HEALTH CARE/Joan Retsinas

Emergency Rooms as Realtors: A Micro Point of Light on the Healthcare Horizon

This season the Grinch rules. Forget the trappings of holiday cheer on billboards, porches, and stores: look at the data. The census of the uninsured is up by 3.5 million. Premiums are up. The outreach to enroll people in the Affordable Care Act has withered. Insurers dread the next twitter: will the subsidies go? Will insurers go back to the future to design the Model T policies that left millions underinsured in the good old days of greatness? Edict by edict, our President is dismantling Obamacare, fueled by his loathing for President Obama; and Congress is complicit.

We even have Grinchlets to wreak havoc on the season of brotherly love. Tennessee’s Congresswoman Diane Black, chair of the House Budget Committee, wants to do away with the Emergency Medical Treatment and Labor Act, a 1986 law passed under Ronald Reagan that forced (conservatives loathe that word) hospitals, even for-profit ones, to treat people who come to emergency rooms, regardless of insurance, ability to pay, or immigration status. In the good old days, for-profit hospitals dumped the unprofitable patients.

Georgia state Rep. Betty Price (Republican wife of the former Department of Health and Human Services Secretary Tom Price) suggested a solution to the epidemic of AIDS: quarantine. She didn’t suggest the spot: maybe a dual use for Guantanamo? If we weaken requirements for compulsory school vaccinations, we may see outbreaks of other infectious diseases: whooping cough, measles, maybe polio. Good news: we can quarantine those patients too. (After the statement, she conceded she was being “provocative.”)

So, in the spirit of this holiday that exalts the “less fortunate” – the people we are called upon to help every December, but only in December — I searched for a good-news tale. No more stinginess, meanness and cupidity – we’ve read enough these past few months. But a garden-variety tale of well-intentioned people are trying to help the poor. Peggy Noonan would call it one of the thousand points of light. Truthfully, it is a micro-point. But let’s shine the sparkling stars on the tale, if only because it dims the Grinches.

The problem focuses on hospitals’ frequent flyers, the people who waft in and out of emergency rooms. Generally they live in shelters, or on the streets. Often they suffer from addiction. They are invariably poor. If they have family members, they are estranged from them. Some of the perpetual patients are seriously mentally ill; all are unemployed – at this stage, unemployable.

Hospitals treat the admitting diagnosis. Whether a gunshot wound, the delirium tremens, hypothermia, asthma, diabetes – if physicians have a clear diagnosis, very often they send the patient home, with a treatment plan, and a prescription. Of course, when “home” is the street, the plan is moot. And the patient returns.

The patients need stable places to live, with some supervision, to see that they follow the regimen. They also need food and shelter. This starts to sound like the Biblical admonition to feed the hungry. But this is the season of Biblical spoutings, so it is OK to spout those rejoinders in December.

A few hospitals have risen to the challenge. They have joined their hospital bureaucracy with their cities’ housing bureaucracy — not an easily formed union, made especially difficult since the Healthcare Grinch is also the Housing Grinch, slashing funding with startling abandon. (Public housing authorities nationally expect a $3 billion cut.) But the result has helped the patients/clients (different bureaucratic systems, different words).

Hospital systems in Sacramento, Portland, Oregon, Orlando and San Francisco, targeting some of their homeless patients, have found them “supportive housing.” The national Corporation for Supportive Housing, estimates that hospitals have spent from $75 to $100 million in the past few years on this endeavor.

Typically the patient gets settled into an apartment for a few months, with a social worker struggling to link the patient to the “human service” bureaucracy’s services. The patient may not morph into a Horatio Alger success story (we do like them, especially during the holidays); but with a lot of effort, a client may be able to stay out of hospital emergency rooms, on his/her medication, and find a niche within the community. All laudable goals, and, for many patient-clients, doable.

At this stage, readers expect a happy ending that extols the cost-benefits of the union. For feel-good tales to last beyond December, we want to hear that this union saved money in the end. But not necessarily. The union spared the hospitals the expense of frequent flyers. The bill for uncompensated care plummeted. But an accountant would need to weigh the money spent on housing.

These small-scale programs, however, helped some people live kinder, healthier lives. The programs may have saved the lives of those people. In this season of good-hearted benevolence, isn’t it enough to light a candle, rather than curse the Grinches?

Joan Retsinas is a sociologist in Providence, R.I., who writes about health care. Email retsinas@verizon.net.

From The Progressive Populist, December 1, 2017

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