President Obama has one thing right: Obamacare will end the process
by which insured patients, or those capable of paying from their own
pockets (e.g., the rich Saudi princes who inhabit the best suites in our
hospitals), subsidize patients who show up in the emergency room, are
treated, and then cannot pay their bills. That raises the cost charged
to insured and self-paying patients as hospitals recoup their bad debts
from caring for the poor.
But
let’s talk about what subsidization in health care is really like, or
at least until now has been like. When I was a kid on the Lower East
Side of New York City, the family doctor operated out of his apartment
on the ground floor of what today would be called a brownstone. Some of
his patients paid cash, at varying rates based on the doctor’s
understanding of the financial circumstances of his neighbors. Those who
were really strapped paid either in kind— chicken soup was one of the
coins of choice—or not at all. Those in more comfortable circumstances
paid fees somewhat higher than they otherwise would have been to support
the neighborhood doctor. Call it subsidization.
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