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The [Friday] Papers

"Cook County government's public health system, known as Cook County Health, treats the most vulnerable people - patients who are already really sick with conditions like heart disease, high blood pressure or diabetes by the time they show up to see a doctor. It's historically been a destination for the uninsured and, increasingly, for people who can't afford the insurance they have," WBEZ reports.

"Budget woes and staffing issues have plagued the health system before. But the rising demands of providing so-called uncompensated care - treatment Cook County Health provides that it does not get paid for - are wreaking havoc on the county government's finances. Those financial pressures not only threaten taxpayers' wallets, but also the quality of care at the health system."

Don't worry, though. Joe Biden has a plan for our health care system. Right?

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I just think it's fascinating to read article after article about health care that is totally disconnected to the policy debates in the presidential campaign - it's almost as if that discussion doesn't exist at all!

The issues discussed in this article don't happen in a vacuum.

But too often, political reporters are laser-focused on the strategy of health care proposals and can only frame such discussions around the immediate, front-end costs - endlessly asking how expensive, say, Medicare for All would be without doing their own homework - while beat reporters hesitate to enter into the political arena. (Similarly, for example, some education reporters were admittedly reluctant to consider the political aspects of the recent Chicago teachers' strike, somehow feeling inadequately able to do so or misguidedly self-tasked to stick within their silo. See also, from Dan Froomkin: Get Political Reporters Off The Coronavirus Story.)

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Anyway:

"Cook County Health has cut at least 750 vacant jobs, causing a staffing crunch that trickles down to patients. In the ER, there are sometimes not enough stretchers . . . Almost half of Stroger's ER nurses are on leave at any given time.

"Just four years from now, Cook County officials expect to grapple with a $308 million budget deficit - about two-thirds of that driven by the health system."

It would be worth asking right here what a health system without these kind of ongoing problems (this is not a unique moment) would look like - and indeed, if such a system exists anywhere in the world that would squeeze out costs while providing care both universal and of higher quality. Perhaps, say, Scandinavia, Europe or Canada.

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Now we get to the crux of the immediate issue facing Cook County:

"[T]he uncompensated care problem has only worsened: Cook County Health expects to provide about $590 million of it this year - an 88% jump in the last six years. Charity care, or medical care that doctors typically provide to people who don't have insurance, is the biggest chunk of that tab, followed by uncollected bills.

"Meanwhile, the county's other nonprofit hospitals have been providing less charity care while enjoying massive property tax breaks. A new WBEZ analysis shows medical centers and their affiliates are getting at least an estimated $390 million in tax relief each year, but it's likely that untold millions more are being diverted from public coffers. Government records are incomplete, and hospitals calculate their own tax breaks."

If only the profit motive was detached from life-saving.

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"The president and CEO of the Illinois Health and Hospital Association, a powerful industry lobbying group, says hospitals earn those tax breaks. They conduct costly medical research and treat patients who otherwise would go to the county.

"But county leaders are still looking for ways to pressure other hospitals to kick in more charity care - potentially by legal force."

Look at this chart:

Screen Shot 2020-03-13 at 5.36.26 AM.png(ENLARGE)

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"In Illinois, there was a push more than a decade ago for nonprofit hospitals to treat more uninsured people in exchange for property tax exemptions. But even after a court battle, there was no clear definition of how much charity care hospitals actually needed to provide."

If only we had a system that didn't have to financially incentivize treating uninsured people. Maybe even one in which no one was uninsured!

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"In 2012, Illinois legislators, the IHA lobbying group and others brokered a deal: Nonprofit hospitals would need to pick from a broad menu of 'community benefits' that are worth at least as much as what their estimated property tax bills would be."

Rationing. For "the community," at least.

"The menu included things many already did: conducting medical research, treating Medicaid enrollees - or providing charity care.

"And there was this: Hospitals would assess the value of their own properties, instead of having local government assessors watchdog the process."

I wonder how that got into the deal.

"The new requirements were tucked into another must-pass bill."

Of course. But I don't like the passive construction of that sentence. Who tucked that provision into another must-pass bill? And what bill sponsor - or their legislative leader - allowed it to be tucked in? Any guesses?

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"The day then-Gov. Pat Quinn signed it, he wrote a letter to state lawmakers: 'It is my hope that together, [these measures] result in more charity care being provided to the uninsured in our state.'

