Monday, January 30, 2012

Physicians say OBAMACARE is wrong for America


Salley Pipes

From FORBES 12/11

Doctors Say Obamacare Is No Remedy for U.S. Health Woes


America’s doctors have conducted a full examination of the president’s health reform law — and their diagnosis of its effects on our healthcare system isn’t good.

Nearly two-thirds of doctors expect the quality of care in this country to decline, according to a new survey from consulting giant Deloitte. Just 27 percent think that the law will lower costs. And nearly seven of every 10 doctors believe that medicine is no longer attractive to America’s “best and brightest.”

Few people know more about our healthcare system than doctors working on the frontlines. Policymakers should pay heed to their indictment of Obamacare and revisit the disastrous law.

President Obama promised that his reform package would begin to stymie the out-of-control growth in the cost of American health care. He pledged $2,500 in health insurance savings for the typical American family.

But doctors don’t buy it. Only one quarter feel that Obamacare will reduce health insurance costs for consumers. Nine out of ten posit that insurers will raise premiums for employers and individuals.

They have good reason to doubt Obamacare’s cost-cutting potential. Healthcare spending is expected to reach $2.7 trillion this year — or about $1 of every $6 spent in our economy. By 2020, health spending will account for a full fifth of America’s GDP.

That increase is in large part thanks to Obamacare. Instead of relieving high insurance premiums, the nonpartisan Congressional Budget Office estimates that American families in the non-group market will see their premiums rise $2,100.

They’re already trending higher. According to the Kaiser Family Foundation, average family premiums in 2011 topped $15,000 — a 9 percent increase from 2010. Prior to Obamacare’s passage — from 2009 to 2010 — premiums went up just 3 percent.

In April 2010, Richard Foster, the Chief Actuary of the Centers for Medicare and Medicaid Services (CMS), concluded that American spending on health care through 2019 would be $311 billion higher than if the law had never passed.

Even with all that additional money flowing through the system, doctors don’t think that the quality of care will improve. Half of all doctors believe that access to care will diminish because of hospital closures prompted by health reform.

Further, nearly 70 percent of doctors believe that long wait times will plague emergency rooms. A full 83 percent of physicians foresee increased wait times for primary care appointments.

That’s in large part because Obamacare is expected to extend government-subsidized insurance coverage to many folks — even as the supply of providers remains relatively constant.

The United States already faces a shortage of primary-care doctors. Medical schools today produce one such physician for every two our country needs. By 2019, the American Academy of Family Physicians warns that the United States will be short 40,000 doctors.

Expanding insurance coverage to millions more Americans won’t do much good if they can’t get doctor’s appointments. Physicians believe that their ability to provide quality care will be further strained by the law’s attempt to change the way they’re paid — from a fee-for-service basis to a vaguely defined system of paying doctors based on patient health and outcomes.

Nine out of ten physicians fear they will receive inadequate payments and endure higher administrative costs. Fewer than a quarter of doctors expect their paperwork requirements to ease up. Time spent wading though paperwork is also time no longer available for actually practicing medicine.

American doctors’ negative view of Obamacare is telling. Proponents of the law may claim that their griping is misplaced, but as Paul Keckley, Ph.D., the lead author of the report explains, “Understanding the view of the physician is fundamental to any attempt to change the health care model.”

In other words, if physicians aren’t on board with Obamacare, it won’t work. A law that hinders the practice of medicine, obstructs access to care, and costs Americans more is clearly not the right remedy for what ails us.

Sally C. Pipes is President, CEO, and Taube Fellow in HealthCare Studies at the Pacific Research Institute. Her next book — The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery) — will be released in January 2012.

Sunday, January 29, 2012

Physicians want to Supreme Court to kill Obama Care! They say this will give a huge boost to the economy!


Supreme Court Might Kill ObamaCare Before Election -- If Obama's Lucky

Larry Elder for Townhall.com

Why did the Obama administration, after dragging out the various court challenges to ObamaCare, suddenly step on the gas?

