The scene outside the emergency room at Highland Hospital was a panoply of colors: white lab coats, green scrubs, dark suits, and the purple windbreakers of the Service Employees International Union Local 616. On September 6, a crowd of more than fifty doctors, nurses, and politicians gathered in the emergency room parking lot at noon, as a fleet of ambulances idled nearby. They had come to launch a campaign against a little-known effort by the Bush administration to cut hundreds of millions of dollars in Medicaid reimbursements for public hospitals, a move that would place the nation's health care providers of last resort in an even more precarious financial position than they are already.
After a long line of physicians and county supervisors had stepped up to the podium to denounce the Bush administration's proposal, the event culminated in a symbolic chaining of the emergency room's doors. If all this sounds a bit tepid and stagey, it was, but it seemed to sum up the feeling in the crowd that under the new national order, symbolic protests are the only option for progressive enclaves such as Alameda County. In truth, it is probably fair to say that the fortunes of the East Bay's hospitals, clinics, and health care providers may never have seemed lower.
The high point of the rally was clearly the speech by Sal Rosselli, the president of SEIU Local 250. Rosselli's union was at the forefront of the campaign to stop the Sutter hospital chain's 1999 acquisition of Summit hospital, and, since the sale, to resist the proposed cuts in operations that inevitably followed. Alone among the speakers, he seemed possessed by the fire needed to change the direction that the modern health care system has taken: hospital mergers, consolidation of medical services, and a federal government that seems determined to undercut critical medical care for the poor.
"Look around, SEIU members!" Rosselli shouted into the microphone. "SEIU has over a thousand members working in this medical center today. While I'm proud we're all here, aren't we missing a few folks? To the [hospital] administration, members of the community, and our elected leaders, let me first say that you can count on our organization to be with you and stop this act by George Bush; we'll be here for that. But I say even if we're successful in this battle, this is just the tip of the iceberg of what George Bush has planned for public health. George Bush cares less about public health than any president since Calvin Coolidge. Over the next few weeks, we're going to develop a comprehensive plan to not only save public health in this county, but to make our union stronger to face our next challenge. Will you come to those meetings? Will you get involved in the union? Will you go to your coworkers who aren't here and make them get involved to save public health?"
Rosselli's sense of urgency was entirely appropriate, for the Bush administration's proposal could threaten some public hospitals with closure. Until a few weeks ago, public hospitals enjoyed some very accommodating rules around the reimbursement of Medicaid payments. Because such hospitals incur a variety of hidden costs in treating the indigent and the uninsured, Congress agreed to reimburse the facilities as much as 150 percent of the paper costs; it was a critical plank in the finances of public hospitals around the country. But recently, Health and Human Services Secretary Tommy Thompson proposed scaling back the payments to one hundred percent. The proposed change could cut as much as $300 million from public hospitals across California, threatening critical medical services for the uninsured.
According to a recent survey, there are roughly 140,000 uninsured people in Alameda County; if they were all assembled in a single city, that city would be the third largest in the East Bay. More than seventy percent of these uninsured adults are people of color, 55 percent have one or more jobs, and 53 percent are immigrants. Roughly one-third of the uninsured are actually eligible for Medi-Cal and Family Care, but are currently not enrolled. For this population, Highland and the rest of the county's public health apparatus is all that stands between them and having no medical care whatsoever.
Unfortunately, even the insured may soon be forced to compete for space at Alameda County's medical facilities. Last week, word broke that the Hunter Group, a downsizing consultant hired to cut services at Alta Bates Summit, was on the verge of issuing its recommendations. According to both physicians and nurses in the system, those recommendations will include the elimination of most medical and cardiovascular surgery at Alta Bates, as the hospital focuses on oncology and obstetrics. Most ominously, Alta Bates Summit plans to give its inpatient psychiatric unit at Herrick three years to increase its revenue. If the unit cannot improve its bottom line, all inpatient psychiatric care will be eliminated. Alta Bates spokesperson Carolyn Kemp declined to talk about the details of the Hunter Group's recommendations, but she made oblique references to the hospital's staggering $40 million in projected losses this year. "It's premature to talk about anything that was put down as a recommendation," Kemp says. "No one likes change, and no one likes to look at health care as a business, but there is a business involved, and anyone with a business background knows that there's no money tree in our backyard."
If Herrick's psych services are eliminated, the county will be swamped with a new host of patients demanding mental health care. Herrick currently has 99 beds set aside for a variety of psychiatric services, and if these beds are gone, patients will have only one option left: the John George Medical Center, which is already struggling to handle the cases dropped off at its door. If John George has to assume expanded psychiatric care duties at the very time that the feds are slashing its Medicaid budget by a third, the result could be disastrous.
"I work in psych emergency," says B.J. Wilson, a registered nurse at John George. "For the last four or five days, we've had twenty or thirty people coming in here every day. All of our beds are full, so they're clustered in a small waiting room, on benches, in chairs, sleeping on the floor. We're talking about 5,150 cases, people coming in off the streets who haven't taken their medicines in weeks, borderline paranoid schizophrenics, bipolar manics, and the substance abusers and dual diagnosed. If Herrick closed its psych services, John George wouldn't be able to handle it. It doesn't have the capacity. We can't even find hospitals to take people with private insurance."
So Alameda County's already fragile public health system is under fire from all sides. But at least health care workers know who's to blame: At the rally on September 6, speaker after speaker decried the Bush administration. In an era whose health care economics are this complex, it must be comforting to have finally found a villain.
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