Eat it
Tuesday, June 2 2009
Whitecoat, in a characteristic snit:
You see, EMTALA [that is, the law that requires emergency rooms to offer care to all comers] requires that hospitals provide stabilizing treatment, but it says nothing about who will pay for the stabilizing treatment. Hospitals will be forced to eat the cost of providing care. As more of the costs are passed on to the hospitals, more and more hospitals will close. Then less medical care, and less emergency medical care will be available for everyone.
Dr. Whitecoat thinks the government “forces” hospitals to eat the cost of charity care, so we should weep and weep for the injustices perpetrated against poor, defenseless doctors. I watched all of John Adams on DVD, and the one thing that was totally clear was that our Founding Fathers gave their lives so that doctors could refuse to help poor people.
What Whitecoat doesn’t mention is that lots of non-profit hospitals benefit from extraordinary tax breaks, and that the amount of charity care they provide isn’t enough to make up the difference. Lots of these hospitals will turn your bill over to a collection service, calling you twenty times a day to pay up, jacking up your bill with interest and fees, if they decide you don’t deserve “charity”. So now Congress is looking at setting a minimum threshold for charity care, which hospitals would have to meet to maintain their tax exempt status:
Mr. Grassley said that many hospitals got “a tremendous advantage” from their tax-exempt status, but did not provide enough charity care to justify it.
The Boston Globe did a report on hospitals in Massachusetts, and found exactly that: the hospitals obtained tremendous tax benefits, but the level of charity care they provided was nowhere near the difference.
However, the combined value of Partners’ charitable work in 2007, $151.4 million, is $120 million less than the value of Partners’ tax breaks and interest discounts, as calculated by the Globe. That’s a big swing from 2001, when Partners reported spending more on community benefits than it got back in tax breaks.
Children’s Hospital also runs a highly regarded charity program, but its cost is $96 million less than the Globe’s estimate of savings from not paying taxes.
If you think that hospitals deserve tax breaks in the grand scheme of things, maybe – just maybe – you could justify the view that these hospitals had to “eat” the costs of charity care. But it would be a lot more rational and accurate to say that, for example, Partners’ charged $271 million dollars for $151 million in charitable care – and the taxpayer got stuck with the whole bill. Do you think Partners is going to close if the government keeps paying too much for charity care? Whitecoat apparently does.
In all candor, I don’t like EMTALA either. It’s a shoddy, ad hoc stopgap against the growing number of uninsured people in this country. Get everybody insured, and the need for laws like EMTALA disappears – in which case, hospitals no longer provide charity care, and can no longer pretend to be non-profits, and we start taxing them for the businesses they are. So it’s entirely reasonable to think that health care reform will not only not have the consequences Dr. Whitecoat conjures, but will also end up offering a net gain for taxpayer in terms of the money we spend on charity care in hospitals. But as far as Whitecoat is concerned, any system that guarantees sick people access to care is “socialized medicine”, which is a Bad Thing – so the rest of us can just eat it.
