Predictably, critics who call the closure of the emergency room for Baton Rouge General Medical Center a failure of public policy show the real failure comes in their unwillingness to grasp of the laws of economics, especially as it related to health care.
For months, the expenses of its emergency room had been outstripping its revenues, especially after the old Earl K. Long Medical Center closed due its deteriorating and outmoded condition, with most of its services done with state money now performed at Our Lady of the Lake Regional Medical Center. This is as BRG Mid City’s was the only ER left near the north Baton Rouge area, the lowest socioeconomic status area in town, and many patients that used EKL for primary care instead of taking the longer trip to OLOL started heading to Mid City.
More business usually is good and helps the bottom line – unless you are in the health care business with its perverse incentives due to extensive subsidization of some people’s health care by others. In fact, business was so good at Mid City that its statistics show the typical wait in the ER was twice the national and Louisiana averages and typical treatment time half again longer, with the federal government’s indicator of hospital quality defining its ER volume as “very high,” or a minimum of a visit every 8 minutes.
But the problem is and always has been, because they get their health care essentially for free, poor adults would access such care for more trivial reasons and in less efficient ways – often a trip to the ER for ailments not deserving of intensive medicine. As the data have shown, the poorer – especially those on Medicaid – are disproportionately likelier to engage in this behavior.
Which means that the provider spends much more in delivery than it would have to for ailments that get a relatively low level of reimbursement, because these don’t require emergency medicine, both from private insurance or government insurance – although relatively few ER visitors there, if they have insurance, have something other than Medicaid – and uncompensated care payments for minor ailments also cannot pay enough for those addressed through emergency medicine. This created such an imbalance in payments that months ago the state set up a special subsidization in order to keep the ER open. Unfortunately, that was not enough and the hospital’s administration announced that soon it would stop delivering that service. The state hopes to steer resources to the area’s urgent care centers, where the vast majority of Mid City’s former ER patients could receive appropriate care, and costing taxpayers and providers less.
Understand that the difficulties have come not from the lack of state dollars going into the area, but from a government-subsidized system of health care in this country that encourages wasteful use of such dollars, worsened by the passage of the misnamed Patient Protection and Affordable Care Act.. That seems lost on critics of the closure, such as one far-left business writer from California who blithely declared Medicaid expansion in Louisiana could have kept that ER open – ignorant, perhaps willfully, that the propensity of the Medicaid expansion population disproportionately to use emergency room services that would have degraded further that service delivery while costing taxpayers and ratepayers more money than ever.
Regrettably, the proportionately few who need intense emergency medicine and fast will have to endure transit to other city ERs. But that’s the fault of socialized medicine that does not discourage overconsumption by those least invested in paying for it and in inefficient use of resources, and perhaps of Mid City administrators who must find more efficient delivery means, not in the lack of dollars provided by a state that already spends over $6 billion a year of its own revenues, or 41 percent of all its own resources, on health care for the indigent and the disabled. Concluding otherwise disregards that inconvenient truth and obscures that the real solution here is not to embrace more, but to retreat from, socialized medicine.