Southern California's health care system is in serious trouble. According to administrators and state figures, about two dozen private medical centers in Los Angeles and Orange counties are on the verge of going belly up.
And the national debate about health care reform is ignoring the main reasons why.
A Sunday report in the Los Angeles Times offered reasons for the crisis: "An increasing load of uninsured and low-income patients has resulted from overcrowding and the shutdown of public facilities. The number of uninsured patients visiting private hospitals, particularly in poor areas, has increased by one-third in Los Angeles County since 2002."
Did you notice which key words were missing from that paragraph of code? Let's start with two: illegal immigration.
Neither of the words appeared anywhere in the Times report. But illegal immigrants comprise a significant share of the uninsured, particularly in California -- the state has an estimated 7 million uninsured or underinsured residents, and at least 3 million illegal immigrants.
These people show up at hospital emergency rooms to receive treatment for urgent and chronic health problems, and most are unable to pay a dime for the services. Low-income citizens are eligible for Medicaid and other government programs, but illegals who can't provide the documentation required for enrollment receive the same care anyway.
Unable to cover expenses, more than 50 community hospitals have closed in Southern California over the past 10 years. Fourteen other emergency rooms and trauma centers have closed in the region over the past five years.
A 2004 study by the Federation for American Immigration Reform estimated that California hospitals and doctors' offices provide $1.4 billion worth of uncompensated care each year.
That's a gap that insured patients can't possibly cover, even with the most drastic cost-shifting.
Already squeezed by so many hospital and emergency room closures, Southern California stands to lose 15 percent of its existing beds if these medical centers don't return to financial health.
Which brings us to the second cause for the hospitals' money ills: regulation.
The Emergency Medical Treatment and Active Labor Act mandates that people receive medical care if they come within 250 yards of an emergency department regardless of their ability to pay. To suggest that hospitals turn away the sick, the bleeding and the dying is inhumane, but it's equally unconscionable that the federal government would impose such a mandate without securing its southern border and ensuring that the "undocumented" can't stream into hospitals to take advantage of our country's compassion.
Californians have only themselves to blame for additional regulatory costs, however. A 1999 state law imposed strict nurse-to-patient ratios, adding further stress to a shortage of the health care professionals. The resulting scramble to comply with the law has intensified hospitals' competition to recruit and retain staff, driving up labor costs. These payroll pressures have accelerated many hospitals' descent into insolvency.
Additionally, the state imposed a 2013 deadline for all hospitals to retrofit their buildings to better withstand major earthquakes. Meeting the requirements of this law would force already-ailing medical centers to spend a total of $110 billion.
"We're talking about a system that is already in crisis," Carol Meyer director of government affairs for the Los Angeles County Department of Health Services, told the Times.
"It's fasten-your-seatbelt-it's-going-to-be-a-bumpy-ride time," James Lott, executive vice president of the Hospital Association of Southern California, told the Times.
Presidential candidates are crisscrossing the country, touting their ideas for health care "reform." All involve more government spending, increased subsidies and cost-shifting and a truckload of new regulations and mandates on private insurers, doctors and hospitals. None addresses the health care costs of illegal immigration.
The next president and Congress can try to pass any of these proposals, but their legislation can't do one thing: force hospitals that are already going broke to stay open.