Failing to address poverty and homelessness may undermine health reform

Will the billions we’re thinking of spending on health care reform matter if we don’t address poverty and homelessness?

Surgeon Amina Merchant has her doubts in a Washington Post opinion piece. She observes something that’s rarely mentioned, namely, that some patients abuse the health system to their benefit:

“I am suicidal with a plan,” they say. People know that that phrase is a key to the psychiatric ward. After it is uttered, the hospital is obliged to house them overnight — provide them a warm bed with a blanket and healthy meals. What would cost someone perhaps a hundred dollars in a basic hotel ends up costing taxpayers thousands — because the hospital must provide not only a bed and food but staffing for its emergency room, a psychiatric consultation, one-to-one observation and monitoring of vital signs. The cost to the patient? A few hours in a heated waiting room.

Indeed, mention a few key words, and patients can buy themselves an admission, all while contributing to skyrocketing health costs.

What Dr. Merchant recommends is that social services be reformed with equal vigor: “If health care is made available to all Americans, care providers will be exploited, and costs will skyrocket, with hospital services a right but food and shelter remaining privileges. Already, hospitals are burdened with patients who are medically cleared but have nowhere to go.”

Failing to concurrently address the disposition of patients may render whatever we spend on health reform moot.

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