THE STRANGE PRIORITIES OF GOVERNMENT MEDICINE IN CALIFORNIA

Jail inmates, most of whom are citizens, go without medical care while non-citizens get a huge amount spent on them. Government medicine always has to prioritize but these priorities don't seem to be medical at all. Two reports below from one newspaper on the same day.

Inmates

Treatment errors and other breakdowns in medical care have contributed to the deaths of at least 14 inmates in the Los Angeles County Jail system since 1999, according to a newspaper report. The jail system lacks enough doctors, nurses and other medical workers, resulting in long delays in treatment for conditions ranging from hernias to heart disease, the Los Angeles Times reported in Sunday editions. Inmates sometimes have wait weeks for exams they're supposed to receive within 24 hours of making a request.

Officials acknowledge that 20 percent of inmates who ask to see a doctor are released from jail without ever being examined, according to the Times. Jody Kent, a court-sanctioned monitor who for three years walked the county's cellblocks documenting complaints for the American Civil Liberties Union, said inmates showed her gaping wounds from infections, broken bones and bulging hernias. "I basically saw grown men crying because they were in such pain," Kent said.

Sheriff's Lt. Stephen Smith, who oversees the jail system's medical services bureau, said treating prisoners is difficult because some conceal a medical condition while others feign illness or are mentally ill. "We face unique challenges, and we do the best we can," Smith said. "These are difficult, angry, messed-up people. We try to treat people with the respect, not that they necessarily deserve, but that human decency demands."

A large problem is understaffing. In a confidential 2004 report, a consultant said an additional 720 jail medical workers were needed to meet minimum state treatment standards. At the time, the work force stood at about 980. "The county incurs significant liability for continuing a system of care that clearly is not working," the consultant said in the report to the Los Angeles County Board of Supervisors. Spurred by those findings, officials began to bolster the ranks of doctors and nurses, but several hundred medical workers are still lacking. An average of about 200,000 people enter the county jails each year. On most nights, the population hovers around 18,000, with more than a third requiring medical care.

The county Sheriff's Department, which runs the jails, is required by law to provide basic medical care to all inmates. When inmates are booked, they are questioned to determine if they are physically or mentally ill. About half require additional screening or treatment before being assigned to a cell. If inmates develop medical problems later, there are daily "sick calls" in which they can sign up to see a nurse. The volume of inmates, coupled with a shortage of doctors and nurses, has resulted in a backlog of hundreds of inmates waiting to be examined. "I could have every doctor in the county of Los Angeles here, and it still wouldn't be enough," said Sander Peck, chief physician in the jail system. "I don't know what 'enough' would be."

Source

Illegals

More than 100,000 undocumented women each year bear children in California with expenses paid by Medi-Cal, according to state reports. Such births and related expenses account for more than $400 million of the nearly $1 billion that the program spends annually on health care for illegal immigrants in California, the Los Angeles Times reported, citing state reports. California long has been one of the more generous states in offering such benefits to illegal immigrants, covering everything from pregnancy tests to postpartum checkups.

Many illegal immigrants who might otherwise shy away from government services view care associated with childbirth as safe to seek. "I wasn't afraid at all," said Sandra Andrade, an illegal immigrant from Colombia who recently gave birth at a Los Angeles hospital. "I'd always heard that pregnant women are treated well here."

Nationally, a debate is simmering about the costs of providing medical care to illegal immigrants. Anti-illegal immigration groups argue that "birthright" U.S. citizenship for babies born in America is an incentive for illegal immigrants to have their children here. "I think most Americans think that while they certainly don't want to do anything to harm children you cannot have a policy that says anybody in the world come here and have a baby and we have a new American," said Ira Mehlman, a spokesman for the Federation of American Immigration Reform, an immigration control group based in Washington, D.C.

Prenatal care is one of the most controversial aspects of providing health care to illegal immigrants. While labor and delivery long have been considered emergencies, entitled to some federal reimbursement, federal officials have often balked at covering prenatal care. Generally, the state and federal governments share the cost of Medicaid programs, called Medi-Cal in California. Advocates of such coverage say it's cheaper to pay for prenatal care than risk complications that could saddle the government with huge medical bills. "Without prenatal care, there's a serious risk that a child will be born with severe disabilities," said Lucy Quacinella, a lobbyist for the Los Angeles-based social service nonprofit group Maternal and Child Health Access. "The cost of caring for that child over a lifetime is astronomical when you compare the cost of having provided the prenatal care."

Still, investing in pregnant illegal immigrants is costly. Births and prenatal care are the biggest single outlay by Medi-Cal for illegal immigrants' health care, with the rest going for various other emergency treatments, limited breast and cervical cancer treatment, abortions and some nursing home care, according to the state. In Los Angeles County's public and private hospitals, undocumented women accounted for 41,240 Medi-Cal births in 2004, roughly half the deliveries covered by the public program. In the four county-run hospitals alone, undocumented women and their newborns will receive more than $20 million in delivery, recovery, nursery and neonatal ICU services this year, according to a county estimate.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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