The administration surprised court watchers by passing up a chance to slow down ObamaCare's long march to an eventual Supreme Court ruling. In failing to request a hearing by all the appeals court judges of the 11th Circuit -- to overturn an anti-ObamaCare decision by three of its members -- the administration now puts the matter on a faster track to the Supreme Court.

The court will likely agree to hear the case because two appellate circuit courts, the 11th and 6th, have issued contradictory rulings -- one striking down the individual mandate as unconstitutional, and the other upholding it. This confusion practically guarantees a hearing by the top court, probably months before next year's election.

What provoked the administration's change of heart?

Obama supposedly did not want a Supreme Court decision so soon because, pro or con, the ruling figures to play large as a re-election issue. On the other hand, ObamaCare already is an issue, with the President's opponent undoubtedly planning to hammer him with it.

But if the court strikes down ObamaCare -- especially with a 5-4 split -- Obama can argue that with his re-election, the next opening gets filled with another Sotomayor/Kagan-like liberal who would have supported ObamaCare. If the vacancy comes from the conservative side, Obama can fulfill a liberal dream of switching the court's majority from center-right -- four conservatives and the Anthony Kennedy "swing" vote -- to a left-wing majority.

Obama's new faster-track tactic might also turn on this: Obama expects the Supreme Court to side with him. If the President wins in court, his Republican opponent will still argue against the merits of ObamaCare. But he or she could no longer flatly call it "unconstitutional," since the court would have just ruled otherwise.

So how would a Supreme Court defeat make Obama lucky in his bid for a second term?

ObamaCare remains unpopular, with a plurality of Americans wanting it repealed. Unlike major historic safety-net legislation like Social Security, Medicare and Medicaid, ObamaCare received no opposition party Senate votes -- none. A majority of state attorneys general either filed or joined lawsuits to overturn the mandate that requires practically all Americans to purchase health insurance.

Romneycare, used as a model for ObamaCare, at best fails to live up to its promises. True, most residents of Massachusetts support Romneycare, and Gov. Mitt Romney's successor praises it. An AP "fact-check" on Romneycare, relying on an MIT economist who helped design Romneycare, pretty much pronounced it a success. But the free-market think tank National Center for Policy Analysis sees the Massachusetts health plan differently. Among its findings:

"There has been no apparent change in self-reported unmet needs. Remarkably, one-third of adults within 300 percent of the federal poverty level report that they were unable to meet a health care need within the past 12 months for 'any reason.' ...

"But (there has been) a statistically significant increase in ER traffic among those within 300 percent of the federal poverty level! This is consistent with a survey of 11 Massachusetts-area hospitals that found ER use rose 4 percent. ...

"New patients must wait from a month to six weeks to see a family doctor or an internist. Make that two months in Boston for a family practitioner. ... About half of all family doctors and internists won't see new patients or accept the insurance provided in the Commonwealth Connector (Massachusetts state authority's broker for private insurance). This was up sharply from 2006."

The Economist, a British center-left magazine, calls Romneycare "a legacy (Romney) can be proud of." But, the Economist points out: "He contrasts (Romneycare) with ObamaCare by claiming that (Romneycare) introduced no new taxes. This is pretty clearly a fib. The law wasn't implemented until after he was gone, and the fact that he didn't raise taxes to pay for it simply meant he refused to deal with the funding issue. His successor ... had to hike business fees by $100 million and to raise the cigarette tax by $1 a pack in 2008 to pay for the program's subsidies. In any case, Commonwealth Care is funded partly through matching funds from the federal Medicaid funding ... ." A legacy to be proud of?

Two-thirds of doctors, according to Investors Business Daily polls, "oppose" ObamaCare and predict lower-quality health care. A poll by the consulting firm McKinsey & Co. finds that nearly one-third of businesses plan to drop heath insurance for their employees after 2014, when much of ObamaCare goes into effect.

