The researches argue that neither health care spending or private premiums would go up that much because "hospital spending on uncompensated care has been relative stable. That is partly because the public hospitals and clinics that most often care for the uninsured often don't have many privately insured patients to absorb the costs."
Translation: most uncompensated care is due to the fact that Medicare and Medicaid don't pay the full cost of medical expenditures. Uncompensated spending has been stable because Medicare and Medicaid have held reimbursement rates steady and because in many cases the state match (to pay for the care of illegals) has skyrocketed with most of the money going to urgent care and maternal health, not complex medical procedures.
GIve people a full blue plate entitlement and watch both government expenditures rise and uncompensated care increase as well. In every state where a single payer plan has been enacted uncompensated care continues to go up. The best example is the Oregon Health plan which ensures the uninsured by rationing access to cutting edge treatments and raising taxes. The trend of uncompensated care since 1994 in that state is below.
Statewide Uncompensated Care by Year: | |||||||
Year | Charity Care | % Change from Prev. Year | Bad Debt | % Change from Prev. Year | Total Uncomp. Care | % Change from Prev. Year | |
1994 | 74,653,735 |
| 90,272,616 |
| 164,926,351 |
| |
1995 | 55,645,120 | -25.5% | 90,262,052 | 0.0% | 145,907,172 | -11.5% | |
1996 | 53,036,784 | -4.7% | 80,387,137 | -10.9% | 133,423,921 | -8.6% | |
1997 | 55,123,781 | 3.9% | 83,974,361 | 4.5% | 139,098,142 | 4.3% | |
1998 | 58,291,332 | 5.7% | 96,289,876 | 14.7% | 154,581,208 | 11.1% | |
1999 | 53,994,527 | -7.4% | 102,732,393 | 6.7% | 156,726,920 | 1.4% | |
2000 | 64,916,584 | 20.2% | 128,914,104 | 25.5% | 193,830,688 | 23.7% | |
2001 | 77,772,655 | 19.8% | 138,822,832 | 7.7% | 216,595,487 | 11.7% | |
| 2002 | 107,854,204 | 38.7% | 164,629,911 | 18.6% | 272,484,115 | 25.8% |
2003 | 183,626,444 | 70.3% | 221,580,947 | 34.6% | 405,207,391 | 48.7% | |
2004 | 268,333,010 | 46.1% | 269,741,864 | 21.7% | 538,074,874 | 32.8% | |
2005 | 374,330,244 | 39.5% | 301,574,208 | 11.8% | 675,904,452 | 25.6% | |
2006 | 445,884,426 | 19.1% | 305,343,908 | 1.3% | 751,228,334 | 11.1% | |
2007 | 524,707,945 | 17.7% | 351,866,447 | 15.2% | 876,574,392 | 16.7% | |
 | |||||||
The same thing happened in Tennessee when Tenncare was enacted. The idea that a single payer system will eliminate uncompensated care is bogus unless the single payer doubles what it pays providers, hospitals, etc. Just the opposite takes place in a single payer system. What will reduce uncompensated care -- apart from rationing which will drive up costs elsewhere -- are changes to the financial and technological structure of healthcare that reward saving and investment in personal health and staying healthy. Indeed, as the percent of people in consumer directed plans increases and includes the uninsured, the amount of out of pocket spending has remained stable and as a RAND study last year shows, the consumer directed plans are associated with reduced hospital and physician visits and increased access to prescriptions. This does not always "control" costs but does appear to improve quality by encouraging more management of costly chronic illnesses,
http://content.healthaffairs.org/cgi/content/full/hlthaff.27.5.w399/DC1
