The extent of downsizing and closures underway in the U.S. medical system—centered on hospitals, is now at the stage of ending public hospital service for huge parts of the nation, and upping the death rate for mass numbers of people—genocide.
Below is a short list of some of the multiple areas of Wall Street/insurance/Obama assault on what remains of the U.S. hospital system, as summarized in the current fact sheet by the American Hospital Association.
Also noted are several of the many bi-partisan expressions of protest to the devastation underway, which will go nowhere without getting Obama out of office, reinstating Glass-Steagall and building an economy, and a real health care system.
The immediate cause of crisis in hospital and related services—logistics, staff, diagnostics, treatment and training—are the cuts in Federal funding mandated by Obama’s 2010 ACA (“Obamacare act”)—focussed on, but not limited to “excess” care for the old and poor,— that is, Medicare and Medicaid. Some of these cuts went into effect last year, some are going into effect right now (FY 2014, which began Oct. 1), and more are set to take effect in the coming months.
The contrived excuse given in 2009-2010 is that there would be “universal coverage”—health care for all, paid for by cutting $500 billions over 10 years from Medicare payments to hospitals and doctors, and another $200 billions in various kinds of additional cuts—which, it was asserted, would come from ending “excessive” care, and “overtreatment.”
The designers of the ACA—the Wall Street insurance sector and the White House, knew they were imposing a corporatist—government/private—system, to loot what remains of health care, and kill people at the same time.
These Obamacare cuts in resources, come on top of prior years of erosion of the U.S. medical care system, over the decades of damage from so-called private “managed care,” (starting in 1973), deregulation to allow for-profit financial groups to buy-up non-profit hospitals (starting in the 1970s), and finally the culmination in corporatism—as seen in the Federal government/private insurance “sign ups” scheme, even if HealthCare.gov is a fiasco.
The number of community hospitals today is falling below 5,000, which itself is below the 5,800 a generation ago. There are far fewer beds per 1000 residents than modern standards of medicine require; and likewise, fewer ratios of scanning, infusion and other facilities.
Each week there are announcements of hospital staff and program reductions, and closings. Examples:
- Washington, D.C.. The for-profit Medstar Washington Hospital Center announced new staff cuts yesterday.
- New York. In the western part of the state, a desperate scramble is on, for how to keep the Lake Shore Healthcare Center open (in Irving), scheduled to shut this Winter. The hospital was bought up, then dumped by the mega-UPMC (University of Pittsburgh Medical Center, technically non-profit, but part of the new globalist med operations). Lake Shore is the main facility for a community which includes the Seneca Nation’s Cattaraugus Territory.
These are a few of the types of deliberate reductions and cancellations in support for the U.S. hospital system, under the Obama Administration:
1. Reduce Medicare payments to hospitals’ outpatient services. Any service to over-65 year olds in a hospital, is to be paid the same as for the same services given in a physicians’ office setting, according to a new MedPAC recommendation before Congress. This will reduce the hospital payment between 65% and 80% for 10 of the most common outpatient hospital services.
- Money Goal: Reduce Medicare spending by $900 million a year, that is $9 billion over 10 years.
- Impact: Services available nowhere else but in a hospital outpatient department, for low-income patients, and for persons with multiple conditions, will be threatened to shut altogether. As of MedPAC’s own data, hospitals are already negative 11% for Medicare outpatient services.
2. Cap Medicare payments for a list of 66 outpatient services (ASC—Ambulatory Services Classification) provided at a hospital, according to a recommendation by MedPAC, under consideration by Congress.
- Money Goal: Reduce Medicare spending by $900 million a year.
- Impact: Access to services may be entirely shut; among the 66 procedures are such things as nerve injections, neuropsychological testing, and others.
3. Reduce Medicare payments to defray the bad debt hospitals took on to treat low-income Medicare patients who could not afford their deductible. Historically, Medicare paid 100% of such bad debt, until the 1990s through today, when payments were reduced.
- Money Goal: These payments were reduced last year for most hospitals, down to 65%. And will be reduced over three years for small, rural CAH—Critical Access Hospitals, down to 65%. Total “saved” multi-millions.
- Impact: The death rate will rise in rural areas, as the critical access hospitals must close. Care for inner-city urban poor likewise will be drastically lessened.