True, the American Medical Association supports ObamaCare. But only 17 percent of doctors belong to the organization, and many dropped their membership because of AMA's support of ObamaCare. Americans consistently rank physicians among the most respected of professionals. Yet the President, a man with virtually no private-sector experience, arrogantly ignores doctors' objections.

Obama, as with his fight to end Bush-era tax rates for the "rich," will also lose this battle -- if he is lucky. A Supreme Court rejection of the ObamaCare mandate would immediately boost the economy and, by extension, Obama's prospect for re-election.

How ironic.

Monday, January 23, 2012

New Medical schools open! (But we still need many many more)!



Published: February 14, 2010

Peter Allen applied to 30 medical schools after graduating from the University of Pittsburgh last year. Twenty-eight said no.

Of the two that said yes, one had something in common with Mr. Allen: It, too, was starting out in medicine. He enrolled in the inaugural class of The Commonwealth Medical College in Scranton, Pa.

“I was ecstatic that I had been accepted to a medical school,” Mr. Allen said, adding that he would have gone for a master’s in bioengineering if he had not been accepted. “It’s a giant sigh of relief; it secures your plans for the rest of your life really.”

The Commonwealth is one of nearly two dozen medical schools that have recently opened or might open across the country, the most at any time since the 1960s and ’70s.

These new schools are seeking to address an imbalance in American medicine that has been growing for a quarter century. Many bright students were fleeing to offshore medical schools, or giving up hope entirely, when they could not get into domestic schools. Meanwhile, American hospitals were using foreign-trained and foreign-born physicians to fill medical residencies. During the 1980s and ’90s only one new medical school was established.

“Huge numbers of qualified American kids were not getting into American medical schools or going abroad to study,” Dr. Lawrence G. Smith, dean of the proposed Hostra University School of Medicine, in Hempstead, N.Y., which is not yet recruiting students, said last week. “I think it was a kind of wake-up call.”

The proliferation of new schools is also a market response to a rare convergence of forces: a growing population; the aging of the health-conscious baby-boom generation; the impending retirement of, by some counts, as many as a third of current doctors; and the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system.

If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country. (By comparison, there are 200 law schools approved by the American Bar Association.) And beyond the new schools, many existing schools are expanding enrollment, sometimes through branch campuses. While The Commonwealth is an independent school, many of the other new or proposed schools are affiliated with established universities, like Hofstra, which is teaming up with North Shore Long Island Jewish Medical Center; Quinnipiac University in Hamden, Conn.; the University of California, Riverside; Central Michigan University; and Rowan University in Camden, N.J.

Supporters of the expansion say that having more doctors will improve care, by getting doctors to urban and rural areas where they are needed, by shifting care to primary and family practice physicians rather than expensive specialists, and by reducing long waits for people to see a doctor and get the care they need.

But skeptics say that although many parts of the country do need more primary care, American doctors tend to congregate in affluent, urban and suburban areas that already have a generous supply.

They say that doctors create demand for their own services, and that nurse practitioners and physician assistants could fill gaps in medical care at a lower cost.

“When you add more physicians to an area, they just add more services, and their salaries don’t go down anywhere near in proportion to the increased supply,” said Dr. David Goodman, professor of pediatrics at the Dartmouth Institute for Health Policy Practice , and a practicing physician who has studied work force issues for 20 years. “More care may not be better, but it certainly is paid for,” Dr. Goodman said.

Many of the developing medical schools are well aware of such arguments, and are billing themselves as different from traditional medical schools, more focused on serving primary care needs in immigrant and disadvantaged communities. Administrators say that they expect that approach to be buttressed by a shift in state and federal reimbursements from specialists to primary care doctors.

Riverside County, an inland area with a diverse population including immigrants and Native Americans that has expanded rapidly, has a deficit of about 3,000 physicians, according to Dr. G. Richard Olds, founding dean of the University of California, Riverside School of Medicine.

