University of Chicago Hospital Shunning Poor Patients

[Guest Conway]

As a business person, I certainly can see why hospitals would want to move non-paying patients to less expensive facilities. However, how on earth can the Obamas, and their leadership team claim that they support an agenda in which healthcare is a right when Michelle Obama herself and three of Barack Obama's top campaign aides are leading a program to deny emergency room services to indigent black patients in their hometown of Chicago? It seems like hypocrisy at its highest level to me.

This article was in yesterday's Chicago Sun Times.

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U. of C. shunning poor patients?

HOSPITAL DISPUTE | Obama's wife, 3 aides tied to plan to free up space

August 23, 2008

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BY TIM NOVAK AND CHRIS FUSCO Staff Reporters

Sen. Barack Obama's wife and three close advisers have been involved with a program at the University of Chicago Medical Center that steers patients who don't have private insurance -- primarily poor, black people -- to other health care facilities.

Michelle Obama -- currently on unpaid leave from her $317,000-a-year job as a vice president of the prestigious hospital -- helped create the program, which aims to find neighborhood doctors for low-income people who were flooding the emergency room for basic treatment. Hospital officials say such patients hinder their ability to focus on more critically ill patients in need of specialized care, such as cancer treatment and organ transplants.

Obama's top political strategist, David Axelrod, co-owns the firm, ASK Public Strategies, that was hired by the hospital last year to sell the program -- called the Urban Health Initiative -- to the community as a better alternative for poor patients. Obama's wife and Valerie Jarrett, an Obama friend and adviser who chairs the medical center's board, backed the Axelrod firm's hiring, hospital officials said.

Another Obama adviser and close friend, Dr. Eric Whitaker, took over the Urban Health Initiative when he was hired at U. of C. in October 2007. Whitaker previously had been director of the Illinois Department of Public Health. Obama has said he recommended Whitaker for the state job, giving his name to Tony Rezko, who helped Gov. Blagojevich assemble his Cabinet. Rezko, a former fund-raiser for Obama and Blagojevich, was convicted in June on federal corruption charges tied to state deals.

Medical center officials and Obama's presidential campaign staff say the Urban Health Initiative -- along with a three-year-old companion program called the South Side Health Collaborative -- will dramatically improve health care for thousands of South Side residents. They say that, rather than having to wait hours at U. of C.'s emergency room, those patients get seen sooner and at less expense at neighborhood clinics and other hospitals. U. of C. even offers them a ride on a shuttle bus to other centers and sometimes provides the doctors at those facilities.

"Senator Obama sees community health centers as a vital part of efforts to invest in prevention and reduce costs," said Ben LaBolt, an Obama spokesman.

But the Urban Health Initiative has critics, including South Side residents and medical professionals.

"I've heard complaints from a handful of constituents, but I've also had calls from people in the health care profession complaining," said Ald. Toni Preckwinkle, whose 4th Ward is just north of the hospital. "The medical professionals who have come to me are accusing the university of dumping patients on its neighboring institutions. ... Whether it's being implemented in the way that's in the best interest of the patient, I can't tell you."

Sen. John McCain, Obama's Republican opponent, criticized the Democratic presidential hopeful Friday for having pledged on the campaign trail to expand health care for Americans at the same time his top political strategist "was running a campaign to cut coverage for the poor."

Axelrod, whose firm stopped working on the project in October, responded that he was concerned that presidential politics was distorting the university's efforts to improve health care for poor people and to lower costs.

Whitaker, who has traveled with Obama on the presidential campaign trail, chalked up the criticism to people opposed to change.

"In the past, we opened our doors and saw whoever came," Whitaker said Friday. "We would see a patient who had general pneumonia, and if we needed to see a patient who needed a liver transplant, that liver transplant patient couldn't get in the door."

And rather than dump patients on other health care facilities, Whitaker said the initiative actually is improving their bottom lines.

"We were taking general patients away from Mercy Hospital, Michael Reese, and they were financially at risk," Whitaker said. "We harmed other hospitals without knowing we harmed other hospitals."

At the same time, the Urban Health Initiative is improving the university's finances. Fewer poor patients are showing up at the U. of C. emergency room for basic medical treatment and are no longer admitted to the hospital. That frees beds for transplants, cancer care and other more-profitable medical procedures that the university prides itself on.

"The collapse of the health care system was driving more and more people to the emergency room," Axelrod said. "The trend line was and is a disastrous one from the standpoint of maintaining the hospital. Their goal was to find an answer."

