Conservatism Collapses in the Emergency Room

A column I've just posted on Firedog Lake [1] takes Sen. John McCain and the Bush administration to task for failing to address one of the most critical failings of our health care system: our overstressed urban hospitals.

It was one of the elephants in the room when McCain rolled out his health care plan last week, which emphasized a wacky free-market fundamentalism as the solution to our health insurance crisis. This week, the House Government Affairs and Oversight Committee exposed the elephant [2] during a two-day series of hearings on what might happen in seven key cities if there were a disaster comparable to the 1994 train bombing in Madrid, Spain.

The results of the survey show that none of the hospitals surveyed in the seven cities had sufficient emergency care capacity to respond to an attack generating the number of casualties that occurred in Madrid. The Level I trauma centers surveyed had no room in their emergency rooms to treat a sudden influx of victims. They had virtually no free intensive care unit beds within their hospital complex. And they did not have enough regular inpatient beds to handle the less severely injured victims. The shortage of capacity was particularly acute in Los Angeles and Washington, D.C.

What this means is that hospital emergency rooms often aren't equipped to properly handle the day-to-day needs of their communities, much less the burdens of a natural disaster or a terrorist attack. And while the hearing did not explore this in detail, this problem is compounded in communities where a large percentage of the patients are low-income and uninsured.

The committee released the report to highlight the damage that could be caused by Bush administration changes in Medicaid reimbursements, a significant share of hospital income. These hospitals are already pinched by reimbursement rates from both government and private insurers that do not fully compensate them for the cost of care, as well as by the millions of uninsured and underinsured patients that use the hospital facilities as a primary care facility because they do not have a doctor.

This is a complicated problem, but it is one that has been made worse, not better, under the conservative regime of the past seven years. We need progressive health care experts to add to the debate the best ideas for fixing our health care infrastructure as well as guaranteeing access to that system to everyone.