Unlike some of the advocacy leaders you quoted in your cover story on charity care and hospital billing, I cannot laud HHS Secretary Tommy Thompson for his deep compassion for the uninsured ("Never pay retail again," Feb. 23, p. 6).
How could you not point out that Medicare bears a great deal of the responsibility for shifting costs from those whose care is paid for by the government to the rest of us? By systematically failing to pay for the full cost (not charges) of healthcare services to their program beneficiaries since 1983, Medicare and Medicaid have forced healthcare providers to cut services and yes to raise prices to others, including insured and uninsured patients.
Your sidebar ("Indigent-care spending low," p. 7) cites an $800 million increase in the cost of charity care in 2002 as paltry, and you graphically misrepresent the change in charity care as a percent of total expenses in a chart (p. 9). The line plunging down the chart is a decline of 0.8 percentage points in the past four years.
Hospitals reported 5.4% of total operating expenses as the cost of charity. Charity care does not include bad debt or the shortfall from Medicare and especially Medicaid (which sometimes pays less than 10% of hospital charges for services provided to Medicaid-eligible recipients). These are the primary reasons costs have been shifted to other payers. But you print an article criticizing the hospital industry for a few well-publicized, errant collection practices.
Hospitals are the primary healthcare safety net for millions of uninsured Americans. Rather than writing brusque letters to those already doing their very best to serve the uninsured, Secretary Thompson should join a call to provide some form of health insurance to all Americans or at least fair payment by the programs he administers.
Director of budget and financial analysis
Hospital Sisters Health System
In your Jan. 26 issue, there were only six pages separating columns written by Editor David Burda ("Common sense on access," p. 26) and Publisher Charles Lauer ("Taking the time to help," p. 33). But ideologically, the two pieces were oceans apart.
Burda was flippantly asserting that the outcome of an NFL football game held more importance for him than the plight of the estimated 43.6 million Americans who are uninsured.
Lauer was extolling the importance of treating others with dignity and respect and keeping one's heart open to them.
We cannot as a nation afford to become hardened or indifferent to the disenfranchisement of so many when it comes to their ability to access and afford healthcare. Modern Healthcare has a duty to its readers to remind us of our commitment to serve the healthcare needs of all segments of society, and to encompass a sense of empathy and advocacy in our missions as healthcare administrators and providers.
Director of payer relations
Grand Rapids, Mich.
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