Riverside has applied for licensing, the first step toward becoming a medical school, and hopes to admit its first four-year class in 2012, and to have 400 students by 2016, a typical size for the new crop of schools. Dr. Olds said his educational focus, building on his background as a tropical disease specialist, would be on prevention and “wellness.”

“I think we have to crank out different kinds of doctors,” said Dr. Olds, who started his new job Feb. 1.

Whether the demand for new medical schools exists among patients, it clearly exists among prospective doctors.

Dr. Olds said that at his former job as chairman of medicine at the Medical College of Wisconsin, 25 percent of the students came from California. “So obviously there’s a ton of California kids trying to get into medical school traveling a long way.”

The Association of American Medical Colleges, a trade group, has called for a 30 percent increase in enrollment, or about 5,000 more doctors a year. The association’s Center for Workforce Studies estimates that 3,500 more M.D.s will enter graduate training over the next 10 years, roughly half of the 7,000 international medical school graduates now entering medical residencies in the United States every year, according to Edward Salsberg, director of the center.

At Quinnipiac, the trustees last month approved plans for a new medical school, to open in 2013 or 2014, if it passes accreditation. John L. Lahey, the university president, said that the proposed school would build on the university’s existing health sciences programs, and the hope was to recruit at least some students who had worked in health care and wanted to become doctors.

“We certainly think they will be what we tend to call nontraditional students, older, some minority,” Dr. Lahey said.

Six developing medical schools, including The Commonwealth, have received preliminary accreditation, enabling them to begin recruiting students, and six more, including Riverside, have begun the application process, according to the Liaison Committee on Medical Education, which accredits American medical schools. An additional 11, including Quinnipiac, have announced their intention to apply for licensing, according to Mr. Salsberg.

Whatever the expansion may mean for the cost of health care, it is a relief to aspiring doctors like Mr. Allen, who took tough undergraduate courses and had a busy extracurricular life of mock trials, robotics and work as an emergency medical technician. His pre-med adviser told him that with his 3.3 grade-point average, he should apply only to osteopathic schools, but he persisted, and was admitted to The Commonwealth and New York Medical College in Valhalla, N.Y.

He was one of 1,300 applicants for 60 positions (eventually class size will double) in the inaugural class at The Commonwealth, according to Dr. Robert M. D’Alessandri, the president and dean. Mr. Allen has a United States Navy scholarship, but for his classmates, the school took $20,000 a year off the tuition, a reduction of about half, as an incentive to take the risk of a new school.

Given the pent-up demand, Dr. D’Alessandri said, he was not worried that he might produce too many doctors for the good of society. “We should worry about too many lawyers,” he said dryly.

Friday, January 13, 2012

Obamacare or The New Healthcare Laws (whatever you call it) will cut Physician Compensation!


Slashing doc pay


By SCOTT GOTTLIEB

Last Updated: 12:18 AM, October 25, 2011



A key government panel voted this month to whack what Medicare pays most doctors to treat patients. It’s an important step on the path to ObamaCare -- because the only way to make European-style health entitlements work in America is to pay US doctors lower European wages.



This is going to hurt doctors -- and hit patients even harder, as American physicians scale down their medical practices to adapt to the lower pay rates. The vote by the Medicare Payment Advisory Commission involves slashing what the program for older Americans pays medical specialists -- then freezing these lower rates for years.



Everyone except primary-care docs would see payments for their services cut by 5.9 percent a year for three years (totalling a 16.7 percent cut in income), followed by a seven-year freeze at the reduced levels. Primary-care providers would have their reimbursement rates frozen at today’s pay levels for the whole decade. All this is part of a larger effort to save Medicare upward of $300 billion over 10 years.

This is no hollow threat: ObamaCare set up an agency called the Independent Payment Advisory Committee to fast-track these kinds of proposals into law by sidestepping Congress.



We doctors have mostly ourselves to blame for this mess. Hoping to preserve some organized power for MDs, groups like the American Medical Association made two Faustian bargains with Washington on behalf of physician members.

