State Rep. John Becker’s plan to force uninsured Ohioans and pregnant women1 to get health care from volunteers, students, and interns would cost the state more money than expanding Medicaid.
I’d say that he’s cutting off his nose to spite his face, but that’s not right. He’s causing needless suffering for a quarter of Ohioans, to spite their faces.
It’s idiotic and cruel, but it is a useful thought experiment into how 1/3 of our medical spending is wasteful.
Here’s the plan:
1. Reject the Medicaid funding.
2. In each city, set up one hospital that:
- Can’t take insurance, Medicaid, or Medicare
- Can’t charge patients
- Can only employ volunteers
- Is immune to malpractice claims
3. Force uninsured people at any other ER to be sent by ambulance to this hospital
4. Presumably, reimburse the hospital for their costs?
Obviously, this is degrading to the 1/4 of Ohioans who are uninsured or on Medicaid. They would have to travel up to 100 miles to see a doctor–except it wouldn’t be a doctor, it would be a high school kid looking for extracurriculars. You know, like a soup kitchen, except more likely to kill you. Because pro-life!
It’s also degrading to doctors! Becker seems to think that any schmuck is just as good as a trained doctor. Of course, if he took a couple minutes to think about this, he’d realize that the way to loosen requirements is by actually loosening requirements through the nursing board2.
Of course, no hospital would ever agree to do this. Only if “labor costs + malpractice claims > income” would a hospital do this.
Becker wants hospitals to give up the entirety of their income, presumably to be reimbursed by the state. University Hospital’s annual budget is $1 billion, of which Hamilton County’s Indigent Care Levy provides $26 million. So Becker’s plan only comes up $974 million short.
But let’s say somebody has set this up; like Becker, we’ll use University Hospital as a model. Let’s say your husband is having an adverse prescription reaction and you take him to a hospital.
If we expand Medicaid
You go to the closest urgent care or ER, where he’s treated after an hour. Medicaid is billed $2000 (the average cost of an ER visit).
- Cost to federal government: $1800
- Cost to state government: $200
- Cost to consumer: $0
If we set up Soup Clinics
You go to the closest urgent care or ER. He can’t be transported until it’s determined that he’s stable enough to leave the hospital, so you’re seen after an hour (costing $2000). He’s transported by ambulance to University, since the hospital is liable for him while he’s in transit (costing $1500).
At University, you wait 6-18 hours (this is how long I’ve had to wait at University) to see a doctor. The doctor gives treatment (costing $2000). University gets billed by the first hospital. You both get fired for missing work.
- Cost to federal government: $0
- Cost to state government: $5500
- Cost to consumer: $0
Becker is assuming that you’ll drive the extra 30-45 minutes to get to University, even though that would put your husband’s health at risk. Because pro-family!
Of course in practice, your Medicaid-covered husband would be far less likely to have an adverse reaction because he would have a primary care physician who would monitor his prescriptions. In Becker’s plan, your husband has to wait 6-18 hours at University to get prescriptions.
The teachable moment here is that the $3500 is wasted medical spending. There was no value-added (in fact, value was lost in the transaction) but the labor was performed anyway, because the system required the treatment. When people say that 31% of American health spending is on wasteful treatments, this is what they’re talking about3.
HB 271 costs state government more than current law; it costs local government more than current law; and it costs state and local governments more than Medicaid costs the federal government.
This isn’t a legislative proposal; it’s an expression of Becker’s contempt for people less fortunate than he.
1 Even though Becker’s plan to strip maternity coverage from a quarter of Ohio’s expectant mothers is technically a separate bill, I’m going to go ahead and count it against him on this one.
2 In fact, there’s a federal law that was passed in 2010 which makes it easier for states to allow Nurse Practitioners to fill some roles that Ohio requires an MD to perform! I’ll let you take a guess which law this is. Hint: it’s the most evil law in history.
3 This wasted treatment is a lot less likely to happen once every doctor has electronic health records. Those were expanded by a 2009 law… again, you’ll just have to guess which one. It’s the second most evil law in history.