Stephen Feman
Americans are proud of their independence and their rights as individuals to express their unique perspectives. No one is about to tell you what to do, and many people would be willing to fight to keep that privilege. That’s good, but our concern in recent weeks has been how that extends to health care. As it is now, everyone goes about getting health insurance on their own, if that is what they desire. Most of the people who have employer-supplied insurance usually accept that. All the people who are older than age 65 have the federal government–sponsored Medicare program accessible to them. Americans who are truly indigent are eligible for the various state-managed Medicaid programs. Individuals with jobs that don’t offer employer sponsored health care insurance can buy it on their own, if they wish. The problem is that this arrangement is partly responsible for the continuing increases in health care costs.

During the past few years, there has been a gradual downturn in our economy. There are fewer jobs, and many of those that exist are offering reduced benefits. In keeping with our independent American spirit, some people are opting out of the personal choice of buying health care insurance. In Missouri, the number of people without health care insurance has continued to grow. Back in 2004, there were 463,000 Missouri citizens without any form of health care insurance. By the beginning of 2007, the number of Missourians without health care insurance had increased to 744,030 people. It is expected that the numbers are higher now, but more recent verifiable data is not accessible.

This year, the St. Louis Area Business Health Coalition examined how changes in our economy have affected some aspects of hospital costs in this region. What they discovered should give us all a reason to rethink the current health care debate. Their report looked at the same years mentioned above.

The first item of theirs that caught my attention was an evolving change in language use. The generic term for hospitals' economic problems is "uncompensated care." Historically, hospitals have listed some nonpayment for services as bad debts, and those items would be transferred to financial services companies. At the same time, those health care service activities that were charity care were thought to be situations in which the hospitals had no expectation of payment. During the past decade, though, the differences between charity care and bad debts were in a state of flux because of variations in the Internal Revenue Service’s reporting guidelines. However, if one only restricts these expenditure types to the generic term “uncompensated care,” there has been a great increase during this time interval.

Here is a look at the exact numbers: It appears that in 2004, the Missouri hospitals included in the Business Health Coalition report spent $60 million on charity care, and, in addition, bad debt cost them another $140 million, for a total of $200 million. By the end of 2005, those same Missouri hospitals spent $73 million in charity care, and bad debt cost them an additional $165 million, for a total of $238 million.

It is important to add here that these figures represent only the hospital care costs. None of these numbers relate to any of the uncompensated care that physicians contribute every day, and none of this relates to uncompensated care supplied by nurses, technical personnel, clinics, surgical centers, medical laboratories, etc. That is, this data is just in regard to the “big box” hospitals.

The arithmetic is very simple, though. There were about 5.8 million people living in Missouri in the years of the Business Health Coalition report. So, $238 million dollars divided by 5.8 million people is $41 per person. That is, during 2005, each and every man, woman, and child in Missouri had to contribute at least $41 toward the hospital uncompensated care bill. (Some might say, “Your tax money at work.”)

This average $41-per-person cost may not seem like much, until you realize that there was a 19-percent increase between 2004 and 2005, and things have continued to rise since that time. Would you be better off if this problem were reduced? Something like that could happen if everyone had their own independent insurance policies. It appears that some countries have done that already and are doing well. Do you think we should try it here?

About the Author

Stephen Feman