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Governor Tours Scripps Mercy Hospital Emergency Room
MR. VAN GORDER: Good afternoon, everybody. My name is Chris Van Gorder, I’m President and CEO of Scripps Health, and on behalf of the Scripps Health Board of Trustees I want to welcome our governor—our governor—to Scripps Mercy Hospital. Scripps Mercy Hospital was the very first hospital in San Diego, and today it is the largest hospital in San Diego.

On March 2nd we wrote an opinion piece that was printed in the Union Tribune. In that Op Ed we congratulated our governor for successfully calling attention to California’s ongoing health care crisis by proposing a comprehensive plan that calls for shared responsibility in finding a solution to our state’s health care crisis. And it is indeed a health care crisis. It’s without a doubt the most complex issue probably facing our government and our society today, and yet we have a governor that is bold enough to take this on, and I thank the governor for that boldness, and for that willingness to bring all the parties together to find a comprehensive solution to this problem. (Applause)

We just went through and talked to a couple of patients, and we owe those patients—those patients—a solution to this crisis. I also want to thank you, Governor, for taking time to visit our emergency department and our Level 1 trauma center today. All too often our communities take these critical community resources for granted, but that’s a mistake. When a member of our community—any one of you today—require emergency services, virtually nothing else is more important at that point in time than to know that that service is available and open to you. As one of your appointees to the California Emergency Medical Services Commission, I’m personally committed to doing my absolute best to assure that these services will always be available to the members of our community and our state.

And so now, ladies and gentlemen, it’s my most sincere honor to introduce the Governor of the great State of California, the Honorable Arnold Schwarzenegger. (Applause)

GOVERNOR: Thank you very much, Chris, for the wonderful introduction and all the nice things you have said about me. That’s exactly the way I wrote it. It’s also nice to be here today with Kim Belshé, my Secretary of Health and Human Services, who is so dedicated and working so hard to make sure that we get good reforms. It’s also great to be here at Scripps Mercy Hospital, which is of course a renowned hospital, and a terrific place where people get great, great care.

And I’ve been traveling up and down the state and talking to the various stakeholders, and talking about the importance of health care reform, and I think that we all know that, especially when you go to places like this, emergency rooms like this, or hospitals like this, the crisis that we face. We have 6.5 million people in California that are uninsured, and that means that the people that are insured are paying for those that are uninsured.

So I want to just start out right now to talk a little bit about the bad math. I mean, when you think about the staggering numbers here—last year alone, 27 hospitals in San Diego County reported losing 620 million dollars because of unpaid hospital bills and medical bills—620 million dollars, you heard correctly. Right here at Scripps Mercy Hospital, the uncompensated care totals 50 million dollars alone. Now, if you do the math, if you multiply that with the amount of hospitals that we have in California, that goes into the billion and billions of dollars. And uncompensated care is exactly what the term suggests. Emergency rooms get flooded with patients who don’t have insurance, and hospitals don’t get paid because of that. But hospitals, of course, have to recover that money, and that means that they have to go and raise the costs for all of us.

So we want to fix this problem once and for all. As one of the city’s best known doctors recently has put it, “The people who pay, pay twice.” As a matter of fact, they pay for themselves and then they have to pay for those that are uninsured. And again, like I said, this is unfair. That’s what we call a hidden tax that we all are paying, if it is higher insurance premiums, through higher deductibles, higher co--pays, and higher out-of-pocket expenses. Obviously this is unsustainable economically.

And hospitals, like any other business, they have to make money in order to stay open. Over the past decade, more than 60 hospitals in California have closed their emergency rooms because so many people have got them stuck with unpaid bills. So what they do is, they close those emergency rooms because they’d rather just close them than treating people that are not paying their bills. Right here in San Diego County seven emergency rooms have closed in the past few years, according to Dr. James Dunford, the city’s Medical Director.

And that puts all of us, of course, in serious jeopardy, because if we get hurt, or if we need emergency care, that means that we are going to an emergency room that is crowded, and that sometimes it takes several hours to go and see a doctor. So we want to get rid of this problem immediately. Some of those crowded places are so over-filled that ambulances get backed up and have to take patients to other places, to other hospitals, and that of course is very risky to do. Here at Scripps, where they treat 55,000 people a year in a facility that is designed for only 30,000, the emergency rooms are crowded, and sometimes they even have to close it down and can not admit new patients.

