Wednesday, January 07, 2009

Not Yet

Health care workers and facilities could all, to a one, make incredible amounts of money if but a single thing were allowed, that thing which all other businesses are permitted to do: refuse customers.

Instead, huge amounts of money are spent on people with no ability to pay for services rendered. Then there are the people who indeed can pay, but doing so renders them bankrupt. And jobless. And in many cases homeless. All because they had the audacity to get sick or injured.

I don't personally mind so much, because I get paid regardless of the patient's legal status, insurance, or lack of such. But hospital nursing is a stressful and difficult job, and if nurse paychecks even just begin to suffer a little because of these things, you can fully expect the already dire nursing shortage to get a lot worse.

Nurses don't want to get rich. We only want to be able to sustain a reasonably healthy and safely comfortable middle-class family lifestyle. If we can't have that, then we get stressed-out and sick, and if that happens you won't have any fucking nurses at all.

Samantha is here illegally. She stayed in the U.S. after her student papers expired a few months ago. Things aren't so well in her home country, largely because of U.S. foreign policy and war, but that's another story. Over the past couple months she'd been feeling sick.

The school clinic sent her to the hospital along with reports of bloodwork they'd drawn. Her blood urea nitrogen levels were over 100 and her creatinine was 17.9. That's
bad. Most of the glomeruli in her kidneys, those little filtration tubules that do the work of cleansing the bloodstream and concentrating urine, had lost function. Who knows why.

She's a dialysis patient now. The hospital is absorbing the cost of her care and is putting in an AV shunt, but soon we will have to discharge her to her country of origin. Her family hopes she can get a kidney transplant there.

Maybe that will happen. Probably not. If not; say for example she is discharged from the hospital, cannot follow up with thrice-weekly dialysis sessions due to cost, and she ends up very sick, she can present right back at our hospital and we will have to take her in. Dialyse, stabilise, and discharge. Repeat as often as necessary.

Define "stable."

You know what? If your kidneys are basically dead and you need dialysis for the rest of your life, your health is never going to be stable. At least not for more than a couple days at a time.

Speaking of you: Your health insurance premiums don't even cover the costs of your own care, let alone that of others. And your taxpayer dollars, while these help, do not come close to reimbursing hospitals for all the charity care they must provide.

Arizona figures for 2005-08

Centers for Medicaid and Medicare Services Section 1011, which dictates how hospitals get paid for care to illegal immigrants:

Arizona figures for 2005-08

Centers for Medicare and Medicaid Services made payments to Arizona for health care services based on the estimated number of illegal immigrants living in the state and the number apprehended. An estimated 283,000 illegal immigrants live in Arizona, and apprehensions are based on the number of people apprehended the previous year.

Payment Year Apprehensions to Arizona
2006 600,838 $47.6 M
2007 565,239 $44.5 M
2008 415,218 $37.9 M

For bug-eyed bigotry, hate, and general ass-hattery, you really can't beat some of the comments that accompany that Tucson Citizen article. Try to resist. Anyways...

A lone large Arizona hospital can rack up $40 million in charity care in any single year. One hospital. And they can't, by law and by good conscience, say "no."


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