Here's the conundrum: Health care for the indigent drives up the cost of health care for everyone, because health care providers have to make up the loss.
Why? Because we are a compassionate people, and by law hospitals cannot refuse treatment to someone because of their inability to pay. There is just something about people dying in the street that we find abhorrent in places like Mumbai, but even more so in Warren, Pennsylvania.
And yet, to alleviate health care providers (mostly hospitals) of the expense, we find ourselves dipping into the public till to fund health care for the indigent. It is called Medicare for the elderly, Medicaid for the unemployed poor and the working poor.
There is no question that the health care system in America, generally, is pretty haphazardly financed through a confusing combination of private payers, health insurance companies, the aforementioned government programs, and even other state-based programs like AdultBasic and CHIPs in Pennsylvania.
As part of the Affordable Care Act - Obamacare, if you will - states have been asked to expand their Medicaid systems to cover a gap that is made up largely of the working poor. They currently earn just enough to disqualify for Medicaid, but can't afford health insurance. They have been asked rather than ordered, because, originally, the coverage was included in the federal government's act, but the Supreme Court ruled the decision must be left up to the states.
Now, Gov. Tom Corbett and the state General Assembly have a conundrum. How do they balance the support of a state association of hospital directors, the AARP, religious leaders and advocates for the poor who urge the state to go along with the expansion, with their own fears that the federal government won't hold to its promise of paying the lion's share of the bill. And, there is that matter of federal money still being taxpayer money.
Corbett has also hinted that he may favor some sort of program where the state would take the money and provide it to qualifying individuals and families to purchase private insurance. But, even that has potholes. The Congressional Budget Office issued a report last summer saying the private plans cost more, almost half again as much, as traditional Medicaid coverage.
And, the private insurer gambit does nothing to ameliorate the complaint that it's all tax dollars being spent.
The conundrums come in layers.
The bottom line, however, is that providing care for indigent patients comes with a cost, whether it's born by taxpayers through government programs, or born by taxpayers who pay higher insurance premiums because the cost of providing indigent care is spread throughout the system.