What else can one conclude from this, except that the Bushies have a dastardly plan to kill us, especially the poorer among us? Arian Campo-Flores writes at Newsweek.com that the Bush Administration is “reforming” Medicaid in a way that will cause emergency rooms and even hospitals themselves to close.

The rule, scheduled to take effect on Sept. 1, deals with the arcane world of Medicaid financing. Two provisions in particular dismay many in the health-care field. One limits states’ ability to tap certain funding sources to meet their Medicaid obligations. The other stipulates that Medicaid reimbursements cannot exceed the cost of treating the Medicaid patient. While that provision may sound reasonable, says Larry Gage of the National Association of Public Hospitals, it doesn’t account for the harsh reality confronting medical facilities that treat large numbers of the uninsured. Since these facilities don’t get reimbursed for that treatment, they rely in part on higher-than-cost Medicaid reimbursements. As a result of the new administration rule, many hospitals may need to make drastic cuts in personnel, beds and more.

Nearly a year ago the Institute of Medicine issued three reports (key findings here) saying the nation’s emergency rooms are inadequate and getting worse. Among other things, it found:

Demand for emergency care has been growing fast—emergency department (ED) visits grew by 26 percent between 1993 and 2003.

But over the same period, the number of EDs declined by 425, and the number of hospital beds declined by 198,000.

ED crowding is a hospital-wide problem—patients back up in the ED because they can not get admitted to inpatient beds.

As a result, patients are often “boarded”—held in the ED until an inpatient bed becomes available—for 48 hours or more.

Also, ambulances are frequently diverted from overcrowded EDs to other hospitals that may be farther away and may not have the optimal services.

In 2003, ambulances were diverted 501,000 times—an average of once every minute.

After these reports came out, David Brown wrote in the Washington Post:

The number of deaths caused by a delay in treatment or lack of expertise is especially uncertain, though it may not be small. San Diego established a trauma system in 1984 after autopsies of accident victims who died after reaching the ER suggested that 22 percent of the deaths were preventable, said Eastman, one of the Institute of Medicine committee members.

This is related to the ongoing controversy over disaster response (quoting the key findings from the National Institute of Medicine linked above):

The emergency care system is ill-prepared to handle a major disaster. [Drawn from all three reports]

With many EDs at or over capacity, there is little surge capacity for a major event, whether it takes the form of a natural disaster, disease outbreak, or terrorist attack.

EMS received only 4 percent of Department of Homeland Security first responder funding in 2002 and 2003.

Emergency Medical Technicians in non-fire based services have received an average of less than one hour of training in disaster response.

Both hospital and EMS personnel lack personal protective equipment needed to effectively respond to chemical, biological, or nuclear threats.

That going on six years after 9/11 there has been no coherent effort to prepare the nation for biochemical or nuclear attacks goes way beyond the parameters of incompetence, IMO. The ridiculous Department of Homeland Security tosses money at pork projects and “contractors” (with ties to Republicans in Washington, one suspects) who don’t deliver. Yet to fund tax cuts for the rich and Bush’s pointless Iraq War — which is supposed to be about keeping America safer somehow — Bush’s government lets our ability to respond to disasters go to rot.

On 9/11 New York City actually had surplus medical emergency response. That day the city’s wealth of world-class medical personnel and state-of-the-art facilities mustered a triage army around the Financial District. (I understand this was done on the initiative of New York City’s medical community; Rudy Giuliani didn’t have to ask.) But the nature of the disaster was such that people either got out, or they didn’t. The crack medical teams had little else to do but wipe bloody noses and wash dust out of eyes.

But poor New Orleans after Katrina was a different story. Kerry Sanders reported for NBC News on September 2, 2005, that the sick, injured and dead alike were being stacked up at the New Orleans airport:

The stench of death reeks inside portions of the airport here. Other parts of the airport just smell as any hospital would if there was no way to clean up. It is human misery as people are lying in pain, ailing and wailing.

The pained screams from patients is like fingers on a chalkboard because there is nothing you can do to reach out and help these people. They have limited medical supplies. They do have aircraft coming in. The C-17s, Storm-30s are moving people out of here as fast as they can. …

… A reporter is supposed to remain detached and just report what’s going on. But, when there is a man lying on the ground, and he’s yelling out to anyone walking by, “Help me! I need some water! Help me!” and there is no one to help this man.

The moral is, if you’re ever a victim of a natural disaster or terrorist attack, be sure you’re someplace with really expensive real estate. Increasingly, America’s alleged “best health care in the world” is reserved for the well-to-do. Last year Jane Bryant Quinn wrote,

America’s health-care “system” looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.

But now, in true Bush style, the Bush Administration is going to take a grim situation and make it worse. Let’s go back to Arian Campo-Flores at Newsweek.com:

The administration calculates that the rule change will reduce federal Medicaid expenditures by about $3.8 billion over five years. But Gage and others estimate the impact on hospitals will be much larger. At Grady, where 42 percent of revenue comes from Medicaid, Kellerman estimates that the hit could total $200 million over five years. “Grady is already struggling,” he says. “This would put it out of business.” Were Grady to close, the consequences would be far-reaching: the hospital is the only Level I trauma center (the highest designation) in a 120-mile radius of Atlanta, and one quarter of Georgia’s physicians are trained there.

Let’s see; the Bushies have run the National Guard into the ground and now they’re fixin’ to close hospitals. This at the very time that disaster and terrorist attack response is supposed to be a critical priority. Does it get dumber, or what?

See also: The Mahablog, “Je m’amuse” (June 15, 2006).