a taxpayer.
When one includes that, the effective tax rate of the average taxpayer far exceeds those of any other country's contribution by individuals.
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