By James Santiago Grisolía, MD
Some 80% of California hospitals lose money on their emergency rooms, according to statewide data recently released by the California Medical Association (CMA). Over the last decade, some 65 hospitals were forced to close across the state, including 7 of 30 hospitals in San Diego County. Others totter on the brink of closing, such as Martin Luther King in LA, which intends to close its trauma and emergency facilities, and San Jose is slated to lose its only Trauma Center in December.
Emergency Departments and Trauma Centers lose money on MediCal and Medicare and on underpayments by HMOs, but lost most on care for the 7 million Californians (and over 400,000 San Diegans) without health insurance. By law, ED and Trauma Centers must take everyone, and if a no-pay patient needs hospitalization, intensive care or emergency surgery, the hospital and the doctors lose.
The most recent statistics show that hospitals and doctors lose some $640 million yearly on no-pay emergency and trauma care. This is what sinks hospitals, which must close their ED or close altogether. Either way, precious time will be lost when your spouse or child’s ambulance gets diverted to a more distant hospital, with their ED even more over-burdened because your neighborhood ED closed. Every second counts for many emergencies, such as when your heart stops and blood stops flowing to your brain.
Proposition 67 on the November ballot is not a massive bond issue that will burden taxpayers. Instead, it uses a commonsense, pay-as-you-go surcharge to provide “Emergency Care to your Emergency Rooms.” Right now, each phone user pays 0.72% of in-state long distance calls to support the existing 911 emergency system. Prop 67 adds a 3% surcharge, not on the whole phone bill but just on in-state long distance, so that the average cell phone user pays just 90¢ monthly. Home lines are capped at 50¢ monthly, but seniors and Lifeline customers don’t have to pay at all.
For just pennies a month we can keep our loved ones safe if they have a car accident, a stroke, a heart attack. Voters understand the connection between 911 telephone charges and emergency care: 911 only helps because it brings us the paramedics, the firemen or the police when we need them! Telephone charges are fair because everyone uses the telephone and anyone could need emergency care, any time.
Some claim the uninsured problem is due to illegal immigration. This is untrue as 90% of uninsured San Diegans belong to working families with jobs in San Diego. The majority of our uninsured are legal residents.
Prop 67 will NOT create any new bureaucracy or administrative costs. 100% of the money will go to emergency care and cannot be used by the Legislature for other purposes. All spending will be audited. Prop 67 funds will be spent as follows:
• 5% of funds will support community clinics to help the uninsured get preventive care so they won’t come to the ED for non-emergencies.
• .75% will go to upgrade 911 system. Right now, 911 operators can’t find cell phone users calling with emergencies. With this upgrade, cell phone users will be pinpointed so they can get help quickly.
• 3.75% will train and equip paramedics and firefighters to provide better emergency and disaster care.
• 30.5% will make sure that emergency doctors and specialists are paid, so that they can afford to keep coming to care for emergency patients.
• 60% will pay hospital emergency and trauma centers for uninsured patients to help keep them open.
We must ACT NOW to keep more hospitals and emergency departments from closing, including here in San Diego. We need to work on complicated problems like covering the uninsured. But in the meantime, this sensible bill provides EMERGENCY RELIEF to your local hospitals and trauma centers. Vote “YES” on Prop 67!!
James Santiago Grisolía is the San Diego-Imperial County representative to the CMA Board of Trustees and is Chief of Medicine at Scripps-Mercy Hospital.