EDITORIAL BOARD
Austin American Statesman
Tuesday, September 28, 2004

View this article on statesman.com

Another sign that our health care system is slowly sinking came last week in a report from the Indigent Care Collaboration. If you're above the water line — that is, you have health insurance — you might not think things are so bad. But the rapidly rising prices you're paying for coverage is a sign that your feet are getting wet.

The cost of medical care is rising for several reasons — new medicines, new technologies and new treatments, among others. But one reason it is rising is inefficiency; too many people without insurance but needing medical attention head to the emergency room because they cannot afford a doctor or because a clinic is too crowded to see them or is closed. That leaves the emergency room, which by law cannot turn away patients.

The collaboration's report found that emergency room visits in Travis, Williamson and Hays counties rose 43 percent among uninsured adults and children between 1999 and 2003. About half of all adult visits — including those with insurance — were not emergencies, and as many as three-fourths of the children's visits were not.

That puts enormous strain on the doctors, nurses and aides working in the emergency room, as well as on the equipment. It also means longer waits for patients and a constant effort to separate true emergencies from non-emergencies. At times, hospitals in Central Texas have been forced to turn away ambulances because there was no room for one more patient.

And the additional load of nonpaying or partial-paying patients at emergency rooms drives up costs, because emergency room care, at about $265 per visit, is much more expensive than seeing a doctor at a clinic, which is about $100. At the same time, the number of emergency-room patients with health insurance has dropped the past few years. Within a few years, adults without insurance visiting emergency rooms might outnumber those who have it, the report says.

The situation wasn't helped last year by the state's leadership and Legislature, which put no new taxes above all else in closing a $10 billion budget gap. Part of that involved a major cut in the Children's Health Insurance Program, which pays for medical care of the children of parents who work but whose employers don't provide health insurance coverage and who earn too little money to buy it on their own.

The Legislature didn't stop people from needing medical care; it only shifted the cost to local property taxpayers supporting hospital districts and put a larger load on the charity care of nonprofit hospitals.

In short, the state lawmakers and the governor solved their financial problem by shoving it down the stairs to the local level and then applauding themselves for making tough decisions. They've done the same with highways, universities and public schools.

Preston Gee, senior vice president for strategic planning at St. David's HealthCare Partnership, summed up the situation well: "Some of us in health care have been saying for years the issue of the uninsured is critical, but unfortunately, there are some folks who wanted to sweep this under the rug. The reality is, it's the elephant in the living room, and we have to get serous about solutions."

The creation of the health care district by Travis County voters this year was a good first step locally, and state leaders recently restored some funding to ensure medical care for some patients.

But this clearly is a major problem for the Legislature to consider when it meets in January.