Sammy Mack writes as fair an article on the subject of private hospitals attempting to recoup costs for the uninsured as possible, in this weeks Gambit Weekly article. She describes the difficulty private hospitals like West Jefferson and Touro have with the higher percentage of indigent patients within a system where the previous default (Charity Hospital) runs at a very small percentage of its previous capacity. And the solutions offered by those practitioners and by other interested parties, including increasing Medicaid coverage, medical homes models, attempts at primary care block grants, et. al are all well and reasonable.
But let's spend a moment on how she describes the initial problem in this city:
"According to a Kaiser Family Foundation study, when Charity was still functional, about half its patient population was uninsured, and Medicaid covered only a third. Local private hospitals cared for only half the national average of uninsured patients who typically get care at private hospitals. Now, without Charity absorbing the uninsured and underinsured of the New Orleans area, the region's private hospitals must serve a very different population than they did prior to the storms " a population that does not have insurance or the means to cover private hospital or physician bills."
Where were these hospitals before the storm? Cherry picking a bunch of insured patients, leaving indigent patients to the whims of a grossly dysfunctional bureaucratic morass - that's where. And now that they've had to 'serve the poor,' they're disgruntled. Sympathy for private practitioners in this circumstance is a little hard to dredge up.
And yet...we kinda have to. It'd be nice to just tell these clinicians to "suck it up and deal with it - our city got pummeled and we all have to chip in." And they did - in the few months after Katrina - only a few hospitals were open (West Jeff, East Jeff and Ochsner) - and none were inside New Orleans proper. Moreover, these clinicians have choices - if they don't want to be here, they can go elsewhere in the country...and continue the New Orleans' brain drain.
So yeah - until we have a new health care system not based on private insurance or profit, especially in post-Katrina New Orleans, we're going to have to compensate these guys. Expand the Disproportionate Share Hospital funds, increase Medicaid eligibility (pass SCHIP!)...whatever.
Worse than listening to these clinicians would be...not listening to them because they're gone from this city.