Mandates jamming big-city hospitals beyond capacity
by John Seiler | September 2, 2023
IN FEBRUARY 2010 SHARP PAINS STRUCK MY GUT around 8 a.m. I drove from my apartment in Huntington Beach to Newport Beach and Hoag Hospital, one of the country’s best, parked and struggled into the emergency room. The triage medic quickly whisked me behind the doors to the area with the beds. A nurse poked me for a blood sample.
About an hour later they told me I had diverticulitis. They wheeled me on the bed up to a room and started two antibiotics, ciprofloxacin and metronidazole, for four days. The meds made me feel as terrible as the words look. Then they sent me home with oral antibiotics for another 10 days. I got better.
In February this year, 13 years later, in my Costa Mesa apartment I accidentally took extra blood pressure medication. I looked online. It said to go to the ER. I drove to Hoag. At 8 a.m. it was packed with patients, maybe 20% homeless. I checked in with the triage medic. He told me to wait. About 45 minutes.
A nice doctor came out of the door from the area with the beds, trailed by a nurse pushing a platform with a laptop computer and a sphygmomanometer. I told them what happened. As I sat in a waiting-room chair, the nurse took my blood pressure, which was low. The doc said it wasn’t too bad and they would check back in an hour. He apologized for the overcrowding and the lack of a bed behind a curtain.
No privacy. It was right out there for everybody else to see what was going on and hear about my stupidity. An hour later the procedure was repeated, my blood pressure now was normal, and I was sent home. The doc also told me they soon were building an emergency-room addition.
MY ANECDOTAL EXPERIENCE IS CONFIRMED by a new study in the Journal of the American Medical Association, “Patterns in Patient Encounters and Emergency Department Capacity in California, 2011-2021.” That time stretches roughly across my two traumas. The study looked at 400 general acute care hospitals in the state in that period and found:
- The number of Emergency Departments (EDs) decreased 3.8%.
- The number of hospital beds decreased 2.5%.
- The number of treatment stations increased 21.1% — “but these stations were concentrated in a smaller number of EDs.”
- ED visits increased 23.4% (from 2011-19).
- Visits rated “severe with threat” increased 67.8% (2011-21).
Using the year 2019 in some of their data is important because that was the pre-COVID year. During COVID, ER visits actually declined.
The study’s conclusion: “ED capacity has not proportionally expanded with the increasing California population and demand for emergency services, offering one potential explanation for increases in ED crowding … . The findings of this cohort study largely suggest that changes in ED capacity have not kept pace with population growth or actual ED use.”
It noted California’s population increased 4.2% from 2011-21, but has been decreasing recently. For my situation, Orange County’s population increased from 3.05 million in 2011 to 3.17 million in 2021. That was an insignificant rise of 0.4%.
What’s going on?
Basically, ERs increasingly are being used for free, basic care for the homeless and recent immigrants. A lot of people in California are on Medi-Cal (the state’s cutesy name for Medicaid), but can’t pay the high deductibles or get a doctor. So they get “free” care from ERs, Sally Pipes told me. She the president, CEO and Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute, Free Cities’ parent organization.
She pointed to Assembly Bill 133 from July 27, 2011, which Gavin Newsom signed into law. As his office enthused at the time, it “expands full-scope Medi-Cal to approximately 235,000 low-income undocumented Californians age 50 and older.” That was the beginning of the fiscal years in which the state ran up a nearly $100 billion budget surplus instead of this year’s $31.5 billion deficit.
It’s just going to get worse. “That will be an attraction for illegals and homeless people in other states to come to California because they think they’re going to get free and excellent medical coverage,” she said. And she pointed to two bills that would give the state single-payer socialized medicine.
Assembly Bill 6090 is by Assemblymember Ash Kalra, D-San Jose. Its wording reads, “It is the intent of the Legislature to guarantee accessible, affordable, equitable and high-quality health care for all Californians through a comprehensive universal single-payer healthcare program that benefits every resident of the state.” It’s a suspense bill now, but could come back next year.
Senate Bill 770 is by Sen. Scott Wiener, D-San Francisco. It would, in the bill’s language, “direct the Secretary of the California Health and Human Services Agency to pursue waiver discussions with the federal government with the objective of a unified health care financing system,” meaning single-payer. It passed the Senate 30-9 and the Assembly Health Committee 10-4, but currently also is a suspense bill.
The problem, Pipes pointed out, is the lack of money. A 2017 study by the nonpartisan Legislative Analyst pegged the cost of single payer at $400 billion.
It’s also obvious to me Newsom doesn’t want this problem percolating during his potential presidential run in 2024. The flip from massive surplus to massive deficit looks bad enough already. But it wouldn’t surprise me if a Democratic candidate in 2026 ran on single payer.
If a single-payer socialized scheme were imposed, it would bring other problems. Pipes pointed to Canada, where the average wait to see a specialist under its government-run system is 27 weeks. “There’s a doctor shortage as a result,” she said. “In the United Kingdom there are 7.6 million people on National Health Service waiting lists now, so more and more people in the UK are going private because private healthcare is allowed.”
At the federal level, Sen. Bernie Sanders, I-Vt., keeps pushing his national single-payer scheme. But with Republicans in charge of the House of Representatives, that’s impossible. Even if Democrats again control both houses of Congress and the White House at the same time, there are enough Democrats from more conservative, “purple” districts who would object.
As to California reforming its current system which clogs the ERs, Pipes said that would take Republicans getting back into power. But they control less than one-third of the seats in both houses of the Legislature. And statewide candidates are lucky to get 40% of the vote.
From an urban-policy standpoint, this situation puts intense pressure particularly on big-city hospitals, and makes it even less appealing for people to live in bigger cities.
It looks like there’s no remedy. At 68, I know there will be future trips to the ER, I hope not one way. I put up a calendar next to my medications and mark off each day so I don’t accidentally double up again. I don’t want to go back before I have to.