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Rose Ann DeMoro Headshot

Public Health Alert: Stage Red

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Maybe Al Gore should make a movie about the slow death of our nation's public health system. If this was a terror alert, the arrow would be on red.

In the past 30 years, the number of public hospitals in America has fallen by 30%. Public hospitals and clinics could soon be as extinct as the woolly mammoth.

In that same period the combined debt of state and local governments has exploded, climbing by 852% to nearly $200 billion. The devastating consequences become more apparent every day.

New York is considering closing or merging one-quarter of all the hospitals in the state, many of them public. Chicago officials are proposing shutting down half of 26 public clinics.

If you think such devastating losses only affect the poor and the uninsured guess again.

Public hospitals last year had triple the number of ER visits as private hospitals. Many of those were insured accident, cardiac arrest, or stroke victims, or people with other health emergencies. The next time you're in a crash on the freeway don't be too surprised if you can't find a nearby trauma center.

There's no great mystery to this who done it. Our public safety net is not simply fraying, it is being systematically dismantled. We spend more on healthcare than any other country on earth. The problem is that less and less of it ends up helping patients.

While our public facilities are starved for resources, hospital profits the past 20 years totaled $310 billion. The 13 largest drug companies recorded $62 billion in profits in 2004. The 20 largest HMOs made $10.8 billion in 2005.

By almost any barometer the disparity is stark. Compared to public facilities, private hospitals have a much greater profit margin, have three times as much new construction activity, and a 50% lower nurse vacancy rate.

Public wealth is being transferred wholesale from the public sector to private industry, to corporate executives who see pain and suffering as a commodity, a business opportunity to reap enormous financial gain.

As Banc of America Securities healthcare analyst Todd Richter said in 2000 while praising Medicare HMOs for "financing discipline" when dropping patients, "it's real nice providing prescription drug coverage and vision care coverage for grandma. But if you can't make a fair return on it there's no reason to do it. They don't have an obligation to take care of grandma at a loss."

Too often, taking care of grandma is not even an option. The private marketers cherry pick the healthier and wealthier patients for their insurance plans and private hospitals. They leave the sicker and poorer patients to public facilities that actually operate with the belief that providing care, not accumulating profits, is their primary mission.

"We see people from all walks of life. We see the poor and the middle class and people who have lost their health insurance," says Karen Kwiatski, a Chicago public health registered nurse of her county's budget fight. If the hospitals and clinics are closed "where are these people going to go."

Apparently some private hospitals in Los Angeles have an answer - dumping patients onto skid row, at least 55 known cases so far.

Meanwhile, the public hospitals and clinics, long the last light of hope for millions of Americans, bleed from a thousand cuts, and even the ones that remain open are bursting at the seems. President Bush is even encouraging states to shift funds from safety net hospitals to pools to buy more insurance for those without coverage. California's Gov. Arnold Schwarzenegger has made a similar proposal, a move that "would kill us," says John Schneider, an emergency room RN at a public hospital near San Francisco.

Still, the present national healthcare debate does present an opportunity -- perhaps the last one - to save our safety net. One reform, but only one, a single-payer type system, as in HR 676 now in Congress that provides public oversight and administration and equal funding for public and private hospitals with one standard of care for all, would keep the lights from going out for good.

Rose Ann DeMoro is executive director of the National Nurses Organizing Committee/ California Nurses Association

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