The first evolved in the late 1990s. In a deal to cut the deficit, the Clinton administration joined with a Republican Congress to cap total payments to doctors and implemented a system of price controls for their services. The AMA signed on to the scheme in part because Washington agreed to leave it to an AMA-run process to decide how the shrinking pie of money Washington spent would be carved up between different medical specialties.



The second Faustian deal was ObamaCare. Doctors’ Washington lobbyists overlooked the fact that ObamaCare would inevitably pay something close to (far below market) Medicaid rates for medical services. Nor did they fathom how much would need to be cut from physicians to pay for the plan’s costly mandates.

American doctors do earn much more than their European counterparts -- if US salaries aren’t adjusted for the different wealth of nations. Some of the best data on these pay differences appear in the September issue of the journal Health Affairs, in a study done by one of the administration’s assistant health secretaries before she took her government job.



Annual pre-tax income (net of practice expenses) for primary-care doctors was $95,000 in France in 2008, compared to $186,000 in the United States. For specialists, the disparities were wider -- with orthopedic surgeons averaging $154,000 in France and $208,000 in Canada compared to $442,000 in America.



The differences reflect lower rates for individual services. In France, for one, private insurance pays doctors about a third of what US physicians earn for office visits -- $34 in France vs. $133 in America for a primary-care doctor. Even public programs like Medicare pay twice what similar French programs offer.



In a view echoed around the Obama administration, the analysis concludes that these bigger salaries “were the main drivers of higher US spending” on health care.

To bring European healthcare to America, these price differences always had to be sanded away. The only way ObamaCare is going to bring our health benefits and spending to European levels is to also adapt European payment rates.



As a result, US doctors will adjust their business models in ways that won’t be good for patients. Some with busy practices in big cities will opt out of the government insurance systems entirely, and go cash-only. Others will retire early. But most doctors won’t have these opportunities available to them. So they’ll need to make up in volume what they lose in margin for their individual medical services. This will mostly mean hiring more nonphysician providers such as nurse practitioners to see most patients. Doctors will become managers of large clinical staffs, leaving more direct care to less-expensive providers.



Patients will lose access to physicians -- and spend more time waiting in busier offices.

As for doctors, there’s still some good news. With baby boomers aging, physicians will have plenty of business coming through their office doors. Of course, under ObamaCare, they aren’t going to get paid much for seeing most of these patients.



Scott Gottlieb, a physician and American Enterprise Institute resident fellow, was a senior official at the Centers from Medicare and Medicaid Services.

Friday, January 6, 2012

Doctors are Going Broke! Costs are up...reimbursements are down!


By Parija Kavilanz for CnnMoney

NEW YORK (CNNMoney) -- Doctors in America are harboring an embarrassing secret: Many of them are going broke.

This quiet reality, which is spreading nationwide, is claiming a wide range of casualties, including family physicians, cardiologists and oncologists.

Industry watchers say the trend is worrisome. Half of all doctors in the nation operate a private practice. So if a cash crunch forces the death of an independent practice, it robs a community of a vital health care resource.

"A lot of independent practices are starting to see serious financial issues," said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors' lack of business acumen is also to blame.

Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. "And we still barely made payroll last paycheck," he said. "Many of us are also skimping on our own pay."

Pentz said recent steep 35% to 40% cuts in Medicare reimbursements for key cardiovascular services, such as stress tests and echocardiograms, have taken a substantial toll on revenue. "Our total revenue was down about 9% last year compared to 2010," he said.

"These cuts have destabilized private cardiology practices," he said. "A third of our patients are on Medicare. So these Medicare cuts are by far the biggest factor. Private insurers follow Medicare rates. So those reimbursements are going down as well."

Pentz is thinking about an out. "If this continues, I might seriously consider leaving medicine," he said. "I can't keep working this way."

Also on his mind, the impending 27.4% Medicare pay cut for doctors. "If that goes through, it will put us under," he said.

