The Predictable Effects of Illegal Immigrants on US Hospitals
And the Unpredicted Outcomes
While some will argue about how many new undocumented or illegal immigrants have entered the United States in the past two years, most will accept the figure of 5 million. If that doesn’t work for you, pick your own number.
These undocumented migrants use our hospital emergency departments, frequently without an address and a means to pay for their care. Under EMTALA, the Emergency Medical Treatment and Labor Act, hospitals are basically required to provide care. This well-intended law causes unintended damage to our healthcare infrastructure when it comes to this group of patients.
Two years ago, half of our US hospitals lost money and last year over two-thirds were in the red. Adding in more clients who don’t pay for services, or underpay if placed on Medicaid, exacerbates the financial stress on the system. The national situation is so dire that this week the American Hospital Association celebrated that the average loss per hospital is only 1.1% per year, instead of the previous 2.1%. In rural states like Wyoming where there is usually only one hospital per community, failing hospitals have no “back-up” facility.
In case you feel that this is not a serious problem, let’s do some simple math. Recently the Wyoming Medicaid per capita payment was about $4700 and considering that is a discounted reimbursement rate that does not cover the cost of care, using that figure is a conservative estimate. (The US national average cost per patient is about $12,000.) Now multiply by 5 million and you get 23.5 billion dollars of unreimbursed care. Divide by 5139 community hospitals, or just use 5000, and you get an additional 4.7 million dollars of loss per hospital.
Ask any hospital leadership member across the US how they would cope with another 4.7 million dollars of loss and, if they are honest, they will admit that they can’t.
Hospitals are where providers, physicians, nurses, and all the allied health team members - radiology and lab technicians, pharmacists, and respiratory and physical therapists - work together. Losing the hospitals, the organizations that coordinate and provide care, and our national healthcare infrastructure stops working. Our normalcy bias, where we are surprised that the electricity or internet is out, is even more severe when one tries to comprehend that the community hospital is gone. It has happened to some communities and will continue to happen. So in a season of bank closings, prepare for hospitals as well.
Some have speculated that the open southern border was a means to import new voters. Maybe we should consider that it is also a way to federalize our hospitals. When more hospitals fail there will be a public outcry to rescue them, and to whom will they call to fix the problem? One guess.
Before we build a new conspiracy theory, we should ask, would the government controlling all hospitals be a bad thing?
Let’s ask veterans. Depending on which historical milestone you choose, the Veterans Administration has been around over a hundred years, with a checkered past. Reforms were attempted when quality issues were brought to light in the 1990’s, but it still provides a dependable source of system failures for news departments who need more grist for the mill, content to put between the commercials.
Mind you, the people working in the VA are overall excellent people. The problem is a system where innovation and adapting to patient needs is slow at best.
The same is true of the UK’s National Health Service (NHS), where polls from last year showed only 36% of the British population was satisfied with the system and 41% were dissatisfied. The maximum allowed wait time to see a consultant in the NHS, a board-certified physician, is 18 weeks. Last year over 50,000 patients were waiting over 13 weeks to get an MRI, CT, or ultrasound scan.
Recently the UK’s nurses went on strike, and then the junior physicians in the NHS did as well, not satisfied with their 14 pound (17.12 dollars) an hour pay. That would never happen here, you say. In some states an anesthesiologist accepting Medicaid makes, after paying malpractice and the cost of billing, a paltry $29 an hour. Then they can decide if they can afford their own healthcare insurance or a retirement plan.
Canada spends among the highest per capita for its national health service and its best regional average wait time to see a specialist physician is over 8 weeks, the worst is 25 weeks. Mortality and survival rates for cancer patients are predictably worse. For a time, it was illegal to seek private medical care in Canada so they would cross the US border to covertly obtain more timely healthcare. (Imagine if there had been federally controlled Canadian digital currency at the time and they couldn’t even buy care here. That’s chilling.)
So national healthcare systems have not been impressive so far.
But system failure and poor patient care are not the only negative outcomes here as the human toll is significant. Healthcare workers pay a price as well. One in ten US physicians has either considered or attempted suicide in the past two years, nearly double the average population rate. As far back as 2003 one national US study estimated one physician a day died by suicide. In the aggregate UK statistics more nurses die by suicide annually than physicians.
In a national healthcare system, a depressed healthcare worker does not have the option to move to another job in a different facility and a different employer. In a private healthcare system hospitals and employers compete to recruit and retain nurses, doctors, providers, and therapists. Not happy where you work? You can move. In a national healthcare system, not so much. The system is the system.
Finally, and most importantly, patients pay a price as well. Increased wait times for care with lower quality outcomes are bad enough but exhausted and depressed healthcare workers suffer empathy challenges, too. Healthcare workers must pay for their healthcare as well, with deductibles and co-pays. So, when a person breezes into the emergency room for free care, at some level, some providers are not as empathetic. Or they internalize their frustration while providing great care and pay for it emotionally later. The system is telling them that their work to become an expert in healthcare is worth…nothing.
In other countries national healthcare systems don’t appear to work well for patients or providers. With over 60 million US citizens on Medicare and 80 million on Medicaid, we are close to a back door route to our own National Health Service. Both these programs pay less than the cost of care, so they tend to hollow out the healthcare infrastructure on a fiscal starvation diet. And the US moves more towards the single payer model while Europe moves away from it.
Adding another 5 million unpaying or underpaying patients into the American healthcare industry sector exacerbates our current problems, whether it was intentional or not. And perpetuating the fiscal lie that government payment campaigns actually cover the cost of care is about to play out as unsustainable. As we darkly say in the operating room, all bleeding stops…eventually.