Raising the Question That Dallas Officials Are Afraid to Ask: How Can Dallas Citizens Get Affordable Health Care and Health Insurance?

Have some patience, but in this post we are going to examine some seldom-mentioned reasons why it is so darned hard for businesses in Dallas Fort Worth to get affordable group health and medical insurance for their employees.  Plus we dare to ask the question that every public official and media person in town has so far been afraid to ask.  How this question gets answered could be part of the solution of affordable health care and insurance.  But if the question is ignored, it could make a big problem worse.  So let's hope Dallas County Commissioners and elected officials really explore the issue.

Most small businesses in Dallas, Texas and in other communities such as Fort Worth and Arlington, TX have reached the end of the line for being able to afford a group health insurance plan for their employees.  Recent surveys have shown that less than 35 percent of area small businesses of 100 employees or less now offer group health insurance benefits to their employees.  

Even for group plans with deductibles that now range from $2,000 to $5,000 per person, the cost to cover a middle aged husband and wife in a Dallas group health plan usually exceeds $1,000 per month, and the monthly cost to cover a family of four can now easily exceed $1,500 per month.  

Fewer small businesses can afford any longer to cover all of the employee's group health insurance premium.   Even fewer businesses can afford to cover any portion of the dependents' insurance premium.  

As a result, even fewer employees can afford the equivalent of another house payment to insure their loved ones. The result is a steady increase in the uninsured levels in Dallas County, and a strain on the public health care system.

Part of the reason that health insurance is so darned expensive is that area health care is so expensive. It is really getting hard for Dallas County general hospitals to make a buck.  Not enough paying customers, too many nonpaying customers, too much government red tape and interference in the prices hospitals can charge, and insurance companies that will reimburse based on what a hospital procedure should cost, not what it actually costs.  And there are just way too many hospitals and beds in Dallas County for the number of paying customers and what they are able to pay. 

Another reason is that in Dallas County as elsewhere, there is a steady increase in the number of individuals with government sponsored health care plans, whether government employee plans, Medicare, Medicaid, TriCare, CHIPS, etc.  These plans' reimbursement rates to doctors and hospitals are fixed by the government.  The record keeping costs to hospitals and doctors that accept these plans is so high, and the reimbursement so low, that many of the providers who can do so no longer accept patients who have this type of plan coverage.

And finally, government regulations prohibit area general hospitals from refusing trauma and emergency care to patients who are unable to pay.  Since it costs area hospitals more to provide indigent care than they get back in government reimbursement, the additional cost  ends up getting buried in what these hospitals charge paying customers.

In the private sector, too many stores or too much office space or too many hotel beds in a declining market would lead to store, office building or hotel closings.  Mergers, acquisitions, or consolidations in a sick industry would presumably lead to stronger, healthier competitors.  Not so, (at least yet) when it comes to general hospitals. 

There have been no hospital closings in Dallas County in recent memory, in spite of the decline in the number of individuals with health insurance, and the rising unreimbursed cost of health care.  In fact, there has been an increase in the total number of hospitals in Dallas County. Not necessarily in the number of general hospitals, but in the number of specialty hospitals. 

Much like how specialty retailers (think Costco/Lowes/Target/Amazon) have flourished while general merchandise retailers (think Montgomery Wards/Sears) are practically extinct,  specialty hospitals such as orthopedic, cardiac, and cosmetic surgery have grown in Dallas.  A specialty hospital, with lower operating costs, siphons off paying customers and the more profitable health care procedures from the general hospitals.

This now brings us to the question about what to do about  Dallas County's Parkland Hospital.  This has truly been a wonderful community asset, and it is one of the finest teaching hospitals in the world, whose mission has been to provide low or no cost health care services to Dallas county residents who cannot afford to pay for their health care.  Businesses and property owners pay taxes to support Parkland's budget.  The average homeowner in Dallas County pays about $400 in taxes per year to support Parkland, though most have probably never set foot inside the hospital. 

The delicate political problem and the financial decision that now must be made is that Parkland is reaching the end of its useful life and the cost of its replacement has been reported to be as high as $1.2 billion.  But the same building materials inflation that have tripled estimates for the DART light rail expansion will no doubt affect Parkland replacement, so don't be surprised if the final replacement figure is north of $4 billion.

The question that should be raised is not whether Parkland should be replaced, but what health care services are needed in Dallas County to serve the needs of its residents, and are there already enough general and specialty hospitals to serve the needs of the community. 

Perhaps a specialized trauma center, burn center or a birthing center, with presumably lower operating costs, is what is needed.  Perhaps these facilities could be operated more efficiently if they were privately owned and operated and required less public subsidy than if they were owned and operated by Dallas County.   And perhaps some of the existing non-profit and for-profit general hospitals would become more cost efficient if they were able to operate at a higher capacity level. 

If we can let private companies build and operate our local highways, surely we should ask elected officials to study whether the exisitng private operators that have capacity could do a better job providing needed quality health care for our residents at a lower cost, and with less tax payer invstment.

Taxes, health care quality and cost, and health insurance costs are significant factors in any business's  decision to relocate or remain in Dallas County, regardless of their size.  Health care efficiency helps reduce the overall cost of health care, and in turn reduces the cost of health insurance. 

A community like Dallas has so much to offer prospective businesses.  Being able to offer affordable health care and affordable group health insurance with stable premiums would be another big inducement for employers to relocate here.  By attacking cost inefficiency and over capacity, officials might reduce the percentage of uninsured in the community, getting more citizens off of public health care and on to employer provided or individual health insurance plans. 

No public official that values their job wants to come out against replacing Parkland. But replacing the grande old dame Parkland with a bigger and much more expensive general hospital without considering other public/private health options that might provide better care at a lower cost and lower investment  is a huge mistake. 

Not discussing this touchy political question could lead to missing an opportunity and a less hopeful future for Dallas.  With fewer businesses moving to town for fear of higher taxes and ridiculous health insurance costs, the continued downward spiral of employer-provided health insurance for the citizens of Dallas, and an escalation in the number of residents who rely on the government for their health care. 

OK, now that the question is out in the open and the fork in the road has been identified, let's hope that community leaders take it.  Let brighter minds review alternatives that could build a stronger community by lowering the cost of health care and helping to make health insurance affordable for more businesses and residents in Dallas.

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