Federal law requires that Medicare reimbursement rates be adjusted annually based on a formula tied to the health of the economy. That law says rates should be cut every year to keep Medicare financially sound.

Although Congress has blocked those cuts from happening 13 times over the past decade, most recently on Dec. 23 with a two-month temporary "patch," this dilemma continues to haunt doctors every year.

Beau Donegan, senior executive with a hospital cancer center in Newport Beach, Calif., is well aware of physicians' financial woes.

"Many are too proud to admit that they are on the verge of bankruptcy," she said. "These physicians see no way out of the downward spiral of reimbursement, escalating costs of treating patients and insurance companies deciding when and how much they will pay them."

Donegan knows an oncologist "with a stellar reputation in the community" who hasn't taken a salary from his private practice in over a year. He owes drug companies $1.6 million, which he wasn't reimbursed for.

Dr. Neil Barth is that oncologist. He has been in the top 10% of oncologists in his region, according to U.S. News Top Doctors' ranking. Still, he is contemplating personal bankruptcy.

That move could shutter his 31-year-old clinical practice and force 6,000 cancer patients to look for a new doctor.

Changes in drug reimbursements have hurt him badly. Until the mid-2000's, drugs sales were big profit generators for oncologists.

In oncology, doctors were allowed to profit from drug sales. So doctors would buy expensive cancer drugs at bulk prices from drugmakers and then sell them at much higher prices to their patients.

"I grew up in that system. I was spending $1.5 million a month on buying treatment drugs," he said. In 2005, Medicare revised the reimbursement guidelines for cancer drugs, which effectively made reimbursements for many expensive cancer drugs fall to less than the actual cost of the drugs.

0:00 / 3:02 Hospital battles infections with robots

"Our reimbursements plummeted," Barth said.

Still, Barth continued to push ahead with innovative research, treating patients with cutting-edge expensive therapies, accepting patients who were underinsured only to realize later that insurers would not pay him back for much of his care.

"I was $3.2 million in debt by mid 2010," said Barth. "It was a sickening feeling. I could no longer care for patients with catastrophic illnesses without scrutinizing every penny first."

He's since halved his debt and taken on a second job as a consultant to hospitals. But he's still struggling and considering closing his practice in the next six months.

"The economics of providing health care in this country need to change. It's too expensive for doctors," he said. "I love medicine. I will find a way to refinance my debt and not lose my home or my practice."

If he does declare bankruptcy, he loses all of it and has to find a way to start over at 60. Until then, he's turning away new patients whose care he can no longer subsidize.

"I recently got a call from a divorced woman with two kids who is unemployed, house in foreclosure with advanced breast cancer," he said. "The moment has come to this that you now say, 'sorry, we don't have the capacity to care for you.' "

Small business 101: A private practice is like a small business. "The only thing different is that a third party, and not the customer, is paying for the service," said Lion.

"Many times I shake my head," he said. "Doctors are trained in medicine but not how to run a business." His biggest challenge is getting doctors to realize where and how their profits are leaking.

"On average, there's a 10% to 15% profit leak in a private practice," he said. Much of that is tied to money owed to the practice by patients or insurers. "This is also why they are seeing a cash crunch."

Dr. Mike Gorman, a family physician in Loganvale, Nev., recently took out an SBA loan to keep his practice running and pay his five employees.

"It is embarrassing," he said. "Doctors don't want to talk about being in debt." But he's planning a new strategy to deal with his rising business expenses and falling reimbursements.

"I will see more patients, but I won't check all of their complaints at one time," he explained. "If I do, insurance will bundle my reimbursement into one payment." Patients will have to make repeat visits -- an arrangement that he acknowledges is "inconvenient."

"This system pits doctor against patient," he said. "But it's the only way to beat the system and get paid."