We know that we can fix this problem, but we have to recognize that we have a broken health care system, and it must be fixed. This is why my reform plan requires, first of all for everyone to have insurance, mandatory insurance. Second of all, insurance companies would not be allowed to refuse anyone, or not give them coverage because of age or any medical history, and that will, of course, mean that people will see their regular doctors more and go to emergency rooms less. They would also be able to concentrate more on prevention and wellness instead of seeking expensive emergency care. Hospitals also will never get stuck again with unpaid bills, and we also will eliminate that hidden tax that we all are paying in order to subsidize and treat the uninsured.

And finally, after years of nibbling around on the edges, we would fix our broken health care system once and for all, and we will prove to the rest of the nation—prove to the rest of the nation that we can provide great health care and have a great health care system that is really good for everybody. And when I say the rest of the nation, I said that because since 1912 the federal government has been talking about providing universal health care, from Teddy Roosevelt on. Now, almost 100 years later, they still haven’t done it. So this is why it is very important to recognize that it’s up to the states to do it themselves, and we in California will do it ourselves. We’re going to bring Democrats and Republicans together to get this reform done this year.

Thank you very much. And now I would like to introduce to you someone that is very dedicated, very talented, hard working, the head of the emergency room here, this is Dr. Valerie Norton. (Applause)

DR. NORTON: Thank you. Thank you very much, Governor. First of all, I want to thank the governor and his staff for coming to San Diego to see firsthand the challenges that we are experiencing in our emergency department. It’s an honor and a pleasure to have you here, and we sincerely appreciate your desire to improve health care in the state of California.

For those of us who are working in an urban emergency department, ‘in the trenches’, as we like to say, we see the problems facing our emergency health care system every day. Emergency departments today are being asked to provide services for far more people than they can reasonably handle. As the Governor told you, we are seeing almost twice as many people in our emergency room as it was designed for. Just yesterday when I was at work I had to go out to the waiting room to see patients because the entire department was full, and there was nowhere to put people. I saw an elderly man in the waiting room, who had been assaulted and had a broken jaw. And even though it was obvious that he was injured, it was more than four hours before we had an open bed that we could put him into for treatment.

And that kind of thing happens every day, and it breaks our hearts. We wish we could do better for all the patients that come to us for care, but our resources are just stretched to the breaking point. As you’ve heard from the governor, many hospitals and emergency departments across the state have closed in the past decade due to rising costs and decreasing reimbursement, making the burden on the remaining hospitals even greater.

The uninsured often turn to our emergency rooms for primary care when they have nowhere else to go, and we’re proud to be the safety net for those people. But the safety net is now being stretched to the breaking point, because hospitals and physicians are considerably underpaid by Medi-Cal and Medicare, and many patients are uninsured or unable to pay at all—as much as 20 percent in our emergency room—many hospitals have stepped in to cover the costs of maintaining physician on call coverage services for a wide array of specialty services. But some hospitals have stopped doing that. Can you imagine if you went to your local emergency room with a broken leg and they said, “Oh, we’re so sorry, we don’t have an orthopedic surgeon on call.” And yet that’s actually happening right here today in San Diego, and it’s going to continue to happen if we don’t take the steps that the governor has suggested to try to fix this broken system.

My colleagues and I welcome the goal that the Governor is considering, to achieve universal coverage and access to all levels of care for those who need it in the most appropriate setting. Thank you so much, Governor Schwarzenegger, for being here today at Scripps Mercy Hospital. There you are—and for providing the leadership that has brought the health care crisis to the top of our public agenda. We really want to tell you from the bottom of our hearts how much it means to us that you are taking this interest, and that you care about the hard work that we’re doing, and we hope that this awareness and your concern will result in meaningful reform to California’s health care system. Thank you very much. (Applause)

GOVERNOR: I want to just have also Kim Belshé, my Secretary of Health and Human Services, say a few words. Please.

SECRETARY BELSHÉ: Thank you very much, Governor. My name is Kim Belshé, I’m the Secretary of Health and Human Services, as the Governor said. I’ve had the distinct honor of working for Governor Schwarzenegger over the course of the past two plus years, and I’ve worked in government for many, many years before that. This is the first governor who has really stepped up, since Governor—I think it was Governor Warren back in the ‘40s—who identified health care reform not just as a priority but the priority for California.