4. Cut graduate medical education. Obama’s FY 2014, now in effect, reduced payments to teaching hospitals, by reducing the GME program—Graduate Medical Education.
- Money Goal: Cut $11 billion over 10 years. Simpson-Bowles wants a reduction of $22 billion by 2025.
- Impact: The severe shortage of physicians will worsen. As is, the deficit of doctors within 10 years, is expected to top 120,000.
5. Reduce payments to providers of Medicaid—medical services for the poor, in various ways. For example, the Federal match rate for disaster-recovery FMAP (Federal Medcial Assistance Percentage) was reduced in 2012 from 71.92% down to 65.51% in Louisiana, eliminating multi-millions of dollars to pay for Medicaid n the state,
- Money goal: Cut $11.2 billion over 10 years. The Simpson-Bowles proposal, is to cut $44 billion by 2020.
- Impact: More will die. Medicaid right now covers 1 in 3 children; 1 in 3 births; 8 million persons with disabilities; 1 in 4 non-elderly adults.
6. Reduce support for small and rural hospitals. Cuts are in effect or planned for whole classes of smaller hospitals, in particular, hitting Medicare Dependent Hospitals (MDH, of which there are 200 nationwide), a program called adjustment for Low Volume Hospital (LVH), and aimed at 1,332 Critical Access Hospitals (CAH) in rural areas. In August, the Obama Administration announced its intention to re-categorize 600 to 800 of the 1,332 CAH hospitals, in a way to deprive them of the means to continue.
- Money goal: Cut tens of billions of dollars.
- Impact: If the CAH proposal goes through, 70 of Iowa’s 80 rural CAH hospitals could shut; in Wisconsin, 53 out of 58; with a similar pattern in other states.
Protest: A bipartisan group of lawmakers is skirmishing to try to save small and rural hospitals, and those serving a population in which at least 60% are enrolled in Medicare. They include Rep. Morgan Griffith (D-VA) and many others. A joint letter defending the CAH hosptials was issued by Rep. Ron Kind (D-Wisc.); and David McKinley (R-W. VA). In the Senate, Tammy Baldwin (D-Wisc.) led a group of 20 Senators demanding the protection of rural hospitals; including, for example, Iowans Chuck Grassley (R) and Tom Harkin (D), whose state has 80 CAH hospitals, 70 of which are threatened by Obama shutdown.
7. Reduce support to hospitals to defray their uncompensated care for charity patients. This is called the Medicaid and Medicare DSH—Disproportionate Share Hospital program, referring to a high share of the hospital’s cases being low income, uninsured and underinsured.
- Money goal: The ACA reduces the Medicaid DSH payments by an estimated $14.1 billion from FY 2014 (now) through FY 2019; and Medicare DSH payments by $22.1 billion from FY 2014 through FY 2019.
- Impact: Care is cut back; programs and hospitals must shut. People die.
8. Impose new restrictive hospital admissions policy—the “two midnights” rule, for Medicare and Medicaid patients. The CMS ordered this into effect Oct. 1, to drive down numbers of patients in the hospital for “observation”—that is, for analysis and care. Chaos and misery are underway. The CMS will pay a hospital for an inpatient case which spans at least two midnights; but if a patient is treated for a shorter stay, the hospital will be paid on the much lower outpatient basis, not matter how clinically severe the case is.
- Money goal: Billions diverted away from hospitals.
- Impact: People’s diagnosis and treatment is compromised; the judgment of doctors, and hospital staff overridden. Patients—even with Medicare and supplemental insurance, find they themselves are socked with huge bills.
Protest: 105 members of Congress appealed to the Obama Administration to delay the Oct. 1 start date of the “two midnights” rule, which was ignored. The CMS conceded to a delay for 3 months of when to start financial penalties on hospitals for non-compliance.
9. Penalize hospitals for “excess” readmissions. This began Oct. 1, 2012. The first year, a “too high rate” of readmissions was monitored for heat attack, heart failure and pneumonia. In 2015, readmission rates will be additionally monitored for chronic obstructive pulmonary disease, and for total hip or knee replacement.
- Money goal: Billions. Last year (FY 2013), hospitals were fined 1% of their Medicare base payments. This is being increased to 3% by FY 2015.
- Impact: Masses of people are sicker, and prone to death.