US Hospital costs: the poor and the aliens

Randy Black is puzzled as to "why Clyde McMorrow finds himself in opposition to my views. This was not my intent. I did not intend to imply or state that I was opposed to free medical care for aliens or indigents if that is his impression. Parkland Hospital delivers more babies than any other hospital in the USA, to my knowledge, and does it professionally and as economically possible without endangering the patients. Still, Parkland sees more than one MILLION patients annually, in addition to the thousands and thousands of baby deliveries.

The two Egyptian twins who were joined at the brain from birth but successfully separated at Children’s Medical Center at Parkland Hospital last year? Free medical care provided by Parkland and Dallas County taxpayers. And the family and twins came FROM Egypt for the procedure. There were not even resident aliens. Cost? About $4 million. Billed to the taxpayers of Dallas County and paid for. It could not have happened in Egypt, ever. Such procedures can only happen in a very few places in the world, mostly in the USA.

The costs were charged entirely to the taxpayers of Dallas County, not to other citizens or counties around the state.

Professor Hilton is correct in his view that many doctors have stopped delivering babies for reasons of liability costs and litigious patients. Staff doctors at Parkland are covered by the county as are physicians at most public hospitals. Private practice physicians who have privileges at Parkland are on their own for insurance coverage. Professor Hilton’s position is correct.

My sister delivers babies as a large part of her private practice in central Texas. Most of her patients are low income, immigrants, indigents, retirees and the rest. They pay what they can, the government supplements that under the Texas children’s insurance program and Medicare, or she simply absorbs the costs personally. She delivers about 200 babies annually and tells me that at least half of the mothers are low income immigrants, legal and illegal, with insurance through their jobs, many without. No one is turned away, however. Her insurance in her relatively small county is in the $50,000 annually range. She’s never had a parking ticket, much less a suit for malpractice.

One thousand dollars per week for insurance just to be able to open your doors, before you pay rent, staff, nurses, utilities, supplies and all the rest even before you pay yourself….

I don’t know how she does it".

RH: If Parkland Hospital loses a class action suit brought by a Hispanic action group and has to pay millions of dollars, the insurance company pays: The insurance costs must be horrendous.

Regarding health systems in different countries, John Heelan replies from the UK: "The UK National Health Service provides health care free at the point of delivery. However, the combination of lack of government investment over a lengthy period- from Thatcher until fairly recently-, rapidly increasing numbers of immigrants, bureaucratic systems that sometimes means that hospitals often employ more administrators that medical staff. The result is that accident and emergency treatment normally involves a wait of up to 4 hours unless the trauma is life-threatening. Waiting lists for non-urgent medical procedures can extend up to 2 years, although recent investment has started to reduce waiting times. Remarkably poor salaries paid to doctors and nurses have resulted in large-scale recruitment of non-UK staff, usually from Third World countries. Private medical insurance is very expensive, especially for senior citizens who no longer receive any tax relied on their premium payments. [My personal health insurance premium increased by over 100% when I reached 60 years after having been insured for some 30 years with the same company, despite having a clean health record and no problem with the annual check-up. Needless to say, the company lost the business!"

RH: In the US, foreign doctors are being hired to work in the inner cities.

Clyde McMorrow writes: "I must apologize to Randy Black. On rereading his initial post I see that he and I are in agreement. My father was a doctor who also had a large low-income practice and who eventually stopped delivering babies because of the insurance costs. His experience was very similar to that of Randy's sister. His practice was in San Diego and he worked for many years at Mercy Hospital, which at that time was a provider of free medical care to all who needed it. That was a long time ago.

How is this problem addressed in other countries? Are there better systems?"

RH: Demands that hospitals be more liberal in accepting patients should bear this in mind: A new survey of hospitals in 15 cities shows that there are waiting times of up to a month for admission. They cannot open their doors to aliens any wider.

RH: The "basis" for class action suits is always the point of dispute- Usually, the charge is that some operations were badly performed. This applies in individual cased as well as in class action suits. Cases involving obstetrics have resulted in doctors refusing to deliver babies or moving to another state. A Hispanic group has just sued a hospital in the East, charging that an operation for some injury was badly performed. As I understand it, the group is acting on behalf of the victim and his family. Perhaps Rob Gaudet, a class action lawyer, has something to say about this. Has Parkland never ben sued?

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From: Ronald Hilton [mailto:hilton@stanford.edu]
Sent: Friday, June 04, 2004 6:29 PM
To: gf
Subject: Spam Alert: US Hospital costs::: the poor and the aliens

Randy Black is puzzled as to "why Clyde McMorrow finds himself in opposition to my views. This was not my intent. I did not intend to imply or state that I was opposed to free medical care for aliens or indigents if that is his impression. Parkland Hospital delivers more babies than any other hospital in the USA, to my knowledge, and does it professionally and as economically possible without endangering the patients. Still, Parkland sees more than one MILLION patients annually, in addition to the thousands and thousands of baby deliveries.