Expanding coverage to all Californians, fixing our broken health care system in terms of coverage, affordability, and quality, really does represent one of the most complicated, significant, challenging issues facing California. Governors in the past have retreated from that challenge; this governor is prepared to step up and lead. It provides an opportunity that California hasn’t had for generations, to actually fix our broken health care system, to achieve that goal of coverage for all, improved affordability and a healthier California. And the Governor is very much committed to working across the aisle with all sectors, hospitals, doctors, health plans, consumer groups, the broader California community, to ensure that all Californians get the kind of health care reform we need and deserve. We see it right here in San Diego; diminished access, increased costs.

We have a plan that’s been put forward that’s the focus of our discussion in Sacramento, and working together we can achieve the kind of reforms that the people of San Diego and Californians broadly deserve. Thank you, Governor. (Applause)

MR. VAN GORDER: So on behalf of the medical staff here at Scripps Mercy Hospital—I think they’re going to make you an honorary doctor, so there you go.

GOVERNOR: Thank you very much.

MR. VAN GORDER: It fits good. There he is.

GOVERNOR: Call me now Dr. Schwarzenegger, okay? Anyway, if you have any questions about all of this, please feel free to ask. Yes?

Q: Governor, your proposal reads as a mandate for all Californians. Does this include the undocumented immigration, or the undocumented population that we have in the state, sir?

GOVERNOR: Well, as you know, undocumented immigrants already get services now, because by federal law emergency rooms and hospitals are not allowed to turn anyone away. So they have already care. So the question we really debate in our health care reform is, how can we provide better care and cheaper care more effectively? Because when you go to an emergency room it costs much more money, so it’s better when people have, let’s say, a medical clinic, a small clinic where they can go and get their prescriptions or take care of the children, or when they have a cold, or headache or something like that, they can get treatment there rather than going to an emergency room and crowding up the emergency rooms. So what we want to do is get rid of the problem that we have right now, which is the overcrowding of emergency rooms because of so many uninsured people, instead of going to a doctor, because they don’t have insurance, they use and up-using the emergency rooms.

Q: Governor, if someone has to pay for health care under your plan, who is paying for health care?

GOVERNOR: Well, it’s a combination of—you know, like I said, it’s shared responsibility. It will be the state, the federal government, then the employers, the hospitals, doctors, everyone will share on this package where we create the pool. And of course, those that can not afford health care, those that are at 250 percent of the poverty level, well, those people will be taken care of, we will take care of that.

Q: You talk about mandatory --

GOVERNOR: Where are you?

Q: Right here. You talk about mandatory health insurance. How does that work? How do you police that?

GOVERNOR: Well, what you do is, you just tell people that by law you have to have health insurance, because you can not go and rely on someone else to pay for you. It is a personal responsibility that people have to take on, and that’s why we want to make sure to bring the costs down, to make it affordable. I think when we go and create this reform we will get rid of that hidden tax, because what you have to recognize, as I said earlier in my speech, there’s a hidden tax that we all are paying. Sometimes it’s 17 percent, that hidden tax. But, just for instance, businesses in California are paying right now 14.7 billion dollars in that hidden tax, all because they have to cover the uninsured.

I think that everyone ought to be insured, number one. That creates therefore a bigger risk pool. And then the insurance companies take that bigger risk pool and can cover everyone, and that means that they can not turn anyone away because of age or because of some medical history, which is the case right now. They are really picking and choosing who they want to insure. I’ve seen situations where a family just recently were telling me that they have two children that are on asthma medication because they live in the Central Valley, it’s not even their fault. And what happens is, they were turned down and they can’t get insurance coverage. So those are the kinds of problems we want to eliminate. I think everyone deserves coverage, and everyone should take on that responsibility. So we all will work together.

And I also want to add that the Bush administration and Dr. Leavitt, the Health and Human Services Secretary in Washington, has already promised that they will help us, and they will add 3.7 billion dollars of matching funds to our pool, so I think that is extraordinary. So this is why I said when everyone works together, we will do it. And there’s a very good spirit in Sacramento. Everyone knows this year is our chance, that the federal government, like I said, has tried for 100 years now to provide universal health care and they didn’t. In California they have tried. People sometimes don’t have the courage, the political courage, to make those kinds of moves and to fix big problems like that, but now I think that courage is in Sacramento. Everyone recognizes it’s the time. Let’s come together and let’s fix it.

Thank you very much. Thank you.


http://gov.ca.gov/index.php?/speech/5931/