"The opposite happened. Since 2012, Cook County Health has provided more charity care in the region while other hospitals provided less, according to a WBEZ analysis of state data.

"In 2018, the county's two hospitals provided about 55% of all the charity care in the county. The tab totaled about $348 million - 15 times more than the next-highest provider, Northwestern Memorial Hospital, the richest medical center in the county at the time."

This isn't about me telling you to vote for Bernie Sanders, but it is about me wondering again how Sanders gets framed as the crazy one and Biden as "pragmatic" when only one of them is upset at facts like these and thinks it should be fixed.

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"It's not entirely clear what's funneling so many charity care patients to Cook County Health, but there are several factors besides the 2012 law.

"After the Affordable Care Act passed in 2010, more people qualified for Medicaid, so some hospitals now treat more low-income people with insurance than those without. But small hospitals that predominantly treat Medicaid patients can't afford to take on more uninsured ones, so they might send them to the county."

Thanks, Obama-Biden.

"Even if people do have insurance, many can't afford their high deductibles. And the state is chipping away at a backlog of Medicaid applications for current and new enrollees. Those people are still seeking care - they just might not be insured at the time."

You're appalled at the lack of COVID-19 tests? Millions of people can't even see a doctor, much less get a test. Welcome to their world.

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INTERLUDE:

"Vice President Joseph R. Biden Jr. announced an agreement Wednesday in which three associations representing the hospital industry agreed to Medicare and Medicaid cuts totaling $155 billion over ten years as part of a health overhaul that assumes coverage of 95 percent of the American people," CQ HealthBeat reported in 2009.

"Folks, reform is coming," Biden declared. "We have never been as close as we are today."

"Biden said the agreement calls for payments to be shaved as more patients treated by hospitals obtain coverage.

"Neither Biden nor hospital executives answered questions at a White House event to announce the agreement between the groups, which are the Federation of American Hospitals, the Catholic Health Association and the American Hospital Association.

"But Federation President Chip Kahn said when reached later that two-thirds of the cuts would come from adjustments to yearly payment updates and the remaining one third from other reductions, including lowering payments made to compensate hospitals for treating uninsured patients. Cuts in these 'disproportionate share hospital' (DSH) payments would be tied to whether milestones are met for increased coverage. Kahn said a 'small part' of the changes in yearly payment updates would hinge on coverage gains but for the most part would kick in regardless."

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Back to WBEZ:

"In tony Streeterville, Northwestern Memorial and an affiliated doctors group received around $113 million in estimated tax breaks in 2018 and provided benefits to their communities worth nearly three times more.

"In a statement, spokesman Christopher King said Northwestern Memorial provides more charity care than any other private hospital in Illinois, but declined to comment further.

"Meanwhile, Norwegian American Hospital on the West Side received the smallest estimated tax break, totaling just over $229,000 in 2018. The hospital provided far more in community benefits - $28.5 million."

Christopher King, you are Today's Worst Person In Chicago.

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There's a lot more, so go read the rest.

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New on the Beachwood today . . .

The Beachwood Radio Sports Hour #295: The Day The Sports Died
Cancel culture. Plus: March Sadness; Summer Training; NBA & NHL Lose Their Christmas; Do Draft Day Digitally; Baffling Bears; Blackhawks Go Out On A High Note; Bulls Go Out On A High Note; Michael Kopech A Little Geeked; Deja Cub; Illinois Hoops Nation; Fire Singe Revolution; Can Gambling Juice Fandom For Women's Sports?; and The Ex-Cub Factor.

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Today's Coronavirus Novel

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ChicagoReddit

Are you free this weekend? We should set up a group who goes grocery shopping for the elderly so they stay indoors. from r/chicago
[Offer] Helping out the most vulnerable in Chicago until COVID-19 gets under control. from r/chicago

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ChicagoGram

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ChicagoTube

Bob Weir and Wolf Bros at the Chicago Theatre on Wednesday night.

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BeachBook

AT&T Waives Data Cap During Coronavirus; Comcast Keeps Charging Overage Fees.

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TweetWood
A sampling of the delight and disgust you can find @BeachwoodReport.

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The Beachwood Tip Line: Hammer a nail.



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Posted on March 13, 2020


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