Axelrod's firm did polling and found that some of the university's primary-care doctors feared the hospital was turning its back on surrounding poor neighborhoods, according to a May 2007 report the firm gave the university.

Axelrod's firm also suggested the program's name be changed. "Some participants view the word 'urban' as code for 'black,' " according to a poll the firm commissioned.

[JKane]

Bullshit.

The initiative is to get people appropriate local care for non-emergency illness instead of them having the ER as their only option *because* of lack of insurance.

It's better for the patient, better for anybody in need of emergency care at that hospital and better for any state or federal programs assisting in funding their care.

That is, access to a local doctor gives patients more ability to seek care *before* a condition becomes an emergency, or even preventative care to avoid it entirely--saving money which can be used to treat more patients.

[Lucky]

Again, bullshit. Conway must be apprenticing for a job at Fox news.

The average emergency room visit costs $1200, yet a significant number of people using such a room don't need it. They should be going to their family doctor or an urgent care clinic. Unneccesary ER visits take up time that prevents real serious cases from getting to the top of the line. Obama's plan is to try to re-direct those who do not need the ER to the proper place for service. There is nothing sinister about it.

So, Conway, when you go to the ER, you don't want to wait while they take care of all of those who shouldn't be there in the first place.

[Guest Conway]

I agree with you completely on the intent of the U of C program, Lucky. I thought that I made it clear, albeit from another perspective, in my preamble that the emergency room is not an appropriate place for those who have non-emergency illnesses to seek care.

However, the reality is that, in inner city neighborhoods, there are going to be less educated, less sophisticated folks who use the emergency room for minor issues because they care nothing about the financial health of the institution providing health care to them and everything about feeling better. They don't have insurance to go to a private doctor and they see the institution as a place to receive gratis treatment.

Who do you think is going to pick up the tab for these patients when they are pushed to the independent small practitioner in the neighborhood? If he chooses to treat them, he will be doing so for free. What the U of c is doing is pushing the responsibility for paying for indigents to those doctors who choose to provide them care. To me, that strategy would seem to provide poorer |Fealthcare to the indigent than they now receive in the emergency room. That. in and of itself, is contrary to the Obama's position on better healthcare for all.

It would seem that, if U of C's goal was to move this care from the emergency room to less expensive practitioners, then their strategic team, including Michelle |Obama, would also recommend opening a lower cost free clinic to treat indigents concomitantly to making the decision not to treat indigents in their emergency room anymore. To me, that would be a critical component of such a plan.

From a fiscal management perspective, as both you and JKane note, it makes perfect sense. From the perspective of being the wife of a Presidential candidate who espouses healthcare for all, it seems hypocritical.

It's just another example of bad judgment exhibited by the Obamas in what they practice versus what they preach, in my opinion.

[BiBottomBoy]

What options other than the emergency room do most inner city people have when they get sick?

Most doctors won't schedule appointments for people without health insurance, so if they have an infection or anything the emergency room is really their only choice.

I agree with you completely on the intent of the U of C program, Lucky. I thought that I made it clear, albeit from another perspective, in my preamble that the emergency room is not an appropriate place for those who have non-emergency illnesses to seek care.

However, the reality is that, in inner city neighborhoods, there are going to be less educated, less sophisticated folks who use the emergency room for minor issues because they care nothing about the financial health of the institution providing health care to them and everything about feeling better. They don't have insurance to go to a private doctor and they see the institution as a place to receive gratis treatment.

Who do you think is going to pick up the tab for these patients when they are pushed to the independent small practitioner in the neighborhood? If he chooses to treat them, he will be doing so for free. What the U of c is doing is pushing the responsibility for paying for indigents to those doctors who choose to provide them care. To me, that strategy would seem to provide poorer |Fealthcare to the indigent than they now receive in the emergency room. That. in and of itself, is contrary to the Obama's position on better healthcare for all.

It would seem that, if U of C's goal was to move this care from the emergency room to less expensive practitioners, then their strategic team, including Michelle |Obama, would also recommend opening a lower cost free clinic to treat indigents concomitantly to making the decision not to treat indigents in their emergency room anymore. To me, that would be a critical component of such a plan.

From a fiscal management perspective, as both you and JKane note, it makes perfect sense. From the perspective of being the wife of a Presidential candidate who espouses healthcare for all, it seems hypocritical.

It's just another example of bad judgment exhibited by the Obamas in what they practice versus what they preach, in my opinion.