Why We Need Health Care Reform, Part 958

From the Times, a look at the health care situation in North Dakota:

The furious pace of oil exploration that has made North Dakota one of the healthiest economies in the country has had the opposite effect on the region’s health care providers. Swamped by uninsured laborers flocking to dangerous jobs, medical facilities in the area are sinking under skyrocketing debt, a flood of gruesome injuries and bloated business costs from the inflated economy.

The problems have been acute at McKenzie County Hospital here. Largely because of unpaid bills, the hospital’s debt has climbed more than 2,000 percent over the past four years to $1.2 million, according to Daniel Kelly, the hospital’s chief executive. Just three years ago, Mr. Kelly added, the hospital averaged 100 emergency room visits per month; last year, that average shot up to 400. . . .

The 12 medical facilities in western North Dakota saw their combined debt rise by 46 percent over the course of the 2011 and 2012 fiscal years, according to Darrold Bertsch, the president of the state’s Rural Health Association.

Hospitals cannot simply refuse to treat people or raise their rates. Expenses at those 12 facilities increased by 15 percent, Mr. Bertsch added, and nine of them experienced operating losses. Costs are rising to hire and retain service staff members, as hospitals compete with fast food restaurants that pay wages of about $20 an hour.

“Plain and simple, those kinds of things are not sustainable,” he said.

Indeed they are not. And the answer is the principle embodied in Obamacare: that all those who can afford to should contribute to the cost of the system. I would prefer to do this through taxation, the most equitable solution, but since that seems impossible, the "mandate" is a partial substitute: next year all people who can afford it will either have to buy insurance or pay into a fund that will cover costs like the ones these North Dakota hospitals are facing. And oil field workers certainly can afford it; I was just reading about all the strippers moving to ND because they can earn $1000 a night in tips from lonely drillers.

If hospitals aren't going to turn away uninsured patients, something almost all Americans oppose, then we have to get the money somewhere. For those out there who don't like mandates, what's your answer?