Wednesday, January 4, 2012

Uninsured illegal aliens occur massive cost to U.S. Healthcare


Hospitals Stuck With Illegal Immigrants, Uninsured ‘Permanent Patients’ at Massive Cost!

An unpleasant new report claims that many hospitals in major metro areas are struggling with the growing problem of “permanent patients.”

What’s a “permanent patient”? According to The New York Times theey are mostly illegal immigrants or people who lack insurance or their own housing that the hospital cannot turn away.

The Times defines a “permanent patient”:

…[someone who has] been languishing for months or even years in…hospitals, despite being well enough to be sent home or to nursing centers for less-expensive care, because they are illegal immigrants or lack sufficient insurance or appropriate housing.

Of course, having dozens of patients hanging around that long means these hospitals are absorbing the bill for millions of dollars in unreimbursed expenses annually.

Unsurprisingly, the majority of these “permanent patients” are illegal immigrants because, as mentioned in the above, they have no housing or family in the area.

Medicaid often pays for emergency care for illegal immigrants, but not for continuing care, and many hospitals in places with large concentrations of illegal immigrants, like Texas, California and Florida, face the quandary of where to send patients well enough to leave,” writes Sam Roberts of the Times.

What kind of cost are we talking about here?

“Care for a patient languishing in a hospital can cost more than $100,000 a year, while care in a nursing home can cost $20,000 or less [emphasis added],” Roberts reports.

Patients fit to be discharged from hospitals but having no place to go typically remain more than five years, says LaRay Brown, a senior vice president for New York City’s Health and Hospitals Corporation.

She says that there were about 300 patients in such a predicament throughout the New York City area alone, most in public hospitals or higher-priced skilled public nursing homes, though a few were in private hospitals, according to the Times.

“Many of those individuals no longer need that care, but because they have no resources and many have no family here, we, unfortunately, are caring for them in a much more expensive setting than necessary based on their clinical need,” said Brown.

The report goes on to cite an example where one patient from Queens, NY, has been at the Coler-Goldwater Specialty Hospital and Nursing Facility for 13 years because the hospital has no place to send him.

The patient, who is in his mid-60s, has been there since an arterial disease cost him part of one leg below the knee and left him in a wheelchair, according to the report.

Or another example:

Five years ago, Yu Kang Fu, 58, who lived in Flushing, Queens, and was a cook at a Chinese restaurant in New Jersey, was dropped off by his boss at New York Downtown Hospital, a private institution in Manhattan, complaining of a severe headache. Mr. Yu was admitted to the intensive-care unit with a stroke.

Mr. Yu remained in the hospital for over four years until he was transferred last spring to the Atlantis Rehabilitation and Residential Health Care Facility, a private center in Fort Greene, Brooklyn, after the federal government certified him as a “permanent resident under color of law,” essentially acknowledging that he could not be returned to China and qualifying him for medical benefits.

“This gentleman cost us millions of dollars,” said Jeffrey Menkes, the president of New York Downtown. “We try to provide physical, occupational therapy, but this is an acute-care hospital. This patient shouldn’t be here.”

The fact of the matter is that hospitals in metro areas that host a large illegal immigrant population are unable to turn away patients who have neither insurance nor proof that they are in the United States legally– two things necessary for discharge purposes and reimbursements, said Chui Man Lai, assistant vice president of patient services at a New York state hospital.

“These patients often arrive in the emergency room acutely ill and unaccompanied, and we have to treat them until they can be discharged safely,” Ms. Lai said. “The hospital is required, by law and its mission, to care for these patients.”

But even worse than “permanent patients,” those who essentially live in hospitals already operating on thin budgets, are what some refer to as “pop drops”: grown adults leaving their parents at the hospitals so that they can go on vacation.

“Hospitals are reluctant to complain publicly about such patients for fear of being perceived as callously seeking to dump nonpaying patients,” writes Roberts. “Elected officials are generally loath to be seen as encouraging illegal immigrants by changing reimbursement formulas. The issue was never addressed during the debate over national health care legislation.”