A piece in the L.A. Times is titled ERs fail as the nation’s safety net. (H/t: Mike H.) The article manages to discuss every possible cause for overcrowded emergency rooms except for one. See if you can guess which one that is.
The story opens:
The long waits that government inspectors say endanger emergency room patients at Harbor-UCLA Medical Center can also be found in backlogged hospitals across the country, according to emergency care experts who have been trying for years to draw attention to the nation’s overloaded safety net.
The article explains that this is a crisis, and that patients are not merely being inconvenienced — they are dying as a result. One in five ER doctors surveyed said they knew of patients who had died because of an overly long wait.
So what is causing the overcrowding and long waits? The article mentions numerous factors: increasing demand, a shortage of beds, a nursing shortage, an aging population, and a lack of specialists willing to be on call. We are also told:
The growing number of people without medical insurance also contributes because the lack of reimbursement, along with ever-shrinking payments from both public and private insurers, has turned many emergency rooms into money-losers and driven some hospitals out of the emergency-care business. Federal law requires hospital emergency rooms to treat patients regardless of their ability to pay.
So what is causing the increase in emergency room demand? And what is a major cause of the increased in uninsured patients?
Let me introduce you to the giant elephant in the room, which the L.A. Times editors appear determined to studiously ignore.
That elephant is called illegal immigration.
A recent study by the U.S. Congressional Budget Office confirms what most people suspect as a matter of common sense: that emergency rooms are feeling a strain from the millions of illegal immigrants in our country, especially in the border states.
[B]ecause unauthorized immigrants are less likely to have health insurance, they are more likely to rely on emergency facilities or public hospitals for treatment of nonemergency illnesses and other health-related problems.
The study cites studies by the RAND Corporation and the Pew Hispanic Center which estimate that 60-65% of illegal immigrants are uninsured. This results in tremendous health care costs. According to the Phoenix Business Journal:
Undocumented immigrants are more likely to access emergency rooms and urgent care facilities because most do not have health care, the study said. In Arizona and other border areas, states paid nearly $190 million in health care costs for undocumented immigrants in 2000, the study reported. The amount, which the study says likely has risen since then, represented one-quarter of all uncompensated health care costs in those states that year.
The amount clearly has risen. A January 2007 story in the San Diego Union Tribune says:
In California, hospitals spend about $700 million annually on emergency room services for illegal immigrants, said Jan Emerson, spokeswoman for the California Hospital Association in Sacramento.
And in 2005, U.S. Senator Jon Kyl put the number much higher for the nation as a whole:
The estimated annual cost to hospitals and other providers of emergency health care nationwide for illegal aliens is $1.45 billion.
Illegals tend to use the ER as their source for non-emergency medical care. The reason: it’s the only way they can afford to see a doctor — because in the ER, taxpayers are footing the bill:
Illegal immigrants can get emergency care through Medicaid, the federal-state program for the poor and people with disabilities. But they can’t get non-emergency care unless they pay.
The rise of the uninsured, which the L.A. Times describes as one of the major problems facing ERs, is also in large part a problem of illegal immigration. USA Today reported in 2005:
The increase in the number of people without health insurance has occurred largely because of illegal immigration, a study found.
Researchers at the RAND Corporation, a non-partisan think tank, analyzed data received from about 2,400 people in Los Angeles County in 2000 and 2001, and applied that information to the nation’s undocumented population at large.
The number of uninsured adults in the United States grew by about 8.7 million between 1980 and 2000. If the trend for Los Angeles County held true for the rest of the country, about a third of that growth can be attributable to illegal immigrants.
Hospitals recognize the problem:
For hospitals, “the burden of the uninsured immigrant is huge,” says Jeff Spade, vice president of the North Carolina Hospital Association. “It’s exploded the amount of work that they have to do.”
A senior economist at RAND had this to say:
“There are pros and cons of providing insurance to the undocumented that should be debated openly,” he said. “Undocumented immigrants make up too much of the issue to be ignored or hidden by polite silence.”
Tell that to the editors of the L.A. Times. Polite silence on this is all they have to offer.
It’s plainly irresponsible to write an article on overcrowded ERs that doesn’t say a single word about the millions of illegal and uninsured immigrants that have entered ERs over the years.
The editors know damn well that the elephant is there, but they choose not to discuss it. Even if the elephant goes on a rampage and starts squashing everyone in the room, the survivors plan to sit there, hands folded, pretending like it’s not happening. After all, getting stomped by a rampaging elephant is bad — but the alternative is far worse: somebody might call them insensitive.