The two Egyptian twins who were joined at the brain from birth but successfully separated at Children’s Medical Center at Parkland Hospital last year? Free medical care provided by Parkland and Dallas County taxpayers. And the family and twins came FROM Egypt for the procedure. There were not even resident aliens. Cost? About $4 million. Billed to the taxpayers of Dallas County and paid for. It could not have happened in Egypt, ever. Such procedures can only happen in a very few places in the world, mostly in the USA.

The costs were charged entirely to the taxpayers of Dallas County, not to other citizens or counties around the state.

Professor Hilton is correct in his view that many doctors have stopped delivering babies for reasons of liability costs and litigious patients. Staff doctors at Parkland are covered by the county as are physicians at most public hospitals. Private practice physicians who have privileges at Parkland are on their own for insurance coverage. Professor Hilton’s position is correct.

My sister delivers babies as a large part of her private practice in central Texas. Most of her patients are low income, immigrants, indigents, retirees and the rest. They pay what they can, the government supplements that under the Texas children’s insurance program and Medicare, or she simply absorbs the costs personally. She delivers about 200 babies annually and tells me that at least half of the mothers are low income immigrants, legal and illegal, with insurance through their jobs, many without. No one is turned away, however. Her insurance in her relatively small county is in the $50,000 annually range. She’s never had a parking ticket, much less a suit for malpractice.

One thousand dollars per week for insurance just to be able to open your doors, before you pay rent, staff, nurses, utilities, supplies and all the rest even before you pay yourself….

I don’t know how she does it".

RH: If Parkland Hospital loses a class action suit brought by a Hispanic action group and has to pay millions of dollars, the insurance company pays: The insurance costs must be horrendous.

Evelyn Aleman from El Salvador lives in Los Angeles. She reports: "In reading the messages about US hospital costs, I'd like to note the following: 1) Not all Hispanics are illegals; and 2) Not all Hispanics lack medical insurance.
I don't know why the Hispanic advocacy group you noted is bringing up a class action suit, but does the ethnicity of the family who is seeking compensation really matter? I'd like to know why the suit is being raised, and whether or not it is fair.

I have no doubt that many illegal aliens take advantage of our medical system (this would include Middle Eastern, Asian and others as well), but I also know that various reasons bring illegal aliens to our hospitals, such as accidents that happen while they work in this country earning a minimum wage with no health insurance, disease, much needed treatment that they wouldn't receive in their home country, and deliveries. Many people from El Salvador, including my family, believe that a visit to a public hospital in that country could kill you.

My mother was not an illegal immigrant when she ended up at County Hospital in Los Angeles in 1999. She was born in El Salvador, came to Los Angeles in the early sixties, and became a naturalized citizen by the time I was 10. She had terminal cancer at age 56, and I would often visit her at the hospital and / or take her to doctor visits. While there, I was so saddened to see so many sick people like my mother, citizens, legal, illegal, black, white, Hispanic, Asian, Indian, Middle Eastern, etc., waiting for hours to be seen or to get checked in. I saw so much abuse and neglect of the patients. At one point, my mother called me frantically at 4 a.m. from the hospital to let me know that she was being prepped up for heart surgery -- without our or her consent/ knowledge. Fortunately, I was able to contact the front desk and stop the procedure. The hospital refused to comment on the issue, and the surgeon didn't really want to speak with me.

Her social workers, provided by the hospital, were abusive and not helpful. One of them told me that the hospital wouldn't be able to provide services for my mother because illegal aliens were taking up their time. He went on to discuss how a man was flown in from Africa; from the airport he took a taxi to the hospital to get very expensive treatment for his illness. According to the social worker, all the man had to do to ensure that he received treatment was to say that he had no relatives in the U.S. I ask, how did he make it to LAX in the first place?

No doubt that this is true, but on the other hand many of our public hospitals are also poorly run. While visiting my mother, I saw staff making personal phone calls for hours -- literally -- while sick people waited in line with broken limbs and other problems. I could go on and on. When you're actually in these hospitals, you're heart goes out to all of those patients who are ill or dying regardless of their socioeconomic background, because many -- you soon realize -- come to our public hospitals as a last resort (I know that my mother did). My heart didn't really go out to all of those young overly self-assured surgeons being trained by older medical staff (much of it very qualified).

I think that the problem lies not among our immigrant populations for seeking a very basic service -- health services -- but within the administration of our health systems. Obviously, we need reform at all levels".

Ronald Hilton -

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